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  • Gruen, Russell L.  (15)
  • Directory of Open Access Journals (DOAJ)  (15)
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  • 1
    Language: English
    In: Journal of Rehabilitation Medicine, 2019, Vol.51(1), pp.32-39
    Description: Objectives: Debate regarding factors associated with persistent symptoms following mild traumatic brain injury continues. Nested within a trial aiming to change practice in emergency department management of mild traumatic brain injury, this study investigated the nature of persistent symptoms, work/...
    Keywords: Mild Traumatic Brain Injury ; Post-Concussion Symptoms ; Anxiety ; Quality Of Life ; Head-Injury ; Early Predictors ; Outcomes ; Population ; Depression ; Validity ; Anxiety ; Scales ; Risk ; Good
    ISSN: 1650-1977
    E-ISSN: 16512081
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  • 2
    In: PLoS ONE, 2016, Vol.11(2)
    Description: Background The Neurotrauma Evidence Translation (NET) Trial aims to design and evaluate the effectiveness of a targeted theory-and evidence-informed intervention to increase the uptake of evidence-based recommended practices for the management of patients who present to an emergency department (ED) with mild head injuries. When designing interventions to bring about change in organisational settings such as the ED, it is important to understand the impact of the context to ensure successful implementation of practice change. Few studies explicitly use organisational theory to study which factors are likely to be most important to address when planning change processes in the ED. Yet, this setting may have a unique set of organisational pressures that need to be taken into account when implementing new clinical practices. This paper aims to provide an in depth analysis of the organisational context in which ED management of mild head injuries and implementation of new practices occurs, drawing upon organisational level theory. Methods Semi-structured interviews were conducted with ED staff in Australia. The interviews explored the organisational context in relation to change and organisational factors influencing the management of patients presenting with mild head injuries. Two researchers coded the interview transcripts using thematic content analysis. The “model of diffusion in service organisations” was used to guide analyses and organisation of the results. Results Nine directors, 20 doctors and 13 nurses of 13 hospitals were interviewed. With regard to characteristics of the innovation (i.e. the recommended practices) the most important factor was whether they were perceived as being in line with values and needs. Tension for change (the degree to which stakeholders perceive the current situation as intolerable or needing change) was relatively low for managing acute mild head injury symptoms, and mixed for managing longer-term symptoms (higher change commitment, but relatively low change efficacy). Regarding implementation processes, the importance of (visible) senior leadership for all professions involved was identified as a critical factor. An unpredictable and hectic environment brings challenges in creating an environment in which team-based and organisational learning can thrive (system antecedents for innovation). In addition, the position of the ED as the entry-point of the hospital points to the relevance of securing buy-in from other units. Conclusions We identified several organisational factors relevant to realising change in ED management of patients who present with mild head injuries. These factors will inform the intervention design and process evaluation in a trial evaluating the effectiveness of our implementation intervention.
    Keywords: Research Article ; Medicine And Health Sciences ; Medicine And Health Sciences ; People And Places ; Medicine And Health Sciences ; Medicine And Health Sciences ; People And Places ; People And Places ; Biology And Life Sciences ; Biology And Life Sciences ; Social Sciences ; Biology And Life Sciences ; Computer And Information Sciences ; Social Sciences ; Medicine And Health Sciences ; Medicine And Health Sciences
    E-ISSN: 1932-6203
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  • 3
    Language: English
    In: BMC Medical Research Methodology, 01 June 2011, Vol.11(1), p.92
    Description: Abstract Background Evidence mapping describes the quantity, design and characteristics of research in broad topic areas, in contrast to systematic reviews, which usually address narrowly-focused research questions. The breadth of evidence mapping helps to identify evidence gaps, and may guide...
    Keywords: Medicine
    ISSN: 1471-2288
    E-ISSN: 1471-2288
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  • 4
    Language: English
    In: PLoS ONE, 01 January 2018, Vol.13(6), p.e0198676
    Description: OBJECTIVE:To appraise the currency, completeness and quality of evidence from systematic reviews (SRs) of acute management of moderate to severe traumatic brain injury (TBI). METHODS:We conducted comprehensive searches to March 2016 for published,...
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 5
    Language: English
    In: Bismark, Marie M., Andrew J. Gogos, Richard B. Clark, Russell L. Gruen, Atul A. Gawande, and David M. Studdert. 2012. Legal disputes over duties to disclose treatment risks to patients: a review of negligence claims and complaints in Australia. PLoS Medicine 9(8): e1001283.
    Description: David Studdert and colleagues identified disputes over informed consent among malpractice claims and serious health care complaints in Australia and provide an analysis of disagreements between patients and doctors over whether particular clinical risks should have been disclosed before treatment.
    Keywords: Medicine ; Public Health ; Behavioral And Social Aspects Of Health ; Surgery ; Social And Behavioral Sciences ; Law ; Medical Law
    ISSN: 1549-1277
    E-ISSN: 15491676
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  • 6
    Language: English
    In: The Lancet Global Health, 27 April 2015, Vol.3, pp.S13-S20
    Description: Surgery is a foundational component of health-care systems. However, previous efforts to integrate surgical services into global health initiatives do not reflect the scope of surgical need and many health systems do not provide essential interventions. We estimate the minimum global volume of surgical need to address prevalent diseases in 21 epidemiological regions from the Global Burden of Disease Study 2010 (GBD). Prevalence data were obtained from GBD 2010 and organised into 119 disease states according to the WHO's Global Health Estimate (GHE). These data, representing 187 countries, were then apportioned into the 21 GBD epidemiological regions. Using previously defined values for the incident need for surgery for each of the 119 GHE disease states, we calculate minimum global need for surgery based on the prevalence of each condition in each region. We estimate that at least 321·5 million surgical procedures would be needed to address the burden of disease for a global population of 6·9 billion in 2010. Minimum rates of surgical need vary across regions, ranging from 3383 operations per 100 000 in central Latin America to 6495 operations per 100 000 in western sub-Saharan Africa. Global surgical need also varied across subcategories of disease, ranging from 131 412 procedures for nutritional deficiencies to 45·8 million procedures for unintentional injuries. The estimated need for surgical procedures worldwide is large and addresses a broad spectrum of disease states. Surgical need varies between regions of the world according to disease prevalence and many countries do not meet the basic needs of their populations. These estimates could be useful for policy makers, funders, and ministries of health as they consider how to incorporate surgical capacity into health systems. US National Institutes of Health.
    Keywords: Public Health
    ISSN: 2214-109X
    E-ISSN: 2214-109X
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  • 7
    Language: English
    In: Implementation Science, Dec 5, 2018, Vol.13(1)
    Description: Background Evidence-based guidelines for the management of mild traumatic brain injury (mTBI) in the emergency department (ED) are now widely available, and yet, clinical practice remains inconsistent with the guidelines. The Neurotrauma Evidence Translation (NET) intervention was developed to increase the uptake of guideline recommendations and improve the management of minor head injury in Australian emergency departments (EDs). However, the adoption of this type of intervention typically entails an upfront investment that may or may not be fully offset by improvements in clinical practice, health outcomes and/or reductions in health service utilisation. The present study estimates the cost and cost-effectiveness of the NET intervention, as compared to the passive dissemination of the guideline, to evaluate whether any improvements in clinical practice or health outcomes due to the NET intervention can be obtained at an acceptable cost. Methods and findings Study setting: The NET cluster randomised controlled trial [ACTRN12612001286831]. Study sample: Seventeen EDs were randomised to the control condition and 14 to the intervention. One thousand nine hundred forty-three patients were included in the analysis of clinical practice outcomes (NET sample). A total of 343 patients from 14 control and 10 intervention EDs participated in follow-up interviews and were included in the analysis of patient-reported health outcomes (NET-Plus sample). Outcome measures: Appropriate post-traumatic amnesia (PTA) screening in the ED (primary outcome). Secondary clinical practice outcomes: provision of written information on discharge (INFO) and safe discharge (defined as CT scan appropriately provided plus PTA plus INFO). Secondary patient-reported, post-discharge health outcomes: anxiety (Hospital Anxiety and Depression Scale), post-concussive symptoms (Rivermead), and preference-based health-related quality of life (SF6D). Methods: Trial-based economic evaluations from a health sector perspective, with time horizons set to coincide with the final follow-up for the NET sample (2 months post-intervention) and to 1-month post-discharge for the NET-Plus sample. Results: Intervention and control groups were not significantly different in health service utilisation received in the ED/inpatient ward following the initial mTBI presentation (adjusted mean difference $23.86 per patient; 95%CI - $106, $153; p = 0.719) or over the longer follow-up in the NET-plus sample (adjusted mean difference $341.78 per patient; 95%CI - $58, $742; p = 0.094). Savings from lower health service utilisation are therefore unlikely to offset the significantly higher upfront cost of the intervention (mean difference $138.20 per patient; 95%CI $135, $141; p 0.000). Estimates of the net effect of the intervention on total cost (intervention cost net of health service utilisation) suggest that the intervention entails significantly higher costs than the control condition (adjusted mean difference $169.89 per patient; 95%CI $43, $297, p = 0.009). This effect is larger in absolute magnitude over the longer follow-up in the NET-plus sample (adjusted mean difference $505.06; 95%CI $96, $915; p = 0.016), mostly due to additional health service utilisation. For the primary outcome, the NET intervention is more costly and more effective than passive dissemination; entailing an additional cost of $1246 per additional patient appropriately screened for PTA ($169.89/0.1363; Fiellers 95%CI $525, $2055). For NET to be considered cost-effective with 95% confidence, decision-makers would need to be willing to trade one quality-adjusted life year (QALY) for 25 additional patients appropriately screened for PTA. While these results reflect our best estimate of cost-effectiveness given the data, it is possible that a NET intervention that has been scaled and streamlined ready for wider roll-out may be more or less cost-effective than the NET intervention as delivered in the trial. Conclusions While the NET intervention does improve the management of mTBI in the ED, it also entails a significant increase in cost and--as delivered in the trial--is unlikely to be cost-effective at currently accepted funding thresholds. There may be a scope for a scaled-up and streamlined NET intervention to achieve a better balance between costs and outcomes. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612001286831, date registered 12 December 2012. Keywords: Mild head injury, Mild traumatic brain injury, Emergency medicine, Implementation science, Clinical practice guideline, Evidence-based practice, Cost-effectiveness
    Keywords: Evidence-Based Practice – Research ; Head Injuries – Care and Treatment ; Hospital Emergency Services – Usage ; Medical Economics – Analysis;
    ISSN: 1748-5908
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  • 8
    Language: English
    In: 2014, Vol.11(2), p.e1001603
    Description: Julian Elliott and colleagues discuss how the current inability to keep systematic reviews up-to-date hampers the translation of knowledge into action. They propose living systematic reviews as a contribution to evidence synthesis to enhance the accuracy and utility of health evidence.
    Keywords: Policy Forum ; Medicine
    ISSN: 15491277
    E-ISSN: 1549-1676
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  • 9
    Language: English
    In: Implementation Science, 01 August 2012, Vol.7(1), p.74
    Description: Abstract The Neurotrauma Evidence Translation (NET) program was funded in 2009 to increase the uptake of research evidence in the clinical care of patients who have sustained traumatic brain injury. This paper reports the rationale and plan for this five-year knowledge translation research...
    Keywords: Knowledge Translation Research ; Study Protocol ; Neurotrauma ; Traumatic Brain Injury ; Public Health
    ISSN: 1748-5908
    E-ISSN: 1748-5908
    Source: Directory of Open Access Journals (DOAJ)
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  • 10
    Language: English
    In: BMC Health Services Research, 01 May 2004, Vol.4(1), p.8
    Description: Abstract Background The interface between primary care and specialist medical services is an important domain for health services research and policy. Of particular concern is optimising specialist services and the organisation of the specialist workforce to meet the needs and demands for specialist...
    Keywords: Public Health
    ISSN: 1472-6963
    E-ISSN: 1472-6963
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