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M Petticrew

Publications and source records attributed to M Petticrew.

At least 37 records · Page 2Linked to original sources
PubMed1999

Quality-assessed reviews of health care interventions and the database of abstracts of reviews of effectiveness (DARE). NHS CRD Review, Dissemination, and Information Teams.

OBJECTIVES: Database of Abstracts of Reviews of Effectiveness (DARE) (http:@www.york.ac.uk/inst/crd/) at the NHS Centre for Reviews and Dissemination provides a unique international resource of structured summaries of quality-assessed reviews of health care interventions. These reviews have been identified from searches of electronic databases and by hand-searching journals. This paper describes and summarizes the DARE database, including the topic areas covered and the review methods used. METHODS: The first 480 structured abstracts on the DARE database were summarized. Data were extracted from each database field and coded for analysis. RESULTS: Most of the systematic reviews investigated the effectiveness of treatments: 54% investigated the effectiveness of medical therapies, and 10% assessed surgical interventions. Around two-thirds used meta-analytic methods to combine primary studies. The quality of the reviews was variable, with just over half of the reviews (52%, n = 251) having systematically assessed the validity of the included primary studies. Narrative reviews were more likely than meta-analyses to reach negative conclusions (42% vs. 25%, p = .0001). The 21 reviews that reported drug company funding were more likely to reach positive conclusions (81% vs. 66%, p = .15). CONCLUSION: The DARE database is a valuable source of quality-assessed systematic reviews, and is free and easily accessible. It provides a valuable online resource to help in filtering out poorer quality reviews when assessing the effectiveness of health technologies.

Abstracting and Indexing↗
PubMed1999

What's the 'best buy' for treatment of constipation? Results of a systematic review of the efficacy and comparative efficacy of laxatives in the elderly.

Constipation is a common cause of general practice consultations in elderly people, and laxative use is common among this group of patients. However, there appears to be little evidence to guide laxative treatment in this population. This paper reports the results of a systematic review of randomized controlled trials of the efficacy of laxatives in the treatment of constipation in the elderly. While the results of the review suggest that laxatives can improve bowel movement frequency, stool consistency, and symptoms of constipation, with a few exceptions, the relevant trials have serious methodological shortcomings. However, the review finds little evidence of marked differences in effectiveness between laxatives and, in particular, there appears to be no evidence to support the current National Health Service (NHS) trend towards prescribing the more expensive stimulant laxatives. This is an area where good quality trial evidence is now needed.

Aged↗
PubMed1998

Assessment of the reproducibility of clinical coding in routinely collected hospital activity data: a study in two hospitals.

BACKGROUND: The aim of the study was to assess the reproducibility of clinical coding in two National Health Service hospitals within North West Thames region. METHODS: A retrospective audit was carried out, of clinical coding in hospital episode statistics, involving comparison of the codes assigned by local staff with those assigned by members of an external team unaware of the locally assigned codes. Where local and external coders disagreed, the records were reviewed for a third time by a further independent coder. The subjects were a random sample of 1607 non-maternity, non-psychiatric admissions occurring between 1991 and 1993, stratified for year and type of disease (asthma, diabetes, appendicitis, fractured femur and 'general'--a random selection of any diagnoses). The main outcome measures were the levels of exact agreement between local and external teams over codes for main diagnosis and procedure, and the level of approximate agreement (over the first three characters of the ICD-9 code for diagnosis and the letter and first two digits of the OPCS-4 code for procedure). For disagreements, the outcome measure was the level of agreement between the 'third' coder and the local and external coders. RESULTS: For the main diagnosis in the 'general' group at hospital A, internal and external coders agreed exactly in 43 per cent of the admissions examined and agreed 'approximately' in 55 per cent (kappa = 0.54). For hospital B the corresponding figures were 60 per cent and 72 per cent (kappa = 0.72). Approximate agreement was higher for the specific diseases considered, particularly for asthma (A: 86 per cent; B: 91 per cent) and fractured femur (A: 84 per cent; B: 89 per cent). For the main procedure at hospital A, there was exact agreement for 58 per cent and approximate agreement for 70 per cent (kappa = 0.66). For hospital B, the corresponding figures were 76 per cent and 83 per cent (kappa = 0.80). In cases of disagreement over the first three digits of the ICD-9 code for main diagnosis, the third coder disagreed with both local and external coders in 53 per cent at hospital A and 38 per cent at hospital B. Agreement was slightly better for discharges in 1992-1993 than in 1991-1992. CONCLUSIONS: The full clinical codes in NHS hospital episode statistics (HES) data should be treated with caution. The first three characters of ICD-9 codes for diagnoses and the OPCS-4 codes for procedures were more reliable. For some specific conditions such as asthma and fractured femur, reliability of the first three characters is much higher (for example, 86 per cent and 91 per cent for asthma in the two hospitals), but for the full codes can be worse. Secondary diagnoses or comorbidities may be significantly undercoded. A higher level of agreement in 1992-1993 than in 1991-1992 suggests that coding may be improving.

Abstracting and Indexing↗
PubMed1998

The performance of screening tests for ovarian cancer: results of a systematic review.

OBJECTIVE: To estimate the performance of currently available tests in detecting ovarian cancer in asymptomatic women. METHODS: Systematic review of prospective screening studies. RESULTS: Twenty-five studies were identified: sixteen studied women at average risk and nine studied women at higher risk. Most studies evaluated only one screening method, were small, detecting few cancers, and gave few follow up details. Sensitivity estimates are therefore imprecise. In a typical larger study, reported sensitivity of ultrasound screening at one year was around 100% (95% CI 54%-100%), while the sensitivity of CA125 measurement followed by ultrasound (multimodal screening) was about 80% (95% CI 49%-95%). False positive rates ranged between 1.2% and 2.5% for grey scale ultrasound, between 0.3% and 0.7% for ultrasound with colour Doppler and between 0.1% and 0.6% for multimodal screening. This implies that, in annual screening of a population with an incidence of 40 per 100,000, and if no cancers were missed, between 2.5 and 60 women would undergo surgery for every primary ovarian cancer detected. CONCLUSIONS: Ultrasound and multimodal screening can detect ovarian cancer in asymptomatic women, but there is currently no evidence on whether screening improves outcome for women in any risk group. On-going randomised controlled trials should establish the magnitude of any benefit of screening. The low prevalence of ovarian cancer in the population, and its rate of progression, may limit the potential cost-effectiveness of screening.

Adolescent↗
PubMed1997

The management of stable angina.

Symptoms of chronic stable angina are easily identifiable and indicate that a patient is at increased risk of heart attack and death. In patients with less severe angina, medical treatments are as effective as more invasive treatments and produce better survival rates. There is little evidence that the main types of medical treatment differ in effectiveness. For patients at higher risk, invasive revascularisation procedures--coronary artery bypass grafting (CABG) and angioplasty--are more appropriate. CABG is slightly more effective than angioplasty. A high proportion of patients receiving angioplasty require re-treatment. The risk of recurrence and coronary events is reduced if patients who receive invasive procedures also have long-term low dose aspirin and cholesterol-lowering therapy. There is no clear evidence that intracoronary stents are more cost-effective than standard angioplasty. There is a need for evidence-based guidance to help determine referral thresholds for further investigation, and revascularisation procedures. There is evidence of inequality of access to testing and treatment, by gender, ethnic group and social class. Access should be monitored in order to promote equity.

Angina Pectoris↗
PubMed1997

The National Psychiatric Morbidity surveys of Great Britain--strategy and methods.

BACKGROUND: This paper describes the rationale and methodology of the first national psychiatric morbidity surveys to be carried out in Great Britain. The objectives of the surveys were to estimate the prevalence of psychiatric morbidity among adults aged 16-64 living in Great Britain; to identify the nature and extent of social disabilities associated with psychiatric morbidity; to describe the use of health and social services by people with psychiatric morbidity and to investigate the association between mental illness and potential environmental risk factors in a household sample. METHODS: Four separate surveys were carried out in order to meet the objectives; a private household sample (N = 10108), a sample of institutions caring for the mentally ill (N = 1191), a sample of homeless people (N = 1166), and a supplementary sample of patients with psychosis living in private households (N = 350). A two-stage assessment procedure was used, in which all subjects were given the Revised Clinical Interview Schedule (CIS-R) administered by lay interviewers to assess neurotic symptoms and disorders and a psychosis screen, including the Psychosis Screening Questionnaire. Those who were positive on the psychosis screen were then interviewed by psychiatrists using the SCAN (incorporating the tenth edition of the Present State Examination). CONCLUSIONS: Large scale national surveys such as this augment the inadequate data on psychiatric morbidity that are routinely available and are, therefore, an important source of information upon which to base policy and generate aetiological hypotheses. These surveys provide a possible model for similar surveys in other countries.

Adolescent↗