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Biomedical subjects

Stephen Birch

Publications and source records attributed to Stephen Birch.

44 records · Page 3Linked to original sources
PubMed2003

Trigger point--acupuncture point correlations revisited.

UNLABELLED: In 1977, Melzack and colleagues examined the possible correspondence of acupuncture points and trigger points for the treatment of pain. They claimed a 71% correspondence between these two classes of points. Their findings have influenced many researchers and practitioners but have not been examined since 1977. The current study explores the claim of a 71% correspondence between these two classes of points through a more extensive examination of the acupuncture literature. OBJECTIVES: To investigate the claim of a 71% correspondence of acupuncture points and trigger points for the treatment of pain. METHODS: The study involved a review of acupuncture texts published since 1977, focusing on five textbooks for the in-depth analyses and a broader range of texts for the more general analyses. RESULTS: If trigger points correspond to any class of acupuncture points it would have to be to the a shi points rather than the "channel" or "extra" points with which the 1977 study attempted to find correlation. Approximately 35% of recommended acupuncture points in the treatment of pain are distant from the site of the pain, making assumptions about the infrequency of use of distant acupuncture points for pain suspect. Sixty-one percent (61%) of the acupuncture points that the 1977 study examined for the treatment of pain are not recommended at all for the treatment of pain, and 44% are not recommended in the treatment of any problem, while only 19% of the acupuncture points are frequently recommended for pain and 20% for all conditions. For the acupuncture points that corresponded in the 1977 study, the equivalent numbers are: 60% not recommended at all for pain, 47% not recommended for anything, 18% commonly recommended for pain, and 16% commonly recommended for anything. CONCLUSION: The claimed 71% correspondence of trigger points to acupuncture points is conceptually not possible. Furthermore, even putting this conceptual problem aside, no more than 40% of the acupuncture points that the 1977 study examined could correlate for the treatment of pain, and more likely, only approximately 18%-19% correlate rather than the 71% that was claimed. However, this study found a probable correspondence of trigger points to a different class of acupuncture points, the a shi points, which appears to be an important finding. Researchers and clinicians who have assumed the conclusions of the 1977 study to be correct will need to reexamine the impact of the current findings on any claims that are dependent on the conclusions of that study.

Acupuncture Points↗
PubMed2003

Beyond demographic change in human resources planning: an extended framework and application to nursing.

OBJECTIVES: To introduce health care production functions into human resources planning and to apply the approach to analysing the need for registered nurses in Ontario during a period of major reduction in inpatient capacity. METHODS: Measurement of changes in services delivered by acute care hospitals in Ontario between 1994/95 and 1998/99, and comparison with changes in the mix of human resources, non-human resources and patient needs. RESULTS: Inpatient episodes per nurse fell by almost 2%. At the same time the number of beds was cut by over 20%. As a result, the number of patients per bed increased by 12%. Allowing for severity, there was a 20% reduction in beds per episode and a 3.7% reduction in nurses per episode. CONCLUSIONS: The demands on nurses in acute care hospitals have increased as an increasing number of severity-adjusted episodes are served using fewer beds by a reduced number of nurses. Human resources planning traditionally only considers the effects of demographic change on the need for and supply of health care. Failure to recognize the variable and endogenous nature of other health care inputs leads to false impressions about the adequacy of existing supplies of human resources. Consideration of human resources in the context of the production function for health services provides a meaningful way of improving the effectiveness and efficiency of human resources planning.

Demography↗
PubMed2003

NICE methodological guidelines and decision making in the National Health Service in England and Wales.

The National Institute for Clinical Excellence (NICE) responds to requests by the Department of Health for guidance on the use of selected new and established technologies in the National Health Service (NHS) in England and Wales. This paper asks whether the NICE methodological guidelines help NHS decision makers meet the objectives of maximum health improvements from NHS resources and an equitable availability of technologies. The analytical basis of the guidelines is a comparison of the costs and consequences of new and existing methods of dealing with particular conditions using the incremental cost-effectiveness ratio. We explain why information on the costs and consequences of a particular technology in isolation is insufficient to address issues of efficiency of resource use. We argue that to increase efficiency, decision makers need information on opportunity costs. We show that in the absence of such information decision makers cannot identify the efficient use of resources. Finally we argue that economics provides valid methods for identifying the maximisation of health improvements for a given allocation of resources and we describe an alternative practical approach to this problem. Drawing on the experience of Ontario, Canada where an approach similar to that proposed by NICE has been in use for almost a decade, and recent reports about the consequences of NICE decisions to date, we conclude that instead of increasing the efficiency or equity of the use of NHS resources, NICE methodological guidelines may lead to: uncontrolled increases in NHS expenditures without evidence of any increase in total health improvements; increased inequities in the availability of services; and concerns about the sustainability of public funding for new technologies.

Decision Making, Organizational↗
PubMed2002

The distribution problem in economic evaluation: income and the valuation of costs and consequences of health care programmes.

To date, a common view in the health economics literature is that the applicability of cost-benefit analysis (CBA) is limited, due to the distribution problem which underlies its main method of valuation (e.g. willingness to pay). One view is that cost effectiveness analysis (CEA) overcomes these problems. We show that the same distributional concerns apply to non-monetary valuations of health consequences, to measurement of costs and to the decision rules of CEA. Hence adopting CEA over CBA cannot be justified on the basis of "avoiding" distributional considerations. The implications of our results are discussed, including alternative strategies for the use of "income-based" research findings in social decision-making.

Consumer Behavior↗
PubMed2002

Unemployment and health: contextual-level influences on the production of health in populations.

While there is a large and growing literature investigating the relationship between an individual's employment status and health, considerably less is known about the effect on this relationship of the context in which unemployment occurs. The aim of this paper is test for the presence and nature of contextual effects in the ways unemployment and health are related, based on a simple underlying model of stress, social support and health using a large population health survey. An individual's health can be influenced directly by own exposure to unemployment and by exposure to unemployment in the individual's context, and indirectly by the effects these exposures have on the relationship between other health determinants and health. Based on this conceptualization an empirical model, using multi-level analysis, is formulated that identifies a five-stage process for exploring these complex pathways through which unemployment affects health. Results showed that the association of individual unemployment with perceived health is statistically significant. Nevertheless, this study did not provide evidence to support the hypothesis that the association of unemployment with health status depends upon whether the experience of unemployment is shared with people living in the same environment. Above all, this study demonstrates both the subtlety and complexity of individual- and contextual-level influences on the health of individuals. Our results caution against simplistic interpretations of the unemployment-health relationship and reinforce the importance of using multi-level statistical methods for investigation of it.

Adult↗
PubMed2002

Management of the low-grade abnormal Pap smear: What are women's preferences?

OBJECTIVE: To evaluate preferences among ethnically diverse women for the management of a low-grade abnormal Pap smear result: early colposcopy or observation with repeat Pap smears. STUDY DESIGN: Structured interviews were conducted with 170 women of diverse ethnic backgrounds to assess their preferences. Trained personnel conducted standardized interviews. A standard description of all tests and procedures was read to participants. The participants were presented with scenarios of contrasting management approaches for a hypothetical low-grade abnormal Pap smear result-observation with repeat Pap smear vs. immediate colposcopy. POPULATION: Study participants were recruited from the waiting rooms of 5 family planning clinics in Northern Californiaamprsquos Central Valley. OUTCOMES MEASURED: The primary outcome measures for each scenario were utilities (quantified preferences for specific health states) measured by the Standard Gamble. RESULTS: The range in utilities was large for all scenarios. Mean utilities (SD) for observation: 0.96 ( 0.13) followed by resolution; 0.93 ( 0.17) followed by cryotherapy; 0.91 ( 0.21) followed by cone biopsy. Mean utilities for early colposcopy: 0.93 ( 0.20) followed by resolution; 0.95 ( 0.14) followed by cryotherapy; and 0.92 ( 0.16) followed by cone biopsy. Subject characteristics explained less than 20% of the variance in utilities. Decision analysis gave a slightly higher overall utility for early colposcopy (0.940 vs 0.932 for observation), but was sensitive to small changes in branch utilities. CONCLUSIONS: Womenamprsquos preferences for management of a low-grade abnormal Pap result vary widely. Clinicians should adopt a flexible approach to the management of low-grade abnormal Pap smears to incorporate individual preferences.

Adolescent↗
PubMedDate not supplied

Individual and regional determinants of mammography uptake.

BACKGROUND: Analysis of mammography utilization has traditionally been performed from an individual-level perspective. The purpose of this study was to explore the combined influence of individual- and regional-level determinants of mammography utilization. METHODS: Logistic hierarchical multilevel modelling was used to investigate the influences of region of residence and individual characteristics on mammography utilization. Socioeconomic status information about health planning regions was derived from the 1996 Canadian Census. Individual-level information was extracted from the 1996 National Population Health Survey. RESULTS: After controlling for individual-level education, regions with fewer high school graduates had lower levels of mammography utilization. A cross-level interaction between regional-level education and individual-level social involvement was found. Other individual-level variables associated with screening confirmed previous literature findings. CONCLUSION: Our findings suggest that higher levels of participation in social activities modify the detrimental influence on mammography utilization of living in a less educated region. This challenges the current focus of mammography screening research on individual-level determinants of uptake. Multilevel, synergistic strategies to possibly achieve higher levels of screening should be considered by health promotion program planners.

Aged↗