Andrew Searles

High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial

BACKGROUND Bronchiolitis is the most common lung infection in infants and treatment focuses on management of respiratory distress and hypoxia. High-flow warm humidified oxygen (HFWHO) is increasingly used, but has not been rigorously studied in randomised trials. We aimed to examine whether HFWHO provided enhanced respiratory support, thereby shortening time to weaning off oxygen. METHODS In this open, phase 4, randomised controlled trial, we recruited children aged less than 24 months with moderate bronchiolitis attending the emergency department of the John Hunter Hospital or the medical unit of the John Hunter Childrens Hospital in New South Wales, Australia. Patients were randomly allocated (1:1) via opaque sealed envelopes to HFWHO (maximum flow of 1 L/kg per min to a limit of 20 L/min using 1:1 air-oxygen ratio, resulting in a maximum FiO2 of 0·6) or standard therapy (cold wall oxygen 100% via infant nasal cannulae at low flow to a maximum of 2 L/min) using a block size of four and stratifying for gestational age at birth. The primary outcome was time from randomisation to last use of oxygen therapy. All randomised children were included in the primary and secondary safety analyses. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12612000685819. FINDINGS From July 16, 2012, to May 1, 2015, we randomly assigned 202 children to either HFWHO (101 children) or standard therapy (101 children). Median time to weaning was 24 h (95% CI 18-28) for standard therapy and 20 h (95% CI 17-34) for HFWHO (hazard ratio [HR] for difference in survival distributions 0·9 [95% CI 0·7-1·2]; log rank p=0·61). Fewer children experienced treatment failure on HFWHO (14 [14%]) compared with standard therapy (33 [33%]; p=0·0016); of these children, those on HFWHO were supported for longer than were those on standard therapy before treatment failure (HR 0·3; 95% CI 0·2-0·6; p<0·0001). 20 (61%) of 33 children who experienced treatment failure on standard therapy were rescued with HFWHO. 12 (12%) of children on standard therapy required transfer to the intensive care unit compared with 14 (14%) of those on HFWHO (difference -1%; 95% CI -7 to 16; p=0·41). Four adverse events occurred (oxygen desaturation and condensation inhalation in the HFWHO group, and two incidences of oxygen tubing disconnection in the standard therapy group); none resulted in withdrawal from the trial. No oxygen-related serious adverse events occurred. Secondary effectiveness outcomes are reported in the Results section. INTERPRETATION HFWHO did not significantly reduce time on oxygen compared with standard therapy, suggesting that early use of HFWHO does not modify the underlying disease process in moderately severe bronchiolitis. HFWHO might have a role as a rescue therapy to reduce the proportion of children requiring high-cost intensive care. FUNDING Hunter Childrens Research Foundation, John Hunter Hospital Charitable Trust, and the University of Newcastle Priority Research Centre GrowUpWell.

An approach to measuring and encouraging research translation and research impact

BackgroundResearch translation, particularly in the biomedical area, is often discussed but there are few methods that are routinely used to measure it or its impact. Of the impact measurement methods that are used, most aim to provide accountability – to measure and explain what was generated as a consequence of funding research. This case study reports on the development of a novel, conceptual framework that goes beyond measurement. The Framework To Assess the Impact from Translational health research, or FAIT, is a platform designed to prospectively measure and encourage research translation and research impact. A key assumption underpinning FAIT is that research translation is a prerequisite for research impact.MethodsThe research impact literature was mined to understand the range of existing frameworks and techniques employed to measure and encourage research translation and research impact. This review provided insights for the development of a FAIT prototype. A Steering Committee oversaw the project and provided the feedback that was used to refine FAIT.ResultsThe outcome of the case study was the conceptual framework, FAIT, which is based on a modified program logic model and a hybrid of three proven methodologies for measuring research impact, namely a modified Payback method, social return on investment, and case studies or narratives of the process by which research translates and generates impact.ConclusionAs funders increasingly seek to understand the return on their research investments, the routine measurement of research translation and research impact is likely to become mandatory rather than optional. Measurement of research impact on its own is insufficient. There should also be a mechanism attached to measurement that encourages research translation and impact – FAIT was designed for this task.

Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media Campaigns Implemented in New South Wales, Australia.

Public education mass media campaigns are an important intervention for influencing behaviour modifications. However, evidence on the effectiveness of such campaigns to encourage the population to reduce sun exposure is limited. This study investigates the benefits and costs of three skin cancer campaigns implemented in New South Wales from 2006–2013. This analysis uses Australian dollars (AUD) and 2010–11 as the currency and base year, respectively. Historical data on skin cancer were used to project skin cancer rates for the period 2006–2020. The expected number of skin cancer cases is derived by combining skin cancer rates, sunburn rates and relative risk of skin cancers due to sun exposure. Counterfactual estimates are based on sunburn exposure in the absence of the campaigns. Monetary values are attached to direct (treatment) and indirect (productivity) costs saved due to fewer skin cancer cases. Monetary benefits are compared with the cost of implementing the campaigns and are presented in the form of a benefit-cost ratio. Relative to the counterfactual (i.e., no campaigns) there are an estimated 13,174 fewer skin cancers and 112 averted deaths over the period 2006–2013. The net present value of these benefits is

The affordability of prescription medicines in Australia: Are copayments and safety net thresholds too high?

60.17 million and the campaign cost is

Communicating population health statistics through graphs: a randomised controlled trial of graph design interventions

15.63 million. The benefit cost ratio is 3.85, suggesting that for every

Measuring research impact in Australia’s medical research institutes: a scoping literature review of the objectives for and an assessment of the capabilities of research impact assessment frameworks

1 invested a return of

Empowering families by engaging and relating Murri way: a grounded theory study of the implementation of the Cape York Baby Basket program

3.85 is achieved. Skin cancer public education mass media campaigns are a good investment given the likely extent to which they reduce the morbidity, mortality and economic burden of skin cancer.

Workplace-based assessment for international medical graduates: at what cost?

OBJECTIVE To create and report survey-based indicators of the affordability of prescription medicines for patients in Australia. METHOD A cross-sectional study of 1502 randomly selected participants in the Hunter Region of NSW, were interviewed by telephone. MAIN OUTCOME MEASURE The self-reported financial burden of obtaining prescription medicines. RESULTS Data collection was completed with a response rate of 59.0%. Participants who had received and filled at least one prescription medicine in the previous 3 months, and eligible for analysis (n=952), were asked to self-report the level of financial burden from obtaining these medicines. Extreme and heavy financial burdens were reported by 2.1% and 6.8% of participants, respectively. A moderate level of burden was experienced by a further 19.5%. Low burden was recorded for participants who said that their prescription medicines presented either a slight burden (29.0%) or were no burden at all (42.6%). CONCLUSION A substantial minority of participants who had obtained prescription medicines in the 3 months prior to survey experienced a level of financial burden from the cost of these medicines that was reported as being moderate to extreme.

General practitioner referral patterns for women with gynaecological symptoms: a randomised incomplete block study design

BackgroundAustralian epidemiologists have recognised that lay readers have difficulty understanding statistical graphs in reports on population health. This study aimed to provide evidence for graph design improvements that increase comprehension by non-experts.MethodsThis was a double-blind, randomised, controlled trial of graph-design interventions, conducted as a postal survey. Control and intervention participants were randomly selected from telephone directories of health system employees. Eligible participants were on duty at the listed location during the study period. Controls received a booklet of 12 graphs from original publications, and intervention participants received a booklet of the same graphs with design modifications. A questionnaire with 39 interpretation tasks was included with the booklet. Interventions were assessed using the ratio of the prevalence of correct responses given by the intervention group to those given by the control group for each task.ResultsThe response rate from 543 eligible participants (261 intervention and 282 control) was 67%. The prevalence of correct answers in the control group ranged from 13% for a task requiring knowledge of an acronym to 97% for a task identifying the largest category in a pie chart. Interventions producing the greatest improvement in comprehension were: changing a pie chart to a bar graph (3.6-fold increase in correct point reading), changing the y axis of a graph so that the upward direction represented an increase (2.9-fold increase in correct judgement of trend direction), a footnote to explain an acronym (2.5-fold increase in knowledge of the acronym), and matching the y axis range of two adjacent graphs (two-fold increase in correct comparison of the relative difference in prevalence between two population subgroups).ConclusionProfound population health messages can be lost through use of overly technical language and unfamiliar statistical measures. In our study, most participants did not understand age standardisation and confidence intervals. Inventive approaches are required to address this problem.

A randomised controlled trial of an online menu planning intervention to improve childcare service adherence to dietary guidelines: a study protocol

BackgroundRealising the economic potential of research institutions, including medical research institutes, represents a policy imperative for many Organisation for Economic Co-operation and Development nations. The assessment of research impact has consequently drawn increasing attention. Research impact assessment frameworks (RIAFs) provide a structure to assess research translation, but minimal research has examined whether alternative RIAFs realise the intended policy outcomes. This paper examines the objectives presented for RIAFs in light of economic imperatives to justify ongoing support for health and medical research investment, leverage productivity via commercialisation and outcome–efficiency gains in health systems, and ensure that translation and impact considerations are embedded into the research process.This paper sought to list the stated objectives for RIAFs, to identify existing frameworks and to evaluate whether the identified frameworks possessed the capabilities necessary to address the specified objectives.MethodsA scoping review of the literature to identify objectives specified for RIAFs, inform upon descriptive criteria for each objective and identify existing RIAFs. Criteria were derived for each objective. The capability for the existing RIAFs to realise the alternative objectives was evaluated based upon these criteria.ResultsThe collated objectives for RIAFs included accountability (top-down), transparency/accountability (bottom-up), advocacy, steering, value for money, management/learning and feedback/allocation, prospective orientation, and speed of translation. Of the 25 RIAFs identified, most satisfied objectives such as accountability and advocacy, which are largely sufficient for the first economic imperative to justify research investment. The frameworks primarily designed to optimise the speed of translation or enable the prospective orientation of research possessed qualities most likely to optimise the productive outcomes from research. However, the results show that few frameworks met the criteria for these objectives.ConclusionIt is imperative that the objective(s) for an assessment framework are explicit and that RIAFs are designed to realise these objectives. If the objectives include the capability to pro-actively drive productive research impacts, the potential for prospective orientation and a focus upon the speed of translation merits prioritisation. Frameworks designed to optimise research translation and impact, rather than simply assess impact, offer greater promise to contribute to the economic imperatives compelling their implementation.