Patient and clinician characteristics and preferences for increasing participation in placebo surgery trials: a scoping review of attributes to inform a discrete choice experiment

Background: Orthopaedic surgeries include some of the highest volume surgical interventions globally; however, studies have shown that a significant proportion of patients report no clinically meaningful improvement in pain or function after certain procedures. As a result, there is increasing interest in conducting randomised placebo-controlled trials in orthopaedic surgery. However, these frequently fail to reach recruitment targets suggesting a need to improve trial design to encourage participation. The objective of this study was to systematically scope the available evidence on patient and clinician values and preferences which may influence the decision to participate in placebo surgery trial. Methods: A systematic review was conducted via a literature search in the MEDLINE, Embase, PsycInfo, CINAHL, and EconLit databases as of 19 July 2021, for studies of any design (except commentaries or opinion pieces) based on two key concepts: patient and clinician characteristics, values and preferences, and placebo surgery trials. Results: Of 3424 initial articles, we retained 18 eligible studies. Characteristics, preferences, values, and attitudes of patients (including levels of pain/function, risk/benefit perception, and altruism) and of clinicians (including concerns regarding patient deception associated with placebo, and experience/training in research) influenced their decisions to participate in placebo-controlled trials. Furthermore, some aspects of trial design, including randomisation procedures, availability of the procedure outside of the trial, and the information and consent procedures used, also influenced decisions to participate. Conclusion: Participant recruitment is a significant challenge in placebo surgery trials, and individual decisions to participate appear to be sensitive to preferences around treatment. Understanding and quantifying the role patient and clinician preferences may play in surgical trials may contribute to the optimisation of the design and implementation of clinical trials in surgery

Investigation of the relationship between low environmental exposure to metals and bone mineral density, bone resorption and renal function

Environmental exposure to metals has been linked to adverse health outcomes. Exposure to cadmium has been associated with decreased bone density, an increased risk of osteoporotic fracture and possible renal dysfunction. Older women are a group at risk of renal and bone density impacts and exposure to metals may be an important risk factor for these health outcomes. This study was a cross sectional study of 77 women aged 50 years and above examining the relationship between metals exposure and renal and bone health. Urinary and blood metals concentrations, plasma creatinine, iron, ferritin and transferrin were measured in these subjects. Bone biomarkers assessed included the pyridinium crosslinks, pyridinoline and deoxypyridinoline measured by ELISA. Renal function was assessed using eGFR and KIM-1. Whole body, hip and lumbar spine bone mineral density was assessed using DEXA. Blood and urinary metals concentrations were generally low in the subjects, with a median urinary cadmium concentration of 0.26. μg/g creatinine (rang

The short-term effects of air pollution on hospital admissions in four Australian cities

Background. This paper examines the short-term health effects of air pollution on daily hospital admissions in Australian cities (those considered comprise more than 50% of the Australian population) for the period 1996-99. Methods: The study used a similar protocol to overseas studies and derived single city and pooled estimates using different statistical approaches to assess the accuracy of the results. Results: There was little difference between the results derived from the different statistical approaches for cardiovascular admissions, while in those for respiratory admissions there were differences. For three of the four cities (for the other the results were positive but not significant), fine particles (measured by nephelometry - bsp) and nitrogen dioxide (NO2) have a significant impact on cardiovascular admissions (for total cardiac admissions, RR=1.0856 for a one-unit increase in bsp (10(-4). m(-1)), RR=1.0023 for a 1 ppb increase in NO2). For three of the four cities (for the other, the results were negative and significant), fine particles, NO2 and ozone have a significant impact on respiratory admissions (for total elderly respiratory admissions, RR=1.0552 per 1 unit (10(-4).m(-1)) increase in bsp, RR=1.0027 per 1ppb increase in NO2, RR=10014 per 1 ppb increase in ozone for elderly asthma and COPD admissions). In all analyses the particle and NO2 impacts appear to be related. Conclusions: Similar to overseas studies, air pollution has an impact on hospital admissions in Australian cities, but there can be significant differences between cities

Environmental and toenail metals concentrations in copper mining and non mining communities in Zambia

Copper mining contributes to increased concentrations of metals in the environment, thereby increasing the risk of metals exposure to populations living in and around mining areas. This study investigated environmental and toenail metals concentrations of non-occupational human exposure to metals in 39 copper-mining town residents and 47 non-mining town residents in Zambia. Elevated environmental concentrations were found in samples collected from the mining town residents. Toenail concentrations of cobalt (GM 1.39. mg/kg), copper (GM 132. mg/kg), lead (21.41. mg/kg) selenium (GM 0.38. mg/kg) and zinc (GM 113. mg/kg) were significantly higher in the mining area and these metals have previously been associated with copper mining. Residence in the mining area, drinking water, dust and soil metals concentrations were the most important contributors to toenail metals concentrations. Further work is required to establish the specific pathways of exposure and the health risks of elevated metals concentrations in the copper mining area

The short-term effects of air pollution on respiratory admissions: A meta-analysis for 4 Australian cities

This poster complements the paper in this area (A description of the SPIRT study for Brisbane, Melbourne, Perth and Sydney: Simpson et al) and details all the results referred in summary in the paper on the short-term health effects of air pollution on respiratory admissions in four Australian cities-Brisbane, Melbourne, Perth and Sydney. The study used a protocol similar to that used in Europe (Air Pollution and Health: A European Approach-APHEA) to examine the associations between health outcomes, such as daily mortality and daily hospital admissions counts, and air pollutants. This poster details all the results for the period 1996-1999 of a meta-analysis for the four cities for the acute health impacts of the pollutants-fine particles, nitrogen dioxide, and ozone. The meta-analyses often show statistically significant differences between the cities indicating the results can be quite different in different cities. Fine particles (as measured by nephelometery) and nitrogen dioxide both have a significant impact on cardiac admissions (14-65 years, greater than 65 years) and IHD admissions (all ages, > 65 years), while ozone has a significant impact on cardiac admissions (14-65 years, greater than 65 years) (although the results are sensitive to how temperature is used in the models). The sensitivity of the results to different statistical methods used in the meta-analyses have been carried out using a combination of three approaches: generalised additive models (GAM) using the S Plus statistical package and loess smoothing, generalised additive models using the S Plus package and natural spiines, and penalised splines using the R statistical package. The results for all methods are presented and for periods of lags of days 0-3 for all pollutants

The short-term effects of air pollution on mortality: A meta-analysis for 4 Australian cities

This poster complements the paper in this area (A description of the SPIRT study for Brisbane, Melbourne, Perth and Sydney: Simpson et al) and details all the results referred in summary in the paper on the short-term health effects of air pollution on respiratory admissions in four Australian cities-Brisbane, Melbourne, Perth and Sydney. The study used a protocol similar to that used in Europe (Air Pollution and Health: A European Approach-APHEA) to examine the associations between health outcomes, such as daily mortality and daily hospital admissions counts, and air pollutants. This poster details all the results for the period 1996-1999 of a meta-analysis for the four cities for the acute health impacts of the pollutants-fine particles, nitrogen dioxide, and ozone. The meta-analyses often show statistically significant differences between the cities indicating the results can be quite different in different cities. Fine particles (as measured by nephelometery) and nitrogen dioxide both have a significant impact on cardiac admissions (14-65 years, greater than 65 years) and IHD admissions (all ages, > 65 years), while ozone has a significant impact on cardiac admissions (14-65 years, greater than 65 years) (although the results are sensitive to how temperature is used in the models). The sensitivity of the results to different statistical methods used in the meta-analyses have been carried out using a combination of three approaches: generalised additive models (GAM) using the S Plus statistical package and loess smoothing, generalised additive models using the S Plus package and natural spiines, and penalised splines using the R statistical package. The results for all methods are presented and for periods of lags of days 0-3 for all pollutants

Maternal exposure to perfluoroalkyl acids measured in whole blood and birth outcomes in offspring

Perfluoralkyl and polyfluoralkyl substances have been measured in plasma and serum of pregnant women as a measure of prenatal exposure. Increased concentrations of individual perfluoroalkyl acids (PFAAs), (typically perfluorooctanoic acid (PFOA) and perfluoroctane sulfonate (PFOS) have been reported to be associated with reductions in birth weight and other birth outcomes. We undertook a study of 14 PFAAs in whole blood (including PFOS, PFHxS, PFHpA, PFOA, PFNA, PFDA and PFUnDA) from 98 pregnant women in Western Australia from 2008 to 2011. Median concentrations (in μg/L) were: PFOS 1.99; PFHxS 0.33; PFOA 0.86; PFNA 0.30; PFDA 0.12 and PFUnDA 0.08. Infants born to women with the highest tertile of PFHxS exposure had an increased odds of being b95% of their optimal birth weight (OR 3.5, 95% CI 1.1 11.5). Conversely, maternal blood concentrations of PFUnDA were associated with non-significant increases in average birth weight (+102 g, 95% CI −41, 245) and significant increases in proportion of optimal birth weight (+4.7%, 95% CI 0.7, 8.8) per ln-unit change. This study has reported a range of PFAAs in the whole blood of pregnant women and suggests that PFHxS and PFUnDA may influence foetal growth and warrant further attention. Additional studies are required to identify the sources of PFAA exposure with a view to prevention, in addition to further studies investigating the long term health effects of these ubiquitous chemicals