16 results
Towards an understanding of GPs’ viewpoint on diagnosing postnatal depression in general practice: a small-scale realist evaluation
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- Ashvanthi Nadira Sriranjan, Ruth Abrams, Geoff Wong, Sophie Park
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- Journal:
- Primary Health Care Research & Development / Volume 21 / 2020
- Published online by Cambridge University Press:
- 09 October 2020, e42
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Background:
Less than half of postnatal depression cases are identified in routine clinical assessment. Guidelines and current literature suggest that general practitioners (GPs) may have an opportunistic role in detecting postnatal depression due to their early contact and existing rapport with many new mothers. There is limited research on the diagnostic approaches chosen by GPs in different GP−patient contexts. Our small-scale study evaluates the thought processes of seven GPs based in one practice when forming a clinical diagnosis of postnatal depression under different contexts.
Methods:Seven GP participants were interviewed using case vignettes about postnatal depression, based on an adapted Johari’s window framework. A realist approach to analysis was undertaken with the intention of understanding GPs’ responses to different situations. Context−mechanism−outcome configurations were constructed, and a programme theory was formed to consolidate the findings.
Findings:Findings suggest that diagnoses may be a clinician-led or collaborative process between GP and patient. In collaborative contexts, stigmatising views were addressed by GPs, time for self-reflection was encouraged and mothers’ views were accounted for. Clinician-led diagnoses often occurred in contexts where there was a lack of acknowledgement of symptoms on behalf of the patient or where safety was a concern. The personal and clinical experience of GPs themselves, as well as effective communication channels with other primary care professionals, was significant mechanisms.
Conclusion:GPs use a variety of strategies to support patient disclosure and acceptance of their condition. The complexity of GP−patient contexts may influence the clinical thought process. We address some of the gaps in existing literature by exploring postnatal depression diagnosis in primary care and provide tentative explanations to suggest what works, for whom and in what contexts.
OP89 Conference Abstract Searching In National Institute For Health And Care Excellence Health Technology Appraisals
- Ruth Wong
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- International Journal of Technology Assessment in Health Care / Volume 35 / Issue S1 / 2019
- Published online by Cambridge University Press:
- 31 December 2019, p. 23
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Introduction
The National Institute for Health and Care Excellence (NICE) guidelines manual recommend that MEDLINE, Embase and Cochrane Central Register of Controlled Trials should be prioritized for searching for reviews of the effectiveness of pharmacological interventions. Additionally, searching trial registries and conference abstracts are recommended to identify ongoing or unpublished research. However, the approaches to searching conference abstracts have not been previously studied. The aim is to analyze searches of conference abstracts reported in NICE Technology Appraisal (TA) company submissions for cancer interventions from 2013 until September 2018.
MethodsThe company submissions were searched and obtained via the NICE technology appraisal guidance website. The sources used to find conference abstracts were identified from the company clinical effectiveness review search methods and appendices. Conference abstract searching in both database and website sources were compared.
ResultsOf all 394 TAs, 124 (31 percent) were cancer TAs. Between 2013 and 2018, 91 TAs were completed or updated, which covered 18 cancer categories and 52 different named technologies. Technologies to treat non-small-cell lung cancer was the most frequently appraised in the last five years. Nivolumab was the most frequently appraised technology. Searches for conference abstracts were reported in 70 (77 percent) out of 91 company submissions. Supplementary searching was reported in 59 (84 percent), compared with 11 (16 percent) searching either/both Embase and the Web of Science Conference Proceeding Index (WoS-CPCI). A total of 54 supplementary website sources were searched which ranged from one to 11 per TA (average four sources). The American Society of Clinical Oncology (ASCO) and the European Society of Medical Oncology were the most frequently searched sources.
ConclusionsWhilst the WoS-CPCI has better coverage of cancer conference abstracts than Embase, searching databases alone are inadequate. Supplementary conference websites should be searched for reasons such as access to the most recent abstracts and incomplete indexing of titles within databases. A wide range of cancer specific sites exists although the impact of broad (e.g. ASCO) versus condition specific sites is unclear.
OP66 Tumor Profiling Tests In Early Breast Cancer: A Systematic Review
- Susan Harnan, Katy Cooper, John Stevens, Ruth Wong, Paul Tappenden, Alice Bessey, Sue Ward, Rachid Rafia, Rob Stein, Janet Brown
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 34 / Issue S1 / 2018
- Published online by Cambridge University Press:
- 03 January 2019, p. 24
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Introduction:
Tumor profiling tests can help to identify whether women with breast cancer need chemotherapy due to their risk of relapse, and some may be able to predict benefit from chemotherapy. We focused on four genetic tests: Oncotype DX (O-DX), MammaPrint (MMP), EndoPredict and Prosigna, and one immunohistochemistry test, IHC4, for the National Institute of Health and Care Excellence as part of their Diagnostic Appraisal Programme.
Methods:A systematic review was undertaken, including searching of nine databases in February 2017 plus other sources including a previous review published in 2013. The review included studies assessing clinical effectiveness of the five tumor profiling tests, with or without clinicopathological factors, to guide decisions about adjuvant chemotherapy in people with ER-positive, HER-2 negative, Stage I-II cancer with 0 to 3 positive lymph nodes (LN). The PROBAST tool and Cochrane risk of bias tools were used to assess risk of bias.
Results:A total of 153 studies were included; the strength of evidence base for individual tests was varied. Results suggest all tests are prognostic for risk of relapse, though results were more varied in LN positive (+) patients than in LN negative (0) patients. Evidence was limited about whether tests can predict benefit from chemotherapy (available for MMP and O-DX only). Studies that assessed the impact of the tests on clinical decisions indicate that the net change in chemotherapy recommendations or decisions pre-/post-test ranged from an increase of one percent to a decrease of 23 percent among UK studies, and a decrease of zero percent to 64 percent across European studies.
Conclusions:The studies included in the review suggest that all of the tests can provide prognostic information on the risk of relapse; however results were more varied in LN+ patients than in LN0 patients. There is limited and varying evidence for prediction of chemotherapy benefit.
Strengthening primary health care through primary care and public health collaboration: the influence of intrapersonal and interpersonal factors
- Ruta K. Valaitis, Linda O’Mara, Sabrina T. Wong, Marjorie MacDonald, Nancy Murray, Ruth Martin-Misener, Donna Meagher-Stewart
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- Journal:
- Primary Health Care Research & Development / Volume 19 / Issue 4 / July 2018
- Published online by Cambridge University Press:
- 12 April 2018, pp. 378-391
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Aim
The aim of this paper is to examine Canadian key informants’ perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration.
BackgroundPrimary health care systems can be strengthened by building stronger collaborations between primary care and public health. Although there is literature that explores interpersonal factors that can influence successful inter-organizational collaborations, a few of them have specifically explored primary care and public health collaboration. Furthermore, no papers were found that considered factors at the intrapersonal level. This paper aims to explore these gaps in a Canadian context.
MethodsThis interpretative descriptive study involved key informants (service providers, managers, directors, and policy makers) who participated in one h telephone interviews to explore their perceptions of influences on successful primary care and public health collaboration. Transcripts were analyzed using NVivo 9.
FindingsA total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor – effective communication – interacted with all of them. Results support and extend our understanding of what influences successful primary care and public health collaboration at these levels and are important considerations in building and sustaining primary care and public health collaborations.
VP169 Grouping Treat-to-Target Studies In Systematic Reviews
- Marrissa Martyn-St James, Emma Hock, Ruth Wong, Matt Stevenson, Allan Wailoo
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, pp. 227-228
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INTRODUCTION:
A Health Technology Assessment (HTA) systematic review was undertaken in rheumatoid arthritis (RA) of treat-to-target (TTT) studies (n = 16) in which studies were grouped according to: TTT versus usual care, trials comparing different targets, or trials comparing different treatment protocols. To our knowledge, this was the first RA TTT review where studies were grouped in this way. We wanted to compare if our approach had been adopted in reviews of hypertension, hyperlipidemia or diabetes.
METHODS:We searched MEDLINE for systematic reviews (SRs) of TTT studies in hypertension, hyperlipidaemia or diabetes.
RESULTS:Eleven SRs were included; eight were in diabetes, and four were in hypertension, while none were in hyperlipidaemia. The diabetes SRs evaluated different insulin regimens (n = 3), non-insulin medications (n = 1), any antidiabetic treatment (n = 2), metformin monotherapy versus combination therapy (n = 1), and tight versus conventional glucose control (n = 1). The metformin review grouped studies by outcome whereas all other diabetes SRs grouped studies by treatment. Two hypertension SRs evaluated the effects of any treatment on two blood pressure targets, whereas one evaluated two different treatment regimen effects on the same blood pressure target. No SR in hypertension or diabetes included a mix of TTT versus usual care, and/or same treatment protocol different targets, and/or different treatment protocols same target study designs.
CONCLUSIONS:In RA TTT does not refer to a single concept but a range of different approaches to the treatment of patients and the evidence reflects this. Whilst our approach to grouping RA TTT studies in a review was novel, this made it complex for us to synthesize evidence and draw general conclusions. We did not identify any TTT reviews in hypertension or diabetes including a mix of the TTT approaches we identified in RA. At present, a comparison of the strengths and limitations of our TTT review study grouping with reviews of hypertension, hyperlipidemia or diabetes cannot be made.
VP166 Selecting Rapid Review Methods For Health Technology Assessment
- Eva Kaltenthaler, Katy Cooper, Marrissa Martyn-St James, Abdullah Pandor, Ruth Wong
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- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, pp. 225-226
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INTRODUCTION:
Rapid reviews are of increasing importance within Health Technology Assessment (HTA) due to the need for timely evidence to underpin the assessment of new technologies as well as financial constraints. There are many rapid review methods available (1) although there is little guidance as to the most suitable methods (2). A recent paper outlines issues to consider when selecting rapid review methods (3). The aim of this presentation is to present key aspects to consider when selecting rapid review methods.
METHODS:We searched the evidence base for guidance on the selection of rapid review methods. We also examined three recently completed systematic reviews to identify rapid review methods used, the reasons for selection and the strengths and weaknesses of each method. Finally we identified key aspects to consider when selecting rapid review methods.
RESULTS:The evidence on guidance identified for the selection of rapid review methods was very limited. The analysis of the three reviews found that each review had distinctly different challenges, such as large numbers of relevant trials and heterogeneity in terms of populations, interventions, comparators and outcomes. All reviews included at least ten randomized controlled trials and numerous outcome measures. Three different approaches to the rapid review of the evidence were used in the three reviews. Key themes to consider when selecting rapid review methods were identified. These include: the size and nature of the evidence base, the characteristics of included studies and the expectations of those commissioning the review.
CONCLUSIONS:Rapid review methods need to be chosen to fit the needs of the review, each of which may have different challenges. Collaboration between those producing rapid reviews and commissioners is crucial when choosing methods to ensure that the needs of commissioners are met and limitations associated with the chosen methods are understood.
PP001 Ultrasound To Guide Treatment Decisions In Rheumatoid Arthritis
- E Simpson, Matt Stevenson, Emma Hock, Ruth Wong, R Wakefield, P Conaghan, C Estrach, C Edwards
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- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, p. 67
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INTRODUCTION:
Ultrasound (US) detects synovitis more accurately than clinical examination (CE) in people with rheumatoid arthritis (RA). This review aimed to investigate the use of US, compared to CE alone, in treatment strategies for RA, and to estimate its potential to be cost-effective in making treatment decisions.
METHODS:A systematic review was conducted of studies: investigating RA treatment response or strategies that compared US with CE-assessed synovitis; and of tapering RA treatment (1). A model was constructed to investigate the potential cost-effectiveness of US in (i) selecting patients suitable for treatment tapering; and (ii) avoiding treatment escalation (2).
RESULTS:Seven prospective cohort studies suggested US-detected synovitis was significantly associated with a treatment response or tapering failure, whereas in most cases clinical examination alone was not. Two randomized controlled trials (RCTs) identified suggested that US added to the Disease Activity Index (DAS)-based treatment strategies but did not significantly improve primary outcomes, but was associated with improved rate of DAS remission. The evidence showed that some patients (proportions varied widely) who had achieved low disease activity could have treatment tapered, with no, or little, short-term harm to the patient.
The model estimated that an average reduction of 2.5 percent in the costs of biological disease-modifying anti-rheumatic drug (bDMARDs) was sufficient to cover the costs of performing US every three months. This value increased to 4 percent and 13 percent for the costs of conventional disease-modifying anti-rheumatic drug (cDMARDs) depending on the assumed regimen.
CONCLUSIONS:Use of US to monitor synovitis could potentially be a cost-effective approach, given that low proportions of patients for whom clinicians consider amending treatment, would need to taper treatment, or remain on therapy without escalation. US could provide clinicians with more confidence in reducing the drug burden. However, there is considerable uncertainty in this conclusion due to lack of robust data relating to key parameters.
OP106 The Impact Of Searching Fewer Databases In Health Technology Assessment Rapid Reviews
- Ruth Wong, Katy Cooper, Marrissa Martyn-St James, Abdullah Pandor, Eva Kaltenthaler
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- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, pp. 49-50
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INTRODUCTION:
Multiple databases are often searched in Health Technology Assessment systematic reviews. However in rapid reviews, time and resources are limited and modifications to the search methodology may be necessary. In this retrospective study, the impact of searching fewer databases for three completed rapid reviews (i) Severe Mental Illness (SMI), (ii) Cannabis Cessation (CC), iii) Premature Ejaculation (PE) for the United Kingdom National Institute for Health Research was investigated.
METHODS:The database coverage and indexing of the study references from the reviews were initially identified. The impact of fewer databases searched was then tested by (i) the number of studies that might be missed, (ii) the number of records for sifting and (iii) the overall rapid review conclusions.
RESULTS:A total of 178 included study references were found in the reviews (SMI n = 14 for 13 studies, CC n = 34 for 33 studies, PE n = 130 for 102 studies). Searching Medline only for SMI, Medline+Embase for CC, Medline+Embase+Cochrane Library for PE, would result in 1902 (74 percent), 466 (43 percent) and 240 (11 percent) fewer records needed to sift, respectively. There would also be a total of ten ‘would be missed’ references (SMI n = 1, CC n = 5 and PE n = 4). However, nine out of the ten references were found to have no or minimal impact on the overall findings of the reviews. The ten references were secondary reports of an included study, papers that lacked sufficient data for meta-analysis such as a conference abstract or an ongoing trial.
CONCLUSIONS:From the three reviews examined, limiting the search to fewer databases had no or minimal impact on the review conclusions despite the variable number of studies that would be missed and records needed to sift. More exploration during the scoping search prior to commencing the review will aid the decision on whether to limit the search to fewer databases.
OP131 Cost-Effectiveness Of Dexamethasone And Adalimumab For Uveitis
- Inigo Bermejo, Hazel Squires, Edith Poku, Katy Cooper, John Stevens, Jean Hamilton, Ruth Wong
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- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, pp. 60-61
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INTRODUCTION:
Uveitis is inflammation inside the eye whose underlying cause may be infectious or non-infectious. The objective of our study was to assess the cost-effectiveness of the dexamethasone implant and adalimumab compared with current practice (immunosuppressants and systemic corticosteroids) in patients with non-infectious intermediate, posterior or pan-uveitis.
METHODS:A Markov model was built to estimate costs and benefits of the interventions. Systematic reviews were performed to identify the relevant evidence. Quality of life data collected in three key randomized-controlled trials (1-3) was used to estimate the interventions effectiveness compared with the trials comparator arms, which consisted of placebo plus limited current practice (LCP). An indirect treatment comparison between adalimumab and dexamethasone was considered inappropriate due to lack of necessary evidence. For adalimumab, patients with active and inactive uveitis were considered separately. Due to the short duration of the trials, the rate of blindness, an important complication of uveitis, was highly uncertain. Substantial exploratory analyses were therefore undertaken. The analysis was performed from the perspective of the National Health Service (NHS) and Personal Social Services (PSS). Costs were calculated based on standard United Kingdom sources.
RESULTS:The estimated incremental cost-effectiveness (ICER) of dexamethasone compared with LCP was GBP19,509 per quality-adjusted life year (QALY) gained. The estimated ICER of adalimumab compared with LCP was GBP94,523 and GBP317,547 per QALY in patients with active and inactive uveitis respectively. The factors with the largest impact upon the ICERs were the rate of blindness and the proportion of cases of blindness avoided by interventions.
CONCLUSIONS:Dexamethasone and adalimumab resulted in health gains, but at significant extra costs, especially adalimumab which is unlikely to be considered a cost-effective use of NHS resources. The results of the analysis are highly uncertain due to the limited availability of evidence on: the comparative effectiveness of dexamethasone, adalimumab and current practice; the effectiveness of treatments in avoiding blindness; and, the effectiveness of interventions in different subgroups.
Contributors
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- By Syed S. Ali, Nathan Allen, John E. Arbo, Elizabeth Arrington, Ani Aydin, Kenneth R. L. Bernard, Amy Caggiula, Nolan Caldwell, Jennifer L. Carey, Jennifer Carnell, Jayaram Chelluri, Michael N. Cocchi, Cristal Cristia, Vishal Demla, Bram Dolcourt, Andrew Eyre, Shawn Fagan, Brandy Ferguson, Sarah Fisher, Jonathan Friedstat, Brian C. Geyer, Brandon Godbout, Jeremy Gonda, Jeremy Goverman, Ashley L. Greiner, Casey Grover, Carla Haack, Abigail Hankin, John W. Hardin, Katrina L. Harper, Gregory Hayward, Stephen Hendriksen, Daniel Herbert-Cohen, Nadine Himelfarb, Calvin E. Hwang, Jacob D. Isserman, Joshua Jauregui, Joshua W. Joseph, Elena Kapilevich, Feras H. Khan, Sarvotham Kini, Karen A. Kinnaman, Ruth Lamm, Calvin Lee, Jarone Lee, Charles Lei, John Lemos, Daniel J. Lepp, Elisabeth Lessenich, Brandon Maughan, Julie Mayglothling, Kevin McConnell, Laura Medford-Davis, Kamal Medlej, Heather Meissen, Payal Modi, Joel Moll, Jolene H. Nakao, Matthew Nicholls, Lindsay Oelze, Carolyn Maher Overman, Viral Patel, Timothy C. Peck, Jeffrey Pepin, Candace Pettigrew, Byron Pitts, Zubaid Rafique, Chanu Rhee, Jonathan C. Roberts, Daniel Rolston, Steven C. Rougas, Benjamin Schnapp, Kathryn A. Seal, Raghu Seethala, Todd A. Seigel, Navdeep Sekhon, Kaushal Shah, Robert L. Sherwin, Kirill Shishlov, Ashley Shreves, Sebastian Siadecki, Jeffrey N. Siegelman, Liza Gonen Smith, Ted Stettner, Marie Carmelle Tabuteau, Joseph E. Tonna, N. Seth Trueger, Chad Van Ginkel, Bina Vasantharam, Graham Walker, Susan Wilcox, Sandra J. Williams, Matthew L. Wong, Nelson Wong, Samantha Wood, John Woodruff, Benjamin Zabar
- Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
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- Practical Emergency Resuscitation and Critical Care
- Published online:
- 05 November 2013
- Print publication:
- 24 October 2013, pp xi-xx
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- By Victoria M. Allen, Frederic Amant, Sarah Armstrong, Thomas F. Baskett, Michael A. Belfort, Meredith Birsner, Renee D. Boss, Leanne Bricker, Josaphat K. Byamugisha, Giorgio Capogna, Michael P. Casaer, Frank A. Chervenak, Vicki Clark, Filip Claus, Malachy O. Columb, Charles Cox, Jean T. Cox, Vegard Dahl, John Davison, Jan Deprest, Clifford S. Deutschman, Roland Devlieger, Karim Djekidel, Steven Dymarkowski, Roshan Fernando, Clare Fitzpatrick, Sreedhar Gaddipati, Thierry Girard, Emily Gordon, Ian A. Greer, David Grooms, Sina Haeri, Katy Harrison, Edward J. Hayes, Michelle Hladunewich, Andra H. James, Tracey Johnston, Bellal Joseph, Erin Keely, Ruth Landau, Stephen E. Lapinsky, Susanna I. Lee, Larry Leeman, Hennie Lombaard, Stephen Lu, Alison MacArthur, Laura A. Magee, Paul E. Marik, Laurence B. McCullough, Alexandre Mignon, Carlo Missant, Jack Moodley, Lisa E. Moore, Kate Morse, Warwick D. Ngan Kee, Catherine Nelson-Piercy, Clemens M. Ortner, Geraldine O’Sullivan, Luis D. Pacheco, Fathima Paruk, Melina Pectasides, Nigel Pereira, Patricia Peticca, Sharon T. Phelan, Felicity Plaat, Lauren A. Plante, Michael P. Plevyak, Dianne Plews, Wendy Pollock, Laura C. Price, Peter Rhee, Leiv Arne Rosseland, Kathryn M. Rowan, Helen Ryan, Helen Scholefield, Neil S. Seligman, Nadir Sharawi, Alex Sia, Bob Silver, Mieke Soens, Ulrich J. Spreng, Silvia Stirparo, Nova Szoka, Andrew Tang, Kha M. Tran, Els Troost, Lawrence C. Tsen, Derek Tuffnell, Kristel Van Calsteren, Marc Van de Velde, Marcel Vercauteren, Chris Verslype, Peter von Dadelszen, Carl Waldman, Michelle Walters, Linda Watkins, Paul Westhead, Cynthia A. Wong, Gerda G. Zeeman, Joost J. Zwart
- Edited by Marc van de Velde, Helen Scholefield, Lauren A. Plante
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- Maternal Critical Care
- Published online:
- 05 July 2013
- Print publication:
- 04 July 2013, pp ix-xiv
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ASSESSING SEARCHES IN NICE SINGLE TECHNOLOGY APPRAISALS: PRACTICE AND CHECKLIST
- Ruth Wong, Suzy Paisley, Christopher Carroll
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- International Journal of Technology Assessment in Health Care / Volume 29 / Issue 3 / July 2013
- Published online by Cambridge University Press:
- 17 June 2013, pp. 315-322
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Objectives: No guidelines exist in the approach that Evidence Review Groups (ERGs) should take to appraise search methodologies in the manufacturer's submission (MS) in Single Technology Appraisals (STA). As a result, ERGs are left to appraise searches using their own approach. This study investigates the limitations of manufacturers' search methodologies as critiqued by ERGs in published STA reports and to provide a recommended checklist.
Methods: Limitations from search critiques in 83 ERG reports published in the NIHR Web site between 2006 and May 2011 were extracted. The limitations were grouped into themes. Comparisons were made between limitations reported in the clinical effectiveness versus cost-effectiveness searches.
Results: Twelve themes were identified, six relating to the search strategy, source, limits, filters, translation, reporting, and missing studies. The search strategy theme contained the most limitations. Missing studies were frequently found by the ERG group in the clinical effectiveness searches. The omission of searches by manufacturers for unpublished and ongoing trials was frequently reported by the ERG. By contrast, failure of the manufacturer to report strategies was the most common limitation in the cost-effectiveness searches. Themes with the most frequent limitations in both types of searches are search strategy, reporting and source.
Conclusions: It is recommended that a checklist that has reporting, source and search strategy elements be used in the appraisal of manufacturer's searches during the STA process.
A scoping literature review of collaboration between primary care and public health
- Ruth Martin-Misener, Ruta Valaitis, Sabrina T. Wong, Marjorie MacDonald, Donna Meagher-Stewart, Janusz Kaczorowski, Linda O-Mara, Rachel Savage, Patricia Austin, the Strengthening Primary Health Care through Public Health and Primary Care Collaborations Team
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- Journal:
- Primary Health Care Research & Development / Volume 13 / Issue 4 / October 2012
- Published online by Cambridge University Press:
- 21 February 2012, pp. 327-346
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Aim
The purpose of this scoping literature review was to determine what is known about: 1) structures and processes required to build successful collaborations between primary care (PC) and public health (PH); 2) outcomes of such collaborations; and 3) markers of their success.
BackgroundCollaboration between PC and PH is believed to enable more effective individual and population services than what might be achieved by either alone.
MethodsThe study followed established methods for a scoping literature review and was guided by a framework that identifies systemic, organizational and interactional determinants for collaboration. The review was restricted to articles published between 1988 and 2008. Published quantitative and qualitative primary studies, evaluation research, systematic and other types of reviews, as well as descriptive accounts without an explicit research design, were included if they addressed either the structures or processes to build collaboration or the outcomes or markers of such collaboration, and were published in English.
FindingsThe combined search strategy yielded 6125 articles of which 114 were included. Systemic-level factors influencing collaboration included: government involvement, policy and fit with local needs; funding and resource factors, power and control issues; and education and training. Lack of a common agenda; knowledge and resource limitations; leadership, management and accountability issues; geographic proximity of partners; and shared protocols, tools and information sharing were influential at the organizational level. Interpersonal factors included having a shared purpose; philosophy and beliefs; clear roles and positive relationships; and effective communication and decision-making strategies. Reported benefits of collaboration included: improved chronic disease management; communicable disease control; and maternal child health. More research is needed to explore the conditions and contexts in which collaboration between PC and PH makes most sense and potential gains outweigh the associated risks and costs.
Methods, strategies and technologies used to conduct a scoping literature review of collaboration between primary care and public health
- Ruta Valaitis, Ruth Martin-Misener, Sabrina T. Wong, Marjorie MacDonald, Donna Meagher-Stewart, Patricia Austin, Janusz Kaczorowski, Linda O-Mara, Rachel Savage, the Strengthening Primary Health Care through Public Health and Primary Care Collaboration Team
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- Journal:
- Primary Health Care Research & Development / Volume 13 / Issue 3 / July 2012
- Published online by Cambridge University Press:
- 16 February 2012, pp. 219-236
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This paper describes the methods, strategies and technologies used to conduct a scoping literature review examining primary care (PC) and public health (PH) collaboration. It presents challenges encountered as well as recommendations and ‘lessons learned’ from conducting the review with a large geographically distributed team comprised of researchers and decision-makers using an integrated knowledge translation approach.
BackgroundScoping studies comprehensively map literature in a specific area guided by general research questions. This methodology is especially useful in researching complex topics. Thus, their popularity is growing. Stakeholder consultations are an important strategy to enhance study results. Therefore, information about how best to involve stakeholders throughout the process is necessary to improve quality and uptake of reviews.
MethodsThis review followed Arksey and O'Malley's five stages: identifying research questions; identifying relevant studies; study selection; charting the data; and collating, summarizing and reporting results. Technological tools and strategies included: citation management software (Reference Manager®), qualitative data analysis software (NVivo 8), web conferencing (Elluminate Live!) and a PH portal (eHealthOntario), teleconferences, email and face-to-face meetings.
FindingsOf 6125 papers identified, 114 were retained as relevant. Most papers originated in the United Kingdom (38%), the United States (34%) and Canada (19%). Of 80 papers that reported on specific collaborations, most were descriptive reports (51.3%). Research studies represented 34 papers: 31% were program evaluations, 9% were literature reviews and 9% were discussion papers. Key strategies to ensure rigor in conducting a scoping literature review while engaging a large geographically dispersed team are presented for each stage. The use of enabling technologies was essential to managing the process. Leadership in championing the use of technologies and a clear governance structure were necessary for their successful uptake.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
- Print publication:
- 20 September 2010, pp xi-xliv
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Examination of Hard Segment and Soft Segment Phase Separation in Polyurethane Medical Materials by Electron Microscopy Techniques
- Jennifer E. Taylor, Peter R. Laity, Steven S. Wong, Keith Norris, Peck Khunkamchoo, Martin Cable, Geoffrey Andrews, Anthony F. Johnson, Ruth E. Cameron
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- Journal:
- Microscopy and Microanalysis / Volume 12 / Issue 2 / April 2006
- Published online by Cambridge University Press:
- 09 December 2005, pp. 151-155
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- April 2006
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A combination of transmission electron microscopy (TEM) and in situ tensile testing in an environmental scanning electron microscopy (ESEM) was used to evaluate the static bulk and dynamic surface morphologies of medical polyurethanes. TEM results showed phase-separated hard segment and soft segment structures. Surface morphology as a function of strain was studied using ESEM in conjunction with a tensometer.