Inform Decisions Research Articles

Occupational therapy interventions for Autism Spectrum Disorders - a Rapid Review

Introduction: This rapid review aimed to synthesise evidence for occupational therapy intervention in the management of autism spectrum disorders. The review forms part of a series of rapid reviews commissioned by the Occupational Therapy Association of South Africa to help inform decision making as South Africa prepares for a new health system.
 Method: Level I and II research studies published from 2017 - 2022 were considered for inclusion. Electronic database searches were conducted on the Cochrane database. The identified records were screened in Rayyan according to inclusion and exclusion criteria. Quality assessment of the selected articles was done with the CASP appraisal tool. Data were extracted to a custom Microsoft Excel® worksheet and analysed quantitatively by percentage/frequency and qualitatively by thematic analysis of statements.
 Results: Thirty-eight records were selected. These included 30 systematic reviews and eight randomised controlled trials. Twelve intervention domains across four age groups were identified with sensory integration and social skills interventions most frequently examined. Interventions were delivered across various venues, including mediation and technology (e.g., telehealth interventions). A number of different outcome measures were used.
 Conclusion: There is evidence to support the effectiveness of occupational therapy interventions for autism spectrum disorder across the lifespan for twelve different domains.
 Implications for practice
 
 Occupational Therapists are involved in the provision of therapy intervention across all age groups for people with ASD.
 Intervention can successfully take place in a clinic setting, but also at home or through means of technology.
 There is growing evidence for sensory integration therapy or techniques when considering functional outcomes when treating people with ASD.
 There is a lack of Level I and II research in the form of randomised control trials and systematic reviews regarding ASD intervention in sub-Saharan Africa.
 

Deterioration of Performance Status during Palliative Radiotherapy Suggests a Significant Short Survival Duration: Indicating the Necessities for Considering Radiotherapy Discontinuation.

Discontinuation of palliative radiotherapy due to a patient's declining general condition poses a clinical dilemma for palliative care physicians. This study aimed to investigate the survival duration of patients whose performance status (PS) deteriorated during palliative radiotherapy and inform decisions regarding early treatment discontinuation. We retrospectively analyzed data from patients referred from our institute's palliative care department who underwent ≥10 fractions of palliative radiotherapy between March 2017 and December 2021. PS was assessed using the Eastern Cooperative Oncology Group (ECOG) scale. Survival duration was calculated from the final day of palliative radiotherapy to death using the Kaplan-Meier method. A total of 35 patients underwent palliative radiotherapy. Seven (20%) experienced deterioration in ECOG PS during treatment. Their median survival duration was significantly shorter at 22 days (95% confidence interval: 1-94 days) compared to 125 days (95% confidence interval: 82-150 days) for the 28 patients whose PS remained stable (p = 0.0007). Deterioration in ECOG PS during palliative radiotherapy signifies a markedly shorter survival duration. Careful assessment of a patient's condition throughout treatment is crucial, and early discontinuation should be considered if their general health worsens rather than strictly adhering to the initial schedule.

Examination of community-level interventions addressing early childhood obesity in Los Angeles County

ObjectiveTo help inform decisions regarding the equitable implementation of obesity interventions, we examined whether interventions were equitably reaching the most vulnerable communities, identified communities that received fewer interventions than expected, and estimated the effect of ‘dose’ of interventions on obesity prevalence. MethodsWe created a database to identify and characterize obesity-related interventions implemented in Los Angeles County from 2005 to 2015 linked to community-level sociodemographic and obesity prevalence data. We ran generalized linear models with a Gamma distribution and log link to determine if interventions were directed toward vulnerable communities and to identify communities that received fewer interventions than expected. We ran fixed-effects models to estimate the association between obesity prevalence and intervention strategy count among preschool-aged children enrolled in the Special Supplemental Nutrition Assistance Program for Women Infants and Children. ResultsWe found that interventions targeted vulnerable communities with high poverty rates and percentages of minority residents. The small cluster of communities that received fewer interventions than expected tended to have poor socioeconomic profiles. Communities which received more intervention strategies saw greater declines in obesity prevalence (β = -0.023; 95 % CI: −0.031, −0.016). ConclusionsIt is important to determine if interventions are equitably reaching vulnerable populations as resources to tackle childhood obesity become available. Evaluating the population impact of multiple interventions implemented simultaneously presents methodological challenges in measuring intervention dose and identifying cost-effective strategies. Addressing these challenges must be an important research priority as community-wide interventions involve multiple intervention strategies to reduce health disparities.

Cracking the NLRP3 code: Pioneering precision medicine for inflammation.

Precisely diagnosing and effectively treating cryopyrin-associated periodic syndrome (CAPS), an inflammatory condition linked to gain-of-function NLRP3 inflammasome mutations, poses challenges. A novel classification approach may help inform therapeutic decisions and offer valuable insights into broader inflammatory conditions (Cosson et al. J. Exp. Med. 2024. https://doi.org/10.1084/jem.20231200).

Prognostic Models for Mortality and Morbidity in Heart Failure With Preserved Ejection Fraction

Accurate risk prediction of morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF) may help clinicians risk stratify and inform care decisions. To develop and validate a novel prediction model for clinical outcomes in patients with HFpEF using routinely collected variables and to compare it with a biomarker-driven approach. Data were used from the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial to derive the prediction model, and data from the Angiotensin Receptor Neprilysin Inhibition in Heart Failure With Preserved Ejection Fraction (PARAGON-HF) and the Irbesartan in Heart Failure With Preserved Ejection Fraction Study (I-PRESERVE) trials were used to validate it. The outcomes were the composite of HF hospitalization (HFH) or cardiovascular death, cardiovascular death, and all-cause death. A total of 30 baseline candidate variables were selected in a stepwise fashion using multivariable analyses to create the models. Data were analyzed from January 2023 to June 2023. Models to estimate the 1-year and 2-year risk of cardiovascular death or hospitalization for heart failure, cardiovascular death, and all-cause death. Data from 6263 individuals in the DELIVER trial were used to derive the prediction model and data from 4796 individuals in the PARAGON-HF trial and 4128 individuals in the I-PRESERVE trial were used to validate it. The final prediction model for the composite outcome included 11 variables: N-terminal pro-brain natriuretic peptide (NT-proBNP) level, HFH within the past 6 months, creatinine level, diabetes, geographic region, HF duration, treatment with a sodium-glucose cotransporter 2 inhibitor, chronic obstructive pulmonary disease, transient ischemic attack/stroke, any previous HFH, and heart rate. This model showed good discrimination (C statistic at 1 year, 0.73; 95% CI, 0.71-0.75) in both validation cohorts (C statistic at 1 year, 0.71; 95% CI, 0.69-0.74 in PARAGON-HF and 0.75; 95% CI, 0.73-0.78 in I-PRESERVE) and calibration. The model showed similar discrimination to a biomarker-driven model including high-sensitivity cardiac troponin T and significantly better discrimination than the Meta-Analysis Global Group in Chronic (MAGGIC) risk score (C statistic at 1 year, 0.60; 95% CI, 0.58-0.63; delta C statistic, 0.13; 95% CI, 0.10-0.15; P < .001) and NT-proBNP level alone (C statistic at 1 year, 0.66; 95% CI, 0.64-0.68; delta C statistic, 0.07; 95% CI, 0.05-0.08; P < .001). Models derived for the prediction of all-cause and cardiovascular death also performed well. An online calculator was created to allow calculation of an individual's risk. In this prognostic study, a robust prediction model for clinical outcomes in HFpEF was developed and validated using routinely collected variables. The model performed better than NT-proBNP level alone. The model may help clinicians to identify high-risk patients and guide treatment decisions in HFpEF.

How Well Do Professional Reference Ratings Predict Teacher Performance?

Abstract While the practice of collecting information from applicants’ professional references is widespread, there is a paucity of research linking references’ assessments of applicants to subsequent performance. In this paper, we examine the predictive validity of a specific type of reference-provided information: categorical ratings of teacher applicants collected from their professional references—a potentially low-cost means of enhancing the applicant information available during the hiring process. We find an overall significant relationship between reference ratings and teacher performance as measured by observational evaluation ratings and teacher value added in math, but that this relationship is moderated by two factors. First, while references’ ratings of applicants with prior teaching experience are predictive of performance, those of novice applicants are not. Second, the predictive validity of reference ratings varies according to rater type: Ratings from references identified as the applicants’ Principal/Other Supervisor, Instructional Coach/Department Chair, or Colleague are significantly predictive of performance whereas those from other types of raters are not. Overall, our findings show that meaningful information can be solicited from applicants’ references in the form of categorical ratings but also demonstrate some limitations in the potential for this type of information to inform hiring decisions.

Quantifying the Cost of Shigella Diarrhea in the Enterics for Global Health (EFGH) Shigella Surveillance Study.

Comparative costs of public health interventions provide valuable data for decision making. However, the availability of comprehensive and context-specific costs is often limited. The Enterics for Global Health (EFGH) Shigella surveillance study-a facility-based diarrhea surveillance study across 7 countries-aims to generate evidence on health system and household costs associated with medically attended Shigella diarrhea in children. EFGH working groups comprising representatives from each country (Bangladesh, Kenya, Malawi, Mali, Pakistan, Peru, and The Gambia) developed the study methods. Over a 24-month surveillance period, facility-based surveys will collect data on resource use for the medical treatment of an estimated 9800 children aged 6-35 months with diarrhea. Through these surveys, we will describe and quantify medical resources used in the treatment of diarrhea (eg, medication, supplies, and provider salaries), nonmedical resources (eg, travel costs to the facility), and the amount of caregiver time lost from work to care for their sick child. To assign costs to each identified resource, we will use a combination of caregiver interviews, national medical price lists, and databases from the World Health Organization and the International Labor Organization. Our primary outcome will be the estimated cost per inpatient and outpatient episode of medically attended Shigella diarrhea treatment across countries, levels of care, and illness severity. We will conduct sensitivity and scenario analysis to determine how unit costs vary across scenarios. Results from this study will contribute to the existing body of literature on diarrhea costing and inform future policy decisions related to investments in preventive strategies for Shigella.

Dural Metastasis in Breast Cancer: MRI-Based Morphological Subtypes and Their Clinical Implications.

This study aimed to investigate the clinical factors associated with breast cancer (BRCA) dural metastases (DMs), their impact on prognosis compared to brain parenchymal metastases (BPMs) alone, and differences between DM subtypes, aiming to inform clinical decisions. We retrospectively analyzed 119 patients with BRCA with brain metastasis, including 91 patients with BPM alone and 28 patients with DM. Univariate and multivariate analyses were performed to compare the clinical characteristics between the two groups and within subtypes of DM. Overall survival after DM (OSDM) and the interval from DM to leptomeningeal carcinomatosis (LMC) were compared using Kaplan-Meier analysis. DM was notably linked with extracranial metastasis, luminal-like BRCA subtype (p=0.033), and skull metastases (p < 0.001). Multiple logistic regression revealed a strong association of DM with extracranial and skull metastases, but not with subtype or hormone receptor status. Patients with DM did not show survival differences compared with patients with BPM alone. In the subgroup analysis, nodular-type DM correlated with human epidermal growth factor receptor 2 status (p=0.044), whereas diffuse-type DM was significantly associated with a higher prevalence of the luminal-like subtype (p=0.048) and the presence of skull metastasis (p=0.002). Patients with diffuse DM did not exhibit a significant difference in OSDM but had a notably shorter interval from DM to LMC compared to those with nodular DM (p=0.049). While the impact of DM on the overall prognosis of patients with BRCA is minimal, our findings underscore distinct characteristics and prognostic outcomes within DM subgroups.

The Anatomy of a Drought in the Upper San Francisco Estuary: Water Quality and Lower-Trophic Responses to Multi-Year Droughts Over a Long-Term Record (1975-2021)

Multi-year droughts are ever-present and transformational features of California’s Mediterranean climate and can fundamentally affect the water quality and the ecosystem responses of the San Francisco Estuary (estuary) and the Sacramento-San Joaquin Delta (Delta). This study assessed data collected by long-term monitoring programs over the past 46 water years (1975-2021) to evaluate how water quality in the estuary changes during multi-year droughts. Data were aggregated by region (South-Central Delta, North Delta, Confluence, Suisun Bay, and Suisun Marsh) and season, then differences between multi-year Drought periods, multi-year Wet periods, and Neutral periods were compared using generalized linear models. We found that multi-year Drought periods altered multiple physical and chemical parameters in the estuary, increasing water temperature, salinity, water clarity, and nutrient levels. This trend was consistent across regions and seasons, with few exceptions. Increases in these parameters during Drought periods were likely caused by reduced Delta inflows that intensified in each successive dry year because of reduced precipitation and managed estuarine inflows and outflows. Drought periods did not substantially affect tidal velocities within the estuary, which remained mostly consistent across Wet and Drought periods. Trends in chlorophyll concentrations during Drought periods were more nuanced with higher concentrations occurring in the South-Central Delta region and during the winter and spring. Together, these results characterized drought in the estuary as warm, clear, high in nutrients, with patchy phytoplankton blooms (as indexed by chlorophyll), all of which have implications for higher trophic levels. Considering that droughts are expected to increase in frequency and intensity in California with climate change, understanding the effects of multi-year droughts on the water quality conditions of the estuary can help inform water management decisions.

Can aerosol optical depth unlock the future of air quality monitoring and lung cancer prevention?

AbstractThis “Policy Brief” explores the potential integration of Aerosol Optical Depth (AOD) into the United Kingdom’s air quality and public health monitoring frameworks, highlighting its potential to enhance existing air pollution control strategies. Amid growing concerns over air pollution’s impact on health, particularly the link between particulate matter and lung cancer, this brief presents a focused investigation into how AOD can be leveraged alongside traditional monitoring methods to provide a more nuanced understanding of air quality trends. By correlating AOD data with lung cancer incidence rates within the UK, the brief aims to uncover potential associations and inform public health decisions. Furthermore, it discusses the advantages and limitations of employing AOD in air pollution and respiratory disease monitoring, advocating for a strategic enhancement of the UK's air pollution monitoring efforts. This approach seeks to complement and refine current monitoring practices with advanced remote sensing techniques, aiming to inform policy innovations that prioritize environmental health and public welfare. Through a comprehensive review of existing data and policies, the brief underscores the urgency of adopting multidimensional air quality management strategies that respond to technological advancements and emerging public health needs.

Reprocessed Single-Use Semicritical and Critical Medical Devices

What Is the Issue?&#x0D; &#x0D; Reprocessing a medical device includes cleaning, reconditioning, testing, and disinfection to ensure the device can safely be reused. In contrast to reusable medical devices, manufacturers are not required to provide instructions for properly cleaning and sterilizing single-use medical devices (SUMDs).&#x0D; Health Canada regulates third-party device reprocessors and requires they meet the same requirements as new device manufacturers. Health Canada does not provide oversight for hospital onsite reprocessing, deferring to the oversight provided at the provincial and territorial levels. Given the potential economic and environmental benefits of using reprocessed SUMDs, there is a growing interest in determining the clinical safety of reprocessed SUMDs.&#x0D; Current standards for reprocessing medical devices use definitions for sterilization and disinfection based on measurement of bioburden, but not necessarily clinical outcomes such as infection.&#x0D; &#x0D; What Did We Do?&#x0D; &#x0D; To inform decisions about the appropriate use of reprocessed critical and semicritical SUMDs, CADTH sought to identify and summarize literature evaluating the clinical safety of reprocessed SUMDs, defined as infections, mortality, or other adverse events, compared with nonreprocessed (new) SUMDs. Microbiological outcomes, such as bacterial colony counts, were not included. An information specialist searched for peer-reviewed and grey literature sources.&#x0D; This report does not provide a comprehensive list of device reprocessors in Canada or recommend any specific methods of reprocessing medical devices.&#x0D; &#x0D; What Did We Find?&#x0D; &#x0D; We identified 8 studies, including one study based in Canada, that evaluated the use of reprocessed SUMDs compared with new SUMDs; most did not report statistically significant differences in patient outcomes between groups.&#x0D; Most of the included studies were of very low to moderate quality, which limits confidence in the observed outcomes resulting from the reuse of these devices. Half of the included studies were published before the year 2005, which may limit applicability given potential improvements and changes over time in reprocessing standards, surgical approaches, device specifications, and patient care protocols.&#x0D; Most of the studies evaluated a different type of reprocessed single-use medical device for different surgical populations, so there is very limited evidence for the use of a specific device in a specific population or intervention of interest. All included studies evaluated SUMDs classified as critical, and all were conducted in surgical settings; however, it is unclear whether patient risk levels would be different for semicritical devices or in nonsurgical settings.&#x0D; &#x0D; What Does it Mean?&#x0D; &#x0D; Given various devices, clinical applications, and reprocessing methods, it is difficult to draw broad conclusions about the appropriateness of reprocessing SUMDs.&#x0D; While the evidence base in this review was insufficient to conclude whether reprocessed critical SUMDs in surgical settings affect patient outcomes, Canadian standards and other resources exist to help inform decisions around medical device reprocessing based on infection risk.&#x0D; To ensure patient safety, any reprocessing of SUMDs should meet standards for safety, effectiveness, and labelling that follow Health Canada regulations.&#x0D;

Instrumental Assessment of Aero-Resistive Expiratory Muscle Strength Rehabilitation Devices.

Expiratory muscle strength training (EMST) is increasingly being used to treat voice, cough, and swallowing deficits in a wide range of conditions. However, a multitude of aero-resistive EMST models are commercially available, and the absence of side-by-side comparative data interferes with clinicians' ability to assess which model is best suited to a particular client's needs. The primary aim of this research was to test and compare the pressure and flow parameters of six currently available EMST models to help inform clinical decision making. We identified and tested five devices of each of six different EMST models to generate benchmark data for minimum trigger pressures across settings. The reliability was tested within each device and between five devices of the same model across settings using coefficient of variation. All six models required higher pressures to initiate flow at the highest setting compared to the lowest setting, as expected. Detailed descriptive statistics for each model/setting combination include average flow-triggering pressure for each model/setting and the variability across trials within a device and across devices of the same model. From these, ranked order of the least to most stable EMST model was derived. Systematic testing of several commercially available expiratory resistance training devices yielded clinical benchmarks and reliability data to aid clinicians in selecting an appropriate therapy device and regimen for a client based on their available airflow and air pressure as well as reliability of the device. These findings allow clinicians to directly compare key parameters across EMST devices.

Freshwater systems in the Anthropocene: why we need to evaluate microplastics in the context of multiple stressors

Microplastics are a diverse contaminant with complex physical and chemical properties. While microplastics have varying effects, most studies to date have focused on evaluating microplastics as a single stressor under stable environmental conditions. In reality, organisms are exposed to more than microplastics, and thus, it will be increasingly important to evaluate the effects of microplastics in the context of multiple anthropogenic stressors. Here, we highlight the need to assess the physical and chemical effects of microplastics, as well as their interactions with other anthropogenic stressors, at multiple levels of biological organization (i.e., sub-organismal, individual, population, community, ecosystem). We also outline research priorities and recommendations that will facilitate ecotoxicological assessments to better encompass the multidimensionality of microplastics as environmental conditions continue to change. By taking a multi-stressor ecotoxicological approach, we can work toward a better understanding of microplastic and other stressor effects at multiple levels of biological organization to help inform robust, evidenced-based policy and management decisions.

Host sweet host: Rodent communities support similar ectoparasite diversity regardless of anthropogenic disturbance

AbstractRodents are important hosts for ectoparasites, such as fleas, ticks, and mites, which means they are also important intermediate hosts for many zoonotic diseases. As anthropogenic environments bring humans and rodents into closer contact, an understanding of host–ectoparasite ecology is essential to predict and manage disease spillover risks. We aimed to understand how disturbances in vegetation cover affect rodent ectoparasite diversity, prevalence, spatial segregation, host (i.e., sex, genus, size, and habitat domain), and environmental (i.e., vegetation structure, forest cover, and rainfall) variables in the state of Michoacan, Mexico. We investigated these relationships by trapping rodents in five paired disturbed (reduced vegetation cover and regular human activities) and undisturbed (no reduction in vegetation cover) sites in the summer and autumn of 2022. From 110 trapped rodents, we collected 138 ectoparasites on 38 individuals. We found no difference in rodent diversity, ectoparasite diversity, or ectoparasite prevalence between disturbed and undisturbed sites. However, arboreal and male rodents had a higher probability of carrying ectoparasites than ground‐dwelling and female rodents. Rodents with ectoparasites were not spatially clustered; rather, they were randomly distributed across trapping grids. We also identified two rodent genera (Rattus and Sigmodon) that carry ectoparasites of medical importance and that are in close contact with humans. Our results highlight the necessity of constant monitoring of rodents, ectoparasites, and their associated transmittable diseases. Assessing these interactions and how they are affected by anthropogenic disturbance could better inform management decisions and support the need for rodent conservation programmes in the area.

Public knowledge, sentiments, and perceptions of low dose radiation (LDR) and power production, with special reference to reactor accidents

Abstract People’s perceptions concerning radiation inform decision making in relation to nuclear power production. There have been extensive studies of people’s perceptions of radiation including in relation to the Fukushima and Chernobyl nuclear events. This paper reports on a social science literature review study and is concerned with public responses to low dose radiation (LDR) and nuclear facilities, particularly in the marine environment. This review confirms that people with little knowledge about radiation have the highest risk perceptions in relation to nuclear power; conversely people with a broader knowledge have lower risk perceptions and are more favourable to nuclear power. Education can increase positive perceptions, but the influence of underlying experience of feeling, emotion, attachment, or mood may dampen this effect. This paper reports studies which document anxiety within the Japanese community in relation to the Fukushima nuclear accident. Literature concerning specific radionuclides released is described. While there are uncertainties about the presence of health impacts following LDR exposures, public attitudes are not in line. There is a need for better dialogue between nuclear professionals and scientists to achieve better nuclear education and public communication outcomes; more specific communication surrounding multi-isotopes, and multi-elements of nuclear power plant disaster releases is warranted. Trusted communicators should include nuclear and social scientists as well as regulators. Given the importance of decarbonization in the context of climate change, this is increasingly important.

Linkage Case Management and Posthospitalization Outcomes in People With HIV

Despite the widespread availability of antiretroviral therapy (ART), people with HIV still experience high mortality after hospital admission. To determine whether a linkage case management intervention (named "Daraja" ["bridge" in Kiswahili]) that was designed to address barriers to HIV care engagement could improve posthospital outcomes. Single-blind, individually randomized clinical trial to evaluate the effectiveness of the Daraja intervention. The study was conducted in 20 hospitals in Northwestern Tanzania. Five hundred people with HIV who were either not treated (ART-naive) or had discontinued ART and were hospitalized for any reason were enrolled between March 2019 and February 2022. Participants were randomly assigned 1:1 to receive either the Daraja intervention or enhanced standard care and were followed up for 12 months through March 2023. The Daraja intervention group (n = 250) received up to 5 sessions conducted by a social worker at the hospital, in the home, and in the HIV clinic over a 3-month period. The enhanced standard care group (n = 250) received predischarge HIV counseling and assistance in scheduling an HIV clinic appointment. The primary outcome was all-cause mortality at 12 months after enrollment. Secondary outcomes related to HIV clinic attendance, ART use, and viral load suppression were extracted from HIV medical records. Antiretroviral therapy adherence was self-reported and pharmacy records confirmed perfect adherence. The mean age was 37 (SD, 12) years, 76.8% were female, 35.0% had CD4 cell counts of less than 100/μL, and 80.4% were ART-naive. Intervention fidelity and uptake were high. A total of 85 participants (17.0%) died (43 in the intervention group; 42 in the enhanced standard care group); mortality did not differ by trial group (17.2% with intervention vs 16.8% with standard care; hazard ratio [HR], 1.01; 95% CI, 0.66-1.55; P = .96). The intervention, compared with enhanced standard care, reduced time to HIV clinic linkage (HR, 1.50; 95% CI, 1.24-1.82; P < .001) and ART initiation (HR, 1.56; 95% CI, 1.28-1.89; P < .001). Intervention participants also achieved higher rates of HIV clinic retention (87.4% vs 76.3%; P = .005), ART adherence (81.1% vs 67.6%; P = .002), and HIV viral load suppression (78.6% vs 67.1%; P = .01) at 12 months. The mean cost of the Daraja intervention was about US $22 per participant including startup costs. Among hospitalized people with HIV, a linkage case management intervention did not reduce 12-month mortality outcomes. These findings may help inform decisions about the potential role of linkage case management among hospitalized people with HIV. ClinicalTrials.gov Identifier: NCT03858998.

Applying Human Factors and Systems Simulation Methods to Inform a Multimillion-Dollar Healthcare Decision.

This article describes a case study of a collaborative human factors (HF) and systems-focused simulation (SFS) project to evaluate potential patient and staff safety risks associated with a multimillion-dollar design and construction decision. The combined integration of HF and SFS methods in healthcare related to testing and informing the design of new environments and processes is underutilized. Few realize the effectiveness of this integration in healthcare to reduce risk and improve decision-making, safety, design, efficiency, patient experience, and outcomes. This project showcases how the combined use of HF and SFS methods can provide objective evidence to help inform decisions. The project was initiated by a healthcare executive team looking for an objective, user informed analysis of a current connector passageway between two existing buildings. The goal was to understand the implications of keeping the current route for simultaneous use for public and patients service flow versus building and financing a new passageway for separate flow and transport. An interprofessional team of intensive care unit professionals participated in two simulations designed to test the current connector. A failure mode and effects analysis and qualitative debrief feedback was used to evaluate risks and potential failures. The evaluation resulted in data that enabled informed executive decision making for the most effective, efficient, and safest option for public, staff, and patient transport between two buildings. This evaluation resulted in the decision to go forward with building a multimillion-dollar new connector passageway to improve integrated care and transport.

Game changers or money pits? Asymmetric impact of sports facilities investment on football revenue

AbstractOur investigation explores the asymmetric association between sports facilities investment and football revenue in the top 10 nations with the highest sports facilities investment. This study employs a distinctive methodology, “Quantile‐on‐Quantile,” to probe the interconnectedness of time series within each country. The findings reveal that investments in sports facilities have a predominantly positive impact on football revenue in the selected economies, particularly in various segments of the data distribution. It underscores the importance of implementing policies that maximize the effect of sports facilities investment on football revenue and inform public policy decisions.

Economic evaluations of assisted reproductive technologies in high-income countries: a systematic review.

Which assited reproductive technology (ART) interventions in high-income countries are cost-effective and which are not? Among all ART interventions assessed in economic evaluations, most high-cost interventions, including preimplantation genetic testing for aneuploidy (PGT-A) for a general population and ICSI for unexplained infertility, are unlikely to be cost-effective owing to minimal or no increase in effectiveness. Approaches to reduce costs in order to increase access have been identified as a research priority for future infertility research. There has been an increasing number of ART interventions implemented in routine clinical practice globally, before robust assessments of evidence on economic evaluations. The extent of clinical effectiveness of some studied comparisons has been evaluated in high-quality research, allowing more informative decision making around cost-effectiveness. We performed a systematic review and searched seven databases (MEDLINE, PUBMED, EMBASE, COCHRANE, ECONLIT, SCOPUS, and CINAHL) for studies examining ART interventions for infertility together with an economic evaluation component (cost-effectiveness, cost-benefit, cost-utility, or cost-minimization assessment), in high-income countries, published since January 2011. The last search was 22 June 2022. Two independent reviewers assessed publications and included those fulfilling the eligibility criteria. Studies were examined to assess the cost-effectiveness of the studied intervention, as well as the reporting quality of the study. The chosen outcome measure and payer perspective were also noted. Completeness of reporting was assessed against the Consolidated Health Economic Evaluation Reporting Standard. Results are presented and summarized based on the intervention studied. The review included 40 studies which were conducted in 11 high-income countries. Most studies (n = 34) included a cost-effectiveness analysis. ART interventions included medication or strategies for controlled ovarian stimulation (n = 15), IVF (n = 9), PGT-A (n = 7), single embryo transfer (n = 5), ICSI (n = 3), and freeze-all embryo transfer (n = 1). Live birth was the mostly commonly reported primary outcome (n = 27), and quality-adjusted life years was reported in three studies. The health funder perspective was used in 85% (n = 34) of studies. None of the included studies measured patient preference for treatment. It remains uncertain whether PGT-A improves pregnancy rates compared to IVF cycles managed without PGT-A, and therefore cost-effectiveness could not be demonstrated for this intervention. Similarly, ICSI in non-male factor infertility appears not to be clinically effective compared to standard fertilization in an IVF cycle and is therefore not cost-effective. Interventions such as use of biosimilars or HMG for ovarian stimulation are cheaper but compromise clinical effectiveness. Lack of both preference-based and standardized outcomes limits the comparability of results across studies. The selection of efficacy evidence offered for some interventions for economic evaluations is not always based on high-quality randomized trials and systematic reviews. In addition, there is insufficient knowledge of the willingness to pay thresholds of individuals and state funders for treatment of infertility. There is variable quality of reporting scores, which might increase uncertainty around the cost-effectiveness results. Investment in strategies to help infertile people who utilize ART is justifiable at both personal and population levels. This systematic review may assist ART funders decide how to best invest to maximize the likelihood of delivery of a healthy child. There was no funding for this study. E.C. and R.W. receive salary support from the National Health and Medical Research Council (NHMRC) through their fellowship scheme (EC GNT1159536, RW 2021/GNT2009767). M.D.-T. reports consulting fees from King Fahad Medical School. All other authors have no competing interests to declare. Prospero CRD42021261537.

Protocol for the development of a tool (INSPECT-SR) to identify problematic randomised controlled trials in systematic reviews of health interventions

IntroductionRandomised controlled trials (RCTs) inform healthcare decisions. It is now apparent that some published RCTs contain false data and some appear to have been entirely fabricated. Systematic reviews are performed...