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Gout T, Zoltie T, Woodward A, Coleman E, Boele F, Chang B, Bartlett P, Ronaldson S, Kalantzis G, Theaker M, El-Hindy N, Walshaw E, Watson J. A cross-over, randomised feasibility study of digitally printed versus hand-painted artificial eyes in adults: PERSONAL-EYE-S - a study protocol. NIHR Open Res 2023; 2:50. [PMID: 37056714 PMCID: PMC7614426 DOI: 10.3310/nihropenres.13311.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Abstract
Background/objective Around 11,500 artificial eyes are required yearly for new and existing patients. Artificial eyes have been manufactured and hand-painted at the National Artificial Eye Service (NAES) since 1948, in conjunction with approximately 30 local artificial eye services throughout the country. With the current scale of demand, services are under significant pressure. Manufacturing delays as well as necessary repainting to obtain adequate colour matching, may severely impact a patient's rehabilitation pathway to a normal home, social and work life. However, advances in technology mean alternatives are now possible. The aim of this study is to establish the feasibility of conducting a large-scale study of the effectiveness and cost-effectiveness of digitally printed artificial eyes compared to hand-painted eyes. Methods A cross-over, randomised feasibility study evaluating a digitally-printed artificial eye with a hand-painted eye, in patients aged ≥18 years with a current artificial eye. Participants will be identified in clinic, via ophthalmology clinic databases and two charity websites. Qualitative interviews will be conducted in the later phases of the study and focus on opinions on trial procedures, the different artificial eyes, delivery times, and patient satisfaction. Discussion Findings will inform the feasibility, and design, of a larger fully powered randomised controlled trial. The long-term aim is to create a more life-like artificial eye in order to improve patients' initial rehabilitation pathway, long term quality of life, and service experience. This will allow the transition of research findings into benefit to patients locally in the short term and National Health Service wide in the medium to long term. ISRCTN registration ISRCTN85921622 (prospectively registered on 17/06/2021).
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Affiliation(s)
- Taras Gout
- Leeds Artificial Eye Service, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Worsley Building, Leeds, LS2 9LU, UK
| | - Tim Zoltie
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Worsley Building, Leeds, LS2 9LU, UK
| | - Amie Woodward
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Florien Boele
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds,, Leeds, LS2 9JT, UK
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, LS9 7TF, UK
| | - Bernard Chang
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Paul Bartlett
- Leeds Artificial Eye Service, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Worsley Building, Leeds, LS2 9LU, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - George Kalantzis
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Mike Theaker
- Patient and Public Involvement representative, Leeds, UK
| | - Nabil El-Hindy
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Emma Walshaw
- Leeds Artificial Eye Service, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Worsley Building, Leeds, LS2 9LU, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
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Marshman Z, Rodd H, Fairhurst C, Porritt J, Dawett B, Day P, Innes N, Vernazza C, Newton T, Ronaldson S, Cross L, Ross J, Baker SR, Hewitt C, Torgerson D, Ainsworth H. The CALM trial protocol: a randomised controlled trial of a guided self-help cognitive behavioural therapy intervention to reduce dental anxiety in children. Trials 2023; 24:15. [PMID: 36609355 PMCID: PMC9817252 DOI: 10.1186/s13063-022-07046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Globally, around 13% of children experience dental anxiety (DA). This group of patients frequently miss dental appointments, have greater reliance on treatment under general anaesthesia (GA) and have poorer oral health-related quality of life (OHRQoL) than their non-dentally anxious peers. Recently, a low-intensity cognitive behavioural therapy (CBT)-based, self-help approach has been recommended for management of childhood anxiety disorders. A feasibility study conducted in secondary care found this guided self-help CBT resource reduced DA and a randomised controlled trial was recommended. The present study aims to establish the clinical and cost-effectiveness of a guided self-help CBT intervention to reduce DA in children attending primary dental care sites compared to usual care. METHODS This 4-year randomised controlled trial will involve 600 children (aged 9-16 years) and their parent/carers in 30 UK primary dental care sites. At least two dental professionals will participate in each site. They will be assigned, using random allocation, to receive the CBT training and deliver the intervention or to deliver usual care. Children with DA attending these sites, in need of treatment, will be randomly allocated to be treated either by the intervention (CBT) or control (usual care) dental professional. Children will complete questionnaires relating to DA, OHRQoL and HRQoL before treatment, immediately after treatment completion and 12 months post-randomisation. Attendance, need for sedation/GA and costs of the two different approaches will be compared. The primary outcome, DA, will be measured using the Modified Child Dental Anxiety Scale. Scores will be compared between groups using a linear mixed model. DISCUSSION Treating dentally anxious patients can be challenging and costly. Consequently, these children are frequently referred to specialist services for pharmacological interventions. Longer waiting times and greater travel distances may then compound existing healthcare inequalities. This research will investigate whether the intervention has the potential to reduce DA and improve oral health outcomes in children over their life-course, as well as upskilling primary dental healthcare professionals to better manage this patient group. TRIAL REGISTRATION This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420).
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Affiliation(s)
- Zoe Marshman
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Helen Rodd
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Caroline Fairhurst
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Jenny Porritt
- grid.5884.10000 0001 0303 540XCentre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Bhupinder Dawett
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Peter Day
- grid.9909.90000 0004 1936 8403 Leeds Dental Institute, University of Leeds, Leeds, UK
| | - Nicola Innes
- grid.5600.30000 0001 0807 5670School of Dentistry, Cardiff University, Cardiff, UK
| | - Christopher Vernazza
- grid.1006.70000 0001 0462 7212School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Tim Newton
- grid.13097.3c0000 0001 2322 6764Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
| | - Sarah Ronaldson
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Liz Cross
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Jennie Ross
- Richmond Dental Care, 427-429 Richmond Road, Sheffield, UK
| | - Sarah R. Baker
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Catherine Hewitt
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David Torgerson
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Hannah Ainsworth
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
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3
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Baker P, Coole C, Drummond A, Khan S, McDaid C, Hewitt C, Kottam L, Ronaldson S, Coleman E, McDonald DA, Nouri F, Narayanasamy M, McNamara I, Fitch J, Thomson L, Richardson G, Rangan A. Occupational advice to help people return to work following lower limb arthroplasty: the OPAL intervention mapping study. Health Technol Assess 2020; 24:1-408. [PMID: 32930659 PMCID: PMC7520717 DOI: 10.3310/hta24450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hip and knee replacements are regularly carried out for patients who work. There is little evidence about these patients' needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively. OBJECTIVES To develop an occupational advice intervention to support early recovery to usual activities including work that is tailored to the requirements of patients undergoing hip or knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks. DESIGN An intervention mapping approach was used to develop the intervention. The research methods employed were rapid evidence synthesis, qualitative interviews with patients and stakeholders, a prospective cohort study, a survey of clinical practice and a modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the intervention mapping process. SETTING Orthopaedic departments in NHS secondary care. PARTICIPANTS Patients who were in work and intending to return to work following primary elective hip or knee replacement surgery, health-care professionals and employers. INTERVENTIONS Occupational advice intervention. MAIN OUTCOME MEASURES Development of an occupational advice intervention, fidelity of the developed intervention when delivered in a clinical setting, patient and clinician perspectives of the intervention and preliminary assessments of intervention effectiveness and cost. RESULTS A cohort study (154 patients), 110 stakeholder interviews, a survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, a personalised return-to-work plan and co-ordination from the health-care team to support the delivery of 13 patient and 20 staff performance objectives. To support delivery, a range of tools (e.g. occupational checklists, patient workbooks and employer information), roles (e.g. return-to-work co-ordinator) and training resources were created. Feasibility was assessed for 21 of the 26 patients recruited from three NHS trusts. Adherence to the defined performance objectives was 75% for patient performance objectives and 74% for staff performance objectives. The intervention was generally well received, although the short time frame available for implementation and concurrent research evaluation led to some confusion among patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff. LIMITATIONS Implementation and uptake of the intervention was not standardised and was limited by the study time frame. Evaluation of the intervention involved a small number of patients, which limited the ability to assess it. CONCLUSIONS The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention. FUTURE WORK The intervention warrants a randomised controlled trial to assess its clinical effectiveness and cost-effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure that adoption is sustained. STUDY REGISTRATION Current Controlled Trials ISRCTN27426982 and PROSPERO CRD42016045235. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 45. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Baker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Carol Coole
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sayeed Khan
- Make UK, The Manufacturers' Organisation, London, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lucksy Kottam
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David A McDonald
- Whole System Patient Flow Programme, Scottish Government, Edinburgh, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Nouri
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Melanie Narayanasamy
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Iain McNamara
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Judith Fitch
- British Orthopaedic Association Patient Liaison Group, Royal College of Surgeons of England, London, UK
| | - Louise Thomson
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- Faculty of Medical Sciences, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Bell K, Corbacho B, Ronaldson S, Richardson G, Hood K, Sanders J, Robling M, Torgerson D. Costs and consequences of the Family Nurse Partnership (FNP) programme in England: evidence from the Building Blocks trial. F1000Res 2019; 8:1640. [PMID: 31632654 PMCID: PMC6784875 DOI: 10.12688/f1000research.20149.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 11/20/2022] Open
Abstract
Background: The Family Nurse Partnership (FNP) is a licensed intensive home visiting intervention programme delivered to teenage mothers which was originally introduced in England in 2006 by the Department of Health and is now provided through local commissioning of public health services and supported by a national unit led by a consortium of partners. The Building Blocks (BB) trial aimed to explore the effectiveness and cost-effectiveness of this programme. This paper reports the results of an economic evaluation of the Building Blocks randomised controlled trial (RCT) based on a cost-consequence approach. Methods: A large sample of 1618 families was followed-up at various intervals during pregnancy and for two years after birth. A cost-consequence approach was taken to appraise the full range of costs arising from the intervention including both health and social measures of cost alongside the consequences of the trial, specifically, the primary outcomes. Results: A large number of potential factors were identified that are likely to attract additional costs beyond the implementation costs of the intervention including both health and non-health outcomes. Conclusion: Given the extensive costs and only small beneficial consequences observed within the two year follow-up period, the cost-consequence model suggests that the FNP intervention is unlikely to be worth the substantial costs and policy makers may wish to consider other options for investment. Trial registration:
ISRCTN23019866 (20/04/2009)
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Affiliation(s)
- Kerry Bell
- Health Sciences, University of York, UK, York, North Yorkshire, YO10 5DD, UK
| | - Belen Corbacho
- Health Sciences, University of York, UK, York, North Yorkshire, YO10 5DD, UK
| | - Sarah Ronaldson
- Health Sciences, University of York, UK, York, North Yorkshire, YO10 5DD, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, UK, York, North Yorkshire, YO10 5DD, UK
| | - Kerry Hood
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, CF14 4XN, UK
| | - Michael Robling
- Population Health Trials, Cardiff University, Cardiff, CF14 4ER, UK
| | - David Torgerson
- Health Sciences, University of York, UK, York, North Yorkshire, YO10 5DD, UK
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5
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Cook L, Northgraves MJ, Fairhurst C, Ronaldson S, Torgerson DJ, Kent J, Reed M. Knee Replacement Bandaging Study (KReBS) evaluating the effect of a two-layer compression bandage system on knee function following total knee arthroplasty: study protocol for a randomised controlled trial. Trials 2019; 20:261. [PMID: 31068223 PMCID: PMC6505287 DOI: 10.1186/s13063-019-3344-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 04/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background Data from a feasibility study suggest that the use of an inelastic, short-stretch compression bandage following total knee arthroplasty is a safe technique that may improve patient-reported health outcomes, and that it is feasible to recruit to a full-scale study. Methods We will conduct a randomised controlled trial (RCT) of 2600 adult patients, which has 80% power to detect a 1 point difference in the Oxford Knee Score (a patient self-reported assessment of knee pain and function) at 52 weeks. Short stretch compression bandaging will be compared with standard wool and crepe bandaging following total knee arthroplasty. Recruitment will take place in orthopaedic units across the United Kingdom. Secondary outcomes include the EuroQol 5 Dimensions (EQ-5D)-5 L and EQ-5D-3 L scores, pain, length of hospital stay, and complications. Discussion The Knee Replacement Bandaging Study (KReBS) is a large study which aims to contribute to the evidence base for informing clinical decisions for the use of compression bandaging following knee arthroplasty. Trial registration International Standard Randomised Controlled Trial Register, ISRCTN 87127065. Registered on 20 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3344-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liz Cook
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Matthew J Northgraves
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Jonathan Kent
- Northumbria Healthcare NHS Foundation Trust and University of York, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK
| | - Mike Reed
- Northumbria Healthcare NHS Foundation Trust and University of York, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK
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Bell K, Corbacho B, Ronaldson S, Richardson G, Torgerson D, Robling M. The impact of pre and perinatal lifestyle factors on child long term health and social outcomes: a systematic review. Health Econ Rev 2018; 8:2. [PMID: 29368151 PMCID: PMC5783983 DOI: 10.1186/s13561-018-0186-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 01/11/2018] [Indexed: 05/22/2023]
Abstract
To understand the full extent of the impact of a trial, it is important to consider the long-term consequences of outcomes beyond the trial follow-up period, especially for early year's interventions. A systematic review of the literature associated with the long-term consequences of four key outcomes from the Building Blocks trial, specifically, low birth weight, smoking during pregnancy, interval to subsequent pregnancy and A&E attendance or inpatient admission was conducted. These factors were guided by the funders, the Department of Health, as being of particular interest in the UK context. Relevant studies were identified from a number of sources including large databases, reference checking and citation searching. The search yielded 3665 papers, 43 of which were considered appropriate for inclusion. Of these, 29 were relating to smoking during pregnancy, 13 to low birth weight, 0 to A&E attendances during early childhood and 1 to short (< 2 years) interval to subsequent pregnancy. Consistent associations were found between maternal smoking during pregnancy and the effects this has on children's health, educational attainment and likelihood of engaging in problem behaviour and criminal activity in later life. Low birth weight was also found to impact on children's long-term health and cognitive development. Subsequent pregnancies within two years of the previous birth were linked with increased likelihood of pre-term birth and neonatal death. Only minimal evidence was identified regarding the consequences of a short interval to second pregnancy and of child A&E and outpatient attendances. Given that these outcomes have been identified by the UK Department of Health as of particular interest for UK benefit, investment of research in these areas is recommended to establish a clearer picture of both short and long-term consequences.
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Affiliation(s)
- Kerry Bell
- York Trials Unit, Department of Health Sciences, University of York, ARRC Building, York, YO10 5DD UK
| | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, ARRC Building, York, YO10 5DD UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, ARRC Building, York, YO10 5DD UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, YO10 5DD UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, ARRC Building, York, YO10 5DD UK
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS Wales
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7
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Stamuli E, Torgerson D, Northgraves M, Ronaldson S, Cherry L. Identifying the primary outcome for a randomised controlled trial in rheumatoid arthritis: the role of a discrete choice experiment. J Foot Ankle Res 2017; 10:57. [PMID: 29270231 PMCID: PMC5732456 DOI: 10.1186/s13047-017-0240-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022] Open
Abstract
Background This study sought to establish the preferences of people with Rheumatoid Arthritis (RA) about the best outcome measure for a health and fitness intervention randomised controlled trial (RCT). The results of this study were used to inform the choice of the trial primary and secondary outcome measure. Methods A discrete choice experiment (DCE) was used to assess people’s preferences regarding a number of outcomes (foot and ankle pain, fatigue, mobility, ability to perform daily activities, choice of footwear) as well as different schedules and frequency of delivery for the health and fitness intervention. The outcomes were chosen based on literature review, clinician recommendation and patients’ focus groups. The DCE was constructed in SAS software using the D-efficiency criteria. It compared hypothetical scenarios with varying levels of outcomes severity and intervention schedule. Preference weights were estimated using appropriate econometric models. The partial log-likelihood method was used to assess the attribute importance. Results One hundred people with RA completed 18 choice sets. Overall, people selected foot and ankle pain as the most important outcome, with mobility being nearly as important. There was no evidence of differential preference between intervention schedules or frequency of delivery. Conclusions Foot and ankle pain can be considered the patient choice for primary outcome of an RCT relating to a health and fitness intervention. This study demonstrated that, by using the DCE method, it is possible to incorporate patients’ preferences at the design stage of a RCT. This approach ensures patient involvement at early stages of health care design. Electronic supplementary material The online version of this article (10.1186/s13047-017-0240-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eugena Stamuli
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Matthew Northgraves
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Lindsey Cherry
- Solent NHS Trust & University of Southampton, Faculty of Health Sciences, B45, Southampton, SO17 1BJ UK
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8
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Corbacho B, Bell K, Stamuli E, Richardson G, Ronaldson S, Hood K, Sanders J, Robling M, Torgerson D. Cost-effectiveness of the Family Nurse Partnership (FNP) programme in England: Evidence from the building blocks trial. J Eval Clin Pract 2017; 23:1367-1374. [PMID: 28799197 DOI: 10.1111/jep.12799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 11/28/2022]
Abstract
RATIONAL, AIMS, AND OBJECTIVES The Family Nurse Partnership (FNP) is a licensed intensive home visiting intervention developed in the United States. It has been provided in England by the Department of Health since 2006. The Building Blocks trial assessed the effectiveness and cost-effectiveness of FNP in England. METHODS We performed a cost-utility analysis (National Health Service (NHS) perspective) alongside the Building Blocks trial (over 2.5 y). The analysis was conducted in accordance with National Institute for Health and Clinical Excellence (NICE) reference case standards. Health-related quality of life was elicited from mothers using the EQ-5D-3L. Resource-use data were collected from self-reported questionnaires, Hospital Episode Statistics, general practitioner records and the central Department of Health FNP database. Costs and quality-adjusted life years (QALYs) were discounted at 3.5%. The base case analysis used an intention to treat approach on the imputed dataset using multiple imputation. RESULTS The FNP intervention costs on average £1812 more per participant compared to usual care (95% confidence interval: -£2700; £5744). Incremental adjusted mean QALYs are marginally higher for FNP (mean difference 0.0036, 95% confidence interval: -0.017; 0.025). The probability of FNP being cost-effective is less than 20% given the current NICE willingness to pay threshold of £20 000 per additional QALY. The results were robust to sensitivity analyses. CONCLUSION Given the absence of significant benefits of FNP in terms of the primary outcomes of the trial and only marginal maternal QALY gains, FNP does not represent a cost-effective intervention when compared with existing services already offered to young pregnant women.
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Affiliation(s)
- Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kerry Bell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Eugena Stamuli
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University Neuadd Meirionnydd, Health Park, Cardiff, UK
| | | | - Michael Robling
- Centre for Trials Research, Cardiff University Neuadd Meirionnydd, Health Park, Cardiff, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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9
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Taylor M, Chilton S, Ronaldson S, Metcalf H, Nielsen JS. Comparing Increments in Utility of Health: An Individual-based Approach. Value Health 2017; 20:224-229. [PMID: 28237199 DOI: 10.1016/j.jval.2016.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 05/27/2023]
Abstract
BACKGROUND Many economic evaluations of health care changes rely on quality-adjusted life year (QALY) estimates. Notably, though, the QALY approach values health states rather than changes in health states. Hence, a gain in utility of health is only indirectly valued through an ex ante preference elicitation of health states and the subsequent subtraction of health state values from one another, rather than being valued directly. There is therefore an underlying assumption that individuals, from an ex ante perspective ceteris paribus, would be indifferent between equal utility increments from health states with different baseline utilities. OBJECTIVE The aim of this paper is to develop a method that would allow us to measure individual-based preferences over utility increments from different baselines. We elicit our data using face-to-face interviews on a sample of UK individuals. RESULTS Overall, we find that gains of "equal" utility increments from different baselines are not found to be equally preferable by the individual. CONCLUSIONS The results indicate that the subtraction approach could lead to sub-optimal resource allocations and suggest that a new approach which values health changes directly would better reflect individual preferences. This paper provides the foundations for a method to achieve this.
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Affiliation(s)
- Matthew Taylor
- York Health Economics Consortium, University of York, York, North Yorkshire, UK.
| | - Susan Chilton
- Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Hugh Metcalf
- Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
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10
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Robling M, Bekkers MJ, Bell K, Butler CC, Cannings-John R, Channon S, Martin BC, Gregory JW, Hood K, Kemp A, Kenkre J, Montgomery AA, Moody G, Owen-Jones E, Pickett K, Richardson G, Roberts ZES, Ronaldson S, Sanders J, Stamuli E, Torgerson D. Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial. Lancet 2016; 387:146-55. [PMID: 26474809 PMCID: PMC4707160 DOI: 10.1016/s0140-6736(15)00392-x] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Many countries now offer support to teenage mothers to help them to achieve long-term socioeconomic stability and to give a successful start to their children. The Family Nurse Partnership (FNP) is a licensed intensive home-visiting intervention developed in the USA and introduced into practice in England that involves up to 64 structured home visits from early pregnancy until the child's second birthday by specially recruited and trained family nurses. We aimed to assess the effectiveness of giving the programme to teenage first-time mothers on infant and maternal outcomes up to 24 months after birth. METHODS We did a pragmatic, non-blinded, randomised controlled, parallel-group trial in community midwifery settings at 18 partnerships between local authorities and primary and secondary care organisations in England. Eligible participants were nulliparous and aged 19 years or younger, and were recruited at less than 25 weeks' gestation. Field-based researchers randomly allocated mothers (1:1) via remote randomisation (telephone and web) to FNP plus usual care (publicly funded health and social care) or to usual care alone. Allocation was stratified by site and minimised by gestation (<16 weeks vs ≥16 weeks), smoking status (yes vs no), and preferred language of data collection (English vs non-English). Mothers and assessors (local researchers at baseline and 24 months' follow-up) were not masked to group allocation, but telephone interviewers were blinded. Primary endpoints were biomarker-calibrated self-reported tobacco use by the mother at late pregnancy, birthweight of the baby, the proportion of women with a second pregnancy within 24 months post-partum, and emergency attendances and hospital admissions for the child within 24 months post-partum. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN23019866. FINDINGS Between June 16, 2009, and July 28, 2010, we screened 3251 women. After enrolment, 823 women were randomly assigned to receive FNP and 822 to usual care. All follow-up data were retrieved by April 25, 2014. 304 (56%) of 547 women assigned to FNP and 306 (56%) of 545 assigned to usual care smoked at late pregnancy (adjusted odds ratio [AOR] 0·90, 97·5% CI 0·64-1·28). Mean birthweight of 742 babies with mothers assigned to FNP was 3217·4 g (SD 618·0), whereas birthweight of 768 babies assigned to usual care was 3197·5 g (SD 581·5; adjusted mean difference 20·75 g, 97·5% CI -47·73 to 89·23. 587 (81%) of 725 assessed children with mothers assigned to FNP and 577 (77%) of 753 assessed children assigned to usual care attended an emergency department or were admitted to hospital at least once before their second birthday (AOR 1·32, 97·5% CI 0·99-1·76). 426 (66%) of 643 assessed women assigned to FNP and 427 (66%) 646 assigned to usual care had a second pregnancy within 2 years (AOR 1·01, 0·77-1·33). At least one serious adverse event (mainly clinical events associated with pregnancy and infancy period) was reported for 310 (38%) of 808 participants (mother-child) in the usual care group and 357 (44%) of 810 in the FNP group, none of which were considered related to the intervention. INTERPRETATION Adding FNP to the usually provided health and social care provided no additional short-term benefit to our primary outcomes. Programme continuation is not justified on the basis of available evidence, but could be reconsidered should supportive longer-term evidence emerge. FUNDING Department of Health Policy Research Programme.
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Affiliation(s)
- Michael Robling
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - Marie-Jet Bekkers
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kerry Bell
- York Trials Unit, University of York, York, UK
| | - Christopher C Butler
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Rebecca Cannings-John
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sue Channon
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Kerry Hood
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Alison Kemp
- School of Medicine, Cardiff University, Cardiff, UK
| | - Joyce Kenkre
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK; Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Gwenllian Moody
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Eleri Owen-Jones
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kate Pickett
- Department of Health Sciences, University of York, York, UK
| | | | | | | | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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van Staa TP, Dyson L, McCann G, Padmanabhan S, Belatri R, Goldacre B, Cassell J, Pirmohamed M, Torgerson D, Ronaldson S, Adamson J, Taweel A, Delaney B, Mahmood S, Baracaia S, Round T, Fox R, Hunter T, Gulliford M, Smeeth L. The opportunities and challenges of pragmatic point-of-care randomised trials using routinely collected electronic records: evaluations of two exemplar trials. Health Technol Assess 2015; 18:1-146. [PMID: 25011568 DOI: 10.3310/hta18430] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pragmatic trials compare the effects of different decisions in usual clinical practice. OBJECTIVES To develop and evaluate methods to implement simple pragmatic trials using routinely collected electronic health records (EHRs) and recruiting patients at the point of care; to identify the barriers and facilitators for general practitioners (GPs) and patients and the experiences of trial participants. DESIGN Two exemplar randomised trials (Retropro and eLung) with qualitative evaluations. SETTING Four hundred and fifty-nine English and Scottish general practices contributing EHRs to a research database, of which 17 participated in the trials. PARTICIPANTS Retropro aimed to recruit 300 patients with hypercholesterolaemia and high cardiovascular risk and eLung aimed to recruit 150 patients with a chronic obstructive pulmonary disease exacerbation. INTERVENTIONS Retropro randomised between simvastatin and atorvastatin and eLung between immediate antibiotics and deferred or non-use. eLung recruited during an unscheduled consultation using EHR flagging. MAIN OUTCOME MEASURE Successful trial completion with implementation of information technology (IT) system for flagging and data processing and documentation of operational and scientific experiences. DATA SOURCES EHR research database. RESULTS The governance approval process took over 3 years. A total of 58.8% of the practices (n = 270) expressed interest in participating. The number of interested practices dropped substantially with each stage of the governance process. In Retropro, 6.5% of the practices (n = 30) were eventually approved and 3.7% (n = 17) recruited patients; in eLung, these numbers were 6.8% (n = 31) and 1.3% (n = 6) respectively. Retropro successfully completed recruitment (301 patients) whereas eLung recruited 31 patients. Retropro recruited 20.6% of all statin starters in recruiting practices and 1.1% in the EHR database; the comparable numbers for eLung were 32.3% and 0.9% respectively. The IT system allowed for complex eligibility criteria with central on and off control of recruitment and flagging at a practice. Good Clinical Practice guidelines, governance and consent procedures were found to have substantially affected the intended simple nature of the trials. One qualitative study of 13 clinicians found that clinicians were generally positive about the principle of computerised trial recruitment (flagging during consultation). However, trials which did not include patients with acute illness were favoured. The second qualitative process evaluation interviewed 27 GPs about their actual experiences, including declining, recruiting and non-recruiting GPs. Opportunistic patient recruitment during a routine GP consultation was found to be the most controversial element. The actual experiences of recruiting patients during unscheduled consultation were generally more positive than the hypothetical views of GPs. Several of the recruiting GPs reported the process took 5 minutes and was straightforward and feasible on most occasions. Almost all GPs expressed their strong support for the use of EHRs for trials. Ten eLung participants were interviewed, all of whom considered it acceptable to be recruited during a consultation and to use EHRs for trials. CONCLUSIONS EHR point-of-care trials are feasible, although the recruitment of clinicians is a major challenge owing to the complexity of trial approvals. These trials will provide substantial evidence on clinical effectiveness only if trial interventions and participating clinicians and patients are typical of usual clinical care and trials are simple to initiate and conduct. Recommendations for research include the development of evidence and implementation of risk proportionality in trial governance and conduct. TRIAL REGISTRATION Current Controlled Trials ISRCTN33113202 and ISRCTN72035428. FUNDING This project was funded by the NIHR Health Technology Assessment programme and the Wellcome Trust and will be published in full in Health Technology Assessment; Vol. 18, No. 43. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tjeerd-Pieter van Staa
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Lisa Dyson
- York Trials Unit, York University, York, UK
| | - Gerard McCann
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Shivani Padmanabhan
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Rabah Belatri
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Ben Goldacre
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jackie Cassell
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
| | - Munir Pirmohamed
- The Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | | | | | - Adel Taweel
- Department of Primary Care and Public Health Sciences Division of Health and Social Care Research, King's College London, London, UK
| | - Brendan Delaney
- Department of Primary Care and Public Health Sciences Division of Health and Social Care Research, King's College London, London, UK
| | - Samhar Mahmood
- Department of Primary Care and Public Health Sciences Division of Health and Social Care Research, King's College London, London, UK
| | - Simona Baracaia
- Department of Primary Care and Public Health Sciences Division of Health and Social Care Research, King's College London, London, UK
| | - Thomas Round
- Department of Primary Care and Public Health Sciences Division of Health and Social Care Research, King's College London, London, UK
| | | | | | - Martin Gulliford
- Primary Care and Public Health Sciences, King's College London, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Ronaldson S, Adamson J, Dyson L, Torgerson D. Waiting list randomized controlled trial within a case-finding design: methodological considerations. J Eval Clin Pract 2014; 20:601-5. [PMID: 24943741 DOI: 10.1111/jep.12161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Randomized controlled trials (RCTs) are widely used in health care research to provide high-quality evidence of effectiveness of an intervention. However, sometimes a study does not require an RCT in order to answer its primary objective; a case-finding design may be more appropriate. The aim of this paper was to introduce a new study design that nests a waiting list RCT within a case-finding study. METHODS An example of the new study design is the DOC Study, which primarily aims to determine the diagnostic accuracy of lung function tests for chronic obstructive pulmonary disease. It also investigates the impact of lung function tests on smoking behaviour through use of a waiting list design. The first step of the study design is to obtain participants' consent. Individuals are then randomized to one of two groups; either the 'intervention now' group or the 'intervention later' group, that is, participants are placed on a waiting list. All participants receive the same intervention; the only difference between the groups is the timing of the intervention. RESULTS AND CONCLUSIONS The design addresses patient preference issues and recruitment issues that can arise in other trial designs. Potential limitations include differential attrition between study groups and potential demoralization for the 'intervention later' group. The 'waiting list case-finding trial' design is a valuable method that could be applied to case-finding studies; the design enables the case-finding component of a study to be maintained while simultaneously exploring additional hypotheses through conducting a trial.
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Affiliation(s)
- Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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13
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Birks Y, Harrison R, Bosanquet K, Hall J, Harden M, Entwistle V, Watt I, Walsh P, Ronaldson S, Roberts D, Adamson J, Wright J, Iedema R. An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration. Health Services and Delivery Research 2014. [DOI: 10.3310/hsdr02200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice.AimThe aim of this work was to both critically evaluate and extend the current evidence base relating to open disclosure, with a view to supporting the implementation of a policy of open disclosure of adverse events in the NHS.MethodsThis work was conducted in three phases. The first phase comprised two focused systematic literature reviews, one summarising empirical research on the effectiveness of interventions to enhance open disclosure, and a second, broader scoping review, looking at reports of current opinion and practice and wider knowledge. The second phase involved primary qualitative research with the objective of generating new knowledge about UK-based stakeholders’ views on their role in and experiences of open disclosure. Stakeholder interviews were analysed using the framework approach. The third phase synthesised the findings from the first two phases to inform and develop a set of short pragmatic suggestions for NHS trust management, to facilitate the implementation and evaluation of open disclosure.ResultsA total of 610 papers met the inclusion criteria for the broad review. A large body of literature discussed open disclosure from a number of related, but sometimes conflicted, perspectives. Evidential gaps persist and current practice is based largely on expert consensus rather than evidence. There appears to be a tension between the existing pragmatic guidance and the more in-depth critiques of what being consistent and transparent in health care really means. Eleven papers met the inclusion criteria for the more focused review. There was little evidence for the effectiveness of disclosure alone on organisational or individual outcomes or of interventions to promote and support open disclosure. Interviews with stakeholders identified strong support for the basic principle of being honest with patients or relatives when someone was seriously harmed by health care. In practice however, the issues are complex and there is confusion about a number of issues relating to disclosure policies in the UK. The interviews generated insights into the difficulties perceived within health care at individual and institutional levels, in relation to fully implementing the Being Open guidance.ConclusionsThere are several clear strategies that the NHS could learn from to implement and sustain a policy of openness. Literature reviews and stakeholder accounts both identified the potential benefits of a culture that was generally more open (not just retrospectively open about serious harm). Future work could usefully evaluate the impact of disclosure on legal challenges within the NHS, best practice in models of support and training for open disclosure, embedding disclosure conversations in critical incident analysis and disclosure of less serious events.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Yvonne Birks
- Social Policy Research Unit, University of York, York, UK
| | - Reema Harrison
- Department of Health Sciences, University of York, York, UK
| | - Kate Bosanquet
- Department of Health Sciences, University of York, York, UK
| | - Jill Hall
- Department of Health Sciences, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Vikki Entwistle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ian Watt
- Department of Health Sciences, University of York, York, UK
| | - Peter Walsh
- Action against Medical Accidents, Croydon, UK
| | | | | | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Rick Iedema
- Centre for Health Communication, Faculty of Arts and Social Sciences, University of Technology, Sydney, Australia
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Ronaldson S, Taylor M, Bech PG, Shenton R, Bufe A. Economic evaluation of SQ-standardized grass allergy immunotherapy tablet (Grazax(®)) in children. Clinicoecon Outcomes Res 2014; 6:187-96. [PMID: 24812522 PMCID: PMC4011810 DOI: 10.2147/ceor.s44079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Grass pollen-induced rhinoconjunctivitis is a common allergic respiratory disorder affecting over 20% of the UK population in terms of quality of life and sleep, work, and school patterns. The SQ-standardized grass allergy immunotherapy tablet (AIT) has been demonstrated as a disease-modifying treatment which gives a sustained effect even after completion of a treatment course. The objective of this study was to provide an economic assessment of whether treatment with the SQ-standardized grass AIT, Grazax® (Phleum pratense) in combination with symptomatic medications is preferable to the standard of care using symptomatic medications only. The analysis was performed for children with grass pollen-induced rhinoconjunctivitis, with or without concomitant asthma, in the UK. Methods The model evaluated the two treatment regimens in a cohort of 1,000 children from a payer’s perspective. Treatment was modeled in terms of management of symptoms, impact on resource use, and development of allergic asthma. The analysis modeled the use of SQ-standardized grass AIT and the sustained effects of treatment over a 9-year time horizon (ie, 3 years of treatment, with modeled long-term benefits). Data inputs were drawn from a recent clinical trial, published studies, and databases. Results SQ-standardized grass AIT improves patient outcomes, generating an incremental cost per quality-adjusted life year gained of £12,168. This is below commonly accepted thresholds in the UK. Conclusion The resulting incremental cost per QALY falls below commonly accepted willingness to pay thresholds. Therefore, the SQ-standardized grass AIT is a cost-effective option for the treatment of grass pollen-induced rhinoconjunctivitis in the UK pediatric population.
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15
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Owen-Jones E, Bekkers MJ, Butler CC, Cannings-John R, Channon S, Hood K, Gregory JW, Kemp A, Kenkre J, Martin BC, Montgomery A, Moody G, Pickett KE, Richardson G, Roberts Z, Ronaldson S, Sanders J, Stamuli E, Torgerson D, Robling M. The effectiveness and cost-effectiveness of the Family Nurse Partnership home visiting programme for first time teenage mothers in England: a protocol for the Building Blocks randomised controlled trial. BMC Pediatr 2013; 13:114. [PMID: 23919573 PMCID: PMC3750355 DOI: 10.1186/1471-2431-13-114] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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] [Received: 07/12/2013] [Accepted: 07/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Nurse Family Partnership programme was developed in the USA where it is made available to pregnant young mothers in some socially deprived geographic areas. The related Family Nurse Partnership programme was introduced in England by the Department of Health in 2006 with the aim of improving outcomes for the health, wellbeing and social circumstances of young first-time mothers and their children. METHODS / DESIGN This multi-centre individually randomised controlled trial will recruit 1600 participants from 18 Primary Care Trusts in England, United Kingdom. The trial will evaluate the effectiveness of Family Nurse Partnership programme and usual care versus usual care for nulliparous pregnant women aged 19 or under, recruited by 24 weeks gestation and followed until the child's second birthday. Data will be collected from participants at baseline, 34-36 weeks gestation, 6, 12, 18 and 24 months following birth. Routine clinical data will be collected from maternity, primary care and hospital episodes statistics. Four primary outcomes are to be reported from the trial: birth weight; prenatal tobacco use; child emergency attendances and/or admissions within two years of birth; second pregnancy within two years of first birth. DISCUSSION This trial will evaluate the effectiveness and cost effectiveness of the Family Nurse Partnership in England. The findings will provide evidence on pregnancy and early childhood programme outcomes for policy makers, health professionals and potential recipients in three domains (pregnancy and birth, child health and development, and parental life course and self-sufficiency) up to the child's second birthday. TRIAL REGISTRATION Trial registration number: ISRCTN23019866.
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Affiliation(s)
- Eleri Owen-Jones
- South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Neuadd Meirionnydd 7th Floor, Heath Park, Cardiff, Wales CF14 4YS, UK
| | - Marie-Jet Bekkers
- South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Neuadd Meirionnydd 7th Floor, Heath Park, Cardiff, Wales CF14 4YS, UK
| | - Chris C Butler
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, Wales CF14 4YS, UK
| | - Rebecca Cannings-John
- South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Neuadd Meirionnydd 7th Floor, Heath Park, Cardiff, Wales CF14 4YS, UK
| | - Sue Channon
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, Wales CF14 4YS, UK
| | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Neuadd Meirionnydd 7th Floor, Heath Park, Cardiff, Wales CF14 4YS, UK
| | - John W Gregory
- Institute of Molecular and Experimental Medicine, Cardiff University, Heath Park, Cardiff, Wales CF14 4XW, UK
| | - Alison Kemp
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, Wales CF14 4YS, UK
| | - Joyce Kenkre
- University of South Wales, Pontypridd, Wales CF37 1DL, UK
| | - Belen Corbacho Martin
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, C Floor, South Block, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - Gwenllian Moody
- South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Neuadd Meirionnydd 7th Floor, Heath Park, Cardiff, Wales CF14 4YS, UK
| | - Kate E Pickett
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK
| | - Zoë Roberts
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, Wales CF14 4YS, UK
| | | | - Julia Sanders
- South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Neuadd Meirionnydd 7th Floor, Heath Park, Cardiff, Wales CF14 4YS, UK
| | - Eugena Stamuli
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK
| | - David Torgerson
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK
| | - Michael Robling
- South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Neuadd Meirionnydd 7th Floor, Heath Park, Cardiff, Wales CF14 4YS, UK
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Smith L, McKenzie H, Ronaldson S, Bundy A, Brown L, Bonsnic-Anticevich S. The Impact of an Innovative Learning and Teaching Module of Patient Self-Management of Chronic Pain on Undergraduate Pharmacy Student Learning. Res Social Adm Pharm 2012. [DOI: 10.1016/j.sapharm.2012.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ali S, Ronaldson S. Ordinal preference elicitation methods in health economics and health services research: using discrete choice experiments and ranking methods. Br Med Bull 2012; 103:21-44. [PMID: 22859714 DOI: 10.1093/bmb/lds020] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The predominant method of economic evaluation is cost-utility analysis, which uses cardinal preference elicitation methods, including the standard gamble and time trade-off. However, such approach is not suitable for understanding trade-offs between process attributes, non-health outcomes and health outcomes to evaluate current practices, develop new programmes and predict demand for services and products. Ordinal preference elicitation methods including discrete choice experiments and ranking methods are therefore commonly used in health economics and health service research. AREAS OF AGREEMENT Cardinal methods have been criticized on the grounds of cognitive complexity, difficulty of administration, contamination by risk and preference attitudes, and potential violation of underlying assumptions. Ordinal methods have gained popularity because of reduced cognitive burden, lower degree of abstract reasoning, reduced measurement error, ease of administration and ability to use both health and non-health outcomes. AREAS OF CONTROVERSY The underlying assumptions of ordinal methods may be violated when respondents use cognitive shortcuts, or cannot comprehend the ordinal task or interpret attributes and levels, or use 'irrational' choice behaviour or refuse to trade-off certain attributes. CURRENT USE AND GROWING AREAS: Ordinal methods are commonly used to evaluate preference for attributes of health services, products, practices, interventions, policies and, more recently, to estimate utility weights. AREAS FOR ON-GOING RESEARCH: There is growing research on developing optimal designs, evaluating the rationalization process, using qualitative tools for developing ordinal methods, evaluating consistency with utility theory, appropriate statistical methods for analysis, generalizability of results and comparing ordinal methods against each other and with cardinal measures.
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Affiliation(s)
- Shehzad Ali
- Department of Health Sciences, University of York, Heslington, York, UK.
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Abstract
The care of patients whose illnesses cannot be cured places many stresses on health professionals (both generalist and specialist), and more importantly on patients and families. The complexities for all concerned in the process of referral to palliative care services should not be underestimated, however there is evidence that the referral process could be better handled by all health professionals. With greater understanding of the dynamics of care, the crisis of living with an incurable illness and dying can be lessened for patients. This article reports on a qualitative research project undertaken at a large metropolitan palliative care service and its referring public hospital. Patients and nurses were interviewed to identify issues relating to the care of patients and families newly referred to palliative care. The findings of this research identify themes in relation to the transition of patients from acute curative to palliative care services, e.g. pace and timing of the transition, fear and (mis)understanding, accepting palliative care, information and education on palliative care, and peer support and supervision for palliative care nurses.
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Affiliation(s)
- S Ronaldson
- Australian Catholic University, North Sydney Campus, Australia
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Ronaldson S, Savy P. Validation therapy: a communication link with the confused older person. Aust Nurses J 1992; 21:19-21. [PMID: 1497540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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