Dissemination and Implementation Science: Research Models and Methods

Dissemination and implementation (DI) science has grown exponentially in the past decade. This chapter reviews and discusses the research methodology pertinent to empirical DI inquiry within mental health services research. This chapter (a) reviews models of DI science, (b) presents and discusses design, variables, and measures relevant to DI processes, and (c) offers recommendations for future research

Evaluating the next generation of RSV intervention strategies:a mathematical modelling study and cost-effectiveness analysis

BACKGROUND: With a suite of promising new RSV prophylactics on the horizon, including long-acting monoclonal antibodies and new vaccines, it is likely that one or more of these will replace the current monoclonal Palivizumab programme. However, choosing the optimal intervention programme will require balancing the costs of the programmes with the health benefits accrued. METHODS: To compare the next generation of RSV prophylactics, we integrated a novel transmission model with an economic analysis. We estimated key epidemiological parameters by calibrating the model to 7 years of historical epidemiological data using a Bayesian approach. We determined the cost-effective and affordable maximum purchase price for a comprehensive suite of intervention programmes. FINDINGS: Our transmission model suggests that maternal protection of infants is seasonal, with 38-62% of infants born with protection against RSV. Our economic analysis found that to cost-effectively and affordably replace the current monoclonal antibody Palivizumab programme with long-acting monoclonal antibodies, the purchase price per dose would have to be less than around £4350 but dropping to £200 for vaccinated heightened risk infants or £90 for all infants. A seasonal maternal vaccine would have to be priced less than £85 to be cost-effective and affordable. While vaccinating pre-school and school-age children is likely not cost-effective relative to elderly vaccination programmes, vaccinating the elderly is not likely to be affordable. Conversely, vaccinating infants at 2 months seasonally would be cost-effective and affordable if priced less than £80. CONCLUSIONS: In a setting with seasonal RSV epidemiology, maternal protection conferred to newborns is also seasonal, an assumption not previously incorporated in transmission models of RSV. For a country with seasonal RSV dynamics like England, seasonal programmes rather than year-round intervention programmes are always optimal

Panel

to bring the best available evidence and expertise to bear on the types of systemic challenges that cannot currently be addressed by single interventions or programs. Authors of practice guides seldom conduct the types of systematic literature searches that are the backbone of a meta-analysis, although they take advantage of such work when it is already published. Instead, authors use their expertise to identify the most important research with respect to their recommendations, augmented by a search of recent publications to ensure that research citations are up-to-date. Unique to IES-sponsored practice guides is that they are subjected to rigorous external peer review through the same office that is responsible for independent review of other IES publications. A critical task for peer reviewers of a practice guide is to determine whether the evidence cited in support of particular recommendations is up-to-date and that studies of similar or better quality that point in a different direction have not been ignored. Because practice guides depend on the expertise of their authors and their group decisionmaking, the content of a practice guide is not and should not be viewed as a set of recommendations that in every case depend

Recommendation on how avoid Interference Issues in companion and organized avalanche rescue

Electronic avalanche rescue devices such as 457kHz transceivers and Recco are today the primary search tools in companion and organized rescue. The requirement for a long receive range in order to shorten rescue time asks for highly sensitive receivers. Such highly sensitive receivers are vulnerable to be influenced by interference from other electronic devices, but as well metal parts and passive electronics may detune the antennas or act as a unwanted reflector in the case of a Recco search. The percentage of users who carry a wide range of electronic devices such as mobile phones, helmet cameras, music players, heart rate monitors etc in the outdoors has considerably increased over time and therefore the negative influence on an efficient search effort has in several cases lead to loss of valuable rescue time and greatly disturbed the rescuers on the accident site. The study includes a detailed analysis on the mechanisms of interference, a matrix of influence and potential consequences as well as a new, user group specific recommendation on how to avoid interference issues in companion and organized rescue

Seasonal influenza vaccination delivery through community pharmacists in England: evaluation of the London pilot.

OBJECTIVE: To evaluate the effectiveness and cost of the pan-London pharmacy initiative, a programme that allows administration of seasonal influenza vaccination to eligible patients at pharmacies. DESIGN: We analysed 2013-2015 data on vaccination uptake in pharmacies via the Sonar reporting system, and the total vaccination uptake via 2011-2015 ImmForm general practitioner (GP) reporting system data. We conducted an online survey of London pharmacists who participate in the programme to assess time use data, vaccine choice, investment costs and opinions about the programme. We conducted an online survey of London GPs to assess vaccine choice of vaccine and opinions about the pharmacy vaccine delivery programme. SETTING: All London boroughs. PARTICIPANTS: London-based GPs, and pharmacies that currently offer seasonal flu vaccination. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Comparison of annual vaccine uptake in London across risk groups from years before pharmacy vaccination introduction to after pharmacy vaccination introduction. Completeness of vaccine uptake reporting data. Cost to the National Health Service (NHS) of flu vaccine delivery at pharmacies with that at GPs. Cost to pharmacists of flu delivery. Opinions of pharmacists and GPs regarding the flu vaccine pharmacy initiative. RESULTS: No significant change in the uptake of seasonal vaccination in any of the risk groups as a result of the pharmacy initiative. While on average a pharmacy-administered flu vaccine dose costs the NHS up to £2.35 less than a dose administered at a GP, a comparison of the 2 recording systems suggests there is substantial loss of data. CONCLUSIONS: Flu vaccine delivery through pharmacies shows potential for improving convenience for vaccine recipients. However, there is no evidence that vaccination uptake increases and the use of 2 separate recording systems leads to time-consuming data entry and missing vaccine record data

Estimates for quality of life loss due to Respiratory Syncytial Virus

BACKGROUND: In children aged <5 years in whom severe respiratory syncytial virus (RSV) episodes predominantly occur, there are currently no appropriate standardised instruments to estimate quality of life years (QALY) loss. OBJECTIVES: We estimated the age-specific QALY loss due to RSV by developing a regression model which predicts the QALY loss without the use of standardised instruments. METHODS: We conducted a surveillance study which targeted confirmed RSV episodes in children aged <5 years (confirmed cases) and their household members who experienced symptoms of RSV during the same time (suspected cases). All participants were asked to complete questions regarding their health during the infection, with the suspected cases additionally providing health-related quality of life (HR-QoL) loss estimates by completing EQ-5D-3L-Y or EQ-5D-3L instruments. We used the responses from the suspected cases to calibrate a regression model which estimates the HR-QoL and QALY loss due to infection. FINDINGS: For confirmed RSV cases in children under 5 years of age who sought health care, our model predicted a QALY loss per RSV episode of 3.823 × 10-3 (95% CI 0.492-12.766 × 10-3 ), compared with 3.024 × 10-3 (95% CI 0.329-10.098 × 10-3 ) for under fives who did not seek health care. Quality of life years loss per episode was less for older children and adults, estimated as 1.950 × 10-3 (0.185-9.578 × 10-3 ) and 1.543 × 10-3 (0.136-6.406 × 10-3 ) for those who seek or do not seek health care, respectively. CONCLUSION: Evaluations of potential RSV vaccination programmes should consider their impact across the whole population, not just young child children

Cost-effectiveness of introducing national seasonal influenza vaccination for adults aged 60 years and above in mainland China: a modelling analysis

BACKGROUND: China has an aging population with an increasing number of adults aged ≥ 60 years. Influenza causes a heavy disease burden in older adults, but can be alleviated by vaccination. We assessed the cost-effectiveness of a potential government-funded seasonal influenza vaccination program in older adults in China. METHODS: We characterized the health and economic impact of a fully funded influenza vaccination program for older adults using China-specific influenza disease burden, and related cost data, etc. Using a decision tree model, we calculated the incremental costs per quality-adjusted life year (QALY) gained of vaccination from the societal perspective, at a willingness-to-pay threshold equivalent to GDP per capita (US$8840). Moreover, we estimated the threshold vaccination costs, under which the fully funded vaccination program is cost-effective using GDP per capita as the willingness-to-pay threshold. RESULTS: Compared to current self-paid vaccination, a fully funded vaccination program is expected to prevent 19,812 (95$4832 (3460-8307), with a 98% probability of being cost-effective. The threshold vaccination cost is US$10.19 (6.08-13.65). However, variations exist between geographical regions, with Northeast and Central China having lower probabilities of cost-effectiveness. CONCLUSIONS: Our results support the implementation of a government fully funded older adult vaccination program in China. The regional analysis provides results across settings that may be relevant to other countries with similar disease burden and economic status, especially for low- and middle-income countries where such analysis is limited

A változás csatornái: hálózati mechanizmusok összevetése a beavatkozások következtében

A tanulmány a személyes kapcsolathálózatoknak az egyén viselkedésére tett hatását vizsgálva a közösségtudomány (community science) ismeretanyagát bővíti, egyúttal csökkentve a kutatástól a gyakorlatig terjedő szakadékot. A kutatás két hálózati jellemzőre (a kohézióra és a strukturális ekvivalenciára) összpontosít, amikor a városi általános iskolák pedagógusainak azon beavatkozásait vizsgálja, amelyek a diákok iskolai előmenetelét és viselkedészavarainak enyhítését célozzák. Regressziós modellekkel vizsgáljuk, hogy a tanácsadói hálózatban elfoglalt hely miként befolyásolja a napi jelentőkártya (daily report card), illetve a társas tanulás (peer-assisted learning) módszerének heti használatát, összesen három iskolában, az óvodáskorúaktól a negyedik osztályosokig tanító pedagógusok körében. Az eredmények azt mutatják, hogy a beavatkozások alkalmazása inkább a hasonló tanácsadói kapcsolathálózati mintázatokkal rendelkező tanárok körében terjed (tehát strukturális ekvivalencián keresztül), nem pedig a tanácsadói pozícióban lévők segítségével (vagyis a kohézió által). A más körülmények között kapott , hasonló eredményekkel összhangban a tanulmány arra hívja fel a figyelmet, hogy amennyiben a beavatkozás erősítése a cél, nem a közvetlen kapcsolatok, hanem a kapcsolathálózati minta alapján érdemes kiválasztani a változásügynököket (change agent)