165 research outputs found
Leader-Member Exchange (LMX) differentiation and work outcomes: Conceptual Clarification and Critical Review
No full textEconomic modelling assessment of cervical cancer screening and HPV vaccination in Brazil
No full textMore than 85% of the global burden of cervical cancer occurs in developing countries, where it
is the second most common cancer among women. In Brazil alone, a total of 17,500 new cases
and 3,300 deaths of cervical cancer are expected in 2012. Despite the investments in cytologybased
screening in the country, the reduction of cervical cancer incidence has been less than
expected. The aim of this thesis was to investigate the cost-effectiveness of alternative cervical
cancer screening and HPV vaccination strategies in Brazil. This was achieved by focusing on
three specific objectives: 1) To evaluate the cost-effectiveness of cervical cancer screening
strategies for women presenting equivocal cytological results, 2) To evaluate the costeffectiveness
of cervical cancer screening strategies for HIV-infected women, 3) To evaluate
the cost-effectiveness of HPVvaccination for pre-adolescent women. An additional objective
was to review and provide guidance on the use of model calibration methods in economic
modelling assessments,as they are particularly important in screening and vaccination studies.
The first empirical analysis found that HPV triage for women above 30 years-old presenting
equivocal cytology results was likely to be very cost-effective. The second empirical analysis
found that to screen HIV-infected women with HPVtesting followed by cytology annually was
also likely to be very cost-effective. The third empirical analysis demonstrated that adding the
quadrivalent vaccination of pre-adolescent girls to the current efforts to control cervical cancer
in Brazil was very cost-effective for most of the scenarios analyzed. The vaccine was even cost
saving when considering low coverage and cost of vaccination. This thesis presents findings
that will inform cervical cancer screening and HPV vaccination policies in middle-income
countries like Brazil and also provides guidance to help improve the standards of model
calibration approaches used in cost-effectiveness analysis
Cost and logistics of alternative roll-out options for implementing human papillomavirus testing as a triage in cervical screening: results of the sentinel sites study.
No full textBACKGROUND: Previous studies have indicated that human papillomavirus (HPV) testing as a triage for managing equivocal cytology is cost-effective. The aim of this study was to assess the costs of alternative roll-out options. METHODS: Detailed cost estimates were collected from six laboratories where HPV triage had been implemented. Costs were assessed for the two different service delivery models that were implemented; a 'hub and spoke model' of central HPV testing in a microbiology laboratory with separate cytology laboratories, and an 'integrated model' where HPV testing was conducted within the cytology laboratory. RESULTS: Comparison of alternative delivery models indicated that setting up HPV processing within existing cytology laboratory, i.e., an 'integrated cytology/HPV laboratory' generated savings in staff time amounting to between £2.54 and 4.86 per sample processed. Running full HPV testing batches was also an important consideration. For full batches to be run on a twice weekly basis requires having no more than two laboratories per Strategic Health Authority. CONCLUSIONS: To be cost-efficient, and to meet turn-around times, HPV testing needs to be conducted at integrated cytology/HPV testing centres with sufficient throughput to run full batches of HPV tests
Economic Evaluation of Prevention Strategies for Women at Increased Risk of Breast and Ovarian Cancer
No full textBACKGROUND: Breast cancer (BC) and ovarian cancer (OC) are common female cancers. A proportion of women can be identified as being at increased risk of BC or OC based on genetic and non-genetic factors. Common BC and OC cancer susceptibility genes include BRCA1 and BRCA2, along-with newer moderate penetrance genes such as PALB2, RAD51C, RAD51D, and BRIP1. BC screening, medical prevention, and risk-reducing surgery are recommended risk management strategies. Surgical prevention, including risk reducing mastectomy (RRM) for BC and risk-reducing salpingo-oophorectomy (RRSO) for OC, are the most clinically effective options. Novel approaches like risk-reducing early salpingectomy are under investigation in clinical trials. This thesis aims to evaluate the cost-effectiveness of eligible prevention and screening strategies and the optimal timing of management for BC and OC prevention in the UK. METHODS: This thesis comprises four broad sections: (1) two systematic reviews on the impact of risk-reducing surgery on quality-of-life and its cost-effectiveness for BC and OC prevention; (2) a cost-effectiveness analysis to identify the lifetime BC risk thresholds for offering RRM compared with risk-stratified breast screening; (3) a cost-effectiveness analysis of recommended strategies (RRM, RRSO, breast screening, and medical prevention) for women carrying pathogenic variants (PVs) in high and moderate penetrance BC and OC cancer susceptibility genes; (4) a preliminary cost-effectiveness analysis of the novel two-step surgical prevention strategy for OC– risk-reducing early salpingectomy and delayed oophorectomy (RRESDO)– among BRCA1 and BRCA2 PV carriers, using data from the Preventing Ovarian Cancer through early Excision of Tubes and late Ovarian Removal (PROTECTOR) trial. RESULTS: RRM and RRSO are well-established and clinically effective procedures. Health related quality-of-life following RRM and RRSO remains unchanged, although negative impacts of RRM on body image and of RRSO on sexual function and menopause symptoms are reported. Both RRM and RRSO have been found to be cost-effective compared with non-surgical alternatives primarily among BRCA1 and BRCA2 PV carriers, while the optimal age for surgery varies. The lifetime OC risk thresholds for offering RRSO have been identified as ≥4%–5%. The cost-effectiveness analysis of RRM identified varying lifetime BC risk thresholds for offering this surgery at different ages. Overall, undergoing RRM at common ages of 30 to 55 years appears cost-effective for women with a lifetime BC risk over 35%, which increases to 41% if women experience a longer duration of disutility from surgery. The analysis among women carrying PVs in common BC or OC cancer susceptibility genes indicated that undergoing both RRM and RRSO was cost-effective, maximizing cancers prevented for individuals carrying BRCA1 (RRM at age 30; RRSO at age 35), BRCA2 (RRM at age 35; RRSO at age 40), and PALB2 (RRM at age 40; RRSO at age 45) PVs, while RRSO was cost-effective at age 45 for RAD51C, RAD51D, and BRIP1 PV carriers. The novel approach of RRESDO is cost-saving in preventing OC compared with no surgery among BRCA1 and BRCA2 PV carriers; however, its cost-effectiveness compared with the standard of care of RRSO remains uncertain. CONCLUSIONS: The identified lifetime BC risk thresholds for offering RRM could potentially expand clinical access to RRM beyond BRCA1, BRCA2, or PALB2 PV carriers. Personalizing risk-reducing surgery and counselling for individual cancer susceptibility gene carriers is crucial when considering RRM or RRSO, and these results have informed NICE guidelines. RRESDO may be an acceptable alternative for women reluctant to undergo RRSO, and the analysis should be updated once key parameters regarding OC risk reduction from salpingectomy and the disutility of surgical procedures become available
Are we blind to the injuries in the visually impaired? A review of the literature
No full textObjectives: To review the literature on the risks and types of injuries associated with visual impairment, and to identify pertinent areas for future research.
Methods: A search of bibliographic databases was conducted in April 2000 for studies published since 1980 and selected studies that met two or more of the following criteria: formal ophthalmic assessment was used; adjustment for confounding variables; large sample size including numbers of visually impaired; and clear definitions and outcomes.
Results: Thirty one studies were selected. The majority of these studies (20) assessed falls (including eight on hip fracture and four on multiple falls), eight studies reported traffic related injuries, and three studies assessed occupational injury. The evidence on falls, which relate predominantly to older people, suggests that those with reduced visual acuity are 1.7 times more likely to have a fall and 1.9 times more likely to have multiple falls compared with fully sighted populations. The odds of a hip fracture are between 1.3 and 1.9 times greater for those with reduced visual acuity. Studies of less severe injuries and other causes of injury were either poorly designed, underpowered, or did not exist.
Conclusions: There are substantial gaps in research on both injuries to which people with visual impairment are especially susceptible and in evaluating interventions to reduce these injuries. It is recommended that in future studies the minimum data captured includes: formal ophthalmic assessment of visual fields and visual acuity, outcome measurement, control for confounders, and the costs of health care resource use and any interventions
Economics of Breast Cancer Screening, Genetic Testing, and Treatment
No full textBreast cancer is the most common female cancer worldwide. This thesis aims to evaluate the cost-effectiveness of breast cancer control across different healthcare contexts and estimate the costs of breast cancer treatment. Four case studies are presented providing detailed estimates of the cost-effectiveness of risk-based breast screening in urban China, the cost-effectiveness of population-based breast screening in rural China, the cost-effectiveness of panel genetic testing among unselected breast cancer patients in the UK and US, and cost of breast cancer treatment by stage at diagnosis in England. The economic evaluation studies on breast cancer screening show that in urban China, high-risk population-based screening for breast cancer is very likely to be cost-effective. But in rural China, breast screening among the general population reports uncertain costeffectiveness and could potentially harm women’s health due to false positives with the current screening tools. In a rural setting with such low breast cancer incidence, priority should be given to ensure that symptomatic women have proper access to diagnosis and treatment at an early stage as this will lead to mortality reductions without the usual screening harms. The economic evaluation on genetic testing based on a microsimulation model showed that unselected panel genetic-testing for all breast cancer patients is extremely costeffective compared to the current practice of family-history/clinical-criteria based genetic (BRCA)-testing for both UK and US health systems. This supports changing the current policy to expand genetic-testing to all women with breast cancer. Costs of breast cancer care increased with increasing stage of the disease at diagnosis in England. Considerable cost savings could be made if breast cancer was detected and treated earlier. Variations in breast cancer costs by age and region raise questions about the efficiency and consistency of breast cancer treatment patterns. Future research could be conducted by undertaking multiple imputation for missing data and censored-adjusted analysis
The Recruitment and Role of Lay Members
No full text The use of lay members on research ethics committees has for some time been felt to be an example of good practice in ethical review processes. In this paper, written by a lay member, the author considers what the recruitment process for lay members might be and argues how this process should largely be shaped by what role the lay member is recruited to undertake. In considering the advantages and disadvantages of lay members, the author shows that defining the role of a lay member is not straightforward but is necessary to the good working of a research ethics committee. </jats:p
Usability and acceptability of a website that provides tailored advice on falls prevention activities for older people
No full textThis article presents the usability and acceptability of a website that provides older people with tailored advice to help motivate them to undertake physical activities that prevent falls. Views on the website from interviews with 16 older people and 26 sheltered housing wardens were analysed thematically. The website was well received with only one usability difficulty with the action plan calendar. The older people selected balance training activities out of interest or enjoyment, and appeared to carefully add them into their current routine. The wardens were motivated to promote the website to their residents, particularly those who owned a computer, had balance problems, or were physically active. However, the participants noted that currently a minority of older people use the Internet. Also, some older people underestimated how much activity was enough to improve balance, and others perceived themselves as too old for the activities
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