Tomah VA uses mobile technology to enhance care

Dr. Sarah Niles was one of the Tomah VA providers who received an iPad as part of the VA Mobile Health Provider Program, an effort to provide VA health care teams with mobile devices to enhance the way they deliver care.

As a hospitalist at the Tomah VA Medical Center in Wisconsin, Dr. Sarah Niles’s 13 to 14-hour days are spent on the move within the hospital, which consists of a series of buildings connected by walkways. Depending on where she begins and where she is headed, it can take her anywhere from a few minutes to 15 minutes to walk to her next destination. For her, a mobile device provides the flexibility to be connected even when she’s on the move.  

In July 2014, Niles received an iPad as part of the VA Mobile Health Provider Program, an effort to provide VA health care teams with mobile devices to enhance the way they deliver care. The mobile devices are equipped with access to VA email, the VA App Catalog, commercial mHealth apps available through the Apple App Store, and Virtual Private Network (VPN) capabilities to access information in the medical center as well as off-site.

Although Niles has only been a part of the Mobile Health Provider Program for a few months, she has already found real value in her mobile device.

“I have found the iPad very useful,” she said. “For example, if I’m bedside with a patient who is not stable and I don’t want to leave them, I can now use my iPad to place orders directly to the laboratory, radiology or pharmacy.”

Previously, Niles had to leave the patient’s bedside and walk to a computer work station to place these orders. If instant orders were needed for a critically ill patient, she would have to give the nurse a verbal order. Thanks to the mobile technology she can remain at the patient’s bedside and send the order request directly to the appropriate department.

“Sending real-time orders through the iPads improves communication and patient safety because it reduces the risk of verbal order errors, and the laboratory, radiology, and pharmacy know exactly what is needed,” said Niles. “This enables the treatment team to accurately begin preparing the needed studies or medications for faster results.”

The Tomah VA is among 18 sites to receive mobile devices through this program. In total, more than 7,000 VHA providers and staff have begun incorporating mobile devices into their clinical practice. As the Mobile Health Provider Program continues to evolve, so do the opportunities to integrate mobile technology into enhanced care delivery. 

For more information on the Mobile Health Provider Program, please visit: https://mobilehealth.va.gov/providers.

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VA Announces Single Regional Framework under MyVA

New regions will enhance service to Veterans

Internal Organizations to Realign Their Existing Structures

Washington – The Department of Veterans Affairs (VA) today announced that it is taking the first steps under the MyVA initiative to realign its many organizational maps into one map with five regions to better serve Veterans. 

The new regions under the MyVA alignment will allow VA to begin the process of integrating disparate organizational boundaries into a single regional framework to enhance internal coordination. 

“We want every Veteran to have a seamless, integrated, and responsive VA customer service experience every time.  This regional alignment is the first step in empowering Veterans to interact with one VA – MyVA,” said Secretary Robert McDonald. “Ultimately, this reform will improve the Veteran experience by enabling Veterans to more easily navigate VA and access their earned care and benefits.”

VA’s new regional design utilizes state boundaries to divide the country into five regions.  Each organization within VA will begin work to ensure their structures are aligned within this framework by the end of June 2015. 

Veterans are already seeing the impacts of changes made through the MyVA initiative. For example, at the suggestion of VA employees, the Department has made improvements to VA call center operations, to allow call center agents to suspend or resume certain benefit payments at the request of the Veteran, which eliminates additional steps typically required of Veterans.  Also at the suggestion of employees, VA is working towards piloting improved signage in certain facilities, to make sure Veterans know where they are going and that directions are easy to follow. 

Additional VA efforts are currently underway to define the next steps to transform the Department into one that is more centered on the Veteran.

Background on MyVA

Launched on September 2, 2014, MyVA is an initiative which will reorient VA around Veteran needs and empower employees to assist them in delivering excellent customer service to improve the Veteran experience. It is the largest department-wide transformation in VA’s history and will be a product of ideas and insights shared by Veterans, employees, members of Congress, VSOs, and other stakeholders.

The first phase of MyVA has included creating the task force and building the team to support the mission and an organizational change of this breadth.  MyVA is focused on five areas of improvement:

1) Improving the Veteran experience

2) Improving the employee experience so they can better serve Veterans

3) Improving internal support services

4) Establishing a culture of continuous improvement, and

5) Enhancing strategic partnerships.

[ The Regional Map can be see at: http://www.va.gov/opa/publications/docs/myva-5-regions-map.pdf ]

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Veterans Integrated Health Care Addition Opening

Veterans Integrated Health Care Addition Opening

Manchester VA Medical Center (Manchester VAMC) is proud to announce the opening of a Veterans Integrated Health Care Addition. The new addition is a 13,000 square foot state-of-the-art space dedicated to the delivery of Veteran health care, including Nurse First (expedited care provided by a registered nurse to resolve minor health concerns), Primary Care, and Mental Health services.

The new addition located on the main campus at 718 Smyth Road, in Manchester, NH includes:

• Handicap parking at public entrance with curb side drop off and wheelchair access
• 32 Evaluation Rooms
• Group treatment conference room with telehealth/video capacity
• Secure tele-video conferencing equipment, allowing Veterans to receive care remotely
• Wireless tablets for providers
• Waiting room with a children’s area, and restrooms with changing stations
• A state-of-the-art check-in area, including a technology charging station
• Information Desk and way finding
• Parking lot shuttle services monitored by continuous loop or at your request, dial 624-4366 extension 6197

At Manchester VAMC, our model of care is to provide an outstanding care experience, and to maintain optimum health for Veterans through proactive care and preventive medicine. The medical center addition incorporates advancements to support this model of care, improve communication with Veterans and increase access to health care.

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World of Women

Dr. Veronica Ades

Daughter of a Colombian mother and Puerto-Rican born Syrian Jew, Dr. Veronica Ades has always felt like a citizen of the world. The new Gynecologist at VA New York Harbor Healthcare System says she was bought up to understand the importance of community service. As a physician, her specific interest in Global Health and the disparities in wealth brought her to Uganda, South Sudan and Jordan with Doctors Without Borders and her fellowship in Reproductive Infectious Disease. On these overseas missions, she tended to difficult obstetric deliveries and a range of GYN illnesses.

Today, Dr. Ades, a native New Yorker, is back living in Brooklyn. At her new job at VA New York Harbor Healthcare System, she treats women Veterans with gynecological issues such as abnormal Pap smears and fibroids and performs laparoscopy and hysteroscopic surgery among other minimally invasive procedures. She advises women regarding routine mammograms, contraception, menopausal symptoms, substance abuse and prenatal and postpartum care. Women Veterans are referred to affiliated hospitals for deliveries.

Dr. Ades says, “I fell in love with Gyn in medical school because of its intensity and the opportunity to talk about subjects that may be taboo but are so important to people's lives." Among other areas of major interest, Dr. Ades says she is committed to treating patients who have experienced Military Sexual Trauma (MST), and in pursuing research about medical problems such as unintended pregnancy and infectious diseases related to these traumatic events. Beyond the clinical problems relating to MST, outside VANYHHS, Dr. Ades oversees a Gouverneur Hospital clinic on the Lower East Side for the care of survivors of sex trafficking and domestic abuse.

In general, Dr. Ades says that recovery for the survivors of abuse is multifaceted. Coming in for treatment is often an act of courage, and tolerating a medical exam itself may be a challenge for women who have suffered abuse.” Dr. Ades added, “the symptoms are worse if there's a history of childhood sex abuse; a sense of being trapped is worse that the trauma itself. Recovery depends on re-empowering oneself and coming to an understanding of one’s needs."

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Heat Sensitivity & Multiple Sclerosis

The Australian summer can be very challenging for people living with multiple sclerosis. 

Nerves that are damaged by multiple sclerosis can become sensitive to heat and even a small increase in temperature of 0.5^oC can temporarily make symptoms worse.

By resting and cooling, symptoms will usually settle down again once the nerves return to normal temperature.  It’s important for people living with multiple sclerosis to take precautions to prevent unnecessary exposure to heat. These simple tips can help:

• Change your fitness regime
  While it is difficult to stay motivated and exercise in the heat, it’s essential to continue exercising in order to maintain muscle strength and fitness. Consider activities which are less likely to cause overheating such as swimming, tai chi and yoga, and exercising in the cooler parts of the day.
• Cooling garments
  Invest in specialist cooling garments such as vests, neck ties and hats that are designed to lower your body temperature using cooling agents. Some providers offer a discount to people living with multiple sclerosis. Call MS Connect on 1800 042 138 for more information.
• Apply for government rebates
  Energy-hungry air conditioners and fans increase energy bills during the summer months. While most providers will let you pay off your electricity bill in instalments, some states also offer energy concessions for people living with multiple sclerosis:
• Health Care Card Holders in Victoria can apply for the Medical Cooling Concession — see www.dhs.vic.gov.au
  
  Health Care Card Holders in NSW can apply for the Medical Energy Rebate — see www.resourcesandenergy.nsw.gov.au
  
  Concession Card Holders in ACT can apply for the Life Support Rebate — see www.assistance.act.gov.au
  
  Multiple Sclerosis Limited (MS) also runs a needs-based Financial Assistance Program to support eligible clients who are experiencing financial hardship with the costs of cooling products. For eligibility criteria and more information, contact MS Connect on 1800 042 138.
• Stay hydrated
  Drink plenty of fluids to replace those lost through perspiration and evaporation. Select meals that combine lean protein, good fats, plenty of vegetables and just the right amount of wholegrain carbohydrates to keep your nutrition levels up without over-working the body during digestion.
• Give yourself a break
  Readjust your plans to adapt to the heat. Give yourself permission to leave some tasks to another day and plan rest periods for the hottest part of the day.
• Make your fan work harder
  Dampen your shirt or put a wet towel around your shoulders and stand in front of a fan to cool down more quickly. You can also lay a wet towel over you while you sleep in front of the fan.
• Make your own cool packs
  Simply fill a plastic bag with water and freeze it to make a cool pack. Wrap it in a sock or towel and place it around your neck or on your chest.
• Freeze your bedding
  Put your sheets in a plastic bag and pop them in the freezer. Put them back on the bed just before you go to sleep to keep you cooler while you drift off. There are also some new products on the market, such as ‘Chillow Pillows’ and cooling blankets.
• Know who to call when you need help
  If you’re having difficulty managing your symptoms in the heat, please seek help:
  
  MS Connect provides free information and advice, and links you in to supports and services.
  Monday to Friday, 8.30am–5pm
  1800 042 138
  msconnect@ms.org.au
  
  If you are concerned or if you are unable to relieve your symptoms by cooling down, you should consult your GP or call 13SICK (that’s 13 7425) for a bulk-billed, after hours doctor home visit from National Home Doctor Service.  Our call centre is open from 4pm weekdays, 10am Saturdays, all day Sunday and public holidays

In an emergency you should always call Triple Zero (000)

MS and National Home Doctor Service have formed a partnership to provide even more support to people living with multiple sclerosis.

 

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As smokers spark up e-cigs to quit, traditional aids suffer

Luna, an electronic cigarette vaporizer, and its components are seen at Thermo-Essence Technologies in San Carlos, California May 2, 2014.

NEW YORK (Reuters) - When Marty Weinstein decided to quit smoking, he took a friend's advice and tried electronic cigarettes rather than government-approved nicotine replacement products.

Weinstein, 58, has gone from a pack a day nine months ago to the equivalent in nicotine of four or five cigarettes. The e-cigs have a familiar look and feel, and quench his desire to hold on to a cigarette and puff.

"I fully understand I'm still addicted to nicotine," said Weinstein, a Connecticut taxi driver who had smoked for more than 20 years. "But I'm now so much healthier."

E-cigarettes, metal tubes that heat liquids typically laced with nicotine and deliver vapor when sucked, are transforming the market for smoking cessation products and slowing the $2.4 billion in global sales of long-standing aids such as nicotine patches and gums. But their impact on health remains unclear, experts say, raising difficult questions for regulators who are starting to impose limits on e-cigarette use.

E-cigarette makers in the United States are barred from explicitly marketing the products as smoking cessation devices, but have found ways to appeal legally to smokers who are thinking of quitting.

“You never say 'quit' because it’s not approved by the FDA as a smoking cessation device,” said Jose Castro, the chief executive of A1 Vapors in Miami, referring to the U.S. Food and Drug Administration.

A1 Vapors runs an ad on its website urging customers to "kiss tobacco goodbye" and give themselves the "gift of your life. literally", adding a disclaimer that e-cigs are not a smoking cessation product.

E-cigarettes, or e-cigs, have only come into widespread use in the past few years, but have already made inroads into traditional quitting therapies.

About a third of British smokers trying to quit were using e-cigarettes, according to a University College London survey in January of 1,800 people, including 450 smokers.

E-cigs are used by almost twice as many people as government-approved nicotine gums, lozenges and patches, according to the survey. That was a reversal from 2011, when only about 5 percent of people were using e-cigarettes and more than 30 percent used over-the-counter products.

Similar data is not yet publicly available for the United States.

Worldwide sales of all nicotine replacement therapies grew just 1.2 percent last year, to almost $2.4 billion, according to data from commercial researcher Euromonitor. U.S. sales, at $900 million, grew 0.2 percent, and are expected by Euromonitor to drop this year by that amount.

Big tobacco companies like Altria, Lorillard and Reynolds American have rushed into the e-cig market. The entire U.S. market for "vapor devices" such as e-cigs grew in 2014 by 40-50 percent to $2.5 billion to $3 billion, Euromonitor said. The global market is worth $5 billion.

RULES ON E-CIGS TIGHTENING

Mark Strobel, a consumer health analyst at Euromonitor, said e-cigarettes have slowed nicotine replacement therapy sales, along with relatively high prices and a shrinking population of smokers, especially in the United States.

"For some consumers it has been a direct substitution."

GlaxoSmithKline (GSK) and Johnson & Johnson don't break out the data on their smoking cessation products, which are relatively small parts of their sales, but the companies have noted the change.

"It's definitely taken a bit of our market, no question at all - but there's a lot of competition in that space," GSK chief executive Andrew Witty told Reuters in an interview this month.

GSK's nicotine replacement therapies and smoking cessation products include the brands Nicorette, NicoDermCQ and the medicine Zyban.

There is little long-term safety data on e-cigarettes, although some healthcare professionals say they may be better for consumers than tobacco cigarettes because they have no carbon monoxide and fewer cancer-causing chemicals.

A growing number of states, cities and countries - including Israel and Australia - are considering or have approved legislation to ban or limit the devices or the liquids, which come in exotic flavors from bacon to bubble gum.

California's top public health official on Wednesday slammed e-cigs as addictive, saying they were leading to nicotine poisoning among children and threatened to unravel the state's decades-long effort to reduce tobacco use.

Earlier this week, California introduced a bill that would ban the devices in public places, and New York Gov. Andrew Cuomo proposed a similar ban earlier this month.

Last year, the World Health Organization recommended that smokers should be encouraged to try already approved treatments rather than e-cigarettes. The FDA last April proposed rules for electronic cigarettes that would, among other things, ban sales to those under 18, but not restrict flavored products, online sales or advertising.

MAKING SMOKING COOL AGAIN?

Many health experts worry that e-cigarettes will become established as smoking cessation aids before enough research is done to determine their health impact. Another concern is that they may stop people from quitting tobacco completely and deter people from trying potentially more effective methods.

Dr. Albert Rizzo, senior medical advisor for the American Lung Association, said that when patients ask about the products, he tells them it's good that they are trying to quit but: "We don't know enough to recommend them."

Some healthcare professionals said that even if they are not opposed to e-cigarettes, they are concerned about their marketing, especially to young people.

The Federal Trade Commission declined to comment on specific e-cig ads but said “advertising must be truthful, non-deceptive and supported by competent and reliable scientific evidence."

E-cigs risk bringing the "cool" back to smoking, reversing the progress over decades in which smoking has become less socially acceptable, said Dr. Robert K. Jackler, a professor at Stanford University School of Medicine.

"A lot of us are very concerned about the renormalization phenomenon," he said. "These glamorize smoking behavior."

Still, some doctors point to the low efficacy of traditional ways to quit smoking.

"They have better results than placebos, but their rates of success are quite low," said Dr. Michael Siegel, a professor at the Boston University School of Public Health, who said e-cigarettes are an alternative, especially for people who have tried the conventional therapies and failed.

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Trial finds GSK Ebola shot is safe and provokes immune response

LONDON (Reuters) - First results from a human trial of an Ebola vaccine from GlaxoSmithKline show it is safe and generates an immune response, scientists said on Wednesday, but larger trials are needed to see if it protects and if a booster is needed.

The vaccine is being developed by the U.S. National Institutes of Health (NIH) and GSK against the Zaire strain of Ebola -- the one circulating in West Africa -- and the first doses for a larger trial arrived in Liberia last week.

That trial is the first of several mid-stage studies planned for West Africa and aims to test GSK's vaccine and one from Merck and NewLink. Johnson & Johnson and Bavarian Nordic have a vaccine in early-stage clinical tests.

The early-stage Phase I trial of GSK's vaccine was primarily designed to test safety, but Adrian Hill, who led the work at Oxford's Jenner Institute, said it was "encouraging" that the shot also prompted responses from the immune system.

"The safety profile is pretty much as we'd hoped and the immune responses are okay, but not great," he told Reuters.

The data, published in the New England Journal of Medicine, were from 60 healthy volunteers given the vaccine in Britain between Sept. 17 and Nov. 18 last year.

The volunteers got one of three doses - low, medium, or high - and data from 28 days after vaccination showed the shot was safe at these doses, with only mild side effects.

"People typically experienced mild symptoms that lasted for one or maybe two days, such as pain or reddening at the injection site, and occasionally people felt feverish," Hill said.

However, the antibody response was weaker than was found in a trial of the same Ebola vaccine in macaque monkeys, in which the animals were also found to be protected.

Hill said the lower antibody levels, together with a lower response detected in the immune system's T-cells, suggested to him that a booster may well be needed.

Jeremy Farrar, director of the Wellcome Trust charity which helped fund the trial, said it provided "good initial evidence that the GSK vaccine will be safe to use in people".

"However, we still don't know whether it will provide protection against Ebola infection in a real-world situation," he said. "That's why trials in West Africa of this, and the other vaccines in development, must begin as soon possible."

(Editing by Louise Ireland)

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AstraZeneca bets on gene editing for broad range of new drugs

A sign is seen at an AstraZeneca site in Macclesfield, central England May 19, 2014.

LONDON (Reuters) - AstraZeneca said on Thursday it had struck four research collaborations in the hot area of genome editing as it bets on a new technology to deliver better and more precise drugs for a range of diseases.

The academic and commercial tie-ups will allow British-based AstraZeneca to use so-called CRISPR technology across its entire drug discovery platform in areas such as oncology, cardiovascular, respiratory and immune system medicine.

CRISPR, which stands for clustered regularly interspaced short palindromic repeats, allows scientists to edit the genes of selected cells accurately and efficiently. It has created excitement since emerging two years ago and is already being tipped for a Nobel Prize.

The collaborations with Britain's Wellcome Trust Sanger Institute, the Innovative Genomics Initiative in California, the Broad Institute and Whitehead Institute in Massachusetts, and Thermo Fisher Scientific build on an in-house CRISPR programme at AstraZeneca that has been running for over a year.

Other drugmakers, keen to exploit the potential of a powerful new scientific tool, are also jumping on the bandwagon.

Earlier this month Switzerland's Novartis struck deals with Intellia Therapeutics and Caribou Biosciences, two unlisted U.S. biotech companies that have been set up to take advantage of CRISPR.

While certain existing techniques already allow scientists to add genes to cells, CRISPR lets them make changes in specific genes far faster and in a much more precise way. It is also much easier to handle in the laboratory.

AstraZeneca believes the technology will help it identify and validate new drug targets more quickly, accelerating the drug development process.

"CRISPR is a simple yet powerful tool that enables us to manipulate genes of potential importance in disease pathways and examine the impact of these modifications in a highly precise way," said Mene Pangalos, AstraZeneca's head of innovative medicines and early development.

No financial details of the collaborations were disclosed but AstraZeneca said it would share cell lines and compounds with its partners, based on an "open innovation" research model. Neither side will own any targets identified.

(Editing by David Holmes)

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UnitedHealth backs Gilead's Harvoni as preferred hepatitis C treatment

(Reuters) - UnitedHealth Group Inc, the largest U.S. health insurer, on Wednesday backed Gilead Sciences Inc's Harvoni as the preferred hepatitis C treatment on its 2015 commercial drug coverage list, another victory for Gilead over competitor AbbVie Inc.

Gilead and AbbVie have been battling for hepatitis C market share since the approval in December for an AbbVie drug that challenges Gilead's blockbusters. Insurers and pharmacy benefit managers have been striking deals for preferred or exclusive status in exchange for discounts for 2015.

UnitedHealth's drug coverage list, which is effective Feb. 1, applies to all of the company's commercial, fully insured customers who use its Optum RX pharmacy benefit manager and self-insured customers such as large employers who follow the drug list.

The update to the formulary, available on the company's website, also applies to its Medicaid, Medicare and military contracts.

"We are constantly working to deliver value and manage costs for customers and consumers throughout our business," UnitedHealth spokesman Tyler Mason said in a statement.

Gilead declined to comment.

Gilead set off a firestorm last year when it launched a breakthrough treatment for hepatitis C called Sovaldi that carries an $84,000-per-treatment price tag.

Insurers, including UnitedHealth, were taken by surprise by its cost and called it out as an unexpected hit to profits last year.

Express Scripts, a pharmacy benefit manager, pushed back against the price of Sovaldi and Gilead's follow-up drug Harvoni, which has a list price of $93,400. It backed AbbVie's Viekira Pak, saying it had gotten a significant discount.

Analysts and investors say the treatments are being discounted by at least 30 percent. The companies have declined to comment.

UnitedHealth is the last of the top three U.S. insurers to strike a deal with either Gilead or AbbVie. Reuters reported two weeks ago that Aetna Inc had backed Gilead, as have Anthem Inc and Humana Inc. Pharmacy benefit manager CVS Health also went with Gilead while smaller competitor Prime Therapeutics kept both on its list.

The state of Missouri earlier this week said it had selected AbbVie's Viekira Pak for Medicaid patients who meet certain criteria, and said the agreement would reduce treatment costs by 30 to 40 percent.

UnitedHealth has 45 million medical customers. Of those, 18 million are employed by companies that are self-insured and use UnitedHealth to administer their plan benefits; not all those employers follow UnitedHealth's commercial drug guideline or use UnitedHealth for their drug benefits.

Gilead shares, which closed down 2.5 percent at $102.45, were trading slightly higher in after-hours activity at $103.11.

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Some Obamacare insurers discriminate against AIDS patients: study

NEW YORK (Reuters) - Some insurers selling policies under Obamacare may be structuring drug coverage in a way that dissuades people with HIV-AIDS from becoming their customers, according to a study published on Wednesday in the New England Journal of Medicine.

President Barack Obama's 2010 Affordable Care Act outlawed discrimination based on pre-existing conditions. Insurers cannot ask about current or past illnesses, charge people with, say, diabetes or cancer more than healthy people, or deny coverage.

Some, however, have found a way to discriminate anyway, wrote researchers at the Harvard T.H. Chan School of Public Health, "resorting to other tactics to dissuade high-cost patients" from enrolling.

Traditionally, insurers use formularies, lists of covered drugs and their out-of-pocket costs, to steer patients toward generic drugs or medicine for which a company has negotiated a favorable price. But formularies can be structured to put off people with pre-existing conditions, said co-author Ben Sommers.

He and Douglas Jacobs analyzed 48 Obamacare policies in 12 states using the federal Healthcare.gov marketplace. In 2014, 12 of the policies placed all covered HIV drugs called nucleoside reverse-transcriptase inhibitors, including generics, in tiers with at least a 30 percent co-pay, usually the highest. Some did not cover the drugs at all.

Customers in the 12 plans had an average annual cost per HIV drug more than triple that of customers in the other plans, $4,892 compared with $1,615.

Premiums in plans with the highest out-of-pocket costs for HIV drugs were lower than others', but someone with HIV would pay $3,000 more each year, the researchers calculated.

"This matches what we've seen in Illinois, where four of seven plans have what we consider unaffordable HIV drugs," said John Peller, president of the AIDS Foundation of Chicago. "We think insurers are looking for ways to make plans less welcoming to people with chronic conditions."

Insurers disagree.

"Individuals can pick the policy that is best for them," said Clare Krusing, spokeswoman for America's Health Insurance Plans, the industry's lobbying group. Subsidies "reduce out-of-pocket costs for prescription drugs even more."

In addition, Obamacare requires that insurers with few costly patients pay those with many, so deterring HIV customers makes no financial sense, she said.

Most of that transfer program phases out after 2016, however.

In late 2014, the Obama administration proposed a rule that would consider policies with all drugs for a condition in the highest out-of-pocket tier discriminatory and therefore disallowed.

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Why being a doctor is one of the best jobs in the world

Dr Mark Cavill has been one of the dedicated doctors working for National Home Doctor Service for more than ten years.  Below he shares what it’s like to be on the road visiting patients and what he enjoys most about his job every day. 

The variety each day brings: 

• Ask any GP if treating patients is all coughs and colds and they'll probably laugh and say “if only”! The persity of patients and symptoms that you can treat on a daily basis is one of the most enjoyable aspects of my job. I thrive on the variety and thrill of not knowing what will come from each home visit.

Feeling valued:

• The biggest tick of all is the people; it is the patients who make my job so enjoyable. To be invited into a person’s home to offer medical care is an honour, and you are always welcomed. I have been met in the driveway with cups of tea, offered to have my car parked and even offered dinner. I know it's a small thing, but as doctors we always appreciate our relationships with patients.

Flexibility: 

• Home visiting is a unique and privileged job. The work is flexible, not only for us as doctors, but for the patients too. We know how valuable it is for parents who are worried about a child’s high fever or earache; or for carers who want a doctor to check their elderly parent after a fall as the service allows them to stay home. In my view, young families and the elderly find this service invaluable. 

Seeing the good with the bad: 

• Being a GP you get the highs with the lows. Treating patients can be tough at times, but there are many positives. Think of managing patients during positive times in their life such as pregnancy and seeing patients get back to good health after a chronic illness. 

If you need a visit from National Home Doctor Service, call 13 SICK.  Home Doctor is available for home visits from 6pm weeknights, 12 noon on Saturdays, all day Sundays and public holidays. To find out if we cover your area, simply type your postcode in our suburb locator here.

 

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Chickenpox 101 from Huggies

 

Did you know approximately nine in ten people will catch chickenpox if they haven’t been vaccinated against it? 

 

Chickenpox is a disease caused by the herpes zoster virus, Varicella Zoster. It spreads from person to person through direct contact and can be very contagious. 

 

If your child has chickenpox, he or she might have:

• An elevated temperature 
• A prickling sensation on the skin
• A flushed and sweaty face
• The tell-tale rash - small red spots which quickly turn into clear fluid filled blisters which start to appear on the trunk and back
• An  intense feeling of itchiness that becomes almost impossible not to scratch 

 

Concerned your child might be developing symptoms of chickenpox? National Home Doctor Service can help. We’re a bulk-billing, after hours, doctor home visiting service and we’re available for home visits from 6pm weeknights, 12 noon on Saturdays, all day Sundays and public holidays.  Call us on 13 SICK (7425).

 

Click here to visit the Huggies website and learn more about chickenpox and how to alleviate the symptoms. 

 

To find out if we cover your area, simply type your postcode in our suburb locator here.

 

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Vaccinations Are Agony For Mummies! VACCINATIONS ARE ESSENTIAL KEEP CALM AND TAKE LOLLIPOPS

By Abi Gold, Family and Parenting Expert, Juggle Family and Parenting Consultancy

When you take your kids for their essential vaccination jabs, keep calm and take lollipops writes Family and Parenting Expert, Abi Gold.

What's the worst bit about being a mum? Is it the relentless fatigue, the tantrums, or perhaps finding poo in the bath?

 

For me, it's vaccinations, or rather being the one who takes my children to the doctor, holds them down and watches their faces crumple in agony. That's my very worst bit.

I don't doubt that vaccinations are essential to their good health and longevity. I believe my littlies are very lucky to have been born in a place where such things are taken for granted, when they are in fact extremely valuable gifts.

 

And I believe that as a mother and my kids' protector, that having them immunised, is a ‘no brainer’. But that's the ‘logical me’.

 

The ‘emotional me’ finds it really hard. The ‘emotional me’ wants to scoop my littlies up, and run far, far away. I want to save them from the needle, from their terrified struggles and that ‘little scratch’ which never really is little.

 

Then there's the expression of horror on their faces, the shock and the condemning look that says ‘traitor’. That bit makes me feel like a heel, and the logic, at that stage, is forgotten.

 

Ultimately though, taking the kids for their jabs has to be done, so the best way to approach it is in a calm and matter-of-fact way.  Your children look to you for their cues.  They rely on you to tell them how to behave in every situation, and vaccination time is no different.  

 

Hysteria and panic will not soothe your children, but will heighten their sensitivity, and make them hysterical too.  

 

Don't invite fear by talking about it in advance, just go in, keep calm, help the nurse to get the job done, and you'll be out of there before you know it.  Oh, and don't forget the lollipops. 

 

Actually, calm isn't a bad thing to take with you wherever you go. And your children will learn to roll with the blows. And there are blows out there, so give them a head start, and teach them how to cope.

 

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Good practice characteristics of diet and physical activity interventions and policies: an umbrella review

Background

This umbrella review aimed at eliciting good practice characteristics of interventions and policies aiming at healthy diet, increasing physical activity, and lowering sedentary behaviors. Applying the World Health Organization’s framework, we sought for 3 types of characteristics, reflecting: (1) main intervention/policy characteristics, referring to the design, targets, and participants, (2) monitoring and evaluation processes, and (3) implementation issues. This investigation was undertaken by the DEDPIAC Knowledge Hub (the Knowledge Hub on the DEterminants of DIet and Physical ACtivity), which is an action of the European Union’s joint programming initiative.

Methods

A systematic review of reviews and stakeholder documents was conducted. Data from 7 databases was analyzed (99 documents met inclusion criteria). Additionally, resources of 7 major stakeholders (e.g., World Health Organization) were systematically searched (10 documents met inclusion criteria). Overall, the review yielded 74 systematic reviews, 16 position review papers, and 19 stakeholders’ documents. Across characteristics, 25% were supported by ≥ 4 systematic reviews. Further, 25% characteristics were supported by ≥ 3 stakeholders’ documents. If identified characteristics were included in at least 4 systematic reviews or at least 3 stakeholders’ documents, these good practice characteristics were classified as relevant.

Results

We derived a list of 149 potential good practice characteristics, of which 53 were classified as relevant. The main characteristics of intervention/policy (n = 18) fell into 6 categories: the use of theory, participants, target behavior, content development/management, multidimensionality, practitioners/settings. Monitoring and evaluation characteristics (n = 18) were grouped into 6 categories: costs/funding, outcomes, evaluation of effects, time/effect size, reach, the evaluation of participation and generalizability, active components/underlying processes. Implementation characteristics (n = 17) were grouped into eight categories: participation processes, training for practitioners, the use/integration of existing resources, feasibility, maintenance/sustainability, implementation partnerships, implementation consistency/adaptation processes, transferability.

Conclusions

The use of the proposed list of 53 good practice characteristics may foster further development of health promotion sciences, as it would allow for identification of success vectors in the domains of main characteristics of interventions/policies, their implementation, evaluation and monitoring processes.

Keywords:

Physical activity; Sedentary behavior; Diet; Good practice; Intervention; Policy; Systematic review

Background

According to the World Health Organization (WHO) low levels of physical activity constitute the fourth leading risk factor for death worldwide and form a key risk factor for non-communicable diseases such as cancer, diabetes, and cardiovascular diseases [1]. Inadequate diet is related to increased likelihood of developing obesity, increased susceptibility to diseases such as diabetes and cardiovascular diseases, reduced immunity, and reduced productivity [1]. Therefore, as suggested by WHO [1] interventions and policies which focus on diet, physical activity, or sedentary behavior are in the main focus of various science disciplines, health organizations, practitioners, and policy makers. Unhealthy diet and physical inactivity are considered among leading causes of the same set the major non-communicable diseases [1], therefore interventions and policies targeting either one of these behaviors or both of them are considered complementary, serving the same overall goals, and they are guided by the same principles for action [1].

Policies constitute of a purposive course of actions to stimulate a healthy diet, physical activity, or to discourage sedentary behavior (defined as the amount of time per day spent sitting, in non-active activities such as watching TV, working at a computer, reading etc.). Policies are formulated in a specific political process; they are adopted, implemented, and enforced by regional, national or international public agencies [2]. In contrast, interventions are actions not yet endorsed, enabled or executed by governments or other public agencies. Interventions may address individuals’ skills, individuals’ beliefs, and contexts such as social systems, physical or build environment, or they may focus on practicing recommended behavior during the intervention sessions. Multilevel and multicomponent interventions may combine these actions and aim at changes at individual, social, and physical environmental levels. Such interventions and policies may have the greatest potential to be effective and thus they may be appealing to practitioners and funding bodies [3]. However, high complexity of interventions and policies hinders identification of the factors responsible for their success.

Good practice characteristics of interventions and polices

Although the number of studies on developing and testing the effects of interventions and policies is growing rapidly, practitioners, policy-makers and researchers indicate difficulties in eliciting factors responsible for a ‘success’ of interventions or policies [4]. ‘Successful’ interventions or policies may be defined as actions that result in significant and sustainable behavior changes and translate behavior change research into real-word settings [5]. Such successful interventions and policies may be characterized by a number of good practice characteristics. These characteristics may include the content of behavior change techniques [6] or aspects of delivery of these techniques [7]. Another line of research stresses that besides the content of an intervention or policy, other characteristics determining ‘successful’ promotion of healthy behaviors may refer to implementation strategies, settings, or integration with local practice [8].

Several conceptual frameworks propose the list of good practice characteristics, defined as characteristics of successful interventions and policies [9],[10]. Those lists vary in terms of the range of included characteristics, and in terms of the breadth of the scope. For example, they may focus on specific populations (e.g., children only) [10] or on aspects of implementation (e.g., fidelity to the protocols, consistent delivery) [9]. Although empirical evidence and theoretical developments are accumulating, we found no list of generic characteristics (e.g., non-specific in terms of population, addressing both policies and interventions), which would account for content, evaluation, and implementation aspects.

To identify a good practice characteristic that is typical of ‘successful’ interventions or policies one needs to establish a list of ‘candidate characteristics’ , which have a potential to determine a success. In case of some characteristics, the evidence accumulated in systematic reviews suggests that the presence (or absence) of a characteristic is linked to effects of interventions/policies on diet, physical activity, and sedentary behavior. The development of an evidence-based list of candidate characteristics may serve several aims, namely (1) it may inform the development of new interventions and policies by indicating areas, which should be considered when planning for new interventions/policies; (2) the list may be used as an extended protocol for reporting on interventions and policies; (3) it may promote collection of extended data on characteristics of interventions/policies; collection of these data would enable identifying the essential criteria of successful health promotion.

Reporting and categorizing characteristics of interventions and policies

A progress towards the development and synthesis of interventions and policies is hindered by a lack of widely approved standards of reporting interventions and policies [4]. Existing checklists and protocols for reporting interventions and policies provide some details, but their depth and breadth are limited. The guidelines for reporting are relatively vague, and thus there is not enough information for thorough replications of complex interventions or policies. For example, CONSORT guidelines [11] require reporting “precise details” of the interventions/policies and indicating “how and when they were actually administered”, therefore a very limited description of procedures may fit these standards. To further aid reporting guidelines, Davidson and colleagues [12] suggested that reports of behavior change actions should include details of: (1) the content, (2) characteristics of those delivering the intervention, (3) characteristics of the recipients, (4) settings (e.g., worksite), (5) the mode of delivery, (6) intensity of actions, (7) their duration, and (8) adherence to delivery protocols. Unfortunately, this proposal uses broad constructs; for example it does not specify the type of characteristics of recipients which may be relevant (e.g., minority status, age, beliefs). In sum, these proposals use broad and unspecific characteristics or leave out many characteristics (e.g., implementation, resources [9]) which may determine a success of interventions or polices.

There are several theoretical frameworks which may inform the organization of good practice characteristic. These frameworks tackle the complexity of characteristics, but they usually emphasize either the aspect of content or implementation, or evaluation processes. For example, the Behavior Change Wheel [13] focuses on the content of the interventions or policies, whereas other approaches such as RE-AIM model [9] focus on implementation processes. Another approach to organizing good practice characteristics was recently proposed by WHO [14]. This framework aims at eliciting and classifying good practice characteristics in actions targeting healthy diet and physically active lifestyle. Good practice characteristics were grouped in 3 domains: (1) main intervention/policy characteristics (including the general design, content, main objectives, planned activities, target groups, and stakeholders), (2) monitoring and evaluation (including outcomes, measurement, and process evaluation aspects), and (3) implementation (including performance of implementation, program management, and participation processes). This broad framework was validated in consultations with stakeholders and pilot tests conducted among large-scale program developers [14].

Aims

As the part of the investigation undertaken by the DEDPIAC project (the Knowledge Hub on the DEterminants of DIet and Physical Activity, which is the first Research Action of the European Union’s Joint Programming Initiative on healthy diet for healthy life) [15], the present study aimed at identifying characteristics of interventions and policies promoting healthy diet, physical activity, and a reduction of sedentary behavior. To achieve this target, we performed an umbrella review (i.e., a systematic review of existing reviews) which integrated empirical evidence from existing systematic reviews, position review papers, and stakeholders’ documents. The questions and methods were developed and approved using the rapid review approach [16]. We investigated the presence of attributes of good or recommended practices in policies and interventions targeting the general population, children, and adults. Applying the best practice framework [14], we sought for (1) main intervention/policy characteristics, (2) monitoring and evaluation characteristics, and (3) implementation characteristics.

Methods

Materials and general procedures

We conducted the umbrella review to identify systematic reviews and stakeholders’ documents. In general, systematic reviews and meta-analyses collate empirical evidence that fits pre-specified eligibility criteria, by using explicit, replicable, systematic search, extraction, and evaluation methods that are selected to minimize biases [17]. Umbrella reviews represent a way of synthesizing the evidence accumulated in systematic reviews and making them suitable for a more general audience of healthcare practitioners [18]-[20]. Although typical umbrella reviews focus on analyzing materials obtained from systematic reviews [17],[18], the aim of this study required integrating the evidence presented in reviews (both systematic and non-systematic position reviews) with practice recommendations issued by major stakeholders.

In order to elicit the good practice characteristics 3 types of documents were analyzed. First, we searched for systematic reviews analyzing characteristics of policies/interventions, and forming recommendations about these characteristics. Second, we searched for position papers that offered a comprehensive review of research evidence supporting good practice characteristics, but did not apply methods of systematic reviews. Finally, we searched for peer-reviewed and non-peer-reviewed documents, issued by major national and international stakeholders. We investigated documents aiming at eliciting evidence-based good practice criteria or providing practice recommendations for interventions/policies targeting healthy diet, physical activity, or sedentary behaviors.

Peer-reviewed documents: search strategy, inclusion, and exclusion criteria

The search was conducted in Medline, Cochrane Database of Systematic Reviews, PsycINFO, PsychArticles, Health Source: Nursing/Academic Edition, Academic Premier, and ScienceDirect databases. Documents published between the inception of databases and February 2014 were included. Combinations of 4 groups of keywords were applied, referring to: (1) practice characteristics (“good practic*” or “best practic*” or “recommended practic*” or “recommended strateg*”), (2) the type of action (intervention or polic*), (3) the design (“systematic review” or review or meta-analys*), (4) diet, physical activity, or sedentary behavior-related outcomes (“physical activity” or active or exercise or sedentary or diet or nutrition or fat or snack or fruit or vegetable or fiber or fibre or soda or meal or food or “energy intake” or calorie* or obes*).

Figure 1 (right panel) presents the stages of the data selection process. The preliminary search yielded 1926 entries, which used a combination of keywords from all 4 categories in either title, or the abstract, or keywords. Identified abstracts were then screened by 2 researchers (KH and AL), and 801 potentially relevant studies were identified.

Figure 1. The flow chart: Selection processes for stakeholders’ documents (left panel) and reviews (right panel).

The researchers (KH and AL) then selected publications that appeared in peer-reviewed English language journals. The following documents were excluded: (a) dissertations, protocols, conference materials, and book chapters; (b) reviews which indicated a need for testing good practice characteristics, but did not investigate such characteristics in the Results sections; (c) documents analyzing interventions or policies focusing on other main outcomes than physical activity, sedentary behaviors or diet. For example, interventions could target prevention or treatment of osteoporosis; such interventions could account for physical activity or diet (listed among multiple behaviors requiring change) but the content, evaluation, and implementation characteristics of such interventions were specific for their respective main outcomes (e.g., focusing on characteristics of prior treatment, current medication, health maintenance organizations); (d) publications aiming at eliciting practice characteristics in multi-behavior interventions/polices, which did not distinguish characteristics specific for either dietary or physical activity or sedentary behaviors; (e) documents which were reviewing guidelines for diet/physical activity/sedentary behaviors, but did not indicate characteristics of interventions/policies; (f) publications which discussed only one example of a policy or intervention.

In case of systematic reviews we included systematic reviews of quantitative studies (criteria for systematic reviews: clearly defined study aims, search strategy, inclusion and exclusion criteria, design of original studies, a suitable synthesis given the heterogeneity of findings [17]). In case of non-systematic position reviews, papers focusing on eliciting evidence-based good practices were included. Regarding peer-reviewed stakeholder’s documents, we included papers indicating a major professional organization (e.g., American Dietetic Association) among the authors or in the title. If several position review papers were prepared by the same authors and dealt with the same original trials, we included the most recent document, and sought for other (distinct) characteristics in earlier documents. Further, manual searches of the reference lists were conducted.

Quality assessment of each systematic review was conducted using the Methodological Quality Checklist (MQC) [18]. It is a 7-item scale with total scores ranging from 0 to 7. MQC evaluates strategies applied in original reviews and accounts for 7 quality criteria: (1) well-defined study participants, intervention, and outcomes; (2) search strategy is defined, combining several databases and other strategies of reference checking; (3) transparent inclusion and exclusion criteria; (4) designs of original studies and the number of studies are clarified; (5) quality assessment of original studies is included; (6) methods of data synthesis is specified and it accounts for data heterogeneity; and (7) at least 2 researchers are involved at each stage of review process. Two researchers (KH and AL) rated all systematic reviews independently. Previous umbrella reviews using MQC applied the cutoff of 4 as representing moderate or high quality [19],[20] and included research which scored ≥ 4 in MQC. Therefore, only systematic reviews scoring ≥ 4, were included into the final analyses.

Because there are no widely used measures of quality evaluation of stakeholders’ documents or non-systematic reviews, we have developed a tool serving this purpose (the Methodological Quality Checklist for Stakeholder Documents and Position Papers, MQC-SP; see Additional file 1). It was based on criteria applied in MQC [18], with a 6-item scale and total scores ranging from 0 to 6. Two researchers (KH and AL) independently rated all peer-reviewed stakeholders’ documents and position review papers. Only papers scoring ≥ 4, representing moderate or high quality, were included into analyses.

For all 3 types of analyzed documents the concordance of quality evaluations was high. The values of kappa coefficient were ranging from .89 (p < .01) to 1.00 (p < .001).

Overall, 99 peer reviewed papers met all inclusion and exclusion criteria. They included 74 systematic reviews, 16 position papers based on a review of empirical evidence, and 9 stakeholders’ documents, published in peer-reviewed journals.

Stakeholders’ documents (other than peer-reviewed): search strategy, inclusion criteria, exclusion criteria, and quality evaluation

Besides identifying the stakeholders’ documents that were published in peer-reviewed journals, we searched for documents published directly by the stakeholders. To obtain major stakeholders’ documents aiming at good practice recommendations, a group of 5 experts used the consensus method [17] to select the stakeholders. The inclusion criteria were: (1) the international or national stakeholder using English language to issue the documents (i.e., developing documents available to researchers, policy makers, and practitioners around the world); (2) the stakeholder issues documents that provide evidence-based good practice recommendations for policies and interventions targeting any populations; (3) the stakeholder develops documents which refer to diet, physical activity, or sedentary behavior as the main outcome of the interventions/policies. Similar inclusion criteria were used in previous reviews of stakeholders’ documents [21]. The following stakeholders were included: European Commission (EC), National Institute for Health and Clinical Excellence (NICE; United Kingdom), World Health Organization, Regional Office for Europe (WHO), Centers for Disease Control and Prevention (CDC; USA), Institute of Medicine (IOM; USA), Australian Department of Health (ADH), and National Health and Medical Research Council (NHMRC; Australia). All websites of respective stakeholders were searched using the same keywords as in the search of the databases. Using a search engine (Google) further attempts to elicit potential documents were undertaken. The sets of keywords used in the databases search were applied, accompanied by the names of the stakeholder organization (or its acronym). Only documents that were available for downloading were included. The initial search resulted in identifying 8279 links to potentially relevant documents (see Figure 1, left panel).

In the next step, the titles of these potentially relevant documents were screened and the documents with titles that appeared relevant for the present umbrella review were further reviewed. We included documents which aimed at (1) reviewing good practices or (2) providing an overview of characteristics of good practices, or (3) formulating practice recommendations in interventions or policies promoting healthy diet, physical activity, or a reduction of sedentary behavior. Only documents developed (or officially endorsed) by a respective stakeholder were included. Documents were excluded if they presented selected examples of good practice in interventions/policies or if they did not focus on the characteristics of interventions/policies. Moreover, we excluded documents aiming at interventions or policies focusing on other main outcomes than physical activity, sedentary behaviors or diet (e.g., osteoporosis prevention). These steps were conducted by 2 researchers (MH and MvdB).

Next, the quality of the documents was evaluated. The quality criteria were based on MQC criteria [18], with a 6-item scale and total scores ranging from 0 to 6 (see Additional file 1). Two researchers (MH, MvdB) independently rated all stakeholders’ documents. Papers scoring ≥ 4, that is representing high or moderate quality, were included into the further analyses. The concordance of the quality evaluation was very high, with κ = 1.00, p < .001.

Overall, we obtained 15 non-peer-reviewed stakeholder documents, meeting all inclusion criteria. However, 5 out of 15 documents presented a major overlap with another document issued by the same stakeholder; such documents were excluded (i.e., the excluded document did not report any additional practices compared to the included document). Thus, 10 documents were used for further analyses.

Data extraction, coding, and synthesis

To ensure accuracy and consistency of data extraction and coding at least 2 researchers extracted and coded data independently. Any disagreements in the processes of data selection and abstraction were resolved by the consensus method (searching for possible rating errors, followed by a discussion and arbitration by a third researcher) [17].

Descriptive data was extracted by one researcher (KH or MH) and then verified by the second researcher (AL). Extracted data included: (1) the descriptive characteristics of the original studies (e.g., participants, target behavior), synthesized in the analyzed reviews and stakeholders’ documents; (2) data necessary for quality evaluation. These descriptive characteristics and quality evaluations are presented in Additional file 1.

Next, the intervention and policy characteristics were extracted. Each document was searched for good practice characteristics. In particular, we retrieved the names of characteristics (as documented by authors of original documents) and their operationalization or definition (e.g., an explanation of the function of a characteristic within the context of development, implementation, and evaluation of policies and interventions). In case of systematic reviews these characteristic had to be included in the original analysis (as a significant determinant or as a moderator) as well as into original conclusions of the review. In case of stakeholders’ documents and position review papers, attributes of intervention/policies listed in the respective documents were coded as good practice characteristics if they were indicated as crucial for the development, implementation, and evaluation of any interventions or policies targeting healthy diet and physically active lifestyle.

The good practice characteristics that had an equivalent operationalization but different original names were considered to represent the same construct (e.g., accounting for cultural customs and addressing ethnic minority values). If an original document used a broad name for a characteristic (e.g., costs) we elicited a functional definition applied in the original document (e.g., total costs, cost per participants, cost per a unit of behavior change), and the broader characteristic was divided into separate units, reflecting its functional definition. The findings are presented using definitions as presented by the authors of the original documents (see Additional file 1). Interventions and policies aiming at any type of physical activity (general levels of physical activity or its specific types, such as walking) or a reduction of sedentary behavior were coded as referring to physical activity. Only 4 documents addressed sedentary behaviors, therefore these behaviors and physical activity were combined into one category. Similarly, interventions and policies targeting narrowly defined dietary behaviors (e.g., a reduction of snacking) as well as addressing more complex dietary changes (e.g., a meal composition) were coded as referring to dietary behavior.

The characteristics were allocated into 3 domains proposed by the WHO [14]. They were considered as representing (1) main intervention/policy characteristics, (2) monitoring and evaluation processes, or (3) implementation issues. The allocation was conducted by 2 researchers (KH, MH) and verified by a third researcher (AL).

Next, characteristics within each domain were combined into broader categories. Two researchers (KH, AL) independently clustered all identified characteristics into categories. The names of categories and characteristics were then independently evaluated by the 3 researchers (MH, MvdB, GR) who searched for flaws in categorization and evaluated the meaningfulness of categories and characteristics.

Finally, the characteristic was categorized as a good practice characteristic if the respective characteristic was indicated in either at least 4 systematic reviews or in at least 3 stakeholders’ documents. This threshold is based on the number of documents supporting each characteristic and it represents the top quartile in the number of the supporting systematic reviews and stakeholders’ documents, respectively. To reach this threshold, the number of documents supporting a characteristic had to fall into the respective upper quartile: across characteristics, 75% were supported by 0–3 systematic reviews, whereas 25% were supported by at least 4 systematic reviews. Further, 75% characteristics were indicated in 0–2 stakeholder documents, whereas only 25% were indicated in at least 3 stakeholders’ documents (see Additional file 1). This arbitrary inclusion threshold was obtained in a consensus meeting by 3 research groups, represented by the researchers from 3 countries, involved in DEDIPAC project. The upper quartile-based thresholds are used in health promotion research eliciting good practice examples [22]. The threshold applied in the present study was considered as indicating strong support in analyzed data.

All good practice characteristic listed in Tables 1, 2, 3, 4 met this threshold (was supported by either at least 4 systematic reviews or by at least 3 stakeholders’ documents); 96 remaining characteristics (see Additional file 1) fell below the threshold and therefore were not included into the final list of best practice characteristics. For example, a good practice characteristic referring to the identification of environmental barriers and resources for participation was supported by 2 documents and therefore it was excluded from the final list.

Table 1. The domain of main characteristics of good practice for interventions and policies aiming at dietary behavior and physical activity change

Table 2. The monitoring and evaluation domain of good practice characteristics for interventions and policies aiming at dietary behavior and physical activity change

Table 3. The implementation domain of good practice characteristics for interventions and policies aiming at dietary behavior and physical activity change

Table 4. The checklist of good practice characteristics for healthy diet and physical activity interventions and policies

Results

Description of analyzed material

The final selection included 74 systematic reviews (67.9%), 19 stakeholders’ documents (17.4%) and 16 position review papers (14.7%). Systematic reviews investigated a total of 2989 original studies. Populations analyzed in original papers included: general population samples (k = 31, 28.4%), children (k = 21, 19.4%), adolescents (k = 2, 1.8%), children and adolescents (k = 13, 11.9%), adults (k = 14, 12.8%), adults with a chronic disease, including cardiovascular or neurological diseases, diabetes, depression, obesity (k = 15, 13.8%), pregnant women (k = 1, 0.9%), adults at workplace (k = 6, 5.5%), older adults (k = 5, 4.7%), and vulnerable populations, such as ethnic minorities (k = 1, 0.8%). Three documents focused on women only. The majority of documents (k = 64, 58.7%) provided recommendations which could be applied both in policies and interventions, 39 (35.8%) formulated recommendations for interventions only; 6 (5.5%) focused on policy only. The majority referred to both physical activity and dietary behaviors (k = 62, 56.9%), whereas 36 (33%) analyzed dietary behaviors only and 11 (10.1%) addressed physical activity/sedentary behaviors only. The majority of documents (k = 97; 89%) referred to multi-level interventions and policies (i.e., using techniques aiming at a change at individual and social/environmental levels). Additional file 1 yields a description of original documents.

Quality of papers included into analysis ranged from moderate to minimal flaws (see Additional file 1). For systematic reviews, MQC scores ranged from 4 to 7, M = 5.50, SD = 0.93. In case of stakeholders’ documents and position review papers the scores for MQC-based measure ranged from 4 to 6, M = 4.68, SD = 0.60.

Good practice attributes

Regarding main intervention/policy characteristics, we identified 40 good practice characteristics that were reported in at least one document (see Additional file 1). The characteristics were grouped into 6 distinct categories: the use of theory (n = 1), participants, (n = 6), target behavior (n = 6), content development and content management (n = 16), multidimensionality of interventions/ policies (n = 4), practitioner and setting contexts (n = 7).

Strong support was found for 18 good practice characteristics. They were reported in at least 4 systematic reviews or at least 3 stakeholders’ documents and thus coded as good practice characteristics (Table 1). The list of main intervention/policy characteristics includes: 1 attribute referring to the use of theory, 3 for participants, 1 for target behavior, 9 for content development and content management, 2 for multidimensionality of intervention/policy, and 2 for practitioner and setting contexts (Table 1). The majority of good practice characteristics (17 out of 18) were generic, that is they were indicated in documents referring to both diet and physical activity/sedentary behavior, referred to different age groups, interventions, and policies (see Additional file 1). The exception is ‘family involvement’, a characteristic referring to interventions and policies targeting children and adolescents only.

The analysis of original documents yielded 37 monitoring and evaluation characteristics of good practice (see Additional file 1). The characteristics were grouped into 6 categories: costs and funding (n = 5), outcomes (n = 11), the evaluation of effects: time and effect size (n = 6), reach (n = 5), the evaluation of participation and generalizability (n = 6), underlying processes and active components (n = 4).

Strong support was found for 18 good practice characteristics (Table 2), which represent the attributes of good practice referring to processes of monitoring and evaluation. They were indicated in at least 3 stakeholders’ documents or 4 systematic reviews. The list of good practice characteristics referring to monitoring and evaluation includes: 3 attributes referring to costs and funding, 5 for outcomes, 3 for the evaluation of effects: time and effect size, 3 for reach, 2 for the evaluation of participation and generalizability, and 2 for processes and active components. All 18 characteristics in the monitoring/evaluation domain were generic: they were found in documents referring to diet and physical activity/sedentary behavior, different age groups, interventions, and policies.

Finally, we identified 72 implementation good practice characteristics (see Additional file 1). They included: participation processes (n = 13), training for practitioners (n = 4), the use/integration of existing resources (n = 18), feasibility (n = 4), maintenance and sustainability (n = 8), partnership for implementation (n = 7), implementation consistency and adaptation processes (n = 13), and transferability (n = 5).

In contrast to findings for other domains (main characteristics and evaluations/processes), the majority of implementation characteristics (72%) was endorsed by less than 3 documents (Additional file 1). Only 17 met the threshold of strong support; only these characteristics were included into the final list of good practice characteristics. The final list includes: 3 attributes for participation processes, 1 for training for practitioners, 3 for use/integration of existing resources, 2 for feasibility, 2 for maintenance and sustainability, 2 for partnership for implementation, 2 for implementation consistency and adaptation processes, and 2 for transferability (see Table 3). The vast majority of good practice characteristics referring to implementation (16 out of 17) were generic. The exception was ‘adherence to protocol/protocol fidelity monitoring’ characteristic which was indicated in documents analyzing interventions, but not policies.

In sum, data synthesis yielded 149 good practice characteristics, referring to policies and interventions aiming at healthy diet and physical activity/sedentary behaviors. We found stronger support for 53 good practice characteristics, of which 51 are generic. The list of good practice characteristics was combined into a checklist (Table 4), which may be used for developing practice and reporting research on interventions and policies.

Discussion and conclusions

This study provides an insight into good practice characteristic in interventions and policies targeting healthy diet, physical activity, and sedentary behavior in various populations. We identified 53 good practice attributes (51 generic), falling into 3 broad domains proposed by WHO [14]: main characteristics, monitoring/evaluations, and implementation. Across these domains, a similar number of characteristics of good practice was identified (18, 18, and 17, respectively), which may be an indicator of equivalent relevance of 3 domains.

Our efforts to identify characteristics which are evidenced and practice-based characteristics were undertaken in a response to concerns and appeals of practitioners, researchers, and editors which indicate difficulties in replicating and applying interventions/policies in various populations, because research reports present limited detail [4],[7]. Compared to other lists [4],[12] which serve similar purposes, the list of good practice characteristics developed in the present umbrella review was not restricted to the one domain of main descriptive intervention or policy characteristics, but also emphasizes the important domains of implementation and evaluation.

The list of 53 potentially crucial practice characteristics may be seen as a point of departure for further syntheses. The list might be shortened if future research would provide evidence for a lack of relevance of some characteristics for the success of interventions/policies. Until then, this broad list has a potential to inspire accumulating more detailed data and, in consequence, it would allow for identifying characteristics responsible for a success of interventions/policies.

The findings indicated that the majority of the 53 characteristics were endorsed by researchers as well as stakeholders, responsible for issuing practice recommendations. So far research on practice attributes reviewed either peer-reviewed studies [20],[23] or stakeholders’ guidelines [21]. Combining 2 types of sources reinforces the conclusions. The list proposed in the present study integrates findings and concerns of researchers, practitioners, and those responsible for developing practice guidelines.

In sum, the list of good practice characteristics provides a comprehensive overview of specific aspects of potentially successful interventions and policies. Researchers, practitioners and policy makers may account for those characteristics when planning, developing, and reporting interventions and policies promoting healthy diet and physical activity. Compared to other lists of guidelines for reporting interventions/policies, the present list is based on a systematic review of empirical evidence and stakeholders’ proposals, therefore it may be feasible not only for researchers, but also for practitioners who need to apply the guidelines formed by major national stakeholders. Further, compared to other proposals, our list does not focus on broad categories e.g. [8], which may be difficult to translate into practice, but on specific, narrowly defined characteristic. Based on existing evidence it may be assumed that accounting for these characteristics increases the likelihood of developing a successful policy or intervention.

We analyzed characteristics indicated in position papers, which presented attributes of practice based on non-systematic reviews of literature. Although those papers were of relatively high quality, the support for a practice characteristic found in this type of documents was not used as a criterion for including the characteristic into the final list of attributes of good practice. A relatively small number of characteristics from the preliminary list (18 out of 149) was supported solely by position papers. It has to be noted, that in the domain of implementation the number of characteristics indicated in position papers only was twice as high as in 2 remaining domains. Therefore, future research investigating implementation practices should explore evidence accumulated in systematic and non-systematic reviews.

Our study has several limitations. The proposed list of good practice characteristics is based on an umbrella review of reviews and stakeholders’ documents. Thus, some recent studies on good practice characteristics were not included. Furthermore, the present study did not differentiate between target groups (e.g., adults versus children) and it is possible that some good practice characteristics are more relevant for some target groups than for others. Additionally, we combined evidence for good practice characteristics for policies and interventions. Although 52 out of 53 characteristics were supported in documents referring to both interventions and policies, future research should investigate if attributes of good practices are different for policies and for interventions. The decision to define characteristics as the attributes of good practice was based on an arbitrary criterion (i.e. the number of documents supporting the characteristic had to fall into the upper quartile for the number of either systematic reviews or stakeholders’ documents), which was chosen by a consensus method [17]. As indicated, the quartile-based thresholds are used in health promotion research eliciting good practice examples [22]. The main limitation of this approach refers to the fast progress in accumulation of the evidence: as new systematic reviews and stakeholders’ documents are published every year, the characteristic that just missed the threshold may fit the criteria of good practice characteristics very soon. Further, with growing evidence the threshold may need to be changed as a different number of documents would represent the upper quartile. Therefore, as new evidence is accumulating, this list should be updated regularly. Finally, the evaluation of the quality of the material included in the present study was based on criteria which were relatively lenient. In sum, all conclusions should be treated with caution and the proposed list of characteristics is preliminary.

In conclusion, our study provides a broad list of good practice characteristics in interventions and policies targeting healthy diet and physical activity. Research aiming at defining successful interventions and policies may need to report the presence (and, where feasible, the content) of those characteristics. The use of the proposed list of good practice characteristics may foster further development of health promotion sciences, as it would allow for identification of success vectors in the domains of main characteristics of interventions/policies, their implementation, evaluation and monitoring processes.

Abbreviations

DEDIPAC: The Knowledge Hub on the DEterminants of DIet and Physical ACtivity

MQC: Methodological Quality Checklist

Competing interests

The authors declare that they have no competing interests.

Authors’ contribution

KH contributed to the conception of the study and its design, conducted data search, data extraction, data analysis and synthesis, drafted and revised the manuscript. AL contributed to the conception of the study and its design, conducted data extraction, data analysis and synthesis, drafted and revised the manuscript. MvdB participated in the conception of the study and its design, data analysis, and revised the draft of the manuscript. MH conceived of the study and its design, participated in data extraction and revised the draft of the manuscript. GR conceived of the study and its design, participated in data synthesis, and revised the draft of the manuscript. IDB contributed to conception of the study and revised the manuscript. HB contributed to conception of the study and revised the manuscript. All authors read and approved the final manuscript.

Additional file

Additional file 1:. Quality evaluation criteria for stakeholders’ documents, descriptive data for all reviewed documents and the list of 149 elicited characteristics (with supporting documents). Additional file includes: (a) the quality evaluation criteria for stakeholders’ documents Methodological Quality Checklist for Stakeholders’ Documents and Position Papers; (MQC-SP); (b) descriptive data retrieved from systematic reviews, stakeholder documents and position review papers included into the umbrella review, (c) the list of 149 best practice characteristics and references to the documents supporting the characteristics.

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Acknowledgements

The preparation of this paper was supported by the DEDIPAC Knowledge Hub. The DEDIPAC project is funded under the Joint Programming Initiative (JPI) a Healthy Diet for a Healthy Life, a research and innovation initiative of European Union member states and associated countries. The content of this article reflects only the authors’ views and the Joint Programming Initiative (JPI) a Healthy Diet for a Healthy Life is not liable for any use that may be made of the information contained therein. This article is supported by the following funding agencies (in alphabetical order of participating Member State): Belgium: Research Foundation – Flanders; The Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw); Norway: The Research Council of Norway; Poland: The National Centre for Research and Development.

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• * Corresponding author: Aleksandra Luszczynska aluszczy@uccs.edu

¹ Department of Psychology, University of Social Sciences and Humanities, 30b Ostrowskiego St, Wroclaw, 53238, Poland

² Trauma, Health, & Hazards Center, University of Colorado, 1861 Austin Bluffs Pkwy, Colorado Springs 80933-7150, CO, USA

³ National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721, the Netherlands

⁴ SIFO – National Institute for Consumer Research, Sandakerveien 24 C, Building B Oslo, Nydalen N-0405, , Oslo, Norway

⁵ Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium

⁶ VU University Medical Center, Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands

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