Tammy Hoffmann

Bond University · Centre for Research in Evidence-Based Practice (CREBP)

Quality use of anti-hypertensives and cholesterol-lowering medications is crucial for successful cardiovascular disease management. This systematic review aimed to estimate levels of over and underuse of services for primary and secondary prevention of cardiovascular diseases from 2000 to 2020: overprescribing/underprescribing, overtesting/undertes...

Thromboembolic events are a common risk in adults with atrial fibrillation, those with previous cerebrovascular accidents and undergoing emergency or elective surgeries. The widespread availability of antithrombotic agents and differing guidelines contribute to practice variations and increased risk of complications and deaths. The objective of thi...

Objectives To examine the reporting of natural history information, and relevant antibiotic stewardship strategies, in clinical guidelines for acute infections commonly seen in primary care and sometimes managed with antibiotics.MethodsA systematic review of national and international guidelines (2010 onwards), electronically available, for managin...

Background Subacromial decompression surgery and rotator cuff repair surgery are often used to treat shoulder pain but evidence suggests these surgeries provide limited clinical benefit and may cause harm. We developed a patient decision aid – guided by the International Patient Decision Aids Standards (IPDAS) – that presents evidence-based informa...

Person-centred care (PCC) and shared decision-making (SDM) are part of national clinical standards for an increasing number of areas of health care delivery. In addition to existing standards for accrediting hospitals, day surgery facilities, public dental services and medical education in Australia, new standards governing primary health care and...

Objective To evaluate the effects of a patient decision aid for people considering shoulder surgery. Methods Participants with shoulder pain considering shoulder surgery (n=425) were recruited online and randomised to i) a decision aid outlining the benefits and harms of shoulder surgery and non-surgical options (then randomised to a side-by-side...

Background: Most antibiotics prescribed in primary care are for acute, and often self-limiting, conditions. Patients' expectations of needing antibiotics are an influential driver of general practitioners' (GPs') prescribing behaviour. Better managing patient expectations in consultations for acute infections may be important for reducing prescrib...

Background Shared decision making is a means of translating evidence into practice and facilitating patient-centred care by helping patients to become more active in the decision-making process. Shared decision making is a collaborative process that involves patients and clinicians making health-related decisions after discussing the available opti...

Background Understanding prognostic information can help patients know what may happen to their health over time and make informed decisions. However, communicating prognostic information well can be challenging. Purpose To conduct a systematic review to identify and synthesize research that has evaluated visual presentations that communicate quan...

Objective To compare the effectiveness of hand hygiene using alcohol-based hand sanitiser to soap and water for preventing the transmission of acute respiratory infections (ARIs) and to assess the relationship between the dose of hand hygiene and the number of ARI, influenza-like illness (ILI) or influenza events. Design Systematic review and meta...

Objective To develop and user test a patient decision aid for people with subacromial pain syndrome that presents evidence-based information on the benefits and harms of subacromial decompression surgery and rotator cuff repair surgery. Design Mixed-methods study outlining the development of a patient decision aid. Setting We assembled a multidis...

Background: The objective of this International Patient Decision Aids Standard (IPDAS) review is to update and synthesize theoretical and empirical evidence on how balanced information can be presented and measured in patient decision aids (PtDAs). Methods: A multidisciplinary team conducted a scoping review using 2 search strategies in multiple...

Objective To assess Australian physiotherapists’ knowledge about, attitudes towards, and self-reported use of shared decision making, as well as perceived barriers to its implementation in practice. Methods Physiotherapists registered for a national Australian physiotherapy conference were invited via email and the conference app to complete a sel...

Background Patient decision aids (PDAs) should provide evidence‐based information so patients can make informed decisions. Yet, PDA developers do not have an agreed‐upon process to select, synthesize and present evidence in PDAs. Objective To reach the consensus on an evidence summarization process for PDAs. Design A two‐round modified Delphi sur...

Background Despite the development of theory-driven frameworks to guide implementation strategies, their application thus far has largely been limited to evaluating effectiveness within specific contexts. This study describes the use of these frameworks to inform a scale-up strategy for shared decision making (SDM) implementation across a state-wid...

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...

p>BACKGROUND: The management of acute respiratory infections (ARIs), urinary tract infections (UTIs), and skin and soft tissue infections (SSTIs) should be guided by high quality evidence. AIM: To compare the quantity and quality of randomised placebo-controlled trials of antibiotics for ARIs, UTIs, and SSTIs. DESIGN & SETTING: A scoping review o...

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:...

Purpose Translation of findings from stroke trials into clinical practice remains low. Little is known about planned translation activities from the perspective of trialists who generate the evidence. This study aims to investigate perceptions of Australian stroke clinical trialists’ about implementation of their findings into practice, and what tr...

Objective To evaluate the effects of information format on intentions to request diagnostic imaging for non-specific low back pain in members of the public. Methods We performed a three arm, 1:1:1, superiority randomised trial on members of the public. Participants were randomised to one of the three groups: a Standard Care Leaflet group (standard...

Objective: To compare the effectiveness of hand hygiene using alcohol-based hand sanitiser to soap and water for preventing the transmission of acute respiratory infections (ARIs), and assess the relationship between the dose of hand hygiene and the number of ARI, influenza-like illness (ILI), or influenza events. Methods: Systematic review of rand...

Background Oral care is important to prevent buccal and systemic infections after an acquired brain injury (ABI). Despite recent advancements in the development of ABI clinical practice guidelines, recommendations for specific clinical processes and actions to attain adequate oral care often lack information. Objective This systematic review will...

Background: Evidence of effectiveness of mobile health (mHealth) apps as well as their usability as non-drug interventions in primary care are emerging around the globe. Objective: This study aimed to explore the feasibility of mHealth app prescription by general practitioners (GPs) and to evaluate the effectiveness of an implementation interventi...

Background Hand and arm activity after stroke improves with evidence-based rehabilitation. Therapists face known barriers when providing evidence-based rehabilitation and require support to implement guidelines. The aim of this study was to investigate the feasibility of two implementation packages on guideline adherence by occupational therapists...

OBJECTIVE: To assess the effectiveness of hand hygiene, surface disinfecting, and other hygiene interventions in preventing or reducing the spread of illnesses from respiratory viruses. DESIGN: Update of a systematic review and meta-analysis focussing on randomised controlled trials (RCTs) and cluster-RCTs (c-RCTs) evidence only. DATA SOURCES: Elig...

OBJECTIVE: To examine the effectiveness of eye protection, face masks, or person distancing on interrupting or reducing the spread of respiratory viruses. DESIGN: Update of a systematic review and meta-analysis. DATA SOURCES: Eligible trials from the previous review; search of Cochrane Central Register of Controlled Trials, PubMed, Embase and CINAH...

BACKGROUND The ubiquity of smartphones and health apps make them a potential self-management tool for patients that could be prescribed by medical professionals. However, little is known about how Australian general practitioners (GPs) and their patients view the possibility of health app prescription. OBJECTIVE To determine barriers and facilitat...

Background: The ubiquity of smartphones and health apps make them a potential self-management tool for patients that could be prescribed by medical professionals. However, little is known about how Australian general practitioners and their patients view the possibility of prescribing mobile health (mHealth) apps as a nondrug intervention. Object...

Background Low-value arthroscopic surgery continues to be used to treat people with degenerative knee conditions (osteoarthritis, degenerative meniscal tears, loose bodies) despite consistent evidence from placebo-controlled trials and guidelines recommending against its use. Patients and some clinicians continue to harbour misconceptions about the...

BACKGROUND Oral care is important to prevent buccal and systemic infections after an acquired brain injury (ABI). Despite recent advancements in the development of ABI clinical practice guidelines, recommendations for specific clinical processes and actions to attain adequate oral care often lack information. OBJECTIVE This systematic review will...

Purpose: Antibiotic use in acne treatment raises concerns about increased resistance, necessitating alternatives. We assessed the effectiveness of blue-light therapy for acne. Methods: We analyzed randomized controlled trials comparing blue light with nonlight interventions. Studies included people of any age, sex, and acne severity, in any sett...

BACKGROUND The accessibility and popularity of mHealth apps make them a potential digital age non-drug intervention. When proven effective they could be prescribed in general practice. OBJECTIVE This study aimed to explore the feasibility of app prescription by general practitioners (GPs) and to evaluate the effectiveness of an implementation inte...

Background: Evidence of effectiveness of mobile health (mHealth) apps as well as their usability as non-drug interventions in primary care are emerging around the globe. Objective: This study aimed to explore the feasibility of mHealth app prescription by general practitioners (GPs) and to evaluate the effectiveness of an implementation interven...

The aim of this study was to identify potential implementation interventions to increase the uptake of shared decision making (SDM) in clinical practice in New South Wales (NSW) Health. The Agency for Clinical Innovation hosted a full-day SDM masterclass in May 2017 and 53 attendees completed a survey to identify barriers to implementing SDM. The T...

Introduction: Despite the availability of stroke clinical practice guidelines and acceptance by therapists that guidelines contain 'best practice' recommendations, compliance remains low. While previous studies have explored barriers associated with implementing rehabilitation guidelines in general, it remains unknown if these barriers are applica...

Perceived knowledge gaps in general practice are not well documented but must be understood to ensure relevant and timely evidence for busy general practitioners (GPs) which reflects their diverse and changing needs. The aim of this study was to classify the types of questions submitted by Australian GPs to an evidence-based practice information se...

Introduction Nudge-interventions aimed at health professionals are proposed to reduce the overuse and underuse of health services. However, little is known about their effectiveness at changing health professionals’ behaviours in relation to overuse or underuse of tests or treatments. Objective The aim of this study is to systematically identify a...

Introduction Treatment fidelity is a complex, multifaceted evaluative process which refers to whether a studied intervention was delivered as intended. Monitoring and enhancing fidelity is one recommendation of the TiDIER (Template for Intervention Description and Replication) checklist, as fidelity can inform interpretation and conclusions drawn a...

Objective This study evaluated whether frequent (fortnightly) audit and feedback cycles over a sustained period of time (>12 months) increased clinician adherence to recommended guidelines in acquired brain injury rehabilitation. Design A before and after study design. Setting A metropolitan inpatient brain injury rehabilitation unit. Participan...

Standards for Reporting Implementation Studies: the StaRI checklist for completion. (DOCX)

Proportion (%) (95% CI) of clinical practice guideline indicator adherence (n = 114) across measurement points. (DOCX)

Background: Clinicians frequently have questions about patient care. However, for more than half of the generated questions, answers are never pursued, and if they are, often not answered satisfactorily. We aimed to characterise the clinical questions asked and answers provided by general practitioners (GP) through posts to a popular professional...

Objectives To explore patients’ or parents of child patients’ understanding of antibiotic resistance and aspects of resistance such as resistance reversibility and its spread among those in close proximity, along with how this may influence attitudes towards antibiotic use for acute respiratory infections (ARIs). Design Qualitative semistructured...

Introduction: Information included in a patient decision aid (PDA) can significantly influence patients' decisions and is, therefore, expected to be evidence-based and rigorously selected and summarised. PDA developers have not yet agreed on a standardised process for the selection and summarisation of the supporting evidence. We intend to generat...

Objective To evaluate the feasibility and acceptability of a personalised telehealth intervention to support dietary self-management in adults with stage 3–4 chronic kidney disease (CKD). Design Mixed-methods process evaluation embedded in a randomised controlled trial. Participants People with stage 3–4 CKD (estimated glomerular filtration rate...

Background: Macrolide antibiotics (macrolides) are among the most commonly prescribed antibiotics worldwide and are used for a wide range of infections. However, macrolides also expose people to the risk of adverse events. The current understanding of adverse events is mostly derived from observational studies, which are subject to bias because it...

Background Antibiotic resistance is a global problem, but the relationship between antibiotic use and resistance development and decay is not well understood. This knowledge is best provided by prospective studies, but to be useful they must be both conducted and reported well. Little is known about the reporting quality of these studies. This stud...

Background: Little research has examined whether shared decision making (SDM) occurs in consultations for acute respiratory infections (ARIs), including what, and how, antibiotic benefits and harms are discussed. We aimed to analyse the extent and nature of SDM in consultations between GPs and patients with ARIs, and explore communication with and...

Background Antibiotic resistance is an urgent global problem, but reversibility is poorly understood. We examined the development and decay of bacterial resistance in community patients after antibiotic use. Methods This was a systematic review and meta-analysis. PubMed, EMBASE and CENTRAL (from inception to May 2017) were searched, with forward a...

Background: Despite the established interest in evidence-based practice (EBP) as a core competence for clinicians, evidence for how best to teach and evaluate EBP remains weak. We sought to systematically assess coverage of the five EBP steps, review the outcome domains measured, and assess the properties of the instruments used in studies evaluat...

Objectives To review all randomised controlled trials that have assessed the effect of nudge-type interventions on clinician treatment, screening, and testing behaviours across all health conditions. Method A systematic review of randomised controlled trials. Two reviewers are conducting the electronic searches of six databases independently.We ar...

[Extract] Researchers now recognize the need to completely describe active interventions within trials.1,2 However, the importance of clearly describing placebo control interventions is not well reported or understood. Placebo controls are interventions used in clinical trials that do not contain the “active” components of the active intervention....

Importance Evidence-based practice (EBP) is necessary for improving the quality of health care as well as patient outcomes. Evidence-based practice is commonly integrated into the curricula of undergraduate, postgraduate, and continuing professional development health programs. There is, however, inconsistency in the curriculum content of EBP teach...

We lack guidance on how to describe population health and policy (PHP) interventions in reports of evaluation studies. PHP interventions are legal, fiscal, structural, organisational, environmental, and policy interventions such as the regulation of unhealthy commodities, health service reorganisation, changes in welfare policy, and neighbourhood i...

Background Health information is readily accessible but is of variable quality. General knowledge about how to assess whether claims about health interventions are trustworthy is not common, so people’s health decisions can be ill-informed, unnecessarily costly and even unsafe. This review aims to identify and evaluate studies of educational interv...

Background: Survivors of critical illness often experience a multitude of problems that begin in the intensive care unit (ICU) or present and continue after discharge. These can include muscle weakness, cognitive impairments, psychological difficulties, reduced physical function such as in activities of daily living (ADLs), and decreased quality o...

In a Perspective, Tammy Hoffmann and colleagues discuss medical decision making for elderly patients with multimorbidity.