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Biomedical subjects

R T Edwards

Publications and source records attributed to R T Edwards.

At least 19 recordsLinked to original sources
PubMed2006

Encouraging fruit consumption in primary schoolchildren: a pilot study in North Wales, UK.

OBJECTIVE: To explore the feasibility and cost of promoting fruit consumption among primary schoolchildren across Anglesey, a region in North Wales, UK. DESIGN, SETTING AND SUBJECTS: A postal survey of the head teachers of all 51 primary schools across Anglesey to ascertain their attitudes to promoting fruit consumption and current initiatives in place was conducted. This was followed by a 1-week pilot study in a single primary school to assess parents' support and willingness to bear or share costs, to determine children's fruit preferences, and to calculate fruit waste. Finally, the cost to local government of providing a piece of fruit to each primary schoolchild daily was calculated. RESULTS: A 53% response rate was obtained in the postal survey of primary school head teachers. All respondents expressed an interest in participating in future fruit promotion programmes. Of 27 primary schools, 26 that responded (96.3%) had programmes in place in which 18 had adopted specific food policies. In the pilot study at the single Anglesey primary school, a response rate of 97% from parents who expressed support for fruit promotion in school was obtained. Parents expressed their willingness to pay at least 15 pence per day towards fruit provision at break time for their children if such a service was not provided by local government. If local government was to invest in this initiative, the total cost of providing one piece of fruit per day to all primary school children in Anglesey would be 211,000 pounds per annum (2004 prices; 19 pence per child per day). CONCLUSION: This pilot study shows support by teachers and parents for initiatives to encourage primary schoolchildren to eat more fruit. Waste can be minimized by choosing fruit that children prefer, in this study, grapes, apples and oranges. The decision as to whether local government or parents are asked to pay for fruit provision is political, depending on local socioeconomic circumstances, local government priorities, national education and nutrition policies.

Child↗
PubMed2004

Estimating the survival benefits gained from providing national cancer genetic services to women with a family history of breast cancer.

The aim of this paper is to compare a service offering genetic testing and presymptomatic surveillance to women at increased risk of developing breast cancer with its predecessor of no service at all in terms of survival and quality-adjusted survival (QALYs) by means of a Markov cohort chain simulation model. Genetic assessment and presymptomatic care provided between 0.07-1.61 mean additional life years and 0.05-1.67 mean QALYs over no services. Prophylactic surgery and surveillance extended mean life expectancy by 0.41-1.61 and 0.32-0.99 years, respectively over no services for high-risk women. Model outcomes were sensitive to all the parameters varied in the sensitivity analysis. Providing cancer genetic services increase survival and as long as services do not induce adverse psychological effects they also provide more QALYs. The greatest survival and QALY benefits were found for women with identified mutations. As more cancer genes are identified, the survival and cost-effectiveness of genetic services will improve. Although mastectomy provided most additional life years, when quality of life was accounted for oophorectomy was the optimal strategy. Delayed entry into coordinated genetic services was found to diminish the average survival and QALY gains for a woman utilising these services.

Adult↗
PubMed2004

Cancer genetics services: a systematic review of the economic evidence and issues.

This paper systematically reviews the published economic research upon cancer genetics services for families at risk of having familial breast, ovarian or colorectal cancer. A structured search was made of 15 electronic databases. The search identified 1030 papers, of which 31 fulfilled the inclusion criteria, two were cost-benefit studies, five were cost consequences, four were cost-effectiveness studies, one was a cost analysis, two were cost-minimisation studies, one was a cost-utility study, 10 modelled life years and six were reviews. Modelling studies indicate that surveillance, prophylactic and chemoprevention techniques extend survival for carriers of identified mutations. Genetic testing has been estimated to cost 70-2400 USD [48-1591 UK pounds] and genetic counselling 129-800 USD [89-551 UK pounds]. The technology of genetic testing has been found to be cost effective. Cost effectiveness was particularly influenced by targeting genetic services for patients with a strong family history of cancer rather than screening the entire population. Future economic evaluation must go beyond merely assessing health outcomes and mutation identification, and account for the impact of genetic services upon the individual, the family and society, establish the value of services to these groups and determine the most effective ways of delivering genetic services.

Breast Neoplasms↗
PubMed2001

Paradigms and research programmes: is it time to move from health care economics to health economics?

As an applied subdiscipline of economics, health economics has flourished, defining itself as the study of how scarce health care resources may be used to meet our needs. This evolutionary pathway has led to health economists adopting a very 'medical' model of health, in which the predominant production function for health is health care. This paper sets out policy challenges to health economics which have arisen in light of growing recognition by governments of the socioeconomic determinants of health and their stated commitment to tackle inequalities in health. It reviews Thomas Kuhn's theory of paradigm shift and Imre Lakatos' theory of scientific research programmes in the natural sciences, favouring the latter as an explanation of the evolution of the subdiscipline of health economics. The paper brings together four recently published visions of the future of health economics-visions that are almost exclusively focused on the production, organization and distribution of health care. In contrast to these visions, in Lakatosian terms, this paper challenges the subdiscipline's core 'positive heuristic', i.e. the set of imperatives which determines how the research programme should unfold, how it may be defended, its scope and boundaries. This paper argues that health economics will need to evolve to embrace a more socioeconomic model of health and, to this end, offers for debate an expansion of Williams' diagrammatic representation of the subdiscipline. It concludes by asking whether the magnitude and the magnetism of health care policy issues will continue to prove too strong to allow health economists, should they wish, to steer their research and educational programmes more directly towards 'health' rather than 'health care' as the relevant social want.

Delivery of Health Care↗
PubMed2001

Trade-offs in the conduct of economic evaluations of child mental health services.

Childhood psychological morbidity places both short-term and long-term costs on families, health services, social services, voluntary organizations, and society as a whole. Internationally, there have been few economic evaluations alongside clinical trials of population-based interventions to improve child mental well-being. This paper sets out a number of trade-offs relevant to the evaluation of the costs and benefits of multisectoral interventions to improve child mental well-being. These trade-offs have relevance for those who fund research, those who conduct research, and those who make policy decisions. The paper sets out a conceptual model for the economic evaluation of population-based interventions to improve child mental health. Finally, the paper argues that with the advent of "joined up" public policy and the breakdown of traditional ring-fenced budgets for health and social care, there is now, more than ever before, an opportunity for the research community to generate guidance for multisectoral collaborative interventions to promote the mental well-being of children and their families.

Child↗
PubMed2001

Steering a course around the genetic iceberg.

A US company is now marketing worldwide, via the Internet, genetic testing for predisposition to breast and ovarian cancer. This paper explores some of the divergent concerns about the implications of private genetic testing for the United States and United Kingdom, with their differing health care systems. As the UK National Health Service faces calls for expansion in its genetic services to meet growing demand, there is now a need for evaluation of the costs and effectiveness of such services so that they may be efficiently targeted to those women who can benefit most from them. In the cases of breast and ovarian cancer, it is relatively straightforward to calculate the benefits in terms of added life expectancy and health-related quality of life resulting from earlier diagnosis and treatment of affected women, but these women are likely to be a small proportion of the total number of women who are referred or self-refer to genetic services. This paper asks how we are to measure and value the benefits of information about risk of cancer to a particular woman or to members of her family; how we are to measure and value the benefits of effective counselling, which encourages autonomous, informed decision-making about whether or not to undergo genetic testing, and which facilitates comprehension of complex results; and ultimately, in the face of advances in genetic science, how we are to steer the NHS around the genetic iceberg.

Breast Neoplasms↗
PubMed2000

Weights for waits: lessons from Salisbury.

OBJECTIVES: This paper describes a waiting list patients' points scheme under development in Salisbury, UK, for the fair management of elective inpatient and day case waiting lists. The paper illustrates how points can be assigned to patients on a waiting list to indicate their relative unmet need, and illustrates the impact on case mix and resource use of the implementations of the points system versus 'first come, first served'. The paper explores a range of philosophical and technical questions raised by the points system. METHODS: The Salisbury Priority Scoring System enables surgeons to assign relative priority to patients at the time they are placed on a waiting list for elective health care. Points are assigned to patients to reflect the rate of progress of their disease, pain or distress, disability or dependence on others, loss of usual occupation and time already waited. In recognition of the need for resource planning alongside the prioritization of elective inpatients and day case waiting lists, a range of iso-resource groups has been developed for all procedures on these lists. These categorize procedures in terms of their resource use (i.e. bed days and theatre time required). RESULTS: In a modelling exercise, application of the Salisbury Points Scheme to a 'first come, first served' orthopaedic waiting list produced considerable changes in the order of patients to be treated. Only seven patients appeared in the first 20 patients to be treated under both regimes. The Salisbury Scheme required fewer resources to treat its first 20 patients than 'first come, first served' and met more Salisbury-defined 'need', but eliminated fewer days of waiting from the list. CONCLUSIONS: Development of a points scheme and iso-resource groupings opens up opportunities for more sophisticated purchasing, based on treating patients in order of unmet need rather than according to arbitrary maximum waiting time guarantees, as has been the dominant policy on waiting lists pursued in the UK, Australia, and Sweden, to date. However, such schemes raise three issues: first, the necessity of defining need as a composite of clinical and social factors; second the necessity to determine the acceptability of explicit prioritization to both health care professionals and patients; third, the thorny issue of whether such prioritization schemes will lead to 'gaming' by well-meaning general practitioners and specialists, aiming to secure the priority of their own patients and clinical specialty. Rigorous piloting of schemes, such as that developed at Salisbury, will be required to identify their dynamic effect over time on case mix, waiting time and resource use.

Delivery of Health Care↗
PubMed1999

Acoustic transient classification with a template correlation processor.

I present an architecture for acoustic pattern classification using trinary-trinary template correlation. In spite of its computational simplicity, the algorithm and architecture represent a method which greatly reduces bandwidth of the input, storage requirements of the classifier memory, and power consumption of the system without compromising classification accuracy. The linear system should be amenable to training using recently-developed methods such as Independent Component Analysis (ICA), and we predict that behavior will be qualitatively similar to that of structures in the auditory cortex.

Algorithms↗
PubMed1995

New South Wales group pathology services--the Southpath model.

There has been significant rationalisation of public pathology service provision in New South Wales through the formation of group pathology services. These services are a fundamental change in the method of service organisation and delivery and little has been reported detailing their organisational and financial structures. Southpath, the group pathology service of the Southern Sydney Area Health Service, has improved service delivery, improved productivity by 18.2 per cent and reduced pathology expenditure per admission by 19.2 per cent. This paper describes the organisation of Southpath as knowledge of the organisational structures and performance of the group pathology service is necessary for the evaluation of this change in the method of service delivery and is essential to the current debate on the value of public pathology services.

Budgets↗
PubMed1993

Physical characterization and quantification of bacteria by sedimentation field-flow fractionation.

Studies in microbial ecology require accurate measures of cell number and biomass. Although epifluorescence microscopy is an accepted and dependable method for determining cell numbers, current methods of converting biovolume to biomass are error prone, tedious, and labor-intensive. This paper describes a technique with sedimentation field-flow fractionation to enumerate bacteria and determine their density, size, and mass. Using cultured cells of different shapes and sizes, we determined optimum values for separation run parameters and sample-handling procedures. The technique described can separate and detect 4', 6-diamidino-2-phenylindole-stained cells and generate a fractogram from which cell numbers and their size or mass distribution can be calculated. A direct method for estimating bacterial biomass (dry organic matter content) which offers distinct advantages over present methods for calculating biomass has been developed.

Journal Article↗
PubMed1993

A comparison of pathology usage in three New South Wales public hospitals.

Data on pathology testing in New South Wales public hospitals are extremely limited. Pathology laboratory billing files and hospital admissions and transfer files were used to obtain data on the pathology testing frequency and cost of testing at three New South Wales public hospitals. Data were also extracted that allowed a comparison of test ordering frequency and cost of testing for various groups of admitting specialists. A high degree of similarity was found in the test ordering patterns at each hospital with 16 common tests or test groups in the top 20 tests or test groups at each hospital. These 16 tests or test groups accounted for 78, 82 and 88% of the total pathology expenditure at each hospital. The total cost of pathology per occupied bed day was found to be A$26.23, A$34.63 and A$44.66 at each hospital and represented 5.5, 5.2 and 6.8% of the total cost per occupied bed day, respectively, at each hospital. Variation was found between hospitals in the cost per occupied bed day for surgery, medicine, obstetrics and gynaecology and paediatrics. Three major reasons for the variations in pathology costs were identified as variations in outpatient loads, variations in test ordering patterns among medical practitioners and casemix.

Ambulatory Care↗
PubMed1986

Production and turnover of planktonic bacteria in two southeastern blackwater rivers.

Production by attached and free-living planktonic bacteria in two blackwater rivers in the Southeastern United States was measured over a period of 14 months by using the rate of incorporation of [methyl-H]thymidine into DNA. Production rates and biomass dynamics were compared to determine the potential for in situ production to supply planktonic biomass. Bacterial production in these rivers was moderate and varied seasonally. Rates varied from 0.058 to 2.120 mg of C m h in the Ogeechee River and from 0.002 to 2.418 mg of C m h in Black Creek. Regressions of growth rate on various environmental variables showed that temperature and total dissolved organic carbon concentration were the best predictors of growth. Although attached bacteria were <21% of the total biomass, they accounted for up to 53% of the total production. Turnover times for attached bacteria ranged from <1 day to >3 years depending on season. Turnover times of free-living bacteria varied from 4.4 days to 11.8 years. Comparisons of biomass with production indicated that during most seasons, the majority of bacterial biomass in these rivers was of allochthonous origin. During summer, when water temperatures were high, bacterial growth in the river may have supplied a greater percentage of the standing stock of bacteria than allochthonous inputs.

Journal Article↗