Browsing by Author "Kredo, Tamara"
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- ItemOpen AccessAGREE to disagree: critical appraisal and the publication of practice guidelines(2014) Wiseman, Roger; Cohen, Karen; Gray, Andy; Jamaloodien, Khadija; Kredo, Tamara; Miot, Jacqui; Parrish, Andy; Taylor, Bettina; Blockman, MarcFaced by an explosion in available evidence for multiple new treatments, busy clinicians value guidelines that are clear, reliable, unbiased and locally applicable. Finding them can be difficult, however. The science of guideline development has moved rapidly in the past decade, resulting in a more robust and systematic process. However, just as the language of evidence-based medicine can be subverted to sound convincing while hiding errors and biases, so too guidelines may look convincing but lack many of the elements needed to ensure quality of care. In particular, the pharmaceutical and health technology industries are intensely aware of the marketing potential offered by widely disseminated and ostensibly neutral documents that ultimately influence medical practice.
- ItemOpen AccessThe clinical role of therapeutic drug monitoring of antiretrovirals : a Cochrane systematic review(2008) Kredo, Tamara; Cohen, KarenThe objective of this study is to evaluate whether ARV TDM reduces mortality and morbidity of adult patients on cART.
- ItemOpen AccessThe impact of the National HIV Health Care Worker Hotline on patient care in South Africa(BioMed Central Ltd, 2011) Chisholm, Briony; Cohen, Karen; Blockman, Marc; Kinkel, Hans-Friedemann; Kredo, Tamara; Swart, AnnoesjkaBACKGROUND:South Africa has a huge burden of illness due to HIV infection. Many health care workers managing HIV infected patients, particularly those in rural areas and primary care health facilities, have minimal access to information resources and to advice and support from experienced clinicians. The Medicines Information Centre, based in the Division of Clinical Pharmacology at the University of Cape Town, has been running the National HIV Health Care Worker (HCW) Hotline since 2008, providing free information for HIV treatment-related queries via telephone, fax and e-mail. RESULTS: A questionnaire-based study showed that 224 (44%) of the 511 calls that were received by the hotline during the 2-month study period were patient-specific. Ninety-four completed questionnaires were included in the analysis. Of these, 72 (77%) were from doctors, 13 (14%) from pharmacists and 9 (10%) from nurses. 96% of the callers surveyed took an action based on the advice received from the National HIV HCW Hotline. The majority of actions concerned the start, dose adaption, change, or discontinuation of medicines. Less frequent actions taken were adherence and lifestyle counselling, further investigations, referring or admission of patients. CONCLUSIONS: The information provided by the National HIV HCW Hotline on patient-specific requests has a direct impact on the management of patients.
- ItemOpen AccessNational stakeholders’ perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa(BioMed Central, 2018-07-31) Kredo, Tamara; Cooper, Sara; Abrams, Amber; Daniels, Karen; Volmink, Jimmy; Atkins, SallaBackground There is increased international focus on improving the rigour of clinical practice guideline (CPG) development practices. However, few empirical studies on CPG development have been conducted in low- and middle-income countries. This paper explores national stakeholders’ perceptions of processes informing CPG development for primary healthcare in South Africa, focusing on both their aspirations and views of what is actually occurring. Methods A qualitative study design was employed including individual interviews with 37 South African primary care CPG development role-players. Participants represented various disciplines, sectors and provinces. The data were analysed through thematic analysis and an interpretivist conceptual framework. Results Strongly reflecting current international standards, participants identified six ‘aspirational’ processes that they thought should inform South African CPG development, as follows: (1) evidence; (2) stakeholder consultation; (3) transparency; (4) management of interests; (5) communication/co-ordination between CPG development groups; and (6) fit-for-context. While perceptions of a transition towards more robust processes was common, CPG development was seen to face ongoing challenges with regards to all six aspirational processes. Many challenges were attributed to inadequate financial and human resources, which were perceived to hinder capacity to undertake the necessary methodological work, respond to stakeholders’ feedback, and document and share decision-making processes. Challenges were also linked to a complex web of politics, power and interests. The CPG development arena was described as saturated with personal and financial interests, groups competing for authority over specific territories and unequal power dynamics which favour those with the time, resources and authority to make contributions. These were all perceived to affect efforts for transparency, collaboration and inclusivity in CPG development. Conclusion While there is strong commitment amongst national stakeholders to advance CPG development processes, a mix of values, politics, power and capacity constraints pose significant challenges. Contrasting perspectives regarding managing interests and how best to adapt to within-country contexts requires further exploration. Dedicated resources for CPG development, standardised systems for managing conflicting interests, and the development of a political environment that fosters collaboration and more equitable inclusion within and between CPG development groups are needed. These initiatives may enhance CPG quality and acceptability, with associated positive impact on patient care.
- ItemOpen AccessScreening strategies for adults with type 2 diabetes mellitus(2022) Mearns, Helen; Kagina, Benjamin M; Kredo, Tamara; Schmidt, Bey-MarriéThere are insufficient randomized controlled trials to address whether screening for type 2 diabetes mellitus (T2DM) improves health outcomes. This systematic review sought to cast a wider net and synthesise evidence from non-randomised intervention studies to assess the effectiveness of T2DM screening in adults for reducing mortality and T2DM-associated morbidity. We searched PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Academic Search Premier and Health Source Nursing Academic (inception onwards; last search July 2021). We included non-randomised intervention studies that assessed T2DM screening compared to no screening, in adults without known T2DM. Screening was performed independently by two reviewers. Data was abstracted by one reviewer and checked by a second, as was risk of bias (ROBINS-I) and certainty of evidence (GRADE). A narrative summary was performed. We screened 10,892 records, retrieving 67 for full-text screening with one record meeting inclusion criteria. The study was a prospective cohort comparing T2DM screening versus no screening. It included adults, 40 - 65 years, with no known T2DM from a single community practice in Ely, England (N = 4,936) and evaluated outcomes at two time periods. The study was assessed as having moderate risk of bias. There may be little or no difference in mortality between those who were invited to screening versus those who were not invited (1990-1999: adjusted hazard ratio (aHR) 0.79 [95% confidence interval (CI) 0.63 – 1.00], n = 4,936, low certainty evidence and 2000 - 2008: aHR 1.18 [95% CI 0.93 - 1.51], n = 3,002, low certainty evidence). We found only one study reporting the effectiveness of screening for T2DM in adults. Therefore, despite ongoing T2DM screening in clinical care, this review highlights an important research gap in understanding the true health benefits of screening.