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Kamarajah SK, Maclennan G, Pandanaboyana S. Complexity of Trials on Pain Management in Acute Pancreatitis: An Ongoing Challenge. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00353-7. [PMID: 38631595 DOI: 10.1016/j.cgh.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Sivesh K Kamarajah
- Department of Global Health and Surgery, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Graeme Maclennan
- The Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Sanjay Pandanaboyana
- Hepato-Pancreatico-Biliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
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King AJ, Hudson J, Azuara-Blanco A, Kirwan JF, Goyal S, Lim KS, Maclennan G. Effects of socioeconomic status on baseline values and outcomes at 24 months in the Treatment of Advanced Glaucoma Study randomised controlled Trial. Br J Ophthalmol 2024; 108:203-210. [PMID: 36596663 DOI: 10.1136/bjo-2022-321922] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIMS Socioeconomic status (SES) is associated with late disease presentation and poorer outcomes. We evaluate the effect of SES on treatment outcomes and report the correlation between SES and baseline characteristics of participants in the Treatment of Advanced Glaucoma Study. METHODS Pragmatic multicentre randomised controlled trial. Four hundred and fifty-three patients presenting with advanced open-angle glaucoma in at least one eye (Hodapp-Parrish-Anderson classification). Participants were randomised to either glaucoma drops (medical arm) or trabeculectomy (surgery arm). Clinical characteristics, Quality of life measurement (QoL) and SES defined by the Index of Multiple Deprivation are reported. Subgroup analysis explored treatment effect modifications of SES at 24 months. Correlation between SES and baseline characteristics was tested with the χ2 test of association for dichotomous variables and pairwise Pearson's correlation for continuous variables. RESULTS The mean visual field mean deviation was -17.2 (6.7)dB for the most deprived quintile of participants and -13.0 (5.5) for the least deprived quintile in the index eye. At diagnosis, there was a strong correlation between SES and ethnicity, age, extent of visual field loss and number of visits to opticians prior to diagnosis. At 24 months, there was no evidence that the treatment effect was moderated by SES. CONCLUSIONS In patients presenting with advanced glaucoma. SES at baseline is correlated with poorer visual function, poorer Visual Function Questionnaire-25 QoL, ethnicity, age and number visits to an optician in the years preceding diagnosis. SES at baseline does not have an effect of the success of treatment at 24 months. TRIAL REGISTRATION NUMBER ISRCTN56878850.
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Affiliation(s)
- Anthony J King
- Departament of Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - James F Kirwan
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | - Saurabh Goyal
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kin Sheng Lim
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Graeme Maclennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Murchie P, Constable L, Hall S, Brant W, Allan J, Johnston M, Masthoff J, Lee A, Treweek S, Ayansina D, Proby C, Rahman K, Walter F, Burrows N, Durrani A, Maclennan G. The Achieving Self-directed Integrated Cancer Aftercare Intervention for Detection of Recurrent and Second Primary Melanoma in Survivors of Melanoma: Pilot Randomized Controlled Trial. JMIR Cancer 2022; 8:e37539. [PMID: 36074560 PMCID: PMC9501683 DOI: 10.2196/37539] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Melanoma is common with increasing incidence. Guidelines recommend monthly total skin self-examinations (TSSEs) by survivors to detect recurrent and new primary melanomas. TSSE is underperformed despite evidence of benefit. OBJECTIVE This study compares the effect on psychological well-being and TSSE practice of a self-directed digital intervention with treatment as usual in patients treated for a first stage 0 to IIC primary cutaneous melanoma within the preceding 60 months. METHODS This randomized clinical trial was conducted at 2 UK National Health Service hospitals (Aberdeen Royal Infirmary, Grampian, and Addenbrooke's, Cambridge). Adults (≥18 years) diagnosed with a first 0 to IIC primary cutaneous melanoma were randomized to receive Achieving Self-directed Integrated Cancer Aftercare (ASICA), a tablet-based intervention prompting and supporting TSSE in survivors of melanoma, or to usual care. The hypothesis was that ASICA would increase TSSE practice in users affected by melanoma and compared with controls without affecting psychological well-being. The main primary outcomes were melanoma worry (Melanoma Worry Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and quality of life (EQ-5D-5L) as well as secondary outcomes collected using postal questionnaires 3, 6, and 12 months following randomization. RESULTS A total of 240 recruits were randomized (1:1) into the ASICA (n=121, 50.4%) or control (n=119, 49.6%) groups. There were no significant differences between groups for melanoma worry at 12 months (mean difference: 0.12, 95% CI -0.6 to 0.84; P=.74), 3 months (0.23, 95% CI -0.31 to 0.78; P=.40), or 6 months (-0.1, 95% CI -0.7 to 0.51; P=.76). The ASICA group had lower anxiety scores at 12 months (-0.54, 95% CI -1.31 to 0.230; P=.17), 3 months (-0.13, 95% CI -0.79 to 0.54; P=.71), and significantly at 6 months (-1.00, 95% CI -1.74 to -0.26; P=.009). Depression scores were similar, being lower at 12 months (-0.44, 95% CI -1.11 to 0.23; P=.20) and 3 months (-0.24, 95% CI -0.84 to 0.35; P=.42) but only significantly lower at 6 months (-0.77, 95% CI -1.41 to -0.12; P=.02). The ASICA group had significantly higher quality of life scores at 12 months (0.044, 95% CI 0.003-0.085; P=.04) and 6 months (0.070, 95% CI 0.032-0.107; P<.001) and nonsignificantly at 3 months (0.024, 95% CI -0.006 to 0.054; P=.11). ASICA users reported significantly more regular (>5) TSSEs during the study year and significantly higher levels of self-efficacy in conducting TSSE. They also reported significantly higher levels of planning and intention to perform TSSE in the future. CONCLUSIONS Using ASICA for 12 months does not increase melanoma worry, can reduce anxiety and depression, and may improve quality of life. ASICA has the potential to improve the well-being and vigilance of survivors of melanoma and enable the benefits of regular TSSE. TRIAL REGISTRATION ClinicalTrials.gov NCT03328247; https://clinicaltrials.gov/ct2/show/NCT03328247. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-019-3453-x.
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Affiliation(s)
- Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Lynda Constable
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Susan Hall
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | | | - Julia Allan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Marie Johnston
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Judith Masthoff
- Department of Information and Computing Sciences, Universiteit Utrecht, Utrecht, Netherlands
| | - Amanda Lee
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Shaun Treweek
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Dolapo Ayansina
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Charlotte Proby
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | | | - Fiona Walter
- Wolfson Institute of Preventive Medicine and Institute of Population Health Sciences, London, United Kingdom
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Nigel Burrows
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Amer Durrani
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Graeme Maclennan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Kernohan A, Homer T, Shabaninejad H, King AJ, Hudson J, Fernie G, Azuara-Blanco A, Burr J, Sparrow JM, Garway-Heath D, Barton K, Norrie J, Maclennan G, Vale L. Cost-effectiveness of primary surgical versus primary medical management in the treatment of patients presenting with advanced glaucoma. Br J Ophthalmol 2022; 107:bjophthalmol-2021-320887. [PMID: 35882513 PMCID: PMC10579172 DOI: 10.1136/bjo-2021-320887] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/29/2022] [Indexed: 11/04/2022]
Abstract
SYNOPSIS Advanced glaucoma is associated with sight loss. This within-trial economic evaluation compares medical and surgical management strategies. At 2 years, medication appears more cost-effective though longitudinal outcomes are an important subject in future research. BACKGROUND/AIMS Open angle glaucoma (OAG) is a progressive optic neuropathy. Approximately 25% of newly diagnosed patients with OAG present with advanced disease in at least one eye. The vision loss associated with OAG can lead to significant impacts on vision, quality of life and health care resources. The Treatment of Advanced Glaucoma Study is a randomised controlled trial comparing the effectiveness of primary surgical and medical management for newly diagnosed advanced patients with OAG. An economic evaluation was carried out to understand the costs and benefits of each strategy. METHODS A cost utility analysis was carried out from a National Health Service perspective over a 2-year time horizon inclusive of patient costs. The primary outcome was patient health-related quality of life measured by the EQ-5D-5L, Health Utilities Index 3 (HUI3) and Glaucoma Utility Index (GUI). Results were expressed as incremental cost per QALY gained. RESULTS Trabeculectomy was associated with higher costs and greater effect, the EQ-5D-5L results have an incremental cost per QALY of £45,456. The likelihood of surgery being cost-effective at a £20, 000, £30,000 and £50,000 QALY threshold is 0%, 12% and 56%, respectively. The results for the HUI3, GUI and inclusion of patient costs do not change the conclusions of the study. CONCLUSION This is the first study to evaluate management strategies for those presenting with advanced glaucoma. At a 2-year time horizon, medication is the more cost-effective approach for managing glaucoma. Future research can focus on the costs and benefits of the treatments over a longer time horizon.
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Affiliation(s)
- Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hosein Shabaninejad
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anthony J King
- Department of Ophthalmology, Nottingham University Hospital, Nottingham, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gordon Fernie
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Jennifer Burr
- School of Medicine, University of St Andrews, St Andrews, UK
| | - John M Sparrow
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - David Garway-Heath
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Keith Barton
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Graeme Maclennan
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- NIHR Applied Research Collaboration North East and North Cumbria, NIHR, Newcastle, UK
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Dasgupta R, Cameron S, Aucott L, Maclennan G, Thomas R, N’dow J, Norrie J, Anson K, Keeley F, Maclennan S, Starr K, Mcclinton S. TISU (Therepeutic Intervention for Stones in the Ureter): ESWL versus Ureteroscopy, a multicentre RCT. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00660-6] [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: 12/01/2022]
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Emerson P, Green DR, Stott S, Maclennan G, Campbell MK, Jansen JO. Equity of access to critical care services in Scotland: A Bayesian spatial analysis. J Intensive Care Soc 2020; 22:127-135. [PMID: 34025752 DOI: 10.1177/1751143720914462] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background There is increasing evidence that access to critical care services is not equitable. We aimed to investigate whether location of residence in Scotland impacts on the risk of admission to an Intensive Care Unit and on outcomes. Methods This was a population-based Bayesian spatial analysis of adult patients admitted to Intensive Care Units in Scotland between January 2011 and December 2015. We used a Besag-York-Mollié model that allows us to make direct probabilistic comparisons between areas regarding risk of admission to Intensive Care Units and on outcomes. Results A total of 17,596 patients were included. The five-year age- and sex-standardised admission rate was 352 per 100,000 residents. There was a cluster of Council Areas in the North-East of the country which had lower adjusted admission rates than the Scottish average. Midlothian, in South East Scotland had higher spatially adjusted admission rates than the Scottish average. There was no evidence of geographical variation in mortality. Conclusion Access to critical care services in Scotland varies with location of residence. Possible reasons include differential co-morbidity burden, service provision and access to critical care services. In contrast, the probability of surviving an Intensive Care Unit admission, if admitted, does not show geographical variation.
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Affiliation(s)
| | - David R Green
- Department of Geography and Environment, University of Aberdeen, Aberdeen, UK
| | - Steve Stott
- Department of Critical Care Medicine, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Graeme Maclennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Jan O Jansen
- Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, USA
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Ye Y, Schreurs N, Johnson P, Corner-Thomas R, Agnew M, Silcock P, Eyres G, Maclennan G, Realini C. Carcass characteristics and meat quality of commercial lambs reared in different forage systems. Livest Sci 2020. [DOI: 10.1016/j.livsci.2019.103908] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tandogdu Z, Lewis R, Duncan A, Penegar S, McDonald A, Vale L, Shen J, Kelly JD, Pickard R, N Dow J, Ramsay C, Mostafid H, Mariappan P, Nabi G, Creswell J, Lazarowicz H, McGrath J, Taylor E, Clark E, Maclennan G, Norrie J, Hall E, Heer R. Photodynamic versus white light-guided treatment of non-muscle invasive bladder cancer: a study protocol for a randomised trial of clinical and cost-effectiveness. BMJ Open 2019; 9:e022268. [PMID: 31481549 PMCID: PMC6731798 DOI: 10.1136/bmjopen-2018-022268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Bladder cancer is the most frequently occurring tumour of the urinary system. Ta, T1 tumours and carcinoma in situ (CIS) are grouped as non-muscle invasive bladder cancer (NMIBC), which can be effectively treated by transurethral resection of bladder tumour (TURBT). There are limitations to the visualisation of tumours with conventional TURBT using white light illumination within the bladder. Incomplete resections occur from the failure to identify satellite lesions or the full extent of the tumour leading to recurrence and potential risk of disease progression. To improve complete resection, photodynamic diagnosis (PDD) has been proposed as a method that can enhance tumour detection and guide resection. The objective of the current research is to determine whether PDD-guided TURBT is better than conventional white light surgery and whether it is cost-effective. METHODS AND ANALYSIS PHOTO is a pragmatic multicentre randomised controlled trial (open parallel group, non-masked and superiority trial) comparing the intervention of PDD-guided TURBT with standard white light resection in newly diagnosed intermediate and high risk NMIBC within the UK National Health Service setting. Clinical effectiveness is measured with time to recurrence. Cost-effectiveness is assessed within trial via the calculation of incremental cost per recurrence avoided and incremental cost per quality-adjusted life per year gained over 3 years and over long term through a modelling exercise over patients' lifetime. ETHICS AND DISSEMINATION Formal ethics review was undertaken with a favourable opinion, in line with UK regulatory procedures (REC reference number: 14/NE/1062). If reductions in time to recurrence is associated with long-term patient benefits, the cost-effectiveness evaluation will provide further evidence to inform adoption of the technology. Findings will be shared in lay media such as patient and charity forums and will be presented at key meetings and published in academic literature.Trial registration number ISRCTN84013636.
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Affiliation(s)
- Zafer Tandogdu
- Urology, Northern Institute for Cancer Research, Newcastle upon Tyne, UK
| | - Rebecca Lewis
- Urology and Head and Neck Trials Team, Institute of Cancer Research, London, UK
| | - Anne Duncan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Steven Penegar
- Urology and Head and Neck Trials Team, Institute of Cancer Research, London, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Jing Shen
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - John D Kelly
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Robert Pickard
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - James N Dow
- Department of Surgery, University of Aberdeen, Aberdeen, UK
| | - Craig Ramsay
- Health Service Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hugh Mostafid
- Urology, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | | | - Ghulam Nabi
- Department of Medicine, University of Dundee, Dundee, UK
| | - Joanne Creswell
- Urology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Henry Lazarowicz
- Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Emma Clark
- Urology, Northern Institute for Cancer Research, Newcastle upon Tyne, UK
| | - Graeme Maclennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Emma Hall
- Urology and Head and Neck Trials Team, The Institute of Cancer Research, London, UK
| | - Rakesh Heer
- Urology, Northern Institute for Cancer Research, Newcastle upon Tyne, UK
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Norman JE, Norrie J, Maclennan G, Cooper D, Whyte S, Cunningham Burley S, Smith JBE, Shennan A, Robson SC, Thornton S, Kilby MD, Marlow N, Stock SJ, Bennett PR, Denton J. Open randomised trial of the (Arabin) pessary to prevent preterm birth in twin pregnancy with health economics and acceptability: STOPPIT-2-a study protocol. BMJ Open 2018; 8:e026430. [PMID: 30530477 PMCID: PMC6286620 DOI: 10.1136/bmjopen-2018-026430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The STOPPIT-2 study aims to determine the clinical utility of the Arabin cervical pessary in preventing preterm birth in women with a twin pregnancy and a short cervix, about which there is current uncertainty. STOPPIT-2 will resolve uncertainty around effectiveness for women with a twin pregnancy and a cervical length of 35 mm or less, define adverse effects, ascertain acceptability and estimate National Health Service costs and savings. METHODS STOPPIT-2 is a pragmatic multicentre open-label randomised controlled trial. Consenting women with twin pregnancy will have an transvaginal ultrasound scan of their cervical length performed between 18+0 and 20+6 weeks' gestation by an accredited practitioner: women with a cervical length of ≤35 mm will be eligible for inclusion in the treatment phase of the study. The intervention by the insertion of the Arabin cervical pessary will be compared with standard treatment (no pessary).The primary outcomes are (obstetric) spontaneous onset of labour for the mother leading to delivery before 34 weeks' gestation and (neonatal) a composite of specific adverse outcomes or death occurring up to the end of the first 4 weeks after the estimated date of delivery to either or both babies.We plan to recruit 500 women in the treatment phase of the study. Assuming a treatment effect of 0.6, and background rates of 35% and 18%, respectively, for each of the primary outcomes, our study has 85% power to detect a difference between the intervention and the control groups. ANALYSIS Data will be analysed on the intention-to-treat principle. ETHICS STOPPIT-2 was approved by the South East Scotland Ethics Committee 02 on 29 August 2014, reference number 14/SS/1031 IRAS ID 159610. DISSEMINATION Peer reviewed journals, presentations at national and international scientific meetings. TRIAL REGISTRATION NUMBER ISRCTN98835694 and NCT02235181.
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Affiliation(s)
- Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Maternal and Fetal Health, University of Edinburgh, Edinburgh, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Graeme Maclennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Sonia Whyte
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Maternal and Fetal Health, University of Edinburgh, Edinburgh, UK
| | | | - Joel B E Smith
- Health Economics Research Centre (HERC), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Shennan
- Tommy's Centre for Maternal and Fetal Health, King's College London, London, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, University of Newcastle, Newcastle, UK
| | - Steven Thornton
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mark D Kilby
- Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust and College of Medical and Dental Science, University of Birmingham, Birmingham, UK
| | - Neil Marlow
- Institute for Women's Health, University College London, London, UK
| | - Sarah J Stock
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Philip R Bennett
- Department of Surgery and Cancer, Imperial College London, London, UK
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Cook JA, Julious SA, Sones W, Hampson LV, Hewitt C, Berlin JA, Ashby D, Emsley R, Fergusson DA, Walters SJ, Wilson ECF, Maclennan G, Stallard N, Rothwell JC, Bland M, Brown L, Ramsay CR, Cook A, Armstrong D, Altman D, Vale LD. DELTA 2 guidance on choosing the target difference and undertaking and reporting the sample size calculation for a randomised controlled trial. Trials 2018; 19:606. [PMID: 30400926 PMCID: PMC6218987 DOI: 10.1186/s13063-018-2884-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/29/2018] [Indexed: 12/29/2022] Open
Abstract
Background A key step in the design of a RCT is the estimation of the number of participants needed in the study. The most common approach is to specify a target difference between the treatments for the primary outcome and then calculate the required sample size. The sample size is chosen to ensure that the trial will have a high probability (adequate statistical power) of detecting a target difference between the treatments should one exist. The sample size has many implications for the conduct and interpretation of the study. Despite the critical role that the target difference has in the design of a RCT, the way in which it is determined has received little attention. In this article, we summarise the key considerations and messages from new guidance for researchers and funders on specifying the target difference, and undertaking and reporting a RCT sample size calculation. This article on choosing the target difference for a randomised controlled trial (RCT) and undertaking and reporting the sample size calculation has been dual published in the BMJ and BMC Trials journals Methods The DELTA2 (Difference ELicitation in TriAls) project comprised five major components: systematic literature reviews of recent methodological developments (stage 1) and existing funder guidance (stage 2); a Delphi study (stage 3); a two-day consensus meeting bringing together researchers, funders and patient representatives (stage 4); and the preparation and dissemination of a guidance document (stage 5). Results and Discussion The key messages from the DELTA2 guidance on determining the target difference and sample size calculation for a randomised caontrolled trial are presented. Recommendations for the subsequent reporting of the sample size calculation are also provided.
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Affiliation(s)
- Jonathan A Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Rd, Oxford, OX3 7LD, UK.
| | - Steven A Julious
- Medical Statistics Group, ScHARR, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - William Sones
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Rd, Oxford, OX3 7LD, UK
| | - Lisa V Hampson
- Statistical Methodology and Consulting, Novartis, Basel, Switzerland.,Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
| | - Catherine Hewitt
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK
| | - Jesse A Berlin
- Johnson & Johnson, 1125 Trenton-Harbourton Road, Titusville, NJ, 08933, USA
| | - Deborah Ashby
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Stephen J Walters
- Medical Statistics Group, ScHARR, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Edward C F Wilson
- Cambridge Centre for Health Services Research & Cambridge Clinical Trials Unit, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - Graeme Maclennan
- The Centre for Healthcare Randomised Trials (CHaRT), Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2D, UK
| | - Nigel Stallard
- Warwick Medical School - Statistics and Epidemiology, University of Warwick, Coventry, CV4 7AL, UK
| | - Joanne C Rothwell
- Medical Statistics Group, ScHARR, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Martin Bland
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK
| | - Louise Brown
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London, WC1V 6LJ, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Health Sciences Building Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Andrew Cook
- Public Health Medicine and Fellow in Health Technology Assessment, Wessex Institute, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK
| | - David Armstrong
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, Kings College London, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Doug Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Rd, Oxford, OX3 7LD, UK
| | - Luke D Vale
- Health Economics Group, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
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11
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Cook JA, Julious SA, Sones W, Hampson LV, Hewitt C, Berlin JA, Ashby D, Emsley R, Fergusson DA, Walters SJ, Wilson ECF, Maclennan G, Stallard N, Rothwell JC, Bland M, Brown L, Ramsay CR, Cook A, Armstrong D, Altman D, Vale LD. DELTA 2 guidance on choosing the target difference and undertaking and reporting the sample size calculation for a randomised controlled trial. Trials 2018. [PMID: 30400926 DOI: 10.1186/s13063‐018‐2884‐0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A key step in the design of a RCT is the estimation of the number of participants needed in the study. The most common approach is to specify a target difference between the treatments for the primary outcome and then calculate the required sample size. The sample size is chosen to ensure that the trial will have a high probability (adequate statistical power) of detecting a target difference between the treatments should one exist. The sample size has many implications for the conduct and interpretation of the study. Despite the critical role that the target difference has in the design of a RCT, the way in which it is determined has received little attention. In this article, we summarise the key considerations and messages from new guidance for researchers and funders on specifying the target difference, and undertaking and reporting a RCT sample size calculation. This article on choosing the target difference for a randomised controlled trial (RCT) and undertaking and reporting the sample size calculation has been dual published in the BMJ and BMC Trials journals METHODS: The DELTA2 (Difference ELicitation in TriAls) project comprised five major components: systematic literature reviews of recent methodological developments (stage 1) and existing funder guidance (stage 2); a Delphi study (stage 3); a two-day consensus meeting bringing together researchers, funders and patient representatives (stage 4); and the preparation and dissemination of a guidance document (stage 5). RESULTS AND DISCUSSION The key messages from the DELTA2 guidance on determining the target difference and sample size calculation for a randomised caontrolled trial are presented. Recommendations for the subsequent reporting of the sample size calculation are also provided.
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Affiliation(s)
- Jonathan A Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Rd, Oxford, OX3 7LD, UK.
| | - Steven A Julious
- Medical Statistics Group, ScHARR, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - William Sones
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Rd, Oxford, OX3 7LD, UK
| | - Lisa V Hampson
- Statistical Methodology and Consulting, Novartis, Basel, Switzerland.,Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
| | - Catherine Hewitt
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK
| | - Jesse A Berlin
- Johnson & Johnson, 1125 Trenton-Harbourton Road, Titusville, NJ, 08933, USA
| | - Deborah Ashby
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Stephen J Walters
- Medical Statistics Group, ScHARR, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Edward C F Wilson
- Cambridge Centre for Health Services Research & Cambridge Clinical Trials Unit, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - Graeme Maclennan
- The Centre for Healthcare Randomised Trials (CHaRT), Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2D, UK
| | - Nigel Stallard
- Warwick Medical School - Statistics and Epidemiology, University of Warwick, Coventry, CV4 7AL, UK
| | - Joanne C Rothwell
- Medical Statistics Group, ScHARR, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Martin Bland
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK
| | - Louise Brown
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London, WC1V 6LJ, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Health Sciences Building Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Andrew Cook
- Public Health Medicine and Fellow in Health Technology Assessment, Wessex Institute, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK
| | - David Armstrong
- School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, Kings College London, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - Doug Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Rd, Oxford, OX3 7LD, UK
| | - Luke D Vale
- Health Economics Group, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
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12
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Craigie CR, Johnson PL, Shorten PR, Charteris A, Maclennan G, Tate ML, Agnew MP, Taukiri KR, Stuart AD, Reis MM. Application of Hyperspectral imaging to predict the pH, intramuscular fatty acid content and composition of lamb M. longissimus lumborum at 24h post mortem. Meat Sci 2017; 132:19-28. [PMID: 28551294 DOI: 10.1016/j.meatsci.2017.04.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 02/09/2017] [Revised: 04/12/2017] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
Abstract
Cost-effective, rapid and objective measurement of lamb quality on a routine basis is an important step for lamb value chains wishing to manage lamb product quality. Hyperspectral imaging (HSI) technology has shown promise as a solution for objective non-invasive prediction of meat quality. The performance of HSI applied 24h post mortem to lamb M. longissimus lumborum (LL) within a processing plant environment was assessed over two sampling years to evaluate its suitability for an objective lamb meat quality assurance tool. Calibration and validation steps were undertaken to evaluate HSI prediction performance for predicting fatty acid content and composition (n=1020 lambs) and pH (n=2406 lambs). Practical considerations of reference meat quality data quality and validation strategies are discussed. HSI can be used to predict meat quality parameters of lamb LL with varying accuracy levels, but ongoing calibration and validation across seasons is required to improve robustness of HSI for objective non-invasive assessment of lamb meat quality.
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Affiliation(s)
- C R Craigie
- AgReserach Food and Bio-based products group, Ruakura Research Centre, 10 Bisley Road, Hamilton 3214, New Zealand.
| | - P L Johnson
- AgReserach Animal Science group, Invermay Agricultural Centre, Puddle Alley, Mosgiel 9092, New Zealand
| | - P R Shorten
- AgReserach Farm Systems and Environment group, Ruakura Research Centre, 10 Bisley Road, Hamilton 3214, New Zealand; Riddet Institute, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand
| | - A Charteris
- Aimee Charteris Genetics Limited, Napier 4140, New Zealand
| | - G Maclennan
- Alliance Group Limited, 51 Don Street, Invercargill 9810, New Zealand
| | - M L Tate
- Alliance Group Limited, 51 Don Street, Invercargill 9810, New Zealand
| | - M P Agnew
- AgReserach Food and Bio-based products group, Ruakura Research Centre, 10 Bisley Road, Hamilton 3214, New Zealand
| | - K R Taukiri
- AgReserach Food and Bio-based products group, Ruakura Research Centre, 10 Bisley Road, Hamilton 3214, New Zealand
| | - A D Stuart
- AgReserach Food and Bio-based products group, Ruakura Research Centre, 10 Bisley Road, Hamilton 3214, New Zealand; Alliance Group Limited, 51 Don Street, Invercargill 9810, New Zealand
| | - M M Reis
- AgReserach Food and Bio-based products group, Ruakura Research Centre, 10 Bisley Road, Hamilton 3214, New Zealand
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13
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Abstract
The authors compared three approaches to feedback of clinical audit findings relating to miscarriage in 15 Scottish maternity services (printed report alone; report plus action planning letter; report plus face-to-face facilitated action planning). Clinicians were surveyed to measure theory of planned behavior constructs (in the context of two audit criteria) before and after feedback ( n = 253) and assessed perceptions of the audit through in-depth interviews ( n = 17). Prefeedback, clinicians had positive attitudes and strong subjective norms and intentions to comply, although perceived behavioral control was lower. Generally, positive attitudes, subjective norms, and intentions increased after feedback but for one of the two criteria (providing a 7-day miscarriage service), perceived behavioral control decreased. No changes over time reached statistical significance, and analysis of covariance (adjusting for prefeedback scores) showed no consistent relationships between method of feedback and postfeedback construct scores. Interviews revealed positive perceptions of audit but frustration at lack of capacity to implement changes. Although interventions that increased intensity of feedback proved feasible and acceptable to clinicians, the authors were unable to demonstrate that they increased intention to comply with audit criteria.
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14
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Cook J, Elders A, Boachie C, Bassigna T, Fraser C, Altman D, Boutron I, Ramsay C, Maclennan G. A systematic review of the use of an expertise-based randomised trial design. Trials 2015. [PMCID: PMC4659262 DOI: 10.1186/1745-6215-16-s2-o55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Treweek S, Bonetti D, Maclennan G, Barnett K, Eccles MP, Jones C, Pitts NB, Ricketts IW, Sullivan F, Weal M, Francis JJ. Paper-based and web-based intervention modeling experiments identified the same predictors of general practitioners' antibiotic-prescribing behavior. J Clin Epidemiol 2014; 67:296-304. [PMID: 24388292 DOI: 10.1016/j.jclinepi.2013.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 09/10/2013] [Accepted: 09/24/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the robustness of the intervention modeling experiment (IME) methodology as a way of developing and testing behavioral change interventions before a full-scale trial by replicating an earlier paper-based IME. STUDY DESIGN AND SETTING Web-based questionnaire and clinical scenario study. General practitioners across Scotland were invited to complete the questionnaire and scenarios, which were then used to identify predictors of antibiotic-prescribing behavior. These predictors were compared with the predictors identified in an earlier paper-based IME and used to develop a new intervention. RESULTS Two hundred seventy general practitioners completed the questionnaires and scenarios. The constructs that predicted simulated behavior and intention were attitude, perceived behavioral control, risk perception/anticipated consequences, and self-efficacy, which match the targets identified in the earlier paper-based IME. The choice of persuasive communication as an intervention in the earlier IME was also confirmed. Additionally, a new intervention, an action plan, was developed. CONCLUSION A web-based IME replicated the findings of an earlier paper-based IME, which provides confidence in the IME methodology. The interventions will now be evaluated in the next stage of the IME, a web-based randomized controlled trial.
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| | - Debbie Bonetti
- Dental Health Services Research Unit, University of Dundee, Kirsty Semple Way, Dundee DD2 4BF, UK
| | - Graeme Maclennan
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Karen Barnett
- Centre for Population Health Sciences, University of Edinburgh, Medical Quad, Teviot Place, Edinburgh EH8 9AG, UK
| | - Martin P Eccles
- Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Kirsty Semple Way, Dundee DD2 4BF, UK
| | - Nigel B Pitts
- Dental Institute, Kings College London, Strand, London WC2R 2LS, UK
| | - Ian W Ricketts
- School of Computing, University of Dundee, Queen Mother Building, Dundee DD1 4HN, UK
| | - Frank Sullivan
- Quality, Safety & Informatics Research Group, University of Dundee, Kirsty Semple Way, Dundee DD2 4BF, UK
| | - Mark Weal
- School of Electronics and Computer Science, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - Jill J Francis
- School of Health Sciences, City University London, Northampton Square, London EC1V 0HB, UK
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16
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Kim YHB, Stuart A, Rosenvold K, Maclennan G. Effect of forage and retail packaging types on meat quality of long-term chilled lamb loins. J Anim Sci 2013; 91:5998-6007. [PMID: 24085415 DOI: 10.2527/jas.2013-6780] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objectives of this study were to determine the effects of different forage regimes and modified atmosphere packaging (MAP) systems [high oxygen (HiOx-MAP): 80% O2 and 20% CO2; and CO2-MAP: 20% CO2 and 80% N2] on color and lipid oxidation stability and sensory attributes of long-term chilled lamb loins during retail display. Lambs (n = 124) were randomly assigned to several pasture-feeding regimes for 12 wk before slaughter. Some had ryegrass (n = 18), lucerne (n = 18), chicory (n = 19), plantain (n = 16), or red clover (Clover 12; n = 17) for all 12 wk. Some were assigned a regime of red clover for 11 wk and pasture for 1 wk (Clover 11; n = 18), with others on red clover for 9 wk and pasture for 3 wk (Clover 9; n = 18). After the lambs were slaughtered, the paired loins (M. longissimus dorsi) were excised at 24 h postmortem, vacuum-packed and stored at -1.5 °C for 9 wk. Cuts were then made from each loin and randomly allocated to either HiOx-MAP or CO2-MAP, and displayed for 7 d at 4 °C under light. Chemical attributes including lipid oxidation, surface color-reversing ability, oxygen consumption, and meat quality attributes (color stability and sensory characteristics) were determined. Among the different forage types, the loins from lambs finished on ryegrass appeared to have greater color stability and less lipid oxidation than the loins from lambs finished on other forage types (P < 0.05). On the other hand, the loins from lambs finished on lucerne had the least color and lipid oxidation stabilities and least color-reversing ability (P < 0.05). The loins from lambs finished on chicory had higher aroma and flavor scores than other pasture types in general (P < 0.05). HiOx-MAP negatively influenced meat quality attributes of lamb loins during display, as substantial increases in surface discoloration and lipid oxidation were observed, along with significant decreases in aroma and flavor during retail display compared with the loins in CO2-MAP. These results suggest that different forage types and packaging conditions could result in substantial impacts on meat quality attributes of long-term chilled lamb loins by affecting oxidation stability. Furthermore, the present study suggests that CO2-MAP could provide beneficial effects on the eating quality of long-term chilled lamb loins by suppressing oxidation-related defects during display without compromising the ability of blooming for meat display.
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Affiliation(s)
- Y H B Kim
- AgResearch Ltd., Ruakura Research Centre, Hamilton, New Zealand
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17
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Francis JJ, Duncan EM, Prior ME, Maclennan G, Marshall AP, Wells EC, Todd L, Rose L, Campbell MK, Webster F, Eccles MP, Bellingan G, Seppelt IM, Grimshaw JM, Cuthbertson BH. Comparison of four methods for assessing the importance of attitudinal beliefs: an international Delphi study in intensive care settings. Br J Health Psychol 2013; 19:274-91. [PMID: 24112280 DOI: 10.1111/bjhp.12066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 08/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Behaviour change interventions often target 'important' beliefs. The literature proposes four methods for assessing importance of attitudinal beliefs: elicitation frequency, importance ratings, and strength of prediction (bivariate and multivariate). We tested congruence between these methods in a Delphi study about selective decontamination of the digestive tract (SDD). SDD improves infection rates among critically ill patients, yet uptake in intensive care units is low internationally. METHODS A Delphi study involved three iterations ('rounds'). Participants were 105 intensive care clinicians in the United Kingdom, Canada, and Australia/New Zealand. In Round 1, semi-structured interviews were conducted to elicit beliefs about delivering SDD. In Rounds 2 and 3, participants completed questionnaires, rating agreement and importance for each belief-statement (9-point Likert scales). Belief importance was assessed using elicitation frequency, mean importance ratings, and prediction of global attitude (Pearson's correlations; beta-weights). Correlations between indices were computed. RESULTS Participants generated 14 attitudinal beliefs. Indices had adequate variation (frequencies: 4-94, mean importance ratings: 4.93-8.00, Pearson's correlations: ± 0.09 to ± 0.54, beta-weights: ± 0.01 to ± 0.30). SDD increases antibiotic resistance was the most important belief according to three methods and was ranked second by beta-weights (behind Overall, SDD benefits patients to whom it is delivered). Spearman's correlations were significant for importance ratings with frequencies and correlations. However, other indices were unrelated. The top four beliefs differed according to the measure used. CONCLUSIONS Results provided evidence of congruence across three methods for assessing belief importance. Beta-weights were unrelated to other indices, suggesting that they may not be appropriate as the sole method. STATEMENT OF CONTRIBUTION What is already known on this subject? Attitudinal beliefs (specific beliefs about the consequences of performing an action) are key to designing interventions to change intentions and behaviour. The literature reports four methods for assessing the importance of attitudinal beliefs: frequency of elicitation in interviews, importance ratings in questionnaires, and strength of prediction (bivariate and multivariate) of global attitude scores. The congruence between these measures of importance is not known. What does this study add? Four indices of importance were examined in a multi-professional, international study about the use of selective digestive decontamination to prevent infection in intensive care settings. Three indices were correlated with one another. Each method used to assess importance produced a different subset of the most important beliefs. Selection of the most important beliefs should use multiple assessment methods. This evidence suggests that multiple regression approaches may not be appropriate as the sole method for assessing belief importance.
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Affiliation(s)
- Jill J Francis
- Health Psychology Group, University of Aberdeen, UK; Health Services Research Unit, University of Aberdeen, UK
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Hoddinott P, Craig L, Maclennan G, Boyers D, Vale L. The FEeding Support Team (FEST) randomised, controlled feasibility trial of proactive and reactive telephone support for breastfeeding women living in disadvantaged areas. BMJ Open 2012; 2:e000652. [PMID: 22535790 PMCID: PMC3341594 DOI: 10.1136/bmjopen-2011-000652] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To assess the feasibility of implementing a dedicated feeding support team on a postnatal ward and pilot the potential effectiveness and cost-effectiveness of team (proactive) and woman-initiated (reactive) telephone support after discharge. DESIGN Randomised controlled trial embedded within a before-and-after study. Participatory approach and mixed-method process evaluation. SETTING A postnatal ward in Scotland. SAMPLE Women living in disadvantaged areas initiating breast feeding. METHODS Eligible women were recruited to a before-and-after intervention study, a proportion of whom were independently randomised after hospital discharge to intervention: daily proactive and reactive telephone calls for ≤14 days or control: reactive telephone calls ≤ day 14. Intention-to-treat analysis compared the randomised groups on cases with complete outcomes at follow-up. PRIMARY OUTCOME any breast feeding at 6-8 weeks assessed by a telephone call from a researcher blind to group allocation. SECONDARY OUTCOMES exclusive breast feeding, satisfaction with care, NHS costs and cost per additional woman breast feeding. RESULTS There was no difference in feeding outcomes for women initiating breast feeding before the intervention (n=413) and after (n=388). 69 women were randomised to telephone support: 35 intervention (32 complete cases) and 34 control (26 complete cases). 22 intervention women compared with 12 control women were giving their baby some breast milk (RR 1.49, 95% CI 0.92 to 2.40) and 17 intervention women compared with eight control women were exclusively breast feeding (RR 1.73, 95% CI 0.88 to 3.37) at 6-8 weeks after birth. The incremental cost of providing proactive calls was £87 per additional woman breast feeding and £91 per additional woman exclusively breast feeding at 6-8 weeks; costs were sensitive to service organisation. CONCLUSIONS Proactive telephone care delivered by a dedicated feeding team shows promise as a cost-effective intervention for improving breastfeeding outcomes. Integrating the FEeding Support Team (FEST) intervention into routine postnatal care was feasible. TRIAL REGISTRATION NUMBER ISRCTN27207603. The study protocol and final report are available on request.
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Affiliation(s)
- Pat Hoddinott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Leone Craig
- Public Health Nutrition Research Group, University of Aberdeen, Aberdeen, UK
| | - Graeme Maclennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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19
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Breeman S, Campbell M, Dakin H, Fiddian N, Fitzpatrick R, Grant A, Gray A, Johnston L, Maclennan G, Morris R, Murray D. Patellar resurfacing in total knee replacement: five-year clinical and economic results of a large randomized controlled trial. J Bone Joint Surg Am 2011; 93:1473-81. [PMID: 22204002 DOI: 10.2106/jbjs.j.00725] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is conflicting evidence regarding the merits of patellar resurfacing during total knee arthroplasty, as many of the previous randomized controlled trials have not been adequately powered. METHODS A pragmatic, multicenter, randomized controlled trial was initiated in 1999 in the United Kingdom. Within a partial factorial design, 1715 patients were randomly allocated to receive or not receive patellar resurfacing during total knee arthroplasty. The primary outcome measure was the Oxford Knee Score; secondary measures included the Short Form-12, the EuroQoL 5D, cost, cost-effectiveness, and the need for subsequent knee surgery. RESULTS The mean Oxford Knee Score was 35 points at five years postoperatively in both groups. There was no significant difference between the groups with respect to the mean Oxford Knee Score (difference, 0.59 point; 95% confidence interval, -0.58 to 1.76 points) or any other outcome measure at five years postoperatively. The outcome was not affected by whether the patella was domed or anatomic. There was no significant difference between the two groups with respect to the prevalence of knee-related readmission, of minor or intermediate reoperation, or of subsequent patella-related surgery. The total health care cost for the primary arthroplasty, subsequent monitoring, and any revision surgery did not differ significantly between the two groups. CONCLUSIONS In the largest randomized controlled trial of patellar resurfacing reported to date, the functional outcome, reoperation rate, and total health care cost five years after primary total knee arthroplasty were not significantly affected by the addition of patellar resurfacing to the surgical procedure.
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Affiliation(s)
- Suzanne Breeman
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, United Kingdom
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20
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Robertson C, Ragupathy SKA, Boachie C, Fraser C, Heys SD, Maclennan G, Mowatt G, Thomas RE, Gilbert FJ. Surveillance mammography for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer: a systematic review. Eur Radiol 2011; 21:2484-91. [PMID: 21833567 PMCID: PMC3217137 DOI: 10.1007/s00330-011-2226-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 06/20/2011] [Accepted: 06/26/2011] [Indexed: 12/02/2022]
Abstract
Objectives To determine the diagnostic accuracy of surveillance mammography for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer in women previously treated for primary breast cancer. Methods A systematic review of surveillance mammography compared with ultrasound, magnetic resonance imaging (MRI), specialist-led clinical examination or unstructured primary care follow-up, using histopathological assessment for test positives and follow-up for test negatives as the reference standard. Results Nine studies met our inclusion criteria. Variations in study comparisons precluded meta-analysis. For routine ipsilateral breast tumour detection, surveillance mammography sensitivity ranged from 64–67% and specificity ranged from 85–97%. For MRI, sensitivity ranged from 86–100% and specificity was 93%. For non-routine ipsilateral breast tumour detection, sensitivity and specificity for surveillance mammography ranged from 50–83% and 57–75% and for MRI 93–100% and 88–96%. For routine metachronous contralateral breast cancer detection, one study reported sensitivity of 67% and specificity of 50% for both surveillance mammography and MRI. Conclusion Although mammography is associated with high sensitivity and specificity, MRI is the most accurate test for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer in women previously treated for primary breast cancer. Results should be interpreted with caution because of the limited evidence base. Key Points • Surveillance mammography is associated with high sensitivity and specificity • Findings suggest that MRI is the most accurate test for detecting further breast cancer • Robust conclusions cannot be made due to the limited evidence base • Further research comparing surveillance mammography and other diagnostic tests is required
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Affiliation(s)
- Clare Robertson
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building Foresterhill, Aberdeen, AB25 2ZD, UK.
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21
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Grimshaw JM, Eccles MP, Steen N, Johnston M, Pitts NB, Glidewell L, Maclennan G, Thomas R, Bonetti D, Walker A. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of lumbar spine x-ray for low back pain in UK primary care practice. Implement Sci 2011; 6:55. [PMID: 21619689 PMCID: PMC3125229 DOI: 10.1186/1748-5908-6-55] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 05/28/2011] [Indexed: 11/17/2022] Open
Abstract
Background Psychological models predict behaviour in a wide range of settings. The aim of this study was to explore the usefulness of a range of psychological models to predict the health professional behaviour 'referral for lumbar spine x-ray in patients presenting with low back pain' by UK primary care physicians. Methods Psychological measures were collected by postal questionnaire survey from a random sample of primary care physicians in Scotland and north England. The outcome measures were clinical behaviour (referral rates for lumbar spine x-rays), behavioural simulation (lumbar spine x-ray referral decisions based upon scenarios), and behavioural intention (general intention to refer for lumbar spine x-rays in patients with low back pain). Explanatory variables were the constructs within the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Weinstein's Stage Model termed the Precaution Adoption Process (PAP), and knowledge. For each of the outcome measures, a generalised linear model was used to examine the predictive value of each theory individually. Linear regression was used for the intention and simulation outcomes, and negative binomial regression was used for the behaviour outcome. Following this 'theory level' analysis, a 'cross-theoretical construct' analysis was conducted to investigate the combined predictive value of all individual constructs across theories. Results Constructs from TPB, SCT, CS-SRM, and OLT predicted behaviour; however, the theoretical models did not fit the data well. When predicting behavioural simulation, the proportion of variance explained by individual theories was TPB 11.6%, SCT 12.1%, OLT 8.1%, and II 1.5% of the variance, and in the cross-theory analysis constructs from TPB, CS-SRM and II explained 16.5% of the variance in simulated behaviours. When predicting intention, the proportion of variance explained by individual theories was TPB 25.0%, SCT 21.5%, CS-SRM 11.3%, OLT 26.3%, PAP 2.6%, and knowledge 2.3%, and in the cross-theory analysis constructs from TPB, SCT, CS-SRM, and OLT explained 33.5% variance in intention. Together these results suggest that physicians' beliefs about consequences and beliefs about capabilities are likely determinants of lumbar spine x-ray referrals. Conclusions The study provides evidence that taking a theory-based approach enables the creation of a replicable methodology for identifying factors that predict clinical behaviour. However, a number of conceptual and methodological challenges remain.
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Affiliation(s)
- Jeremy M Grimshaw
- Clinical Epidemiology Programme, Ottawa Health Research Institute and Department of Medicine, University of Ottawa, 1053 Carling Avenue, Administration Building Room 2-017, Ottawa, K1Y 4E9, Canada.
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Bonetti D, Johnston M, Clarkson JE, Grimshaw J, Pitts NB, Eccles M, Steen N, Thomas R, Maclennan G, Glidewell L, Walker A. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of placing preventive fissure sealants. Implement Sci 2010; 5:25. [PMID: 20377849 PMCID: PMC2864198 DOI: 10.1186/1748-5908-5-25] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 04/08/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychological models are used to understand and predict behaviour in a wide range of settings, but have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. This study explored the usefulness of a range of models to predict an evidence-based behaviour -- the placing of fissure sealants. METHODS Measures were collected by postal questionnaire from a random sample of general dental practitioners (GDPs) in Scotland. Outcomes were behavioural simulation (scenario decision-making), and behavioural intention. Predictor variables were from the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model, and knowledge (a non-theoretical construct). Multiple regression analysis was used to examine the predictive value of each theoretical model individually. Significant constructs from all theories were then entered into a 'cross theory' stepwise regression analysis to investigate their combined predictive value. RESULTS Behavioural simulation - theory level variance explained was: TPB 31%; SCT 29%; II 7%; OLT 30%. Neither CS-SRM nor stage explained significant variance. In the cross theory analysis, habit (OLT), timeline acute (CS-SRM), and outcome expectancy (SCT) entered the equation, together explaining 38% of the variance. Behavioural intention - theory level variance explained was: TPB 30%; SCT 24%; OLT 58%, CS-SRM 27%. GDPs in the action stage had significantly higher intention to place fissure sealants. In the cross theory analysis, habit (OLT) and attitude (TPB) entered the equation, together explaining 68% of the variance in intention. SUMMARY The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the creation of a replicable methodology for identifying factors that may predict clinical behaviour and so provide possible targets for knowledge translation interventions. Results suggest that more evidence-based behaviour may be achieved by influencing beliefs about the positive outcomes of placing fissure sealants and building a habit of placing them as part of patient management. However a number of conceptual and methodological challenges remain.
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Affiliation(s)
- Debbie Bonetti
- Dental Health Services Research Unit, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK.
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Fearn P, Avenell A, McCann S, Milne AC, Maclennan G. Factors influencing the participation of older people in clinical trials - data analysis from the MAVIS trial. J Nutr Health Aging 2010; 14:51-6. [PMID: 20082054 DOI: 10.1007/s12603-010-0009-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Older people are less likely to be included in clinical trials. Little is known about factors influencing older people's decisions about participating in clinical trials. OBJECTIVES To examine the views of older people about participating in clinical trials. METHODS Postal questionnaire to 801 participants who had completed the MAVIS nutrition trial, aged 65 yrs and older. Closed and open questions sought participants' views about factors important to them when deciding to take part in a trial, features of the MAVIS trial they liked and disliked and changes they would suggest. RESULTS 540 (59% of MAVIS trial participants) returned the questionnaire. The most important reasons reported for taking part in the trial were helping the research team and medical knowledge, and helping other older people. Participants valued good communication with the trial staff and good organisation. Participants reported concerns about swallowing pills and taking a placebo. Participants reported that future participation in trials could be influenced by poor health status. LIMITATIONS This questionnaire surveyed older participants who had taken part in a randomised controlled trial. It did not elicit the views of people who had withdrawn or never decided to take part in the trial. CONCLUSIONS Older people report altruistic reasons for taking part in trials. Simple trial designs, which minimise demands on participants and maintain good communications should be preferred. Explaining the need for older people, despite poor health, to participate in trials may help the generalisability of clinical trials.
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Affiliation(s)
- P Fearn
- Centre of Academic, Primary Care, University of Aberdeen, Foresterhill Health Centre, Aberdeen, AB25 2AY, UK.
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Robertson C, Langston AL, Stapley S, McColl E, Campbell MK, Fraser WD, Maclennan G, Selby PL, Ralston SH, Fayers PM. Meaning behind measurement: self-comparisons affect responses to health-related quality of life questionnaires. Qual Life Res 2009; 18:221-30. [PMID: 19142744 DOI: 10.1007/s11136-008-9435-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 12/15/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE The subjective nature of quality of life is particularly pertinent to the domain of health-related quality of life (HRQOL) research. The extent to which participants' responses are affected by subjective information and personal reference frames is unknown. This study investigated how an elderly population living with a chronic metabolic bone disorder evaluated self-reported quality of life. METHODS Participants (n = 1,331) in a multi-centre randomised controlled trial for the treatment of Paget's disease completed annual HRQOL questionnaires, including the SF-36, EQ-5D and HAQ. Supplementary questions were added to reveal implicit reference frames used when making HRQOL evaluations. Twenty-one participants (11 male, 10 female, aged 59-91 years) were interviewed retrospectively about their responses to the supplementary questions, using cognitive interviewing techniques and semi-structured topic guides. RESULTS The interviews revealed that participants used complex and interconnected reference frames to promote response shift when making quality of life evaluations. The choice of reference frame often reflected external factors unrelated to individual health. Many participants also stated that they were unclear whether to report general or disease-related HRQOL. CONCLUSIONS It is important, especially in clinical trials, to provide instructions clarifying whether 'quality of life' refers to disease-related HRQOL. Information on self-comparison reference frames is necessary for the interpretation of responses to questions about HRQOL.
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Affiliation(s)
- Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 22D, UK.
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Clarkson JE, Turner S, Grimshaw JM, Ramsay CR, Johnston M, Scott A, Bonetti D, Tilley CJ, Maclennan G, Ibbetson R, Macpherson LMD, Pitts NB. Changing clinicians' behavior: a randomized controlled trial of fees and education. J Dent Res 2008; 87:640-4. [PMID: 18573983 DOI: 10.1177/154405910808700701] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The fissure-sealing of newly erupted molars is an effective caries prevention treatment, but remains underutilized. Two plausible reasons are the financial disincentive produced by the dental remuneration system, and dentists' lack of awareness of evidence-based practice. The primary hypothesis was that implementation strategies based on remuneration or training in evidence-based healthcare would produce a higher proportion of children receiving sealed second permanent molars than standard care. The four study arms were: fee per sealant treatment, education in evidence-based practice, fee plus education, and control. A cost-effectiveness analysis was conducted. Analysis was based on 133 dentists and 2833 children. After adjustment for baseline differences, the primary outcome was 9.8% higher when a fee was offered. The education intervention had no statistically significant effect. 'Fee only' was the most cost-effective intervention. The study contributes to the incentives in health care provision debate, and led to the introduction of a direct fee for this treatment.
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Fielding S, Maclennan G, Cook JA, Ramsay CR. A review of RCTs in four medical journals to assess the use of imputation to overcome missing data in quality of life outcomes. Trials 2008; 9:51. [PMID: 18694492 PMCID: PMC3225816 DOI: 10.1186/1745-6215-9-51] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 08/11/2008] [Indexed: 12/24/2022] Open
Abstract
Background Randomised controlled trials (RCTs) are perceived as the gold-standard method for evaluating healthcare interventions, and increasingly include quality of life (QoL) measures. The observed results are susceptible to bias if a substantial proportion of outcome data are missing. The review aimed to determine whether imputation was used to deal with missing QoL outcomes. Methods A random selection of 285 RCTs published during 2005/6 in the British Medical Journal, Lancet, New England Journal of Medicine and Journal of American Medical Association were identified. Results QoL outcomes were reported in 61 (21%) trials. Six (10%) reported having no missing data, 20 (33%) reported ≤ 10% missing, eleven (18%) 11%–20% missing, and eleven (18%) reported >20% missing. Missingness was unclear in 13 (21%). Missing data were imputed in 19 (31%) of the 61 trials. Imputation was part of the primary analysis in 13 trials, but a sensitivity analysis in six. Last value carried forward was used in 12 trials and multiple imputation in two. Following imputation, the most common analysis method was analysis of covariance (10 trials). Conclusion The majority of studies did not impute missing data and carried out a complete-case analysis. For those studies that did impute missing data, researchers tended to prefer simpler methods of imputation, despite more sophisticated methods being available.
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Affiliation(s)
- Shona Fielding
- Section of Population Health, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
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Langston AL, Johnston M, Francis J, Robertson C, Campbell MK, Entwistle VA, Marteau T, Maclennan G, Weinman J, McCallum M, Miedzybrodska Z, Charnock K, Ralston SH. Protocol for stage 2 of the GaP study (genetic testing acceptability for Paget's disease of bone): a questionnaire study to investigate whether relatives of people with Paget's disease would accept genetic testing and preventive treatment if they were available. BMC Health Serv Res 2008; 8:116. [PMID: 18510762 PMCID: PMC2442429 DOI: 10.1186/1472-6963-8-116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 05/29/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paget's disease of bone (PDB) disrupts normal bone architecture and causes pain, deformity, deafness, osteoarthritis, and fractures. Genetic factors play a role in PDB and genetic tests are now conducted for research purposes. It is thus timely to investigate the potential for a clinical programme of genetic testing and preventative treatment for people who have a family history of PDB. This study examines the beliefs of relatives of people with PDB. It focuses particularly on illness and treatment representations as predictors of the acceptability and uptake of potential clinical programmes. Illness representations are examined using Leventhal's Common Sense Self-Regulation Model while cognitions about treatment behaviours (acceptance of testing and treatment uptake) are conceptualised within the Theory of Planned Behaviour. METHODS/DESIGN A postal questionnaire of non-affected relatives of people with Paget's disease. The sample will include relatives of Paget's patients with a family history of Paget's disease and relatives of Paget's patients without a family history of Paget's disease. The questionnaire will explore whether a range of factors relate to acceptability of a programme of genetic testing and preventive treatment in relatives of Paget's disease sufferers. The questionnaire will include several measures: illness representations (as measured by the Brief Illness Perceptions Questionnaire); treatment representations (as measured by Theory of Planned Behaviour-based question items, informed by a prior interview elicitation study); descriptive and demographic details; and questions exploring family environment and beliefs of other important people. Data will also be collected from family members who have been diagnosed with Paget's disease to describe the disease presentation and its distribution within a family. DISCUSSION The answers to these measures will inform the feasibility of a programme of genetic testing and preventive treatment for individuals who are at a high risk of developing Paget's disease because they carry an appropriate genetic mutation. They will also contribute to theoretical and empirical approaches to predicting diagnostic and treatment behaviours from the combined theoretical models.
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Affiliation(s)
- Anne L Langston
- Edinburgh Clinical Trials Unit, University of Edinburgh, Queens Medical Research Institute, Room E1,16, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
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Azuara-Blanco A, Burr J, Thomas R, Maclennan G, McPherson S. The accuracy of accredited glaucoma optometrists in the diagnosis and treatment recommendation for glaucoma. Br J Ophthalmol 2007; 91:1639-43. [PMID: 17537783 PMCID: PMC2095552 DOI: 10.1136/bjo.2007.119628] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2007] [Indexed: 11/04/2022]
Abstract
AIM To compare the diagnostic performance of accredited glaucoma optometrists (AGO) for both the diagnosis of glaucoma and the decision to treat with that of routine hospital eye care, against a reference standard of expert opinion (a consultant ophthalmologist with a special interest in glaucoma). METHODS A directly comparative, masked, performance study was undertaken in Grampian, Scotland. Of 165 people invited to participate, 100 (61%) were examined. People suspected of having glaucoma underwent, within one month, a full ophthalmic assessment in both a newly established community optometry led glaucoma management scheme and a consultant led hospital eye service. RESULTS Agreement between the AGO and the consultant ophthalmologist in diagnosing glaucoma was substantial (89%; kappa = 0.703, SE = 0.083). Agreement over the need for treatment was also substantial (88%; kappa = 0.716, SE = 0.076). The agreement between the trainee ophthalmologists and the consultant ophthalmologist in the diagnosis of glaucoma and treatment recommendation was moderate (83%, kappa = 0.541, SE = 0.098, SE = 0.98; and 81%, kappa = 0.553, SE = 0.90, respectively). The diagnostic accuracy of the optometrists in detecting glaucoma in this population was high for specificity (0.93 (95% confidence interval, 0.85 to 0.97)) but lower for sensitivity (0.76 (0.57 to 0.89)). Performance was similar when accuracy was assessed for treatment recommendation (sensitivity 0.73 (0.57 to 0.85); specificity 0.96 (0.88 to 0.99)). The differences in sensitivity and specificity between AGO and junior ophthalmologist were not statistically significant. CONCLUSIONS Community optometrists trained in glaucoma provided satisfactory decisions regarding diagnosis and initiation of treatment for glaucoma. With such additional training in glaucoma, optometrists are at least as accurate as junior ophthalmologists but some cases of glaucoma are missed.
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Affiliation(s)
- A Azuara-Blanco
- The Eye Clinic, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK.
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Eccles MP, Grimshaw JM, Johnston M, Steen N, Pitts NB, Thomas R, Glidewell E, Maclennan G, Bonetti D, Walker A. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of managing upper respiratory tract infections without antibiotics. Implement Sci 2007; 2:26. [PMID: 17683558 PMCID: PMC2042498 DOI: 10.1186/1748-5908-2-26] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 08/03/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychological models can be used to understand and predict behaviour in a wide range of settings. However, they have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. The aim of this study was to explore the usefulness of a range of psychological theories to predict health professional behaviour relating to management of upper respiratory tract infections (URTIs) without antibiotics. METHODS Psychological measures were collected by postal questionnaire survey from a random sample of general practitioners (GPs) in Scotland. The outcome measures were clinical behaviour (using antibiotic prescription rates as a proxy indicator), behavioural simulation (scenario-based decisions to managing URTI with or without antibiotics) and behavioural intention (general intention to managing URTI without antibiotics). Explanatory variables were the constructs within the following theories: Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Stage Model (SM), and knowledge (a non-theoretical construct). For each outcome measure, multiple regression analysis was used to examine the predictive value of each theoretical model individually. Following this 'theory level' analysis, a 'cross theory' analysis was conducted to investigate the combined predictive value of all significant individual constructs across theories. RESULTS All theories were tested, but only significant results are presented. When predicting behaviour, at the theory level, OLT explained 6% of the variance and, in a cross theory analysis, OLT 'evidence of habitual behaviour' also explained 6%. When predicting behavioural simulation, at the theory level, the proportion of variance explained was: TPB, 31%; SCT, 26%; II, 6%; OLT, 24%. GPs who reported having already decided to change their management to try to avoid the use of antibiotics made significantly fewer scenario-based decisions to prescribe. In the cross theory analysis, perceived behavioural control (TPB), evidence of habitual behaviour (OLT), CS-SRM cause (chance/bad luck), and intention entered the equation, together explaining 36% of the variance. When predicting intention, at the theory level, the proportion of variance explained was: TPB, 30%; SCT, 29%; CS-SRM 27%; OLT, 43%. GPs who reported that they had already decided to change their management to try to avoid the use of antibiotics had a significantly higher intention to manage URTIs without prescribing antibiotics. In the cross theory analysis, OLT evidence of habitual behaviour, TPB attitudes, risk perception, CS-SRM control by doctor, TPB perceived behavioural control and CS-SRM control by treatment entered the equation, together explaining 49% of the variance in intention. CONCLUSION The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the creation of a replicable methodology for identifying factors that predict clinical behaviour. However, a number of conceptual and methodological challenges remain.
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Affiliation(s)
- Martin P Eccles
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy M Grimshaw
- Clinical Epidemiology Programme, Ottawa Health Research Institute and Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Marie Johnston
- School of Psychology, University of Aberdeen, Aberdeen, UK
| | - Nick Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nigel B Pitts
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Ruth Thomas
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Graeme Maclennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Debbie Bonetti
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Anne Walker
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Langston AL, Campbell MK, Fraser WD, Maclennan G, Selby P, Ralston SH. Clinical determinants of quality of life in Paget's disease of bone. Calcif Tissue Int 2007; 80:1-9. [PMID: 17205328 DOI: 10.1007/s00223-006-0184-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Accepted: 09/14/2006] [Indexed: 10/23/2022]
Abstract
Paget's disease of bone (PDB) can adversely affect quality of life, but relatively little is known about the clinical predictors of reduced quality of life in patients with the disease. Here, we studied quality of life and its determinants in a large cohort of PDB patients who had been enrolled into the PRISM study, a randomized comparative trial of intensive versus symptomatic treatment for PDB. Health-related quality of life was assessed using the Short-Form 36 (SF36) questionnaire and other validated assessment instruments in 1,324 subjects with PDB. Clinical predictors of quality of life were identified by multivariate regression analysis. The physical summary (mean +/- standard deviation) score of the SF36 was substantially reduced in PDB to 36.3 +/- 11.3 compared with the expected population norm of 50 (P < 0.001). The mental summary score was only slightly reduced, to 48.7 +/- 11.8, in PDB; but this was statistically significant (P < 0.001). Bone pain due to PDB, previous bisphosphonate therapy, and increasing age were identified as negative predictors of the SF36 physical summary score (P < 0.001); but serum levels of total alkaline phosphatase (ALP) did not predict physical summary score. We conclude that PDB has a substantial negative impact on health-related quality of life, which mainly affects physical functioning. The lack of correlation between ALP and quality of life observed in this study emphasizes the importance of addressing quality-of-life issues when treating PDB and not just focussing on response of ALP levels.
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Affiliation(s)
- A L Langston
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 22D, United Kingdom
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Grimshaw JM, Eccles MP, Greener J, Maclennan G, Ibbotson T, Kahan JP, Sullivan F. Is the involvement of opinion leaders in the implementation of research findings a feasible strategy? Implement Sci 2006; 1:3. [PMID: 16722572 PMCID: PMC1436013 DOI: 10.1186/1748-5908-1-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 02/22/2006] [Indexed: 11/10/2022] Open
Abstract
Background There is only limited empirical evidence about the effectiveness of opinion leaders as health care change agents. Aim To test the feasibility of identifying, and the characteristics of, opinion leaders using a sociometric instrument and a self-designating instrument in different professional groups within the UK National Health Service. Design Postal questionnaire survey. Setting and participants All general practitioners, practice nurses and practice managers in two regions of Scotland. All physicians and surgeons (junior hospital doctors and consultants) and medical and surgical nursing staff in two district general hospitals and one teaching hospital in Scotland, as well as all Scottish obstetric and gynaecology, and oncology consultants. Results Using the sociometric instrument, the extent of social networks and potential coverage of the study population in primary and secondary care was highly idiosyncratic. In contrast, relatively complex networks with good coverage rates were observed in both national specialty groups. Identified opinion leaders were more likely to have the expected characteristics of opinion leaders identified from diffusion and social influence theories. Moreover, opinion leaders appeared to be condition-specific. The self-designating instrument identified more opinion leaders, but it was not possible to estimate the extent and structure of social networks or likely coverage by opinion leaders. There was poor agreement in the responses to the sociometric and self-designating instruments. Conclusion The feasibility of identifying opinion leaders using an off-the-shelf sociometric instrument is variable across different professional groups and settings within the NHS. Whilst it is possible to identify opinion leaders using a self-designating instrument, the effectiveness of such opinion leaders has not been rigorously tested in health care settings. Opinion leaders appear to be monomorphic (different leaders for different issues). Recruitment of opinion leaders is unlikely to be an effective general strategy across all settings and professional groups; the more specialised the group, the more opinion leaders may be a useful strategy.
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Affiliation(s)
| | - Martin P Eccles
- Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle, UK
| | - Jenny Greener
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme Maclennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Tracy Ibbotson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Frank Sullivan
- NHS Tayside Professor of Research & Development in General Practice and Primary Care, Community Health Sciences Division, University ofDundee, Dundee, UK
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