A Community Jury on initiating weight management conversations in primary care.

BACKGROUND: Current guidelines recommend that patients attending general practice should be screened for excess weight, and provided with weight management advice. OBJECTIVE: This study sought to elicit the views of people with overweight and obesity about the role of GPs in initiating conversations about weight management. METHODS: Participants with a body mass index ≥25 were recruited from a region in Australia to take part in a Community Jury. Over 2 days, participants (n = 11) deliberated on two interconnected questions: 'Should GPs initiate discussions about weight management?' And 'if so, when: (a) opportunistically, (b) in the context of disease prevention, (c) in the context of disease management or (d) other?' The jury deliberations were analysed qualitatively to elicit their views and recommendations. RESULTS: The jury concluded GPs should be discussing weight management, but within the broader context of general health. The jury were divided about the utility of screening. Jurors felt GPs should initiate the conversation if directly relevant for disease prevention or management, otherwise GPs should provide opportunities for patients to consent to the issue being raised. CONCLUSION: The jury's verdict suggests informed people affected by overweight and obesity believe GPs should discuss weight management with their patients. GPs should feel reassured that discussions are likely to be welcomed by patients, particularly if embedded within a more holistic focus on person-centred care. PUBLIC CONTRIBUTION: Members of the public took part in the conduct of this study as jurors, but were not involved in the design, analysis or write-up.

The Impact of Systematic Review Automation Tools on Methodological Quality and Time Taken to Complete Systematic Review Tasks: Case Study.

BACKGROUND: Systematic reviews (SRs) are considered the highest level of evidence to answer research questions; however, they are time and resource intensive. OBJECTIVE: When comparing SR tasks done manually, using standard methods, versus those same SR tasks done using automated tools, (1) what is the difference in time to complete the SR task and (2) what is the impact on the error rate of the SR task? METHODS: A case study compared specific tasks done during the conduct of an SR on prebiotic, probiotic, and synbiotic supplementation in chronic kidney disease. Two participants (manual team) conducted the SR using current methods, comprising a total of 16 tasks. Another two participants (automation team) conducted the tasks where a systematic review automation (SRA) tool was available, comprising of a total of six tasks. The time taken and error rate of the six tasks that were completed by both teams were compared. RESULTS: The approximate time for the manual team to produce a draft of the background, methods, and results sections of the SR was 126 hours. For the six tasks in which times were compared, the manual team spent 2493 minutes (42 hours) on the tasks, compared to 708 minutes (12 hours) spent by the automation team. The manual team had a higher error rate in two of the six tasks-regarding Task 5: Run the systematic search, the manual team made eight errors versus three errors made by the automation team; regarding Task 12: Assess the risk of bias, 25 assessments differed from a reference standard for the manual team compared to 20 differences for the automation team. The manual team had a lower error rate in one of the six tasks-regarding Task 6: Deduplicate search results, the manual team removed one unique study and missed zero duplicates versus the automation team who removed two unique studies and missed seven duplicates. Error rates were similar for the two remaining compared tasks-regarding Task 7: Screen the titles and abstracts and Task 9: Screen the full text, zero relevant studies were excluded by both teams. One task could not be compared between groups-Task 8: Find the full text. CONCLUSIONS: For the majority of SR tasks where an SRA tool was used, the time required to complete that task was reduced for novice researchers while methodological quality was maintained.

Natural history of non-bullous impetigo: a systematic review of time to resolution or improvement without antibiotic treatment.

BACKGROUND: Non-bullous impetigo is typically treated with antibiotics. However, the duration of symptoms without their use has not been established, which hampers informed decision making about antibiotic use. AIM: To determine the natural history of non-bullous impetigo. DESIGN AND SETTING: Systematic review. METHOD: The authors searched PubMed up to January 2020, as well as reference lists of articles identified in the search. Eligible studies involved participants with impetigo in either the placebo group of randomised trials, or in single-group prognostic studies that did not use antibiotics and measured time to resolution or improvement. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were percentage of participants who had either symptom resolution, symptom improvement, or failed to improve at any timepoint. Adverse event data were also extracted. RESULTS: Seven randomised trials (557 placebo group participants) were identified. At about 7 days, the percentage of participants classified as resolved ranged from 13% to 74% across the studies, whereas the percentage classified as 'failure to improve' ranged from 16% to 41%. The rate of adverse effects was low. Incomplete reporting of some details limited assessment of risk of bias. CONCLUSION: Although some uncertainty around the natural history of non-bullous impetigo remains, symptoms resolve in some patients by about 7 days without using antibiotics, with about one-quarter of patients not improving. Immediate antibiotic use may not be mandatory, and discussions with patients should include the expected course of untreated impetigo and careful consideration of the benefits and harms of antibiotic use.

Natural history of uncomplicated urinary tract infection without antibiotics: a systematic review.

BACKGROUND: Although uncomplicated urinary tract infection (UTI) is commonly treated with antibiotics, the duration of symptoms without their use is not established; this hampers informed decision making about antibiotic use. AIM: To determine the natural history of uncomplicated UTI in adults. DESIGN AND SETTING: Systematic review. METHOD: PubMed was searched for articles published until November 2019, along with reference lists of articles identified in the search. Eligible studies were those involving adults with UTIs in either the placebo group of randomised trials or in single-group prognostic studies that did not use antibiotics and measured symptom duration. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were the percentage of patients who, at any time point, were symptom free, had symptom improvement, or had worsening symptoms (failed to improve). Adverse event data were also extracted. RESULTS: Three randomised trials (346 placebo group participants) were identified, all of which specified women only in their inclusion criteria. The risk of bias was generally low, but incomplete reporting of some details limited assessment. Over the first 9 days, the percentage of participants who were symptom free or reported improved symptoms was reported as rising to 42%. At 6 weeks, the percentage of such participants was 36%; up to 39% of participants failed to improve by 6 weeks. The rate of adverse effects was low and, in two trials, progression to pyelonephritis was reported in one placebo participant. CONCLUSION: Although some uncertainty around the natural history of uncomplicated UTIs remains, some women appear to improve or become symptom free spontaneously, and most improvement occurs in the first 9 days. Other women either failed to improve or became worse over a variable timespan, although the rate of serious complications was low.

Improving the translation of search strategies using the Polyglot Search Translator: a randomized controlled trial.

BACKGROUND: Searching for studies to include in a systematic review (SR) is a time- and labor-intensive process with searches of multiple databases recommended. To reduce the time spent translating search strings across databases, a tool called the Polyglot Search Translator (PST) was developed. The authors evaluated whether using the PST as a search translation aid reduces the time required to translate search strings without increasing errors. METHODS: In a randomized trial, twenty participants were randomly allocated ten database search strings and then randomly assigned to translate five with the assistance of the PST (PST-A method) and five without the assistance of the PST (manual method). We compared the time taken to translate search strings, the number of errors made, and how close the number of references retrieved by a translated search was to the number retrieved by a reference standard translation. RESULTS: Sixteen participants performed 174 translations using the PST-A method and 192 translations using the manual method. The mean time taken to translate a search string with the PST-A method was 31 minutes versus 45 minutes by the manual method (mean difference: 14 minutes). The mean number of errors made per translation by the PST-A method was 8.6 versus 14.6 by the manual method. Large variation in the number of references retrieved makes results for this outcome inconclusive, although the number of references retrieved by the PST-A method was closer to the reference standard translation than the manual method. CONCLUSION: When used to assist with translating search strings across databases, the PST can increase the speed of translation without increasing errors. Errors in search translations can still be a problem, and search specialists should be aware of this.

Efficacy of habit-based weight loss interventions: a systematic review and meta-analysis.

Habit-based interventions are a novel and emerging strategy to help reduce excess weight in individuals with overweight or obesity. This systematic review and meta-analysis aims to determine the efficacy of habit-based interventions on weight loss. We identified potential studies through electronic searches in February 2019. Included studies were randomized/quasi randomized controlled trials comparing weight loss interventions founded on habit-theory with a control (active or non-active) and enrolled adults with overweight or obesity (body mass index ≥ 25 kg/m2). Five trials (630 participants) met our inclusion criteria. After the intervention period (range 8-14 weeks), weight loss was modest but statistically different between groups (1.4 kg [95% confidence interval 0.5, 2.3; P = 0.004]) favoring habit-based interventions. Intervention groups averaged 2.5 kg weight loss (range 1.7 to 6.7 kg) compared with control 1.5 kg (range 0.4 to 5.8 kg) and were 2.4 times more likely to achieve clinically beneficial weight loss (≥ 5% weight reduction). Average weight losses in adults with overweight and obesity using habit-based interventions appear to be of clinical benefit. There were statistically significant differences in weight loss between habit-based interventions and controls, post-intervention. Longer studies powered to examine at least 12-month follow-up are required to more accurately determine the role of habit-based interventions on long-term weight loss maintenance.Trial registration Prospero ID: CRD42017065589. Available from https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017065589 .

Usability and acceptability of four systematic review automation software packages: a mixed method design.

AIM: New software packages help to improve the efficiency of conducting a systematic review through automation of key steps in the systematic review. The aim of this study was to gather qualitative data on the usability and acceptability of four systematic review automation software packages (Covidence, SRA-Helper for EndNote, Rayyan and RobotAnalyst) for the citation screening step of a systematic review. METHODS: We recruited three volunteer systematic reviewers and asked them to use allocated software packages during citation screening. They then completed a 12-item online questionnaire which was tailored to capture data for the software packages used. FINDINGS: All four software packages were reported to be easy or very easy to learn and use. SRA-Helper for EndNote was most favoured by participants for screening citations and Covidence for resolving conflicts. Overall, participants reported that SRA-Helper for EndNote would be their software package of choice, primarily due to its efficiency. CONCLUSION: This study identified a number of considerations which systematic reviewers can use as a basis of their decision which software to use when performing the citation screening and dispute resolution steps of a systematic review.

Habit-based interventions for weight loss maintenance in adults with overweight and obesity: a randomized controlled trial.

OBJECTIVES: The objective of this study was to determine whether habit-based interventions are clinically beneficial in achieving long-term (12-month) weight loss maintenance and explore whether making new habits or breaking old habits is more effective. METHODS: Volunteer community members aged 18-75 years who had overweight or obesity (BMI ≥ 25 kg/m2) were randomized in a single-blind, three-arm, randomized controlled trial. Ten Top Tips (TTT), Do Something Different (DSD), and the attention-only waitlist (WL) control groups were conducted for 12 weeks from July to October 2015. Participants were followed up post-intervention (all groups) and at 6 and 12-month post-intervention (Ten Top Tips and Do Something Different only). The primary outcome was weight-loss maintenance at 12-month follow-up. Secondary outcomes included weight loss at all time points, fruit and vegetable consumption, exercise, wellbeing, depression, anxiety, habit strength, and openness to change. RESULTS: Of the 130 participants assessed for eligibility, 75 adults (mean BMI 34.5 kg/m2 [SD 6.2]), with a mean age of 51 years were recruited. Assessments were completed post-intervention by 66/75 (88%) of participants and by 43/50 (86%) at 12 months. At post-intervention, participants in the Ten Top Tips (-3.3 kg; 95% CI -5.2, -1.4) and Do Something Different (-2.9 kg; 95% CI -4.3, -1.4) interventions lost significantly more weight (P = < .001) than those on the waitlist control (-0.4 kg; 95% CI -1.2, 0.3). Both intervention groups continued to lose further weight to the 12-month follow-up; TTT lost an additional -2.4 kg (95% CI -5.1, 0.4) and DSD lost -1.7 kg (95% CI -3.4, -0.1). At 12-month post-intervention, 28/43 (65%) of participants in both intervention groups had reduced their total body weight by ≥5%, a clinically important change. CONCLUSIONS: Habit-based weight-loss interventions-forming new habits (TTT) and breaking old habits (DSD), resulted in clinically important weight-loss maintenance at 12-month follow-up.

Participant experiences of two successful habit-based weight-loss interventions in Australia: a qualitative study.

OBJECTIVES: Habit-based weight-loss interventions have shown clinically important weight loss and weight-loss maintenance. Understanding why habit-based interventions work is therefore of great value, but there is little qualitative evidence about the experiences of participants in such programmes. We explored the perspectives of individuals who completed two habit-based weight-management programmes, Ten Top Tips and Do Something Different. DESIGN: One-on-one, face-to-face, semistructured interviews were conducted and analysed thematically. SETTING: Participants from the community were interviewed at Bond University, Australia. PARTICIPANTS: Using a maximum variation design, we recruited 15 participants (eight men, seven women) aged 39-69 years (mean 53.3 years, SD 10.3) with a range of education levels (no high school to university degree) and percentage weight change on the programmes (+4.0% to -10.4%). MAIN OUTCOME MEASURES: (1) The general experience of participants who completed the Ten Top Tips or Do Something Different intervention, (2) whether and how the interventions affected the participants' lifestyle postintervention, and (3) participants' views regarding the acceptability and practical application of Ten Top Tips and Do Something Different. RESULTS: Participants reported positive experiences of the two programmes, both during and after the interventions. Participants particularly enjoyed the novelty of the interventions as they shifted focus from diet and exercise, to practical everyday habit changes. They also reported indirect health benefits such as increased energy levels, increased confidence and improved self-awareness. Accountability throughout the programmes and convenience of the interventions were identified as key themes and facilitators for weight-loss success. CONCLUSIONS: This study offers insight into how and why habit-based interventions might work. Overall, Ten Top Tips and Do Something Different are practical and convenient to implement, and are viewed favourably by participants when compared with conventional lifestyle programmes for weight control. TRIAL REGISTRATION NUMBER: ACTRN12615000114549.