Ruth is an Associate Professor and Medical Advisor in the Centre for Health Economics and Research Evaluation. After graduating from Medicine at the University of Sydney in 2001, Ruth worked in the Australian hospital system as a clinician before commencing her research career. She has a Masters in International Public Health as well as a PhD in Medicine and has expertise in the design, conduct and analysis of large scale clinical trials. Before joining CHERE, Ruth was the Global Head of Medicine and Interim Global Business Manager in George Health Technologies, a social enterprise of The George Institute for Global Health. In this role she was involved in all aspects of scaling up effective digital health solutions to improve the diagnosis and management of chronic disease globally.
As a researcher, she has a particular interest in the development of novel strategies to bridge the evidence-practice gap in Cardiovascular Disease prevention. She is actively involved in trials of various types of fixed dose combination therapy (polypill) strategies, as well as improving use of technology in Australian general practice.
Can supervise: YES
Ecker, S, Joshi, R, Shanthosh, J & Webster, R 2020, 'Non-medical Prescribing Policies: A global scoping review', Health Policy.
Hespe, CM, Campain, A, Webster, R, Patel, A, Rychetnik, L, Harris, MF & Peiris, DP 2020, 'Implementing cardiovascular disease preventive care guidelines in general practice: an opportunity missed', MEDICAL JOURNAL OF AUSTRALIA.View/Download from: Publisher's site
Karia, AM, Balane, C, Norman, R, Robinson, S, Lehnbom, E, Durakovic, I, Laba, T-L, Joshi, R & Webster, R 2020, 'Community pharmacist workflow: Space for Pharmacy-Based Interventions and Consultation TimE (SPICE) study protocol', International Journal of Pharmacy Practice.View/Download from: Publisher's site
Orchard, J, Li, J, Freedman, B, Webster, R, Hespe, C, Gallagher, R, Neubeck, L & Lowres, N 2020, '223Atrial fibrillation screen, management and guideline recommended therapy (AF SMART II) in the rural primary care setting: eHealth tools to support all stages of screening', EP Europace, vol. 22, no. Supplement_1.View/Download from: Publisher's site
National Heart Foundation of Australia: CVRN Grant and Vanguard Grant; investigator-initiated grant from Pfizer-BMS; AliveCor provided free devices
Internationally, most atrial fibrillation (AF) management guidelines recommend screening for AF in people aged ≥65 years, as well as treatment with oral anticoagulants (OAC) for those at high stroke risk ( CHA2DS2-VA ≥2). However, in practice, gaps remain in both screening and treatment. In Australian general practice in 2017, the estimated rate of AF screening was 11%, and only about 60% of diagnosed AF patients received guideline-based OAC. Our 2018 screening study using eHealth tools in metropolitan general practices increased screening to 16% of eligible patients, leading to further refinement of the eHealth tools.
To investigate the impact of an AF screening program in rural general practices, using a suite of custom-designed eHealth tools designed to increase the proportion screened and treated for AF in accordance with guidelines.
General practices (n = 8) in rural New South Wales, Australia participated in the study between September 2018 – June 2019. General practitioners (GPs) and practice nurses conducted opportunistic screening of eligible patients (i.e. aged ≥65 years without existing AF diagnosis) using a smartphone electrocardiogram during practice visits. Practices were also provided with 1) an electronic screening prompt (which appeared w...
Orchard, J, Li, J, Freedman, B, Webster, R, Salkeld, G, Hespe, C, Gallagher, R, Patel, A, Kamel, B, Neubeck, L & Lowres, N 2020, 'Atrial Fibrillation Screen, Management, and Guideline-Recommended Therapy in the Rural Primary Care Setting: A Cross-Sectional Study and Cost-Effectiveness Analysis of eHealth Tools to Support All Stages of Screening.', Journal of the American Heart Association, vol. 9, no. 18, p. e017080.View/Download from: Publisher's site
BACKGROUND Internationally, most atrial fibrillation (AF) management guidelines recommend opportunistic screening for AF in people ≥65 years of age and oral anticoagulant treatment for those at high stroke risk (CHA₂DS₂-VA≥2). However, gaps remain in screening and treatment. METHODS AND RESULTS General practitioners/nurses at practices in rural Australia (n=8) screened eligible patients (≥65 years of age without AF) using a smartphone ECG during practice visits. eHealth tools included electronic prompts, guideline-based electronic decision support, and regular data reports. Clinical audit tools extracted de-identified data. Results were compared with an earlier study in metropolitan practices (n=8) and nonrandomized control practices (n=69). Cost-effectiveness analysis compared population-based screening with no screening and included screening, treatment, and hospitalization costs for stroke and serious bleeding events. Patients (n=3103, 34%) were screened (mean age, 75.1±6.8 years; 47% men) and 36 (1.2%) new AF cases were confirmed (mean age, 77.0 years; 64% men; mean CHA₂DS₂-VA, 3.2). Oral anticoagulant treatment rates for patients with CHA₂DS₂-VA≥2 were 82% (screen detected) versus 74% (preexisting AF)(P=NS), similar to metropolitan and nonrandomized control practices. The incremental cost-effectiveness ratio for population-based screening was AU$16 578 per quality-adjusted life year gained and AU$84 383 per stroke prevented compared with no screening. National implementation would prevent 147 strokes per year. Increasing the proportion screened to 75% would prevent 177 additional strokes per year. CONCLUSIONS An AF screening program in rural practices, supported by eHealth tools, screened 34% of eligible patients and was cost-effective. Oral anticoagulant treatment rates were relatively high at baseline, trending upward during the study. Increasing the proportion screened would prevent many more strokes with minimal incremental cost-effectiveness ratio chang...
Wang, N, Salam, A, Webster, R, De Silva, A, Guggilla, R, Stepien, S, Mysore, J, Billot, L, Jan, S, Maulik, PK, Naik, N, Selak, V, Thom, S, Prabhakaran, D, Patel, A & Rodgers, A 2020, 'Association of Low-Dose Triple Combination Therapy with Therapeutic Inertia and Prescribing Patterns in Patients with Hypertension: A Secondary Analysis of the TRIUMPH Trial', JAMA Cardiology.View/Download from: Publisher's site
© 2020 American Medical Association. All rights reserved. Importance: Fixed-dose combination (FDC) therapies are being increasingly recommended for initial or early management of patients with hypertension, as they reduce treatment complexity and potentially reduce therapeutic inertia. Objective: To investigate the association of antihypertensive triple drug FDC therapy with therapeutic inertia and prescribing patterns compared with usual care. Design, Setting, and Participants: A post hoc analysis of the Triple Pill vs Usual Care Management for Patients With Mild-to-Moderate Hypertension (TRIUMPH) study, a randomized clinical trial of 700 patients with hypertension, was conducted. Patients were enrolled from 11 urban hospital clinics in Sri Lanka from February 2016 to May 2017; follow-up ended in October 2017. Data were analyzed from September to November 2019. Interventions: Once-daily FDC antihypertensive pill (telmisartan, 20 mg; amlodipine, 2.5 mg; and chlorthalidone, 12.5 mg) or usual care. Main Outcomes and Measures: Therapeutic inertia, defined as not intensifying therapy in those with blood pressure (BP) above target, was assessed at baseline and during follow-up visits. Prescribing patterns were characterized by BP-lowering drug class and treatment regimen potency. Predictors of therapeutic inertia were assessed with binomial logistic regression. Results: Of the 700 included patients, 403 (57.6%) were female, and the mean (SD) age was 56 (11) years. Among patients who did not reach the BP target, therapeutic inertia was more common in the triple pill group compared with the usual care group at the week 6 visit (92 of 106 [86.8%] vs 124 of 194 [63.9%]; P <.001) and week 12 visit (81 of 90 [90%] vs 116 of 179 [64.8%]; P <.001). At the end of the study, 221 of 318 patients in the triple pill group (69.5%) and 182 of 329 patients in the usual care group (55.3%) reached BP targets. Among those who received treatment intensification, the increase in estimated...
Wang, N, Salam, A, Webster, R, de Silva, A, Guggilla, R, Stepien, S, Mysore, J, Billot, L, Jan, S, Maulik, PK, Naik, N, Selak, V, Thom, S, Prabhakaran, D, Patel, A & Rodgers, A 2020, 'Effects of low-dose triple combination therapy on therapeutic inertia and prescribing patterns in hypertension: results from the TRIUMPH trial', JAMA Cardiology.
Webster, R, Murphy, A, Bygrave, H, Ansbro, É, Grobbee, DE & Perel, P 2020, 'Implementing Fixed Dose Combination Medications for the Prevention and Control of Cardiovascular Diseases', Global heart, vol. 15, no. 1, p. 57.View/Download from: Publisher's site
Copyright: © 2020 The Author(s). Highlights: - Despite clinical evidence of its effectiveness in secondary prevention of cardiovascular disease, uptake of fixed dose combination therapy (FDCs) for CVD has been poor.- A symposium was held bringing together stakeholders on this issue, including from academia, government and NGOs.- The conclusion made was that what is now needed to improve implementation of FDCs is country-specific health systems analyses to design appropriate implementation strategies.- Implementation strategies must look beyond listing on the WHO Essential Medicines List to consider approaches to improving FDC availability, accessibility, affordability, and adherence.- Strategies might include incorporation of FDCs into the WHO HEARTS technical package, simplified treatment and monitoring algorithms, decentralisation of medicine dispensing and task-sharing for treatment management.
Daivadanam, M, Ingram, M, Annerstedt, KS, Parker, G, Bobrow, K, Dolovich, L, Gould, G, Riddell, M, Vedanthan, R, Webster, J, Absetz, P, Alvesson, HM, Androutsos, O, Chavannes, N, Cortez, B, Devarasetty, P, Fottrell, E, Gonzalez-Salazar, F, Goudge, J, Herasme, O, Jennings, H, Kapoor, D, Kamano, J, Kasteleyn, MJ, Kyriakos, C, Manios, Y, Mogulluru, K, Owolabi, M, Lazo-Porras, M, Silva, W, Thrift, A, Uvere, E, Webster, R, van der Kleij, R, van Olmen, J, Vardavas, C, Zhang, P, Almeda-Valdes, P, Britton, J, Cristobal, F, Delobelle, P, Gonzalez, C, Gould, G, Guwatudde, D, Gyamfi, J, Johnson, C, Kirkham, R, Lopez-Jaramillo, P, Lucero, VP, Mills, K, Oldenburg, B, Patel, A, Riddell, M, Saulson, R, Silva, N, Trieu, K & Vardavas, C 2019, 'The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma', PLOS ONE, vol. 14, no. 4.View/Download from: Publisher's site
Limbani, F, Goudge, J, Joshi, R, Maar, MA, Miranda, JJ, Oldenburg, B, Parker, G, Pesantes, MA, Riddell, MA, Salam, A, Trieu, K, Thrift, AG, Van Olmen, J, Vedanthan, R, Webster, R, Yeates, K, Webster, J & Global Alliance for Chronic Diseases, Process.Evaluation Working Group 2019, 'Process evaluation in the field: global learnings from seven implementation research hypertension projects in low-and middle-income countries.', BMC public health, vol. 19, no. 1.View/Download from: Publisher's site
BACKGROUND:Process evaluation is increasingly recognized as an important component of effective implementation research and yet, there has been surprisingly little work to understand what constitutes best practice. Researchers use different methodologies describing causal pathways and understanding barriers and facilitators to implementation of interventions in diverse contexts and settings. We report on challenges and lessons learned from undertaking process evaluation of seven hypertension intervention trials funded through the Global Alliance of Chronic Diseases (GACD). METHODS:Preliminary data collected from the GACD hypertension teams in 2015 were used to inform a template for data collection. Case study themes included: (1) description of the intervention, (2) objectives of the process evaluation, (3) methods including theoretical basis, (4) main findings of the study and the process evaluation, (5) implications for the project, policy and research practice and (6) lessons for future process evaluations. The information was summarized and reported descriptively and narratively and key lessons were identified. RESULTS:The case studies were from low- and middle-income countries and Indigenous communities in Canada. They were implementation research projects with intervention arm. Six theoretical approaches were used but most comprised of mixed-methods approaches. Each of the process evaluations generated findings on whether interventions were implemented with fidelity, the extent of capacity building, contextual factors and the extent to which relationships between researchers and community impacted on intervention implementation. The most important learning was that although process evaluation is time consuming, it enhances understanding of factors affecting implementation of complex interventions. The research highlighted the need to initiate process evaluations early on in the project, to help guide design of the intervention; and the importance of effecti...
Lung, T, Jan, S, Guggilla, R, Webster, R & Laba, T-L 2019, 'Fixed low-dose triple combination antihypertensive medication versus usual care in patients with mild to moderate hypertension in Sri Lanka: A within-trial and modelled economic evaluation of the TRIUMPH trial', The Lancet Global Health, vol. 7, no. 10, pp. e1359-e1366.
Orchard, J, Neubeck, L, Freedman, B, Li, J, Webster, R, Zwar, N, Gallagher, R, Ferguson, C & Lowres, N 2019, 'eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline-Recommended Therapy in Metropolitan General Practice: The AF - SMART Study.', Journal of the American Heart Association, vol. 8, no. 1.View/Download from: Publisher's site
Background This eH ealth implementation study aimed to evaluate strategies to promote opportunistic atrial fibrillation ( AF ) screening using electronic screening prompts and improve treatment using electronic decision support ( EDS ) software. Methods and Results An electronic screening prompt appeared whenever an eligible patient's (aged ≥65 years, no AF diagnosis) medical record was opened in participating general practices. General practitioners and practice nurses offered screening using a smartphone ECG, with validated AF algorithm. Guideline-based EDS was provided to assist treatment decisions. Deidentified data were collected from practices using a data extraction tool. General practices (n=8) across Sydney, Australia, screened for a median of 6 months. A total of 1805 of 11 476 (16%) eligible patients who attended were screened (44% men, mean age 75.7 years). Screening identified 19 (1.1%) new cases of AF (mean age, 79 years; mean CHA 2 DS 2- VAS c, 3.7; 53% men). General practitioners (n=30) performed 70% of all screenings (range 1-448 patients per general practitioner). The proportion of patients with AF who had CHA 2 DS 2- VAS c ≥2 for men or ≥3 for women prescribed oral anticoagulants was higher for those diagnosed during the study: 15 of 18 (83%) for screen-detected and 39 of 46 (85%) for clinically detected, compared with 933 of 1306 (71%) patients diagnosed before the study ( P<0.001). The EDS was accessed 111 times for patients with AF and for 4 of 19 screen-detected patients. Conclusions The eH ealth tools showed promise. Adherence to guideline-based oral anticoagulant prescription was significantly higher in patients diagnosed during the study period, although the EDS was only used in a minority. While the proportion of eligible patients screened and EDS use was relatively low, further refinements may improve uptake in clinical practice. Clinical Trial Registration URL : www.anzctr.org.au . Unique identifier: ACTRN 12616000850471.
Salam, A, Atkins, ER, Hsu, B, Webster, R, Patel, A & Rodgers, A 2019, 'Efficacy and safety of triple versus dual combination blood pressure-lowering drug therapy: a systematic review and meta-analysis of randomized controlled trials.', Journal of hypertension, vol. 37, pp. 1567-1573.View/Download from: Publisher's site
BACKGROUND AND OBJECTIVES:Most patients with hypertension need at least two drugs to achieve goal blood pressure. This systematic review assessed efficacy and safety of triple versus dual combination therapy for the management of hypertension. METHODS:Publication databases, clinical trial registries and regulatory agency websites were searched until April 2018 for double-blind randomized controlled trials (RCTs) comparing triple with dual therapy of BP-lowering drugs, for at least 3 weeks, among patients with hypertension. Meta-analyses for efficacy and safety outcomes were performed using random-effects model. Regimen efficacy was predicted using the Therapeutic Intensity Score (TIS) and the Law et al. method (which predict dose doubling increases efficacy by 100% and around 20%, respectively), and compared with observed efficacy. RESULTS:Fourteen RCTs (11 457 participants) were included. Overall, triple compared with dual therapy reduced BP by 5.4/3.2 mmHg (P < 0.001), and improved BP control by 58 versus 45% [relative risk (RR) 1.33 (95% CI 1.25-1.41)], whereas incidence of withdrawals because of adverse events were 3.3 versus 3.4% [RR 1.24 (95% CI 1.00-1.54), P = 0.05]. Law et al.'s method was superior to TIS in predicting differences in efficacy between triple and dual therapies. For patients uncontrolled on submaximal dose dual therapy, adding a third drug achieved on average approximately four times more BP reduction than doubling the dose of dual therapy component drugs (6.0/3.6 versus 1.5/0.8 mmHg, respectively). CONCLUSION:Addition of a third drug is likely to be more efficacious without increasing adverse events, compared with increasing dose of existing dual therapy. Early use of triple therapy can significantly improve hypertension control.
Salam, A, Praveen, D, Patel, A, Tewari, A & Webster, R 2019, 'Barriers and Facilitators to the Use of Cardiovascular Fixed-Dose Combination Medication (Polypills) in Andhra Pradesh, India: A Mixed-Methods Study.', Global heart, vol. 14, no. 3, pp. 303-310.View/Download from: Publisher's site
BACKGROUND:Polypills, fixed-dose combinations of blood pressure-lowering drug(s), and statin, with or without aspirin, improve the use of these recommended drugs in patients with or at high risk of cardiovascular disease. However, in India, there has been poor uptake of polypills despite market availability. OBJECTIVES:This study sought to assess availability and cost of polypills and explore barriers and facilitators to their use in the state of Andhra Pradesh in India. METHODS:A mixed-methods study was conducted. Availability and cost of polypills as well as individual component drugs was assessed through a survey of pharmacies across urban, urban slum, and rural regions in state of Andhra Pradesh in India. In-depth interviews with stakeholders at each level of the health system explored barriers and facilitators to use of polypills. RESULTS:Overall, 30 pharmacies were surveyed (10 in each of urban, urban slum, and rural region). In urban region, 2 pharmacies stocked polypills (without aspirin) costing 121 Indian rupees (INR) per 10 pills, and 1 other pharmacy stocked a polypill (with aspirin) costing 24 INR per 10 pills. All pharmacies stocked a wide range of component drugs as separate pills with combined cost of the cheapest angiotensin-converting enzyme inhibitor, statin, and aspirin INR 124 per 10 pills. Patients were willing to use polypills if prescribed by their doctor, and pharmacies were willing to stock polypills if there was market demand. For prescribers, key barriers included perceptions that current polypills contained outdated drugs and inadequate flexibility in prescribing. CONCLUSIONS:In a market in which polypill use is licensed, their availability and use is very low. Lack of prescription of polypills was the predominant barrier to polypill use; therefore, making polypills with drugs that are more acceptable and at different available strengths, in conjunction with broader prescriber education and training, may improve their use.
Selak, V, Webster, R, Stepien, S, Bullen, C, Patel, A, Thom, S, Arroll, B, Bots, ML, Brown, A, Crengle, S, Dorairaj, P, Elley, CR, Grobbee, DE, Harwood, M, Hillis, GS, Laba, T-L, Neal, B, Peiris, D, Rafter, N, Reid, C, Stanton, A, Tonkin, A, Usherwood, T, Wadham, A & Rodgers, A 2019, 'Reaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials.', Heart (British Cardiac Society), vol. 105, no. 1, pp. 42-48.View/Download from: Publisher's site
OBJECTIVE:The aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) cholesterol and antiplatelet therapy. METHODS:We conducted an individual participant data meta-analysis of three randomised clinical trials that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior cardiovascular disease (CVD) event or who were at high risk of their first event. Overall, the trials included 3140 patients from Australia, England, India, Ireland, the Netherlands and New Zealand (75% male, mean age 62 years and 76% with a prior CVD event). The primary outcome for this study was the proportion of people achieving ESC guideline targets for BP, LDL and antiplatelet therapy. RESULTS:Those randomised to polypill-based care were more likely than those receiving usual care to achieve recommended targets for BP (62% vs 58%, risk ratio (RR) 1.08, 95% CI 1.02 to 1.15), LDL (39% vs 34%, RR 1.13, 95% CI 1.02 to 1.25) and all three targets for BP, LDL and adherence to antiplatelet therapy (the latter only applicable to those with a prior CVD event) simultaneously (24% vs 19%, RR 1.27, 95% CI 1.10 to 1.47) at 12 months. There was no difference between groups in antiplatelet adherence (96% vs 96%, RR 1.00, 95% CI 0.98 to 1.01). There was heterogeneity by baseline treatment intensity such that treatment effects increased with the fewer the number of treatments being taken at baseline: for patients taking 3, 2 and 0-1 treatment modalities the RRs for reaching all three guideline goals simultaneously were 1.10 (95% CI 0.94 to 1.30, 22% vs 20%), 1.62 (95% CI 1.09 to 2.42, 27% vs 17%) and 3.07 (95% CI 1.77 to 5.33, 35% vs 11%), respectively. CONCLUSIONS:Polypill-based therapy significantly improved the achievement of all three ESC targets for BP, LDL and antiplatelet therap...
Webster, R, Grobbee, D & Rodgers, A 2019, 'The 2016 Joint European Prevention Guidelines and the uses of polypills: Time to update the evidence', EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, vol. 27, no. 4, pp. 437-440.View/Download from: Publisher's site
Webster, R, Hespe, C, Campain, A, Patel, A & Peiris, D 2019, 'P5319Evidence-practice gaps in the screening and management of cardiovascular risk factors in the Australian General Practice population', European Heart Journal, vol. 40, no. Supplement_1.View/Download from: Publisher's site
Cardiovascular disease (CVD) is a major cause of death and disability in Australia affecting 1 in 6 of the Australian population. Studies a decade ago showed large evidence-practice gaps in the screening and management of CVD risk in Australian General Practice. A new risk-based screening and management guideline was launched in 2012.
This study aimed to update the evidence to evaluate appropriate screening for, and management of, cardiovascular risk factors in Australian General Practice and explore practice and patient level predictors for appropriate screening and management.
Cross-sectional de-identified data from GP electronic health records were extracted for patients >18 years having attended at least once in the last 6 months and 3 times in the last 2 years (i.e. active patients). Practice-level data were also collected manually. The statistical cohort included Aboriginal and Torres Strait Islander people 35+ years and all others 45+ years, or any individual classified as "high CVD risk" regardless of age. High risk was defined as having either established CVD, pre-defined clinically high risk conditions or a calculated 5-year risk >15% using a Framingham based risk calculator. Appropriate screening was defined as having recorded/updated all essential risk factors for measurement of CVD risk within recommended time frames. Appropriate management was defined as: ≥1 BP lowering drug and a statin for people at high risk without CVD and the addition of an antiplatelet or anticoagulant agent for people with established CVD.
Webster, R, Parker, G, Heritier, S, Joshi, R, Yeates, K, Lopez-Jaramillo, P, Miranda, JJ, Oldenburg, B, Ovbiagele, B, Owolabi, M, Peiris, D, Praveen, D, Salam, A, Schwalm, J-D, Thankappan, KR, Thomas, N, Tobe, S & Vedanthan, R 2019, 'Strategic, Successful, and Sustained Synergy: The Global Alliance for Chronic Diseases Hypertension Program.', Global heart, vol. 14, no. 4, pp. 391-394.View/Download from: Publisher's site
Abdul Salam, M, Praveen, D, Patel, A, Tewari, A & Webster, R 2018, 'PO171 Barriers to the Use of Cardiovascular Polypills In India: A Mixed-Methods Study', Global Heart, vol. 13, no. 4, pp. 418-418.View/Download from: Publisher's site
Cavaye, D, Lehnbom, EC, Laba, T-L, El-Boustani, E, Joshi, R & Webster, R 2018, 'Considering pharmacy workflow in the context of Australian community pharmacy: A pilot time and motion study', RESEARCH IN SOCIAL & ADMINISTRATIVE PHARMACY, vol. 14, no. 12, pp. 1157-1162.View/Download from: Publisher's site
Orchard, J, Freedman, B, Li, J, Webster, R, Gallagher, R, Ferguson, C, Neubeck, L & Lowres, N 2018, 'P1935Use of a smartphone electrocardiogram, electronic prompts and electronic decision support for atrial fibrillation screening in metropolitan general practices', European Heart Journal, vol. 39, no. suppl_1.View/Download from: Publisher's site
Orchard, J, Freedman, B, Li, J, Webster, R, Zwar, N, Gallagher, R, Ferguson, C, Neubeck, L & Lowres, N 2018, 'Use of a Smartphone Electrocardiogram, Electronic Prompts and Electronic Decision Support for Atrial Fibrillation Screening in Metropolitan General Practices', Heart, Lung and Circulation, vol. 27, pp. S201-S201.View/Download from: Publisher's site
Orchard, JJ, Neubeck, L, Freedman, B, Webster, R, Patel, A, Gallagher, R, Li, J, Hespe, CM, Ferguson, C, Zwar, N & Lowres, N 2018, 'Atrial Fibrillation Screen, Management And Guideline Recommended Therapy (AF SMART II) in the rural primary care setting: an implementation study protocol', BMJ OPEN, vol. 8, no. 10.View/Download from: Publisher's site
Owolabi, MO, Yaria, JO, Daivadanam, M, Makanjuola, AI, Parker, G, Oldenburg, B, Vedanthan, R, Norris, S, Oguntoye, AR, Osundina, MA, Herasme, O, Lakoh, S, Ogunjimi, LO, Abraham, SE, Olowoyo, P, Jenkins, C, Feng, W, Bayona, H, Mohan, S, Joshi, R, Webster, R, Kengne, AP, Trofor, A, Lotrean, LM, Praveen, D, Zafra-Tanaka, JH, Lazo-Porras, M, Bobrow, K, Riddell, MA, Makrilakis, K, Manios, Y & Ovbiagele, B 2018, 'Gaps in Guidelines for the Management of Diabetes in Low- and Middle-Income Versus High-Income Countries-A Systematic Review', DIABETES CARE, vol. 41, no. 5, pp. 1097-1105.View/Download from: Publisher's site
Salam, A, Webster, R, Patel, A, Godamunne, P, Pathmeswaran, A, de Silva, HA, Rogers, A, Jan, S & Laba, T-L 2018, 'Process evaluation of a randomised controlled trial of a pharmacological strategy to improve hypertension control: protocol for a qualitative study', BMJ OPEN, vol. 8, no. 8.View/Download from: Publisher's site
Selak, V & Webster, R 2018, 'Polypills for the secondary prevention of cardiovascular disease: effective in improving adherence but are they safe?', THERAPEUTIC ADVANCES IN DRUG SAFETY, vol. 9, no. 2, pp. 157-162.View/Download from: Publisher's site
Webster, R, Salam, A, De Silva, HA, Selak, V, Stepien, S, Rajapakse, S, Amarasekara, S, Amarasena, N, Billot, L, de Silva, AP, Fernando, M, Guggilla, R, Jan, S, Jayawardena, J, Maulik, PK, Mendis, S, Mendis, S, Munasinghe, J, Naik, N, Prabhakaran, D, Ranasinghe, G, Thom, S, Tisserra, N, Senaratne, V, Wijekoon, S, Wijeyasingam, S, Rodgers, A & Patel, A 2018, 'Fixed Low-Dose Triple Combination Antihypertensive Medication vs Usual Care for Blood Pressure Control in Patients With Mild to Moderate Hypertension in Sri Lanka A Randomized Clinical Trial', JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, vol. 320, no. 6, pp. 566-579.View/Download from: Publisher's site
Angell, B, Laba, T-L, Lung, T, Brown, A, Eades, S, Usherwood, T, Peiris, D, Billot, L, Hillis, G, Webster, R, Tonkin, A, Reid, C, Molanus, B, Rafter, N, Cass, A, Patel, A & Jan, S 2017, 'Healthcare expenditure on Indigenous and non-Indigenous Australians at high risk of cardiovascular disease', INTERNATIONAL JOURNAL FOR EQUITY IN HEALTH, vol. 16.View/Download from: Publisher's site
Bennett, A, Chow, CK, Chou, M, Dehbi, H-M, Webster, R, Salam, A, Patel, A, Neal, B, Peiris, D, Thakkar, J, Chalmers, J, Nelson, M, Reid, C, Hillis, GS, Woodward, M, Hilmer, S, Usherwood, T, Thom, S & Rodgers, A 2017, 'Efficacy and Safety of Quarter-Dose Blood Pressure-Lowering Agents A Systematic Review and Meta-Analysis of Randomized Controlled Trials', HYPERTENSION, vol. 70, no. 1, pp. 85-93.View/Download from: Publisher's site
Chow, CK, Thakkar, J, Bennett, A, Hillis, G, Burke, M, Usherwood, T, Vo, K, Rogers, K, Atkins, E, Webster, R, Chou, M, Dehbi, H-M, Salam, A, Patel, A, Neal, B, Peiris, D, Krum, H, Chalmers, J, Nelson, M, Reid, CM, Woodward, M, Hilmer, S, Thom, S & Rodgers, A 2017, 'Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review', LANCET, vol. 389, no. 10073, pp. 1035-1042.View/Download from: Publisher's site
Lafeber, M, Spiering, W, Visseren, FLJ, Grobbee, DE, Bots, ML, Stanton, A, Patel, A, Prabhakaran, D, Webster, R, Thom, S & Rodgers, A 2017, 'Impact of switching from different treatment regimens to a fixed-dose combination pill (polypill) in patients with cardiovascular disease or similarly high risk: The influence of baseline medication on LDL-cholesterol, blood pressure and calculated risk reduction when switching to a cardiovascular polypill', EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, vol. 24, no. 9, pp. 951-961.View/Download from: Publisher's site
Riddell, MA, Edwards, N, Thompson, SR, Bernabe-Ortiz, A, Praveen, D, Johnson, C, Kengne, AP, Liu, P, McCready, T, Ng, E, Nieuwlaat, R, Ovbiagele, B, Owolabi, M, Peiris, D, Thrift, AG, Tobe, S & Yusoff, K 2017, 'Developing consensus measures for global programs: lessons from the Global Alliance for Chronic Diseases Hypertension research program', GLOBALIZATION AND HEALTH, vol. 13.View/Download from: Publisher's site
Vedanthan, R, Bernabe-Ortiz, A, Herasme, OI, Joshi, R, Lopez-Jaramillo, P, Thrift, AG, Webster, J, Webster, R, Yeates, K, Gyamfi, J, Ieremia, M, Johnson, C, Kamano, JH, Lazo-Porras, M, Limbani, F, Liu, P, McCready, T, Jaime Miranda, J, Mohan, S, Ogedegbe, O, Oldenburg, B, Ovbiagele, B, Owolabi, M, Peiris, D, Ponce-Lucero, V, Praveen, D, Pillay, A, Schwalm, J-D, Tobe, SW, Trieu, K, Yusoff, K & Fuster, V 2017, 'Innovative Approaches to Hypertension Control in Low- and Middle-Income Countries', CARDIOLOGY CLINICS, vol. 35, no. 1, pp. 99-+.View/Download from: Publisher's site
Webster, R, Bullen, C, Patel, A, Selak, V, Stepien, S, Thom, S & Rodgers, A 2017, 'Impact of switching to polypill based therapy by baseline potency of medication: Post-hoc analysis of the SPACE Collaboration dataset', INTERNATIONAL JOURNAL OF CARDIOLOGY, vol. 249, pp. 443-447.View/Download from: Publisher's site
Hayek, A, Joshi, R, Usherwood, T, Webster, R, Kaur, B, Saini, B, Armour, C, Krass, I, Laba, T-L, Reid, C, Shiel, L, Hespe, C, Hersch, F, Jan, S, Lo, S, Peiris, D, Rodgers, A & Patel, A 2016, 'An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: protocol for a cluster randomized controlled trial', IMPLEMENTATION SCIENCE, vol. 11.View/Download from: Publisher's site
Hirakawa, Y, Arima, H, Webster, R, Zoungas, S, Li, Q, Harrap, S, Liu, L, Hamet, P, Mancia, G, Poulter, N, Neal, B, Williams, B, Rogers, A, Woodward, M & Chalmers, J 2016, 'Risks associated with permanent discontinuation of blood pressure-lowering medications in patients with type 2 diabetes', JOURNAL OF HYPERTENSION, vol. 34, no. 4, pp. 781-787.View/Download from: Publisher's site
Lafeber, M, Webster, R, Visseren, FLJ, Bots, ML, Grobbee, DE, Spiering, W & Rodgers, A 2016, 'Estimated cardiovascular relative risk reduction from fixed-dose combination pill (polypill) treatment in a wide range of patients with a moderate risk of cardiovascular disease', EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, vol. 23, no. 12, pp. 1289-1297.View/Download from: Publisher's site
Mohammad, AS, Atkins, E, Hsu, B, Webster, R, Rodgers, A & Patel, A 2016, 'PS 14-28 EFFICACY AND SAFETY OF COMBINATION OF THREE OR MORE BP LOWERING DRUGS FOR THE MANAGEMENT OF HIGH BLOOD PRESSURE', Journal of Hypertension, vol. 34, no. Supplement 1, pp. e442-e442.View/Download from: Publisher's site
© The Author(s) 2016. Non-communicable diseases (NCDs) have reached pandemic levels globally and pose a major threat to social and economic development worldwide. The discipline of epidemiology has done much to bring this issue to the forefront of global health. Epidemiological approaches have broadened our understanding of the impact of NCDs in widening socioeconomic disparities. Over a number of decades, this discipline has also contributed to the development of many preventive measures and treatments of known efficacy and safety. However, epidemiology also has a critical role to play in better translating these discoveries into practice, through the new science of implementation. As we strive to achieve the 25 by 25 goal of a 25% reduction in premature mortality from common NCDs by 2025, the discipline of epidemiology will need to continuously evolve to remain an essential tool for public health action.
Santo, K, Kirkendall, S, Laba, T, Thakkar, J, Webster, R, Chalmers, J, Chow, CK & Redfern, J 2016, 'PM082 Interventions to Improve Medication Adherence in Coronary Disease Patients: A Systematic Review of Randomised Controlled Trials', Global Heart, vol. 11, no. 2, pp. e83-e84.View/Download from: Publisher's site
Santo, K, Kirkendall, S, Laba, T-L, Thakkar, J, Webster, R, Chalmers, J, Chow, CK & Redfern, J 2016, 'Interventions to improve medication adherence in coronary disease patients: A systematic review and meta-analysis of randomised controlled trials', EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, vol. 23, no. 10, pp. 1065-1076.View/Download from: Publisher's site
Selak, V, Bullen, C, Stepien, S, Arroll, B, Bots, M, Bramley, D, Cass, A, Grobbee, D, Hillis, GS, Molanus, B, Neal, B, Patel, A, Rafter, N, Rodgers, A, Thom, S, Tonkin, A, Usherwood, T, Wadham, A & Webster, R 2016, 'Do polypills lead to neglect of lifestyle risk factors? Findings from an individual participant data meta-analysis among 3140 patients at high risk of cardiovascular disease', EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, vol. 23, no. 13, pp. 1393-1400.View/Download from: Publisher's site
Tobe, SW 2016, 'The Global Alliance for Chronic Diseases Supports 15 Major Studies in Hypertension Prevention and Control in Low- and Middle-Income Countries', JOURNAL OF CLINICAL HYPERTENSION, vol. 18, no. 7, pp. 600-605.View/Download from: Publisher's site
Webster, R, Patel, A, Selak, V, Billot, L, Bots, ML, Brown, A, Bullen, C, Cass, A, Crengle, S, Elley, CR, Grobbee, DE, Neal, B, Peiris, D, Poulter, N, Prabhakaran, D, Rafter, N, Stanton, A, Stepien, S, Thom, S, Usherwood, T, Wadham, A & Rodgers, A 2016, 'Effectiveness of fixed dose combination medication ('polypills') compared with usual care in patients with cardiovascular disease or at high risk: A prospective, individual patient data meta-analysis of 3140 patients in six countries', INTERNATIONAL JOURNAL OF CARDIOLOGY, vol. 205, pp. 147-156.View/Download from: Publisher's site
Joshi, R, Patel, A, Peiris, D, Saini, B, Usherwood, T, Armor, C, Webster, R, Lo, S, Rodgers, A, Laba, T, Jan, S, Reid, C, Krass, I & Hespe, C 2015, 'INTegrated Electronic General practice support tool, phaRmacy led intervention And combination Therapy Evaluation trial (INTEGRATE)', Heart, Lung and Circulation, vol. 24, pp. S385-S385.View/Download from: Publisher's site
Lafeber, M, Grobbee, DE, Schrover, IM, Thom, S, Webster, R, Rodgers, A, Visseren, FLJ, Bots, ML & Spiering, W 2015, 'Comparison of a morning polypill, evening polypill and individual pills on LDL-cholesterol, ambulatory blood pressure and adherence in high-risk patients; a randomized crossover trial', INTERNATIONAL JOURNAL OF CARDIOLOGY, vol. 181, pp. 193-199.View/Download from: Publisher's site
Patel, A, Cass, A, Peiris, D, Usherwood, T, Brown, A, Jan, S, Neal, B, Hillis, GS, Rafter, N, Tonkin, A, Webster, R, Billot, L, Bompoint, S, Burch, C, Burke, H, Hayman, N, Molanus, B, Reid, CM, Shiel, L, Togni, S & Rodgers, A 2015, 'A pragmatic randomized trial of a polypill-based strategy to improve use of indicated preventive treatments in people at high cardiovascular disease risk', EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, vol. 22, no. 7, pp. 920-930.View/Download from: Publisher's site
Peiris, D, Thompson, SR, Beratarrechea, A, Cardenas, MK, Diez-Canseco, F, Goudge, J, Gyamfi, J, Kamano, JH, Irazola, V, Johnson, C, Kengne, AP, Keat, NK, Miranda, JJ, Mohan, S, Mukasa, B, Ng, E, Nieuwlaat, R, Ogedegbe, O, Ovbiagele, B, Plange-Rhule, J, Praveen, D, Salam, A, Thorogood, M, Thrift, AG, Vedanthan, R, Waddy, SP, Webster, J, Webster, R, Yeates, K & Yusoff, K 2015, 'Behaviour change strategies for reducing blood pressure-related disease burden: findings from a global implementation research programme', IMPLEMENTATION SCIENCE, vol. 10.View/Download from: Publisher's site
Truelove, M, Patel, A, Bompoint, S, Brown, A, Cass, A, Hillis, GS, Peiris, D, Rafter, N, Reid, CM, Rodgers, A, Tonkin, A, Usherwood, T & Webster, R 2015, 'The Effect of a Cardiovascular Polypill Strategy on Pill Burden', CARDIOVASCULAR THERAPEUTICS, vol. 33, no. 6, pp. 347-352.View/Download from: Publisher's site
Webster, R & Rodgers, A 2015, 'Polypill: Progress and Challenges to Global Use-Update on the Trials and Policy Implementation', CURRENT CARDIOLOGY REPORTS, vol. 17, no. 12.View/Download from: Publisher's site
Webster, R, Patel, A, Thom, S, Selak, V, Bullen, C, Stepien, S & Rodgers, A 2015, 'Impact of polypill based therapy on SBP and LDL cholesterol control stratified by potency of baseline regimen', Heart, Lung and Circulation, vol. 24, pp. S383-S384.View/Download from: Publisher's site
Laba, TL, Hayes, A, Jan, S, Rodgers, A, Patel, A, Cass, A, Reid, C, Tonkin, A, Usherwood, T & Webster, R 2014, 'CAN A CVD POLYPILL SAVE MONEY IN THE 'REAL WORLD'?', VALUE IN HEALTH, vol. 17, no. 7, pp. A482-A482.View/Download from: Publisher's site
Laba, T-L, Hayes, A, Lo, S, Peiris, DP, Usherwood, T, Hillis, GS, Rafter, N, Reid, CM, Tonkin, AM, Webster, R, Neal, BC, Cass, A, Patel, A, Rodgers, A & Jan, S 2014, 'An economic case for a cardiovascular potypill? A cost analysis of the Kanyini GAP trial', MEDICAL JOURNAL OF AUSTRALIA, vol. 201, no. 11, pp. 671-673.View/Download from: Publisher's site
Lafeber, M, Grobbee, DE, Bots, ML, Thom, S, Webster, R, Rodgers, A, Visseren, FLJ & Spiering, W 2014, 'The Evening versus Morning Polypill Utilization Study: the TEMPUS rationale and design', EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, vol. 21, no. 4, pp. 425-433.View/Download from: Publisher's site
Salam, A, Webster, R, Singh, K, Kallakuri, S, Rodgers, A, Prabhakaran, D, Maulik, PK, Jan, S, Thom, S, Naik, N, Guggilla, R, Selak, V & Patel, A 2014, 'TRIple pill vs Usual care Management for Patients with mild-to-moderate Hypertension (TRIUMPH): Study protocol', AMERICAN HEART JOURNAL, vol. 167, no. 2, pp. 127-132.View/Download from: Publisher's site
Truelove, M, Webster, R, Bompoint, S & Patel, A 2014, 'PW203 Impact of pill burden on the effects of a polypill-based strategy on use of indicated medications in people with or at high risk of cardiovascular disease', Global Heart, vol. 9, no. 1, pp. e298-e298.View/Download from: Publisher's site
A polypill is a combination of several drugs acting on different risk factors in one formulation. The concept has been proposed as a strategy for reducing cardiovascular events. Several trials have assessed the efficacy of the polypill compared to placebo for primary prevention. These trials showed short-term risk factor reductions, approximately equivalent to the predicted effects of the individual components. At present, the effect of the polypill on the primary prevention of cardiovascular morbidity and mortality is unknown. Large trials have been completed comparing a polypill-based strategy with usual care in populations with established indications for the component drugs. These trials have shown improved adherence with a polypill-based strategy.
Woodward, M, Webster, R, Murakami, Y, Barzi, F, Lam, T-H, Fang, X, Suh, I, Batty, GD, Huxley, R & Rodgers, A 2014, 'The association between resting heart rate, cardiovascular disease and mortality: evidence from 112,680 men and women in 12 cohorts', EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, vol. 21, no. 6, pp. 719-726.View/Download from: Publisher's site
Webster, R, Patel, A, Billot, L, Cass, A, Burch, C, Neal, B, Usherwood, T, Thom, S, Poulter, N, Stanton, A, Bots, ML, Grobbee, DE, Prabhakaran, D, Reddy, KS, Field, J, Bullen, C, Elley, CR, Selak, V, Rafter, N, Wadham, A, Berwanger, O & Rodgers, A 2013, 'Prospective meta-analysis of trials comparing fixed dose combination based care with usual care in individuals at high cardiovascular risk: The SPACE Collaboration', INTERNATIONAL JOURNAL OF CARDIOLOGY, vol. 170, no. 1, pp. 30-35.View/Download from: Publisher's site
Elley, CR, Gupta, AK, Webster, R, Selak, V, Jun, M, Patel, A, Rodgers, A & Thom, S 2012, 'The Efficacy and Tolerability of 'Polypills': Meta-Analysis of Randomised Controlled Trials', PLOS ONE, vol. 7, no. 12.View/Download from: Publisher's site
Hillis, GS, Woodward, M, Rodgers, A, Chow, CK, Li, Q, Zoungas, S, Patel, A, Webster, R, Batty, GD, Ninomiya, T, Mancia, G, Poulter, NR & Chalmers, J 2012, 'Resting heart rate and the risk of death and cardiovascular complications in patients with type 2 diabetes mellitus', DIABETOLOGIA, vol. 55, no. 5, pp. 1283-1290.View/Download from: Publisher's site
Lafeber, M, Spiering, W, Singh, K, Guggilla, RK, Patil, V & Webster, R 2012, 'The cardiovascular polypill in high-risk patients', EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, vol. 19, no. 6, pp. 1234-1242.View/Download from: Publisher's site
Chalmers, J, Woodward, M, Rodgers, A, Chow, C, Patel, A, Webster, R, Batty, D, Li, Q, Ninomiya, T, Zoungas, S & Hillis, G 2011, 'RESTING HEART RATE AND THE RISK OF DEATH AND CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS', Journal of Hypertension, vol. 29, pp. e113-e114.View/Download from: Publisher's site
Peiris, D, Redfern, J, Groenestein, P, Heeley, E, Webster, R, Usherwood, T, Turnbull, F & Patel, A 2011, 'HealthTracker Decision Support for Primary Care Practitioners: Development and Validation Testing', Heart, Lung and Circulation, vol. 20, pp. S248-S248.View/Download from: Publisher's site
Rodgers, A, Patel, A, Berwanger, O, Bots, M, Grimm, R, Grobbee, DE, Jackson, R, Neal, B, Neaton, J, Poulter, N, Rafter, N, Raju, PK, Reddy, S, Thom, S, Vander Hoorn, S & Webster, R 2011, 'An International Randomised Placebo-Controlled Trial of a Four-Component Combination Pill ("Polypill") in People with Raised Cardiovascular Risk', PLOS ONE, vol. 6, no. 5.View/Download from: Publisher's site
Cardiovascular disease (CVD) is still the leading cause of death and disability worldwide despite the availability of well-established and effective preventive options. Accurate perception of a patient's risk by both the patient and the doctors is important as this is one of the components that determine health-related behavior. Doctors tend to not use cardiovascular (CV) risk calculators and underestimate the absolute CV risk of their patients. Patients show optimistic bias when considering their own risk and consistently underestimate it. Poor patient health literacy and numeracy must be considered when thinking about this problem. Patients must possess a reasonably high level of understanding of numerical processes when doctors discuss risk, a level that is not possessed by large numbers of the population. In order to overcome this barrier, doctors need to utilize various tools including the appropriate use of visual aids to accurately communicate risk with their patients. Any intervention has been shown to be better than nothing in improving health understanding. The simple process of repeatedly conveying risk information to a patient has been shown to improve accuracy of risk perception. Doctors need to take responsibility for the accurate assessment and effective communication of CV risk in their patients in order to improve patient uptake of cardioprotective lifestyle choices and preventive medications. © 2010 Webster and Heeley.
Webster, R, Li, SCH, Sullivan, DR, Jayne, K, Su, SYS & Neal, B 2010, 'Effects Of Internet-Based Tailored Advice on the Use of Cholesterol-Lowering Interventions: A Randomized Controlled Trial', JOURNAL OF MEDICAL INTERNET RESEARCH, vol. 12, no. 3.View/Download from: Publisher's site
Peiris, D, Joshi, R, Webster, R, Groenestein, P, Usherwood, T, Turnbull, F, Lipman, A, Heeley, E & Patel, A 2009, 'A novel electronic decision support system to assist General Practitioners in cardiovascular disease risk management—A pilot evaluation', Heart, Lung and Circulation, vol. 18, pp. S269-S269.View/Download from: Publisher's site
Peiris, DP, Joshi, R, Webster, RJ, Groenestein, P, Usherwood, TP, Heeley, E, Turnbull, FM, Lipman, A & Patel, AA 2009, 'An Electronic Clinical Decision Support Tool to Assist Primary Care Providers in Cardiovascular Disease Risk Management: Development and Mixed Methods Evaluation', JOURNAL OF MEDICAL INTERNET RESEARCH, vol. 11, no. 4.View/Download from: Publisher's site
Webster, RJ, Heeley, EL, Peiris, DP, Bayram, C, Cass, A & Patel, AA 2009, 'Gaps in cardiovascular disease risk management in Australian general practice', MEDICAL JOURNAL OF AUSTRALIA, vol. 191, no. 6, pp. 324-329.View/Download from: Publisher's site
Webster, R, Heeley, E, Bayram, C & Patel, A 2007, 'Blood Pressure and Lipid Management in Australian General Practice—Are Guidelines Being Implemented?', Heart, Lung and Circulation, vol. 16, pp. S195-S196.View/Download from: Publisher's site
Webster, R, Heeley, E, Bayram, C & Patel, A 2007, 'Cardiovascular Risk Management in Australian General Practice', Heart, Lung and Circulation, vol. 16, pp. S196-S196.View/Download from: Publisher's site
Webster, R, Lacey, J & Quine, S 2007, 'Palliative care: A public health priority in developing countries', JOURNAL OF PUBLIC HEALTH POLICY, vol. 28, no. 1, pp. 28-39.View/Download from: Publisher's site