A critical analysis of multi-criteria models for the prioritisation of health threats

© 2019 Elsevier B.V. Multi-criteria assessments are increasingly being employed in the prioritisation of health threats, supporting decision processes related to health risk management. The use of multi-criteria analysis in this context is welcome, as it facilitates the consideration of multiple impacts of health threats, it can encompass the use of expert judgment to complement and amalgamate the evidence available, and it permits the modelling of policy makers’ priorities. However, these assessments often lack a clear multi-criteria conceptual framework, in terms of both axiomatic rigour and adequate procedures for preference modelling. Such assessments are ad hoc from a multi-criteria decision analysis perspective, despite the strong health expertise used in constructing these models. In this paper we critically examine some key assumptions and modelling choices made in these assessments, comparing them with the best practices of multi-attribute value analysis. Furthermore, we suggest a set of guidelines on how simulation studies might be employed to assess the impact of these modelling choices. We apply these guidelines to two relevant studies available in the health threat prioritisation domain. We identify severe variability in our simulations due to poor modelling choices, which could cause changes in the ranking of threats being assessed and thus lead to alternative policy recommendations than those suggested in their reports. Our results confirm the importance of carefully designing multi-criteria evaluation models for the prioritisation of health threats

A multi-stakeholder ethical framework for AI-augmented HRM

Purpose: This narrative review presents a multi-stakeholder ethical framework for AI-augmented HRM, based on extant research in the domains of ethical HRM and ethical AI. More specifically, the authors identify critical ethical issues pertaining to AI-augmented HRM functions and suggest ethical principles to address these issues by identifying the relevant stakeholders based on the responsibility ethics approach. Design/methodology/approach: This paper follows a narrative review approach by first identifying various ethical/codes/issues/dilemmas discussed in HRM and AI. The authors next discuss ethical issues concerning AI-augmented HRM, drawing from recent literature. Finally, the authors propose ethical principles for AI-augmented HRM and stakeholders responsible for managing those issues. Findings: The paper summarises key findings of extant research in the ethical HRM and AI domain and provides a multi-stakeholder ethical framework for AI-augmented HRM functions. Originality/value: This research's value lies in conceptualising a multi-stakeholder ethical framework for AI-augmented HRM functions comprising 11 ethical principles. The research also identifies the class of stakeholders responsible for identified ethical principles. The research also presents future research directions based on the proposed model

Screening for non-adherence to antihypertensive treatment as a part of the diagnostic pathway to renal denervation.

Renal denervation is a potential therapeutic option for resistant hypertension. A thorough clinical assessment to exclude reversible/spurious causes of resistance to antihypertensive therapy is required prior to this procedure. The extent to which non-adherence to antihypertensive treatment contributes to apparent resistance to antihypertensive therapy in patients considered for renal denervation is not known. Patients (n=34) referred for renal denervation entered the evaluation pathway that included screening for adherence to antihypertensive treatment by high-performance liquid chromatography-tandem mass spectrometry-based urine analysis. Biochemical non-adherence to antihypertensive treatment was the most common cause of non-eligibility for renal denervation-23.5% of patients were either partially or completely non-adherent to prescribed antihypertensive treatment. About 5.9% of those referred for renal denervation had admitted non-adherence prior to performing the screening test. Suboptimal pharmacological treatment of hypertension and 'white-coat effect' accounted for apparently resistant hypertension in a further 17.7 and 5.9% of patients, respectively. Taken together, these three causes of pseudo-resistant hypertension accounted for 52.9% of patients referred for renal denervation. Only 14.7% of referred patients were ultimately deemed eligible for renal denervation. Without biochemical screening for therapeutic non-adherence, the eligibility rate for renal denervation would have been 38.2%. Non-adherence to antihypertensive treatment and other forms of therapeutic pseudo-resistance are by far the most common reason of 'resistant hypertension' in patients referred for renal denervation. We suggest that inclusion of biochemical screening for non-adherence to antihypertensive treatment may be helpful in evaluation of patients with 'resistant hypertension' prior to consideration of renal denervation

Innovative work behavior driving Indian startups go global – the role of authentic leadership and readiness for change

Purpose: The purpose of the study was to find out the effect of authentic leadership on innovative work behavior among employees in the context of Indian startups that have gone global in the past one decade. The study also aimed to investigate the mediating effect of one organizational-level variable, i.e. organizational climate and one individual-level variable, i.e. readiness for change on the direct relationship between authentic leadership and innovative work behavior. Design/methodology/approach: The study used survey method with a sample of 261 employees working in Indian startups that have gone global in the past one decade. Authentic leadership, organizational climate, readiness for change and innovative work behavior were measured using standardized questionnaires. Findings: Structural equation modeling revealed that authentic leadership had significant direct effect on innovative work behavior and this effect was mediated by readiness for change. However, organizational climate had no significant effect. Practical implications: The findings of the study have important implications for startups that employ millennials as employees and have plans to go global. Millennials have very different characteristics in the workplace and they regard authenticity in the leader very highly. Since they are assertive and they question everything, it becomes imperative for founder-leaders to exhibit authenticity in their actions, words and thoughts. Originality/value: This is the first study in the context of Indian startups that have gone global by taking important variables of authentic leadership, readiness for change and innovative work behavior

Urine Concentration Does Not Affect Biochemical Testing for Non-adherence

Hypertension is one of the most important modifiable risk factor causing cardiovascular disease. Unfortunately, non-adherence to antihypertensive medications is frequently observed in hypertensive patients and can lead to an increase in morbidity and mortality. Until recently, there was no robust clinical method to objectively diagnose non-adherence. Recently, the detection of medications in urine or blood by mass spectrometry techniques such as liquid chromatography-tandem mass spectrometry (LC–MS-MS) has been accepted as the diagnostic method of choice for the detection of non-adherence. Despite this, it is unclear whether the concentration of urine can affect the detection of medications in urine. Therefore, this study aimed to assess the effect of urine concentration on detection of antihypertensive medications by LC–MS-MS in which urine creatinine is used as an independent marker of urine concentration. Biochemical adherence results for 22 different medications (1,709 prescriptions) in 463 different subjects were converted to an adherence score. The adherence score was defined as the ratio of the total number of subjects in which the drug was detected to the total number of subjects to whom the drug was prescribed. The adherence scores for each medication were correlated with urine creatinine concentration for each medication. Non-adherence was observed in 47.1% of samples with a mean urine creatinine concentration of these samples of 9.4 ± 7.1 mmol/L. There was no significant difference between the urine creatinine concentrations in the detected vs non-detected groups for each of the 22 medications. Furthermore, there are no differences in adherence scores across the urine creatinine concentration. This is the first study to demonstrate that urine creatinine concentration does not affect the results of the adherence screening by LC–MS-MS.</p

An Innovative Chemical Adherence Test Demonstrates Very High Rates of Nonadherence to Oral Cardio-Metabolic Medications

Chronic kidney disease (CKD) is one of the leading causes of death worldwide. About 13% of the world’s population are living with CKD; and over the last 20 years, there has been over a 40% increase in mortality rates due to CKD.1,2 Compared to patients without CKD, CKD stages G3a to G4 (estimated glomerular filtration rate 15–60 ml/min per 1.73 m2) is associated with a 2 to 3 fold increase in risk of cardiovascular disease mortality.3 It is estimated that about 17% to 74% of patients with CKD are nonadherent to their medications.4 Improvement in adherence has been identified as a key strategy to enhance cardiovascular outcomes.5 However, the diagnosis of nonadherence, until recently, was difficult due to the lack of objective tools in busy clinics because some subjective methods have been found to be unreliable.6 Chemical adherence testing (CAT) is a novel, objective, robust and clinically reliable test that uses liquid-chromatography tandem mass spectrometry to assess adherence to medications. A random spot urine or blood sample is screened to determine the presence or absence of 70 of the most common cardio-metabolic medications (Supplementary Table S1) (including antihypertensives, lipid lowering medications, and glucose lowering drugs).7 There are guidelines available to help implement the use of the test and address common questions about the clinical use of the test.7 Currently, CAT is being used in routine care in some specialist hypertension clinics across Europe and has been recommended by the European Society of Cardiology and the European Society of Hypertension as the method to be used to measure adherence in patients with suspected resistant hypertension.8 The use of CAT is limited outside of hypertension and to the best of our knowledge there has been no publication that has used CAT to diagnose medication nonadherence in renal patients. The aim of this study was therefore to demonstrate and highlight the usefulness of CAT to determine the prevalence of nonadherence to cardio-metabolic medications in patients attending routine renal clinics.</p

Analysis of health overseas development aid for internally displaced persons in low- and middle-income countries

Background There are an estimated 55 million internally displaced persons (IDPs) globally. IDPs commonly have worse health outcomes than host populations and other forcibly displaced populations such as refugees. Official development assistance (ODA) is a major source of the global financial response for health in low- and middle-income countries (LMICs), including for populations affected by armed conflict and forced displacement. Analysis of ODA supports efforts to improve donor accountability, transparency and the equitable use of ODA. The aim of this study is to examine international donor support and responsiveness to IDP health needs through analysis of ODA disbursements to LMICs between 2010 and 2019. Methods ODA disbursement data to LMICs from 2010 to 2019 were extracted from the Creditor Reporting System (CRS) database and analysed with Stata software using a combination of: (i) text searching for IDP and refugee related terms; and (ii) relevant health and humanitarian CRS purpose codes. Descriptive analysis was used to examine patterns of ODA disbursement, and nonlinear least squared regression analysis was used to examine responsiveness of ODA disbursement to recipient country IDP population size and health system capacity and health characteristics. Findings The study highlighted declining per IDP capita health ODA from USD 5.34 in 2010 to USD 3.72 in 2019 (with annual average decline of -38% from the 2010 baseline). In contrast, health ODA for refugees in LMICs increased from USD 18.55 in 2010 to USD 23.31 in 2019 (with an annual average increase of +14%). Certain health topics for IDPs received very low ODA, with only 0.44% of IDP health ODA disbursed for non-communicable diseases (including mental health). There was also weak evidence of IDP health ODA being related to recipient country IDP population size, and health system capacity and health characteristics. The paper highlights the need for increased investment by donors in IDP health ODA and to ensure that it is responsive to their health needs.</p

The Ready to Reduce Risk (3R) Study for a Group Educational Intervention With Telephone and Text Messaging Support to Improve Medication Adherence for the Primary Prevention of Cardiovascular Disease: Protocol for a Randomized Controlled Trial.

BACKGROUND: Poor adherence to cardiovascular medications is associated with worse clinical outcomes. Evidence for effective education interventions that address medication adherence for the primary prevention of cardiovascular disease is lacking. The Ready to Reduce Risk (3R) study aims to investigate whether a complex intervention, involving group education plus telephone and text messaging follow-up support, can improve medication adherence and reduce cardiovascular risk. OBJECTIVE: This protocol paper details the design and rationale for the development of the 3R intervention and the study methods used. METHODS: This is an open and pragmatic randomized controlled trial with 12 months of follow-up. We recruited participants from primary care and randomly assigned them at a 1:1 frequency, stratified by sex and age, to either a control group (usual care from a general practitioner) or an intervention group involving 2 facilitated group education sessions with telephone and text messaging follow-up support, with a theoretical underpinning and using recognized behavioral change techniques. The primary outcome was medication adherence to statins. The primary measure was an objective, novel, urine-based biochemical measure of medication adherence. We also used the 8-item Morisky Medication Adherence Scale to assess medication adherence. Secondary outcomes were changes in total cholesterol, blood pressure, high-density lipoprotein, total cholesterol to high-density lipoprotein ratio, body mass index, waist to hip ratio, waist circumference, smoking behavior, physical activity, fruit and vegetable intake, patient activation level, quality of life, health status, health and medication beliefs, and overall cardiovascular disease risk score. We also considered process outcomes relating to acceptability and feasibility of the 3R intervention. RESULTS: We recruited 212 participants between May 2015 and March 2017. The 12-month follow-up data collection clinics were completed in April 2018, and data analysis will commence once all study data have been collected and verified. CONCLUSIONS: This study will identify a potentially clinically useful and effective educational intervention for the primary prevention of cardiovascular disease. Medication adherence to statins is being assessed using a novel urine assay as an objective measure, in conjunction with other validated measures. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number ISRCTN16863160; http://www.isrctn.com/ISRCTN16863160 (Archived by WebCite at http://www.webcitation.org/734PqfdQw). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/11289

Corrigendum and Editorial Warning Regarding Use of the MMAS Scale (The Ready to Reduce Risk (3R) Study for a Group Educational Intervention With Telephone and Text Messaging Support to Improve Medication Adherence for the Primary Prevention of Cardiovascular Disease: Protocol for a Randomized Controlled Trial).

The authors of “The Ready to Reduce Risk (3R) Study for a Group Educational Intervention With Telephone and Text Messaging Support to Improve Medication Adherence for the Primary Prevention of Cardiovascular Disease: Protocol for a Randomized Controlled Trial” [JMIR Res Protoc 2018;7(11):e11289] require corrections in relationship to the use of the Morisky Medication Adherence Scale (MMAS-8)

High non-adherence rates to secondary prevention by chemical adherence testing in patients with TIA

Introduction: Transient ischaemic attack (TIA) clinics are important for secondary prevention of fatal or disabling stroke. Non-adherence to prescribed medications is an important reason for treatment failure but difficult to diagnose. This study ascertained the utility of a novel biochemical tool in the objective biochemical diagnosis of non-adherence. Methods: One-hundred consecutive urine samples collected from patients attending the TIA clinic, at a tertiary centre, were analysed for presence or absence of prescribed cardiovascular medications using liquid chromatography-mass spectrometry (LC-MS/MS). Patients were classified as adherent or non-adherent, respectively. Demographic and clinical characteristics were compared between the two cohorts. Univariate regression analyses were performed for individual variables and model fitting was undertaken for significant variables. Results: The mean duration of follow-up from the index event was 31 days [standard deviation (SD): 18.9]. The overall rate of non-adherence for at least one medication was 24%. In univariate analysis, the number of comorbidities [3.4 (SD: 1.9) vs. 2.5 (1.9), P = 0.032] and total number of all prescribed medications [6.0 (3.3) vs 4.4 (2.1), P = 0.032] were higher in the non-adherent group. On multivariate analysis, the total number of medications prescribed correlated with increased non-adherence (odds ratio: 1.27, 95% Confidence Intervals: 1.1-1.5, P = 0.01). Conclusions: LC-MS/MS is a clinically useful tool for the diagnosis of non-adherence. Nearly a quarter of TIA patients were non-adherent to their cardiovascular medications Addressing non-adherence early may reduce the risk of future disabling cardiovascular events