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J E Brazier

Publications and source records attributed to J E Brazier.

30 records · Page 2Linked to original sources
PubMed1995

Evaluating translations of health status questionnaires. Methods from the IQOLA project. International Quality of Life Assessment.

There is growing demand for translations of health status questionnaires for use in multinational drug therapy studies and for population comparisons of health statistics. The International Quality of Life Assessment (IQOLA) Project is conducting a three-stage research program to determine the feasibility of translating the SF-36 Health Survey, widely used in English-speaking countries, into other languages. In stage 1, the conceptual equivalence and acceptability of translated questionnaires are evaluated and improved using qualitative and quantitative methods. In stage 2, assumptions underlying the construction and scoring of questionnaire scales are tested empirically. In stage 3, the equivalence of the interpretation of questionnaire scores across countries is tested using methods that closely approximate their intended use, and empirical results are compared. Data analyses from Sweden and the United Kingdom, as well as other research cited, support the feasibility of cross-cultural health measurement using the SF-36.

Activities of Daily Living↗
PubMed1994

A comparison of the costs and performance of an emergency helicopter and land ambulances in a rural area.

The costs and performance of the Cornwall and Isles of Scilly Ambulance Service Helicopter Unit (CASHU) air ambulance (A/A) was assessed during 1 year (1 December 1990-30 November 1991). The helicopter, with a crew of one pilot and two paramedics, commenced 797 patient-related missions during the year, 554 (69.5 per cent) as an emergency response ambulance. Eighty-one (15 per cent) of the emergency missions were aborted with no patient attended. Compared with the activity of ground ambulances, the A/A attended more accidents (66.5 per cent vs 40.8 per cent), and more incidents occurring outside in fields, or on cliffs or beaches (47.1 per cent vs 9.5 per cent). In its role as an emergency response vehicle the helicopter performance was not better than that of ground ambulances. Activation times, response times and on-scene times were all longer on average than for ground ambulances. However, transport times to hospital were sometimes much faster by helicopter. Although total times from 999 call to arrival in hospital were similar in the two cohorts, this was principally because longer distances were involved in the helicopter missions. Standardized for distance the A/A was, on average, 10 min faster than predicted for a land ambulance. The estimated direct costs of CASHU were 595,000 pounds for the year, and the costs of carrying out the helicopter missions by road have been estimated to be 97,805 pounds. The consequent marginal cost of around 500,000 pounds must be set against any health benefits accruing from the performance improvements for patients.

Air Ambulances↗
PubMed1994

Cost effectiveness of adjuvant bile salt treatment in extracorporeal shock wave lithotripsy for the treatment of gall bladder stones.

The relative cost effectiveness of adjuvant urso and chenodeoxycholic acid treatment in extracorporeal shockwave lithotripsy (ESWL) has been assessed as part of a pragmatic randomised controlled trial of ESWL as a treatment of gall bladder stones. Of the first patients with gall stone volume < 4 cm3 randomised to ESWL in the main trial, 24 were randomised to have ESWL alone and 26 to have adjuvant bile acid treatment, one of whom died before the end of the 12 month follow up period. At 12 months after treatment, differences in gall stone clearance between ESWL alone (3/24 (13%) clear, 5 (21%) referred for surgery) and ESWL and bile acids (6/25 (24%) clear, 2 (8%) referred for surgery) were not significant (p = 0.36, log rank test). Patients in both groups had substantial and significant health gains (according to biliary pain frequency and severity, Nottingham Health Profile scores, visual analogue scale symptom scores, and complications) but there were no significant differences between the groups. Improvements in both groups usually occurred within a few weeks of treatment and were unrelated to gall stone clearance. Costs were greater in the bile salt group (95% confidence intervals for estimated cost difference: 90 pounds to 630 pounds). If the purpose of treatment is symptom relief rather than gall stone clearance then adjuvant bile salt treatment seems to be unnecessary.

Adult↗
PubMed1994

Health and healthcare costs and benefits of exercise.

To assess the value of promoting health through exercise, we review what is known about the medical and medical care resource costs and benefits of exercise. Literature searches were undertaken to derive estimates of the relative risk, in individuals who exercise regularly compared with those who do not, of each of the major disease groups for which there is good evidence that the disease can be ameliorated by exercise (coronary heart disease, stroke, diabetes, hip fracture, and mental illness). These relative risks were used to estimate the incidence of hospital admissions and mortality, and associated healthcare costs, which could be prevented if the whole population exercised. Literature on the incidence and costs of exercise-related morbidity and mortality was also reviewed to derive estimates of both the costs to health and also the healthcare resource implications of exercise in total population. Indirect costs and benefits, and also quality-of-life effects associated with exercise were not included in this assessment. The results show that in younger adults (ages 15 to 44 years) the average annual medical care costs per person that might be incurred as a result of full participation in sport and exercise (approximately 30 pounds British sterling) exceed the costs that might be avoided by the disease-prevention effects of exercise ( less than 5 pounds British sterling per person). However, in older adults ( greater than or equal to 45) the estimated costs avoided ( greater than 30 pounds British sterling per person) greatly outweigh the costs that would be incurred ( less than 10 pounds British sterling). There was little evidence that exercise leads to deferred health or health service resource benefits. We conclude that with regard to health and medical care costs, there are strong economic arguments in favour of exercise in adults aged greater than or equal to 45 but not in younger adults. Estimates derived from the international scientific literature and routine UK data sources may have limited direct application in the healthcare systems of other countries. Nevertheless, the result that exercise costs exceed the benefits in younger adults but vice versa in older people is likely to be generally true. Indeed, a similar result has been found in a study of a Dutch population.

Adolescent↗
PubMed1992

Randomised controlled trial of cost-effectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones.

Inpatient extracorporeal shockwave lithotripsy for treatment of gallbladder stones has not previously been compared with open cholecystectomy in terms of cost-effectiveness. In a randomised controlled trial, 163 patients, stratified by gallstone bulk (over 4 cm3 or not), were randomised to lithotripsy or cholecystectomy (38 large-bulk and 27 small-bulk cholecystectomy; 37 large-bulk and 61 small-bulk lithotripsy) and followed up for 1 year. Both treatments gave significant health gains in terms of a reduction in episodes of biliary pain, improved perceived health status, and symptom relief, but few differences between treatments were found. There was some evidence that biliary-pain episodes were less severe after cholecystectomy. Cholecystectomy patients also had greater improvements in mean health gain for three related symptoms: vomiting, feeling sick, and fatty-food upset. However, there were no differences between groups in perceived health status. Among lithotripsy patients, health gain was not related to stone clearance. Lithotripsy was more expensive than cholecystectomy, principally because of the costs of the inpatient stay and adjuvant bile-salt therapy. Conventional lithotripsy appears at least as cost-effective as cholecystectomy for patients with small-bulk stones but less cost-effective for those with large-bulk stones. To some extent treatment choice can be guided by patient preference.

Adult↗
PubMed1992

Validating the SF-36 health survey questionnaire: new outcome measure for primary care.

OBJECTIVES: To test the acceptability, validity, and reliability of the short form 36 health survey questionnaire (SF-36) and to compare it with the Nottingham health profile. DESIGN: Postal survey using a questionnaire booklet together with a letter from the general practitioner. Non-respondents received two reminders at two week intervals. The SF-36 questionnaire was retested on a subsample of respondents two weeks after the first mailing. SETTING: Two general practices in Sheffield. PATIENTS: 1980 patients aged 16-74 years randomly selected from the two practice lists. MAIN OUTCOME MEASURES: Scores for each health dimension on the SF-36 questionnaire and the Nottingham health profile. Response to questions on recent use of health services and sociodemographic characteristics. RESULTS: The response rate for the SF-36 questionnaire was high (83%) and the rate of completion for each dimension was over 95%. Considerable evidence was found for the reliability of the SF-36 (Cronbach's alpha greater than 0.85, reliability coefficient greater than 0.75 for all dimensions except social functioning) and for construct validity in terms of distinguishing between groups with expected health differences. The SF-36 was able to detect low levels of ill health in patients who had scored 0 (good health) on the Nottingham health profile. CONCLUSIONS: The SF-36 is a promising new instrument for measuring health perception in a general population. It is easy to use, acceptable to patients, and fulfils stringent criteria of reliability and validity. Its use in other contexts and with different disease groups requires further research.

Adolescent↗
PubMed1992

A prospective trial of endoscopic sclerotherapy v oesophageal transection and gastric devascularisation in the long term management of bleeding oesophageal varices.

In a prospective three centre study oesophageal transection and gastric devascularisation have been compared with endoscopic sclerotherapy in the long term management of bleeding oesophageal varices. Cirrhotic patients (Child's A or B grade) with documented bleeding oesophageal varices were treated initially with emergency sclerotherapy, and after five days stability, were allocated to one of the two treatment regimes. The endoscopic sclerotherapy group underwent regular sclerotherapy until variceal obliteration while those undergoing surgery were not endoscoped unless bleeding recurred, when they were treated by sclerotherapy if appropriate. Ninety two patients were eligible for analysis (68% alcoholic cirrhosis; mean age 50.1 years) and follow up was achieved for a mean of 52.5 months (range 17-83). Mortality in the first three months was greater in the oesophageal transection and gastric devascularisation group (20% v 1%) but by two years the survival curves were the same and thereafter there was no difference in mortality. Rebleeding occurred in 13/41 (31%) patients, undergoing oesophageal transection and gastric devascularisation. The costs incurred during the first year of oesophageal transection and gastric devascularisation treatment were significantly greater than with endoscopic sclerotherapy (4369 pounds v 1067 pounds, p < 0.0001) and the high rate of rebleeding in the surgical group meant that no cost savings occurred in subsequent years. It is concluded that oesophageal transection and gastric devascularisation confers no benefit over endoscopic sclerotherapy in terms of long term survival and that it is not cost effective as judged by the current health care costs in the United Kingdom.

Adult↗
PubMed1992

Cost effectiveness of minor surgery in general practice: a prospective comparison with hospital practice.

The cost effectiveness of general practitioners undertaking minor surgery in their practices was determined in a prospective comparison of patients having minor surgery undertaken in five general practices over a 12 week period in 1989, and in the departments of dermatology and general surgery in Rotherham District General Hospital over a contemporaneous eight week period. There were no differences between the settings in the reported rates of wound infection or other complications and only one general practice patient was subsequently referred to hospital for specialist treatment. General practitioners sent a smaller proportion of specimens to a histopathology laboratory than hospital doctors (61% versus 90%, P less than 0.001); incorrectly diagnosed a larger proportion of malignant conditions as benign (10% versus 1%, P less than 0.05) and inadequately excised 5% of lesions where this never happened in hospital (difference not significant). General practice patients had shorter waiting times between referral and treatment, spent less time and money attending for treatment and more of them were satisfied with their treatment. The cost of a procedure undertaken in general practice was less than in hospital--pounds 33.53 versus pounds 45.54 for the excision of a lesion and pounds 3.00 versus pounds 3.22 for cryotherapy of a wart (1989-90 prices). Performing minor surgery in general practice would seem cost effective compared with a hospital setting. However, the risk of general practitioners inadequately excising a malignancy and not sending it to a histopathology laboratory must be addressed and the conclusion regarding cost effectiveness only applies where general practice is a substitute for the hospital setting and not an additional activity.

Case-Control Studies↗