Relevant Evidence Base Research Articles

If it walks like a duck…: Monitored Emergency Use of Unregistered and Experimental Interventions (MEURI) is research

Monitored Emergency Use of Unregistered and Experimental Interventions (MEURI) is an ethical framework developed by the WHO for using unproven interventions in public health emergencies outside the context of medical...

The new 2023 ESC guidelines for the management of cardiomyopathies: a guiding path for cardiologist decisions.

In the ESC 2023 guidelines, cardiomyopathies are conservatively defined as 'myocardial disorders in which the heart muscle is structurally and functionally abnormal, in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease sufficient to cause the observed myocardial abnormality'. They are morpho-functionally classified as hypertrophic, dilated, restrictive, and arrhythmogenic right ventricular cardiomyopathy with the addition of the left ventricular non-dilated cardiomyopathy that describes intermediate phenotypes not fulfilling standard disease definitions despite the presence of myocardial disease on cardiac imaging or tissue analysis. The new ESC guidelines provide 'a guide to the diagnostic approach to cardiomyopathies, highlight general evaluation and management issues, and signpost the reader to the relevant evidence base for the recommendations'. The recommendations and suggestions included in the document provide the tools to build up pathways tailored to specific cardiomyopathy (phenotype and cause) and define therapeutic indications, including target therapies where possible. The impact is on clinical cardiology, where disease-specific care paths can be assisted by the guidelines, and on genetics, both clinics and testing, where deep phenotyping and participated multi-disciplinary evaluation provide a unique tool for validating the pathogenicity of variants. The role of endomyocardial biopsy remains underexploited and confined to particular forms of restrictive cardiomyopathy, myocarditis, and amyloidosis. New research and development will be needed to cover the gaps between science and clinics. Finally, the opening up to disciplines such as bioinformatics, bioengineering, mathematics, and physics will support clinical cardiologists in the best governance of the novel artificial intelligence-assisted resources.

GP Evidence: a new website to support evidence-based practice.

GPs regularly prescribe lifelong treatments for long-term conditions, supported by clinical guidelines and encouraged by performance measures. However, GPs have a poor understanding of the absolute benefits and harms of these treatments, impairing their ability to engage in genuine shared decision making or optimally manage polypharmacy. There are few easily accessible and understandable sources of this kind of quantitative information. To produce a novel website to communicate understandable, usable information to GPs on the benefits and harms of treatments for long-term conditions alongside supporting information about the relevant evidence base. Participatory co-design/research-by-design methods. A pragmatic evidence collation and curation process with expert and patient involvement. A new website, gpevidence.org (openly available from launch date, 1 February 2022) has been developed providing evidence on treatments for 12 common long-term conditions. It employs graphic design and 'content-designed' textual information within an information architecture mapping to GPs' practice and mental models. User-testing and preliminary evaluation have shown it successfully communicates complex evidence about the benefits and harms of treatments to GPs in a way that will be usable and useful in practice. It is possible to communicate quantitative information about the clinical evidence base behind treatments in a way that will be usable in practice and that complements existing clinical guidelines and normative practice. This has the potential to support shared decision making, improve the management of polypharmacy, and increase GPs' confidence in this area of practice.

Enhancing the evidence base for spiritually integrated psychotherapies: Progressing the paradigm of practice-based evidence.

Spiritually integrated approaches to psychological therapies enable practitioners to be responsive to clients' religious and spiritual concerns and have been combined with most mainstream therapeutic approaches. As such, although evidence is required regarding their efficacy, with randomized controlled trials having a privileged status, a single research paradigm is unlikely to deliver both a robust and relevant evidence base for the psychological therapies, that is, embedded in routine practice. The research paradigm of practice-based evidence provides a complementary approach to trials methodology as carried out in routine practice via the application of a myriad of qualitative and quantitative research designs. Accordingly, this article provides the background to a special section comprising 12 articles within a practice-based evidence paradigm that captures a focus on the therapist, the content of sessions and therapist-patient interactions, applications to specific patient populations and therapy modality, and the outcomes of spiritually integrated psychological therapies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

How Much Food Can We Grow in Urban Areas? Food Production and Crop Yields of Urban Agriculture: A Meta-Analysis.

Urban agriculture can contribute to food security, food system resilience and sustainability at the city level. While studies have examined urban agricultural productivity, we lack systemic knowledge of how agricultural productivity of urban systems compares to conventional agriculture and how productivity varies for different urban spaces (e.g., allotments vs. rooftops vs. indoor farming) and growing systems (e.g., hydroponics vs. soil‐based agriculture). Here, we present a global meta‐analysis that seeks to quantify crop yields of urban agriculture for a broad range of crops and explore differences in yields for distinct urban spaces and growing systems. We found 200 studies reporting urban crop yields, from which 2,062 observations were extracted. Lettuces and chicories were the most studied urban grown crops. We observed high agronomic suitability of urban areas, with urban agricultural yields on par with or greater than global average conventional agricultural yields. “Cucumbers and gherkins” was the category of crops for which differences in yields between urban and conventional agriculture were the greatest (17 kg m−2 cycle−1 vs. 3.8 kg m−2 cycle−1). Some urban spaces and growing systems also had a significant effect on specific crop yields (e.g., tomato yields in hydroponic systems were significantly greater than tomato yields in soil‐based systems). This analysis provides a more robust, globally relevant evidence base on the productivity of urban agriculture that can be used in future research and practice relating to urban agriculture, especially in scaling‐up studies aiming to estimate the self‐sufficiency of cities and towns and their potential to meet local food demand.

Characterising health promotion in Aboriginal and Torres Strait Islander languages: A content analysis of COVID-19 and maternal health resources.

Issue addressedHealth promotion resources in Aboriginal and Torres Strait Islander (Indigenous) languages are being widely translated and disseminated at the community, health service and government level. In addition to outlining the relevant Australian policy context and evidence base, this study sought to describe the availability and characteristics of COVID‐19 and maternal health promotion resources incorporating Indigenous languages.MethodsHealth promotion resources published online between June 2005 and June 2020 were identified by a desktop scan and screened against quality inclusion criteria. A content analysis by resource type, health topic, purpose, use of language and source was conducted.ResultsA total of 215 resources was eligible for inclusion, incorporating 50 different Indigenous languages and representing a varied approach to language use and health promotion. Almost 7 times as many COVID‐19 resources were identified than maternal health materials.ConclusionsIn contrast to maternal health, COVID‐19 has seen a sharp rise in the number of health promotion resources produced in language, especially in formats capable of streamlined replication in multiple languages. Strong use of narrative, storytelling and alternative primary aims such as language education suggests potential for greater collaboration between health promotion organisations and other community groups and services. Bilingual resources may have applications for communities where traditional language knowledge is being reawakened.So what?Emerging capacity to efficiently produce health promotion resources in multiple Indigenous languages could be capitalised for health topics beyond COVID‐19. However, further research in determining best practice and user perspectives is essential in guiding the development of these resources.

Perceptions and Motivation Regarding Performing Research in Physicians Specializing in Care for Older Adults Involved in a Mandatory Evidence-Based Medicine Training Study: A Mixed-Methods Study

PurposeEvidence underpinning treatment of older persons with complex conditions is often sparse, and involving more early career physicians committed to optimizing care for older adults may help increase a relevant evidence base. We examined perception of and motivation to conduct research in physicians (residents) specializing in care of older adults.Subjects and MethodsResidents of an academic medical centre in the Netherlands enrolled in a 3-year training programme. The programme includes a mandatory evidence-based medicine (EBM) training study on pain and discomfort in cognitively impaired nursing home patients, in which residents perform their research over the 3-year duration of the programme. We employed a mixed-methods design with survey and qualitative interviews (December 2019–April 2020). The survey included validated scales with agreement response options rated 1–7. Qualitative interviews were underpinned by interpretative phenomenological analysis.ResultsOf 38 invited residents, 23 (15 females) participated. The mean score on perceptions of research was 4.1 (SD 0.8); on intrinsic motivation 4.8 (SD 1.0); on extrinsic motivation 4.3, with a higher SD of 1.4. Eight interviews also showed diversity in the extent to which residents felt equipped to conduct the mandatory EBM training study, and research more generally, which was related to previous experiences performing research. The residents generally did not anticipate conducting research themselves despite recognizing the benefits of training in research.ConclusionPerceptions and motivation of the residents specializing in care of older people to conduct research, although considered relevant to their practice, were not very positive. The study results in recommendations to motivate physicians in geriatrics training to conduct research, eg through personalized boosting of self-efficacy. This is crucial to motivate future physicians to contribute to research relevant to older people in more ways than just delivering data for research conceived by (non-clinical) researchers.

The impact of physical activity and sport programs on mental, social and emotional wellbeing of young Aboriginal and Torres Strait Islander people: A systematic review

Background: Aboriginal and Torres Strait Islander young people experience significantly poorer mental, social and emotional health disparities compared to their non-Indigenous counterparts as a result of sustained disadvantage and intergenerational trauma. The relationship between physical activity and sport participation and positive mental and psychosocial health in young people is well established, yet little is known about this relationship in Aboriginal and Torres Strait Islander young people. This review aims to address this gap by systematically identifying and assessing existing evidence of the impact of sport and physical activity programs on mental health and social and emotional wellbeing outcomes within young Aboriginal and Torres Strait Islander people. The review also aims to highlight limitations of current practice within the research area. Methods: A systematic search of literature was undertaken on three peer-reviewed databases (PsycINFO, MEDLINE and SPORTSDiscus) and grey literature until July 2020. Studies were included if they described a sport and physical activity program for young (10-24 years) Aboriginal and Torres Strait Islander people and reported mental health or social and emotional wellbeing outcomes. Results: Seventeen studies were selected for this review. Within these studies, the most commonly reported outcomes were related to psychosocial development (N = 12) and a sense of connectedness (N = 12). Mental illness related outcomes (N = 1) were rarely reported, as were substance use (N = 2) and social and emotional literacy (N = 1). Other promising outcomes included increased connection to culture, self-esteem and confidence. Nonetheless, due to indirectness, suboptimal study design, and risk of bias, the precise impact on these outcomes cannot be determined. Discussion: A relevant evidence base is emerging on the impact sport and physical activity programs have on the mental, social and emotional wellbeing of young Aboriginal and Torres Strait Islander people. However, further research that utilises robust, culturally appropriate methodologies and tools (e.g., participatory action research, body mapping and yarns) needs to be undertaken before the effects of sport and physical activity programs can reliably be discerned. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest relevant to the submission of this abstract.

What is the evidence that counter‐wildlife crime interventions are effective for conserving African, Asian and Latin American wildlife directly threatened by exploitation? A systematic map protocol

Abstract Human activities are driving a global biodiversity crisis. In response, a broad range of conservation actions have been implemented. With finite resources available, and a rapidly narrowing window, the scientific and policy communities have acknowledged the need to better understand the effectiveness of interventions for conserving threatened species. Given the recent emphasis on the use of counter wildlife crime interventions (i.e. those that directly protect wildlife from illegal harvest, detect and sanction rule‐breakers, and interdict and control illegal wildlife commodities), there is a clear need to summarize the available evidence on biological and threat reduction outcomes of such actions to help make evidence‐informed management and funding decisions. Here, we present a protocol for a systematic map that will collate the existing body of literature addressing the effectiveness of counter‐wildlife crime interventions for protecting targeted species. Our focus will be on select species or species groups directly threatened by exploitation (i.e. illegal harming whether by harvest as a resource or for control/persecution) and native to Africa, Asia and Latin America, which are regions that have experienced significant wildlife populations declines. The systematic map will aim to capture available evidence found in commercially published and grey literature. We will search for the literature using four publication databases, Google Scholar, 36 specialist websites and databases and sources identified through a call for evidence among relevant networks. Eligibility screening will be conducted at two stages: (1) title and abstract and (2) full text. Relevant information from included papers will be extracted and entered into a searchable, coded database (MS‐Excel). Narrative synthesis and descriptive statistics will describe the key characteristics of the relevant evidence base (e.g. geographic location, species, interventions, direct threats, outcomes and study designs). Using visual heat maps, we will identify key knowledge gaps warranting further research and clusters of evidence that could serve as topics for future systematic reviews. The resulting map will guide further exploration on evaluating the effectiveness of counter‐wildlife crime interventions, and aid in building an evidence base that supports both management and funding decisions to ensure efficient use of limited resources and maximal conservation benefits.

The systematic development of a mobile phone–delivered brief intervention for hazardous drinking in India

BackgroundThe treatment gap for alcohol use disorders (AUD) in India is the highest among all mental health and substance use disorders. Despite evidence of the cost effectiveness of brief interventions (BIs) for hazardous drinking, implementation in low- and middle-income countries (LMICs) is rare due to several human resource–related barriers. This paper describes the processes and outputs of a study aimed at systematically developing a mobile phone–delivered BI to overcome such barriers. MethodsThis is a mixed methods study with four steps: (1) Review of existing relevant evidence base by extracting data from studies cited in two recent, relevant and high-quality systematic reviews; (2) In-depth interviews (IDIs) with 11 national experts in addictions research and practice, and 22 hazardous drinkers; (3) Delphi survey (2 rounds) to identify components for the intervention package through consensus building; and (4) Content and intervention development workshops with a range of stakeholders to develop the intervention package. ResultsThe research team sourced 72 journal articles from two selected systematic reviews. Key content areas extracted from the studies included facts and statistics about health related to drinking behavior, self-reflection, goal-setting messages, motivational messages, and skills to manage risky situations. The IDIs with experts and hazardous drinkers endorsed most of these content areas as well. The Delphi survey achieved consensus on 19 content areas, which included targeted recommendations, personalized feedback and information, goal management, and coping skills. The content and intervention development workshops resulted in an intervention package delivered over 8 weeks, with the following seven themes guiding the content of the weekly messages: safe drinking/health education, alcohol reduction, drinking and risk management, drinking alternatives, situational content, urge management, and maintenance and relapse prevention. ConclusionThe research team designed this study to consider contextual factors while developing the intervention, which is important to ensure acceptability and feasibility of the intervention. Interestingly, the contextually informed intervention components had several commonalities with BIs developed and tested in high-income countries.

Evidence that maintaining optimal nutrition status for well-functioning immune system might promote recovery for mild COVID-19 patients

COVID-19 is a viral infectious disease caused by SARS-COV2. Its clinical signs and symptoms are on a broad spectrum ranging from asymptomatic to severe complications like multi-organ failure, thromboembolism, and severe pneumonia with respiratory failure. Worse outcomes and higher mortality rates have been reported in the elderly, people with co-morbidities, and malnourished individuals. Nutrition is fundamental to good health and immune function. It forms an integral component of treatment modalities for various acute and chronic diseases, especially where a causative treatment is not yet recognized. Taking into consideration the magnitude of demands this pandemic has posed on hospital resources, an orderly assessment of nutritional status and body composition may not be possible for critically ill and/or for patients with mild-moderate symptoms who are managing their illness at home. Adequate intake of various macro and micro-nutrients--energy, protein, fat, vitamins--A, B, C, D, E and minerals--iron, selenium, zinc, and copper, along with supportive health practices like hydration, meal consistency, frequency of meal consumption and physical activity, often ameliorate respiratory infections, in part by modulating the immune response. Though at present there is a lack of well-defined nutrition-based guidelines for COVID-19 patient care, this paper brings forward the existing relevant evidence base for caregivers and patients to use as a reference/guide.

An Individual Cognitive Stimulation Therapy App for People With Dementia: Development and Usability Study of Thinkability.

BackgroundThere is a lack of technological resources for the mental stimulation and communication of people with dementia, which can be helpful in improving cognition and quality of life. Paper-based individual cognitive stimulation therapy (iCST) for people with dementia has the potential to be adapted to a touchscreen format. This can improve accessibility and provide mental stimulation using interactive features. There is a need for a rigorous and systematic approach toward development, leading to improved suitability and implementation of the intervention, so that more people can benefit from its use.ObjectiveThis study aims to develop and investigate the usability of Thinkability, an iCST app that can be used by people with dementia and carers on touchscreen tablets.MethodsThe Medical Research Council framework for evaluating complex interventions and the Centre for eHealth Research roadmap served as frameworks for the stages of intervention and technology development. The development of the iCST app itself adopted an agile approach with elements from action research. Hence, it was developed in 3 successive sprints and was evaluated by relevant stakeholders at each sprint. Sprint 1 included 2 patient and public involvement (PPI) consultation meetings, sprint 2 included 1 PPI consultation meeting, and 4 focus groups and 10 individual interviews were organized in sprint 3. A feasibility trial is currently underway.ResultsThe findings from each sprint were used to inform the development. Sprint 1 helped to identify the relevant evidence base and explored the attitudes of people with dementia and carers toward a potential iCST app. In sprint 2, an initial prototype was evaluated in a small PPI consultation meeting. In sprint 3, feedback was gathered through a qualitative study on the quality and perceived effectiveness of the iCST app. It was well received by people with dementia and carers. A need for more updated and personalized content was highlighted.ConclusionsThis study proves that an agile approach toward technology development involving all relevant stakeholders is effective in creating suitable technology. Adding to our previous knowledge of noncomputerized cognitive stimulation therapy, the release of the iCST app will make this psychosocial intervention accessible to more users worldwide.

Investigating the Geochemical Controls on Pb Bioaccessibility in Urban Agricultural Soils to Inform Sustainable Site Management

The solid-phase speciation of contaminants in soil plays a major role in regulating both the environmental mobility of contaminants and their bioavailability in biological receptors such as humans. With the increasing prevalence of urban agriculture, in tandem with growing evidence of the negative health impacts of even low levels of exposure to Pb, there is a pressing need to provide regulators with a relevant evidence base on which to build human health risk assessments and construct sustainable site management plans. We detail how the solid-phase fractionation of Pb from selected urban agricultural soil samples, using sequential extraction, can be utilised to interpret the bioaccessible fraction of Pb and ultimately inform sustainable site management plans. Our sequential extraction data shows that the Pb in our urban soils is primarily associated with Al oxide phases, with the second most important phase associated with either Fe oxyhydroxide or crystalline FeO, and only to a limited extent with Ca carbonates. We interpret the co-presence of a P component with the Al oxide cluster to indicate the soils contain Pb phosphate type minerals, such as plumbogummite (PbAl3(PO4)2(OH)5·H2O), as a consequence of natural “soil aging” processes. The presence of Pb phosphates, in conjunction with our biomonitoring data, which indicates the lack of elevated blood Pb levels in our gardeners compared to their non-gardening neighbours, suggests the (legacy) Pb in these soils has been rendered relatively immobile. This study has given confidence to the local authority regulators, and the gardeners, that these urban gardens can be safe to use, even where soil Pb levels are up to ten times above the UK’s recommended lead screening level. The advice to our urban gardeners, based on our findings, is to carry on gardening but follow recommended good land management and hygiene practices.

The impact of COVID-19 on and recommendations for breast cancer care: the Singapore experience.

The ensuing COVID-19 pandemic poses unprecedented and daunting challenges to the routine delivery of oncological and supportive care to patients with breast cancer. Considerations include the infective risk of patients who are inherently immunosuppressed from their malignancy and therapies, long-term oncological outcomes from the treatment decisions undertaken during this extraordinary period, and diverted healthcare resources to support a coordinated whole-of-society outbreak response. In this review, we chronicle the repercussions of the COVID-19 outbreak on breast cancer management in Singapore and describe our approach to triaging and prioritising care of breast tumours. We further propose adaptations to established clinical processes and practices across the different specialties involved in breast oncology, with references to the relevant evidence base or expert consensus guidelines. These recommendations have been developed within the unique context of Singapore's public healthcare sector. They can serve as a resource to guide breast cancer management for future contingencies in this city-state, while certain elements therein may be extrapolatable to other medical systems during this global public health emergency.

Neurosurgeons’ experiences of conducting and disseminating clinical research in low- and middle-income countries: a qualitative study protocol

IntroductionLow-income and middle-income countries (LMICs) face the greatest burden of neurotrauma. However, most of the research published in scientific journals originates from high-income countries, suggesting those in LMICs are either...

Digital psychotherapy as an effective and timely treatment option for depression and anxiety disorders: Implications for rural and remote practice.

Patients in regional, rural and remote communities experience perennial difficulties accessing mental health treatments in a timely manner, which contributes to inequitable outcomes when compared with their metropolitan counterparts. This situation frequently stems from a shortage of specialised face-to-face psychotherapy services available in local areas. The recent development of digital psychotherapy as an alternative treatment delivery method provides an opportunity to address this healthcare gap and to avoid the challenges related to workforce maldistribution. This article provides a targeted narrative review of the relevant evidence base, and discusses the potential applications within the rural and remote context. Multiple randomised controlled trials and a large meta-analysis demonstrate that digital psychotherapy, particularly cognitive-behavioural therapy, is as effective as face-to-face psychotherapy. Its use has consequently been endorsed across international clinical practice guidelines as an efficacious and practical way to provide mental healthcare. Despite this, the adoption of digital psychotherapeutic options has been limited to date. Increased awareness of the available options may improve access to psychological treatments in rural and remote populations. Digital psychotherapy should be considered an option for patients with depressive or anxiety disorders of mild-to-moderate severity.

The Three Basic Axioms of the Adam Smith-John Maynard Keynes Approach to Decision Making Versus the Three Basic Axioms of Jeremy Bentham and His students (Ricardo, Say, James Mills, J S Mills, Senior, Walras, and Marshall) Approach to Decision Making

Adam Smith and J M Keynes were both practitioners of virtue ethics who rejected Benthamite Utilitarianism. Their axiomatic foundations consist of the following three axioms only. The first is that probabilities are nonadditive, in general. Additivity is a special case. The second is that probability preferences are generally nonlinear. Linearity is a special case. The third axiom, which follows from the first two, is that the relevant information, data, evidence or the knowledge base required in order to make decisions is generally incomplete. A State of completeness of the relevant information, data, evidence or knowledge base is a special case. The axiomatic structure of Benthamite Utilitarianism is practically identical to that which underlies the Rational Expectations-Real Business Cycle – Dynamic Stochastic General Equilibrium approaches. Bentham’s first axiom was that all probabilities (“uncertainties”) were numerical and additive. Bentham’s second axiom was that all probability preferences were linear. The whole is nothing more than the individual sum of each part. The third axiom was that all the relevant information, data, evidence or knowledge base is complete, so that individual decision makers can make rational (optimal) decisions in both the short run and long run. Based on these three axioms, Bentham asserted that all rational decision makers would be able to actually maximize utility and returns as long as government would “be quit” and “stay out of the sunlight” of businessmen .The normal result would be that an economy would always be operating on the boundary of the Production Possibilities Frontier unless an external shock (war, revolution, plague, etc.) occurred. Smith and Keynes’s axioms are more general than those of Jeremy Bentham and his students. It is impossible to maximize utility or profits, in general, for Smith and Keynes, except as a very special case. The only conclusion possible is that the Rational Expectations-Real Business Cycle – Dynamic Stochastic General Equilibrium approaches are all very special cases of the more generalized Smith – Keynes axiom set. Keynes did exactly what he said he would do in the General Theory on page 3. He generalized classical and Neoclassical theory by providing a more general axiomatic structure .Modern economists are still working with the special theory of Bentham.

Helicopter Emergency Medical Services Literature 1972-2017: Characteristics and Trends

Since its inception in the latter part of the 20th century, the rapid expansion of helicopter emergency medical services (HEMS) has been accompanied by remarkable growth in the relevant evidence base. There are many review articles describing lessons contained within the various arenas of HEMS literature, but there is little or no characterization of the numbers and types of publications comprising the HEMS-related evidence base. This study analyzed all indexed publications mentioning HEMS (with abstract included) in the United States National Library of Medicine's PubMed collection. The aims of the analysis were to provide quantitative, qualitative, and longitudinal trend information regarding the 1972 to 2017 evidence base relevant to HEMS.

Packed red cells versus whole blood transfusion for severe paediatric anaemia, pregnancy-related anaemia and obstetric bleeding: an analysis of clinical practice guidelines from sub-Saharan Africa and evidence underpinning recommendations.

Blood component transfusion is increasingly promoted in sub-Saharan Africa (SSA), but is resource-intensive so whole blood is often used. We examined SSA recommendations about whole blood and packed red cell transfusions for pregnancy-related bleeding or anaemia, and paediatric anaemia, and evaluated the evidence underpinning these recommendations. Relevant SSA guidelines were identified using five electronic databases, websites for SSA Ministries of Health, blood transfusion services and WHO. To facilitate comparisons, indications for transfusing packed red cells or whole blood within these guidelines and reasons given for these recommendations were recorded on a pre-designed matrix. The AGREE II tool was used to appraise guidelines that gave a reason for recommending either packed red cells or whole blood. We systematically searched MEDLINE, CINAHL, Global Health, Cochrane library and NHSBT Transfusion Evidence Library, using PRISMA guidelines, for clinical studies comparing whole blood with packed red cells or combined blood components in obstetric bleeding or anaemia, or paediatric anaemia. Characteristics and findings of included studies were extracted in a standardised format and narratively summarised. 32 English language guidelines from 15 SSA countries mentioned packed red cell or whole blood use for our conditions of interest. Only seven guidelines justified their recommendation for using packed red cells or whole blood. No recommendations or justifications had supporting citations to research evidence. 33 full-text papers, from 11234 citations, were reviewed but only one study met our inclusion criteria. This was a single-centre study in post-partum haemorrhage. Evidence comparing whole blood and packed red cell transfusion for common paediatric and maternal indications is virtually absent in SSA. Therefore, it is unclear whether policies promoting red cells over whole blood transfusion are clinically appropriate. Building a relevant evidence base will help develop effective policies promoting the most appropriate use of blood in African settings.

Speech and language therapy for primary progressive aphasia: Referral patterns and barriers to service provision across the UK.

ObjectiveTo assess the extent of UK speech and language therapy engagement in assessment and management of primary progressive aphasia, determine the factors contributing to any shortfall and explore a gap in the research literature on current speech and language therapy practices with people with primary progressive aphasia.MethodsA 37-item, pilot-tested survey was distributed electronically via clinical networks and through the Royal College of Speech and Language Therapists. Survey items included questions on intervention approaches, referral numbers and demographics, referral sources and access to services.ResultsOne hundred and five speech and language therapists completed the survey. Over the previous 24 months, respondents reported seeing a total of 353 people with primary progressive aphasia (an average of 3.27 per speech and language therapist). Neurologists were the most commonly reported referrers to speech and language therapy (22.5%). Seventy-eight percent of respondents reported that people with primary progressive aphasia experienced barriers to accessing speech and language therapy. Key barriers were a lack of referrer awareness of a speech and language therapist’s role, and restrictive eligibility criteria for services.ConclusionsThis study highlighted inequities in access to speech and language therapy for people with primary progressive aphasia. The medical and speech and language therapy professions need to develop appropriate care pathways for people with primary progressive aphasia. Speech and language therapists have a duty to develop a relevant evidence base for speech and language interventions for people with primary progressive aphasia.