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Irvine A, Jones A, Beattie P, Baron S, Browne F, Ashoor F, O'Neill L, Rosala-Hallas A, Sach T, Spowart C, Taams L, Walker C, Wan M, Webb N, Williamson P, Flohr C. The TREatment of severe Atopic eczema Trial (TREAT). Br J Dermatol 2018. [DOI: 10.1111/bjd.17052] [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: 11/29/2022]
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Irvine AD, Jones AP, Beattie P, Baron S, Browne F, Ashoor F, O'Neill L, Rosala-Hallas A, Sach T, Spowart C, Taams L, Walker C, Wan M, Webb N, Williamson P, Flohr C. A randomized controlled trial protocol assessing the effectiveness, safety and cost-effectiveness of methotrexate vs. ciclosporin in the treatment of severe atopic eczema in children: the TREatment of severe Atopic eczema Trial (TREAT). Br J Dermatol 2018; 179:1297-1306. [PMID: 29727479 DOI: 10.1111/bjd.16717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral systemic immunomodulatory medication is regularly used off-licence in children with severe atopic eczema. However, there is no firm evidence regarding the effectiveness, safety, cost-effectiveness and impact on quality of life from an adequately powered randomized controlled trial (RCT) using systemic medication in children. OBJECTIVES To assess whether there is a difference in the speed of onset, effectiveness, side-effect profile and reduction in flares post-treatment between ciclosporin (CyA) and methotrexate (MTX), and also the cost-effectiveness of the drugs. Treatment impact on quality of life will also be examined in addition to whether FLG genotype influences treatment response. In addition, the trial studies the immune-metabolic effects of CyA and MTX. METHODS Multicentre, parallel group, assessor-blind, pragmatic RCT of 36 weeks' duration with a 24-week follow-up period. In total, 102 children aged 2-16 years with moderate-to-severe atopic eczema, unresponsive to topical treatment will be randomized (1 : 1) to receive MTX (0·4 mg kg-1 per week) or CyA (4 mg kg-1 per day). RESULTS The trial has two primary outcomes: change from baseline to 12 weeks in Objective Severity Scoring of Atopic Dermatitis (o-SCORAD) and time to first significant flare following treatment cessation. CONCLUSIONS This trial addresses important therapeutic questions, highlighted in systematic reviews and treatment guidelines for atopic eczema. The trial design is pragmatic to reflect current clinical practice.
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Affiliation(s)
- A D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,Paediatric Dermatology, Our Lady's Children Hospital Crumlin, Dublin, Ireland.,National Children's Research Centre, Crumlin, Dublin, Ireland
| | - A P Jones
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, U.K
| | - P Beattie
- Royal Hospital for Children NHS Trust, Glasgow, U.K
| | - S Baron
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - F Browne
- Paediatric Dermatology, Our Lady's Children Hospital Crumlin, Dublin, Ireland
| | - F Ashoor
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, U.K
| | - L O'Neill
- Biochemistry, Trinity College Dublin, Dublin, Ireland
| | - A Rosala-Hallas
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, U.K
| | - T Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, U.K
| | - C Spowart
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, U.K
| | - L Taams
- Centre for Molecular and Cellular Biology of Inflammation, King's College London, London, U.K
| | - C Walker
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - M Wan
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - N Webb
- Renal Research Laboratories, Manchester Royal Infirmary, Manchester, U.K
| | - P Williamson
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, U.K
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, U.K
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- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, U.K
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Horne JC, Robinson K, Sims E, Stirling S, Sach T, Armstrong S, Logan PA. 24IMPROVING TRIAL RECRUITMENT IN CARE HOMES: THE FALLS IN CARE HOME (FINCH) EXPERIENCE. Age Ageing 2018. [DOI: 10.1093/ageing/afy124.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - K Robinson
- Research and Innovation, Nottinghamshire Healthcare NHS Trust
| | - E Sims
- Norwich Clinical Trials Units, University of East Anglia, UK
| | - S Stirling
- Norwich Clinical Trials Units, University of East Anglia, UK
| | - T Sach
- Norwich Clinical Trials Units, University of East Anglia, UK
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Crossman‐Barnes C, Peel A, Fong‐Soe‐Khioe R, Sach T, Wilson A, Barton G. Economic evidence for nonpharmacological asthma management interventions: A systematic review. Allergy 2018; 73:1182-1195. [PMID: 29105788 PMCID: PMC6033175 DOI: 10.1111/all.13337] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 11/29/2022]
Abstract
Asthma management, education and environmental interventions have been reported as cost‐effective in a previous review (Pharm Pract (Granada), 2014;12:493), but methods used to estimate costs and outcomes were not discussed in detail. This review updates the previous review by providing economic evidence on the cost‐effectiveness of studies identified after 2012, and a detailed assessment of the methods used in all identified studies. Twelve databases were searched from 1990 to January 2016, and studies included economic evaluations, asthma subjects and nonpharmacological interventions written in English. Sixty‐four studies were included. Of these, 15 were found in addition to the earlier review; 53% were rated fair in quality and 47% high. Education and self‐management interventions were the most cost‐effective, in line with the earlier review. Self‐reporting was the most common method used to gather resource‐use data, accompanied by bottom‐up approaches to estimate costs. Main outcome measures were asthma‐related hospitalizations (69%), quality of life (41%) and utility (38%), with AQLQ and the EQ‐5D being the most common questionnaires measured prospectively at fixed time points. More rigorous costing methods are needed with a more common quality of life tool to aid greater replicability and comparability amongst asthma studies.
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Affiliation(s)
| | - A. Peel
- Norwich Medical School University of East Anglia Norwich UK
| | | | - T. Sach
- Norwich Medical School University of East Anglia Norwich UK
| | - A. Wilson
- Norwich Medical School University of East Anglia Norwich UK
| | - G. Barton
- Norwich Medical School University of East Anglia Norwich UK
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Sach T. Safety gains don't translate into reduced costs or increased QALYs for doxycycline compared with prednisolone for patients with bullous pemphigoid. Br J Dermatol 2018; 178:320-321. [DOI: 10.1111/bjd.16226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T. Sach
- Health Economics Group; Norwich Medical School; University of East Anglia; Norwich NR4 7TJ U.K
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Affiliation(s)
- E McManus
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, U.K
| | - T Sach
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, U.K
| | - N J Levell
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, U.K
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Heinl D, Prinsen CAC, Sach T, Drucker AM, Ofenloch R, Flohr C, Apfelbacher C. Measurement properties of quality-of-life measurement instruments for infants, children and adolescents with eczema: a systematic review. Br J Dermatol 2017; 176:878-889. [PMID: 27543747 DOI: 10.1111/bjd.14966] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quality of life (QoL) is one of the core outcome domains identified by the Harmonising Outcome Measures for Eczema (HOME) initiative to be assessed in every eczema trial. There is uncertainty about the most appropriate QoL instrument to measure this domain in infants, children and adolescents. OBJECTIVES To systematically evaluate the measurement properties of existing measurement instruments developed and/or validated for the measurement of QoL in infants, children and adolescents with eczema. METHODS A systematic literature search in PubMed and Embase, complemented by a thorough hand search of reference lists, retrieved studies on measurement properties of eczema QoL instruments for infants, children and adolescents. For all eligible studies, we judged the adequacy of the measurement properties and the methodological study quality with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Results from different studies were summarized in a best-evidence synthesis and formed the basis to assign four degrees of recommendation. RESULTS Seventeen articles, three of which were found by hand search, were included. These 17 articles reported on 24 instruments. No instrument can be recommended for use in all eczema trials because none fulfilled all required adequacy criteria. With adequate internal consistency, reliability and hypothesis testing, the U.S. version of the Childhood Atopic Dermatitis Impact Scale (CADIS), a proxy-reported instrument, has the potential to be recommended depending on the results of further validation studies. All other instruments, including all self-reported ones, lacked significant validation data. CONCLUSIONS Currently, no QoL instrument for infants, children and adolescents with eczema can be highly recommended. Future validation research should primarily focus on the CADIS, but also attempt to broaden the evidence base for the validity of self-reported instruments.
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Affiliation(s)
- D Heinl
- Department of Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - C A C Prinsen
- VU University Medical Center, Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, Amsterdam, the Netherlands
| | - T Sach
- Norwich Medical School, University of East Anglia, Norwich, U.K
| | - A M Drucker
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, U.S.A
| | - R Ofenloch
- Department of Clinical Social Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - C Flohr
- St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - C Apfelbacher
- Department of Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany.,Division of Public Health and Primary Care, Brighton and Sussex Medical School, Falmer, U.K
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Chalmers J, Simpson E, Apfelbacher C, Thomas K, Kobyletzki L, Schmitt J, Singh J, Svensson Å, Williams H, Abuabara K, Aoki V, Ardeleanu M, Awici‐Rasmussen M, Barbarot S, Berents T, Block J, Bragg A, Burton T, Bjerring Clemmensen K, Creswell‐Melville A, Dinesen M, Drucker A, Eckert L, Flohr C, Garg M, Gerbens L, Graff A, Hanifin J, Heinl D, Humphreys R, Ishii H, Kataoka Y, Leshem Y, Marquort B, Massuel M, Merhand S, Mizutani H, Murota H, Murrell D, Nakahara T, Nasr I, Nograles K, Ohya Y, Osterloh I, Pander J, Prinsen C, Purkins L, Ridd M, Sach T, Schuttelaar MA, Shindo S, Smirnova J, Sulzer A, Synnøve Gjerde E, Takaoka R, Vestby Talmo H, Tauber M, Torchet F, Volke A, Wahlgren C, Weidinger S, Weisshaar E, Wollenberg A, Yamaga K, Zhao C, Spuls P. Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative). Br J Dermatol 2016; 175:69-79. [DOI: 10.1111/bjd.14773] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 12/24/2022]
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Heinl D, Prinsen CAC, Deckert S, Chalmers JR, Drucker AM, Ofenloch R, Humphreys R, Sach T, Chamlin SL, Schmitt J, Apfelbacher C. Measurement properties of adult quality-of-life measurement instruments for eczema: a systematic review. Allergy 2016; 71:358-70. [PMID: 26564008 DOI: 10.1111/all.12806] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Harmonising Outcome Measures for Eczema (HOME) initiative has identified quality of life (QoL) as a core outcome domain to be evaluated in every eczema trial. It is unclear which of the existing QoL instruments is most appropriate for this domain. Thus, the aim of this review was to systematically assess the measurement properties of existing measurement instruments developed and/or validated for the measurement of QoL in adult eczema. METHODS We conducted a systematic literature search in PubMed and Embase identifying studies on measurement properties of adult eczema QoL instruments. For all eligible studies, we assessed the adequacy of the measurement properties and the methodological quality with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A best evidence synthesis summarizing findings from different studies was the basis to assign four degrees of recommendation (A-D). RESULTS A total of 15 articles reporting on 17 instruments were included. No instrument fulfilled the criteria for category A. Six instruments were placed in category B, meaning that they have the potential to be recommended depending on the results of further validation studies. Three instruments had poor adequacy in at least one required adequacy criterion and were therefore put in category C. The remaining eight instruments were minimally validated and were thus placed in category D. CONCLUSIONS Currently, no QoL instrument can be recommended for use in adult eczema. The Quality of Life Index for Atopic Dermatitis (QoLIAD) and the Dermatology Life Quality Index (DLQI) are recommended for further validation research.
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Affiliation(s)
- D. Heinl
- Medical Sociology; Department of Epidemiology and Preventive Medicine; University of Regensburg; Regensburg Germany
| | - C. A. C. Prinsen
- VU University Medical Center; Department of Epidemiology and Biostatistics; EMGO+ Institute for Health and Care Research; Amsterdam The Netherlands
| | - S. Deckert
- Centre for Evidence-based Healthcare; Medizinische Fakultät Carl Gustav Carus; TU Dresden; Dresden Germany
| | - J. R. Chalmers
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - A. M. Drucker
- Division of Dermatology; University Health Network; Toronto ON Canada
| | - R. Ofenloch
- Department of Clinical Social Medicine; University Hospital Heidelberg; Heidelberg Germany
| | | | - T. Sach
- Norwich Medical School; University of East Anglia; Norwich UK
| | - S. L. Chamlin
- Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - J. Schmitt
- Centre for Evidence-based Healthcare; Medizinische Fakultät Carl Gustav Carus; TU Dresden; Dresden Germany
| | - C. Apfelbacher
- Medical Sociology; Department of Epidemiology and Preventive Medicine; University of Regensburg; Regensburg Germany
- Division of Public Health and Primary Care; Brighton and Sussex Medical School; Falmer UK
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Watson M, Holland R, Ferguson J, Porteous T, Sach T, Cleland J, Bond C, Wright D. Managing minor ailments: Patients’ health-seeking behaviour and the role of community pharmacy. Res Social Adm Pharm 2014. [DOI: 10.1016/j.sapharm.2014.07.082] [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: 11/17/2022]
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Vass CD, Sahota O, Drummond A, Kendrick D, Grainge M, Gladman J, Sach T, Avis M, O'Halloran AM, King-Kallimanis B, Kenny RA, Kumar A, Carpenter H, Morris R, Iliffe S, Kendrick D, Bamford C, Parry S, Deary V, Finch T, Cronin H, Savva G, O'Regan C, Donoghue OA, Kearney P, Kenny RA, Sutton GM, Hussain R, Bhangu J, King-Kallimanis B, Cunningham C, Kenny RA, Duggan E, Finucane C, Cronin H, O'Regan C, Savva G, Loughman J, Kenny RA, Donoghue OA, Horgan F, Savva G, Cronin H, O'Regan C, Kenny RA, Shipway DJH, Shipway MDH, Shah M, Jenkin RP, Wang Q, Chua EC. Falls, fractures and trauma. Age Ageing 2013. [DOI: 10.1093/ageing/aft019] [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: 11/13/2022] Open
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Coupland CAC, Dhiman P, Barton G, Morriss R, Arthur A, Sach T, Hippisley-Cox J. A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database. Health Technol Assess 2011; 15:1-202, iii-iv. [PMID: 21810375 DOI: 10.3310/hta15280] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [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
OBJECTIVES The aim of this study was to establish the relative safety and balance of risks for antidepressant treatment in older people. The study objectives were to (1) determine relative and absolute risks of predefined adverse events in older people with depression, comparing classes of antidepressant drugs [tricyclic and related antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs) and other antidepressants] and commonly prescribed individual drugs with non-use of antidepressant drugs; (2) directly compare the risk of adverse events for SSRIs with TCAs; (3) determine associations with dose and duration of antidepressant medication; (4) describe patterns of antidepressant use in older people with depression; and (5) estimate costs of antidepressant medication and primary care visits. DESIGN A cohort study of patients aged 65 years and over diagnosed with depression. SETTING The study was based in 570 general practices in the UK supplying data to the QResearch database. PARTICIPANTS Patients diagnosed with a new episode of depression between the ages of 65 and 100 years, from 1 January 1996 to 31 December 2007. Participants were followed up until 31 December 2008. INTERVENTIONS The exposure of interest was treatment with antidepressant medication. Antidepressant drugs were grouped into the major classes and commonly prescribed individual drugs were identified. MAIN OUTCOME MEASURES There were 13 predefined outcome measures: all-cause mortality, sudden cardiac death, suicide, attempted suicide/self-harm, myocardial infarction, stroke/transient ischaemic attack (TIA), falls, fractures, upper gastrointestinal bleeding, epilepsy/seizures, road traffic accidents, adverse drug reactions and hyponatraemia. RESULTS In total, 60,746 patients were included in the study cohort. Of these, 54,038 (89.0%) received at least one prescription for an antidepressant during follow-up. The associations with the adverse outcomes were significantly different between the classes of antidepressant drugs for seven outcomes. SSRIs were associated with the highest adjusted hazard ratios (HRs) for falls [1.66, 95% confidence interval (CI) 1.58 to 1.73] and hyponatraemia (1.52, 95% CI 1.33 to 1.75), and the group of other antidepressants was associated with the highest HRs for all-cause mortality (1.66, 95% CI 1.56 to 1.77), attempted suicide/self-harm (5.16, 95% CI 3.90 to 6.83), stroke/TIA (1.37, 95% CI 1.22 to 1.55), fracture (1.63, 95% CI 1.45 to 1.83) and epilepsy/seizures (2.24, 95% CI 1.60 to 3.15) compared with when antidepressants were not being used. TCAs did not have the highest HR for any of the outcomes. There were also significantly different associations between the individual drugs for seven outcomes, with trazodone, mirtazapine and venlafaxine associated with the highest rates for several of these outcomes. The mean incremental cost (for all antidepressant prescriptions) ranged between £51.58 (amitriptyline) and £641.18 (venlafaxine) over the 5-year post-diagnosis period. CONCLUSIONS This study found associations between use of antidepressant drugs and a number of adverse events in older people. There was no evidence that SSRIs or drugs in the group of other antidepressants were associated with a reduced risk of any of the adverse outcomes compared with TCAs; however, they may be associated with an increased risk for certain outcomes. Among individual drugs trazodone, mirtazapine and venlafaxine were associated with the highest rates for some outcomes. Indication bias and residual confounding may explain some of the study findings. The risks of prescribing antidepressants need to be weighed against the potential benefits of these drugs. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C A C Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Logan PA, Coupland CAC, Gladman JRF, Sahota O, Stoner-Hobbs V, Robertson K, Tomlinson V, Ward M, Sach T, Avery AJ. Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial. BMJ 2010; 340:c2102. [PMID: 20460331 PMCID: PMC2868162 DOI: 10.1136/bmj.c2102] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate whether a service to prevent falls in the community would help reduce the rate of falls in older people who call an emergency ambulance when they fall but are not taken to hospital. DESIGN Randomised controlled trial. SETTING Community covered by four primary care trusts, England. PARTICIPANTS 204 adults aged more than 60 living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital. INTERVENTIONS Referral to community fall prevention services or standard medical and social care. MAIN OUTCOME MEASURES The primary outcome was the rate of falls over 12 months, ascertained from monthly diaries. Secondary outcomes were scores on the Barthel index, Nottingham extended activities of daily living scale, and falls efficacy scale at baseline and by postal questionnaire at 12 months. Analysis was by intention to treat. RESULTS 102 people were allocated to each group. 99 (97%) participants in the intervention group received the intervention. Falls diaries were analysed for 88.6 person years in the intervention group and 84.5 person years in the control group. The incidence rates of falls per year were 3.46 in the intervention group and 7.68 in the control group (incidence rate ratio 0.45, 95% confidence interval 0.35 to 0.58, P<0.001). The intervention group achieved higher scores on the Barthel index and Nottingham extended activities of daily living and lower scores on the falls efficacy scale (all P<0.05) at the 12 month follow-up. The number of times an emergency ambulance was called because of a fall was significantly different during follow-up (incidence rate ratio 0.60, 95% confidence interval 0.40 to 0.92, P=0.018). CONCLUSION A service to prevent falls in the community reduced the fall rate and improved clinical outcome in the high risk group of older people who call an emergency ambulance after a fall but are not taken to hospital. TRIAL REGISTRATION Current Controlled Trials ISRCTN67535605.
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Siriwardena AN, Fairchild P, Gibson S, Sach T, Dewey M. Investigation of the effect of a countywide protected learning time scheme on prescribing rates of ramipril: interrupted time series study. Fam Pract 2007; 24:26-33. [PMID: 17052988 DOI: 10.1093/fampra/cml051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Protected learning time (PLT) schemes have been set up in primary care across the UK. There is little published evidence of their effectiveness. OBJECTIVE To investigate the effect of a PLT intervention for general practice to increase prescribing of ramipril for prevention of cardiovascular outcomes. DESIGN Quasi-experimental, interrupted time series. SETTING Lincolnshire, UK. METHODS Prescribing data were analysed one year before and after the education for change in rate of increase of prescribing of ramipril, whether change in prescribing was related to postulated explanatory variables and to determine intervention costs. MAIN OUTCOME The primary outcome was the rate of change of ramipril (10 mg) prescription items 12 months after compared with before the educational intervention. Secondary outcomes included cost. RESULTS Ramipril prescribing at therapeutic dosage increased significantly (odds ratio 1.50, 95% CI 1.07-1.93) following education by 52,345 items (31,132 items at 10 mg) at a cost of pound 292k to pound 460k depending on formulation. This occurred despite a background of secular change. Most practices were represented by GPs, nurses or both during the education. Single-handed GPs were less likely to attend. Practices showed considerable variation in response to the educational intervention. The only predictor of whether practices increased in prescribing rate after the education was whether a practice nurse had undertaken specific diabetes training. Total list size, dispensing, training or single-handed status and GP attendance did not predict a change in prescribing. CONCLUSION PLT schemes can contribute to beneficial changes in prescribing across a large geographical area.
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Affiliation(s)
- A N Siriwardena
- School of Health and Social Care, University of Lincoln, Lincoln, UK.
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Sach T, O'Neill C, Whynes DK, Archbold SM, O'Donoghue GM. Evidence of improving cost-effectiveness of pediatric cochlear implantation. Int J Technol Assess Health Care 2003; 19:421-31. [PMID: 12862198 DOI: 10.1017/s0266462303000370] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To examine the cost-effectiveness of pediatric cochlear implantation over time. METHODS A prospective study based on ninety-eight children implanted between 1989 and 1996 at Nottingham's Paediatric Cochlear Implantation Programme, UK. The influence of outcomes and other variables on total costs was examined using multivariate regression analysis. RESULTS Having controlled for potential confounding variables, total cost was negatively related to year of implant and positively related to the number of hours of rehabilitation (p=.000). CONCLUSIONS Having controlled for outcomes (Categories of Auditory Performance and Speech Intelligibility Rating), the cost-effectiveness improved over time. This finding may be due to a learning curve and have policy implications.
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Affiliation(s)
- T Sach
- School of Economics, University of Nottingham, England.
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Abstract
OBJECTIVE To investigate variations in gains in auditory performance in children with cochlear implants. STUDY DESIGN The auditory performance of 98 children was measured with the Category of Auditory Performance survey instrument. All data were collected prospectively. Variables used to explain gain in Category of Auditory Performance were age at implantation, sex, the duration of "untreated" deafness, the year in which implantation occurred, health care inputs, and cause of hearing impairment. The data were analyzed by ordered probabilistic regression analysis. RESULTS Gain in Category of Auditory Performance was observed to be negatively related to age at implantation, the year in which implantation took place, and the number of medical consultations the child received. None of the other variables were significant determinants of gain in Category of Auditory Performance. CONCLUSION This study demonstrates the value of examining incremental gain from implantation rather than simply examining outcome levels. It was found that pediatric implantation is subject to diminishing returns. This suggests that further relaxation of entry criteria to implant programs should be undertaken only after careful consideration. The study also confirmed that age at implantation is an important determinant of outcomes. Greater gain in Category of Auditory Performance was experienced by those who underwent implantation at a younger age. This finding has implications for screening, as well as for purchasers and providers of implant services, highlighting the importance of responding in a timely fashion to identified need.
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Affiliation(s)
- Ciaran O'Neill
- School of Policy Studies, University of Ulster at Jordanstown, Newtownabbey, Northern Ireland, UK.
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17
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Abstract
The high rates of morbidity and mortality arising from preterm birth and low birth weight impose an immense burden on the health, education and social services, and on families. This paper presents the results of a systematic review of the published and unpublished evidence regarding the long-term economic implications of preterm birth and low birth weight for various sectors of the economy and for individuals. The paper highlights the variable methodological quality of the bulk of long-term economic studies of preterm birth and low birth weight and suggests ways in which these methodological limitations can be overcome. The paper reveals that preterm birth and low birth weight can result in substantial costs to the health sector following the infant's initial discharge from hospital. It can also impose a substantial burden on special education and social services, on families and carers of the infants and on society generally. In addition to the costs identified by the literature, preterm birth and low birth weight can have other long-term consequences that require evaluation from an economic perspective.
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Affiliation(s)
- S Petrou
- National Perinatal Epidemiology Unit, Institute of Health Sciences, University of Oxford, Oxford, UK.
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