Randomised controlled trials of complex interventions and large-scale transformation of services

Complex interventions and large-scale transformations of services are necessary to meet the health-care challenges of the 21st century. However, the evaluation of these types of interventions is challenging and requires methodological development. Innovations such as cluster randomised controlled trials, stepped-wedge designs, and non-randomised evaluations provide options to meet the needs of decision-makers. Adoption of theory and logic models can help clarify causal assumptions, and process evaluation can assist in understanding delivery in context. Issues of implementation must also be considered throughout intervention design and evaluation to ensure that results can be scaled for population benefit. Relevance requires evaluations conducted under real-world conditions, which in turn requires a pragmatic attitude to design. The increasing complexity of interventions and evaluations threatens the ability of researchers to meet the needs of decision-makers for rapid results. Improvements in efficiency are thus crucial, with electronic health records offering significant potential

The Allen Telescope Array Twenty-centimeter Survey -- A 700-Square-Degree, Multi-Epoch Radio Dataset -- II: Individual Epoch Transient Statistics

We present our second paper on the Allen Telescope Array Twenty-centimeter Survey (ATATS), a multi-epoch, ~700 sq. deg. radio image and catalog at 1.4 GHz. The survey is designed to detect rare, bright transients as well as to commission the ATA's wide-field survey capabilities. ATATS explores the challenges of multi-epoch transient and variable source surveys in the domain of dynamic range limits and changing (u,v) coverage. Here we present images made using data from the individual epochs, as well as a revised image combining data from all ATATS epochs. The combined image has RMS noise 3.96 mJy / beam, with a circular beam of 150 arcsec FWHM. The catalog, generated using a false detection rate algorithm, contains 4984 sources, and is >90% complete to 37.9 mJy. The catalogs generated from snapshot images of the individual epochs contain between 1170 and 2019 sources over the 564 sq. deg. area in common to all epochs. The 90% completeness limits of the single epoch catalogs range from 98.6 to 232 mJy. We compare the catalog generated from the combined image to those from individual epochs, and from the NRAO VLA Sky Survey (NVSS), a legacy survey at the same frequency. We are able to place new constraints on the transient population: fewer than 6e-4 transients / sq. deg., for transients brighter than 350 mJy with characteristic timescales of minutes to days. This strongly rules out an astronomical origin for the ~1 Jy sources reported by Matsumura et al. (2009), based on their stated rate of 3.1e-3 / sq. deg.Comment: 28 pages, 12 figures, ApJ accepte

Self-management interventions in patients with long-term conditions: a structured review of approaches to reporting inclusion, assessment, and outcomes in multimorbidity

Background: Multimorbidity has many potential implications for healthcare delivery, but a particularly important impact concerns the validity of trial evidence underpinning clinical guidelines for individual conditions. Objective: To review how authors of published trials of self-management interventions reported inclusion criteria, sample descriptions, and consideration of the impact of multimorbidity on trial outcomes. Methods: We restricted our analysis to a small number of exemplar long-term conditions: type 2 diabetes mellitus, coronary heart disease, and chronic obstructive pulmonary disease. We focussed our search on published Cochrane reviews. Data were extracted from the trials on inclusion/exclusion, sample description, and impact on outcomes. Results: Eleven reviews consisting of 164 unique trials were identified. Sixty percent of trials reported excluding patients with forms of multimorbidity. Reasons for exclusion were poorly described or defined. Reporting of multimorbidity within the trials was poor, with only 35% of trials reporting on multimorbidity in their patient samples. Secondary analyses, exploring the impact of multimorbidity, were very rare. Conclusions: The importance of multimorbidity in trials is only going to become more important over time, but trials often exclude patients with multimorbidity, and reporting of multimorbidity in trials including such patients is generally poor. This limits judgements about the external validity of the results for clinical populations. A consistent approach to the conduct and reporting of secondary analyses of the effects of multimorbidity on outcomes, using current best-practice guidance, could lead to a rapid development of the evidence base. Journal of Comorbidity 2014;4(1):37–4

The effectiveness of self help technologies for emotional problems in adolescents: a systematic review

Abstract Background Adolescence is a transition period that involves physiological, psychological, and social changes. Emotional problems such as symptoms of anxiety and depression may develop due to these changes. Although many of these problems may not meet diagnostic thresholds, they may develop into more severe disorders and may impact on functioning. However, there are barriers that may make it difficult for adolescents to receive help from health professionals for such problems, one of which is the limited availability of formal psychological therapy. One way of increasing access to help for such problems is through self help technology (i.e. delivery of psychological help through information technology or paper based formats). Although there is a significant evidence base concerning self help in adults, the evidence base is much weaker in adolescents. This study aims to examine the effectiveness of self help technology for the treatment of emotional problems in adolescents by conducting a systematic review of randomized and quasi-experimental evidence. Methods Five major electronic databases were searched: Medline, PsycInfo, Embase, Cochrane Controlled Trials Register and CINAHL. In addition, nine journals were handsearched and the reference lists of all studies were examined for any additional studies. Fourteen studies were identified. Effect sizes were calculated across 3 outcome measures: attitude towards self (e.g. self esteem); social cognition (e.g. self efficacy); and emotional symptoms (i.e. depression and anxiety symptoms). Results Meta analysis showed small, non-significant effect size for attitude towards self (ES = -0.14, 95% CI = -0.72 to 0.43), a medium, non-significant effect size for social cognition (ES = -0.49, 95% CI = -1.23 to 0.25) and a medium, non-significant effect size for emotional symptoms (ES = -0.47, 95% CI = -1.00 to 0.07). However, these findings must be considered preliminary, because of the small number of studies, their heterogeneity, and the relatively poor quality of the studies. Conclusion At present, the adoption of self help technology for adolescents with emotional problems in routine clinical practice cannot be recommended. There is a need to conduct high quality randomised trials in clearly defined populations to further develop the evidence base before implementation.</p

Interview with Harold Bower

Harold Bower gives a history of the Kokosing River area.https://digital.kenyon.edu/lak_interviews/1022/thumbnail.jp

Identification of stable endogenous reference genes for real-time PCR in the human fetal gonad using an external standard technique

Peer reviewedPostprin

Systematic review of patients’ views on the quality of primary health care in sub-Saharan Africa

This is the first systematic review of patient views on the quality of primary health care services in sub-Saharan Africa using studies identified from MEDLINE, CINAHL Plus, EMBASE and PsycINFO. In total, 20 studies (3 qualitative, 3 mixed method and 14 quantitative) were included. Meta-analysis was done using quantitative findings from facility- and community-based studies of patient evaluation of primary health care. There was low use of validated measures, and the most common scales assessed were humanness (70%) and access (70%). While 66% (standard deviation = 21%) of respondents gave favourable feedback, there were discrepancies between surveys in community and facility contexts. Findings suggest that patient views could vary with subject recruitment site. We recommend improvement in the methods used to examine patient views on quality of primary health care