1
|
Sebastian S, Dhar A, Baddeley R, Donnelly L, Haddock R, Arasaradnam R, Coulter A, Disney BR, Griffiths H, Healey C, Hillson R, Steinbach I, Marshall S, Rajendran A, Rochford A, Thomas-Gibson S, Siddhi S, Stableforth W, Wesley E, Brett B, Morris AJ, Douds A, Coleman MG, Veitch AM, Hayee B. Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy. Gut 2023; 72:12-26. [PMID: 36229172 PMCID: PMC9763195 DOI: 10.1136/gutjnl-2022-328460] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 12/08/2022]
Abstract
GI endoscopy is highly resource-intensive with a significant contribution to greenhouse gas (GHG) emissions and waste generation. Sustainable endoscopy in the context of climate change is now the focus of mainstream discussions between endoscopy providers, units and professional societies. In addition to broader global challenges, there are some specific measures relevant to endoscopy units and their practices, which could significantly reduce environmental impact. Awareness of these issues and guidance on practical interventions to mitigate the carbon footprint of GI endoscopy are lacking. In this consensus, we discuss practical measures to reduce the impact of endoscopy on the environment applicable to endoscopy units and practitioners. Adoption of these measures will facilitate and promote new practices and the evolution of a more sustainable specialty.
Collapse
Affiliation(s)
- Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, East Riding of Yorkshire, UK .,Clinical Sciences Centre, Hull York Medical School, Hull, UK
| | - Anjan Dhar
- Department of Gastroenterology, Darlington Memorial Hospital, Darlington, UK,School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Robin Baddeley
- Institute for Therapeutic Endoscopy, King's College Hospital, London, UK,Department of Gastroenterology, St Mark's National Bowel Hospital & Academic Institute, London, UK
| | - Leigh Donnelly
- Department of Gastroenterology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Rosemary Haddock
- Department of Gastroenterology, Ninewells Hospital & Medical School, Dundee, UK
| | - Ramesh Arasaradnam
- Applied Biological and Experimental Sciences, Coventry University, Coventry, UK,Department of Gastroenterology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Archibald Coulter
- Department of Gastroenterology, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Benjamin Robert Disney
- Department of Gastroenterology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Helen Griffiths
- Department of Gastroenterology, Brecon War Memorial Hospital, Brecon, UK
| | - Christopher Healey
- Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, UK
| | | | | | - Sarah Marshall
- Bowel Cancer Screening & Endoscopy, London North West University Healthcare NHS Trust, Harrow, UK,Joint Advisory Group on GI Endoscopy, London, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Andrew Rochford
- Department of Gastroenterology, Royal Free Hospitals, London, UK
| | - Siwan Thomas-Gibson
- Department of Gastroenterology, St Mark's National Bowel Hospital & Academic Institute, London, UK
| | - Sandeep Siddhi
- Department of Gastroenterology, NHS Grampian, Aberdeen, UK
| | - William Stableforth
- Departments of Gastroenterology & Endoscopy, Royal Cornwall Hospital, Truro, UK
| | - Emma Wesley
- Departments of Gastroenterology & Endoscopy, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Bernard Brett
- Department of Gastroenterology, Norfolk and Norwich Hospitals NHS Trust, Norwich, UK
| | | | - Andrew Douds
- Department of Gastroenterology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Mark Giles Coleman
- Joint Advisory Group on GI Endoscopy, London, UK,Department of Colorectal Surgery, Plymouth University Hospitals Trust, Plymouth, UK
| | - Andrew M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Bu'Hussain Hayee
- King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
Chanchlani N, Lin S, Auth MK, Lee CL, Robbins H, Looi S, Murugesan SV, Riley T, Preston C, Stephenson S, Cardozo W, Sonwalkar SA, Allah‐Ditta M, Mansfield L, Durai D, Baker M, London I, London E, Gupta S, Di Mambro A, Murphy A, Gaynor E, Jones KDJ, Claridge A, Sebastian S, Ramachandran S, Selinger CP, Borg‐Bartolo SP, Knight P, Sprakes MB, Burton J, Kane P, Lupton S, Fletcher A, Gaya DR, Colbert R, Seenan JP, MacDonald J, Lynch L, McLachlan I, Shields S, Hansen R, Gervais L, Jere M, Akhtar M, Black K, Henderson P, Russell RK, Lees CW, Derikx LAAP, Lockett M, Betteridge F, De Silva A, Hussenbux A, Beckly J, Bendall O, Hart JW, Thomas A, Hamilton B, Gordon C, Chee D, McDonald TJ, Nice R, Parkinson M, Gardner‐Thorpe H, Butterworth JR, Javed A, Al‐Shakhshir S, Yadagiri R, Maher S, Pollok RCG, Ng T, Appiahene P, Donovan F, Lok J, Chandy R, Jagdish R, Baig D, Mahmood Z, Marsh L, Moss A, Abdulgader A, Kitchin A, Walker GJ, George B, Lim Y, Gulliver J, Bloom S, Theaker H, Carlson S, Cummings JRF, Livingstone R, Beale A, Carter JO, Bell A, Coulter A, Snook J, Stone H, Kennedy NA, Goodhand JR, Ahmad T. Implications for sequencing of biologic therapy and choice of second anti-TNF in patients with inflammatory bowel disease: results from the IMmunogenicity to Second Anti-TNF therapy (IMSAT) therapeutic drug monitoring study. Aliment Pharmacol Ther 2022; 56:1250-1263. [PMID: 36039036 PMCID: PMC9804266 DOI: 10.1111/apt.17170] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Anti-drug antibodies are associated with treatment failure to anti-TNF agents in patients with inflammatory bowel disease (IBD). AIM To assess whether immunogenicity to a patient's first anti-TNF agent would be associated with immunogenicity to the second, irrespective of drug sequence METHODS: We conducted a UK-wide, multicentre, retrospective cohort study to report rates of immunogenicity and treatment failure of second anti-TNF therapies in 1058 patients with IBD who underwent therapeutic drug monitoring for both infliximab and adalimumab. The primary outcome was immunogenicity to the second anti-TNF agent, defined at any timepoint as an anti-TNF antibody concentration ≥9 AU/ml for infliximab and ≥6 AU/ml for adalimumab. RESULTS In patients treated with infliximab and then adalimumab, those who developed antibodies to infliximab were more likely to develop antibodies to adalimumab, than patients who did not develop antibodies to infliximab (OR 1.99, 95%CI 1.27-3.20, p = 0.002). Similarly, in patients treated with adalimumab and then infliximab, immunogenicity to adalimumab was associated with subsequent immunogenicity to infliximab (OR 2.63, 95%CI 1.46-4.80, p < 0.001). For each 10-fold increase in anti-infliximab and anti-adalimumab antibody concentration, the odds of subsequently developing antibodies to adalimumab and infliximab increased by 1.73 (95% CI 1.38-2.17, p < 0.001) and 1.99 (95%CI 1.34-2.99, p < 0.001), respectively. Patients who developed immunogenicity with undetectable drug levels to infliximab were more likely to develop immunogenicity with undetectable drug levels to adalimumab (OR 2.37, 95% CI 1.39-4.19, p < 0.001). Commencing an immunomodulator at the time of switching to the second anti-TNF was associated with improved drug persistence in patients with immunogenic, but not pharmacodynamic failure. CONCLUSION Irrespective of drug sequence, immunogenicity to the first anti-TNF agent was associated with immunogenicity to the second, which was mitigated by the introduction of an immunomodulator in patients with immunogenic, but not pharmacodynamic treatment failure.
Collapse
|
3
|
Puebla Fortier J, Coulter A. Creative cross-sectoral collaboration: a conceptual framework of factors influencing partnerships for arts, health and wellbeing. Public Health 2021; 196:146-149. [PMID: 34216813 DOI: 10.1016/j.puhe.2021.05.017] [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: 12/01/2020] [Revised: 04/08/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The objective of this study was to investigate the factors impacting cross-sectoral collaboration in arts, health and wellbeing programme, policy and strategy development in South West England. STUDY DESIGN The study used a participatory action research approach and qualitative methods in the context of a broader effort to develop a regional arts, health and wellbeing strategy. METHODS Data collection methods included participant observation, semi-structured interviews, a focus group and feedback collected through collaborative online discussion documents. Data were coded using qualitative data analysis software and analysed using thematic analysis. Data were used inductively to develop the conceptual framework of key factors influencing cross-sectoral collaboration in arts, health and wellbeing. RESULTS Seven key factors that affect cross-sectoral collaboration for arts, health and wellbeing activities were derived from the data and analysis: value and legitimacy, relationships, policy and system complexity, power, capacity, resources and alignment. A conceptual framework shows how these factors relate to each other in multiple configurations and shape cross-sectoral collaborations. CONCLUSIONS There are increasing opportunities for organisations to partner on arts, health and wellbeing activities. This study highlights key factors influencing the ability to collaborate across sectors and to align with local and national policy agendas. The proposed conceptual framework offers a way to think holistically about how to design for and manage these collaborations.
Collapse
Affiliation(s)
- J Puebla Fortier
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - A Coulter
- Arts & Health South West, PO Box 929, Oxford, OX1 9RU, UK
| |
Collapse
|
4
|
Affiliation(s)
| | | | - B Moulton
- Informed Medical Decisions Foundation, Boston, MA, US
| |
Collapse
|
5
|
von Vopelius-Feldt J, Coulter A, Benger J. The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest. Resuscitation 2015; 96:290-5. [PMID: 26375661 DOI: 10.1016/j.resuscitation.2015.08.020] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/26/2015] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Abstract
AIM To assess the impact of a pre-hospital critical care team (CCT) on survival from out-of-hospital cardiac arrest (OHCA). METHODS We undertook a retrospective observational study, comparing OHCA patients attended by advanced life support (ALS) paramedics with OHCA patients attended by ALS paramedics and a CCT between April 2011 and April 2013 in a single ambulance service in Southwest England. We used multiple logistic regression to control for an anticipated imbalance of prognostic factors between the groups. The primary outcome was survival to hospital discharge. All data were collected independently of the research. RESULTS 1851 cases of OHCA were included in the analysis, of which 1686 received ALS paramedic treatment and 165 were attended by both ALS paramedics and a CCT. Unadjusted rates of survival to hospital discharge were significantly higher in the CCT group, compared to the ALS paramedic group (15.8% and 6.5%, respectively, p<0.001). After adjustment using multiple logistic regression, the effect of CCT treatment was no longer statistically significant (OR 1.54, 95% CI 0.89-2.67, p=0.13). Subgroup analysis of OHCA with first monitored rhythm of ventricular fibrillation or pulseless ventricular tachycardia showed similar results. CONCLUSION Pre-hospital critical care for OHCA was not associated with significantly improved rates of survival to hospital discharge. These results are in keeping with previously published studies. Further research with a larger sample size is required to determine whether CCTs can improve outcome in OHCA.
Collapse
Affiliation(s)
- Johannes von Vopelius-Feldt
- Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom.
| | - Archibald Coulter
- North Bristol NHS Trust, Southmead Road, BS10 5NB Bristol, United Kingdom
| | - Jonathan Benger
- Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom; University of the West of England, Bristol, United Kingdom
| |
Collapse
|
6
|
Coulter A, Dodson T, Keith D, Lahey E, August M. Prognostic Factors Associated With Arthroscopy Success in the Treatment of Temporomandibular Joint Internal Derangement. J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.joms.2013.06.175] [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: 10/26/2022]
|
7
|
|
8
|
Nanka O, Krejci E, Pesevski Z, Sedmera D, Smart N, Rossdeutsch A, Dube KN, Riegler J, Price AN, Taylor A, Muthurangu V, Turner M, Lythgoe MF, Riley PR, Kryvorot S, Vladimirskaya T, Shved I, Schwarzl M, Seiler S, Huber S, Steendijk P, Maechler H, Truschnig-Wilders M, Pieske B, Post H, Caprio C, Baldini A, Chiavacci E, Dolfi L, Verduci L, Meghini F, Cremisi F, Pitto L, Kuan TC, Chen MC, Yang TH, Wu WT, Lin CS, Rai H, Kumar S, Sharma AK, Mastana S, Kapoor A, Pandey CM, Agrawal S, Sinha N, Orlowska-Baranowska EH, Placha G, Gora J, Baranowski R, Abramczuk E, Hryniewiecki T, Gaciong Z, Verschuren JJW, Wessels JAM, Trompet S, Stott DJ, Sattar N, Buckley B, Guchelaar HJ, Jukema JW, Gharanei M, Hussain A, Mee CJ, Maddock HL, Wijnen WJ, Van Den Oever S, Van Der Made I, Hiller M, Tijsen AJ, Pinto YM, Creemers EE, Nikulina SUY, Chernova A, Petry A, Rzymski T, Kracun D, Riess F, Pike L, Harris AL, Gorlach A, Katare R, Oikawa A, Riu F, Beltrami AP, Cesseli D, Emanueli C, Madeddu P, Zaglia T, Milan G, Franzoso M, Pesce P, Sarais C, Sandri M, Mongillo M, Butler TJ, Seymour AML, Ashford D, Jaffre F, Bussen M, Ferrara N, Koch WJ, Leosco D, Akhmedov A, Klingenberg R, Brokopp C, Hof D, Zoller S, Corti R, Gay S, Flohrschutz I, Von Eckardstein A, Hoerstrup SP, Luescher TF, Heijman J, Zaza A, Johnson DM, Rudy Y, Peeters RLM, Volders PGA, Westra RL, Martin GR, Morais CAS, Oliveira SHV, Brandao FC, Gomes IF, Lima LM, Fujita S, Okamoto R, Taniguchi M, Konishi K, Goto I, Engelhardt S, Sugimoto K, Nakamura M, Shiraki K, Buechler C, Ito M, Kararigas G, Nguyen BT, Jarry H, Regitz-Zagrosek V, Van Bilsen M, Daniels A, Munts C, Janssen BJA, Van Der Vusse GJ, Van Nieuwenhoven FA, Montalvo C, Villar AV, Merino D, Garcia R, Llano M, Ares M, Hurle MA, Nistal JF, Dembinska-Kiec A, Beata Kiec-Wilk BKW, Anna Polus AP, Urszula Czech UC, Tatiana Konovaleva TK, Gerd Schmitz GS, Bertrand L, Balteau M, Timmermans A, Viollet B, Sakamoto K, Feron O, Horman S, Vanoverschelde JL, Beauloye C, De Meester C, Martinez E, Martin R, Miana M, Jurado R, Gomez-Hurtado N, Bartolome MV, San Roman JA, Lahera V, Nieto ML, Cachofeiro V, Rochais F, Sturny R, Mesbah K, Miquerol L, Kelly RG, Messaoudi S, Gravez B, Tarjus A, Pelloux V, Samuel JL, Delcayre C, Launay JM, Clement K, Farman N, Jaisser F, Hadyanto L, Castellani C, Vescovo G, Ravara B, Tavano R, Pozzobon M, De Coppi P, Papini E, Vettor R, Thiene G, Angelini A, Meloni M, Caporali A, Cesselli D, Fortunato O, Avolio E, Madeddu P, Beltrami AP, Emanueli C, Schindler R, Simrick S, Brand T, Dube KN, Riley PR, Smart NS, Oikawa A, Katare R, Herman A, Emanueli C, Madeddu P, Roura Ferrer S, Rodriguez Bago J, Soler-Botija C, Pujal JM, Galvez-Monton C, Prat-Vidal C, Llucia-Valldeperas A, Blanco J, Bayes-Genis A, Foldes G, Maxime M, Ali NN, Schneider MD, Harding SE, Reni C, Mangialardi G, Caporali A, Meloni M, Emanueli C, Madeddu P, De Pauw A, Sekkali B, Friart A, Ding H, Graffeuil A, Catalucci D, Balligand JL, Azibani F, Tournoux F, Schlossarek S, Polidano E, Fazal L, Merval R, Carrier L, Chatziantoniou C, Samuel JL, Delcayre C, Buyandelger B, Linke W, Zou P, Kostin S, Ku C, Felkin L, Birks E, Barton P, Sattler M, Knoell R, Schroder K, Benkhoff S, Shimokawa H, Grisk O, Brandes RP, Parepa IR, Mazilu L, Suceveanu AI, Suceveanu A, Rusali L, Cojocaru L, Matei L, Toringhibel M, Craiu E, Pires AL, Pinho M, Pinho S, Sena C, Seica R, Leite-Moreira A, Zaglia T, Milan G, Franzoso M, Dabroi F, Pesce P, Schiaffino S, Sandri M, Mongillo M, Kiseleva E, Krukov N, Nikitin O, Ardatova L, Mourouzis I, Pantos C, Kokkinos AD, Cokkinos DV, Scoditti E, Massaro M, Carluccio MA, Pellegrino M, Calabriso N, Gastaldelli A, Storelli C, De Caterina R, Lindner D, Zietsch C, Schultheiss HP, Tschope C, Westermann D, Everaert BR, Nijenhuis VJ, Reith FCM, Hoymans VY, Timmermans JP, Vrints CJ, Simova I, Mateev H, Katova T, Haralanov L, Dimitrov N, Mironov N, Golitsyn SP, Sokolov SF, Yuricheva YUA, Maikov EB, Shlevkov NB, Rosenstraukh LV, Chazov EI, Radosinska J, Knezl V, Benova T, Slezak J, Urban L, Tribulova N, Virag L, Kristof A, Kohajda ZS, Szel T, Husti Z, Baczko I, Jost N, Varro A, Sarusi A, Farkas AS, Orosz SZ, Forster T, Varro A, Farkas A, Zakhrabova-Zwiauer OM, Hardziyenka M, Nieuwland R, Tan HL, Raaijmakers AJA, Bourgonje VJA, Kok GJM, Van Veen AAB, Anderson ME, Vos MA, Bierhuizen MFA, Benes J, Sebestova B, Sedmera D, Ghouri IA, Kemi OJ, Kelly A, Burton FL, Smith GL, Bourgonje VJA, Vos MA, Ozdemir S, Acsai K, Doisne N, Van Der Nagel R, Beekman HDM, Van Veen TAB, Sipido KR, Antoons G, Harmer SC, Mohal JS, Kemp D, Tinker A, Beech D, Burley DS, Cox CD, Wann KT, Baxter GF, Wilders R, Verkerk A, Fragkiadaki P, Germanakis G, Tsarouchas K, Tsitsimpikou C, Tsardi M, George D, Tsatsakis A, Rodrigues P, Barros C, Najmi AK, Khan V, Akhtar M, Pillai KK, Mujeeb M, Aqil M, Bayliss CR, Messer AE, Leung MC, Ward D, Van Der Velden J, Poggesi C, Redwood CS, Marston S, Vite A, Gandjbakhch E, Gary F, Fressart V, Leprince P, Fontaine G, Komajda M, Charron P, Villard E, Falcao-Pires I, Gavina C, Hamdani N, Van Der Velden J, Stienen GJM, Niessens HWM, Leite-Moreira AF, Paulus WJ, Messer AE, Marston S, Memo M, Leung MC, Bayliss CR, Memo M, Messer AE, Marston SB, Vafiadaki E, Qian J, Arvanitis DA, Sanoudou D, Kranias EG, Elmstedt N, Lind B, Ferm-Widlund K, Westgren M, Brodin LA, Mansfield C, West T, Ferenczi M, Wijnker PJM, Foster DB, Coulter A, Frazier A, Murphy AM, Stienen GJM, Van Der Velden J, Shah M, Sikkel MB, Desplantez T, Collins TP, O' Gara P, Harding SE, Lyon AR, Macleod KT, Ottesen AH, Louch WE, Carlson C, Landsverk OJB, Stridsberg M, Sjaastad I, Oie E, Omland T, Christensen G, Rosjo H, Cartledge J, Clark LA, Ibrahim M, Siedlecka U, Navaratnarajah M, Yacoub MH, Camelliti P, Terracciano CM, Chester A, Gonzalez-Tendero A, Torre I, Garcia-Garcia F, Dopazo J, Gratacos E, Taylor D, Bhandari S, Seymour AM, Fliegner D, Jost J, Bugger H, Ventura-Clapier R, Regitz-Zagrosek V, Carpi A, Campesan M, Canton M, Menabo R, Pelicci PG, Giorgio M, Di Lisa F, Hancock M, Venturini A, Al-Shanti N, Stewart C, Ascione R, Angelini G, Suleiman MS, Kravchuk E, Grineva E, Galagudza M, Kostareva A, Bairamov A, Krychtiuk KA, Watzke L, Kaun C, Demyanets S, Pisoni J, Kastl SP, Huber K, Maurer G, Wojta J, Speidl WS, Varga ZV, Farago N, Zvara A, Kocsis GF, Pipicz M, Csonka C, Csont T, Puskas GL, Ferdinandy P, Klevstigova M, Silhavy J, Manakov D, Papousek F, Novotny J, Pravenec M, Kolar F, Novakova O, Novak F, Neckar J, Barallobre-Barreiro J, Didangelos A, Yin X, Fernandez-Caggiano M, Drozdov I, Willeit P, Domenech N, Mayr M, Lemoine S, Allouche S, Coulbault L, Galera P, Gerard JL, Hanouz JL, Suveren E, Whiteman M, Baxter GF, Studneva IM, Pisarenko O, Shulzhenko V, Serebryakova L, Tskitishvili O, Timoshin A, Fauconnier J, Meli AC, Thireau J, Roberge S, Lompre AM, Jacotot E, Marks AM, Lacampagne A, Dietel B, Altendorf R, Daniel WG, Kollmar R, Garlichs CD, Verduci L, Parente V, Balasso S, Pompilio G, Colombo G, Milano G, Squadroni L, Cotelli F, Pozzoli O, Capogrossi MC, Ajiro Y, Saegusa N, Iwade K, Giles WR, Stafforini DM, Spitzer KW, Sirohi R, Candilio L, Babu G, Roberts N, Lawrence D, Sheikh A, Kolvekar S, Yap J, Hausenloy DJ, Yellon DM, Aslam M, Rohrbach S, Schlueter KD, Piper HM, Noll T, Guenduez D, Malinova L, Ryabukho VP, Lyakin DV, Denisova TP, Montoro-Garcia S, Shantsila E, Lip GYH, Kalaska B, Sokolowska E, Kaminski K, Szczubialka K, Kramkowski K, Mogielnicki A, Nowakowska M, Buczko W, Stancheva N, Mekenyan E, Gospodinov K, Tisheva S, Darago A, Rutkai I, Kalasz J, Czikora A, Orosz P, Bjornson HD, Edes I, Papp Z, Toth A, Riches K, Warburton P, O'regan DJ, Ball SG, Turner NA, Wood IC, Porter KE, Kogaki S, Ishida H, Nawa N, Takahashi K, Baden H, Ichimori H, Uchikawa T, Mihara S, Miura K, Ozono K, Lugano R, Padro T, Garcia-Arguinzonis M, Badimon L, Yin X, Ferraro F, Viner R, Ho J, Cutler D, Mayr M, Matchkov V, Aalkjaer C, Mangialardi G, Katare R, Oikawa A, Madeddu P, Krijnen PAJ, Hahn NE, Kholova I, Sipkens JA, Van Alphen FP, Simsek S, Schalkwijk CG, Van Buul JD, Van Hinsbergh VWM, Niessen HWM, Simova I, Katova T, Haralanov L, Caro CG, Seneviratne A, Monaco C, Hou D, Singh J, Gilson P, Burke MG, Heraty KB, Krams R, Coppola G, Albrecht K, Schgoer W, Wiedemann D, Bonaros N, Steger C, Theurl M, Stanzl U, Kirchmair R, Amadesi S, Fortunato O, Reni C, Katare R, Meloni M, Ascione R, Spinetti G, Cangiano E, Valgimigli M, Madeddu P, Caporali A, Meloni M, Miller AM, Cardinali A, Vierlinger K, Fortunato O, Spinetti G, Madeddu P, Emanueli C, Pagano G, Liccardo D, Zincarelli C, Femminella GD, Lymperopoulos A, De Lucia C, Koch WJ, Leosco D, Rengo G, Hinkel R, Husada W, Trenkwalder T, Di Q, Lee S, Petersen B, Bock-Marquette I, Niemann H, Di Maio M, Kupatt C, Nourian M, Yassin Z, Kelishadi R, Nourian M, Kelishadi R, Yassin Z, Memarian SH, Heidari A, Leuner A, Poitz DM, Brunssen C, Ravens U, Strasser RH, Morawietz H, Vogt F, Grahl A, Flege C, Marx N, Borinski M, De Geest B, Jacobs F, Muthuramu I, Gordts SC, Van Craeyveld E, Herijgers P, Weinert S, Poitz DM, Medunjanin S, Herold J, Schmeisser A, Strasser RH, Braun-Dullaeus RC, Wagner AH, Moeller K, Adolph O, Schwarz M, Schwale C, Bruehl C, Nobiling R, Wieland T, Schneider SW, Hecker M, Cross A, Strom A, Cole J, Goddard M, Hultgardh-Nilsson A, Nilsson J, Mauri C, Monaco C, Mitkovskaya NP, Kurak TA, Oganova EG, Shkrebneva EI, Kot ZHN, Statkevich TV, Molica F, Burger F, Matter CM, Thomas A, Staub C, Zimmer A, Cravatt B, Pacher P, Steffens S, Blanco R, Sarmiento R, Parisi C, Fandino S, Blanco F, Gigena G, Szarfer J, Rodriguez A, Garcia Escudero A, Riccitelli MA, Wantha S, Simsekyilmaz S, Megens RT, Van Zandvoort MA, Liehn E, Zernecke A, Klee D, Weber C, Soehnlein O, Lima LM, Carvalho MG, Gomes KB, Santos IR, Sousa MO, Morais CAS, Oliveira SHV, Gomes IF, Brandao FC, Lamego MRA, Lima LM, Fornai L, Angelini A, Kiss A, Giskes F, Eijkel G, Fedrigo M, Valente ML, Thiene G, Heeren RMA, Grdinic A, Vojvodic D, Djukanovic N, Grdinic AG, Obradovic S, Majstorovic I, Rusovic S, Vucinic Z, Tavciovski D, Ostojic M, Lin CS, Kuan TC, Lai SC, Chen MY, Wu HT, Gouweleeuw L, Oberdorf-Maass SU, De Boer RA, Van Gilst WH, Maass AH, Van Gelder IC, Azibani F, Benard L, Schlossarek S, Merval R, Tournoux F, Launay JM, Carrier L, Chatziantoniou C, Samuel JL, Delcayre C, Li C, Warren D, Shanahan CM, Zhang QP, Bye A, Vettukattil R, Aspenes ST, Giskeodegaard G, Gribbestad IS, Wisloff U, Bathen TF, Cubedo J, Padro T, Alonso R, Mata P, Badimon L, Ivic I, Vamos Z, Cseplo P, Kosa D, Torok O, Hamar J, Koller A, Norita K, De Noronha SV, Sheppard MN, Torre I, Amat-Roldan I, Iruretagoiena I, Psilodimitrakopoulos S, Gonzalez-Tendero A, Crispi F, Artigas D, Loza-Alvarez P, Gratacos E, Harrison JC, Smart SD, Besely EH, Kelly JR, Yao Y, Sammut IA, Hoepfner M, Kuzyniak W, Sekhosana E, Hoffmann B, Litwinski C, Pries A, Ermilov E, Fontoura D, Lourenco AP, Vasques-Novoa F, Pinto JP, Roncon-Albuquerque R, Leite-Moreira AF, Oyeyipo IP, Olatunji LA, Usman TO, Olatunji VA, Bacova B, Radosinska J, Viczenczova C, Knezl V, Dosenko V, Benova T, Goncalvesova E, Vanrooyen J, Tribulova N, Maulik SK, Seth S, Dinda AK, Jaiswal A, Mearini G, Khajetoorians D, Kraemer E, Gedicke-Hornung C, Precigout G, Eschenhagen T, Voit T, Garcia L, Lorain S, Carrier L, Mendes-Ferreira P, Maia-Rocha C, Adao R, Lourenco AP, Cerqueira RJ, Mendes MJ, Castro-Chaves P, De Keulenaer GW, Leite-Moreira AF, Bras-Silva C, Ruiter G, Wong YY, Lubberink M, Knaapen P, Raijmakers P, Lammertsma AA, Marcus JT, Westerhof N, Van Der Laarse WJ, Vonk-Noordegraaf A, Poitz DM, Steinbronn N, Koch E, Steiner G, Strasser RH, Berezin A, Lisovaya OA, Soldatova AM, Kuznetcov VA, Yenina TN, Rychkov AYU, Shebeko PV, Altara R, Hessel MHM, Hermans JJR, Janssen BJA, Blankesteijn WM, Soldatova AM, Kuznetcov VA, Yenina TN, Rychkov AYU, Shebeko PV, Berezin A, Berezina TA, Seden V, Bonanad C, Nunez J, Navarro D, Chilet MF, Sanchis F, Bodi V, Minana G, Chaustre F, Forteza MJ, Llacer A, Femminella GD, Rengo G, Galasso G, Zincarelli C, Liccardo D, Pagano G, De Lucia C. Poster session 3. Cardiovasc Res 2012. [DOI: 10.1093/cvr/cvr336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
9
|
Fisher WP, Elbaum B, Coulter A. Reliability, precision, and measurement in the context of data from ability tests, surveys, and assessments. ACTA ACUST UNITED AC 2010. [DOI: 10.1088/1742-6596/238/1/012036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
10
|
Chatterton TJ, Coulter A, Musselwhite C, Lyons G, Clegg S. Understanding how transport choices are affected by the environment and health: views expressed in a study on the use of carbon calculators. Public Health 2008; 123:e45-9. [PMID: 19101000 DOI: 10.1016/j.puhe.2008.10.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [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: 11/17/2022]
Abstract
OBJECTIVES To examine the influence that the provision of environmental information might be able to make on personal travel behaviour through analysis of the views of members of the public expressed in a study for the UK Department for Transport on attitudes towards carbon calculator tools. STUDY DESIGN A three-stage qualitative survey taking an ideographic approach to analysing public attitudes to the use of carbon calculator tools in relation to making transport decisions. METHODS Interviews and discussion groups with stakeholders, non-users and users providing extensive data that were analysed using the British Market Research Bureau's matrix mapping methodology. RESULTS Despite considerable awareness of climate change as an issue, personal carbon emissions were not found to have much influence on personal transport choice, which could be seen as being dominated by issues of cost (both in time and money), comfort and convenience. CONCLUSIONS The spatial and temporal dislocation of the cause and effects of climate change make it difficult to link the impacts of personal travel behaviour with specific activities. If environmental- and health-based information is to be provided as a lever to change travel behaviour, it may be necessary to provide information on issues such as local air pollution and personal health impacts in order to link wider benefits with a travel user's self-interest.
Collapse
Affiliation(s)
- T J Chatterton
- Air Quality Management Resource Centre, Institute for Sustainability, Health and Environment, University of the West of England, Bristol BS16 1QY, UK.
| | | | | | | | | |
Collapse
|
11
|
Coulter A. Patients, Power and Responsibility. J R Soc Med 2003. [DOI: 10.1258/jrsm.96.10.512] [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: 11/18/2022] Open
|
12
|
Affiliation(s)
- A Coulter
- Picker Institute Europe, King's Mead House, Oxpens Road, Oxford OX1 1RX, UK
- Picker Institute Europe, King's Mead House, Oxpens Road, Oxford OX1 1RX, UK. E-mail:
| |
Collapse
|
13
|
Kennedy ADM, Sculpher MJ, Coulter A, Dwyer N, Rees M, Horsley S, Cowley D, Kidson C, Kirwin C, Naish C, Bidgood K, Cullimore J, Kerr-Wilson R, Abrams KR, Stirrat G. A multicentre randomised controlled trial assessing the costs and benefits of using structured information and analysis of women's preferences in the management of menorrhagia. Health Technol Assess 2003; 7:1-76. [PMID: 12633525 DOI: 10.3310/hta7080] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A D M Kennedy
- Health Economics Research Group, Brunel University, Uxbridge, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Jenkinson C, Coulter A, Bruster S, Richards N. The coronary heart disease in-patient experience questionnaire (I-PEQ (CHD)): results from the survey of National Health Service patients. Qual Life Res 2002; 11:721-7. [PMID: 12482156 DOI: 10.1023/a:1020818500819] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/12/2022]
Abstract
OBJECTIVE Analysis of data from the National Survey of Coronary Heart Disease patients to develop a core measure of patient experiences of health care. A secondary purpose was to determine whether a single summary index figure could be generated from the instrument. DESIGN The data reported here comes from the survey of coronary heart disease (CHD) patients, which was the second in the programme of National Surveys of National Health Service (NHS) patients. It took place during 1999. After an in-patient episode for CHD, questionnaires were mailed out to patients with a covering letter and a pre-paid stamped addressed envelope. Those patients who did not reply within two weeks of the initial mailing were sent a reminder letter and, if this elicited no reply within two weeks, they were sent another copy of the questionnaire. SAMPLE Of the 116,872 patients who were sent questionnaires, 3399 proved to be ineligible or out-of scope to the survey. Responses were gained from 84,310 (74.3% of eligible respondents). RESULTS Reliability analysis supported the existence of seven dimensions which seem to be tapping distinct underlying phenomena: hospital environment, information and communication, patient involvement, coordination of care, discharge and transition, and pain. Higher order factor analysis indicated these dimensions constituted one factor and, consequently, can be summed to create an index figure. The construct validity of the measure was assessed, and it distinguished between groups as was hypothesised. CONCLUSIONS The dimensions of the questionnaire have high internal reliability. Both the dimensions of the instrument and the index score were found to have high construct validity. The instrument provides a core set of issues that should be covered when assessing the quality of care for hospital patients with coronary heart disease.
Collapse
Affiliation(s)
- C Jenkinson
- Picker Institute Europe, King's Mead House, Oxpens Road, Oxford OX1 1RX.
| | | | | | | |
Collapse
|
15
|
Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T. Patients' experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Qual Saf Health Care 2002; 11:335-9. [PMID: 12468693 PMCID: PMC1757991 DOI: 10.1136/qhc.11.4.335] [Citation(s) in RCA: 359] [Impact Index Per Article: 16.3] [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: 11/03/2022]
Abstract
OBJECTIVE To determine what aspects of healthcare provision are most likely to influence satisfaction with care and willingness to recommend hospital services to others and, secondly, to explore the extent to which satisfaction is a meaningful indicator of patient experience of healthcare services. DESIGN Postal survey of a sample of patients who underwent a period of inpatient care. Patients were asked to evaluate their overall experience of this episode of care and to complete the Picker Inpatient Survey questionnaire on specific aspects of their care. SAMPLE Patients aged 18 and over presenting at five hospitals within one NHS trust in Scotland. METHOD 3592 questionnaires were mailed to patients' homes within 1 month of discharge from hospital during a 12 month period. Two reminders were sent to non-responders; 2249 (65%) questionnaires were returned. RESULTS Almost 90% of respondents indicated that they were satisfied with their period of inpatient care. Age and overall self-assessed health were only weakly associated with satisfaction. A multiple linear regression indicated that the major determinants of patient satisfaction were physical comfort, emotional support, and respect for patient preferences. However, many patients who reported their satisfaction with the care they received also indicated problems with their inpatient care as measured on the Picker Inpatient Survey; 55% of respondents who rated their inpatient episode as "excellent" indicated problems on 10% of the issues measured on the Picker questionnaire. DISCUSSION The evidence suggests that patient satisfaction scores present a limited and optimistic picture. Detailed questions about specific aspects of patients' experiences are likely to be more useful for monitoring the performance of various hospital departments and wards and could point to ways in which delivery of health care could be improved.
Collapse
|
16
|
Abstract
Plans for improving safety in medical care often ignore the patient's perspective. The active role of patients in their care should be recognised and encouraged. Patients have a key role to play in helping to reach an accurate diagnosis, in deciding about appropriate treatment, in choosing an experienced and safe provider, in ensuring that treatment is appropriately administered, monitored and adhered to, and in identifying adverse events and taking appropriate action. They may experience considerable psychological trauma both as a result of an adverse outcome and through the way the incident is managed. If a medical injury occurs it is important to listen to the patient and/or the family, acknowledge the damage, give an honest and open explanation and an apology, ask about emotional trauma and anxieties about future treatment, and provide practical and financial help quickly.
Collapse
Affiliation(s)
- C A Vincent
- Clinical Risk Unit, Department of Psychology, University College London, London WC1E 6BT, UK.
| | | |
Collapse
|
17
|
|
18
|
Windon RG, Chaplin PJ, McWaters P, Tavarnesi M, Tzatzaris M, Kimpton WG, Cahill RN, Beezum L, Coulter A, Drane D, Sjölander A, Pearse M, Scheerlinck JP, Tennent JM. Local immune responses to influenza antigen are synergistically enhanced by the adjuvant ISCOMATRIX. Vaccine 2001; 20:490-7. [PMID: 11672914 DOI: 10.1016/s0264-410x(01)00332-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [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: 10/27/2022]
Abstract
The peripheral (draining) lymph node, as the primary site of immune induction, determines the course of systemic responses to an injected antigen. Lymphatic duct cannulation procedures in sheep were used to investigate local immunoreactivity to human influenza virus antigen (Flu ag) admixed with the adjuvant ISCOMATRIX (IMX). Compared to Flu ag or IMX alone, the co-administration of Flu ag and IMX (Flu ag+IMX) synergistically enhanced a number of immunological responses (lymphocyte and blast migration from the node, antigen-specific antibody levels and IL6 output in efferent lymph, and antigen-induced proliferation in cultured efferent lymph cells). Together, these results demonstrate that IMX is an immune modulator, and that lymphatic duct cannulation procedures may be used to evaluate antigen/adjuvant combinations for vaccine development.
Collapse
Affiliation(s)
- R G Windon
- Cooperative Research Centre for Vaccine Technology Unit, CSIRO Livestock Industries, Private Bag 24, Geelong 3220, Vic., Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Murray E, Davis H, Tai SS, Coulter A, Gray A, Haines A. Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care. BMJ 2001; 323:493-6. [PMID: 11532845 PMCID: PMC48138 DOI: 10.1136/bmj.323.7311.493] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2001] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether a decision aid on benign prostatic hypertrophy influences decision making, health outcomes, and resource use. DESIGN Randomised controlled trial. SETTING 33 general practices in the United Kingdom. PARTICIPANTS 112 men with benign prostatic hypertrophy. INTERVENTION Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary. OUTCOME MEASURES Patients' and general practitioners' perceptions of who made the decision, decisional conflict scores, treatment choice and prostatectomy rate, American Urological Association symptom scale, costs, anxiety, utility, and general health status. RESULTS Both patients and general practitioners found the decision aid acceptable. A higher proportion of patients (32% v 4%; mean difference 28%, 95% confidence interval 14% to 41%) and their general practitioners (46% v 25%; 21%, 3% to 40%) perceived that treatment decisions had been made mainly or only by patients in the intervention group compared with the control group. Patients in the intervention group had significantly lower decisional conflict scores than those in the control group at three months (2.3 v 2.6; -0.3, -0.5 to -0.1, P<0.01) and this was maintained at nine months. No differences were found between the groups for anxiety, general health status, prostatic symptoms, utility, or costs (excluding costs associated with the video disc equipment). CONCLUSIONS The decision aid reduced decisional conflict in men with benign prostatic hypertrophy, and the patients played a more active part in decision making. Such programmes could be delivered cheaply by the internet, and there are good arguments for coordinated investment in them, particularly for conditions in which patient utilities are important.
Collapse
Affiliation(s)
- E Murray
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, London N19 3UA
| | | | | | | | | | | |
Collapse
|
20
|
Shickle D, Carlisle J, Fryers P, Wallace S, Suckling R, Cork M, Bowns I, Beyleveld D, McDonagh A, Sandvik L, Mowinckel P, Abdelnoor M, Erikssen G, Erikssen J, White R, Altmann DR, Nanchahal K, Oliver S, Donovan JL, Peters TJ, Frankel S, Hamdy FC, Neal DE, Whincup PH, Gilg J, Papacosta O, Miller GJ, Alberti KGMM, Cook D, Lawlor DA, Ebrahim S, Smith GD, Lampe F, Morris R, Whincup P, Walker M, Ebrahim S, Shaper A, Brunner E, Shipley M, Hemingway H, Juneja M, Page M, Stansfeld S, Kumari M, Walker B, Andrew R, Seckl J, Papadopoulos A, Checkley S, Marmot M, Wood D, Sheehan J, Reilly M, Twomey H, Collins M, Daly A, Loningsigh S, Dolan E, Smith GD, Ben-Shlomo Y, Perry I, Moher M, Yudkkin P, Wright L, Turner R, Fuller A, Schofield T, Mant D, Feder G, Lilford RJ, Dobbie F, Warren R, Braunholtz D, Boaden R, Nolte E, Scholz R, Shkolnikov V, McKee M, Neilson S, Gilthorpe MS, Wilson RC, Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T, Cromwell DA, Griffiths DA, Campbell MJ, Mollison J, McIntosh E, Grimshaw J, Thomas R, Rovers MM, Straatman H, Zielhuis GA, Hemminki E, Hove SL, Veerus P, Hakama M, Tuimala R, Rahu M, Ukoumunne OC, Gulliford MC, Shepstone L, Spencer N, Araya R, Rojas G, Fritsch RE, Acuna J, Lewis G, Ajdacic-Gross V, Bopp M, Eich D, Rossler W, Gutzwiller F, Corcoran P, Brennan A, Reilly M, Perry IJ, Middleton N, Whitley E, Frankel S, Dorling D, Gunnell D, Stanistreet D, Paine K, Scherf C, Morison L, Walraven G, O'Cathain A, Sampson F, Nicholl J, Munro J, Chapple A, Ziebland S, McPherson A, Herxheimer A, Shepperd S, Miller R, Brindle L, Donovan JL, Peters TJ, Quine S, O'Reilly M, Cahill M, Perry IJ, Maconochie N, Doyle P, Prior S, Ego A, Subtil D, Cosson M, Legoueff F, Houfflin-Debarge V, Querleu D, Rasmussen F, Smith GD, Sterne JAC, Tynelius P, Leon DA, Doyle P, Roman E, Maconochie N, Smith P, Beral V, Macfarlane A, Shoham-Vardi I, Winer N, Weitzman D, Levcovich A, Lahelma E, Kivela K, Roos E, Tuominen T, Dahl E, Diderichsen F, Elstad J, Lissau I, Lundberg O, Rahkonen O, Rasmussen NK, Yngwe MA, Gilmore AB, McKee M, Rose R, Salmond C, Crampton P, Tobias M, Li L, Manor O, Power C, Bruster S, Coulter A, Jenkinson C, Osler M, Prescott E, Gronbak M, Andersen AN, Due P, Engholm G, Drury N, Bruce J, Poobalan AS, Smith WCS, Jeffrey RR, Chambers WA, Mueller JE, Doring A, Stieber J, Thorand B, Lowel H, Chen R, Tunstall-Pedoe H, Redpath A, Macintyre K, Stewart S, Chalmers JWT, Boyd AJ, Finlayson A, Pell JP, McMurray JJV, Capewell S, Chalmers JWT, Macintyre K, Stewart S, Boyd AJ, Finlayson A, Pell JP, Redpath, McMurray JJV, Capewell S, Critchley J, Capewell S, Stefoski-Mikeljevic J, Johnston C, Cartman M, Sainsbury R, Forman D, Haward R, Morris E, Haward R, Forman D, Cartman M, Johnston C, Moebus S, Lehmann N, Goodacre S, Calvert N, Montgomery AA, Fahey T, Ben-Shlomo Y, Harding J, Anderson W, Florin D, Gillam S, Ely M, Nath U, Ben-Shlomo Y, Thomson RG, Morris HR, Wood NW, Lees AJ, Burn DJ, West RR, Fielder HM, Palmer SR, Dunstan F, Fone D, Higgs G, Senior M, Moss N, Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, Donovan J, Rottingen JA, Garnett GP, Jagger C, Robine JM, Clarke M, Tobiasz-Adamczyk B, Szafraniec K, Lall R, Campbell MJ, Walter SJ, McGrother C, Donaldson M, Dallosso H, Dineen BP, Bourne RR, Ali SM, Huq DMN, Johnson GJ, Stang A, Jockel KH, Karvonen S, Vikat A, Rimpela M, Borras JM, Schiaffino A, Fernandez E, Borrell C, Garcia M, Salto E, Jefferis B, Power C, Graham H, Manor O, Yudkin P, Hey K, Roberts S, Welch S, Johnstone E, Murphy M, Griffiths S, Jones L, Walton R, Rasul F, Stansfeld SA, Hart CL, Gillis C, Smith GD, Marks D, Lambert H, Thorogood M, Neil H, Humphries S, Wonderling D, Surman G, Newdick H, Johnson A, Pharoah P, Glinianaia SV, Wright C, Rankin J, Basso O, Christensen K, Olsen J, Love A, Cheung WY, Williams J, Jackson S, Maddocks A, Hutchings H, Gissler M, Pakkanen M, Olausson PO, Owen CG, Whincup PH, Odoki K, Gilg JA, Cook DG, Aveyard P, Markham WA, Sherratt E, Bullock A, Macarthur C, Cheng KK, Daniels H, Murphy S, Egger M, Grimsley M, Green G, Read C, Redgrave P, Suokas A, McCulloch A, Zagozdzon P, Zaborski L, Cardano M, Costa G, Demaria M, Gnavi R, Spadea T, Vannoni F, Batty D, Leon DA, Rahi J, Morton S, Leon D, Stavola BDE, Gunnell D, Fouskakis D, Rasmussen F, Tynelius P, Harrison G, Spadea T, Faggiano F, Armaroli P, Maina L, Costa G, Ellison GTH, Travis R, Phillips M, Dedman D, Upton M, McCarthy A, Elwood P, Davies D, Shlomo YB, Smith GD, Berrington A, Cramer DW, Kuper H, Harlow BL, Titus-Ernstoff L, McLeod A, Stockton D, Brown H, Leyland AH, Liratsopulos G, West CR, Williams EMI, Abrams K, Sharp L, Little J, Brockton N, Cotton SC, Haites NE, Cassidy J, Kamali A, Kinsman J, Kintu P, Quigley M, Carpenter L, Kengeya-Kayondo J, Whitworth. JAG, Porter K, Noah N, Rawson H, Crampin A, Smith WCS, Group CMSOBOTMS, Jahn A, Kudzala A, Kitundu H, Lyamuya E, Razum O, Thomas SL, Wheeler JG, Hall AJ, Moore L, Dennehy A, Shemilt I, Belderson P, Brandon M, Harvey I, Moffatt P, Mugford M, Norris N, O'Brien M, Reading R, Robinson J, Schofield G, Shepstone L, Thoburn J, Cliffe S, Leiva A, Tookey P, Hamers F, Nicoll A, Critchley J, Capewell S, Ness AR, Hughes J, Elwood PC, Whitley E, Smith GD, Burr ML, Chase D, Roderick P, Cooper K, Davies R, Raftery J, Martikainen P, Kauppinen TM, Valkonen T, Somerville M, Barton A, Foy C, Basham M, Thomson H, Petticrew M, Morrison D, Chandola T, Biddulph J, McCarthy M, Gallivan S, Utley M, Kinra S, Black ME, Murphy M, Hey K, Jones L, Brzezinski ZJ, Mazur J, Mierzejewska E, Evans JG, Clarke R, Sherliker P, Birks J, Wrieden WL, Connaghan JP, Tunstall-Pedoe H, Silva IDS, Mangtani P, McCormack V, Bhakta D, Sevak L, McMichael AJ, Sauvaget C, Nagano J, Ogilvie D, Raffle AE, Alden B, Brett M, Babb PJ, Quinn M, Banks E, Beral V, Bull D, Reeves G, Leung GM, Lam TH, Thach TQ, Hedley AJ, Roderick P, Davies R, Crabbe D, Patel P, Raftery J, Bhandari P, Pearce R, Thomas MC, Walker M, Lennon LT, Thomson AG, Lampe FC, Shaper AG, Whincup PH, Fallon UB, Ben-Shlomo Y, Laurence KM, Lancashire RJ, Pharoah POD, Nevin NC, Smith GD, Fear NT, Roman E, Ansell P, Bull D, Nilsen TIL, Vatten LJ, Lane JA, Harvey RF, Murray LJ, Harvey IM, Donovan JL, Egger M, Wright CM, Parker L, Lamont D, Craft AW, Hallqvist J, Lundberg M, Diderichsen F, Boniface DR, McNeilly E, Bromen K, Pohlabeln H, Ahrens W, Jahn I, Jockel KH, Darby S, Doll R, Whitley E, Key T, Silcocks P, Linos D, Markaki I, Ntalles K, Riza E, Linos A, Memon A, Darif M, AL-Saleh K, Suresh A, de Vries CS, Bromley SE, Williams TJ, Farmer RDT, Ruiz M, Nieto A, Boshuizen HC, Nagelkerke NJD, Schellekens JFP, Peeters MF, Den Boer JW, Van Vliet JA, Neppelenbroek SE, Spaendonck MAECV, Mazloomzadeh S, Woodman CBJ, Collins S, Winter H, Bailey A, Young LS, Rosenbauer J, Herzig P, Giani G, Olowokure B, Spencer NJ, Hawker JI, Blair I, Smith R, Olowokure B, White J, Rush M, Hawker JI, Ramsay M, Watkins J, Mayor S, Matthews I, Crilly M, Bundred P, Prosser H, Walley T, Walker ZAK, Oakley L, Townsend JL, Donovan C, Smith H, Bell J, Hurst Z, Marshall S, Wild S, Whyman C, Barter M, Wishart K, Macleod C, Marinko K, Malmstrom M, Johansson SE, Sundquist J, Crampton P, Salmond C, Tobias M, Lumley J, Small R, Brown S, Watson L, Gunn J, Hawe P, Shiell A, Langer M, Steiner G, Tiefenthaler M, Adamek S, Ronsmans C, Khlat M, Waterstone M, Bewley S, Wolfe C, Hooper R, Moore L, Campbell R, Whelan A, Winter H, Macarthur C, Bick D, Lancashire R, Knowles H, Henderson C, Belfield C, Gee H, Biggerstaff D, Lilford R, Olsen J, the EuroMap Group, Spencer EA, Davey GK, Appleby PN, Key TJ., Breeze E, Leon D, Clarke R, Fletcher A, Boniface DR, McNeilly E, Lam TH, Ho SY, Hedley AJ, Mak KH, Canoy D, Khaw KT, Thorogood M, Appleby PN, Mann JI, Key TJ, Bobak M, Pikhart H, Martikainen P, Rose R, Marmot M, Rooney CIF, Cook L, Uren Z, Watson MC, Bond CM, Grimshaw JM, Mollison J, Ludbrook A, Poobalan AS, Bruce J, King PM, Krukowksi ZH, Smith WCS, Chambers WA, Seagroatt V, Goldacre M, Purcell B, Majeed A, Mayor S, Watkins J, Matthews I, Morris RW, Whincup PH, Emberson J, Lampe FC, Walker M, Wannamethee G, Shaper AG, Ebrahim S, May M, McCarron P, Frankel S, Smith GD, Yarnell J, Ebrahim S, May M, McCarron P, Shlomo YB, Stansfeld S, Gallacher J, Smith GD, Taylor FC, Rees K, Ebrahim S, Angelini GD, Ascione R, Muller-Nordhorn J, Binting S, Kulig M, Voller H, Willich SN, Group FTPS, Whincup PH, Emberson J, Papacosta O, Walker M, Lennon L, Thomson A, Sturdy PM, Anderson HR, Butland BK, Bland JM, Victor CR, Wilman C, Gupta R, Anderson HR, Mindell J, Joffe M, Nikiforov B, Pattenden S, Armstrong B, Hedley AJ, Wong CM, Thach TQ, Chau P, Lam TH, Anderson HR, Whitley E, Darby S, Deo H, Doll R, Raleigh VS, Logie J, Macrae K, Lawrenson R, Villegas R, Nielson S, O'Halloran DJ, Perry IJ, Gallacher JEJ, Elwood PC, Yarnell JWG, Shlomo YB, Pickering J, Evans JMM, Morris AD, Sedgwick JEC, Pearce AJ, Gulliford MC, Walker M, Thomson A, Whincup P, Lyons RA, Jones S, Richmond P, McCarthy J, Fone D, Lester N, Johansen A, Saunders J, Palmer SR, Barnes I, Banks E, Beral V, Jones GT, Watson KD, Taylor S, Papageorgiou AC, Silman AJ, Symmons DPM, Macfarlane GJ, Pope D, Hunt I, Birrell F, Silman A, Macfarlane G, Thorpe L, Thomas K, Fitter M, Brazier J, Macpherson H, Campbell M, Nicholl J, Morgan A, Roman M, Allison T, Symmons D, Urwin M, Brammah T, Roxby M, Williams G, Primatesta P, Falaschetti E, Poulter NR, Knibb R, Armstrong SJ, Chilvers CED, Logan RFA, Woods KL, Bhavnani V, Clarke A, Dowie J, Kennedy A, Pell I, Goldacre MJ, Kurina L, Seagroatt V, Yeates D, Watson E, Clements A, Yudkin P, Rose P, Bukach C, Mackay J, Lucassen A, Austoker J, Guillemin M, Brown W, Tell GS, Nurk E, Vollset SE, Nygard O, Refsum H, Ueland PM, Villegas R, Nielson S, Creagh D, Hinchion R, Perry IJ, Allen NE, Key TJ, Vatten LJ, Odegard RA, Nilsen ST, Austgulen R, Harding AH, Khaw KT, Wareham NJ, Riza E, Silva IDS, De Stavola B, Bradlow HL, Sepkovic DW, Linos D, Linos A. Society for Social Medicine and the International Epidemiological Association European Group. Abstracts of oral presentations. Br J Soc Med 2001. [DOI: 10.1136/jech.55.suppl_1.a1] [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: 11/03/2022]
|
21
|
Murray E, Davis H, Tai SS, Coulter A, Gray A, Haines A. Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care. BMJ 2001; 323:490-3. [PMID: 11532844 PMCID: PMC48137 DOI: 10.1136/bmj.323.7311.490] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether a decision aid on hormone replacement therapy influences decision making and health outcomes. DESIGN Randomised controlled trial. SETTING 26 general practices in the United Kingdom. PARTICIPANTS 205 women considering hormone replacement therapy. INTERVENTION Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary. OUTCOME MEASURES Patients' and general practitioners' perceptions of who made the decision, decisional conflict, treatment choice, menopausal symptoms, costs, anxiety, and general health status. RESULTS Both patients and general practitioners found the decision aid acceptable. At three months, mean scores for decisional conflict were significantly lower in the intervention group than in the control group (2.5 v 2.8; mean difference -0.3, 95% confidence interval -0.5 to -0.2); this difference was maintained during follow up. A higher proportion of general practitioners perceived that treatment decisions had been made "mainly or only" by the patient in the intervention group than in the control group (55% v 31%; 24%, 8% to 40%). At three months a lower proportion of women in the intervention group than in the control group were undecided about treatment (14% v 26%; -12%, -23% to -0.4%), and a higher proportion had decided against hormone replacement therapy (46% v 32%; 14%, 1% to 28%); these differences were no longer apparent by nine months. No differences were found between the groups for anxiety, use of health service resources, general health status, or utility. The higher costs of the intervention were largely due to the video disc technology used. CONCLUSIONS An interactive multimedia decision aid in the NHS would be popular with patients, reduce decisional conflict, and let patients play a more active part in decision making without increasing anxiety. The use of web based technology would reduce the cost of the intervention.
Collapse
Affiliation(s)
- E Murray
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, London N19 3UA.
| | | | | | | | | | | |
Collapse
|
22
|
Jenkinson C, Chandola T, Coulter A, Bruster S. An assessment of the construct validity of the SF-12 summary scores across ethnic groups. J Public Health Med 2001; 23:187-94. [PMID: 11585190 DOI: 10.1093/pubmed/23.3.187] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim of the study was to determine the construct validity of the 12-item Short Form health survey questionnaire (SF-12) across ethnic groups in a large community sample of the United Kingdom. METHODS A postal survey was carried out in English using a questionnaire booklet, containing the SF-12 and a number of other items relating to experiences of chronic illness and utilization of health care services. The dataset was the National Survey of NHS Patients. The sample consisted of 1000 residents within each Health Authority in England who were randomly selected from the electoral registers, giving an initial sample of 100000. RESULTS A total of 61 426 (61.4 per cent) questionnaires were returned; 94.3 per cent of respondents classified themselves as white and 5.7 per cent classified themselves as members of other ethnic groups. Construct validity of the SF-12 was assessed by comparing results from the two summary scores (the Mental Health Component Summary (MCS) score and the Physical Health Component Summary (PCS) score) with overall self-assessed health and limiting longstanding illness. Although there were generally consistent patterns of association between overall self-assessed health or limiting longstanding illness and the MCS and PCS scores in all the ethnic groups, there were significant differences between the MCS and PCS scores of Indians, Pakistanis and Bangladeshis who understood English fluently and those who did not. Furthermore, there were differences in the completion rates of the SF-12 between ethnic groups and a reversal of the general pattern of increasing MCS scores with increasing age in Bangladeshis. CONCLUSION The results indicate that the use of the SF-12 to measure the health of ethnic minorities seems acceptable in most instances, but may prove problematic in those instances where respondents complete the questionnaire via an untrained translator, such as a friend or family member. The systematic differences in MCS and PCS scores between ethnic minorities who understood English fluently and those who did not suggest that the meaning of specific SF-12 items may change when informally translated. Future research using the SF-12 to measure the health status of ethnic minorities in the United Kingdom via postal surveys must include questions on whether respondents completed the questionnaires via informal translations. In general, those wishing to measure the health of members of ethnic groups who are unable to read English might consider using different techniques to gain the information from these groups.
Collapse
|
23
|
Abstract
Rationing health care in publicly funded health care systems is becoming more challenging because of the growing gap between the possibility of effective medical intervention and limited resources. This poses both an economic challenge and a political puzzle. On the basis of experience in those systems that have adopted a systematic approach to rationing, it can be suggested that the dilemmas involved should be addressed by strengthening both the information base to support decisions and the institutional framework in which decisions are taken. The contribution both of experts and of lay people is needed to inform decision-making, and the processes adopted need to allow for this as well as being transparent and accountable. In practice, rationing is likely to combine explicit and implicit decision-making and to result in the exclusion of services at the margins and the development of guidelines in the mainstream. The politics of rationing may favour muddling through and the evasion of responsibility but this will be difficult to sustain in an environment in which public awareness of decision-making in health care is growing.
Collapse
Affiliation(s)
- C Ham
- Health Services Management Centre, University of Birmingham, 40 Edgbaston Park Road, Birmingham B15 2RT, UK
| | | |
Collapse
|
24
|
Affiliation(s)
- A Coulter
- Picker Institute-Europe, Oxford, United Kingdom
| |
Collapse
|
25
|
Abstract
Analysis of patient surveys carried out in Germany, Sweden, Switzerland, the United Kingdom, and the United States in 1998-2000 revealed high rates of problems during inpatient hospital stays. Problems with information and education, coordination of care, respect for patients' preferences, emotional support, physical comfort, involvement of family and friends, and continuity and transition were prevalent in all five countries. These dimensions of patients' experience appear to be salient and relevant in each of the five countries, but attempts to develop international rankings based on this type of evidence will have to overcome a number of methodological problems.
Collapse
Affiliation(s)
- A Coulter
- Picker Institute Europe, and University of Oxford
| | | |
Collapse
|
26
|
Holmes-Rovner M, Llewellyn-Thomas H, Entwistle V, Coulter A, O'Connor A, Rovner DR. Patient choice modules for summaries of clinical effectiveness: a proposal. BMJ 2001; 322:664-7. [PMID: 11250855 PMCID: PMC1119848 DOI: 10.1136/bmj.322.7287.664] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/03/2000] [Indexed: 11/04/2022]
Affiliation(s)
- M Holmes-Rovner
- College of Human Medicine, Michigan State University, East Lansing MI 48823, USA.
| | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Windon RG, Chaplin PJ, Beezum L, Coulter A, Cahill R, Kimpton W, Drane D, Pearse M, Sjölander A, Tennent JM, Scheerlinck JY. Induction of lymphocyte recruitment in the absence of a detectable immune response. Vaccine 2000; 19:572-8. [PMID: 11027823 DOI: 10.1016/s0264-410x(00)00148-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [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: 11/20/2022]
Abstract
Lymphocyte recruitment from blood into the lymph node is thought to be initiated by the presence of antigen. In this study, we have used lymphatic cannulation in sheep to demonstrate that the adjuvant ISCOMATRIX can induce dramatic lymph node activation in the absence of antigen. Consistent patterns of node shutdown (decreased output) and cell recruitment (increased output) with minimal blast cell responses were observed indicating that an antigen-specific immune response is not required. Production of IL-6, IL-8 and IFN-gamma, and the transient presence of red blood cells and neutrophils in the efferent lymph were associated with changes in efferent lymph cell trafficking. These early events may facilitate the screening of low frequency antigen-specific cells for binding to antigen and the subsequent amplification of the immune response.
Collapse
Affiliation(s)
- R G Windon
- CSIRO Animal Health, CRC for Vaccine Technology Unit, Private Bag 1, Victoria 3052, Parkville, Australia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
|
31
|
Deliyannis G, Jackson DC, Dyer W, Bates J, Coulter A, Harling-McNabb L, Brown LE. Immunopotentiation of humoral and cellular responses to inactivated influenza vaccines by two different adjuvants with potential for human use. Vaccine 1998; 16:2058-68. [PMID: 9796065 DOI: 10.1016/s0264-410x(98)00080-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [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: 02/09/2023]
Abstract
Two quite different adjuvants, currently under development for use in humans, have been examined for their effects on the magnitude and type of immunity elicited in response to inactivated influenza vaccine. Immunostimulating complexes (ISCOM adjuvant) contain the saponin ISCOPREP 703, and SPT is an oil-in-water emulsion of squalane, non-ionic block copolymer (L121) and Tween 80. Influenza virus vaccines formulated in either adjuvant were far superior to the non-adjuvanted aqueous vaccine in eliciting antibody and T-cell responses in mice, particularly at lower doses of antigen. In addition, the vaccines containing adjuvant were superior in eliciting protective immunity. One of the shortcomings of the unadjuvanted inactivated influenza vaccine was its inability to elicit a primary proliferative T-cell response. However, after one dose of either adjuvanted vaccine, strong proliferative responses were achieved. We also show that subcutaneous vaccination with inactivated vaccines is capable of modulating the isotype profile of antibody secreting cells generated in the lungs of mice in response to intranasal challenge with live virus. In this system, the isotype of antibody elicited after challenge of mice that had received ISCOM vaccine more closely mimicked that of animals vaccinated with live virus.
Collapse
Affiliation(s)
- G Deliyannis
- Department of Microbiology and Immunology, University of Melbourne, Parkville, Australia
| | | | | | | | | | | | | |
Collapse
|
32
|
Gillam S, Coulter A. Evaluating primary care groups. Br J Gen Pract 1998; 48:1640-1. [PMID: 10071394 PMCID: PMC1313236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
|
33
|
|
34
|
Coulter A, Wong TY, Drane D, Bates J, Macfarlan R, Cox J. Studies on experimental adjuvanted influenza vaccines: comparison of immune stimulating complexes (Iscoms) and oil-in-water vaccines. Vaccine 1998; 16:1243-53. [PMID: 9682385 DOI: 10.1016/s0264-410x(98)80125-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [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: 11/19/2022]
Abstract
Detergent-disrupted influenza virus vaccines, formulated as Iscoms, or oil-in-water (o/w) emulsions, were administered parenterally to mice and evaluated for immunogenicity and protective efficacy. Both formulations enhanced both primary and secondary serum antibody responses. The magnitude of these responses with o/w emulsions was further enhanced by the addition of the non-ionic block copolymer L121 in the emulsion. Four weeks after primary immunization, mice were challenged by exposure to an aerosol containing infectious virus. Resistance to challenge in terms of survival rate and weight change correlated well with serum antibody titre for all formulations. Two major differences were observed between the adjuvant formulations. Iscom vaccines, formulated with Quil-A or the less toxic Quillaia saponin preparation Iscoprep 703, induced specific cytotoxic T-lymphocyte responses, whereas the o/w-based vaccines did not. In addition, dose-site reactivity studies in sheep showed that Iscom vaccines were less reactive than o/w-based vaccines, the degree of reactivity of the latter increasing sharply with increasing L121 concentration. On the basis of these studies, Iscoms were chosen for development as a potential adjuvant for human influenza vaccines.
Collapse
Affiliation(s)
- A Coulter
- CSL Limited, Parkville, Victoria, Australia
| | | | | | | | | | | |
Collapse
|
35
|
|
36
|
Ziebland S, Thorogood M, Yudkin P, Jones L, Coulter A. Lack of willpower or lack of wherewithal? "Internal" and "external" barriers to changing diet and exercise in a three year follow-up of participants in a health check. Soc Sci Med 1998; 46:461-5. [PMID: 9460826 DOI: 10.1016/s0277-9536(97)00190-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [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: 02/06/2023]
Abstract
The aims of this paper were to assess whether anticipated barriers to change in diet and exercise which were cited before a health check intervention were related to subsequent behaviour changes. In 1989 a health and lifestyle questionnaire was posted to 17,965 people aged 35-64 who were registered with five general practices in Bedfordshire. Taking account of non-contacts, a response rate of 80.3% was achieved and 11,090 people described their exercise and dietary habits. Those expressing an interest in changing each behaviour were asked to identify reasons why change might be difficult. Two types of barriers--"internal" and "external"--were identified. A total of 2205 respondents were invited to attend a health check in Year One and a recheck three years later and 1660 attended. In this subgroup improvement in exercise and diet was examined in relation to the participants' baseline characteristics, including the type of barriers selected. Internal barriers to change (e.g. lack of willpower, too lazy, too busy) were chosen most frequently. In a logistic regression including a range of baseline variables those who selected only internal barriers were less likely to take more exercise (OR 0.59, 95% CI 0.41, 0.86) than those who cited only external (e.g. no transport, can't afford sports facilities) or mixed barriers to changing. There was a similar but not statistically significant trend for changing diet (OR 0.78, 95% CI 0.48, 1.28). Those who are aware of external limitations may be better placed to circumvent them. Further research is needed to explore this relationship between type of barrier and behaviour change.
Collapse
Affiliation(s)
- S Ziebland
- ICRF General Practice Research Group, University of Oxford Department of Public Health & Primary Care, Radcliffe Infirmary, U.K
| | | | | | | | | |
Collapse
|
37
|
Abstract
The traditional style of medical decision-making in which doctors take sole responsibility for treatment decisions is being challenged. Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources. This article examines the evidence for and against these claims. There is considerable evidence that patients want more information and greater involvement, although knowledge about the circumstances in which shared decision-making should be encouraged, and the effects of doing so, is sparse. There is an urgent need for more research into patients' information needs and preferences and for the development and evaluation of decision-support mechanisms to enable patients to become informed participants in treatment decisions.
Collapse
Affiliation(s)
- A Coulter
- King's Fund Development Centre, London, UK
| |
Collapse
|
38
|
|
39
|
Coulter A, Sheldon T. The need for systematic reviews in the treatment of menstrual disorders--another Cochrane collaborative review group is born. Br J Obstet Gynaecol 1997; 104:271. [PMID: 9070157] [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: 02/03/2023]
|
40
|
Lawrence K, McWhinnie D, Jenkinson C, Coulter A. Quality of life in patients undergoing inguinal hernia repair. Ann R Coll Surg Engl 1997; 79:40-5. [PMID: 9038494 PMCID: PMC2502599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Inguinal hernia repair is one of the most common surgical procedures undertaken in the NHS. Despite this, no previous work has examined quality of life in this patient group. This study examines quality of life preoperatively and at 3 and 6 months postoperatively in 140 patients undergoing inguinal hernia repair in the context of a randomised controlled trial of laparoscopic versus open hernia repair. Surgery was undertaken on a day case basis, and quality of life was assessed using the Short Form 36 (SF36). In the initial phase of the study, 57% of those screened for suitability met the study inclusion criteria and were randomised. No significant differences were found between laparoscopic and open hernia repair in terms of quality of life at 3 and 6 months postoperatively. No difference was found between 3 and 6 month scores, suggesting that patients had already made a good recovery by 3 months. A significant improvement was found between preoperative and postoperative scores, with the greatest change arising on dimensions assessing pain, physical function, and role limitation owing to physical restriction. After standardising for age, sex, and social class, a comparison of the hernia patients to population norms for the SF36 was consistent with improvement from preoperative to postoperative assessment. This study has demonstrated the improvement in quality of life in patients undergoing elective inguinal hernia repair by experienced surgeons on a day case basis. It has also demonstrated the feasibility of assessing quality of life using generic measures in this patient group. Further work in this area is required. Ultimately, the priority given to elective inguinal hernia repair will depend on how the demonstrated benefits compare with those derived from other elective surgical procedures.
Collapse
Affiliation(s)
- K Lawrence
- Department of Public Health and Primary Care, University of Oxford
| | | | | | | |
Collapse
|
41
|
Jenkinson C, Layte R, Coulter A, Wright L. Evidence for the sensitivity of the SF-36 health status measure to inequalities in health: results from the Oxford healthy lifestyles survey. J Epidemiol Community Health 1996; 50:377-80. [PMID: 8935473 PMCID: PMC1060298 DOI: 10.1136/jech.50.3.377] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [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: 02/03/2023]
Abstract
OBJECTIVES The short form 36 (SF-36) health questionnaire may not be appropriate for population surveys assessing health gain because of the low responsiveness (sensitivity to change) of domains on the measure. An hypothesised health gain of respondents in social class V to that of those in social class I indicated only marginal improvement in self reported health. Subgroup analysis, however, showed that the SF-36 would indicate dramatic changes if the health of social class V could be improved to that of social class I. DESIGN Postal survey using a questionnaire booklet containing the SF-36 and a number of other items concerned with lifestyles and illness. A letter outlining the purpose of the study was included. SETTING The sample was drawn from family health services authority (FHSA) computerised registers for Berkshire, Buckinghamshire, Northamptonshire, and Oxfordshire. SAMPLE The questionnaire was sent to 13,042 randomly selected subjects between the ages of 17-65. Altogether 9332 (72%) responded. OUTCOME MEASURES Scores for the eight dimensions of the SF-36. STATISTICS The sensitivity of the SF-36 was tested by hypothesising that the scores of those in the bottom quartile of the SF-36 scores in class V could be improved to the level of the scores from the bottom quartile of SF-36 scores in class I using the effect size statistic. RESULTS SF-36 scores for the population at the 25th, 50th, and 75th centiles were provided. Those who reported worse health on each dimension of the SF-36 (ie in the lowest 25% of scores) differ dramatically between social class I and V. Large effect sizes were gained on all but one dimension of the SF-36 when the health of those in the bottom quartile of the SF-36 scores in class V were hypothesised to have improved to the level of the scores from the bottom quartile of SF-36 scores in class I. CONCLUSIONS Analysis of SF-36 data at a population level is inappropriate; subgroup analysis is more appropriate. The data suggest that if it were possible to improve the functioning and wellbeing of those in worst health in class V to those reporting the worst health in class I the improvement would be dramatic. Furthermore, differences between the classes detected by the SF-36 are substantial and more dramatic than might previously have been imagined.
Collapse
Affiliation(s)
- C Jenkinson
- Health Services Research Unit, University of Oxford
| | | | | | | |
Collapse
|
42
|
Abstract
A primary care-led health service is the latest fashion in health policy, yet there is no consensus on what this means. One manifestation of this policy is the attempt to shift the balance of resources from secondary to primary care, with the goal of improving the cost-effectiveness of health care. This has been taken furthest in the UK, where GP fundholders have been given resources to purchase a significant proportion of their patients' health care. The scheme provides incentives to shift the location of care out of hospitals, but there is very little evidence that this will result in better quality patient care at lower cost.
Collapse
Affiliation(s)
- A Coulter
- King's Fund Development Centre, London, UK
| |
Collapse
|
43
|
Stewart-Brown S, Surender R, Doll H, Bradlow J, Coulter A. Authors' reply. West J Med 1996. [DOI: 10.1136/bmj.312.7034.848b] [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: 11/03/2022]
|
44
|
Jenkinson C, Peto V, Coulter A. Making sense of ambiguity: evaluation in internal reliability and face validity of the SF 36 questionnaire in women presenting with menorrhagia. Qual Health Care 1996; 5:9-12. [PMID: 10157276 PMCID: PMC1055348 DOI: 10.1136/qshc.5.1.9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [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: 11/03/2022]
Abstract
OBJECTIVE To determine the face validity and internal reliability of the short form 36 (SF 36) health survey questionnaire in women presenting with menorrhagia. DESIGN Postal survey of women recruited by their general practitioners followed by interviews of a selected subsample. PATIENTS 348 women who had consulted their general practitioner with excessive menstrual bleeding and completed questionnaires after treatment. 49 women selected from this group were interviewed in depth about their health status, and requested to complete the SF 36 questionnaire. MAIN MEASURES Subjective accounts of functioning and wellbeing as measured by the eight scales of the SF 36 questionnaire. RESULTS Data from the postal survey indicated that the ¿general health perceptions¿ and ¿mental health¿ scales of the SF 36 questionnaire had lower internal reliability coefficients than documented elsewhere. In the follow up interviews several questions on the SF 36 questionnaire were commented on as inappropriate or difficult to answer for patients with heavy menstrual bleeding. CONCLUSIONS Some questions on the SF 36 questionnaire were difficult to answer for this group of patients. Such problems can adversely effect the validity of the measure. It is suggested that comments of patients upon measures such as the SF 36 questionnaire could both determine the appropriateness of such measures for given studies and influence questionnaire design.
Collapse
Affiliation(s)
- C Jenkinson
- University of Oxford, Department of Public Health and Primary Care, UK
| | | | | |
Collapse
|
45
|
Coulter A, Bradlow J, Stewart-Brown S, Doll H. Authors' reply. West J Med 1996. [DOI: 10.1136/bmj.312.7028.445b] [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: 11/04/2022]
|
46
|
Stewart-Brown S, Surender R, Bradlow J, Coulter A, Doll H. The effects of fundholding in general practice on prescribing habits three years after introduction of the scheme. BMJ 1995; 311:1543-7. [PMID: 8520399 PMCID: PMC2548182 DOI: 10.1136/bmj.311.7019.1543] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To observe changes in prescribing practice that occurred after the introduction of fundholding in first wave practices and to contrast these with changes occurring in similar non-fundholding practices. DESIGN Prospective observational study. SETTING Oxford region fundholding study. SUBJECTS Eight first wave fundholding practices and five practices that were not interested in fundholding in 1990-1, which were similar in terms of practice size, training status, locality, and urban rural mix. Three of the fundholding and none of the non-fundholding practices were dispensing practices. MAIN OUTCOME MEASURES Changes in prescribing practice as measured by net cost per prescribing unit, cost per item, number of items prescribed, and substitution rates for generic drugs three years after the introduction of fundholding. Data for fundholding practices were analysed separately according to whether they were dispensing or non-dispensing practices. RESULTS Prescribing costs rose by a third or more in all types of practice. The patterns of change observed in this cohort after one year of fundholding were reversed. No evidence existed that fundholding had controlled prescribing costs among non-dispensing fundholders; costs among dispensing fundholders rose least, but the differences were small compared with the overall increase in costs. CONCLUSIONS Early reports of the effectiveness of fundholding in curbing prescribing costs have not been confirmed in this longer term study.
Collapse
Affiliation(s)
- S Stewart-Brown
- Department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary
| | | | | | | | | |
Collapse
|
47
|
|
48
|
Abstract
Our objective was to assess the acceptability of using an interactive video system in a general practice setting to inform patients about treatment choices. A descriptive cohort study was carried out in eight general practices in Oxfordshire. Fifty-four patients with mild hypertension and 29 with benign prostatic hypertrophy were studied. Patients' views of the video, treatment preference, level of involvement in treatment decision and satisfaction with decision-making process and GPs' views of the effect of the video on subsequent consultations were measured. Both patients and GPs reported favourable impressions of the interactive video system: 71% of patients said it definitely helped with their treatment decision; GPs said they found the video helpful in 82% of cases. The results of this pilot study were sufficiently encouraging to indicate the need for a randomized controlled trial to evaluate the impact of the video on the doctor-patient relationship, on subsequent treatment decisions and on health outcomes and patients' well-being.
Collapse
Affiliation(s)
- S Shepperd
- Department of Public Health and Primary Care, University of Oxford, UK
| | | | | |
Collapse
|
49
|
Coulter A, Bradlow J. Critique of fundholding study contained errors. BMJ 1995; 311:1439. [PMID: 8520311 PMCID: PMC2544415 DOI: 10.1136/bmj.311.7017.1439a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
50
|
Surender R, Bradlow J, Coulter A, Doll H, Brown SS. Prospective study of trends in referral patterns in fundholding and non-fundholding practices in the Oxford region, 1990-4. BMJ 1995; 311:1205-8. [PMID: 7488902 PMCID: PMC2551123 DOI: 10.1136/bmj.311.7014.1205] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare outpatient referral patterns in fundholding and non-fundholding practices before and after the NHS reforms in April 1991. DESIGN Prospective collection of data on general practitioners' referrals to specialist outpatient clinics between June 1990 and January 1994 and detailed comparisons of three phases--October 1990 to March 1991 (phase 1), October 1991 to March 1992 (phase 2), and October 1993 to January 1994 (phase 3). SETTING 10 first wave fundholding practices and six non-fundholding practices in the Oxford region. SUBJECTS Patients referred to consultant out-patient clinics. RESULTS NHS referral rates increased in fundholding practices in phase 2 and phase 3 of the study by 8.1/1000 patients a year (95% confidence interval 5.7 to 10.5), an increase of 7.5% from phase 1 (107.3/1000) to phase 3 (115.4/1000). Non-fundholders' rates increased significantly, by 25.3/1000 patients (22.5-28.1), an increase of 26.6% from phase 1 (95.0/1000) to phase 3 (120.3/1000). The fundholders' referral rates to private clinics decreased by 8.8%, whereas those from non-fundholding practices increased by 12.2%. The proportion of referrals going outside district boundaries did not change significantly. Three of the four practices entering the third and fourth wave of fundholding increased their referral rates significantly in the year before becoming fundholders. CONCLUSIONS No evidence existed that budgetary pressures caused first wave fundholders to reduce referral rates, although the method of budget allocation may have encouraged general practitioners to inflate their referral rates in the preparatory year. Despite investment in new practice based facilities, no evidence yet exists that fundholding encourages a shift away from specialist care.
Collapse
Affiliation(s)
- R Surender
- Department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary
| | | | | | | | | |
Collapse
|