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Outputs (44)

Pre-treatment assessment of chemotherapy for cancer patients: a multi-site evidence implementation project of 74 hospitals in China (2024)
Journal Article
Lai, J., Pilla, B., Stephenson, M., Brettle, A., Zhou, C., Li, W., …Wu, Y. (in press). Pre-treatment assessment of chemotherapy for cancer patients: a multi-site evidence implementation project of 74 hospitals in China. BMC Nursing, 23(1), 320. https://doi.org/10.1186/s12912-024-01997-8

Background: Chemotherapy, whilst treating tumours, can also lead to numerous adverse reactions such as nausea and vomiting, fatigue and kidney toxicity, threatening the physical and mental health of patients. Simultaneously, misuse of chemotherapeuti... Read More about Pre-treatment assessment of chemotherapy for cancer patients: a multi-site evidence implementation project of 74 hospitals in China.

Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease: a multi-professional scoping review (2022)
Journal Article
Hurst, H., Young, H., Nixon, A., Brettle, A., & Ormandy, P. (2022). Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease: a multi-professional scoping review. Age and ageing, 51(12), https://doi.org/10.1093/ageing/afac296

Background The growing older population with advanced chronic kidney disease (ACKD stages 4-5) poses a challenge for healthcare worldwide. The high prevalence of frailty and associated adverse health outcomes highlights concerns for management and... Read More about Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease: a multi-professional scoping review.

Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: a regional cross-sectional study. (2022)
Journal Article
Lai, J., Brettle, A., Zhang, Y., Zhou, C., Li, C., Fu, J., & Wu, Y. (2022). Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: a regional cross-sectional study. Nurse Education Today, 116, 105436. https://doi.org/10.1016/j.nedt.2022.105436

There is a widespread international agreement that healthcare should be based on high-quality evidence; however, bridging the gap from evidence to practice is still problematic. Although barriers to the implementation of evidence-based nursing practi... Read More about Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: a regional cross-sectional study..

Validation of a generic impact survey for use by health library services indicates the reliability of the questionnaire (2022)
Journal Article
Urquhart, C., & Brettle, A. (2022). Validation of a generic impact survey for use by health library services indicates the reliability of the questionnaire. Health Information and Libraries Journal, 39(4), 323-335. https://doi.org/10.1111/hir.12427

Background. A validated generic impact questionnaire can demonstrate how individual, and groups of health libraries contribute to continuing education and patient care outcomes. Objectives. To validate an existing generic questionnaire for Knowledg... Read More about Validation of a generic impact survey for use by health library services indicates the reliability of the questionnaire.

UK survey demonstrates a wide range of impacts attributable to clinical librarian services (2021)
Journal Article
Divall, P., James, C., Heaton, M., & Brettle, A. (2021). UK survey demonstrates a wide range of impacts attributable to clinical librarian services. Health Information and Libraries Journal, 39(2), 116-131. https://doi.org/10.1111/hir.12389

Objective: To understand the impact of the UK Clinical Librarian (CL) workforce and benchmark the results against a study undertaken in the North West region of the English National Health Service (NHS). Methods: An online survey was distribute... Read More about UK survey demonstrates a wide range of impacts attributable to clinical librarian services.

Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease : a multiprofessional scoping review protocol (2021)
Journal Article
Hurst, H., Jones, E., Ormandy, P., Brettle, A., Nixon, A., Young, H., …Finnigan, R. (2021). Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease : a multiprofessional scoping review protocol. BMJ Open, 11(3), e040715. https://doi.org/10.1136/bmjopen-2020-040715

Reported outcomes for older people with advanced chronic kidney disease (CKD) often focus on survival and mortality and little attention is paid to symptom burden and health-related quality of life. Recognising frailty and providing interventions tha... Read More about Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease : a multiprofessional scoping review protocol.

What is the evidence for the impact of gardens and gardening on health and well-being : a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription (2020)
Journal Article
Howarth, M., Brettle, A., Hardman, M., & Maden, M. (2020). What is the evidence for the impact of gardens and gardening on health and well-being : a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription. BMJ Open, 10(7), https://doi.org/10.1136/bmjopen-2020-036923

Objective: To systematically identify and describe studies that have evaluated the impact of gardens and gardening on health and wellbeing. A secondary objective was to use this evidence to build evidence-based logic models to guide health stra... Read More about What is the evidence for the impact of gardens and gardening on health and well-being : a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription.

Implementing evidence-based practice : a guide for radiographers (2020)
Journal Article
Brettle, A. (2020). Implementing evidence-based practice : a guide for radiographers. Radiography, 26(Sup. 2), S37-S41. https://doi.org/10.1016/j.radi.2020.05.013

Evidence-based practice is a concept that has grown across health disciplines over the last 25 years as a way of providing high quality health care. Radiographers are keen to implement evidence-based approaches but barriers remain in practice. This a... Read More about Implementing evidence-based practice : a guide for radiographers.

Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease : a systematic scoping review (2020)
Journal Article
Hounkpatin, H., Fraser, S., Honney, R., Dreyer, G., Brettle, A., & Roderick, P. (2020). Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease : a systematic scoping review. BMC Nephrology, 21(1), 217. https://doi.org/10.1186/s12882-020-01852-3

Background: There are a growing number of studies on ethnic differences in progression and mortality for pre-dialysis chronic kidney disease (CKD), but this literature has yet to be synthesised, particularly for studies on mortality. Methods: This sc... Read More about Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease : a systematic scoping review.

Midwife-moderated social media groups as a validated information source for women during pregnancy (2020)
Journal Article
McCarthy, R., Byrne, G., Brettle, A., Choucri, L., Ormandy, P., & Chatwin, J. (2020). Midwife-moderated social media groups as a validated information source for women during pregnancy. Midwifery, 88, 102710. https://doi.org/10.1016/j.midw.2020.102710

Background Widespread use of the internet has fundamentally altered the way people access health information and communicate with health providers. Pregnant women are a group who are particularly highly motivated to seek out information online. H... Read More about Midwife-moderated social media groups as a validated information source for women during pregnancy.

A co-designed social media intervention to satisfy information needs and improve outcomes in patients with chronic kidney disease : a longitudinal study (2020)
Journal Article
Vasilica, C., Brettle, A., & Ormandy, P. (2020). A co-designed social media intervention to satisfy information needs and improve outcomes in patients with chronic kidney disease : a longitudinal study. JMIR Formative Research, 4(1), e13207. https://doi.org/10.2196/13207

Background The number of people living with a long-term condition is increasing worldwide. Social media offers opportunities for patients to exchange information and experiences with others with the same condition, potentially leading to better self-... Read More about A co-designed social media intervention to satisfy information needs and improve outcomes in patients with chronic kidney disease : a longitudinal study.

Inequalities and outcomes : end stage kidney disease in ethnic minorities (2019)
Journal Article
Wilkinson, E., Brettle, A., Waqar, M., & Randhawa, G. (2019). Inequalities and outcomes : end stage kidney disease in ethnic minorities. BMC Nephrology, 20(1), 234. https://doi.org/10.1186/s12882-019-1410-2

The international evidence about outcomes of End Stage Kidney Disease (ESKD) for ethnic minorities was reviewed to identify gaps and make recommendations for researchers and policy makers. Nine databases were searched systematically with 112 studies... Read More about Inequalities and outcomes : end stage kidney disease in ethnic minorities.

A self-management education programme for adults with asthma (2019)
Journal Article
Dailah, H., Brettle, A., & Ormandy, P. (2019). A self-management education programme for adults with asthma. Clinical Medicine, 19(Sup 3), 42. https://doi.org/10.7861/clinmedicine.19-3-s42

Introduction Globally, asthma is one of the major non-communicable diseases, with 235 million people currently suffering from the condition. In Saudi Arabia, there is a 4% prevalence of asthma among the adult population. This study aimed to develop... Read More about A self-management education programme for adults with asthma.

The effectiveness of shared care in cancer survivors - a systematic review (2018)
Journal Article
Zhao, Y., Brettle, A., & Qiu, L. (2018). The effectiveness of shared care in cancer survivors - a systematic review. International Journal of Integrated Care, 18(4), 2. https://doi.org/10.5334/ijic.3954

Objectives: To determine whether the shared care model during the follow-up of cancer survivors is effective in terms of patient-reported outcomes, clinical outcomes, and continuity of care. Methods: Using systematic review methods, studies were s... Read More about The effectiveness of shared care in cancer survivors - a systematic review.

Do educational interventions aimed at nurses to support the implementation of evidence-based practice improve patient outcomes? A systematic review (2018)
Journal Article
Wu, Y., Brettle, A., Zhou, C., Ou, J., Wang, Y., & Wang, S. (2018). Do educational interventions aimed at nurses to support the implementation of evidence-based practice improve patient outcomes? A systematic review. Nurse Education Today, 70, 109-114. https://doi.org/10.1016/j.nedt.2018.08.026

Background: Numerous articles have sought to identify the impact of educational interventions for improving evidence-based practice (EBP) amongst nurses, most of these focus on skills and knowledge acquired. No systematic review has explored whether... Read More about Do educational interventions aimed at nurses to support the implementation of evidence-based practice improve patient outcomes? A systematic review.

Developing a generic tool to routinely measure the impact of health libraries (2018)
Journal Article
Ayre, S., Brettle, A., Gilroy, D., Knock, D., Pattinson, S., Smith, S., & Turner, J. (2018). Developing a generic tool to routinely measure the impact of health libraries. Health Information and Libraries Journal, 35(3), 227-245. https://doi.org/10.1111/hir.12223

Background – Health libraries contribute to many activities of a healthcare organization. Impact assessment needs to capture that range of contributions. Objectives – To develop and pilot a generic impact questionnaire that: 1) could be used rout... Read More about Developing a generic tool to routinely measure the impact of health libraries.

Gathering evidence for routine decision-making (2017)
Journal Article
Brettle, A. (2017). Gathering evidence for routine decision-making. Evidence Based Library and Information Practice, 12(4), 193. https://doi.org/10.18438/B85Q29

This paper is based on the opening keynote address at the 9th International Evidence Based Library and Information Practice Conference, Philadelphia, 18-21 June 2017.

Midwifery continuity : the use of social media (2017)
Journal Article
McCarthy, R., Choucri, L., Ormandy, P., & Brettle, A. (2017). Midwifery continuity : the use of social media. Midwifery, 52, 34-41. https://doi.org/10.1016/j.midw.2017.05.012

Background Continuity models of midwifery care improve women’s experiences of care and clinical outcomes, but organisationally driven working practices do not facilitate a continuity model and the midwifery care received by most women is fragmented... Read More about Midwifery continuity : the use of social media.

160: Being evidence based : a health library perspective (2017)
Journal Article
Brettle, A. (2017). 160: Being evidence based : a health library perspective. BMJ Open, 7(Suppl), https://doi.org/10.1136/bmjopen-2016-015415.160

Health librarians play a key role in the evidence based practice (EBP) movement by providing services and support to find, access, interpret and disseminate evidence. Health librarians also pioneered the concept of evidence based practice within the... Read More about 160: Being evidence based : a health library perspective.

A client focused perspective of the effectiveness of Counselling for Depression (CfD) (2016)
Journal Article
Goldman, S., Brettle, A., & McAndrew, S. (2016). A client focused perspective of the effectiveness of Counselling for Depression (CfD). Counselling and Psychotherapy Research, 16(4), 288-297. https://doi.org/10.1002/capr.12088

Background In the UK, only one in four people with a diagnosis of depression receive any form of treatment. To address this, the Improving Access to Psychological Therapies (IAPT) programme was established with the main therapeutic approach being... Read More about A client focused perspective of the effectiveness of Counselling for Depression (CfD).

The impact of clinical librarian services on patients and health care organisations (2016)
Journal Article
Brettle, A., Maden, M., & Payne, C. (2016). The impact of clinical librarian services on patients and health care organisations. Health Information and Libraries Journal, 33(2), 100-120. https://doi.org/10.1111/hir.12136

Background - Systematic reviews have found limited evidence of effectiveness and impact of clinical librarians (CLs) due to the poor quality of reporting, scale and design of previous studies. Objectives - To measure specific CL impact on organisa... Read More about The impact of clinical librarian services on patients and health care organisations.

Self care-self-help strategies for persons with menieres disease: a systematic review (2015)
Journal Article
Long, A., & Brettle, A. (2015). Self care-self-help strategies for persons with menieres disease: a systematic review. Patient Intelligence, 7, 33-51. https://doi.org/10.2147/PI.S70804

In recent years, health care practitioners and researchers have become increasingly interested in finding ways to help persons with long-standing health problems cope and live their everyday lives. This article presents the findings of the first syst... Read More about Self care-self-help strategies for persons with menieres disease: a systematic review.

Assessing the impact of evidence summaries in library and information practice (2014)
Journal Article
Kloda, L., Koufogiannakis, D., & Brettle, A. (2014). Assessing the impact of evidence summaries in library and information practice. Library and Information Research, 38(119), 29-46. https://doi.org/10.29173/lirg644

Objective This study developed, validated and administered an instrument to investigate the impact of research evidence summaries published in the journal, Evidence Based Library and Information Practice. Methods Using the critical incident te... Read More about Assessing the impact of evidence summaries in library and information practice.

Evidence of impact (Editorial) (2014)
Journal Article
Brettle, A. (2014). Evidence of impact (Editorial). Evidence Based Library and Information Practice, 9(2), 1-2

[No abstract available]

Nonpharmacological interventions for managing respiratory symptoms in lung cancer (2012)
Journal Article
Yorke, J., Brettle, A., & Molassiotis, A. (2012). Nonpharmacological interventions for managing respiratory symptoms in lung cancer. Chronic Respiratory Disease, 9(2), 117-129. https://doi.org/10.1177/1479972312441632

Patients with lung cancer experience significant symptom burden, particularly symptoms of a respiratory nature. Such symptom burden can be distressing for patients and negatively impact their functional status and quality of life. The aim of this rev... Read More about Nonpharmacological interventions for managing respiratory symptoms in lung cancer.

Developing information literacy skills in re-registration nurses: An experimental study of teaching methods (2012)
Journal Article
Brettle, A., & Raynor, M. (2012). Developing information literacy skills in re-registration nurses: An experimental study of teaching methods. Nurse Education Today, 33(2), 103-109. https://doi.org/10.1016/j.nedt.2011.12.003

Aim To compare the effectiveness of an online information literacy tutorial with a face-to-face session for teaching information literacy skills to nurses. Design Randomised control trial. Participants Seventy-seven first year undergraduat... Read More about Developing information literacy skills in re-registration nurses: An experimental study of teaching methods.

Exploring the evidence base for acupuncture in the treatment of Meniere’s Syndrome — A systematic review (2011)
Journal Article
of Meniere’s Syndrome — A systematic review. Evidence-Based Complementary and Alternative Medicine, 2011, 429102. https://doi.org/10.1093/ecam/nep047

Meniere’s syndrome is a long-term, progressive disease that damages the balance and hearing parts of the inner ear. To address the paucity of information on which evidence-based treatment decisions should be made, a systematic review of acupuncture... Read More about Exploring the evidence base for acupuncture in the treatment of Meniere’s Syndrome — A systematic review.

Evaluating clinical librarian services : a systematic review (2010)
Journal Article
Brettle, A., Maden-Jenkins, M., Anderson, L., McNally, R., Pratchett, T., Tancock, J., …Webb, A. (2011). Evaluating clinical librarian services : a systematic review. Health Information and Libraries Journal, 28(1), 3-22. https://doi.org/10.1111/j.1471-1842.2010.00925.x

Background: Previous systematic reviews have indicated limited evidence and poor quality evaluations of clinical librarian (CL) services. Rigorous evaluations should demonstrate the value of CL services, but guidance is needed before this can be ac... Read More about Evaluating clinical librarian services : a systematic review.

Systematic reviews and evidence based library and information practice (2009)
Journal Article
Brettle, A. (2009). Systematic reviews and evidence based library and information practice. Evidence Based Library and Information Practice, 4(1), 43-50. https://doi.org/10.18438/B8N613

This commentary presents a rationale for undertaking systematic reviews in library and information practice. As library and information practitioners have the skills to undertake systematic reviews, it is questioned why there are not more in the fiel... Read More about Systematic reviews and evidence based library and information practice.

Current status and future prospects (2008)
Journal Article
Brettle, A. (2008). Current status and future prospects. Health Information and Libraries Journal, 25, 32-34. https://doi.org/10.1111/j.1471-1842.2008.00802.x

User education, information skills training, information technology skills training, health informatics training, information handling skills, information literacy, literature searching training and finding information for evidence-based practice ar... Read More about Current status and future prospects.

Counselling in primary care : a systematic review of the evidence (2008)
Journal Article
Brettle, A., Hill, A., & Jenkins, P. (2008). Counselling in primary care : a systematic review of the evidence. Counselling and Psychotherapy Research, 8(4), 207-214. https://doi.org/10.1080/14733140802453794

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost-effectiveness and user perspectives regarding counselling in primary care.... Read More about Counselling in primary care : a systematic review of the evidence.

Workplace physical activity interventions: a systematic review (2008)
Journal Article
Dugdill, L., Brettle, A., Hulme, C., McCluskey, S., & Long, A. (2008). Workplace physical activity interventions: a systematic review. International Journal of Workplace Health Management, 1(1), 20-40. https://doi.org/10.1108/17538350810865578

Purpose – This paper aims to report a synopsis of a recent systematic review of the literature regarding the effectiveness of workplace physical activity interventions, commissioned by the National Institute for Health and Clinical Excellence (NICE... Read More about Workplace physical activity interventions: a systematic review.

Evaluating information skills training in health libraries: a systematic review (2007)
Journal Article
Brettle, A. (2007). Evaluating information skills training in health libraries: a systematic review. Health Information and Libraries Journal, 24(Suppl), 18-37. https://doi.org/10.1111/j.1471-1842.2007.00740.x

Introduction : Systematic reviews have shown that there is limited evidence to demonstrate that the information literacy training health librarians provide is effective in improving clinicians’ information skills or has an impact on patient care.... Read More about Evaluating information skills training in health libraries: a systematic review.

Effectiveness of information skills training and mediated searching: qualitative results from the EMPIRIC project (2007)
Journal Article
Brettle, A., Hulme, C., & Ormandy, P. (2007). Effectiveness of information skills training and mediated searching: qualitative results from the EMPIRIC project. Health Information and Libraries Journal, 24(1), 24-33. https://doi.org/10.1111/j.1471-1842.2007.00702.x

Objectives: To explore library staff and health professionals' views on the effectiveness of information skills training and librarian mediated searching as methods of providing information for patient care. This is the second article describing the... Read More about Effectiveness of information skills training and mediated searching: qualitative results from the EMPIRIC project.

The costs and effectiveness of information skills training and mediated searching: quantitative results from the EMPIRIC project (2006)
Journal Article
Brettle, A., Hulme, C., & Ormandy, P. (2006). The costs and effectiveness of information skills training and mediated searching: quantitative results from the EMPIRIC project. Health Information and Libraries Journal, 23(4), 239-247. https://doi.org/10.1111/j.1471-1842.2006.00670.x

Objectives: To compare the effectiveness and costs of providing information for patient care via librarian-mediated searches and information-skills training. Methods: A questionnaire survey to library staff and health professionals in the North Wes... Read More about The costs and effectiveness of information skills training and mediated searching: quantitative results from the EMPIRIC project.

Counselling older people: what can we learn from the research evidence? (2006)
Journal Article
Brettle, A., & Hill, A. (2006). Counselling older people: what can we learn from the research evidence?. Journal of Social Work Practice, 20(3), 281-297. https://doi.org/10.1080/02650530600931807

This paper reports on a systematic review aimed at providing a reliable overview of the effectiveness, appropriateness and feasibility of counselling older people. Papers were located from a wide range of sources to ensure comprehensive coverage of t... Read More about Counselling older people: what can we learn from the research evidence?.

Developing and evaluating an interactive information skills tutorial (2006)
Journal Article
Grant, M., & Brettle, A. (2006). Developing and evaluating an interactive information skills tutorial. Health Information and Libraries Journal, 23, 79-86. https://doi.org/10.1111/j.1471-1842.2006.00655.x

Objective:  To develop and evaluate a web-based interactive information skills tutorial integrated into the curriculum. To determine whether the tutorial was acceptable to students and explore the use of a skills assessment tool in identifying whethe... Read More about Developing and evaluating an interactive information skills tutorial.

The effectiveness of counselling with older people: results of a systematic review (2005)
Journal Article
Hill, A., & Brettle, A. (2005). The effectiveness of counselling with older people: results of a systematic review. Counselling and Psychotherapy Research, 5(4), 265-272. https://doi.org/10.1080/14733140500510374

In 2003 the British Association for Counselling and Psychotherapy (BACP) commissioned a systematic review of the research evidence relating to counselling older people. This paper reports on some of the findings of this review, particularly those whi... Read More about The effectiveness of counselling with older people: results of a systematic review.

Information skills training: a systematic review of the literature (2003)
Journal Article
Brettle, A. (2003). Information skills training: a systematic review of the literature. Health Information and Libraries Journal, 20(s1), 3-9. https://doi.org/10.1046/j.1365-2532.20.s1.3.x

The objectives of this study were to undertake a systematic review to determine the effectiveness of information skills training, to identify effective methods of training and to determine whether information skills training affects patient care. A s... Read More about Information skills training: a systematic review of the literature.

Comparison of bibliographic databases for information on the rehabilitation of people with severe mental illness (2001)
Journal Article
Brettle, A., & Long, A. (2001). Comparison of bibliographic databases for information on the rehabilitation of people with severe mental illness. Bulletin of the Medical Library Association, 89(4), 353-362

Objective: The research sought to examine the overlap in coverage between several health-related databases, thus enabling the identification of the most important sources for searching for information on the rehabilitation of people with severe menta... Read More about Comparison of bibliographic databases for information on the rehabilitation of people with severe mental illness.

Reviewing and selecting outcome measures for use in routine practice (1998)
Journal Article
Greenhalgh, J., Long, A., Brettle, A., & Grant, M. (1998). Reviewing and selecting outcome measures for use in routine practice. Journal of Evaluation in Clinical Practice, 4(4), 339-350. https://doi.org/10.1111/j.1365-2753.1998.tb00097.x

For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is neede... Read More about Reviewing and selecting outcome measures for use in routine practice.

Searching for information on outcomes: do you need to be comprehensive? (1998)
Journal Article
Brettle, A., Long, A., Grant, M., & Greenhalgh, J. (1998). Searching for information on outcomes: do you need to be comprehensive?. Quality and Safety in Health Care, 7(3), 163-167. https://doi.org/10.1136/qshc.7.3.163

The concepts of evidence-based practice and clinical effectiveness are reliant on up to date, accurate, high quality, and relevant information. Although this information can be obtained from a range of sources, computerised databases such as MEDLINE... Read More about Searching for information on outcomes: do you need to be comprehensive?.

The value of an outcomes information resource: an evaluation of the UK Clearing House on Health Outcomes (1996)
Journal Article
Greehhalgh, J., Long, A., Brettle, A., & Grant, M. (1996). The value of an outcomes information resource: an evaluation of the UK Clearing House on Health Outcomes. Journal of Management in Medicine, 10(5), 55-66. https://doi.org/10.1108/02689239610146553

Reports on the first phase of an evaluation of the UK Clearing House on Health Outcomes (UKCHHO) undertaken by a sample survey of purchasers and providers on its mailing list and users of its enquiry service. Explores user satisfaction with the servi... Read More about The value of an outcomes information resource: an evaluation of the UK Clearing House on Health Outcomes.