Browsing by Author "Kredo, T."
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- ItemBuilding capacity for development and implementation of clinical practice guidelines(Health and Medical Publishing Group, 2017) Louw, Q.; Dizon, J. M.; Grimmer, K.; McCaul, M.; Kredo, T.; Young, T.Robust, reliable and transparent methodologies are necessary to ensure that clinical practice guidelines (CPGs) meet international criteria. In South Africa (SA) and other low- and middle-income countries, upskilling and training of individuals in the processes of CPG development is needed. Since de novo CPG development is time-consuming and expensive, new emerging CPG-development approaches (adopting, contextualising, adapting and updating existing good-quality CPGs) are potentially more appropriate for our context. These emerging CPG-development methods are either not included or sparsely covered in existing training opportunities. The SA Guidelines Excellence (SAGE) team has responded innovatively to the need for CPG training in SA. We have revised an existing SA course and developed an online, open-access CPG-development toolkit. This Guideline Toolkit is a comprehensive guideline resource designed to assist individuals who are interested in knowing how to develop CPGs. Findings from the SAGE project can now be implemented with this innovative CPG training programme. This level of CPG capacity development has the potential to influence CPG knowledge, development, practices and uptake by clinicians, managers, academics and policy-makers around the country.
- ItemEvidence insufficient to confirm the value of population screening for diabetes and hypertension in low- and-middle-income settings(Health & Medical Publishing Group, 2015) Durao, S.; Ajumobi, O.; Kredo, T.; Naude, C.; Levitt, N. S.; Steyn, K.; Bradshaw, D.; Young, T.To assess the evidence from systematic reviews on the effect on morbidity and mortality of blanket screening for hypertension or diabetes mellitus compared with targeted, opportunistic or no screening, we searched for relevant systematic reviews and conducted duplicate study selection, data extraction and quality appraisal. Results were summarised narratively. We included two completed reviews of moderate quality and one ongoing Cochrane review. In one completed review, general health checks had no effect on total morbidity or mortality or on healthcare services compared with no health checks. In the other, intensive hypertension screening methods were ineffective in increasing screening uptake or detecting new cases compared with less intensive methods. Both reviews included studies in high-income settings. There is insufficient evidence from currently available systematic reviews to confirm a beneficial effect of blanket screening for hypertension and/or diabetes compared with other types of screening methods in low- and middle-income settings. Scarce resources are being mobilised to implement mass screening intervention for diabetes and hypertension without adequate evidence of its effects. A systematic review is needed to assess clinical effectiveness, cost-effectiveness and overall impact on the health system of screening strategies, especially in low- and middle-income settings such as exist in South Africa. Robust evaluation of these outcomes would then be necessary to inform secondary prevention strategies.
- ItemInterventions for improving childhood vaccination coverage in low- and middle-income countries(Health & Medical Publishing Group, 2015) Wiysonge, Charles S.; Young, T.; Kredo, T.; McCaul, M.; Volmink, J.Cochrane Corner’ in the November SAMJ highlights a Cochrane review that evaluated the effects of interventions for improving childhood vaccination coverage in low- and middle-income countries. Question: Which interventions increase the uptake of childhood vaccines in low and middle-income countries? Bottom line: Health education, home visits, and reminders probably increase the uptake of childhood vaccines in low and middle-income countries.
- ItemPre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction (Review)(2014) Lourens, A.; Kredo, T.; McCaul, M.Background: Early thrombolysis for individuals experiencing a myocardial infarction is associated with better mortality and morbidity outcomes. While traditionally thrombolysis is given in hospital, pre-hospital thrombolysis is proposed as an effective intervention to save time and reduce mortality and morbidity in individuals with ST-elevation myocardial infarction (STEMI). Despite some evidence that prehospital thrombolysis may be delivered safely, there is a paucity of controlled trial data to indicate whether the timing of delivery can be effective in reducing key clinical outcomes. Objectives: To assess the morbidity and mortality of pre-hospital versus in-hospital thrombolysis for STEMI.
- ItemRestricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents (Review)(2014) Parry, C. D. H.; Jere, M.; Kredo, T.; Volmink, J.; Ataguba, J. E.; Pienaar, D. C.; Siegfried, N.Background: Alcohol is estimated to be the fifth leading risk factor for global disability-adjusted life years. Restricting or banning alcohol advertising may reduce exposure to the risk posed by alcohol at the individual and general population level. To date, no systematic review has evaluated the effectiveness, possible harms and cost-effectiveness of this intervention. Objectives: To evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter-advertising, on alcohol consumption in adults and adolescents.
- ItemTask shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy(Cochrane, 2014) Adeniyi, F. B.; Kredo, T.; Bateganya, M.; Pienaar, E. D.Background: The high levels of healthcare worker shortage is recognised as a severe impediment to increasing patients’ access to antiretroviral therapy. This is particularly of concern where the burden of disease is greatest and the access to trained doctors is limited.This review aims to better inform HIV care programmes that are currently underway, and those planned, by assessing if task-shifting care from doctors to non-doctors provides both high quality and safe care for all patients requiring antiretroviral treatment. Objectives: To evaluate the quality of initiation and maintenance of HIV/AIDS care in models that task shift care from doctors to non-doctors.
- ItemTask-shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy(Health and Medical Publishing Group, 2015) Kredo, T.; McCaul, M.; Volmink, J.'Cochrane Corner’ in the August SAMJ offers evidence relating to articles published in this issue, namely ‘Improving access to antiretrovirals in rural South Africa – a call to action’, ‘Multimorbidity, control and treatment of non-communicable diseases among primary healthcare attenders in the Western Cape, South Africa’ and ‘Prevalence of tobacco use among adults in South Africa: Results from the first South African National Health and Nutrition Examination Survey’, and the editorial by Yach and Alexander, ‘Turbo-charging tobacco control in South Africa’.