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    ABSTRACT: To examine the process of case finding for depression in people with diabetes and coronary heart disease within the context of a pay-for-performance scheme.
    BMJ Open 08/2014; 4(8):e005146. DOI:10.1136/bmjopen-2014-005146
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    ABSTRACT: To determine the optimal databases to search for studies of faith-sensitive interventions for treating depression. We examined 23 health, social science, religious, and grey literature databases searched for an evidence synthesis. Databases were prioritized by yield of (1) search results, (2) potentially relevant references identified during screening, (3) included references contained in the synthesis, and (4) included references that were available in the database. We assessed the impact of databases beyond MEDLINE, EMBASE, and PsycINFO by their ability to supply studies identifying new themes and issues. We identified pragmatic workload factors that influence database selection. PsycINFO was the best performing database within all priority lists. ArabPsyNet, CINAHL, Dissertations and Theses, EMBASE, Global Health, Health Management Information Consortium, MEDLINE, PsycINFO, and Sociological Abstracts were essential for our searches to retrieve the included references. Citation tracking activities and the personal library of one of the research teams made significant contributions of unique, relevant references. Religion studies databases (Am Theo Lib Assoc, FRANCIS) did not provide unique, relevant references. Literature searches for reviews and evidence syntheses of religion and health studies should include social science, grey literature, non-Western databases, personal libraries, and citation tracking activities.
    Journal of clinical epidemiology 04/2014; 67(7). DOI:10.1016/j.jclinepi.2014.02.017
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    ABSTRACT: Preventable sight loss is one of the Public Health Outcome Indicators in England. Despite availability of NHS-funded eye examinations, many people do not take up their entitlement. This paper explores older adults understanding of eye health and the purpose of eye examinations and the reasons why they do or do not attend for eye examinations. The aim is to provide evidence to inform policy on increasing uptake of eye examinations among older people who have increased risk of preventable sight loss. 10 focus-group meetings were held with people living in deprived areas of Leeds, recruited via community groups and neighbourhood networks. Focus groups were transcribed and a thematic analysis approach was used. The majority of participants were aged over 60, wore spectacles, and had regular eye examinations. Most were eligible for a NHS-funded eye examination. There was poor knowledge about eye disease and the purpose of different elements of the eye examination. Participants felt very vulnerable about getting the tests 'wrong' and looking foolish. Wearing of spectacles was associated with appearing old and frail. Many did not trust the veracity of optometrists, and perceived opticians to be expensive places, where it was difficult to control spending. Many had experienced 'hard sell' and opaque pricing. Most, but not all, were happy with the optometric services received. Participants indicated a preference for utilising a local optometrist located alongside other familiar health care services. Not-for-profit services co-located with other public services are needed to address concerns about cost of spectacles, lack of trust in optometrists, and poor access to eye examinations in local settings. It will also be important to raise public understanding about the purpose of eye examinations in terms of other causes of preventable sight loss and not just refractive error and need for spectacles.
    Ophthalmic and Physiological Optics 01/2014; 34(1):38-45. DOI:10.1111/opo.12100
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    ABSTRACT: Abstract Background: Patients with unresectable, metastatic colorectal cancer with wild type Kirsten ras mutational status are eligible for sequentialtreatments which include monoclonal antibodies as first line (1L), second line (2L) or third line (3L) regimens. Objective: To compare the economic outcomes of different sequences which include monoclonal antibodies for the treatment of unresectable metastatic colorectal cancer. Methods: Individual drug regimens for 1L, 2L and 3L treatments were compiled according to the clinical studies in the Summary of Product Characteristics for monoclonal antibodies. They were combined into plausible treatment sequences. Health outcomes were approximated using additive median PFS benefit, and economic outcomes were calculated with a treatment sequencing costing tool. Limitations of the analysis include the clinical trial data sources, cost assumptions and additive PFS methodology. Results: Seventeen sequences were evaluated. Results of the analysis show that sequences including 1L anti-EGFRs generally have relatively low to medium health outcomes at the highest comparative sequence costs compared to sequences including 2L anti-EGFRs, which have lower health outcomes at the lowest cost. Sequences including 3L anti-EGFRs (sequential bevazicumab-based 1L and 2L) have the highest health outcomes with potential cost savings of €5,972 - €11,676 if replacing 2L anti-EGFRs or an additional cost of €5,909 - €12,708 if replacing 1L anti-EGFR regimens. Conclusion: Clinical sequences consisting of 1L and 2L line bevacizumab followed by 3L anti-EGFR potentially yield the greatest health outcomes associated with a reasonable trade-off in additional cost when replacing 1L anti-EGFRs and are potentially cost-saving if replacing 2L anti-EGFRs, per patient per lifetime. To maximize health outcomes, optimal sequences include anti -EGFRs as 3L regimen, with an approximately equivalent trade-off in costs between the most costly (anti-EGFR 2L) and least costly (anti-EGFR 1L) sequences.
    Journal of Medical Economics 11/2013; DOI:10.3111/13696998.2013.864973
  • Age and Ageing 10/2013; 42(6). DOI:10.1093/ageing/aft147
  • BMJ (online) 09/2013; 347:f5740. DOI:10.1136/bmj.f5740
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    ABSTRACT: Robotic assistance has the potential to compensate for the limitations inherent in standard laparoscopic surgery. The daVinci® surgical system remains the only currently available commercial robotic system. It has found popularity in rectal cancer surgery where its application has consistently been shown to reduce the need to convert to open surgery. With this exception, the technological advances of the robotic system have not so far translated into any reproducible patient benefit. The first part of this manuscript presents an overview of the current daVinci® platform, its applications, the evidence base and future developments in colorectal surgery. The second part of the manuscript looks at other robot systems in development and the different innovations and strategies taken to advance minimally invasive surgery.The English full-text version of this article is available at SpringerLink (under supplemental).
    Der Chirurg 08/2013; 84(8):635-42. DOI:10.1007/s00104-013-2499-7
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    ABSTRACT: The rise in child obesity poses a serious public health challenge. It has been argued that efforts may be best targeted towards prevention, but there is a relative dearth of initiatives targeting infants. Earlier evaluation of the impact of HENRY (Health Exercise Nutrition for the Really Young) has shown an improvement in the way practitioners work with families and a positive impact upon their work setting and personal life. This study of the impact on families found that parents participating in HENRY groups report a healthier family lifestyle, which was sustained at follow-up. Participants reported increased parental self-efficacy around lifestyle change and parenting generally. They also reported increased consumption of fruit and vegetables; positive changes in mealtime behaviours and reduced screen time. One-quarter of children in England are overweight/obese at school entry. We investigated the impact of a programme designed to provide parents of infants and preschool children with the skills required for a healthier family lifestyle. A cohort of families was followed across the 8-week HENRY (Health Exercise Nutrition for the Really Young) parent course at nine locations in England. Seventy-seven parents enrolled on the course, of which 71 agreed to complete questionnaires addressing eating behaviours, dietary intake and parental self-efficacy. Pre- and post-course data was available from 60 (84.5%) parents (8-week follow-up data from 58 parents) and was analysed using repeated measures analyses. Significant changes were observed, with most sustained at follow-up. Parents reported increased self-efficacy and ability to encourage good behaviour (P < 0.001). Increased consumption of fruits and vegetables was reported in both children and adults, together with reduced consumption of sweets, cakes and fizzy drinks in adults (all P < 0.01). There were also positive changes in eating behaviours (e.g. frequency of family mealtimes and eating while watching television or in response to negative emotion [P < 0.01] ) and reduced screen time in adults (P < 0.001). The results build upon earlier evaluation, indicating that the HENRY intervention has a beneficial impact upon the families of infants and preschool children. Furthermore, the findings suggest that positive changes inspired by the programme can be maintained beyond its completion. Such changes may serve to protect against later obesity.
    Pediatric Obesity 07/2013; 9(5). DOI:10.1111/j.2047-6310.2013.00183.x
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    ABSTRACT: The views of people with inherited retinal disease are important to help develop health policy and plan services. This study aimed to record levels of understanding of and attitudes to genetic testing for inherited retinal disease, and views on the availability of testing. Telephone questionnaires comprising quantitative and qualitative items were completed with adults with inherited retinal disease. Participants were recruited via postal invitation (response rate 48%), approach at clinic or newsletters of relevant charitable organisations. Questionnaires were completed with 200 participants. Responses indicated that participants' perceived understanding of genetic testing for inherited retinal disease was variable. The majority (90%) considered testing to be good/very good and would be likely to undergo genetic testing (90%) if offered. Most supported the provision of diagnostic (97%) and predictive (92%) testing, but support was less strong for testing as part of reproductive planning. Most (87%) agreed with the statement that testing should be offered only after the individual has received genetic counselling from a professional. Subgroup analyses revealed differences associated with participant age, gender, education level and ethnicity (p<0.02). Participants reported a range of perceived benefits (eg, family planning, access to treatment) and risks (eg, impact upon family relationships, emotional consequences). Adults with inherited retinal disease strongly support the provision of publicly funded genetic testing. Support was stronger for diagnostic and predictive testing than for testing as part of reproductive planning.
    The British journal of ophthalmology 06/2013; 97(9). DOI:10.1136/bjophthalmol-2013-303434
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    ABSTRACT: This article reports the development of natural history and active treatment benchmarks for psychological treatments of chronic pain. The benchmarks were derived from randomized controlled trials reported in a published meta-analysis (Eccleston C, et al. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Review, 2009). In two preliminary studies we surveyed small samples of active clinicians working in UK pain management programs. Study1 assessed the fit between routine clinical treatment and the selected randomized controlled trials. In Study 2 Delphi methodology was used to determine a set of outcome domains to be used in the development of benchmarks. In Study 3 we extracted data from a set of randomized controlled trials where both pre-treatment and post-treatment data were reported. Measures were allocated to one of 5 outcome domains (cognitive coping and appraisal, pain experience, pain behaviour, emotional functioning and physical functioning). Pre-treatment to post-treatment effect sizes (Cohen's d) were computed and where necessary aggregated within trial so that each trial contributed a single estimate to outcome domain. Effect size (ES) benchmarks were computed for all trials and those trials with an explicit cognitive behavior therapy protocol. In no case did the ES estimates for the untreated control deviate from 0. The average ES across outcome domains for the treatment arms was approximately 0.35. These benchmarks may be used to assess the effectiveness of routine clinical treatments for chronic pain. The application of these data and the limitations of the study are discussed.
    Pain 06/2013; 154(10). DOI:10.1016/j.pain.2013.06.033
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