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Barlow J, Beake S, Bick D, Bryson C, Day L, Gilby N, Glover V, Knibbs S, Leyland A, Lindsay G, Mathers S, McKenna K, Petrou S, Purdon S, Sylva K, Summerbell CD, Tudor F, Wheeler A, Woolgar V. Initial protocol for a national evaluation of an area-based intervention programme (A Better Start) on early-life outcomes: a longitudinal cohort study with comparison (control) cohort samples. BMJ Open 2017; 7:e015086. [PMID: 28851771 PMCID: PMC5724149 DOI: 10.1136/bmjopen-2016-015086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Pregnancy and the first few years of a child's life are important windows of opportunity in which to equalise life chances. A Better Start (ABS) is an area-based intervention being delivered in five areas of socioeconomic disadvantage across England. This protocol describes an evaluation of the impact and cost-effectiveness of ABS. METHODS AND ANALYSIS The evaluation of ABS comprises a mixed-methods design including impact, cost-effectiveness and process components. It involves a cohort study in the 5 ABS areas and 15 matched comparison sites (n=2885), beginning in pregnancy in 2017 and ending in 2024 when the child is age 7, with a separate cross-sectional baseline survey in 2016/2017. Process data will include a profiling of the structure and services being provided in the five ABS sites at baseline and yearly thereafter, and data regarding the participating families and the services that they receive. Eligible participants will include pregnant women living within the designated sites, with recruitment beginning at 16 weeks of pregnancy. Data collection will involve interviewer-administered and self-completion surveys at eight time points. Primary outcomes include nutrition, socioemotional development, speech, language and learning. Data analysis will include the use of propensity score techniques to construct matched programme and comparison groups, and a range of statistical techniques to calculate the difference in differences between the intervention and comparison groups. The economic evaluation will involve a within-cohort study economic evaluation to compare individual-level costs and outcomes, and a decision analytic cost-effectiveness model to estimate the expected incremental cost per unit change in primary outcomes for ABS in comparison to usual care. ETHICS AND DISSEMINATION Ethical approval to conduct the study has been obtained. The learning and dissemination workstream involves working within and across the sites to generate learning via communities of practice and a range of learning and dissemination events.
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Affiliation(s)
- Jane Barlow
- Department of Social Policy, University of Oxford, Oxford, UK
| | - Sarah Beake
- Florence Nightingale of School of Nursing and Midwifery, Kings College London, London, UK
| | - Debra Bick
- Florence Nightingale of School of Nursing and Midwifery, Kings College London, London, UK
| | | | - Laurie Day
- Policy and Research Unit, Ecorys, Birmingham, UK
| | | | - Vivette Glover
- Department of Surgery and Cancer, Institute for Reproductive and Developmental Biology, Imperial College, London, UK
| | - Sarah Knibbs
- Social Research Institute, Ipsos MORI, London, UK
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Geoff Lindsay
- Department of Education, University of Warwick, Coventry, UK
| | - Sandra Mathers
- Department of Education, University of Oxford, Oxford, UK
| | | | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Kathy Sylva
- Department of Education, University of Oxford, Oxford, UK
| | | | - Fiona Tudor
- Social Research Institute, Ipsos MORI, London, UK
| | - Amy Wheeler
- Social Research Institute, Ipsos MORI, London, UK
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Abstract
AIMS The aim of this study was to examine the results of revision total knee arthroplasty (TKA) undertaken for stiffness in the absence of sepsis or loosening. PATIENTS AND METHODS We present the results of revision surgery for stiff TKA in 48 cases (35 (72.9%) women and 13 (27.1%) men). The mean age at revision surgery was 65.5 years (42 to 83). All surgeries were performed by a single surgeon. Stiffness was defined as an arc of flexion of < 70° or a flexion contracture of > 15°. The changes in the range of movement (ROM) and the Western Ontario and McMasters Osteoarthritis index scores (WOMAC) were recorded. RESULTS At a mean follow up of 59.9 months (12 to 272) there was a mean improvement in arc of movement of 45.0°. Mean flexion improved from 54.4° (5° to 100°) to 90° (10° to 125°) (p < 0.05) and the mean flexion contracture decreased from 12.0° (0° to 45°) to 3.5° (0° to 25°) (p < 0.05). The mean WOMAC scores improved for pain, stiffness and function. In patients with extreme stiffness we describe a novel technique, which we have called the 'sloppy' revision. This entails downsizing the polyethylene insert by 4 mm and using a more constrained liner to retain stability. CONCLUSION To our knowledge, this is the largest series of revision surgeries for stiffness reported in the literature where infection and loosening have been excluded. TAKE HOME MESSAGE Whilst revision surgery is technically demanding, improvements in ROM and outcome can be achieved, particularly when the revision is within two years of the primary surgery. Cite this article: Bone Joint J 2016;98-B:622-7.
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Affiliation(s)
| | - F Tudor
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - J Gollish
- Sunnybrook Health Sciences Centre, Toronto, Canada
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Hee C, Singh A, Tudor F, Akinola K, Cohen AT. Overview of Current Practice and Future Trends in Thromboprophylaxis for General Surgery. ACTA ACUST UNITED AC 2005. [DOI: 10.2174/156727005774329618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Tudor F. Progress in Ventilating School-Houses. J Mass Assoc Boards Health 1891; 1:72-91. [PMID: 19599705 PMCID: PMC2474989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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