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Biomedical subjects

C Donaldson

Publications and source records attributed to C Donaldson.

At least 19 recordsLinked to original sources
PubMed1998

Determinants of carer stress in Alzheimer's disease.

OBJECTIVES: To explore the impact of subgroups and individual symptoms of non-cognitive disturbance on the carers of Alzheimer's disease patients. DESIGN: Cross-sectional study using clinically valid scales to assess patient symptomatology and self-report questionnaires to measure carer variables. SETTING: Old age psychiatry outreach services in South and Central Manchester. SUBJECTS: 100 patients with Alzheimer's disease living at home and their carers. MAIN OUTCOME MEASURES: Subjective burden and distress in carers. RESULTS: Separate statistical analyses were performed for subgroups and individual symptoms of non-cognitive disturbance. For subgroups, multivariate analyses identified depression and behavioural disturbances in patients as significant predictors of subjective burden in carers. Carer distress was predicted by depression, psychosis and cognitive impairments in patients and carer gender. For individual symptoms of non-cognitive disturbance, three features of depression in patients (mood-related signs, physical signs and behaviour changes), walking disruptions and the patient-carer relationship predicted of subjective burden in carers. Variance in the level of carer distress was accounted for by sleep disruptions, hallucinations and mood-related depressive features in patients and carer gender. CONCLUSION: The findings confirm that the non-cognitive features of Alzheimer's disease are stressful for carers and indicate specific relationships between mood-related and behavioural signs of depression, walking and sleep disruptions and hallucinations in patients and adverse carer outcomes. Patient depression and the mood-related signs of depression in particular were the most consistent and powerful predictors of psychological morbidity in carers. Intervention strategies need to identify and target troublesome behaviours in patients and aim to either change these behaviours or alter the way carers respond to them. Thus, interventions need to be symptoms-rather than service-led and are likely to require multidisciplinary and multi-agency approaches.

Activities of Daily Living↗
PubMed1998

Helicopters, hearts and hips: using willingness to pay to set priorities for public sector health care programmes.

The paper reports from a study that asked 150 interviewees their willingness to pay (WTP) in increased earmarked taxation for three different health care programmes: a helicopter ambulance service, more heart operations and more hip replacements. Reasons behind the stated WTP were asked for. Ordinary least squares regression analyses were used to analyse factors associated with WTP for each of the three programmes, and factors associated with the relative WTP for one programme compared with the total of the three. Comparisons were made of WTP for these programmes and the health outcome in terms of quality adjusted life years.

Adult↗
PubMed1998

Intimacy as a determinant of expressed emotion in carers of people with Alzheimer's disease.

BACKGROUND: Although high expressed emotion (EE) has been found to be an important predictor of poor prognosis in a wide range of conditions such as schizophrenia, anorexia and depression no complete explanation exists for individual differences in EE responses. The aim of this paper is to investigate the role of intimacy in determining the level of EE in carers of people with dementia. METHODS: Ninety-nine carers of people with dementia who presented to Old Age Psychiatry Services in South and Central Manchester completed questionnaires to ascertain past and current levels of intimacy. Camberwell Family Interviews (CFIs) were carried out to ascertain levels of EE. RESULTS: Current intimacy was found to be strongly related to EE such that low current intimacy was associated with high EE and there was a significant difference between high and low intimacy groups on measures of criticism and hostility, though not warmth. CONCLUSIONS: The association found between intimacy and EE indicates that high EE may be a characteristic of low intimacy relationships between the carer and the cared-for-person. Since the assessment of EE is time intensive, perhaps a measure of intimacy will provide a short-hand screen for identifying critical and hostile caring environments.

Aged↗
PubMed1998

Is in vitro expansion of human cord blood cells clinically relevant?

Peripheral blood recovery after cord blood (CB) transplantation is delayed compared with marrow. Expansion of CB haemopoietic cells has been investigated with the aim of reducing cytopenia following transplantation. Mature cells, post-progenitors, progenitors and long-term culture-initiating cells (LTC-IC) from expansion products may contribute to peripheral blood recovery. We investigated the increase in total nucleated cells, colony-forming cells (CFC), CD34+ cells and LTC-IC by limiting dilution after a 14 day culture of CB CD34+ cells (5 x 10(3)/ml) with SCF, IL-3, IL-6, GM-CSF and G-CSF all at 10 ng/ml. On average, nucleated cells increased 2500-fold, CD34+ cells 39-fold and CFU-GM 49-fold with maintenance of BFU-E. The more primitive LTC-IC expanded on average 2.5-fold but effects on long-term marrow-repopulating cells (LTRC) during culture are unknown. A practical application of in vitro expansion of CB might be to expand a 20% aliquot of a CB donation and infuse the remainder unmanipulated. This could provide a 5- to 7-fold increase in progenitor cells, an estimated 1570-fold increase in post-progenitor cells and maintenance of LTC-IC compared to an untreated donation. Combined with in vivo post-transplant growth factor therapy this could prompt early peripheral blood recovery after CB transplantation, without significant loss of LTC-IC or donor lymphocytes.

Antigens, CD34↗
PubMed1998

Assessing strength of preference for abortion method using 'willingness to pay': a useful research technique for measuring values.

Policy makers and practitioners need to differentiate between patient preferences which are strongly held, and those which are not. This study measured not only women's preferences for medical abortion versus surgical vacuum aspiration, but also the strength of these preferences, using a 'willingness to pay' (WTP) technique. Fifty women were recruited and interviewed prior to and following termination of early pregnancy. Due to the sensitivity of the situation, the WTP approach was administered by interview. Results revealed that 34 (64%) preferred to have the medical method. The amounts offered for each method were similar; however, a minority gave higher values for the medical method, thus for those women their strength of preference for that method was more intense. Validity of the technique was supported by the finding of a positive association with social class and the importance women attached to having choice. It is argued that WTP is an acceptable method for the elicitation of strength of treatment preferences. Its further use by nurses and midwives to assess health care preferences should be explored, particularly when considering aspects of care which are traditionally difficult to identify and measure.

Abortion, Induced↗
PubMed1998

Willingness to pay: a method for measuring preferences for maternity care?

BACKGROUND: The aim of this study was to assess the feasibility of the use of "willingness to pay" as a measure of the benefits of intrapartum care. METHODS: A questionnaire was mailed to 150 pregnant women booking at Aberdeen Maternity Hospital in the northeast of Scotland, giving information on options for intrapartum care compiled from a recent randomized trial of care in a midwife-managed delivery unit versus care in a consultant-led labor ward. Women were asked which type of care they preferred and what would be their maximum willingness to pay for their preferred option. Data were also collected on demographic and clinical characteristics. RESULTS: Most women (55%) expressed a preference for care in a midwives unit. However, strength of preference, as reflected in willingness to pay, was greater among those in the smaller group, who expressed a preference for care in a consultant-led labor ward. The willingness-to-pay results were not associated with ability to pay. CONCLUSIONS: These data should be used together with cost data to decide on provision of care. Given the strength of preference of the minority group, and if the cost implications are not too great, a flexible service that takes account of women's wishes should be provided, even if this goes against the trend for care of those at low risk. By analyzing choice of care by income groups and social class groupings, it is possible to examine whether willingness-to-pay results are associated with indicators of ability to pay. In this case, they were not. Willingness to pay has an advantage in allowing respondents to account for more than just health gain when valuing different types of care.

Attitude↗
PubMed1998

Evaluating innovation in general practice: a pragmatic framework using programme budgeting and marginal analysis.

BACKGROUND: Innovation in primary care in the UK, in terms of new service developments, is occurring at a fast pace. However, little information is available on the costs and benefits of these changes. OBJECTIVES: We aimed to illustrate the use of programme budgeting and marginal analysis (PBMA) as a framework for evaluating innovation in primary care, using an example of practice-based diabetes care. The aim was to examine changes in the use of practice resources and the changes in benefits to patients, following the introduction of a diabetes clinic. METHODS: PBMA is a form of pragmatic economic evaluation combining practice data for the 'before' period and data from the literature to model the 'after' period. RESULTS: In 1995/6, the total amount of resources devoted to diabetes care in the two practices was 145813 pound sterling (634 pound sterling per patient). Of this sum, 62% was allocated to out-patient visits, 28% to prescribing, 5% to hospital admissions, 2% to GP consultations and 2% to tests. The literature suggests that a nurse-run diabetes clinic would result in similar health outcomes and better access for patients. The introduction of such a clinic could potentially save each practice between 2000 pound sterling and 16000 pound sterling per year. This result takes into account a wide range of assumptions about changes in resource use, but does depend on the findings of previous studies. CONCLUSIONS: The results of this study show that PBMA is a useful framework for helping practices be accountable and make 'evidence-based' decisions about service innovations in primary care.

Adult↗
PubMed1998

Surgery versus radiation therapy as single-modality treatment of tonsillar fossa carcinoma: the Roswell Park Cancer Institute experience (1971-1991).

OBJECTIVE: To compare the efficacy and treatment outcomes in patients with tonsillar fossa cancer using surgery or radiation as a single modality therapy. METHODS: From 1971 to 1991 239 patients with oral pharyngeal cancer were treated at Roswell Park Cancer Institute. Of these patients 90 had tonsillar carcinoma. Seventy-six of these patients received either surgery (SA) (n = 56) or radiation therapy (RA) (n = 20) as single-modality therapy and are the subject of this review. All patients in the radiation arm of this review were surgical candidates who declined primary surgical therapy. RESULTS: Sixty-three percent of the SA and 80% of the RA treatment groups presented with either stage III or stage IV disease (P < or = .05). Forty-seven percent of the SA group and 52% of the RA patients had clinically positive regional disease at initial presentation. There was a predictable pattern of nodal presentation, with level II the most frequently involved region. The rate of occult metastasis was 27% and was evenly distributed between T1 and T4 disease. The overall local control rate in the SA group was 75%, compared with 60% in the RA group (P value was not significant). The disease-specific survival (all stages) was 61% in the SA group and 37% in the RA group (P < or = .05). The disease-free survival for stage III and stage IV disease in the SA group was 47% and in the RA group 27% (P < or = .05). Survival measured against clinical response to radiation therapy, in complete responders (all stages) was 83%; by contrast there were no survivors past 24 months in the partial response group (P < or = .001). CONCLUSION: The results from this study suggest that for early disease (stage I/II), surgery or radiation therapy as single-modality treatment is equally effective. For advanced disease radiation therapy is inferior to surgery as a single-modality treatment, as measured by ultimate survival and the local control of disease. There is, however, a subset of patients with advanced disease who respond to radiation therapy and whose survival is equivalent to our surgical cohort of patients.

Adult↗
PubMed1998

Application of the principle of marginal analysis to sampling practice using prostatic chippings as a model.

AIMS: To demonstrate an application of health economic principles in histopathology by using the sampling of transurethral resections of prostate specimens. By demonstrating how marginal costs are calculated the aim is to illustrate that the potential opportunity cost of sampling entire specimens is much greater than would be anticipated by taking average cost, or the cost of producing a histological section alone. METHOD: A mathematical model is used with data obtained from the Aberdeen pathology department files and published estimates of the likely percentage of cancerous chippings in each specimen. RESULTS: The average cost of each cancer detected remains low, between 47 Pounds and 151 Pounds, in all the scenarios examined. However, the marginal costs can become high, exceeding 10,000 Pounds in larger specimens, if all the chippings are processed. CONCLUSIONS: This study demonstrates that there are potential opportunity cost penalties to histopathological services associated with sampling strategies. Although the results are derived from a hypothetical mathematical model using local data that applies only to histopathology, the method could be widely applied. The principles of marginal analysis should be performed by multidisciplinary teams and include outcomes as well as a broader range of costs, including those that arise subsequent to diagnosis.

Costs and Cost Analysis↗
PubMed1998

The (near) equivalence of cost-effectiveness and cost-benefit analyses. Fact or fallacy?

There has been much recent debate in the health economics literature as to the (near) equivalence of cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA). The aim of this paper is to demonstrate that whether such a (near) equivalence exists depends on whether one defines economic evaluations as 'CBA' or 'CEA' on the basis of either what is measured or what question the analyst is seeking to answer. The former basis of definition is popular within the 'decision science' approach to economic evaluation, but does not seem to have any theoretical support. If the latter, more theoretically correct, basis is accepted, there is no longer a case for the (near) equivalence of CBA and CEA.

Cost-Benefit Analysis↗
PubMed1998

Educate ICU assistive personnel.

Many institutions use assistive personnel in intensive care units (ICUs) to provide more cost-effective nursing care. One ICU uses a comprehensive, competency-based orientation program to help fulfill the assistive personnel's unique orientation needs.

Competency-Based Education↗
PubMed1997

Assessing community values in health care: is the 'willingness to pay' method feasible?

In this paper an economics approach to assessing community values in health care priority setting is examined. The approach is based on the concept of 'willingness to pay' (WTP). Eighty two parents were interviewed with regard to three aspects of provision of child health services. For each aspect a choice of two courses of action was presented. Parents were asked which course of action they preferred and what was the maximum amount of money they would be prepared to pay for this rather than their less preferred option. WTP responses are acceptable to the majority of respondents and appear to 'behave' in accordance with a priori expectations. A method of assessing the influence of ability to pay on preferences and WTP is outlined. Preferences and WTP do not appear to have been unduly distorted by ability to pay. Use of WTP data does have the potential to provide health care purchasers and providers with information on intensity as well as direction of the preferences of members of the community.

Child↗