1,721,285 research outputs found
Judgment, resources, and complexity: a qualitative study of the experiences of systematic reviewers of health promotion
No full textSystematic reviews play an increasingly important role in decision making in health promotion and public health. However, little has been published on how systematic reviewers acquire necessary knowledge and skills, and on the challenges they face in producing reviews. Semistructured interviews were conducted with a purposive sample of 17 systematic reviewers of health promotion. They described practice, training, and mentoring as being key ways that they learned reviewing skills, often in combination. Practice-based learning was considered to be particularly beneficial. Training was generally easy to access, though questions were raised about the feasibility of training stakeholders such as health professionals to become reviewers. It was suggested that an understanding of research methods is beneficial for novice reviewers. While funding opportunities for doing reviews are available, long-term investment is needed to support an infrastructure for the production of high-quality systematic reviews of important health promotion priorities
An investigation into effective peer-led HIV prevention and sexual health promotion with young gay and bisexual men
No full textPegylated and non-pegylated interferon-alfa and ribavirin for the treatment of mild chronic hepatitis C: A systematic review and meta-analysis
No full textObjectives: traditionally, patients with chronic hepatitis C virus (HCV) infection have not received treatment until their infection reaches the moderate to severe stage. The aim of this systematic review was to assess the clinical effectiveness of pegylated (PEG) and non-pegylated interferon (IFN) alfa and ribavirin (RBV) for the treatment of adults with histologically mild HCV.Methods: we performed a sensitive search of fourteen electronic bibliographic databases for literature that met criteria defined in a research protocol. Two reviewers independently selected studies, extracted data and assessed methodological quality.Results: ten randomized, controlled trials (RCTs) were included. Treatment with PEG + RBV combination therapy resulted in significantly higher sustained virological response (SVR) rates than treatment with IFN + RBV combination therapy. Treatment for 48 weeks with PEG + RBV was significantly more effective than the same treatment for 24 weeks. Significantly higher SVR rates were seen with IFN + RBV compared with either IFN monotherapy or no treatment. In the meta-analysis (four IFN trials), the relative risk of not experiencing an SVR was 0.59 (95 percent CI, 0.51 – 0.69) and was statistically significant (p < .00001). SVRs were higher for patients with genotype non-1 compared with genotype 1 for both PEG + RBV and IFN + RBV treatments.Conclusions: patients with histologically mild HCV can be successfully treated with both PEG and IFN combination therapy, and response rates are broadly comparable with those achieved in patients with advanced disease. Treating patients in the early milder stages of HCV is, therefore, a clinically effective option<br/
A systematic review of the cost-effectiveness of peginterferon alfa-2b in the treatment of chronic hepatitis C
No full textA systematic review was conducted of the full economic evaluations of the cost-effectiveness of peginterferon alfa-2b (PEG-IFN alfa-2b) plus ribavirin (RBV) in the treatment of chronic hepatitis C (CHC). A total of 439 references were screened and 11 studies were included. The studies employed decision analytic Markov models in which hypothetical cohorts of patients progressed through a series of health states characteristic of the natural history of CHC. The studies analyzed various regimens of PEG-IFN alfa-2b plus RBV including stopping rules for different genotypes, and fixed or weight-based dosing of RBV. In all studies, PEG-IFN alfa-2b plus RBV was associated with favorable incremental cost-effectiveness ratios (ICERs) when compared with IFN plus RBV. Tailored treatment according to bodyweight dosing and circumscribed treatment for different genotypes improves ICERs further. Further cost-effectiveness analyses should consider the impact of antiviral treatment in subgroups of patients including those co-infected with HIV, hemophiliacs and patients who are retreated following previous treatment failure, where data are available
Information on ethnic minorities and demographic data from asthma clinical trials does not reach the public domain: evidence from a systematic review and implications for tackling health disparities
No full textAssessing quality in systematic reviews of the effectiveness of health promotion: areas of consensus and dissension
No full textSystematic reviews have played an increasingly important role in health promotion in recentyears. Yet there are debates about how they should be conducted, particularly about how thequality of evidence should be assessed. The aim of this research was to assess currentapproaches to, and general views on, the use of quality assessment in systematic reviews ofeffectiveness in health promotion, and to identify areas of consensus and dissension around thechoice of techniques, methods and criteria employed.There were two stages of data collection. The first was a structured mapping of a randomsample of 30 systematic reviews of the effectiveness of health promotion to identify and explaintrends and themes in methods and approaches to quality assessment. During the second stagesemi-structured interviews were conducted with a purposive sample of 17 systematic reviewerswho had conducted at least one review of a health promotion topic, to investigate some of thesetrends and approaches in greater detail.The mapping found that the majority of systematic reviews had assessed the quality of theincluded studies, to varying degrees. However, procedures were not always explicitly reportedor consistent. There was some degree of consensus over criteria, with experimental evaluationmethods commonly favoured. Most frequently used quality assessment criteria includedparticipant attrition, the validity and reliability of data collection and analysis methods, andadequacy of sample sizes. External validity was commonly assessed, primarily in terms ofgeneralisability and replicability, but less so in terms of intervention quality.The interviews revealed some of the barriers to effective systematic reviewing, including: lackof time and resources, complexity of some health promotion interventions, inclusion ofobservational evaluation designs, and poor reporting of primary studies. Systematic reviewingwas commonly done in small teams, mostly comprising academics, sometimes withpractitioners. Interviewees learned systematic review skills through a combination of training,support from colleagues and mentors, literature and a strong emphasis on hands-on practicallearning. Subjective judgement was often required, contra to the popular belief that systematicreviews are wholly objective.The overall conclusions of this study are that systematic reviewing in health promotion is oftenchallenging due the complexity of interventions and evaluation designs. This places additionaldemands on reviewers in terms of knowledge and skills required, often exacerbated by finitetime scales and limited funding. Initiatives are in place to foster shared ways of working,although the extent to which complete consensus is achievable in a multi- disciplinary area suchas health promotion is questionable
An economic evaluation of school-based skills building behavioural interventions of preventing sexually transmitted infections in young people
No full textPatient-reported outcomes in clinical trials of inhaled asthma medications: systematic review and research needs
No full textNumerous validated PRO instruments are available but it is unclear why few are used in asthma clinical trials. Problems include poor reporting, and uncritical analysis and interpretation of PRO scores. Research needs include identifying and recommending a set of PROs for use in asthma clinical research and providing guidance for researchers on the application, analysis and interpretation of PRO measures in clinical trials
Darolutamide with androgen deprivation therapy for treating hormone sensitive metastatic prostate cancer: a cost-comparison technology appraisal
No full textThis report is a critique of the company’s submission (CS) to NICE from Bayer ondarolutamide with androgen deprivation therapy (ADT) for treating hormone sensitive metastatic prostate cancer (mHSPC). It identifies the strengths and weakness of the CS
Enfortumab vedotin with pembrolizumab for first-line treatment of unresectable or metastatic urothelial cancer who are eligible for platinum-containing chemotherapy [ID6332]: a single technology appraisal
No full textThis report is a critique of the company’s submission (CS) to NICE from Astellas Pharma Ltd on the clinical effectiveness and cost effectiveness of enfortumab vedotin with pembrolizumab for the first-line treatment of adult patients with unresectable or metastatic urothelial cancer who are eligible for platinum-containing chemotherapy. It identifies the strengths and weaknesses of the CS
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