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The 67th UN CND-upholding human rights in drug policy. Lancet 2024; 403:1851-1852. [PMID: 38734469 DOI: 10.1016/s0140-6736(24)00763-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/12/2024] [Indexed: 05/13/2024]
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Delivering health for all: the critical role of gender-responsive health systems. Lancet Glob Health 2024; 12:e733-e734. [PMID: 38461835 DOI: 10.1016/s2214-109x(24)00120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
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Confronting the elephants in the room: reigniting momentum for universal health coverage. Lancet 2024; 403:1611-1613. [PMID: 38432238 DOI: 10.1016/s0140-6736(24)00365-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
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From polycrisis to metacrisis: harnessing windows of opportunity for renewed political leadership in global health diplomacy. BMJ Glob Health 2024; 9:e015340. [PMID: 38637121 PMCID: PMC11029238 DOI: 10.1136/bmjgh-2024-015340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 04/20/2024] Open
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Harti Hauora Tamariki: randomised controlled trial protocol for an opportunistic, holistic and family centred approach to improving outcomes for hospitalised children and their families in Aotearoa, New Zealand. Front Pediatr 2024; 12:1359214. [PMID: 38455391 PMCID: PMC10917950 DOI: 10.3389/fped.2024.1359214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
Background Health and wellbeing inequities between the Indigenous Māori and non-Māori populations in Aotearoa, New Zealand continue to be unresolved. Within this context, and of particular concern, hospitalisations for diseases of poverty are increasing for tamariki Māori (Māori children). To provide hospitalised tamariki Māori, and their whānau (families) comprehensive support, a wellbeing needs assessment; the Harti Hauora Tamariki Tool (The Harti tool) was developed. The purpose of this study is to determine how effective the Harti tool is at identifying wellbeing needs, ensuring the documentation of needs, enabling access to services and improving wellbeing outcomes for tamariki and their whānau. Methods The study uses a Kaupapa Māori methodology with qualitative and quantitative methods. Qualitative methods include in-depth interviews with whānau. This paper presents an overview of a randomised, two parallel, controlled, single blinded, superiority trial for quantitative evaluation of the Harti programme, and hospital satisfaction with care survey. Participants will be Māori and non-Māori tamariki/children aged 0-4 years admitted acutely to the paediatric medical wards at Waikato Hospital, Hamilton, Aotearoa New Zealand. They will be randomised electronically into the intervention or usual care group. The intervention group will receive usual care in addition to the Harti programme, which includes a 24-section health needs assessment delivered by trained Māori navigators to whānau during the time they are in hospital. The primary endpoint is the relative risk of an acute hospital readmission in the 30 days following discharge for the intervention group patients compared with control group patients. Secondary outcomes include access and utilisation of preventative health services including: oral health care, general practice enrolment, immunisation, healthy home initiatives, smoking cessation and the Well Child Tamariki Ora universal health checks available free of charge for children in Aotearoa New Zealand. Discussion Randomised controlled trials are a gold standard for measuring efficacy of complex multifaceted interventions and the results will provide high quality evidence for implementing the intervention nationwide. We expect that this study will provide valuable evidence for health services and policy makers who are considering how to improve the configuration of paediatric hospital services. Trial registration The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number: ACTRN12618001079235.
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Superiority and cost-effectiveness of Individual Placement and Support versus standard employment support for people with alcohol and drug dependence: a pragmatic, parallel-group, open-label, multicentre, randomised, controlled, phase 3 trial. EClinicalMedicine 2024; 68:102400. [PMID: 38299044 PMCID: PMC10828604 DOI: 10.1016/j.eclinm.2023.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
Background Individual Placement and Support (IPS) is a specialist intervention to help people attain employment in the open competitive labour market. IPS has been developed in severe mental illness and other disabilities, but it is of unknown effectiveness for people with alcohol and drug dependence. The Individual Placement and Support-Alcohol and Drug (IPS-AD) is the first superiority trial to evaluate effectiveness and cost-effectiveness. Methods IPS-AD was a pragmatic, parallel-group, multi-centre, randomised, controlled, phase 3 trial of standard employment support (treatment-as-usual [TAU]) versus IPS. IPS was offered as a single episode for up to 13 months. The study was done at seven community treatment centres for alcohol and drug dependence in England. Study participants were adults (18-65 years), who had been enrolled for at least 14 days in treatment for alcohol use disorder (AUD), opioid use disorder (OUD), or another drug use disorder (DUD; mostly cannabis and stimulants); were unemployed or economically inactive for at least six months; and wished to attain employment in the open competitive labour market. After random allocation to study interventions, the primary outcome was employment during 18-months of follow-up, analysed by mixed-effects logistic regression, using multiple imputation for the management of missing outcome data. There were two cost-effectiveness outcomes: a health outcome expressed as a quality adjusted life year (QALY) using £30,000 and £70,000 willingness-to-pay [WTP] thresholds; and additional days of employment, with a WTP threshold of £200 per day worked. The study was registered with ISRCTN (ISRCTN24159790) and is completed. Findings Between 8 May 2018 and 30 September 2019, 2781 potentially eligible patients were identified. 812 were excluded before screening, and 1720 participants were randomly allocated to TAU or IPS. In error, nine participants were randomised to study interventions on two occasions-so data for their first randomisation was analysed (modified intention-to-treat). A further 24 participants withdrew consent for all data to be used (full-analysis set therefore 1687 participants [70.1% male; mean age 40.8 years]; TAU, n = 844; IPS, n = 843 [AUD, n = 610; OUD, n = 837; DUD, n = 240]). Standard employment support was received by 559 [66.2%] of 844 participants in the TAU group. IPS was received by 804 [95.37%] of 843 participants in the IPS group. IPS was associated with an increase in attainment of employment compared with TAU (adjusted odds ratio [OR] 1.29; 95% CI 1.02-1.64; p-value 0.036). IPS was effective for the AUD and DUD groups (OR 1.48; 95% CI 1.14-1.92; p-value 0.004; OR 1.45, 95% CI 1.03-2.04, p-value 0.031, respectively), but not the OUD group. IPS returned an incremental QALY outcome gain of 0.01 (range 0.003-0.02) per participant with no evidence of cost-effectiveness at either WTP threshold-but QALY gains were cost-effective for the AUD and DUD groups at the £70,000 WTP threshold (probability 0.52 and 0.97, respectively). IPS was cost-effective for additional days of employment (probability 0.61), with effectiveness relating to the AUD group only (probability >0.99). Serious Adverse Events were reported by 39 participants (13 [1.5%] of 844 participants in the TAU group and 23 [2.7%] of 43 participants in the IPS group). There was a total of 25 deaths (1.5%; 9 in the TAU group and 16 in the IPS group)-none judged related to study interventions. Interpretation In this first superiority randomised controlled trial of IPS in alcohol and drug dependence, IPS helped more people attain employment in the open competitive labour market than standard employment support. IPS was cost-effective for a QALY health outcome (£70,000 WTP threshold) for the AUD and DUD groups, and for additional days of employment for the AUD group (£200 per day worked WTP threshold). Funding UK government Work and Health Unit.
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Universal health coverage is fundamental to preparing for a healthier and better tomorrow. Lancet Glob Health 2024; 12:e190-e191. [PMID: 38096889 DOI: 10.1016/s2214-109x(23)00591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024]
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Reforming the WHO regional director elections: an opportunity to restore trust. BMJ 2024; 384:q167. [PMID: 38253408 DOI: 10.1136/bmj.q167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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Pathways to a healthy net-zero future: report of the Lancet Pathfinder Commission. Lancet 2024; 403:67-110. [PMID: 37995741 DOI: 10.1016/s0140-6736(23)02466-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 07/24/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023]
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From private incentives to public health need: rethinking research and development for pandemic preparedness. Lancet Glob Health 2023; 11:e1658-e1666. [PMID: 37652070 DOI: 10.1016/s2214-109x(23)00328-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 09/02/2023]
Abstract
Pandemic preparedness and response have relied primarily on market dynamics to drive development and availability of new health products. Building on calls for transformation, we propose a new value proposition that instead prioritises equity from the research and development (R&D) stage and that strengthens capacity to control outbreaks when and where they occur. Key elements include regional R&D hubs free to adapt well established technology platforms, and independent clinical trials networks working with researchers, regulators, and health authorities to better study questions of comparative benefit and real-world efficacy. Realising these changes requires a shift in emphasis: from pandemic response to outbreak control, from one-size-fits-all economies of scale to R&D and manufacture for local need, from de novo product development to last-mile innovation through adaptation of existing technologies, and from proprietary, competitive R&D to open science and financing for the common good that supports collective management and sharing of technology and know-how.
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Health taxes for healthier lives: an opportunity for all governments. BMJ Glob Health 2023; 8:e013761. [PMID: 37857436 PMCID: PMC10603522 DOI: 10.1136/bmjgh-2023-013761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 10/21/2023] Open
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The G20 must act now for the health and wellbeing of women, children, and adolescents around the world. BMJ 2023; 382:1897. [PMID: 37595975 DOI: 10.1136/bmj.p1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
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Reimagining health security and preventing future pandemics: the NUS-Lancet Pandemic Readiness, Implementation, Monitoring, and Evaluation Commission. Lancet 2023; 401:2021-2023. [PMID: 37187195 DOI: 10.1016/s0140-6736(23)00960-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/10/2023] [Indexed: 05/17/2023]
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Teaching sustainable health care through the critical medical humanities. Lancet 2023; 401:1912-1914. [PMID: 37187196 DOI: 10.1016/s0140-6736(23)00809-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
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The WHO's 75th anniversary: WHO at a pivotal moment in history. BMJ Glob Health 2023; 8:bmjgh-2023-012344. [PMID: 37085271 PMCID: PMC10124202 DOI: 10.1136/bmjgh-2023-012344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 04/23/2023] Open
Abstract
The World Health Organisation (WHO) was inaugurated in 1948 to bring the world together to ensure the highest attainable standard of health for all. Establishing health governance under the United Nations (UN), WHO was seen as the preeminent leader in public health, promoting a healthier world following the destruction of World War II and ensuring global solidarity to prevent disease and promote health. Its constitutional function would be 'to act as the directing and coordinating authority on international health work'. Yet today, as the world commemorates WHO's 75th anniversary, it faces a historic global health crisis, with governments presenting challenges to its institutional legitimacy and authority amid the ongoing COVID-19 pandemic. WHO governance in the coming years will define the future of the Organisation and, crucially, the health and well-being of billions of people across the globe. At this pivotal moment, WHO must learn critical lessons from its past and make fundamental reforms to become the Organisation it was meant to be. We propose reforms in WHO financing, governance, norms, human rights and equity that will lay a foundation for the next generation of global governance for health.
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It is time for ambitious, transformational change to the epidemic countermeasures ecosystem. Lancet 2023; 401:978-982. [PMID: 36924776 DOI: 10.1016/s0140-6736(23)00526-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
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Gender equal leadership makes all kinds of sense. BMJ 2023; 380:567. [PMID: 36894173 DOI: 10.1136/bmj.p567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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To assess the effects of cross-education on strength and motor function in post stroke rehabilitation: a systematic literature review and meta-analysis. Physiotherapy 2023; 119:80-88. [PMID: 36940490 DOI: 10.1016/j.physio.2023.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/10/2022] [Accepted: 02/21/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Cross-education refers to the increase in motor output of the untrained limb following unilateral training of the opposite limb. Cross education has been shown to be beneficial in clinical settings. OBJECTIVES This systematic literature and meta-analysis aims to assess the effects of cross-education on strength and motor function in post stroke rehabilitation. DATA SOURCES MEDLINE, CINAHL, Cochrane Library, PubMed, PEDro, Web of Science, ClinicalTrails.gov and Cochrane Central registers were searched up to 1st October 2022. STUDY SELECTION Controlled trials using unilateral training of the less affected limb in individuals diagnosed with stroke and English language. DATA SYNTHESIS Methodological quality was assessed using Cochrane Risk-of-Bias tools. Quality of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation. Meta-analyses were performed using RevMan 5.4.1. RESULTS Five studies capturing 131 participants were included in the review and three studies capturing 95 participants were included in the meta-analysis. Cross education was shown to have a statistically and clinically significant effect on upper limb strength (p < 0.003; SMD 0.58; 95% CI 0.20-0.97; n = 117) and upper limb function (p = 0.04; SMD 0.40; 95% CI 0.02-0.77; n = 119). LIMITATIONS Small number of studies, with all studies identified as having some risk of bias. Quality of evidence graded 'low' due to limitations and imprecision. CONCLUSION Cross education may be beneficial in improving strength and motor function in the more affected upper limb post stroke. Further studies are needed as the research into the benefits of cross education in stroke rehabilitation is still limited. Systematic Review Registration Number: PROSPERO (CRD42020219058).
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What are the effects of pilates in the post stroke population? A systematic literature review & meta-analysis of randomised controlled trials. J Bodyw Mov Ther 2023; 33:223-232. [PMID: 36775522 DOI: 10.1016/j.jbmt.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/10/2022] [Accepted: 09/24/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Stroke is a leading cause of death and disability worldwide. Pilates, a programme of mind-body exercises is theorised to have beneficial effects on strength, postural control, balance, proprioception, coordination and gait in people with deficits due to a neurological condition. However, the evidence of pilates in stroke patients has never been systemised. The objectives of this systematic literature review are to investigate the effects of pilates in post stroke individuals and compare this intervention to other forms of exercise, standard care and/or physiotherapy. DATA SOURCES A comprehensive search was conducted in the following databases: Pubmed (including MEDline), Web of Science, the Cochrane library, Science Direct, Embase and PEDro. STUDY SELECTION Studies were selected, screened, filtered and reviewed in detail to identify those that met the inclusion criteria. DATA EXTRACTION Data was extracted to a table with specific headings for analysis and studies were rated using the Physiotherapy Evidence Database (PEDro) scale. DATA SYNTHESIS Data from a total of 5 included studies with 122 participants was pooled and analysed using the Revman 5 software. Significant findings were found in favour of the pilates intervention groups on balance (P<0.00001), quality of Life (P=0.0002), and gait parameters (P=0.001), when results from the studies were combined and analysed. CONCLUSIONS This review found moderate evidence for pilates exercises improving balance in post stroke individuals and limited evidence for improvements in quality of life, cardiopulmonary function and gait. Future studies should examine long term follow up, home programmes and comparisons with other forms of exercise in post stroke patients.
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Abstract
A BMJ collection urges decision makers to reverse decades of neglect
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Leaders can choose to prevent pandemics. Nature 2022; 610:S37. [DOI: 10.1038/d41586-022-03355-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Understanding clinician barriers to providing equitable healthcare for ethnic minority populations. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
It has long been recognised that ethnic minority groups have worse health outcomes in the UK. Social determinants of health (SDH) contribute significantly to these inequalities. However, inequalities persist, even after controlling for these determinants. As well as being less likely to engage with healthcare services, ethnic minority groups are more likely to report poor experiences. The majority of healthcare in the UK is delivered through patient: clinician interactions (PCI), therefore a good working relationship with patients is paramount. Recent focus has been placed on ensuring “cultural competence”. Whilst this is important, we suggest also examining the culture within healthcare itself. Healthcare professionals are not immune to bias, preconceptions and the stresses of work and this must be taken into account. A seminal piece of work on this is the “culture of medicine” framework proposed by Boutin-Foster et al, which examines the impact of these factors.
Aims and Methodology
This paper aims to examine barriers within PCI that impact healthcare for ethnic minorities. A formal literature review was conducted and 131 relevant studies were identified. Grounded theory was used for analysis and data was categorised into themes with Boutin-Foster’s framework used as a structure.
Results
The review found that the concept of implicit bias was paramount in PCI. Three major barriers resulting from this bias are suggested: its impact on clinical decision making, the impact on clinician-patient communication and finally the resultant lack of trust in clinicians and poor perceived quality of care by ethnic minority groups.
Conclusions
Clinician implicit bias is a major barrier to equitable healthcare for ethnic minority populations. A solution we propose is to acknowledge our own preconceptions. Awareness of our own culture, preconceptions and the pressures around us will allow us to find solutions to these barriers, including further research and education.
Key messages
• Clinician implicit bias within the “Culture of Medicine” is a barrier to equitable healthcare for ethnic minority populations.
• Awareness of our own culture and preconceptions is paramount to addressing these barriers.
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Resuscitation status conversations: a short education session improves junior doctors’ confidence. BMJ Support Palliat Care 2022; 12:292-295. [DOI: 10.1136/bmjspcare-2020-002479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 11/04/2022]
Abstract
AimJunior doctors are frequently required to discuss resuscitation status with patients. They generally lack experience, confidence and skill in having these conversations. However, there is currently no formal postgraduate education requirement to improve or develop in this area. The aim of this educational intervention was to improve junior doctors’ level of confidence and skill in having resuscitation status conversations with patients.MethodAn educational intervention for 27 prevocational postgraduate second and third-year house officers at a tertiary hospital in Hamilton, New Zealand was conducted. A self-administered survey was completed preintervention and postintervention.ResultsFour factors were assessed in the survey (level of confidence having conversations regarding resuscitation status, ability to prognosticate, content of conversations and perceived barriers to having conversations), with a statistically significant difference found with respect to level of confidence having conversations regarding resuscitation status (p=0.001).ConclusionThis study demonstrated that a short education session improves confidence in discussing resuscitation status. It has also identified the need for further postgraduate training in complex communication skills.
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Conflict, climate change, and covid-19 combine to create a breeding ground for sexual and gender based violence. BMJ 2022; 378:o2093. [PMID: 36028250 DOI: 10.1136/bmj.o2093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Transforming or tinkering: the world remains unprepared for the next pandemic threat. Lancet 2022; 399:1995-1999. [PMID: 35597246 PMCID: PMC9114832 DOI: 10.1016/s0140-6736(22)00929-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 12/28/2022]
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Women, children, and adolescents face extreme vulnerability in conflict-and so do the health workers striving to protect them. BMJ 2022; 377:o1041. [PMID: 35470220 DOI: 10.1136/bmj.o1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Outcomes to measure the effects of pharmacological interventions for pain management for women during labour and birth: a review of systematic reviews and randomised trials. BJOG 2021; 129:845-854. [PMID: 34839565 DOI: 10.1111/1471-0528.17031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pharmacological pain management options can relieve women's pain during labour and birth. Trials of these interventions have used a wide variety of outcomes, complicating meaningful comparisons of their effects. To facilitate better assessment of the effectiveness of labour pain management in trials and meta-analyses, consensus about key outcomes and the development of a core outcome set is essential. OBJECTIVE To identify all outcomes used in studies of pharmacological pain management interventions during labour and birth. DESIGN A review of systematic reviews and their included randomised controlled trials was undertaken. SEARCH STRATEGY Cochrane CENTRAL was searched to identify all Cochrane systematic reviews describing pharmacological pain management options for labour and birth. Search terms included 'pain management', 'labour' and variants, with no limits on year of publication or language. SELECTION CRITERIA Cochrane reviews and randomised controlled trials contained within these reviews were included, provided they compared a pharmacological intervention with other pain management options, placebo or no treatment. DATA COLLECTION AND ANALYSIS All outcomes reported by reviews or trials were extracted and tabulated, with frequencies of individual outcomes reported. MAIN RESULTS Nine Cochrane reviews and 227 unique trials were included. In total, 146 unique outcomes were identified and categorised into maternal, fetal, neonatal, child, health service, provider's perspective or economic outcome domains. CONCLUSIONS Outcomes of pharmacological pain management interventions during labour and birth vary widely between trials. The standardisation of trial outcomes would permit the assessment of meta-analyses for best clinical practice. TWEETABLE ABSTRACT Outcomes to measure pharmacological pain management options during labour are highly variable and require standardisation.
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Abstract
Sudhvir Singh and colleagues summarise the recommendations of the Independent Panel for Pandemic Preparedness and Response to try to prevent future pandemics
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Bridging the evidence gap to achieve a healthy, net zero future. Lancet 2021; 398:1551-1553. [PMID: 34672966 DOI: 10.1016/s0140-6736(21)02278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
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Achieving vaccination justice: A call for global cooperation. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000036. [PMID: 36962097 PMCID: PMC10021616 DOI: 10.1371/journal.pgph.0000036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Four years of prevocational Community Based Attachments in New Zealand: a review. THE NEW ZEALAND MEDICAL JOURNAL 2021; 134:56-62. [PMID: 34320615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM The aim of this study was to evaluate the learning environment of the 13-week Community Based Attachment (CBA) (or 'rotation') during the prevocational training years at a metropolitan hospital in New Zealand, and to compare the results with general hospital attachments' scores using an internationally validated survey, the Postgraduate Hospital Educational Environment Measure (PHEEM). METHOD A retrospective analysis of data gathered from the PHEEM over four years was conducted. Responses from interns who undertook a CBA attachment at Waikato District Health Board (DHB) were compared with those who undertook a hospital-based attachment at the same DHB during that time period. RESULTS CBAs were rated significantly higher than the hospital-based attachments for all subscales (autonomy, teaching and social support) as well as the PHEEM total score. The majority of individual items also rated higher with the CBA cohort, with 26/40 items being statistically significant. Four items were rated higher by the hospital cohort; however, none were significantly different. CONCLUSIONS In this study, the CBA attachments appear to have provided valuable learning experiences for prevocational doctors at Waikato DHB. Resident medical officers (RMOs) who have undertaken CBAs confirm a positive, supportive learning environment with enthusiastic and motivated clinical supervisors.
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Report of the Independent Panel for Pandemic Preparedness and Response: making COVID-19 the last pandemic. Lancet 2021; 398:101-103. [PMID: 33991477 PMCID: PMC9751704 DOI: 10.1016/s0140-6736(21)01095-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
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Subcutaneous Lidocaine Infusion for Complex Cancer Pain: A Retrospective Review. J Pain Palliat Care Pharmacother 2021; 35:137-142. [PMID: 34187295 DOI: 10.1080/15360288.2021.1920544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This retrospective review assesses the safety and efficacy of subcutaneous lidocaine infusions for complex cancer pain, in a specialist palliative care unit. A retrospective chart review was undertaken of 18 infusions over a 2-year period. Data collected included patient demographics, use of adjuvant analgesics, methadone use and opioid requirements (as oral morphine equivalent daily dose, oMEDD) at three time periods: 24 hours prior to starting infusion, 24 hours after starting infusion and 24 hours after stopping infusion. Data was collected on infusion characteristics, adverse events and the patient's perception of lidocaine efficacy. Eighteen infusions were analyzed; all patients had metastatic cancer with 83.3% having stage IV disease. The majority of patients were prescribed three or more adjuvant analgesics, in addition, methadone was prescribed in 16 oMEDD use both 24 hours after starting, and 24 hours after stopping the lidocaine infusions. Events were reported in three out of 18 infusions, only one minor adverse event was attributed to lidocaine. Thirteen out of 18 infusions were perceived, by patients, to be effective for pain. This retrospective review has shown that a subcutaneous lidocaine infusion is a safe and effective means of managing complex cancer pain in a specialist palliative care unit.
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Children in All Policies 2030: a new initiative to implement the recommendations of the WHO-UNICEF-Lancet Commission. Lancet 2021; 397:1605-1607. [PMID: 33891894 DOI: 10.1016/s0140-6736(21)00718-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/19/2022]
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The Lancet Pathfinder Commission: pathways to a healthy, zero-carbon future-a call for evidence. Lancet 2021; 397:779. [PMID: 33640048 DOI: 10.1016/s0140-6736(21)00460-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
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A commitment to support the world's most vulnerable women, children, and adolescents. Lancet 2021; 397:450-452. [PMID: 33503455 DOI: 10.1016/s0140-6736(21)00137-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/17/2022]
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Should I stay or should I go now? Why risk communication is the critical component in disaster risk reduction. PROGRESS IN DISASTER SCIENCE 2020; 8:100139. [PMID: 34977532 PMCID: PMC8714028 DOI: 10.1016/j.pdisas.2020.100139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 05/22/2023]
Abstract
Risk communication is a critical component in disaster risk reduction, especially in designing and implementing early warning systems. The ability to communicate hazard forecasts and risk information to vulnerable communities and stakeholders successfully is crucial for effective disaster preparedness and response, to reduce impact, and to prevent loss of life. Successful risk communication, however, is challenged constantly. Even the most sophisticated forecasting models and advanced early warning systems can be rendered ineffective if the information is not communicated clearly, on time, and in a way that allows the end-user to consider options and act appropriately. These challenges not only apply to fast onset hazards such as cyclones and tsunamis, but also to slower onset hazards such as the current COVID-19 pandemic. Around the world, governments' responses to the current pandemic provide examples of how complex and difficult successful risk communication is. This paper discusses the importance of risk communication as a critical component of early warning systems and explores the constant challenges that vulnerable communities face, how early warning systems sit within the wider Sendai Framework, and what governments have learned from the COVID-19 pandemic, and discusses how we can communicate more effectively in the future to reduce harm.
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Harmful marketing to children - Authors' reply. Lancet 2020; 396:1735. [PMID: 33248493 DOI: 10.1016/s0140-6736(20)32471-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 10/22/2022]
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Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe. LANCET (LONDON, ENGLAND) 2020. [PMID: 32979936 DOI: 10.1016/s0140-6736(20032007-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic is an unprecedented global crisis. Many countries have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; some have instituted full or partial lockdowns. However, lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19. Governments worldwide now face the common challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. To facilitate cross-country learning, this Health Policy paper uses an adapted framework to examine the approaches taken by nine high-income countries and regions that have started to ease COVID-19 restrictions: five in the Asia Pacific region (ie, Hong Kong [Special Administrative Region], Japan, New Zealand, Singapore, and South Korea) and four in Europe (ie, Germany, Norway, Spain, and the UK). This comparative analysis presents important lessons to be learnt from the experiences of these countries and regions. Although the future of the virus is unknown at present, countries should continue to share their experiences, shield populations who are at risk, and suppress transmission to save lives.
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Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe. Lancet 2020; 396:1525-1534. [PMID: 32979936 PMCID: PMC7515628 DOI: 10.1016/s0140-6736(20)32007-9] [Citation(s) in RCA: 421] [Impact Index Per Article: 105.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic is an unprecedented global crisis. Many countries have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; some have instituted full or partial lockdowns. However, lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19. Governments worldwide now face the common challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. To facilitate cross-country learning, this Health Policy paper uses an adapted framework to examine the approaches taken by nine high-income countries and regions that have started to ease COVID-19 restrictions: five in the Asia Pacific region (ie, Hong Kong [Special Administrative Region], Japan, New Zealand, Singapore, and South Korea) and four in Europe (ie, Germany, Norway, Spain, and the UK). This comparative analysis presents important lessons to be learnt from the experiences of these countries and regions. Although the future of the virus is unknown at present, countries should continue to share their experiences, shield populations who are at risk, and suppress transmission to save lives.
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Stereotactic Ablative Radiotherapy (SABR) For Oligometastases: Risk Stratification Using Positional Uncertainty. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Using Inter-Institutional Patient Reported Outcomes And Dosimetry To Enable Hypothesis Generation And Model Validation. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bio-inspired optics: general discussion. Faraday Discuss 2020; 223:183-194. [PMID: 33034321 DOI: 10.1039/d0fd90014a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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