Author: Rhona MacDonald

Launch of the PLOS Pediatric Medicine Collection

PLOS Medicine Editors Rhona MacDonald and Amy Ross on the launch of the new PLOS Pediatric Medicine Collection and the upcoming Pediatric Academic Societies and Asian Society for Pediatric Research Meeting, where PLOS will be in attendance.

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Image credits (clockwise from top left): Matt Erasmus, Flickr.com; D.C. Atty, Flickr.com; Frank Douwes, Flickr.com; U.S. Air Force photo/Staff Sgt Eric T. Sheler, Wikimedia Commons

To coincide with PLOS Medicine’s participation in the Pediatric Academic Societies and Asian Society for Pediatric Research joint meeting (PAS/ASPR 14) in Vancouver on May 3-6, PLOS is delighted to announce the launch of a new collection on pediatric medicine. This collection collates key research and commentary relating to the health of children that has been published across the PLOS journals over the past year.

The Pediatric Medicine Collection covers children of all ages, includes those living in high, middle, and low-income countries, and covers the main conditions affecting children world-wide.
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Category: Collections, Conference news, General, Maternal Newborn and Child Health | Comments Off

Maximizing the Impact of Research: New Reporting Guidelines Collection from PLOS

Image credit: CCAC North Library, Flickr.com

Image credit: CCAC North Library, Flickr.com

As experts in their field, many authors assume they already know the best way to report their research findings, but this is not always true. Reporting guidelines are designed help make sure that you don’t forget to include crucial bits of information that might be obvious to you as the author, but not necessarily obvious to your audience. Reporting checklists are not just exercises in ticking boxes – they are about helping you to effectively communicate what you have done so that it can be widely read, used, and influence future work in the field. It is not only frustrating to read a research paper where key pieces of information about the methods or results are missing, but more importantly, inadequate research reporting and can lead to biases in interpretation of research and wasted resources in attempts to replicate the methods.

Many researchers are unaware of the growing number of resources that can be used to guide preparation of research manuscripts and improve the quality of reporting. A new PLOS Reporting Guidelines Collection, including papers from PLOS Medicine, PLOS ONE, PLOS Biology, PLOS Computational Biology, and PLOS NTDs, aims to highlight some of these resources and has been launched to coincide with the Seventh International Congress on Peer Review and Biomedical Publication, held in Chicago from September 8 to 10, 2013.  The collection is consistent with the goals of the Peer Review Congress: “to improve the quality and credibility of scientific peer review and publication and to help advance the efficiency, effectiveness, and equitability of the dissemination of biomedical information throughout the world”.
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Q&A with Pamela Collins – lead author of new series in PLOS Medicine on integrating mental health

2066_Columbia_Collins_20070711In the latest installment of the Speaking of Medicine series of Q&A blog posts, we hear from Pamela Collins, the corresponding author of a series of Policy Forum articles in PLOS Medicine that provides a global perspective on integrating mental health.  Pamela Collins M.D., M.P.H., is the Director of the Office for Research on Disparities and Global Mental Health at the National Institute of Mental Health (NIMH). I asked her about some of the topics discussed in the new series, which will be published in PLOS Medicine weekly for the  next five weeks, starting with the publication today of a Policy Forum article discussing integration in research, policy, and practice.

1. Why is the integration of mental health care so important?

Integration of mental health care is important on several levels. First, there is a need to integrate mental health concerns into the broader discussions in global public health because of the tremendous disability and suffering that mental disorders cause around the world. Mental disorders are global problems which, untreated, result in increased morbidity and mortality, as well as increased health system and societal costs.  Second, we know that mental disorders co-occur with many other medical conditions, including cardiovascular disease, diabetes, and HIV-related disease.  Depression is a good example. When depression co-occurs with these conditions, the risk of poor outcomes, including death, increases.  Third, integration of mental health interventions into other areas of routine care (e.g. primary care or maternal health care) has the potential for improving access to needed services, enabling health care providers to deliver holistic care.  Establishing access to evidence-based, effective care for depression in settings where women receive routine health services may increase the likelihood that women with depression receive the care they need.

2. What were your main motivations for initiating the series?

NIMH and its partners completed the priority setting initiative, the Grand Challenges in Global Mental Health, in 2011. One of the Grand Challenges identified by the group of international stakeholders was to “redesign health systems to integrate mental, neurological, and substance use (MNS) disorders with other chronic disease care, and create parity between mental and physical illness in investment to research, training, treatment and prevention.”  Notably, meeting this challenge requires the cooperation of stakeholders within and outside of the mental health arena.  It is timely, too.  Much of the global health community is now focused on how to leverage resources efficiently in order to achieve the best health outcomes for populations in need. Integrating mental health services that build on existing platforms may be one way to introduce efficiency.

3. How did you get interested in this area of research?

My past research focused on the intersection of mental health care and HIV-related care in high-, middle-, and low-income country settings.  I entered this arena of integration while first working to reduce the risk of HIV infection among women with schizophrenia, bipolar disorder, and depression in New York City in the 1990s, and I subsequently began to work with providers in South Africa and Rwanda around similar issues.  People with severe mental illnesses have a much higher prevalence HIV infection in the United States. Yet, this is not a population that we usually hear about in public health efforts to prevent HIV and care for people with HIV.  But the risk for HIV infection is not solely a high-income country phenomenon.  Studies from sub-Saharan Africa also show a high prevalence of HIV infection among people hospitalized in psychiatric facilities. This population also has higher rates of mortality and earlier mortality from non-communicable diseases.  These findings point to the possibility of integrated care as a means of insuring that people with mental illnesses gain access to the prevention and care they need for other health conditions.  At the same time people who develop a mental illness while being treated for other health conditions need access to services where the symptoms of mental illness will be recognized and treated appropriately.

4. What are the main barriers to moving this field forward?

One critical barrier is the inequity in human resources for health care around the world. There is a dearth of mental health care providers in many parts of the world. The 2011 WHO Mental Health Atlas tells us that nearly half of the world’s population lives in a setting with one psychiatrist or less serving 200,000 people. But, barriers also provide opportunities.  The mental health community has long experimented with using non-specialists to deliver mental health services including community health workers, nurses, or primary care doctors. We now have a growing number of rigorous studies that provide evidence that effective mental health interventions can be delivered by non-specialists in settings where the specialist workforce is simply insufficient.

5. What further research is needed in this area?

Given that the resources allocated for mental health care are limited in many settings, we need to understand the best methods of equipping available health care providers to deliver evidence-based mental health services, in tandem with interventions for other disorders, in a variety of health system environments.  We have tools, through the WHO Mental Health Gap Action Programme, to assist with screening for some MNS disorders, but we need more understanding of how disease processes interact to affect the course of illness.  As we will see in the concluding paper in the series, Vikram Patel and colleagues argue that at  the systems level, we have more to learn about how and where to integrate services for people with different kinds of mental illnesses, such as chronic psychosis, dementia, or childhood mental disorders.  Furthermore, most of the studies that provide the evidence base for integrating mental health services into other delivery platforms have been carried out in high-income countries, so we need more data from settings with fewer resources that show how best to provide these services. Last year NIMH published a funding opportunity announcement called “Grand Challenges in Global Mental Health: Integrating Mental Health into Chronic Disease Care Provision in Low- and Middle-Income Countries.”  We hope the studies to be funded through this initiative will answer some of these questions.


Category: Mental Health | 1 Comment

Making PROGRESS in Prognostic Research

For anyone that’s sick, understanding what the likely outcome is one of the first questions they want the answer to. Yet despite the millions of dollars poured into health research every year actually predicting outcomes is a surprisingly inexact science.

This week the PROGnosis RESearch Strategy (PROGRESS) Group, comprised of investigators from multiple countries who participated in three workshops (which also included  one editor each from the BMJ and PLOS Medicine) and discussions, publish four papers in PLOS Medicine and the BMJ, (itself an unusual collaboration between journals ) that aim to better define the field of prognosis research.

Prognosis research is defined in the series as the investigation of the “relations between future outcomes (endpoints) among people with a given baseline health state (startpoints) in order to improve health”.

Prognosis research has yet to be identified as a distinct field of research and a major issue in this area is the lack of cohesion for methodology, analysis, and data reporting. Currently, there are a multitude of disparate studies claiming to have identified factors or models that predict future clinical outcomes in relation to current diagnostic and treatment practice. In a single clinical field there may be several studies that identify different factors or models for the same outcomes, but do not attempt to build on or even compare previously identified factors and models. In addition, individual studies are often underpowered or not replicated or validated in other populations.  A good example of this can be found in a study by Malats and colleagues that analyzed 168 reports and concluded that “after 10 years of research [including over 10 000 patients], evidence is not sufficient to conclude whether changes in P53 act as markers of outcome in patients with bladder cancer.” In reality, there are very few prognostic studies with sufficiently robust methods to be clinically informative; common methodological problems include the use of retrospective study designs, study biases, and selective reporting of significant findings.

In the papers published this week the researchers provide a four point framework for prognostic research to take the field further:

(1) The course of health related conditions in the context of the nature and quality of current care (fundamental prognosis research)

(2) Specific factors (such as biomarkers) that are associated with prognosis (prognostic factor research)

(3) The development, validation, and impact of statistical models that predict individual risk of a future outcome

(prognostic model research)

(4) The use of prognostic information to help tailor treatment decisions to an individual or group of individuals with similar characteristics (stratified medicine research).

 

There are  many reporting guidelines designed to help researchers improve study design and reporting of clinical research outcomes (e.g. STROBE, CONSORT, PRISMA, STARD). These four PROGRESS papers extend earlier work outlining prognosis models in clinical practice published in the BMJ in 2009Ten steps towards improving prognosis research published in the BMJ in 2010, and a related set of recommendations that were developed specifically for prognosis research related to tumor markers (REporting recommendations for tumour MARKer prognostic studies, REMARK). The PROGRESS group’s recommendations highlight the importance of  study registration, a published protocol, ideally a prospective approach, and an appropriate statistical analysis plan.  In addition, the PROGRESS papers provide a broader overview of examples of prognosis research from cancer, cardiovascular disease, musculoskeletal disorders, trauma, and beyond to provide a more cohesive approach to research practices in the field of prognosis research and will help prognosis researchers to enforcing the high standards required in other fields.

 

The PROGRESS series has been published as a collaborative effort between the PROGRESS Group, PLOS Medicine and BMJ. The first and fourth papers are published in BMJ and second and third papers are published in PLOS Medicine and can be accessed in the links below:

Prognosis research strategy (PROGRESS) 1: A framework for researching clinical outcomes

Prognosis research strategy (PROGRESS) 2: Prognostic factor research

Prognosis research strategy (PROGRESS) 3: Prognostic model impact research

Prognosis research strategy (PROGRESS) 4: Stratified medicine research

 

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