Background
Extensive evidence shows that well over 50% of people prefer to be cared for and to die at home provided circumstances allow choice. Despite best efforts and policies, one-third or less of all deaths take place at home in many countries of the world.

Objectives
1. To quantify the effect of home palliative care services for adult patients with advanced illness and their family caregivers on patients' odds of dying at home; 2. to examine the clinical effectiveness of home palliative care services on other outcomes for patients and their caregivers such as symptom control, quality of life, caregiver distress and satisfaction with care; 3. to compare the resource use and costs associated with these services; 4. to critically appraise and summarise the current evidence on cost-effectiveness.

Search methods
We searched 12 electronic databases up to November 2012. We checked the reference lists of all included studies, 49 relevant systematic reviews, four key textbooks and recent conference abstracts. We contacted 17 experts and researchers for unpublished data.

Selection criteria
We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITSs) evaluating the impact of home palliative care services on outcomes for adults with advanced illness or their family caregivers, or both.

Data collection and analysis
One review author assessed the identified titles and abstracts. Two independent reviewers performed assessment of all potentially relevant studies, data extraction and assessment of methodological quality. We carried out meta-analysis where appropriate and calculated numbers needed to treat to benefit (NNTBs) for the primary outcome (death at home).

Main results
We identified 23 studies (16 RCTs, 6 of high quality), including 37,561 participants and 4042 family caregivers, largely with advanced cancer but also congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), HIV/AIDS and multiple sclerosis (MS), among other conditions. Meta-analysis showed increased odds of dying at home (odds ratio (OR) 2.21, 95% CI 1.31 to 3.71; Z = 2.98, P value = 0.003; Chi2 = 20.57, degrees of freedom (df) = 6, P value = 0.002; I2 = 71%; NNTB 5, 95% CI 3 to 14 (seven trials with 1222 participants, three of high quality)). In addition, narrative synthesis showed evidence of small but statistically significant beneficial effects of home palliative care services compared to usual care on reducing symptom burden for patients (three trials, two of high quality, and one CBA with 2107 participants) and of no effect on caregiver grief (three RCTs, two of high quality, and one CBA with 2113 caregivers). Evidence on cost-effectiveness (six studies) is inconclusive.

Authors' conclusions
The results provide clear and reliable evidence that home palliative care increases the chance of dying at home and reduces symptom burden in particular for patients with cancer, without impacting on caregiver grief. This justifies providing home palliative care for patients who wish to die at home. More work is needed to study cost-effectiveness especially for people with non-malignant conditions, assessing place of death and appropriate outcomes that are sensitive to change and valid in these populations, and to compare different models of home palliative care, in powered studies.

/pdf/effectiveness-and-cost-effectiveness-of-home-palliative-care-27st4o4429.pdf

Effectiveness and cost‐effectiveness of home palliative care services for adults with advanced illness and their caregivers

Vivian Welch and colleagues present consensus-based guidelines for reporting equity-focused systematic reviews, the PRISMA-Equity extension.

/pdf/prisma-equity-2012-extension-reporting-guidelines-for-50dje4sr1t.pdf

PRISMA-Equity 2012 Extension: Reporting Guidelines for Systematic Reviews with a Focus on Health Equity

Background
Many systematic reviews exist on interventions to improve safe and effective medicines use by consumers, but research is distributed across diseases, populations and settings. The scope and focus of such reviews also vary widely, creating challenges for decision-makers seeking to inform decisions by using the evidence on consumers’ medicines use.

This is an update of a 2011 overview of systematic reviews, which synthesises the evidence, irrespective of disease, medicine type, population or setting, on the effectiveness of interventions to improve consumers' medicines use.

Objectives
To assess the effects of interventions which target healthcare consumers to promote safe and effective medicines use, by synthesising review-level evidence.

Methods
Search methods: We included systematic reviews published on the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. We identified relevant reviews by handsearching databases from their start dates to March 2012.

Selection criteria: We screened and ranked reviews based on relevance to consumers’ medicines use, using criteria developed for this overview.

Data collection and analysis: We used standardised forms to extract data, and assessed reviews for methodological quality using the AMSTAR tool. We used standardised language to summarise results within and across reviews; and gave bottom-line statements about intervention effectiveness. Two review authors screened and selected reviews, and extracted and analysed data. We used a taxonomy of interventions to categorise reviews and guide syntheses.

Main results
We included 75 systematic reviews of varied methodological quality. Reviews assessed interventions with diverse aims including support for behaviour change, risk minimisation and skills acquisition. No reviews aimed to promote systems-level consumer participation in medicines-related activities. Medicines adherence was the most frequently-reported outcome, but others such as knowledge, clinical and service-use outcomes were also reported. Adverse events were less commonly identified, while those associated with the interventions themselves, or costs, were rarely reported.

Looking across reviews, for most outcomes, medicines self-monitoring and self-management programmes appear generally effective to improve medicines use, adherence, adverse events and clinical outcomes; and to reduce mortality in people self-managing antithrombotic therapy. However, some participants were unable to complete these interventions, suggesting they may not be suitable for everyone.

Other promising interventions to improve adherence and other key medicines-use outcomes, which require further investigation to be more certain of their effects, include:

· simplified dosing regimens: with positive effects on adherence;

· interventions involving pharmacists in medicines management, such as medicines reviews (with positive effects on adherence and use, medicines problems and clinical outcomes) and pharmaceutical care services (consultation between pharmacist and patient to resolve medicines problems, develop a care plan and provide follow-up; with positive effects on adherence and knowledge).

Several other strategies showed some positive effects, particularly relating to adherence, and other outcomes, but their effects were less consistent overall and so need further study. These included:

· delayed antibiotic prescriptions: effective to decrease antibiotic use but with mixed effects on clinical outcomes, adverse effects and satisfaction;

· practical strategies like reminders, cues and/or organisers, reminder packaging and material incentives: with positive, although somewhat mixed effects on adherence;

· education delivered with self-management skills training, counselling, support, training or enhanced follow-up; information and counselling delivered together; or education/information as part of pharmacist-delivered packages of care: with positive effects on adherence, medicines use, clinical outcomes and knowledge, but with mixed effects in some studies;

· financial incentives: with positive, but mixed, effects on adherence.

Several strategies also showed promise in promoting immunisation uptake, but require further study to be more certain of their effects. These included organisational interventions; reminders and recall; financial incentives; home visits; free vaccination; lay health worker interventions; and facilitators working with physicians to promote immunisation uptake. Education and/or information strategies also showed some positive but even less consistent effects on immunisation uptake, and need further assessment of effectiveness and investigation of heterogeneity.

There are many different potential pathways through which consumers' use of medicines could be targeted to improve outcomes, and simple interventions may be as effective as complex strategies. However, no single intervention assessed was effective to improve all medicines-use outcomes across all diseases, medicines, populations or settings.

Even where interventions showed promise, the assembled evidence often only provided part of the picture: for example, simplified dosing regimens seem effective for improving adherence, but there is not yet sufficient information to identify an optimal regimen.

In some instances interventions appear ineffective: for example, the evidence suggests that directly observed therapy may be generally ineffective for improving treatment completion, adherence or clinical outcomes.

In other cases, interventions may have variable effects across outcomes. As an example, strategies providing information or education as single interventions appear ineffective to improve medicines adherence or clinical outcomes, but may be effective to improve knowledge; an important outcome for promoting consumers' informed medicines choices.

Despite a doubling in the number of reviews included in this updated overview, uncertainty still exists about the effectiveness of many interventions, and the evidence on what works remains sparse for several populations, including children and young people, carers, and people with multimorbidity.

Authors' conclusions
This overview presents evidence from 75 reviews that have synthesised trials and other studies evaluating the effects of interventions to improve consumers' medicines use.

Systematically assembling the evidence across reviews allows identification of effective or promising interventions to improve consumers’ medicines use, as well as those for which the evidence indicates ineffectiveness or uncertainty.

Decision makers faced with implementing interventions to improve consumers' medicines use can use this overview to inform decisions about which interventions may be most promising to improve particular outcomes. The intervention taxonomy may also assist people to consider the strategies available in relation to specific purposes, for example, gaining skills or being involved in decision making. Researchers and funders can use this overview to identify where more research is needed and assess its priority. The limitations of the available literature due to the lack of evidence for important outcomes and important populations, such as people with multimorbidity, should also be considered in practice and policy decisions.

/pdf/interventions-to-improve-safe-and-effective-medicines-use-by-4v83thdzsz.pdf

Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews.

Lost Science in the Third World

Slums are a global urban challenge, with less developed countries being particularly impacted. To adequately detect and map them, data is needed on their location, spatial extent and evolution. High- and very high-resolution remote sensing imagery has emerged as an important source of data in this regard. The purpose of this paper is to critically review studies that have used such data to detect and map slums. Our analysis shows that while such studies have been increasing over time, they tend to be concentrated to a few geographical areas and often focus on the use of a single approach (e.g., image texture and object-based image analysis), thus limiting generalizability to understand slums, their population, and evolution within the global context. We argue that to develop a more comprehensive framework that can be used to detect and map slums, other emerging sourcing of geospatial data should be considered (e.g., volunteer geographic information) in conjunction with growing trends and advancements in technology (e.g., geosensor networks). Through such data integration and analysis we can then create a benchmark for determining the most suitable methods for mapping slums in a given locality, thus fostering the creation of new approaches to address this challenge.

A Critical Review of High and Very High-Resolution Remote Sensing Approaches for Detecting and Mapping Slums: Trends, Challenges and Emerging Opportunities

Background: Research on identifying trials using geographic filters is limited.

Objectives:  To test the sensitivity and precision of a filter to identify African randomised controlled trials (RCTs).

Methods:  We searched medline and embase for RCTs published in 2004 using a Cochrane filter for RCTs. The search was limited to HIV/AIDS but irrespective of location. Two investigators independently identified African RCTs from the retrieved records forming a reference set. We then repeated the search using an African geographic filter comprising country and regional terms forming the filter set. We compared the sensitivity and precision of the sets.

Results:  The medline reference set comprised 1799 records with 23 African RCTs; for embase, the reference set comprised 763 records with 37 African RCTs. The medline filter set comprised 180 records with 17 African RCTs; the embase filter set comprised 98 records with 27 African RCTs. Sensitivity of the filter was 74% (medline) and 73% (embase). Addition of the filter improved precision from 1.3% to 9.4% (medline) and from 5% to 28% (embase).

Conclusion:  The African filter improved precision with some loss in sensitivity. Incomplete reporting of trial location in electronic bibliographic records restricts efficiency of geographic filters. Prospective trial registration should alleviate this.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1471-1842.2011.00936.x

Developing a geographic search filter to identify randomised controlled trials in Africa: finding the optimal balance between sensitivity and precision

Background
Home-based care (HBC), to promote quality-of-life and limit hospital care, is used in many countries, especially where public health services are overburdened.

Objectives
This review assessed the effects of HBC on morbidity and mortality in those with HIV/AIDS.

Search methods
Randomised and controlled clinical trials of HBC including all forms of treatment, care and support offered in the home were included. A highly sensitive search strategy was used to search CENTRAL, MEDLINE, EMBASE, AIDSearch, CINAHL, PsycINFO/LIT. Risk of bias of all trials was assessed.

Selection criteria
All randomised and controlled clinical trials were included of HIV/AIDS positive individuals, adults and children, of any gender, and from any setting. Home-based care, provided by family, lay and/or professional people, including all forms of treatment, care and support offered in the HIV/AIDS positive person's home as compared to hospital or institutional based care

Data collection and analysis
Titles, abstracts and descriptor terms of the electronic search results were screened independently by two authors for relevance based on the types of participants, interventions, and study design. Full text articles were obtained of all selected abstracts and an eligibility form was used to determine final study selection. Data extraction and assessment of risk of bias were done independently. Narrative synthesis of results were done. Relevant effect measures and the 95% confidence intervals were reported.

Main results
Ten studies randomised individuals and trial sizes varied from n=31 to n=549. One study randomised 392 households and enrolled a total of 509 persons with HIV and 1,521 HIV-negative household members. Two ongoing studies were identified. Intensive home-based nursing significantly improved self-reported knowledge of HIV and medications, self-reported adherence and difference in pharmacy drug refill (1 study). Another study, comparing proportion of participants with greater than 90% adherence, found statistically significant differences over time but no significant change in CD4 counts and viral loads. A third study found significant differences in HIV stigma, worry and physical functioning but no differences in depressive symptoms, mood, general health, and overall functioning. Comprehensive case management by trans-professional teams compared to usual care by primary care nurses had no significant difference in quality-of-life after 6-months of follow-up (n=57) and average length of time on service (n=549). Home total parenteral nutrition had no significant impact on overall survival and rate of re-hospitalisation. Two trials comparing computers with brochures/nothing/standard medical care found no significant effect on health status, and decision-making confidence and skill, but a reduction in social isolation after controlling for depression. Two trials evaluating home exercise programmes found opposing results. Home-based safe water systems reduced diarrhea frequency and severity among persons with HIV in Africa.

Authors' conclusions
Studies were generally small and very few studies were done in developing countries. There was a lack of studies truly looking at the effect of home based care itself or looking at significant end points (death and progression to AIDS). However, the range of interventions and HBC models evaluated can assist in making evidence-based decisions about HIV care and support.

Home‐based care for reducing morbidity and mortality in people infected with HIV/AIDS

Objectives : To identify all African medical journals actively publishing in 2005, and to create a geodatabase of these to evaluate and monitor future journal activity. Design : A search was done for relevant African medical journals on electronic databases, library catalogues and internet sites, and a list was compiled of active journals. A survey was conducted via questionnaire of editors of all listed African medical journals defined as having an editorial base on the continent. Results : One hundred and fifty-eight African medical journals were identified, published in 33 countries. One hundred and fifty-three editors were surveyed via email, post and/or fax. There was a 39% response rate from editors based in 17 countries. Fifty-one journals were published in English, 7 in French and 1 in Portuguese. Most journals were owned by an association or a society and were funded from a combination of sources. Journals covered general medical and specialist medical interest equally. Most (41 of 59 journals) had a circulation below 1 000, and most (52/59) published 4 or fewer issues a year. Almost all the journals included original research, and articles were peer reviewed. Few were indexed on Medline (N = 18) and EMBASE (N = 10). Plotting journal location using Geographic Information Systems (GIS) software provided a snapshot view of current journal activity. Conclusions : This study is likely to represent the most comprehensive list of current African medical journals. It confirms growth in African health care research and journal activity on the continent. Limited inclusion in international databases and accessibility to African researchers remain challenges in achieving publication of high-quality African research in high-quality African journals. South African Medical Journal Vol. 96(6) 2006: 533-537

/pdf/scope-and-geographical-distribution-of-african-medical-35r92qsyyd.pdf

Scope and geographical distribution of African medical journals active in 2005

Shaping the future. Planning Africa Conference 2008, Johannesburg, South Africa, April 14-16, 2008

Potential application of remote sensing in monitoring informal settlements in developing countries where complimentary data does not exist

Remotely sensed images are used for many purposes in today's world. In this paper, we explore the potential application
of high resolution satellite images in extracting features and classifying urban settlements. The test area is Soweto, an
urban area in the Greater Johannesburg Metropolitan area, in Gauteng, South Africa. We propose a new settlement
typology for efficient classification of formal and informal settlements via QuickBird satellite images. Following on, an
automated classification procedure based on the local binary pattern texture features is introduced. Using a convenience
sample of 25 images, we show the feasibility of the new typology by applying it to both a manual classification
procedure and an automated one. The manual classification procedure was conducted by a group of five experts who
interpreted the images and classified them according to formal and informal settlements. Analysis of the results revealed
an overall mean classification accuracy of 99.2% with a standard deviation of 1.79%. The automated method involved
extracting tiles at random positions within the 25-sample dataset. The features extracted from these tiles were classified
using a support vector machine. Classification accuracy on new samples was 56.27%, but cross-validation on the training
data reached classification accuracies of 98%.

Karishma Busgeeth

Papers

Developing a geographic search filter to identify randomised controlled trials in Africa: finding the optimal balance between sensitivity and precision

Home‐based care for reducing morbidity and mortality in people infected with HIV/AIDS

Scope and geographical distribution of African medical journals active in 2005

Potential application of remote sensing in monitoring informal settlements in developing countries where complimentary data does not exist

Potential application of remote sensing in monitoring informal settlements in South Africa where complimentary data does not exist