Correction: Predictors of Health Information-Seeking Behavior: Systematic Literature Review and Network Analysis.

[This corrects the article DOI: 10.2196/21680.].

Predictors of Health Information-Seeking Behavior: Systematic Literature Review and Network Analysis.

BACKGROUND: People engage in health information-seeking behavior to support health outcomes, and being able to predict such behavior can inform the development of interventions to guide effective health information seeking. Obtaining a comprehensive list of the predictors of health information-seeking behavior through a systematic search of the literature and exploring the interrelationship of these predictors are critical first steps in this process. OBJECTIVE: This study aims to identify significant predictors of health information-seeking behavior in the primary literature, develop a common taxonomy for these predictors, and identify the evolution of the concerned research field. METHODS: A systematic search of PsycINFO, Scopus, and PubMed was conducted for all years up to and including December 10, 2019. Quantitative studies identifying significant predictors of health information-seeking behavior were included. Information seeking was broadly defined and not restricted to any source of health information. Data extraction of significant predictors was performed by 2 authors, and network analysis was conducted to observe the relationships between predictors with time. RESULTS: A total of 9549 articles were retrieved, and after the screening, 344 studies were retained for analysis. A total of 1595 significant predictors were identified. These predictors were categorized into 67 predictor categories, with the most central predictors being age, education, gender, health condition, and financial income. With time, the interrelationship of predictors in the network became denser, with the growth of new predictor grouping reaching saturation (1 new predictor identified) in the past 7 years, despite increasing publication rates. CONCLUSIONS: A common taxonomy was developed to classify 67 significant predictors of health information-seeking behavior. A time-aggregated network method was developed to track the evolution of the research field, showing the maturation of new predictor terms and an increase in primary studies reporting multiple significant predictors of health information-seeking behavior. The literature has evolved with a decreased characterization of novel predictors of health information-seeking behavior. In contrast, we identified a parallel increase in the complexity of predicting health information-seeking behavior, with an increase in the literature describing multiple significant predictors.

Convalescent plasma for hospitalized patients with COVID-19: an open-label, randomized controlled trial.

The efficacy of convalescent plasma for coronavirus disease 2019 (COVID-19) is unclear. Although most randomized controlled trials have shown negative results, uncontrolled studies have suggested that the antibody content could influence patient outcomes. We conducted an open-label, randomized controlled trial of convalescent plasma for adults with COVID-19 receiving oxygen within 12 d of respiratory symptom onset ( NCT04348656 ). Patients were allocated 2:1 to 500 ml of convalescent plasma or standard of care. The composite primary outcome was intubation or death by 30 d. Exploratory analyses of the effect of convalescent plasma antibodies on the primary outcome was assessed by logistic regression. The trial was terminated at 78% of planned enrollment after meeting stopping criteria for futility. In total, 940 patients were randomized, and 921 patients were included in the intention-to-treat analysis. Intubation or death occurred in 199/614 (32.4%) patients in the convalescent plasma arm and 86/307 (28.0%) patients in the standard of care arm-relative risk (RR) = 1.16 (95% confidence interval (CI) 0.94-1.43, P = 0.18). Patients in the convalescent plasma arm had more serious adverse events (33.4% versus 26.4%; RR = 1.27, 95% CI 1.02-1.57, P = 0.034). The antibody content significantly modulated the therapeutic effect of convalescent plasma. In multivariate analysis, each standardized log increase in neutralization or antibody-dependent cellular cytotoxicity independently reduced the potential harmful effect of plasma (odds ratio (OR) = 0.74, 95% CI 0.57-0.95 and OR = 0.66, 95% CI 0.50-0.87, respectively), whereas IgG against the full transmembrane spike protein increased it (OR = 1.53, 95% CI 1.14-2.05). Convalescent plasma did not reduce the risk of intubation or death at 30 d in hospitalized patients with COVID-19. Transfusion of convalescent plasma with unfavorable antibody profiles could be associated with worse clinical outcomes compared to standard care.

Convalescent plasma for adults with acute COVID-19 respiratory illness (CONCOR-1): study protocol for an international, multicentre, randomized, open-label trial.

BACKGROUND: Convalescent plasma has been used for numerous viral diseases including influenza, severe acute respiratory syndrome, Middle East respiratory syndrome and Ebola virus; however, evidence to support its use is weak. SARS-CoV-2 is a novel coronavirus responsible for the 2019 global pandemic of COVID-19 community acquired pneumonia. We have undertaken a randomized controlled trial to assess the efficacy and safety of COVID-19 convalescent plasma (CCP) in patients with SARS-CoV-2 infection. METHODS: CONCOR-1 is an open-label, multicentre, randomized trial. Inclusion criteria include the following: patients > 16 years, admitted to hospital with COVID-19 infection, receiving supplemental oxygen for respiratory complications of COVID-19, and availability of blood group compatible CCP. Exclusion criteria are : onset of respiratory symptoms more than 12 days prior to randomization, intubated or imminent plan for intubation, and previous severe reactions to plasma. Consenting patients are randomized 2:1 to receive either approximately 500 mL of CCP or standard of care. CCP is collected from donors who have recovered from COVID-19 and who have detectable anti-SARS-CoV-2 antibodies quantified serologically. The primary outcome is intubation or death at day 30. Secondary outcomes include ventilator-free days, length of stay in intensive care or hospital, transfusion reactions, serious adverse events, and reduction in SARS-CoV-2 viral load. Exploratory analyses include patients who received CCP containing high titre antibodies. A sample size of 1200 patients gives 80% power to detect a 25% relative risk reduction assuming a 30% baseline risk of intubation or death at 30 days (two-sided test; α = 0.05). An interim analysis and sample size re-estimation will be done by an unblinded independent biostatistician after primary outcome data are available for 50% of the target recruitment (n = 600). DISCUSSION: This trial will determine whether CCP will reduce intubation or death non-intubated adults with COVID-19. The trial will also provide information on the role of and thresholds for SARS-CoV-2 antibody titres and neutralization assays for donor qualification. TRIAL REGISTRATION: Clinicaltrials.gov NCT04348656 . Registered on 16 April 2020.

Rapid visual recovery following intravenous tocilizumab in glucocorticoid resistant refractory giant cell arteritis.

A 72-year-old man presented with a short history of headache, jaw claudication, double vision, amaurosis fugax and distended temporal arteries. A diagnosis of giant cell arteritis (GCA) was confirmed on temporal artery ultrasound and temporal artery biopsy. Despite treatment with high-dose oral glucocorticoid (GC) and multiple pulses of intravenous methylprednisolone, his vision deteriorated to hand movements in one eye. 8 mg/kg intravenous tocilizumab, a humanised, recombinant anti-IL-6 receptor antibody, was administered within 48 hours of vision loss and continued monthly, resulting in marked visual improvement within days, as well as sustained remission of GCA. This case suggests a possible role for tocilizumab as a rescue therapy to prevent or recover visual loss in patients with GCA resistant to GC treatment, termed refractory GCA. Further research is required to elucidate the role of intravenous administration of tocilizumab in this setting.

Weekly vinorelbine versus docetaxel for metastatic breast cancer after failing anthracycline treatment.

BACKGROUND: Vinorelbine and docetaxel are active in anthracycline-pretreated, metastatic breast cancer. We compared their efficacy. PATIENTS AND METHODS: Patients were randomized to receive weekly vinorelbine (VIN) or weekly docetaxel (DOC), 6 weekly doses per 8-week cycle, with optional crossover (X-DOC vs. X-VIN. The primary end point was time to progression (TTP) on initial treatment. Remission induction, survival, and quality of life were secondary end points. RESULTS: Among 122 poor risk patients, a non-significant trend for better TTP was seen for DOC, both on initial and on crossover treatment. Responses were seen on either treatment, but progression was more common with VIN than with DOC, while more patients had a response with X-DOC than with X-VIN. Survival was identical in those receiving only the initial VIN vs. DOC and in the subgroups receiving crossover treatments. Grade 3-4 toxicity, especially hematological toxicity resulting in treatment delay, was more common with VIN. Non-graded toxicity contributed to abandoning DOC. Quality of life scores reflected worse results in patients crossing treatment arms, in either direction. CONCLUSIONS: DOC showed marginally better activity but did not improve TTP or other endpoints over VIN in this poor risk population.

Emergency contraception supply in Australian pharmacies after the introduction of ulipristal acetate: a mystery shopping mixed-methods study.

OBJECTIVE: To explore the supply of emergency contraception (EC) from Australian community pharmacies after the introduction of ulipristal acetate (UPA) and to explore pharmacists' knowledge, decision-making, attitudes and beliefs surrounding supplying EC. STUDY DESIGN: A mixed-methods approach of mystery shopping with structured interview was employed. From August to November 2017, 20 pharmacy students mystery-shopped 10 community pharmacies in metropolitan Sydney, Australia, requesting "the morning after pill." Each pharmacy was visited five times with varying scenarios. Structured interviews were conducted immediately postvisit. Visit data were analyzed descriptively and comparatively. Interviews were transcribed verbatim and categorically analyzed. RESULTS: Of 50 planned visits, 43 were analyzed. EC was supplied in 38 requests by pharmacists (54% male). Levonorgestrel (LNG) was more frequently supplied than UPA (74% vs. 26%). UPA was only supplied when intercourse occurred >72 h prior. Directions for use were provided in 35 supplies. No difference in questioning or counseling was found based on sex of requester. Female pharmacists provided more counseling points (MED=4 [IQR=4-5] vs. MED=3 [IQR=0-4]; p<.01). Two pharmacists asked all guideline questions, and no pharmacist provided all guideline counseling points. Interviews elicited supply guidelines, regulatory and clinical knowledge, financial considerations, privacy and stock availability as factors influencing EC supply. CONCLUSIONS: EC was supplied in accordance with local legislation in all instances, with the majority supplied within the licensed timeframe for each EC formulation. LNG was supplied more frequently than UPA. UPA was only supplied in the 72-120-h timeframe. Clinical and regulatory knowledge, availability and cost to consumer were identified as factors influencing supply. IMPLICATIONS: This study found that despite the introduction of ulipristal acetate to the Australian market, it is not frequently supplied. Interviews identified the need for continuing professional development regarding pharmacist clinical and regulatory knowledge. Future guideline development should consider utility and user needs to optimize the implementation of guidelines.

Management of common ailments requiring referral in the pharmacy: a mystery shopping intervention study.

Background Pharmacists can play a key role in managing ailments through their primary roles of supplying over-the-counter (non-prescription) medicines and advice-giving. It must be ensured that pharmacy staff practise in an evidence-based, guideline-compliant manner. To achieve this, mystery shopping can be used as an intervention to assess and train pharmacy staff. Objective To determine if repeated student pharmacist mystery shopping with immediate feedback affected the outcome of scenarios requiring referral to a medical practitioner. To determine what, if any, factors may influence whether referral occurred. Setting Thirteen community pharmacies across metropolitan Sydney, Australia. Methods Sixty-one student pharmacist mystery shoppers visited 13 community pharmacies across metropolitan Sydney once weekly over nine weeks between March-October 2015 to conduct audio-recorded mystery shopping visits with assigned scenarios (asthma, dyspepsia, diarrhoea). Students returned to the pharmacy immediately to provide staff members with feedback. Pharmacy staff were scored by mystery shoppers according to a standardised scoresheet. Score data and other characteristics, such as the assigned scenario, were analysed via correlation and logistic regression modelling. Main outcome measure Whether a student mystery shopper was appropriately referred to a medical practitioner based on the presenting symptoms. Results 158 visits were eligible for analysis. Referral to a medical practitioner was appropriately made in 66% of visits. The regression model provided an R2 value of 0.73; the questioning score of the interaction and if a pharmacist was involved in the interaction were significant predictor of appropriate outcome (p < 0.001 and p < 0.01 respectively). Statistically significant differences were found between median questioning and total scores of interactions involving a pharmacist compared to those that did not (p < 0.001). No statistically significant correlation was found between the number of visits and appropriate outcome (p > 0.05). Conclusions Mystery shopping with feedback did not improve pharmacy staff performance over time. Increased questioning and involvement of a pharmacist in the interaction were significant predictors of referral to a medical practitioner occurring.

Mystery shopping and coaching as a form of audit and feedback to improve community pharmacy management of non-prescription medicine requests: an intervention study.

OBJECTIVES: To determine whether repeated mystery shopping visits with feedback improve pharmacy performance over nine visits and to determine what factors predict an appropriate outcome. DESIGN: Prospective, parallel, repeated intervention, repeated measures mystery shopping (pseudopatient) design. SETTING: Thirty-six community pharmacies in metropolitan Sydney, Australia in March-October 2015. PARTICIPANTS: Sixty-one University of Sydney pharmacy undergraduates acted as mystery shoppers. Students enrolled in their third year of Bachelor of Pharmacy in 2015 were eligible to participate. Any community pharmacy in the Sydney metropolitan region was eligible to take part and was selected through convenience sampling. INTERVENTION: Repeated mystery shopping with immediate feedback and coaching. OUTCOME MEASURES: Outcome for each given scenario (appropriate or not) and questioning scores for each interaction. RESULTS: Five hundred and twenty-one visits were analysed, of which 54% resulted in an appropriate outcome. Questioning scores and the proportion of interactions resulting in an appropriate outcome significantly improved over time (P<0.001). Involvement of pharmacists, visit number, increased questioning score and the prescribed scenario were predictors of an appropriate outcome (P=0.008, P=0.022, P<0.001 and P<0.001, respectively). Interactions involving a pharmacist had greater scores than those without (P<0.001). CONCLUSIONS: Repeated mystery shopping visits with feedback were associated with improved pharmacy performance over time. Future work should focus on the role of non-pharmacist staff and design interventions accordingly.

Outcomes and costs associated with PHiD-CV, a new protein D conjugate pneumococcal vaccine, in four countries.

This study estimated the impact of routine vaccination of infants with a new 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on health outcomes and costs across the entire population in Canada, Germany, Mexico, and Norway. A compartmental, static model with a 1-year time period for a steady-state population that allowed for the incorporation of direct and indirect (i.e., herd immunity and serotype replacement) vaccine effects across all age groups was used. Cases of disease prevented, deaths prevented, life-years gained, quality-adjusted life-years gained, and incremental costs in the steady-state year were calculated for PHiD-CV compared with 7-valent pneumococcal conjugate vaccine (PCV-7). A short-term analysis was also conducted to estimate the incremental difference in disease and cost outcomes for the two vaccines within the first 10 years. All costs were in 2008 local currency. In all four countries, the model estimated that PHiD-CV prevented more cases of disease, prevented more deaths, and resulted in more life-years and quality-adjusted life-years compared with PCV-7 in both the short term and the steady-state year. Assuming price parity for the vaccines, the model projected that routine vaccination with PHiD-CV resulted in lower costs compared with PCV-7 in both the short term and the steady-state year. Scenario analysis showed the incremental cost savings for PHiD-CV compared with PCV-7 in the steady-state year were sensitive to assumptions regarding duration of vaccine efficacy.

Randomized trial of single compared with tandem high-dose chemotherapy followed by autologous stem-cell transplantation in patients with chemotherapy-sensitive metastatic breast cancer.

PURPOSE: To compare progression-free survival between single and tandem high-dose chemotherapy (HDT) followed by autologous stem-cell transplantation in chemotherapy-sensitive metastatic breast cancer patients. PATIENTS AND METHODS: Between February 1997 and June 2001, 187 patients with complete and partial remission were randomly assigned to receive either one or two cycles of HDT, consisting of thiotepa (125 mg/m2/d for 4 days), cyclophosphamide (1,500 mg/m2/d for 4 days), and carboplatin (200 mg/m2/d for 4 days), followed by autologous stem-cell transplantation. RESULTS: One hundred seventy one of 187 randomly assigned patients completed first HDT, but only 52 of 85 completed the second HDT cycle in the tandem HDT arm. The rate of complete remission on an intent-to-treat-basis was 33% in the single-dose HDT arm and 37% in the tandem HDT arm (P = .48). The median progression-free survival times in single and tandem HDT arms were 9.4 and 11.2 months, respectively (one-sided P = .06; two one-sided P = .12), whereas median overall survival time tended to be greater after single versus tandem HDT (29 v 23.5 months, respectively; P = .4). In a multivariate analysis for progression-free survival, tandem HDT (hazard ratio [HR] = 0.71; 95% CI, 0.52 to 0.98; P = .03) and achievement of complete remission after induction chemotherapy (HR = 0.59; 95% CI, 0.37 to 0.96; P = .03) were factors for a better progression-free survival, whereas the factor of three or more sites of metastases (HR = 1.66; 95% CI, 1.12 to 2.47; P = .01) was associated with a worse progression-free survival. CONCLUSION: Despite a trend of improved progression-free survival, tandem HDT cannot be recommended for patients with chemotherapy-sensitive metastatic breast cancer because of a trend for shorter overall survival and higher toxicity compared with single HDT.

The effects of aging and dorsal hippocampal lesions: performance on spatial and nonspatial comparable versions of the water maze.

Aged intact and young hippocampal-lesioned rats show similar deficits on the spatial water maze. However, this does not necessitate that the source of these deficits in the aged animals is due to hippocampal damage. These water maze deficits may arise from other aging factors such as changes in thermoregulation, muscle fatigue, swim ability, and response to stress. Consequently, it is imperative to examine the performance of aged rats on a comparable nonhippocampal version of this task. Past attempts to develop a hippocampus-independent version of the water maze were confounded because these tasks were easier (i.e., the rats spent much less time swimming in the water) than the spatial versions of the task. The current study examined performance on a hippocampus-independent task comparable in difficulty to the spatial water one. Middle-aged (16-m) and old (25-m) male F344 rats were given sham or dorsal hippocampus lesions and tested on both a spatial and a nonspatial water maze. The middle-aged rats with hippocampal lesions were impaired on the spatial task but not on the nonspatial task. Conversely, aged animals showed a similar impairment on both types of water maze tasks. Additionally, hippocampal lesions exacerbated the age-related impairment on both tasks. These findings indicate that caution must be used when interpreting the results of water maze tasks for aged animals.