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81.
We recently completed a study which demonstrated that the costs of health technology assessment (HTA) by randomised controlled trial (RCT) can be reduced by substituting routine datasets for data designed and collected specifically for a trial. This cost reduction, however, had the effect of reducing the quality of the research output. In the present study we attempted to tease out the values attached to the 'better' information provided by designed data RCTs using a mock grants committee. Two valuation techniques, implied values and willingness to pay, were used. Ex ante valuations were determined by comparing alternative research proposals - a more costly version using designed data and a cheaper version using routine data. Ex post valuations were determined by comparing results of both versions. The exercise was performed on four exemplar studies. Overall, the committee expressed a general lack of trust towards routine data both ex ante and ex post and placed high values on the better information from the designed data studies - particularly information on preferences. This suggests that currently available routine datasets are not perceived to be able to provide efficient alternatives to designed data for RCTs. 相似文献
82.
83.
M H Chin L Jin T G Karrison R Mulliken D C Hayley J Walter A Miller P D Friedmann 《Annals of emergency medicine》1999,34(5):595-603
STUDY OBJECTIVES: We sought to describe older patients' health-related quality of life during a 4-month period surrounding a visit to the emergency department and to identify factors associated with less recovery. METHODS: We prospectively studied 983 patients 65 years or older who presented to an urban academic ED in 1995 and 1996. Eighty percent of the patients were African American, and 63% were women. The primary outcome measures were the Katz Index of Activities of Daily Living and revised validated questions from the Medical Outcomes Study Health Survey at 1 month before the ED visit, the time of the ED visit, and 2-week and 3-month follow-up periods. RESULTS: In general, patients worsened markedly during the illness and then improved, although not to baseline levels. After adjustment for demographic and social factors, the most consistently powerful predictors of poor recovery were more deficiencies in activities of daily living at baseline, reports of needing more help with everyday tasks, increasing Charlson Comorbidity Index scores, and requiring a proxy for the initial survey. CONCLUSION: Emergency physicians and primary care physicians should consider inquiring about functional status and the adequacy of help at home in addition to comorbid conditions for their acutely ill older patients to target those at greatest risk for poor recovery. Future work needs to test interventions that may improve the health-related quality of life of these vulnerable patients. 相似文献
84.
Hayley M. Vasileff Lauren E. Whitten Jennifer A. Pink Sharon J. Goldsworthy Manya T. Angley 《Pharmacy World & Science》2009,31(3):373-379
Objective To determine the frequency and clinical significance of medication errors when (a) pharmacists elicit medication histories
in the Emergency Department after medications have been prescribed by doctors and (b) pharmacists obtain and chart medication
histories prior to doctors’ approval. Setting The Queen Elizabeth Hospital, a 350 bed South Australian teaching hospital, serving the local adult community. Method Emergency Department patients at risk of medication misadventure were recruited in two phases with a ‘usual practice’ arm
(6 weeks) and a ‘pharmacist medication charting’ arm (5 weeks) reflecting an alternative intervention. In the ‘usual care’
arm, medication histories were compiled by a pharmacy researcher after a doctor had completed the medication chart. The researcher-elicited
medication histories were compared with the doctors’ medication charts and unintentional discrepancies were recorded. In the
‘pharmacist medication charting’ arm, the same process was followed except the researcher compiled the patients’ medication
histories at triage, prior to patients seeing a doctor. The medication history was then transcribed onto a medication chart
for authorisation by a doctor. In addition, whether resolution of unintentional discrepancies for patients in the ‘usual care’
arm had occurred by discharge was determined by examining patients’ medical records. Main outcome measure Frequency of unintentional discrepancies and medication errors. Results The study included 45 and 29 patients in the ‘usual care’ and intervention arms, respectively. In the ‘usual care’ arm, 75.6%
of patients had one or more unintentional discrepancies compared with 3.3% in the ‘pharmacist medication charting’ arm. This
resulted in an average of 2.35 missed doses per patient in the ‘usual care’ arm and 0.24 in the intervention arm. In addition,
an average of 1.04 incorrect doses per patient were administered in the ‘usual care’ arm and none in the ‘pharmacist medication
charting’ arm. The differences observed between the arms were statistically significant (P < 0.05) and deemed clinically significant by a multidisciplinary panel. Conclusion This study provides evidence for pharmacists eliciting medication histories to prepare medication charts at the earliest
possible opportunity following a patient’s presentation to the Emergency Department 相似文献
85.
Hayley E Cutt Matthew W Knuiman Billie Giles-Corti 《The international journal of behavioral nutrition and physical activity》2008,5(1):17
Background
This study examines changes in socio-demographic, environmental and intrapersonal factors associated with dog acquisition in non-dog owners at baseline to 12-months follow-up and the effect of dog acquisition on minutes per week of recreational walking. 相似文献86.
P D Friedmann L Jin T Karrison M Nerney D C Hayley R Mulliken J Walter A Miller M H Chin 《The American journal of drug and alcohol abuse》1999,25(3):529-542
OBJECTIVE: To examine the effect of alcohol abuse on the subsequent health status of elderly patients seen in an emergency department (ED). PATIENTS AND METHODS: A sample of 966 patients aged 65 or older who presented to one urban academic ED between the hours of 8 A.M. and 12 midnight was followed for 1 year. A personal interview was administered during the ED visit. Current problem drinkers had a score of 1 or greater on the CAGE questionnaire at ED presentation and drank within the prior 6 months; former problem drinkers had a score of 1 or greater on the CAGE questionnaire at ED presentation and a last drink more than 6 months previously. We used 13 items from the Medical Outcomes Study short form adapted to the ED setting and 6 items from the Index of Activities of Daily Living (ADL) to measure health status. RESULTS: In multivariate models for repeated-measures controlling for potential confounding factors, current problem drinkers had worse overall health (parameter estimate beta -3.6; 95% CI -7.1 to -0.04), and former problem drinkers had worse mental health (beta -3.6; CI -6.9 to -0.24) on follow-up. We could find no effect of problem drinking on physical health or social function. CONCLUSIONS: Current problem drinking is associated with worse self-perceived health among elderly patients in the year following presentation to an ED. The magnitude of decline in health perception may approximate the effect of having back pain, sciatica, or other musculoskeletal complaints. Elderly former problem drinkers suffer from more severe mental health problems over that same period. 相似文献
87.
Although use of the internal thoracic artery (ITA) for coronary artery bypass grafting results in superior graft patency and improved patient survival, our initial clinical observations suggested an increased incidence of pleuropulmonary morbidity with its use. One hundred consecutive patients with left ITA grafts were studied prospectively and compared with a consecutive retrospective group of 100 patients undergoing coronary artery bypass grafting with saphenous vein grafts only. Preoperative, postoperative day (POD) 2, POD 6, and postoperative week 8 chest roentgenograms were analyzed for atelectasis and effusion. Postoperative left lower lobe atelectasis was common in both groups on both POD 2 (saphenous vein, 43%, versus ITA, 53%; not significant) and POD 6 (saphenous vein, 40%, versus ITA, 41%; not significant). There was a significantly higher incidence of pleural effusion on POD 6 in the ITA group (84% versus 47%; p less than 0.05) but most of these were small. There was more chest tube drainage (1,413 versus 1,028 mL; p less than 0.01) and a greater need for secondary thoracostomy or thoracentesis (4% versus 0%) in the ITA group. The left pleural space was opened in 67 of the 100 ITA patients but pleurotomy did not appear to influence postoperative morbidity. We conclude that use of the internal thoracic artery for coronary artery bypass grafting results in a small but significant increase in pleuropulmonary morbidity. 相似文献
88.
Eric L. Smith David J. Tybor Hayley D. Daniell Laura A. Naccarato Mary E. Pevear Charles Cassidy 《The Journal of arthroplasty》2018,33(7):2047-2049
Background
Orthopedic surgeons utilize the 22-modifier when billing for complex procedures under the American Medical Association's Current Procedural Terminology (CPT) for reasons such as excessive blood loss, anatomic abnormality, and morbid obesity, cases that would ideally be reimbursed at a higher rate to compensate for additional physician work and time. We investigated how the 22-modifier affects physician reimbursement in knee and hip arthroplasty.Methods
We queried hospital billing data from 2009 to 2016, identifying all cases performed at our urban tertiary care orthopedic center for knee arthroplasty (CPT codes 27438, 27447, 27487, and 27488) and hip arthroplasty (CPT codes 27130, 27132, 27134, 27236). We extracted patient insurance status and reimbursement data to compare the average reimbursement between cases with and without the 22-modifier.Results
We analyzed data from 2605 procedures performed by 10 providers. There were 136 cases with 22-modifiers. For knee arthroplasty (n = 1323), the 22-modifier did not significantly increase reimbursement after adjusting for insurer, provider, and fiscal year (4.2% dollars higher on average, P = .159). For hip arthroplasty (n = 1282), cases with a 22-modifier had significantly higher reimbursement than those without the 22-modifier (6.2% dollars more, P = .049). For hip arthroplasty cases with a 22-modifier, those noting morbid obesity were reimbursed 29% higher than those cases with other etiology.Conclusions
The effect of the 22-modifier on reimbursement amount is differential between knee and hip arthroplasty. Hip arthroplasty procedures coded as 22-modifier are reimbursed more than those without the 22-modifier. Providers should consider these potential returns when considering submitting a 22-modifier. 相似文献89.
Hayley T Morris Loic Fort Heather J Spence Rachana Patel David F Vincent James H Park Scott B Snapper Francis A Carey Owen J Sansom Laura M Machesky 《The Journal of pathology》2018,245(3):337-348
N‐WASP (WASL) is a widely expressed cytoskeletal signalling and scaffold protein also implicated in regulation of Wnt signalling and homeostatic maintenance of skin epithelial architecture. N‐WASP mediates invasion of cancer cells in vitro and its depletion reduces invasion and metastatic dissemination of breast cancer. Given this role in cancer invasion and universal expression in the gastrointestinal tract, we explored a role for N‐WASP in the initiation and progression of colorectal cancer. While deletion of N‐wasp is not detectably harmful in the murine intestinal tract, numbers of Paneth cells increased, indicating potential changes in the stem cell niche, and migration up the crypt–villus axis was enhanced. Loss of N‐wasp promoted adenoma formation in an adenomatous polyposis coli (Apc) deletion model of intestinal tumourigenesis. Thus, we establish a tumour suppressive role of N‐WASP in early intestinal carcinogenesis despite its later pro‐invasive role in other cancers. Our study highlights that while the actin cytoskeletal machinery promotes invasion of cancer cells, it also maintains normal epithelial tissue function and thus may have tumour suppressive roles in pre‐neoplastic tissues. © 2018 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland. 相似文献
90.
Paul D.E Miller Thushan I. de Silva Hayley Leonard Chloe Anthias Katja Hoschler Kathryn Goddard Karl Peggs Alejandro Madrigal John A. Snowden 《Vaccine》2019,37(3):452-457
Traditionally, immune response to influenza vaccines has been measured using the haemagglutination inhibition (HAI) assay. A broader repertoire of techniques including the sensitive viral microneutralization (VMN) assay is now recommended by the European Medicines Agency (EMA). Comparing HAI and VMN, we determined immune response to a trivalent 2015–2016 seasonal inactivated influenza vaccine (SIIV) administered to 28 recipients of allogeneic haematopoietic stem cell transplant (HSCT). Vaccination was within the first-year post-transplant at a median of 78.5 (24–363) days. The proportion of patients with baseline and post-vaccination HAI titres?≥?1:40 were 28.6% and 25% for A(H1N1)pdm09, 14.3% at both timepoints for A(H3N2), and 32.1% and 25% for B(Phuket). Pre and Post-vaccination geometric mean titres(GMT) were higher by VMN than HAI for A(H1N1)pdm09 and A(H3N2), but lower for B(Phuket)(p=<0.05). Geometric mean ratios(GMR) of baseline and post-vaccination titres were similar by HAI and VMN(p?>?0.05) for all components. A single seroconversion to A(H1N1) was detected by ELISA-VMN. None of patient age, lymphocyte count, days from transplant to vaccination, donor type, or graft-versus-host disease (GVHD) or immunosuppressive therapy (IST) at vaccination correlated with baseline or post-vaccination titres by either assay. This absence of seroresponse to SIIV in the first-year post HSCT highlights the need for novel immunogenic vaccination formulations and schedules in this high-risk population. 相似文献