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Biomedical subjects

J Seymour

Publications and source records attributed to J Seymour.

At least 37 records · Page 2Linked to original sources
PubMed2001

Actions for wrongful birth and wrongful life.

This paper discusses wrongful birth and wrongful life actions taken under the common law of negligence in the United States, Canada, England and Australia. The paper explains the nature of the actions and offers comments on the legal and ethical issues. In particular, it considers the problem of identifying the harm suffered by the parents of an unwanted child and explores some of the questions posed by the law's attempts to assign responsibility following the birth of a normal or a disabled child.

Abortion, Induced↗
PubMed2000

Quality of life related to fear of falling and hip fracture in older women: a time trade off study.

OBJECTIVE: To estimate the utility (preference for health) associated with hip fracture and fear of falling among older women. DESIGN: Quality of life survey with the time trade off technique. The technique derives an estimate of preference for health states by finding the point at which respondents show no preference between a longer but lower quality of life and a shorter time in full health. SETTING: A randomised trial of external hip protectors for older women at risk of hip fracture. PARTICIPANTS: 194 women aged >/= 75 years enrolled in the randomised controlled trial or who were eligible for the trial but refused completed a quality of life interview face to face. OUTCOME MEASURES: Respondents were asked to rate their own health by using the Euroqol instrument and then rate three health states (fear of falling, a "good" hip fracture, and a "bad" hip fracture) by using time trade off technique. RESULTS: On an interval scale between 0 (death) and 1 (full health), a "bad" hip fracture (which results in admission to a nursing home) was valued at 0.05; a "good" hip fracture (maintaining independent living in the community) 0.31, and fear of falling 0.67. Of women surveyed, 80% would rather be dead (utility=0) than experience the loss of independence and quality of life that results from a bad hip fracture and subsequent admission to a nursing home. The differences in mean utility weights between the trial groups and the refusers were not significant. A test-retest study on 36 women found that the results were reliable with correlation coefficients within classes ranging from 0.61 to 0.88. CONCLUSIONS: Among older women who have exceeded average life expectancy, quality of life is profoundly threatened by falls and hip fractures. Older women place a very high marginal value on their health. Any loss of ability to live independently in the community has a considerable detrimental effect on their quality of life.

Accidental Falls↗
PubMed2000

Are preferences over health states complete?

Most applied work in health economics accepts, if only implicitly, the axiom of completeness. Preferences over health states or health services are assumed to be well formed. They are effectively 'data' waiting to be collected. An alternative perspective suggests that values are initially incomplete and are constructed rather than just revealed in the process of answering choice-related questions such as willingness to pay or standard gambles. What might appear as measurement error may, therefore, be a more deliberate process of reflection and deliberation. This paper reports on a study that assessed the completeness of health preferences. The results show a mixed pattern. For most of the sample, values were stable over repeat administration, suggesting completeness. However, one-third of participants deliberately changed their answers and suggested that the interview process had forced them to think about their values more deeply. While it is premature to draw conclusions from this small sample, the suggestion is that completeness cannot be taken for granted.

Adult↗
PubMed2000

Getting the questions right: an example of loss of validity during transfer of a brief screening approach for depression in the elderly.

Screening for depression in the elderly has been advocated to improve detection and management. This article summarises the trend towards briefer screening instruments, and the integration of mental health screening with other assessments. The study aimed to validate a single question depression screen which has previously shown adequate sensitivity and specificity in a new context: a multi-faceted assessment instrument used by nurse practitioners within a community sample of over 75 year olds. The GMS-AGECAT computerised interview assessment was used as a 'gold standard' to determine the accuracy of the depression question in this new setting. Three hundred and twenty-eight patients were screened by their own nurse practitioners, of whom 100 consenting patients underwent a further interview with a research assistant using the GMS-AGECAT. The prevalence of depression was 30%, the sensitivity of the question was 67%, and its specificity 60% (compared with 88% and 71% previously). Responses indicating disability and loneliness were more closely correlated with depression than the depression screen itself. Relevant factors may include: the derivation of the question, the effect of a different sample, altered reliability when used by multiple interviewers, differing patient expectations, and the wording and context of the question within the multi-faceted screening instrument. Depression screening questions need repeated validation when used in different contexts. Patient and staff expectations may influence how screening instruments are used in practice in a way that may also alter reliability. Further studies are needed to establish the causes of loss of validity when screening approaches are used in new settings.

Aged↗
PubMed2000

A tool to improve quality of reporting published economic analyses.

OBJECTIVES: To test the feasibility of obtaining a baseline level of quality of reporting for cost-utility analysis (CUA) studies using the British Medical Journal economic submissions checklist, test interrater reliability of this tool, and discuss its longer term implications. METHODS: CUA studies in peer-reviewed English language journals in 1996, assessed using the British Medical Journal checklist, a quality index, and interrater reliability correlations. RESULTS: Forty-three CUA studies were assessed, with 23 checklist items acceptable and 10 items inadequate. Lowest quality scores were reported in specialist medical journals. Proportional agreement between assessors was over 80%. CONCLUSIONS: The British Medical Journal checklist is a feasible tool to collect baseline information on the quality of reporting in journals other than the British Medical Journal. Editors of specialist medical journals are in greatest need of economic guidance. If handled carefully, they might consider adopting the British Medical Journal checklist.

Cost-Benefit Analysis↗
PubMed2000

Early stage breast cancer: costs and quality of life one year after treatment by mastectomy or conservative surgery and radiation therapy.

This paper reports a descriptive study of the costs and quality of life (QoL) outcome of treatments for early stage breast cancer in a cohort of Australian women, one year after initial surgical treatment. Mastectomy without breast reconstruction is compared to breast conserving surgery and radiotherapy (breast conservation). Of the 397 women eligible for the study, costing data were collected for 81% and quality of life data for 73%. The cost differences between treatment groups were mainly accounted for by adjuvant therapies, the more expensive being radiotherapy. When compared to women treated by mastectomy, those treated by breast conservation reported better body image but worse physical function. The negative impact of breast cancer and its treatment was greater for younger women, across a number of dimensions of quality of life (regardless of treatment type). While this study shows that breast conservation is more expensive than mastectomy, the QoL results reinforce the importance of patient participation in treatment decisions.

Journal Article↗
PubMed1999

Raising the quality of cost-utility analyses: lessons learnt and still to learn.

Heightened awareness by health care funders of the need to find more efficient ways of using scarce health care resources has led to greater demand for evidence of cost-effectiveness. Implicit in this demand is that evidence is generated using clear reporting and accepted methods. The research reported here updates an earlier review of published cost-utility analyses (CUAs) to address whether previously identified gaps in reporting have diminished over time. Raising CUA standards requires systematic and regular reviews of published material to allow adequate monitoring and evaluation. There is also a need to 'appraise the appraisers' in the sense of reviewing peer-review processes. This is particularly so in those journals which are growing in importance as outlets for economic evaluation information. The findings from this study indicate continuing variation in the quality of reporting. At the lower end of this spectrum improvements could be made in the reporting of comparators, in the clarity of effectiveness evidence, in the assignment of utility weights to health states and in reporting of sensitivity analysis. CUAs published in peer-reviewed specialist medical journals were more likely to be lower in quality suggesting guidance on the appraisal of economic submissions needs to be extended to the editors of these particular journals. These findings could be used to help to target attempts to raise the quality of evidence-based CUA information.

Australia↗
PubMed1999

An efficient, adaptive method of measuring loudness growth functions.

This paper presents a new categorical loudness scaling procedure that differs from previously published loudness scaling procedures by (i) adaptively selecting a new set of levels for each new sequence, (ii) deriving levels that are equispaced on the loudness scale, and (iii) using a continuous scale with few labels. A major advantage of the adaptive procedure is that the individual dynamic range need not be measured prior to loudness testing. The adaptive procedure proved to be time efficient and to produce complete loudness functions from Not heard to Uncomfortably loud for normal hearing and hearing impaired subjects. The pattern of short-term and long-term reliability was similar to that reported for non-adaptive loudness scaling procedures. Three presentations produced a stable loudness function. Normative curves for one octave babble-noise at six test frequencies are presented and compared to normative data obtained with a selection of published categorical scaling procedures.

Adolescent↗
PubMed1997

Ciprofloxacin-resistant Escherichia coli emerging in a rehabilitation medical center.

A retrospective review of laboratory records from 1988 to 1996 has shown an increased rate of ciprofloxacin-resistant (cip(r)) Escherichia coli in our rehabilitation center. Resistance increased from 0.6% in 1989 to 5.9% in 1996. Of 7870 E. coli strains isolated during this period, 257 cip(r)-E. coli were recovered from 257 patients. The majority (96%) of these resistant strains were isolated from the urine samples. One hundred and twenty strains of cip(r)-E. coli were also resistant to four other fluoroquinolones. MICs ranging from 64 to 512 micrograms/mL were observed in 75% of the strains and > or = 1028 micrograms/mL in 6.4% of the strains. Resistance to ciprofloxacin was due to possible mutations in topoisomerase gyrA.

Anti-Infective Agents↗
PubMed1997

The quiet revolution: reporting of health outcomes in general medical journals.

This study reviews the extent of evaluation of health outcomes in three general medical journals over the past decade by examining papers published in the original research section of the New England Journal of Medicine (NEJM), The Lancet, and the Medical Journal of Australia (MJA) in 1982 and 1992. Evaluations were identified and classified according to the type of comparison group and the type of outcome measures employed. They were divided into three categories: those employing a comparison group; those employing a before-and-after study design (or own comparison group); and those with no comparison group. The categories of outcome measures were mortality, clinical or intermediate measures of health state, and final outcome measures (quality of life). Results show that the proportion of papers evaluating a health services intervention remained stable over the period. However, the MJA published considerably fewer evaluations than the other journals. In the NEJM and The Lancet, 75 per cent of evaluations incorporated comparison groups, in the MJA, less than 40 per cent. Overall, the proportion of papers reporting final outcome measures increased significantly between 1982 and 1992 (p = 0.04) but the change in each journal individually did not reach statistical significance. This study indicates that the reporting of health outcomes evaluations has remained constant but there has been some change in the use of comparison groups and final outcome measures over time.

Australia↗
PubMed1996

A multisite survey of factors contributing to medically unnecessary ambulance transports.

OBJECTIVES: To determine the social and demographic factors associated with medically unnecessary ambulance utilization, and to determine the willingness of patients to use alternate modes of transportation to the ED. METHODS: A multisite prospective survey was conducted of all patients arriving by ambulance to 1 suburban and 4 urban EDs in New York State during a 1-week period. RESULTS: For 626 patients surveyed, 71 (11.3%) transports were judged medically unnecessary by the receiving emergency physicians using preestablished guidelines. The patient's type of medical insurance and age were significant predictors of unnecessary ambulance transport (stepwise forward logistic regression analysis). Of the 71 patients whose ambulance transports were deemed medically unnecessary, 42 (59%) were Medicaid recipients and 53 (74%) were < 40 years of age. The most common reason for using ambulance transport was lack of an alternate mode of transportation (38.5%), although 82% would have been willing to use an alternate mode of transportation if it had been available. Of those who had medically unnecessary ambulance use, 30% indicated that they would not pay for the ambulance service if billed and 50% believed the cost of their ambulance transports was < $100. More than 85% of the patients whose ambulance transports were deemed medically unnecessary were unemployed; and nearly 85% reported a net annual income of < $20,000. While 33% had a primary care provider, only 22% had attempted to contact their doctors before requesting an ambulance. CONCLUSIONS: Patient age < 40 years and Medicaid coverage were associated with medically unnecessary ambulance use. Those patients for whom ambulance use was considered medically unnecessary commonly had no alternate means of transportation. Providing alternate means of unscheduled transportation may reduce the incidence of unnecessary ambulance use.

Adolescent↗
PubMed1994

An effective age-unrestricted m-AMSA-based second-line regimen for poor prognosis acute myeloid leukaemia.

The efficacy and toxicity of a regimen consisting of amsacrine (m-AMSA), cytarabine, and thioguanine for remission-induction therapy in poor prognosis categories of acute myeloid leukaemia (AML) were determined in a single arm study of 46 patients. The study group consisted of 17 patients with disease refractory to daunorubicin plus cytarabine-based induction regimens, 22 patients with disease which had relapsed during daunorubicin plus cytarabine maintenance therapy, or following completion of this maintenance programme after receiving > or = 500 mg daunorubicin/m2, and 7 previously untreated patients where cardiac disease contraindicated anthracycline therapy. Complete remission (CR) was attained in 46%, and probability of survival was comparable to published results for first-line treatment with daunorubicin plus cytarabine regimens. There was no statistically significant difference in CR rate or probability of survival between these three categories of poor prognosis AML, and cardiotoxic complications were uncommon despite extensive anthracycline exposure in the majority. In the 43% of patients who were 60-76 years of age, there was no statistically significant difference in CR rate or probability of survival relative to patients < 60 years. This observation fails to support the view that less myelotoxic regimens with lesser efficacy should be the basic approach to treatment of AML in patients > or = 60 years of age.

Adult↗