Papers by thanya pathirana
BMJ evidence-based medicine, May 23, 2024
Objective To synthesise the available evidence on the effects of interventions designed to improv... more Objective To synthesise the available evidence on the effects of interventions designed to improve the delivery of healthcare that reduces the greenhouse gas (GHG) emissions of healthcare. Design Systematic review and structured synthesis. Search sources Cochrane Central Register of Controlled Trials, PubMed, Web of Science and Embase from inception to 3 May 2023. Selection criteria Randomised, quasi-randomised and non-randomised controlled trials, interrupted time series and controlled or uncontrolled beforeafter studies that assessed interventions primarily designed to improve the delivery of healthcare that reduces the GHG emissions of healthcare initiated by clinicians or healthcare services within any setting. Main outcome measures Primary outcome was GHG emissions. Secondary outcomes were financial costs, effectiveness, harms, patientrelevant outcomes, engagement and acceptability. Data collection and analysis Paired authors independently selected studies for inclusion, HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ Rigorous trials that measure GHG emissions of such interventions using gold-standard life cycle assessment are needed.
JAMA Network Open
ImportanceOveruse of surgical procedures is increasing around the world and harms both individual... more ImportanceOveruse of surgical procedures is increasing around the world and harms both individuals and health care systems by using resources that could otherwise be allocated to addressing the underuse of effective health care interventions. In low- and middle-income countries (LMICs), there is some limited country-specific evidence showing that overuse of surgical procedures is increasing, at least for certain procedures.ObjectivesTo assess factors associated with, extent and consequences of, and potential solutions for low-value surgical procedures in LMICs.Evidence ReviewWe searched 4 electronic databases (PubMed, Embase, PsycINFO, and Global Index Medicus) for studies published from database inception until April 27, 2022, with no restrictions on date or language. A combination of MeSH terms and free-text words about the overuse of surgical procedures was used. Studies examining the problem of overuse of surgical procedures in LMICs were included and categorized by major focus:...
Family Practice, Oct 4, 2023
Background: In a therapeutic partnership, physicians rely on patients to describe their health co... more Background: In a therapeutic partnership, physicians rely on patients to describe their health conditions, join in shared decision-making, and engage with supported self-management activities. In shared care, the patient, primary care, and specialist services partner together using agreed processes and outputs for the patient to be placed at the centre of their care. However, few empirical studies have explored physicians' trust in patients and its implications for shared care models. Aim: To explore trust in patients amongst general practitioners (GPs), and the impacts of trust on GPs' willingness to engage in new models of care, such as colorectal cancer shared care. Methods: GP participants were recruited through professional networks for semi-structured interviews. Transcripts were integrity checked, coded inductively, and themes developed iteratively. Results: Twenty-five interviews were analysed. Some GPs view trust as a responsibility of the physician and have a high propensity for trusting patients. For other GPs, trust in patients is developed over successive consultations based on patient characteristics such as honesty, reliability, and proactivity in self-care. GPs were more willing to engage in colorectal cancer shared care with patients with whom they have a developed, trusting relationship. Conclusions: Trust plays a significant role in the patient's access to shared care. The implementation of shared care should consider the relational dynamics between the patient and health care providers.
Preventing overdiagnosis meeting abstracts
BackgroundPopulation trends in PSA screening and prostate cancer incidence do not perfectly corre... more BackgroundPopulation trends in PSA screening and prostate cancer incidence do not perfectly correspond. We aimed to better understand relationships between trends in PSA screening, prostate cancer incidence and mortality in Australia.MethodsDescription of age standardised time trends in PSA tests, prostate biopsies, cancer incidence and mortality within Australia for the age groups: 45-74, 75-84, and 85+ years.ResultsPSA testing increased from its introduction in 1989 to a peak in 2008. It then declined in men aged 45-84 years. Prostate biopsies and cancer incidence declined from 1995 to 2000, in parallel with decrease in trans-urethral resections of prostate (TURP). After 2000, changes in biopsies and cancer incidence paralleled PSA screening in men 45-84 years, while in men ≥85 years, biopsies stabilised and incidence declined. More recently a reduction in TURP correlated with increased Dutasteride and Tamsulosin usage. Prostate cancer mortality in men aged 45-74 years remained lo...
Medical Journal of Australia
he burden of cancer is increasing rapidly, 1 including in Australia, 2 partly because of ageing p... more he burden of cancer is increasing rapidly, 1 including in Australia, 2 partly because of ageing populations, reduced competing mortality from cardiovascular disease, and changes in exposure to risk factors for cancer. A further contributor is overdiagnosis, or the diagnosis of cancer in people who would never have experienced symptoms or harm had the cancer remained undetected and untreated. 3,4 Overdiagnosis of certain screen-detected cancers is common, 5 including 20-50% of prostate cancer 6 and 11-19% of breast cancer diagnoses. 7 Cancer can also be overdiagnosed outside screening programs. Overdiagnosis of thyroid cancer 8 is attributable to incidental detection during investigations of unrelated problems; 9 overdiagnosis of renal cancer and melanoma is less well investigated. 10 Overdiagnosis is important because of the associated iatrogenic harms and costs. 3,11 Harms include the psychosocial impact of unnecessary cancer diagnoses, such as the increased suicide risk for men after being diagnosed with prostate cancer. 12,13 Cancer treatments such as surgery, radiotherapy, endocrine therapy, and chemotherapy can cause physical harm, but the risks are considered acceptable if diagnosis is appropriate. When someone is unnecessarily diagnosed with cancer, however, they can only be harmed by treatment, not helped. 4 Concerns about the overdiagnosis and overtreatment of cancer have led to calls to investigate the problem. 5,14 To facilitate the evaluation of interventions for reducing overdiagnosis, we estimated overdiagnosis levels in Australia for five of the seven cancers for which overdiagnosis has been documented: 4 melanoma, and breast, prostate, thyroid and renal cancers. Neuroblastoma was not included because neuroblastoma screening is not undertaken in Australia, and lung cancer was excluded because declines in smoking rates and the unquantified uptake of screening complicate the assessment of overdiagnosis. Methods We aimed to estimate the proportion of cancer diagnoses in Australia that might reasonably be attributed to overdiagnosis by calculating and comparing current and past lifetime risks of cancer, a method we developed for assessing prostate cancer overdiagnosis. 15 Excess lifetime risk for five cancers with recognised overdiagnosis potential We analysed data routinely collected by the Australian Institute of Health and Welfare. 16 We extracted data on cancerspecific diagnoses, cancer-specific deaths, all deaths, and population numbers to calculate, separately for women and men, differences in the lifetime risks of being diagnosed with specific cancers during in 1982 and in 2012. The comparator year (1982) was the first for which publicly available national data were available; further, there was no breast cancer screening program in 1982, little informal screening for prostate cancer or melanoma, and ultrasound and computed tomography (CT) screening that could detect incidental thyroid and renal cancers was infrequent. The index year (2012) was the most recent year for which data on the included cancers (invasive and in situ) were available. We assumed that by 2012 older people were exposed to early detection (screening or incidental detection on imaging) when younger, so that any effects of
Medical Journal of Australia
ancer (46 307 deaths in 2016 1) and coronary heart disease (19 077 deaths in 2016 2) are the lead... more ancer (46 307 deaths in 2016 1) and coronary heart disease (19 077 deaths in 2016 2) are the leading causes of death in Australia. An estimated 470 new cancers were diagnosed and 161 cancer deaths recorded per 100 000 Australian adults in 2017; the five most frequently diagnosed cancers were breast cancer, colorectal cancer, prostate cancer, melanoma of the skin, and lung cancer. 3 State-based registries record and submit cancer incidence and mortality data to the Australian Institute of Health and Welfare (AIHW), which compiles these data annually for the Australian Cancer Database. The International Agency for Research on Cancer grades the quality of these data as "A", the highest level on their scale. 4 AIHW Australian Cancer Database reports are an important source of information on cancer epidemiology and guide initiatives for improving cancer prevention, screening, diagnosis, and treatment at the local, state, and national levels. 5
South-East Asian Journal of Medical Education
The prevalence of breast cancer in Sri Lanka is on the rise. A need analysis was carried out to i... more The prevalence of breast cancer in Sri Lanka is on the rise. A need analysis was carried out to identify the learning needs and utilization of currently available learning resources on breast cancer management among the general practitioners (GPs) in Sri Lanka. A pretested questionnaire was posted to 210 GPs affiliated to College of General Practitioners of Sri Lanka. The data were analyzed using descriptive statistics. Response rate was 55.2%. Fifty nine (50.9%) participants were aged between 31-50 years and 77 (66.4%) were males. Majority 87(75%) had not previously taken part in any CPD program on breast cancer management. Awareness on the guide for primary care doctors and family physicians on management of breast symptoms (31, 26.7%) and national guidelines on management of breast carcinoma (20, 17.2%) were markedly low. Although majority (99, 85.3%) reported a medium to high involvement in referral, 77(66.4%) admitted of low involvement in shared follow up care while 72(62.1%) reported low involvement in palliative care. Accordingly, palliative care (68,58.6%) and shared follow up care(77,66.4%) were identified to be among the top two priority areas to be included in a future CPD module. Majority (83, 71.5%) preferred either online or blended modes of learning. In conclusion, participation of GPs in CPD programs on breast cancer management and awareness on current guidelines are deficient. Although current involvement in referral of breast cancer patients for tertiary care is substantial, involvement in shared follow up care and palliative care is low. Thus, a future online CPD module should be established with greater emphasize on these areas.
BMJ Open
ObjectivesTo quantify the risk of overdiagnosis associated with prostate cancer screening in Aust... more ObjectivesTo quantify the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach.DesignModelling and validation of the lifetime risk method using publicly available population data.SettingOpportunistic screening for prostate cancer in the Australian population.ParticipantsAustralian male population (1982–2012).InterventionsProstate-specific antigen testing for prostate cancer screening.Primary and secondary outcome measuresPrimary: lifetime risk of overdiagnosis in 2012 (excess lifetime cancer risk adjusted for changing competing mortality); Secondary: lifetime risk of prostate cancer diagnosis (unadjusted and adjusted for competing mortality); Excess lifetime risk of prostate cancer diagnosis (for all years subsequent to 1982).ResultsThe lifetime risk of being diagnosed with prostate cancer increased from 6.1% in 1982 (1 in 17) to 19.6% in 2012 (1 in 5). Using 2012 competing mortality rates, the lifetime risk in 1982 was 11...
Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals, Apr 1, 2018
Childhood obesity is rising in prevalence in Australia. This study aimed to evaluate the impact o... more Childhood obesity is rising in prevalence in Australia. This study aimed to evaluate the impact of the "Have Fun-Be Healthy" (HFBH) intervention, delivered in the Playgroup setting, to generate short term changes in dietary, physical activity and sedentary behaviours of children under 5 years and self-efficacy of parents and primary carers. This intervention consisted of eight structured cooking and physical play sessions delivered over a period of 8 weeks by trained facilitators. Pre- and post-intervention data collection was performed using survey questionnaires administered to parents and carers of children under 5 years from low socioeconomic backgrounds recruited through convenience sampling. A total of 640 pre-intervention surveys and 312 post-intervention surveys were returned. The matched response rate was 45.5%. There was an improvement in mean intake of healthy foods and mean physical activity with a decrease in mean intake of unhealthy food and mean screen time ...
Australian and New Zealand journal of public health, 2018
We performed a systematic review to identify, critically appraise and synthesise the existing lit... more We performed a systematic review to identify, critically appraise and synthesise the existing literature on the association between SEP and multimorbidity occurrence. We searched Medline and Embase from inception to December 2014. Where possible we performed meta-analysis to obtain summary odds ratios (ORs), exploring heterogeneity between studies through sub-group analysis. We identified 24 cross-sectional studies that largely reported on education, deprivation or income in relation to multimorbidity occurrence. Differences in analysis methods allowed pooling of results for education only. Low versus high education level was associated with a 64% increased odds of multimorbidity (summary OR: 1.64, 95% CI 1.41 to 1.91), with substantial heterogeneity between studies partly explained by method of multimorbidity ascertainment. Increasing deprivation was consistently associated with increasing risk of multimorbidity, whereas the evidence on income was mixed. Few studies reported on int...
BMJ
What's driving overdiagnosis? Possible drivers of overdiagnosis span five domains: culture, the h... more What's driving overdiagnosis? Possible drivers of overdiagnosis span five domains: culture, the health system, industry, professionals, and patients and the public (table 1⇓; fig 2⇓). In this section, we offer a narrative summary of some important drivers that appear most commonly in the literature.
Journal of hypertension, Oct 1, 2016
The evidence for an association between depression and anxiety and increased hypertension risk is... more The evidence for an association between depression and anxiety and increased hypertension risk is inconsistent. We aimed to investigate the association between each of depression and anxiety and incident hypertension. We included women born between 1946 and 1951 from the Australian Longitudinal Study on Women's Health, surveyed triennially from 1998 to 2013, without a history of hypertension at baseline. We defined depression using the Center for Epidemiological Studies Depression scale shortened version 10 and anxiety using self-reported doctor-diagnosis. We related depression and anxiety to incident hypertension, using generalized estimating equations, adjusting for time-varying covariates. Among 9182 women, 2738 developed hypertension during 15-year follow-up. Depression was associated with a 30% increased odds of hypertension [age-adjusted odds ratio (OR) 1.30, 95% confidence interval (CI) 1.19-1.43]. This attenuated and was no longer significant in fully adjusted analyses (...
Abstract Introduction /Aim: Skin cancer is a major public health issue in Queensland with 21,000 ... more Abstract Introduction /Aim: Skin cancer is a major public health issue in Queensland with 21,000 new cases diagnosed each year and up to 99% of cases being attributable to sun exposure. Intermittent, episodic exposures to high Ultra violet radiation levels such as those which occur during outdoor sporting activities further increase the risk of melanoma which is the most common cancer in the 15-24 years age group in Queensland. However, skin cancer is largely preventable through the practice of relatively simple and cost effective sun safety measures. This program aimed to create a more sun safe university campus through the implementation of a comprehensive health promotion approach. Methods: A comprehensive health promotion program based on the five action areas of the Ottawa Charter for Health Promotion was planned and implemented at Griffith University’s(GU) Gold Coast Campus. This program specifically targeted students that regularly participated in outdoor sporting activities ...
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Papers by thanya pathirana