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C Donaldson

Publications and source records attributed to C Donaldson.

157 records · Page 9Linked to original sources
PubMedDate not supplied

Using economics alongside clinical trials: why we cannot choose the evaluation technique in advance.

When drafting protocols for the use of economic evaluation alongside clinical trials, it is common to have to specify which type of economic evaluation is going to be carried out. Will it be a cost-benefit analysis (CBA), cost-effectiveness analysis (CEA) or a cost-utility analysis (CUA)? It is our contention that prior specification of the appropriate economic technique is not possible, in the majority of cases, until data on effectiveness and cost are actually available. In this letter, we aim to demonstrate the thinking behind our contention and to illustrate this with two case studies; one of a recent randomised trial, the other of a trial currently in progress.

Clinical Protocols↗
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Using willingness to pay to value close substitutes: carrier screening for cystic fibrosis revisited.

Evidence suggests that previous uses of willingness to pay (WTP) to value close substitutes may have failed to discriminate between the alternatives being evaluated. This paper reports on the application of a new technique for measuring WTP in such contexts. The alternatives evaluated are two methods of screening for cystic fibrosis carrier status. The results suggest that the new method is more discriminating. Furthermore, the paper provides evidence, from reasons for respondents' WTP valuations and regression analyses, that the use of open-ended WTP questions is not valid. This is in line with the recommendations of a recent, influential, report on the use WTP techniques.

Analysis of Variance↗
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Private versus social opportunity cost of time: valuing time in the demand for health care.

In this paper we examine whether the current method of valuing time within economic appraisals is appropriate. The cost to society of time taken to use health care may differ from the private opportunity cost of such time. However, demand for health care may be affected by the private opportunity time cost and not by the value of time to society. In this paper we show that the private opportunity cost of time is a better predictor of demand for a screening service than the societal approach. It is important, therefore, to use the private opportunity cost of time when assessing the demand for, and impact of, a health care intervention.

Bone Density↗
PubMedDate not supplied

Willingness to pay for antenatal carrier screening for cystic fibrosis.

We report on a study of women's willingness to pay (WTP) for a cystic fibrosis carrier test by one or other method of service delivery (disclosure or non-disclosure). The results demonstrate that there was no statistically significant difference in WTP for the methods of testing. Those women who received a negative test result were followed up and asked their WTP for such a result. Values obtained at this stage were 16 per cent higher than those obtained pretest result. Use of prompts, rather than simply asking women to state their WTP, had a statistically significant effect on post-test result values. The opportunity to terminate the pregnancy, if a test proved positive, was important, but was not the only consideration. This demonstrates the importance to women of other benefits of screening.

Abortion, Eugenic↗
PubMedDate not supplied

Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial.

BACKGROUND: Elderly people who have a fracture are at high risk of another. Vitamin D and calcium supplements are often recommended for fracture prevention. We aimed to assess whether vitamin D3 and calcium, either alone or in combination, were effective in prevention of secondary fractures. METHODS: In a factorial-design trial, 5292 people aged 70 years or older (4481 [85%] of whom were women) who were mobile before developing a low-trauma fracture were randomly assigned 800 IU daily oral vitamin D3, 1000 mg calcium, oral vitamin D3 (800 IU per day) combined with calcium (1000 mg per day), or placebo. Participants who were recruited in 21 UK hospitals were followed up for between 24 months and 62 months. Analysis was by intention-to-treat and the primary outcome was new low-energy fractures. FINDINGS: 698 (13%) of 5292 participants had a new low-trauma fracture, 183 (26%) of which were of the hip. The incidence of new, low-trauma fractures did not differ significantly between participants allocated calcium and those who were not (331 [12.6%] of 2617 vs 367 [13.7%] of 2675; hazard ratio (HR) 0.94 [95% CI 0.81-1.09]); between participants allocated vitamin D3 and those who were not (353 [13.3%] of 2649 vs 345 [13.1%] of 2643; 1.02 [0.88-1.19]); or between those allocated combination treatment and those assigned placebo (165 [12.6%] of 1306 vs 179 [13.4%] of 1332; HR for interaction term 1.01 [0.75-1.36]). The groups did not differ in the incidence of all-new fractures, fractures confirmed by radiography, hip fractures, death, number of falls, or quality of life. By 24 months, 2886 (54.5%) of 5292 were still taking tablets, 451 (8.5%) had died, 58 (1.1%) had withdrawn, and 1897 (35.8%) had stopped taking tablets but were still providing data for at least the main outcomes. Compliance with tablets containing calcium was significantly lower (difference: 9.4% [95% CI 6.6-12.2]), partly because of gastrointestinal symptoms. However, potentially serious adverse events were rare and did not differ between groups. INTERPRETATION: The findings do not support routine oral supplementation with calcium and vitamin D3, either alone or in combination, for the prevention of further fractures in previously mobile elderly people.

Accidental Falls↗
PubMedDate not supplied

Age-restricted cervical screening: HPV testing at age 50 identifies a high risk group for cervical disease.

Changes to the present age policy of cervical screening are currently under consideration. We conducted a retrospective matched case-control study and cost analysis study to identify risk factors for the development of an abnormal smear after age 50 and to determine the impact of age-restricted cervical screening on the annual cost of the screening program. All women (229) from an 11-year birth cohort who developed an abnormal smear at age 50 or over were age-matched for two controls with negative smears. Routine screening smears taken between age 48 and 52 were tested for human papillomavirus (HPV) subtypes 16 and 18. Epidemiologic data were collected by postal questionnaire. Changes in costs under a policy of HPV testing and age-restricted screening were assessed. We found that HPV 16 status was the only independently significant risk factor for abnormal cytology after age 50 with an odds ratio of 10.26 (95% CI 1.25-84.11). A policy of early withdrawal from screening at age 50 on the basis of HPV testing would produce net cost savings. These findings suggest that HPV testing could be a valuable means of identifying the small proportion of women still at risk after 50, and of releasing health care resources.

Age Factors↗
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NBTS/BRIC 8. A monoclonal anti-C3d antibody.

A stable mouse hybridoma line secreting monoclonal anti-C3d antibody (NBTS/BRIC 8) was produced. Ascitic fluid containing BRIC 8 can be used at a final dilution of 1 to 5000 to provide an excellent antiglobulin reagent when mixed with a conventional polyclonal rabbit anti-human IgG serum.

Animals↗
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Developing an orientation program for assistive personnel in the ICU.

Assistive personnel are being used in intensive care unit (ICU) settings in response to the demand for more cost-effective nursing care. Nurse managers, educators, and advanced practice nurses must address the unique orientation needs of these workers. A comprehensive, competency-based orientation program for assistive personnel can help the ICU technician be successful. Despite the multitude of assistive personnel being used in the critical care settings, little information is available regarding the development of an orientation program for ICU technicians. This article discusses one ICU's experience in developing an orientation program for their ICU technicians.

Hospital Restructuring↗
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One more fallen angel.

Explore the source record for details and available documents.

Burnout, Professional↗
PubMedDate not supplied

Economic evaluation in dentistry: an ethical imperative?

In this paper a case is made for the use of principles and techniques of economic evaluation to aid the planning of oral health services. The reader is taken through a case study, which highlights not only the importance of economic principles but also the challenges involved in carrying out economic evaluations in dentistry. These challenges need to be faced if oral health services are to be planned in a way that is of maximum benefit to the community.

Child↗