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Biomedical subjects

A Oxman

Publications and source records attributed to A Oxman.

11 recordsLinked to original sources
PubMed2001

Strategies for partner notification for sexually transmitted diseases.

BACKGROUND: Partner notification has been practiced for decades, with substantial resources directed towards it, and with little evidence on whether it has made a public health impact on disease transmission. Most of the evaluations were not randomized controlled trials, and were conducted in the United States, prior to the HIV/AIDS epidemic. There are reasons to question whether partner notification for gonorrhoea and chlamydia is applicable to HIV. It is also questionable whether interventions for the developed world are applicable to the developing world. OBJECTIVES: This review aims to compare the effects of various sexually transmitted disease (STD) partner notification strategies, including to compare provider referral with contract and patient referral, and to compare different patient referral strategies to each other. In addition to updating previous reviews, it addresses partner notification in developing countries as well as in developed countries, with particular consideration for HIV/AIDS. It attempts to address some of the methodological limitations of earlier reviews. SEARCH STRATEGY: The search strategy included MEDLINE, EMBASE, Psychological Abstracts, Sociological Abstracts, the Cochrane Controlled Trials register, the proceedings of the International AIDS Conferences and the International Society for STD Research meetings. SELECTION CRITERIA: The review includes published or unpublished randomised controlled trials (RCTs) comparing two or more partner notification strategies for people diagnosed with STDs. DATA COLLECTION AND ANALYSIS: For each comparison within each study, the difference in the rate of partners elicited, notified, medically evaluated, harmed, etc, the 95% confidence interval, and if significant, the numbers needed to treat (NNT) were calculated. MAIN RESULTS: We found 11 RCTs, including 8014 participants. Only two trials were conducted in developing countries, and only two trials were conducted among HIV positive patients. There was some risk of bias in all the included trials. The review found moderately strong evidence that: 1. provider referral alone, or the choice between patient and provider referral, when compared with patient referral among patients with HIV or any STD, increases the rate of partners presenting for medical evaluation; 2. contract referral, when compared with patient referral among patients with gonorrhoea, results in more partners presenting for medical evaluation; 3. verbal, nurse-given health education together with patient-centred counselling by lay workers, when compared with standard care among patients with any STD, results in small increases in the rate of partners treated. REVIEWER'S CONCLUSIONS: There is a need for evaluations of interventions combining provider training and patient education, and for evaluations conducted in developing countries. All partner notification evaluations, but especially those among HIV positive patients, need to measure potential harmful effects, such as domestic violence, to ensure that partner notification does more good than harm.

Chlamydia Infections↗
PubMed2001

Changing provider behavior: an overview of systematic reviews of interventions.

BACKGROUND: Increasing recognition of the failure to translate research findings into practice has led to greater awareness of the importance of using active dissemination and implementation strategies. Although there is a growing body of research evidence about the effectiveness of different strategies, this is not easily accessible to policy makers and professionals. OBJECTIVES: To identify, appraise, and synthesize systematic reviews of professional educational or quality assurance interventions to improve quality of care. RESEARCH DESIGN: An overview was made of systematic reviews of professional behavior change interventions published between 1966 and 1998. RESULTS: Forty-one reviews were identified covering a wide range of interventions and behaviors. In general, passive approaches are generally ineffective and unlikely to result in behavior change. Most other interventions are effective under some circumstances; none are effective under all circumstances. Promising approaches include educational outreach (for prescribing) and reminders. Multifaceted interventions targeting different barriers to change are more likely to be effective than single interventions. CONCLUSIONS: Although the current evidence base is incomplete, it provides valuable insights into the likely effectiveness of different interventions. Future quality improvement or educational activities should be informed by the findings of systematic reviews of professional behavior change interventions.

Education, Medical, Continuing↗
PubMed1998

The limits of leadership: opinion leaders in general practice.

OBJECTIVE: To explore the importance and characteristics of opinion leaders in general practice, particularly in relationship to the use of laboratory tests. DESIGN: Focus group discussions and a mailed survey. SUBJECTS: Five focus groups (n = 29 participants) in four different municipalities and a random sample of 85 general practitioners (GPs) in Norway. RESULTS: While Norwegian GPs recognised colleagues who were influential in determining how they practised, they found it difficult to identify opinion leaders specifically with respect to the use of laboratory tests. Opinion leaders were thought to be less important in influencing the use of laboratory tests than continuing medical education activities and practice guidelines, but more important than industry, patients or personal financial interests. Norwegian GPs recognised and characterised opinion leaders in much the same way as physicians in the USA. Influential colleagues were characterised as being good conveyers of information and willing to take time, as well as being up-to-date and having a high level of clinical expertise. GPs expressed a negative attitude towards 'superspecialists' who give advice without knowing the epidemiology of general practice, people who are arrogant and people who do not show respect towards GPs. CONCLUSIONS: The potential to identify and use opinion leaders to improve the use of laboratory tests by GPs in Norway appears to be limited.

Attitude of Health Personnel↗
PubMed1996

Screening for toxoplasmosis in pregnancy: what is the evidence of reducing a health problem?

OBJECTIVES: Toxoplasma gondii is a parasite which may give rise to congenital infection. Screening pregnant women for antibodies against toxoplasmosis is being debated in many countries. The preventive impact of toxoplasmosis screening of pregnant women depends on the magnitude of disease caused by congenital toxoplasmosis (incidence x transmission rate to fetus x diseased proportion of infected children), on the one hand, and the preventable proportion of disease (sensitivity of the screening test x efficacy of the treatment x compliance), on the other. In this study the preventive impact of screening pregnant women for toxoplasmosis antibodies is assessed by letting the value for these variables change within reasonable limits. METHODS: To obtain information on these variables, relevant publications were reviewed in the Medline database from 1983 to February 1996 and the Cochrane Pregnancy and Childbirth Database. References in review articles on congenital toxoplasmosis were also studied. RESULTS: The literature review showed that no population based prospective studies of the natural history of toxoplasmosis infection during pregnancy, nor any randomised controlled trials of the efficacy of antiparasitic treatment, had been carried out. In the empirical studies which have been performed the values of most variables show considerable differences. According to these values, the estimates in this study of the impact of toxoplasmosis screening in pregnancy may range from 0 to 40 children in whom disease is preventable per 100,000 pregnant women susceptible to toxoplasmosis infection. CONCLUSION: Sufficient scientific evidence is not yet available to propose screening for toxoplasmosis in pregnant women, and efforts should be made to provide such knowledge. Also, the magnitude of the negative impact of screening, such as induced abortion of healthy fetuses, anxiety in women with false positive screening tests, and side effects of treatment, has not been sufficiently examined.

Antiprotozoal Agents↗