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Kuldeep Kumar’s contribution to the Discussion of ‘Some statistical aspects of the Covid-19 response’ by Wood et al
No full textLeveling the playing field: evaluating measurement equivalence in MMIs between genders
Get PDFIntroduction: The selection process for medical schools plays a vital role in identifying candidates with the attributes and capabilities needed for success in medicine. Multiple Mini-Interviews (MMI) are widely used to assess non-cognitive attributes like communication, empathy, and ethical judgment. Ensuring their fairness and validity across diverse applicant groups is essential for equitable selection.Aims:This study aimed to investigate: (1) is there evidence to support the factorial validity of MMI structure; (2) whether non-cognitive attributes assessed by MMIs are consistently interpreted across gender groups; and (3) whether gender-related disparities exist in MMI performance.Methods: Data were drawn from applicants to an Australian Medical School across three selection cycles (2022–2024). Confirmatory Factor Analysis (CFA) was used to assess the dimensionality of MMI performance, with multiple competing models tested to identify the best-fitting structure. The selected model was then assessed for measurement invariance across gender using Multi-Group CFA. Once scalar invariance was established, latent mean comparisons were conducted to examine gender-related differences in MMI performance.Results: CFA indicated a well-fitting structure for MMIs, with a higher-order model emerging as the most appropriate representation across cohorts. Measurement invariance testing confirmed scalar invariance across gender groups, indicating that MMI non-cognitive attributes were demonstrated equivalently by males and females. Significant latent mean differences were identified, with female applicants consistently outperforming male applicants across all 3 years.Discussion: The results provided empirical support for the factorial validity and measurement fairness of the MMI across gender groups. However, the consistent gender-based performance differences highlight the need for continued research into potential sources of group disparities and how they may impact selections equity. The results are relevant for medical educators and policymakers committed to evidence-based and equitable selection processes
Trial-based economic evaluations of non-drug interventions in the Royal Australian College of General Practitioners (RACGP) Handbook of Non-Drug Interventions in primary care: a systemic review
No full textObjective: This systematic review assessed trial-based economic evaluations to provide empirical evidence on the cost-effectiveness of non-drug interventions (NDIs) that are currently recommended within the Royal Australian College of General Practitioners Handbook of Non-Drug Interventions (HANDI).Methods: Medline, CINAHL and PsycINFO along with clinical trial registries (clinicaltrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 1 July 2025. Randomised controlled trials (RCTs) that reported cost effectiveness for a prescribed non-drug intervention (NDI) from HANDI were included in the study. The primary outcome was the incremental cost-utility ratio (ICUR) derived from cost-utility analyses (CUAs).Results:A total of 11 187 citations were identified, from which 156 RCTs were included. These RCTs enrolled a total of 66 926 participants (median=214, IQR 139-342), with a median follow-up duration of 12 months (IQR 6-12 months). Over half of the CUA NDIs were for mental health conditions (n=81; 54.0%), one-third were for were for musculoskeletal conditions (n=44; 29.3%), while only 16.0% (n=24) were for those with cardiovascular/metabolic conditions. Out of the 150 NDIs that reported CUAs, 40% were deemed to be in the south-east (SE) quadrant (cheaper and more effective) and 49.3% fell in the north-east (NE) quadrant (more costly but more effective), with 70% considered cost effective against a £25 000/quality-adjusted life-year (QALY) willingness to pay threshold. The overall median ICUR was £2400/QALY (IQR -18 986 to 20 027).Conclusions:Most of the HANDI NDIs that were included within this systematic review are cost-effective compared with a variety of alternatives including usual care or waiting list controls. HANDI NDIs warrant use as a first line of treatment when clinically appropriate
Do Self-Measured Blood Pressure Devices Change Outcomes?: Implementation Does: Team-Based Insights from the ASPIRE Hybrid Trial
No full textHypertension remains one of the most important modifiable risk factors for developing cardiovascular events and associated mortality. The global prevalence of hypertension in 2019 was estimated to be 30% in those aged 30–79, and affects more than 1.3 billion individuals.1 However, many are unaware, untreated, or undertreated. Hypertension control is particularly weak in low- and middle-income countries (LMICs), with a control rate of around 10%, due to structural barriers to primary care, limited access to validated devices, and interruptions in care. However, even in high-income countries, optimal blood pressure control is only achieved in about 40% of patients.1 In particular, socioeconomically disadvantaged populations, including racial and ethnic minorities and individuals, such as those insured through Medicaid in the USA, exhibit disproportionately poor hypertension outcomes
Critically appraised papers Manual therapy may improve passive cervical range of motion, symmetric head posture and reduce sternocleidomastoid tumour thickness in infants and young children with congenital muscular torticollis
No full textSynopsis:Summary of: Antares JB, Jones MA, Chak NTN, Chi Y, Li H, Li M, et al. Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2025;26:178
Dear Rachelle: The Hunt for My Sister’s Killer, a conversational review
No full textDear Rachelle: The Hunt For My Sister’s Killer investigates the cold case murder of Rachelle Childs, whose body was found in beachside scrub in New South Wales, Australia, in 2001. In this conversational review, journalists and academics Caroline Graham and Kylie Stevenson reflect on the ways true crime podcasts have become a 'medium of last resort' for cold cases and the ethical complexities this creates for reporters. Through the lens of Dear Rachelle and their own podcast reporting practice, they discuss the subjective position of a true crime podcast reporter, intimacy in podcast reporting practice, the changing and sometimes blurred relationships between journalists and police in longform true crime and ethical challenges in structuring longform audio documentary.<br/
Optimising patient care, expectations and experiences: Healthcare providers’ experiences of delivering sleep medicine services within an Australian tertiary paediatric facility
Get PDFObjective: This research sought to understand the experiences of healthcare providers working at the coalface of paediatric sleep medicine in a large tertiary children’s hospital with a focus on the current service needs, challenges, and strategies.Method: This qualitative study utilised semi-structured focus groups undertaken in an Australian tertiary paediatric sleep medicine department. There were 17 participants, encompassing paediatric sleep medicine specialists, clinical nurses, sleep scientists and administrative staff. Focus group interviews were transcribed verbatim, and member checked. Thematic analysis was undertaken.Results: Three themes were identified: 1) Patient care optimisation, 2) Families’ unrealistic expectations for their child’s diagnostic testing and treatment adherence, 3) Families’ difficult experiences with diagnostic and specific sleep therapies.Conclusion: This study provides unique insights and perspectives of healthcare providers regarding the current challenges faced within the growing demand and complexity of patients accessing paediatric sleep medicine service. Despite clinicians optimising sleep medicine services, wait lists continue to grow, which in turn impact staff workload and patient care. Innovation in areas of sleep diagnostics, monitoring and therapy continue to be explored by tertiary services. Education and training for both primary healthcare providers and the public are still urgently required to optimise sleep and sleep disorders.<br/
Enhancing eco-efficiency in China’s construction industry: measurement, drivers, and policy implications using an EBM–Tobit approach
Get PDFChina’s construction industry plays a critical role in economic development but is also a major source of resource consumption, environmental degradation, and carbon emissions. Achieving sustainable growth in this sector requires robust methods to assess eco-efficiency and identify its structural determinants. This study advances the scientific assessment of construction eco-efficiency by developing an enhanced EBM model that integrates both radial and non-radial input-output characteristics, undesirable outputs such as CO2 emissions, and super-efficiency evaluation. The model was applied to 30 provinces from 2010 to 2019, demonstrating superior robustness and discriminatory power compared to traditional CCR and SBM models. To explain regional variations in eco-efficiency, a Tobit panel regression incorporating institutional, economic, industrial, and technological variables was conducted. Empirical results reveal that regional economic development, clean energy adoption, and the growth of auxiliary industries such as design and consulting significantly enhance eco-efficiency. In contrast, outdated technologies and rigid environmental regulations constrain improvements. These findings provide actionable insights for policymakers, including promoting flexible, outcome-based regulation, incentivizing technological innovation, and supporting upstream construction services to foster sustainable industry transformation. This study contributes novel scientific knowledge on measuring, explaining, and improving construction eco-efficiency by combining methodological refinement with empirical analysis. It establishes a framework.</p
Prevalence of central sensitisation associated symptoms and associations with treatment outcomes in surgical, interventional and injection-based treatment for patients with chronic spinal pain
No full textObjectives:This study aimed to assess the prevalence of symptoms potentially related to central sensitisation (CS) in patients with spinal pain and explore its association with patient-reported treatment outcomes.Methods:This study was designed as a single-centre prospective cohort study evaluating 496 patients undergoing surgical and non-surgical management for spinal pain between 2020 and 2023. Patients with symptoms lasting more than three months were assessed for symptoms associated with CS using the validated Central Sensitisation Inventory (CSI) before treatment. Treatment satisfaction was then assessed using a 5-point Likert scale. Complete data on patient demographics were available for 492 patients.Results:The prevalence of a CSI score of 40+ was 49.9%. Non-surgical patients had a higher median CSI score (42, IQR: 32–49) compared to surgical patients (34.5, IQR: 24–48) (p = 0.001). A moderate negative correlation was found between CSI scores and Likert scores (r = −0.69, p < 0.001). Multiple regression analysis showed that both treatment type and CSI scoring significantly impacted satisfaction scores (p < 0.001). Logistic regression revealed that higher CSI scores (40+) decreased treatment satisfaction (OR = 0.09) (p < 0.001). Where post-treatment patient-reported outcome scores were available, the cohort of patients with CSI⩾40 compared to the <40 cohort had a lower proportion of patients who achieved minimum clinically important difference and patient acceptable symptom state for both Neck Disability Index and Oswestry Disability Index (p < 0.05).Conclusions:Overall, high CSI scores were common in patients with chronic spinal pain and were significantly associated with treatment dissatisfaction. Higher CSI scores should be considered when selecting treatment and managing patient expectations