Different Aspects Of Health Care Research Articles

3.Y.1. Genomics in EU Health Systems: Navigating the Opportunities and Challenges for Personalized Health

Abstract The rapid advancements in genomics research offer significant promise for revolutionizing healthcare, potentially reshaping how we approach disease prevention, diagnosis, and treatment. However, unlocking the full potential of genomics requires more than just scientific breakthroughs-it necessitates translating these discoveries into clinical practice. This involves bridging the gap between research and healthcare implementation, addressing challenges such as technical infrastructure, ethical and legal frameworks, healthcare professional competencies, and citizen engagement. As we navigate the evolving landscape of individualized patient care, it becomes increasingly crucial to implement effective risk stratification methodologies and personalized preventive measures. Among these methodologies, polygenic risk scores are gaining prominence. However, the adoption of these innovations necessitates careful consideration of their clinical utility, including their feasibility, cost-effectiveness, and acceptability in diverse healthcare settings. Validating these approaches from multiple perspectives is essential to ensure their effectiveness in real-world clinical practice. Integrating genomic sequencing data with health records presents an invaluable resource that can enhance patient outcomes and drive further research. The creation of infrastructures and initiatives such as those carried out by projects like the European Health Data Space and Genomic Data Infrastructure are fundamental to unleash the enormous potential of data-driven innovation. To date, the implementation of genomics in medical practice varies across European countries, with discrepancies in adoption levels across different aspects of healthcare, including prevention, diagnosis, and personalized treatment. Addressing these disparities and promoting standardized approaches to genomic medicine implementation are crucial steps toward ensuring equitable access and maximizing the benefits of genomics for all individuals across Europe. This workshop aims to provide decision-makers, healthcare professionals and researchers with a comprehensive overview of the state-of-the-art for the adoption of personalized approaches, and of the maturity of genomic medicine practices within different healthcare systems as well outlining the benefits of data accessibility for research. The speakers are coordinators and partners of EU projects as B1MG (Beyond One Million Genomes), Prophet (A PeRsOnalized Prevention roadmap for the future Healthcare), EHDS (European Health Data Space), GDI (European Genomic Data Infrastructure), GoE (Genome of Europe) and CanHeal. Key messages • Genomics has the potential to improve health outcomes. • Equal access to genomic medicine critical for personalized health. Ensuring equity, while considering feasibility.

Pharmacist knowledge, attitude, and practice regarding pharmacy code of practice and ethics in Iraq.

The Iraqi pharmacy code of practice and ethics enables pharmacists to resolve conflicts between the code and patient demands and satisfy their needs. This study evaluates pharmacists' knowledge, attitude, and practice toward the pharmacy code of practice and ethics. This cross-sectional study was conducted in three different provenances (Baghdad, Al-Diwaniya, and Wasit) from October 1st to December 31st, 2022. Among 202 Iraqi pharmacists, the mean age was (30.4 ± 6.8) years old, and about (59%) of the participants were aware of the Iraqi Code of Practice and Ethics; similar results were found regarding their practice. About two-thirds of the participants agreed that modifying the Iraqi Pharmacy Code of Practice and Ethics will enable pharmacists to resolve the conflict between the code and patient demands, satisfy their needs, and raise healthcare standards. More than two-thirds of the participants thought that they don't need training courses to give vaccines for addiction, smoking cessation, obesity, or sleeping problems. According to the study, more than half of the Iraqi pharmacists exhibited good knowledge, attitude, and practice regarding the pharmacy code of practice and ethics. However, it is recommended that Iraqi pharmacists engage in comprehensive training programs covering different aspects of healthcare, such as vaccination and smoking cessation, to further improve their contribution to the healthcare system.

Endophytic fungi as a potential source of anti-cancer drug.

Endophytes are considered one of the major sources of bioactive compounds used in different aspects of health care including cancer treatment. When colonized, they either synthesize these bioactive compounds as a part of their secondary metabolite production or augment the host plant machinery in synthesising such bioactive compounds. Hence, the study of endophytes has drawn the attention of the scientific community in the last few decades. Among the endophytes, endophytic fungi constitute a major portion of endophytic microbiota. This review deals with a plethora of anti-cancer compounds derived from endophytic fungi, highlighting alkaloids, lignans, terpenes, polyketides, polyphenols, quinones, xanthenes, tetralones, peptides, and spirobisnaphthalenes. Further, this review emphasizes modern methodologies, particularly omics-based techniques, asymmetric dihydroxylation, and biotic elicitors, showcasing the dynamic and evolving landscape of research in this field and describing the potential of endophytic fungi as a source of anticancer drugs in the future.

Defining a Preprocessing Pipeline for the MULTI-SITA Project and General Medical Italian Natural Language Data.

The application of Natural Language Processing (NLP) to medical data has revolutionized different aspects of health care. The benefits obtained from the implementation of this technique spill over into several areas, including in the implementation of chatbots, which can provide medical assistance remotely. Every possible application of NLP depends on one first main step: the pre-processing of the corpus retrieved. The raw data must be prepared with the aim to be used efficiently for further analysis. Considerable progress has been made in this direction for the English language but for other languages, such as Italian, the state of the art is not equivalently advanced, especially for texts containing technical medical terms. The aim of this work is to identify and develop a preprocessing pipeline suitable for medical data written in Italian. The pipeline has been developed in Python environment, employing Enchant, ntlk modules and Hugging Face's BERT and BART-based models. Then, it has been tested on real conversations typed between patients and physicians regarding medical questions. The algorithm has been developed within the MULTI-SITA project of the Italian Society of Anti-Infective Therapy (SITA), but shows a flexible structure that can adapt to a large variety of data.

Care Robotics: An Assessment of Professional Perception in the Face of the COVID-19 Pandemic

The COVID-19 crisis accelerated the adoption of technologies. Technological advancement is also expected in robotics applied to any sector, including in healthcare. The aim is to assess the professional perception of care robotics facing COVID-19. This study aimed to (1) select a tool for assessing different aspects of healthcare, (2) analyse the professional perception about the development, usefulness and helpfulness of technologies and robotics in the field of healthcare and (3) evaluate the correlation between the perceived helpfulness of care robotics and the selected tool. We implement five validated clinical tests which integrate 80 items about a person and their clinical situation. From the sample of 46 professionals, 95.65% affirmed that technology was moderately to completely useful for professional performance in the context of the pandemic, lowering to 67.39% when asked only about robotics; 93.48% stated that the inclusion of robotics in at least one health area affected by COVID-19 would have helped them. Finally, the variables extracted from clinical tests corresponded to the most relevant health areas as identified by the professionals. This research shows the potential of care robotics oriented towards healthcare from a care paradigm.

Synthetic data in health care: A narrative review.

Data are central to research, public health, and in developing health information technology (IT) systems. Nevertheless, access to most data in health care is tightly controlled, which may limit innovation, development, and efficient implementation of new research, products, services, or systems. Using synthetic data is one of the many innovative ways that can allow organizations to share datasets with broader users. However, only a limited set of literature is available that explores its potentials and applications in health care. In this review paper, we examined existing literature to bridge the gap and highlight the utility of synthetic data in health care. We searched PubMed, Scopus, and Google Scholar to identify peer-reviewed articles, conference papers, reports, and thesis/dissertations articles related to the generation and use of synthetic datasets in health care. The review identified seven use cases of synthetic data in health care: a) simulation and prediction research, b) hypothesis, methods, and algorithm testing, c) epidemiology/public health research, d) health IT development, e) education and training, f) public release of datasets, and g) linking data. The review also identified readily and publicly accessible health care datasets, databases, and sandboxes containing synthetic data with varying degrees of utility for research, education, and software development. The review provided evidence that synthetic data are helpful in different aspects of health care and research. While the original real data remains the preferred choice, synthetic data hold possibilities in bridging data access gaps in research and evidence-based policymaking.

Impact of COVID-19 on Ophthalmic Pathology

The Coronavirus disease-19 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) remains a significant concern to the public and a major challenge to healthcare workers. Although vaccination programs are generally regarded as successful, recent reports have shown that vaccine effectiveness is decreasing gradually, particularly as booster uptakes are low. The next pandemic is unpredictable and inevitable. Therefore, understanding the impact of COVID-19 on different aspects of healthcare will aid in adaptation to life with pandemics and enable prioritization of medical treatment. The SARS-CoV-2 outbreak significantly changed all sectors of healthcare. Ocular oncology and pathology practices were adapted to adjust to the many new challenges the COVID-19 pandemic presented. This review highlights laboratory modifications and shows how the number, type, and histology of eye oncology cases were impacted during the pandemic.

"Context, content, and system" supporting digital health hub (DHH)-enabled models of care (MoCs) for fragility hip fractures: perspectives of diverse multidisciplinary stakeholders in South Australia from qualitative in-depth interviews.

SummaryCombining thematic analysis and a human–computer persuasive systems framework suggests that hip fracture recovery among older people can be enhanced through person-centered digital health hub models of care focused on behavior change education and integrated care. The findings intend to guide settings involving comorbid conditions and low- and middle-income countries in developing innovative digital health solutions.PurposeThe purpose of this study was to understand stakeholders’ perspectives on the development of a digital health-enabled model of care for fragility hip fractures and to map out factors that could influence the design and implementation of such a model.MethodsQualitative in-depth interviews were conducted with stakeholders from various clinical disciplines, allied health, and computer science. A hybrid process involving thematic analysis of the raw data using inductive coding was the first step. In the second step, the tenets of a theoretical framework (health behavior change supporting systems) were deductively applied to the thematic constructs generated as part of the first step of the analysis.ResultsIn total, 24 in-depth interviews were conducted with stakeholders. We identified 18 thematic constructs presented under the categories of context, content, and system. Context covered patient characteristics such as frailty, digital literacy, and patient or carer participation, whereas healthcare delivery aspects included the structure and culture of existing practice and the need for innovative holistic models of care. Content outlines the active ingredients and approach in developing a digital health hub, and it highlights the importance of targeted education and behavior change. The system is a complicated matrix crossing different aspects of healthcare and offering a value proposition design through personalization across modes of content delivery. This must foster trust, ensure adequate financing, and support ownership and privacy by establishing appropriate mechanisms for embedding change.ConclusionThe findings from this study provide insights around potential factors related to patients, community support, and healthcare delivery influencing the design and next-stage implementation of a digital health hub model of care for fragility hip fractures.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11657-021-01031-3.

Detecting Topic and Sentiment Trends in Physician Rating Websites: Analysis of Online Reviews Using 3-Wave Datasets.

(1) Background: Physician rating websites (PRWs) are a rich resource of information where individuals learn other people response to various health problems. The current study aims to investigate and analyze the people top concerns and sentiment dynamics expressed in physician online reviews (PORs). (2) Methods: Text data were collected from four U.S.-based PRWs during the three time periods of 2018, 2019 and 2020. Based on the dynamic topic modeling, hot topics related to different aspects of healthcare were identified. Following the hybrid approach of aspect-based sentiment analysis, the social network of prevailing topics was also analyzed whether people expressed positive, neutral or negative sentiments in PORs. (3) Results: The study identified 30 dominant topics across three different stages which lead toward four key findings. First, topics discussed in Stage III were quite different from the earlier two stages due to the COVID-19 outbreak. Second, based on the keyword co-occurrence analysis, the most prevalent keywords in all three stages were related to the treatment, questions asked by patients, communication problem, patients’ feelings toward the hospital environment, disease symptoms, time spend with patients and different issues related to the COVID-19 (i.e., pneumonia, death, spread and cases). Third, topics related to the provider service quality, hospital servicescape and treatment cost were the most dominant topics in Stages I and II, while the quality of online information regarding COVID-19 and government countermeasures were the most dominant topics in Stage III. Fourth, when zooming into the topic-based sentiments analysis, hot topics in Stage I were mostly positive (joy be the dominant emotion), then negative (disgust be the dominant emotion) in Stage II. Furthermore, sentiments in the initial period of Stage III (COVID-19) were negative (anger be the dominant emotion), then transformed into positive (trust be the dominant emotion) later. The findings also revealed that the proposed method outperformed the conventional machine learning models in analyzing topic and sentiment dynamics expressed in PRWs. (4) Conclusions: Methodologically, this research demonstrates the ability and importance of computational techniques for analyzing large corpora of text and complementing conventional social science approaches.

Impact of COVID-19 pandemic on the pediatric services of a tertiary care hospital in North India: A retrospective review

Background: The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected the world at large. To control the spread of the virus, the Government of India promoted simple measures such as social distancing and hand hygiene. Yet, the most prominent one was a strict nationwide lockdown on all non-essential services and complete curtailment of the public transport. Objective: Our study aims to quantify the impact of COVID-19 pandemic and lockdown measures on the pediatric services of a tertiary care center in North India. Materials and Methods: A retrospective observational study was done to analyze the change in our outpatient visits, admissions, and number of institutional deliveries, immunization services, pediatric surgeries, and mortality rates during the lockdown period when compared to the pre-lockdown period. Data of all children aged 0–12 years who presented to the pediatric medicine and pediatric surgery departments were collected. Data were divided into two groups; January 1, 2020–March 31, 2020 and April 1, 2020–June 30, 2020. Results: There was a reduction of 79.1% OPD attendance and 70.8% in immunization visits. Inpatient admission in pediatrics medicine and surgery decreased by 59.8% and 67.6%, respectively. The mortality rate increased from 11.8% to 13% and 7.6% to 19.6%, respectively. Emergency area visits decreased by 55.3% with an increase in mortality rate from 2.4% to 6.2%. Intramural births decreased by 55.4%. Conclusion: The COVID-19 pandemic has led to an unmet need of pediatric services. This requires urgent management or else it may halt the progress made in different aspects of health care.

The evaluation of nursing students by patients instrument (ENSPA): Development and validation

BackgroundPatient participation is increasingly used in different aspects of healthcare due to its positive outcomes. Still, instruments for involving patients in the evaluation of nursing students during their internship are scarce. ObjectivesTo develop and validate an instrument that enables patients to evaluate nursing students during their internship. Design and methodsA 3-phased validation process was conducted: (1) development of an instrument through literature and patient interviews; (2) content and response process validation by use of cognitive interviews and pilot-testing; (3) testing construct validity and reliability of the instrument which was completed by 244 hospitalized patients. Settings and participantsPatients from a variety of wards in a general hospital were recruited for the different phases. In phase 1, 17 interviews and 47 thought shower sessions with patients were performed. In phase 2, 9 cognitive interviews and pilot testing by 4 patients evaluating actual nursing students were used to refine the instrument. In phase 3, 380 patients were eligible to participate. Of these patients, 317 completed the instrument. A sample of 244 completed instruments was useful to perform the psychometric analyses. To assess the test-retest reliability, 50 patients completed the instrument twice with a 4 hour time interval. ResultsThe 19-item Evaluation of Nursing Students by Patients instrument (ENSPa) is designed. The ENSPa-instrument comprises 7 items that assess whether the patient can place trust in the student, 5 items evaluating person-oriented skills, 4 items appraising caring and 3 items to grade the integrity and honesty of the nursing students. Each item is scored both for importance and rating. The instrument shows high reliability and consistency ratings. ConclusionsThe ENSPa-instrument is a valuable instrument for collecting data on the performance and skills of nursing students during their internship from the patient's perspective. By receiving structured feedback from patients, important learning opportunities are created for nursing students.

Integrated Diabetic Clinic in a Rural Hospital of Nepal

Diabetes is an important public health concern which is increasing rapidly in developing countries. It is challenging to prevent and manage diabetes in a rural setting. The Integrated Diabetic Clinic is comprehensive diabetes care under one roof. Its aim is to provide efficient accessible and affordable comprehensive care. It will make a huge difference in the management of diabetes. This clinic will play a major role in unifying different aspects of health care under one roof and offer the most comprehensive and cost-effective accessible health care to minimize mortality and morbidity associated with diabetes.

Exploring pathways to outpatients\u2019 satisfaction with health care in Chinese public hospitals in urban and rural areas using patient-reported experiences

BackgroundThis study aimed to measure outpatients’ general satisfaction with and experiences of different aspects of health care in Chinese public hospitals and to investigate to what extent general satisfaction could be explained by patients’ experiences in public hospitals located at urban and rural areas.MethodsData on 4782 outpatients were derived from a patient survey in 9 city-level (urban) and 16 county-level (rural) public hospitals across China in 2016. According to Donabedian’s model, questions on patients’ experiences were categorized into six aspects under “structure” and “process”, with general satisfaction representing “outcome”. The Chi-square tests were used to test the differences in patients’ experiences and general satisfaction between urban and rural areas. The Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to estimate effects of patients’ experiences on general satisfaction.ResultsCompared with respondents in rural areas, there were significantly higher percentages of respondents in urban areas reporting satisfaction and positive experiences in most aspects. As manifested by the path coefficients in PLS models, the positive effect of professional competence (0.197) on general satisfaction was the most significant in respondents at urban areas, followed by communication and information (0.183), and caring attitudes and emotional support (0.174). Among respondents at rural areas, the positive effect of environment facilities (0.199) was the most significant, followed by caring attitudes and emotional support (0.188), and professional competence (0.179). The PLS models explained 44.9 and 46.0% of variations in patient satisfaction at urban and rural areas, respectively.ConclusionsLevels of patient satisfaction and experiences at Chinese public hospitals were higher in urban than in rural areas. Outpatients’ experiences of professional competence, caring attitudes and emotional support were strongly related to their satisfaction in both settings. However, among respondents in urban areas, experiences of communication and information were more strongly related to satisfaction, whereas among respondents in rural areas, experiences of environment and facilities were more strongly related to satisfaction.

From childhood to adulthood: health care use in individuals with cerebral palsy.

To analyse the health care usage of individuals with cerebral palsy (CP) as a function of age and ambulatory status. In total, 970 self-administered questionnaires relating to health care usage were sent, via a clinical network of professionals and institutions, to children and adults with CP in Brittany, France. Frequency of use of different aspects of health care were analysed as a function of age and ambulatory status. Multivariate logistic regression evaluated differences in the frequency of each health care type with age; the transition from childhood to adulthood was specifically analysed. The response rate was 53% (282 adults, 230 children). Use of medication (particularly psychotropic and analgesic) increased with age, while physical-types of health care (rehabilitation, physical medicine and rehabilitation follow-up, and equipment) decreased with age, independently of ambulatory status. Use of other treatments, such as botulinum toxin injections, was not influenced by age. The provision of rehabilitation was particularly affected by the period of transition. Although health care needs change naturally in adulthood, the large decrease in usage of specific types of rehabilitation after the transition to adulthood suggested individuals had difficulty accessing this type of health care after childhood. These results provide objectives for the development of patient-centred, transitional consultations, and longitudinal studies. Use of medication, particularly psychotropic and analgesic drugs, increased with age in individuals with cerebral palsy. Use of orthoses, physical medicine and rehabilitation physician follow-up, and rehabilitation decreased with age. Transition from childhood to adulthood involved significant changes in health care usage.

Harnessing and supporting consumer involvement in the development and implementation of Models of Care for musculoskeletal health.

Consumer involvement in the design and delivery of their healthcare is an integral strategy to ensure that health services and systems meet consumers' needs. This is also true for the design and delivery of Models of Care. This chapter presents the identified healthcare needs of people with musculoskeletal conditions and focuses on the current systematic review evidence for consumer involvement interventions in musculoskeletal Models of Care across the micro, meso and macro levels of healthcare. Thischapter also presents three case studies of consumer involvement in different aspects of healthcare, offers a series of practice points to help translate the systematic review evidence into practice, and also provides direction to available resources, which support the implementation of consumer involvement within Models of Care.

Understanding persuasion contexts in health gamification: A systematic analysis of gamified health behavior change support systems literature

BackgroundGamification is increasingly used as a design strategy when developing behavior change support systems in the healthcare domain. It is commonly agreed that understanding the contextual factors is critical for successful gamification, but systematic analyses of the persuasive contexts have been lacking so far within gamified health intervention studies. Objectives and methodsThrough a persuasion context analysis of the gamified health behavior change support systems (hBCSSs) literature, we inspect how the contextual factors have been addressed in the prior gamified health BCSS studies. The implications of this study are to provide the practitioners and researchers examples of how to conduct a systematic analysis to help guide the design and research on gamified health BCSSs. The ideas derived from the analysis of the included studies will help identify potential pitfalls and shortcomings in both the research and implementations of gamified health behavior change support systems. ResultsWe systematically analyzed the persuasion contexts of 15 gamified health intervention studies. According to our results, gamified hBCSSs are implemented under different facets of lifestyle change and treatments compliance, and use a multitude of technologies and methods. We present a set of ideas and concepts to help improve endeavors in studying gamified health intervention through comprehensive understanding of the persuasive contextual factors. ConclusionsFuture research on gamified hBCSSs should systematically compare the different combinations of contextual factors, related theories, chosen gamification strategies, and the study of outcomes to help understand how to achieve the most efficient use of gamification on the different aspects of healthcare. Analyzing the persuasion context is essential to achieve this. With the attained knowledge, those planning health interventions can choose the ‘tried-and-tested’ approaches for each particular situation, rather than develop solutions in an ad-hoc manner.

A cross-sectional study on patient satisfaction in an Urban Health Care Centre of Siliguri Municipal Corporation, Darjeeling, West Bengal

Background: Patient satisfaction can be explored which may draw attention of the health care providers, administrators, and health policy makers, in order to monitor the performance, determine patients' needs, plan the development of services, and provide evidence to support the applications for financial support and expenditure. Aims and Objectives: To assess the level of satisfaction of patients regarding the different aspects of health care in an Urban Health Care Centre of Siliguri Municipal Corporation, Darjeeling, West Bengal and to identify the reasons of dissatisfaction among patients in that urban health care center. Materials and Methods: A cross-sectional survey on 102 patients with a Patient Satisfaction Questionnaire-18 was done. Systematic random sampling was adopted to draw samples. Results: Overall satisfaction was 73.1% with a mean value of 3.655. Highest satisfaction was in general satisfaction, and the lowest was in time spent with doctors Conclusion: Mean score and percentage of the patient satisfaction was high in that Urban Health Centre. Only matter of concern was time spent with the doctor. Doctor's time, lack of facility and poor quality of services were the major reasons for dissatisfaction among a few dissatisfied patients.

Inpatients' awareness of admission reasons and management plans of their clinical conditions at a tertiary hospital in South Africa.

BackgroundInpatient awareness of the reason for their admission and the planned management enhances patient compliance and empowers patients to be resourceful in subsequent consultations. The objective of this study was to determine patients’ awareness of their clinical conditions while admitted to an academic hospital.MethodsA survey was conducted at Dr George Mukhari Academic Hospital in Pretoria, from 6 to 17 December 2010, on 264 inpatients drawn from a population of 837 through a systematic sampling method. Data on inpatient awareness were collected using a researcher-administered questionnaire, which was available in English, as well as isiZulu and Setswana. Components of patients’ global awareness were clinical diagnosis, necessity for admission, planned management, possible condition cause(s), duration of admission, and planned investigations, operations and procedures. We conducted regression analysis on possible predictors of global awareness: age, marital status, occupation and educational level. The SAS (Release 9.2) was used for data analysis.ResultsOne hundred and thirty-six inpatients (51.5%) had global awareness of their clinical conditions and management plans. High degrees of awareness were reported on clinical diagnosis 206 (78.0%), reason for admission 203 (76.9%), planned management 206 (78.0%), and current medication 222 (84.1%). Fifty (18.9%) respondents were aware of their estimated admission duration. Patients who were informed of admission duration were likely to be informed of their planned management (p < 0.01). When health care practitioners did not volunteer information, most respondents (>69%) did not seek information. When information was provided, the majority of respondents (>70%) reported understanding the information. The proportion of patients who acknowledged the shared responsibility by the health care practitioner and the patient to raise awareness among the inpatients was significantly more than those who did not (p = 0.03). Patients’ age, marital status, occupation and educational level were not predictors of global awareness (p > 0.05).ConclusionsThe proportions of respondents who were aware of the different aspects of health care ranged from 18.9% to 84.1%. About half of respondents had global awareness of their admission reasons and management plans. Raising awareness of patients’ clinical conditions should be part of the health care practitioner-patient encounter.

Risk as an Attribute in Discrete Choice Experiments: A Systematic Review of the Literature

Discrete choice experiments (DCEs) are used to elicit preferences of current and future patients and healthcare professionals about how they value different aspects of healthcare. Risk is an integral part of most healthcare decisions. Despite the use of risk attributes in DCEs consistently being highlighted as an area for further research, current methods of incorporating risk attributes in DCEs have not been reviewed explicitly. This study aimed to systematically identify published healthcare DCEs that incorporated a risk attribute, summarise and appraise methods used to present and analyse risk attributes, and recommend best practice regarding including, analysing and transparently reporting the methodology supporting risk attributes in future DCEs. The Web of Science, MEDLINE, EMBASE, PsycINFO and Econlit databases were searched on 18 April 2013 for DCEs that included a risk attribute published since 1995, and on 23 April 2013 to identify studies assessing risk communication in the general (non-DCE) health literature. Healthcare-related DCEs with a risk attribute mentioned or suggested in the title/abstract were obtained and retained in the final review if a risk attribute meeting our definition was included. Extracted data were tabulated and critically appraised to summarise the quality of reporting, and the format, presentation and interpretation of the risk attribute were summarised. This review identified 117 healthcare DCEs that incorporated at least one risk attribute. Whilst there was some evidence of good practice incorporated into the presentation of risk attributes, little evidence was found that developing methods and recommendations from other disciplines about effective methods and validation of risk communication were systematically applied to DCEs. In general, the reviewed DCE studies did not thoroughly report the methodology supporting the explanation of risk in training materials, the impact of framing risk, or exploring the validity of risk communication. The primary limitation of this review was that the methods underlying presentation, format and analysis of risk attributes could only be appraised to the extent that they were reported. Improvements in reporting and transparency of risk presentation from conception to the analysis of DCEs are needed. To define best practice, further research is needed to test how the process of communicating risk affects the way in which people value risk attributes in DCEs.

The role of mathematical modelling in the development of recommendations in the 2013 WHO consolidated antiretroviral therapy guidelines.

Despite the exponential growth in the literature on modelling and simulation studies of impact and cost-effectiveness in different aspects of healthcare, there is no clear consensus on the appropriate role of modelling in the development of recommendations in clinical guidelines. This is compounded both by the lack of a standardised approach to assess the quality of modelling, and lack of clarity on its positioning within the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) method for decision-making in the development of WHO guidelines, that considers both evidence from systematic reviews of randomized clinical trials (RTCs) or observational studies, together with stakeholder values and preferences, resource use, and feasibility issues. In the development of the 2013 WHO Consolidated Guidelines on the use of Antiretroviral drugs for treating and preventing HIV infection, a series of modelling projects were undertaken to inform the recommendations on eligibility criteria for ART initiation, and approaches to monitoring for treatment response. We report our experiences, challenges encountered, and several key considerations to guide the future use of modelling in the development of WHO guidelines. These are: (1) Transparency in the conduct and reporting of model inputs and results; (2) The need for agreed standards for critical appraisal and use of modelling data in healthcare policy making; (3) recognition that modelling of cost-effectiveness is only one component of decision-making in development of WHO recommendations and in priority-setting; (4) The need for closer interaction and an ongoing dialogue between modellers and model end-users or decision-makers; (5) the important role of WHO in convening and facilitating comparative assessment of multiple models; and (6) The need to optimize research and data collection to inform modelling studies.