Browsing by Subject "United Kingdom"

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    Barriers to and facilitators of interventions to counter publication bias: thematic analysis of scholarly articles and stakeholder interviews.
    (BMC Health Serv Res, 2014-11-13) Kien, Christina; Nußbaumer, Barbara; Thaler, Kylie J; Griebler, Ursula; Van Noord, Megan G; Wagner, Petra; Gartlehner, Gerald; UNCOVER Project Consortium
    BACKGROUND: When the nature and direction of research results affect their chances of publication, a distortion of the evidence base - termed publication bias - results. Despite considerable recent efforts to implement measures to reduce the non-publication of trials, publication bias is still a major problem in medical research. The objective of our study was to identify barriers to and facilitators of interventions to prevent or reduce publication bias. METHODS: We systematically reviewed the scholarly literature and extracted data from articles. Further, we performed semi-structured interviews with stakeholders. We performed an inductive thematic analysis to identify barriers to and facilitators of interventions to counter publication bias. RESULTS: The systematic review identified 39 articles. Thirty-four of 89 invited interview partners agreed to be interviewed. We clustered interventions into four categories: prospective trial registration, incentives for reporting in peer-reviewed journals or research reports, public availability of individual patient-level data, and peer-review/editorial processes. Barriers we identified included economic and personal interests, lack of financial resources for a global comprehensive trial registry, and different legal systems. Facilitators identified included: raising awareness of the effects of publication bias, providing incentives to make data publically available, and implementing laws to enforce prospective registration and reporting of clinical trial results. CONCLUSIONS: Publication bias is a complex problem that reflects the complex system in which it occurs. The cooperation amongst stakeholders to increase public awareness of the problem, better tailoring of incentives to publish, and ultimately legislative regulations have the greatest potential for reducing publication bias.
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    Do You Want to Hear the Bad News? The Value of Diagnostic Tests for Alzheimer's Disease.
    (Value Health, 2016-01) Mühlbacher, Axel; Johnson, F Reed; Yang, Jui-Chen; Happich, Michael; Belger, Mark
    OBJECTIVE: The diagnosis of Alzheimer's disease (AD) remains difficult. Lack of diagnostic certainty or possible distress related to a positive result from diagnostic testing could limit the application of new testing technologies. The objective of this paper is to quantify respondents' preferences for obtaining AD diagnostic tests and to estimate the perceived value of AD test information. METHODS: Discrete-choice experiment and contingent-valuation questions were administered to respondents in Germany and the United Kingdom. Choice data were analyzed by using random-parameters logit. A probit model characterized respondents who were not willing to take a test. RESULTS: Most respondents indicated a positive value for AD diagnostic test information. Respondents who indicated an interest in testing preferred brain imaging without the use of radioactive markers. German respondents had relatively lower money-equivalent values for test features compared with respondents in the United Kingdom. CONCLUSIONS: Respondents preferred less invasive diagnostic procedures and tests with higher accuracy and expressed a willingness to pay up to €700 to receive a less invasive test with the highest accuracy.
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    Early-life soy exposure and age at menarche.
    (Paediatr Perinat Epidemiol, 2012-03) Adgent, Margaret A; Daniels, Julie L; Rogan, Walter J; Adair, Linda; Edwards, Lloyd J; Westreich, Daniel; Maisonet, Mildred; Marcus, Michele
    This study examines the timing of menarche in relation to infant-feeding methods, specifically addressing the potential effects of soy isoflavone exposure through soy-based infant feeding. Subjects were participants in the Avon Longitudinal Study of Parents and Children (ALSPAC). Mothers were enrolled during pregnancy and their children have been followed prospectively. Early-life feeding regimes, categorised as primarily breast, early formula, early soy and late soy, were defined using infant-feeding questionnaires administered during infancy. For this analysis, age at menarche was assessed using questionnaires administered approximately annually between ages 8 and 14.5. Eligible subjects were limited to term, singleton, White females. We used Kaplan-Meier survival curves and Cox proportional hazards models to assess age at menarche and risk of menarche over the study period. The present analysis included 2920 girls. Approximately 2% of mothers reported that soy products were introduced into the infant diet at or before 4 months of age (early soy). The median age at menarche [interquartile range (IQR)] in the study sample was 153 months [144-163], approximately 12.8 years. The median age at menarche among early soy-fed girls was 149 months (12.4 years) [IQR, 140-159]. Compared with girls fed non-soy-based infant formula or milk (early formula), early soy-fed girls were at 25% higher risk of menarche throughout the course of follow-up (hazard ratio 1.25 [95% confidence interval 0.92, 1.71]). Our results also suggest that girls fed soy products in early infancy may have an increased risk of menarche specifically in early adolescence. These findings may be the observable manifestation of mild endocrine-disrupting effects of soy isoflavone exposure. However, our study is limited by few soy-exposed subjects and is not designed to assess biological mechanisms. Because soy formula use is common in some populations, this subtle association with menarche warrants more in-depth evaluation in future studies.
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    Genomics research: world survey of public funding.
    (BMC Genomics, 2008-10-10) Pohlhaus, Jennifer Reineke; Cook-Deegan, Robert M
    BACKGROUND: Over the past two decades, genomics has evolved as a scientific research discipline. Genomics research was fueled initially by government and nonprofit funding sources, later augmented by private research and development (R&D) funding. Citizens and taxpayers of many countries have funded much of the research, and have expectations about access to the resulting information and knowledge. While access to knowledge gained from all publicly funded research is desired, access is especially important for fields that have broad social impact and stimulate public dialogue. Genomics is one such field, where public concerns are raised for reasons such as health care and insurance implications, as well as personal and ancestral identification. Thus, genomics has grown rapidly as a field, and attracts considerable interest. RESULTS: One way to study the growth of a field of research is to examine its funding. This study focuses on public funding of genomics research, identifying and collecting data from major government and nonprofit organizations around the world, and updating previous estimates of world genomics research funding, including information about geographical origins. We initially identified 89 publicly funded organizations; we requested information about each organization's funding of genomics research. Of these organizations, 48 responded and 34 reported genomics research expenditures (of those that responded but did not supply information, some did not fund such research, others could not quantify it). The figures reported here include all the largest funders and we estimate that we have accounted for most of the genomics research funding from government and nonprofit sources. CONCLUSION: Aggregate spending on genomics research from 34 funding sources averaged around $2.9 billion in 2003-2006. The United States spent more than any other country on genomics research, corresponding to 35% of the overall worldwide public funding (compared to 49% US share of public health research funding for all purposes). When adjusted to genomics funding intensity, however, the United States dropped below Ireland, the United Kingdom, and Canada, as measured both by genomics research expenditure per capita and per Gross Domestic Product.
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    International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States: The MINAP/NICOR, SWEDEHEART/RIKS-HIA, and ACTION Registry-GWTG/NCDR registries.
    (Int J Cardiol, 2014-08-01) McNamara, RL; Chung, SC; Jernberg, T; Holmes, D; Roe, M; Timmis, A; James, S; Deanfield, J; Fonarow, GC; Peterson, ED; Jeppsson, A; Hemingway, H
    OBJECTIVES: To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries. BACKGROUND: Results from clinical trials suggest significant variation in care across the world. However, international comparisons in "real world" registries are limited. METHODS: We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n=137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n=45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n=147,438] clinical registries. RESULTS: Patients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%). CONCLUSIONS: The care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.
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    Leadership development for early career doctors.
    (Lancet (London, England), 2012-05) Coltart, Cordelia EM; Cheung, Ronny; Ardolino, Antonella; Bray, Ben; Rocos, Brett; Bailey, Alex; Bethune, Rob; Butler, John; Docherty, Mary; Drysdale, Kate; Fayaz, Alan; Greaves, Felix; Hafferty, Jonathan; Malik, Aeesha NJ; Moolla, Ahmad; Morganstein, Louise; Pathiraja, Fiona; Shah, Aditi; Sleat, Graham; Tang, Vivian; Yardley, Iain; Donaldson, Liam
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    Long-Term Impact of an Electronic Health Record-Enabled, Team-Based, and Scalable Population Health Strategy Based on the Chronic Care Model.
    (AMIA ... Annual Symposium proceedings. AMIA Symposium, 2016-01) Kawamoto, Kensaku; Anstrom, Kevin J; Anderson, John B; Bosworth, Hayden B; Lobach, David F; McAdam-Marx, Carrie; Ferranti, Jeffrey M; Shang, Howard; Yarnall, Kimberly SH
    The Chronic Care Model (CCM) is a promising framework for improving population health, but little is known regarding the long-term impact of scalable, informatics-enabled interventions based on this model. To address this challenge, this study evaluated the long-term impact of implementing a scalable, electronic health record (EHR)- enabled, and CCM-based population health program to replace a labor-intensive legacy program in 18 primary care practices. Interventions included point-of-care decision support, quality reporting, team-based care, patient engagement, and provider education. Among 6,768 patients with diabetes receiving care over 4 years, hemoglobin A1c levels remained stable during the 2-year pre-intervention and post-intervention periods (0.03% and 0% increases, respectively), compared to a 0.42% increase expected based on A1c progression observed in the United Kingdom Prospective Diabetes Study long-term outcomes cohort. The results indicate that an EHR-enabled, team- based, and scalable population health strategy based on the CCM may be effective and efficient for managing population health.
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    Shale Gas Development and Housing Value in the United Kingdom: Impact of the 13th Onshore Licensing, 2008
    (2015-04-17) Lho, Esther
    While shale gas is a prospective energy source, it is known to bring environmental deficits to the drilling neighborhood. Because of such concerns, property values fluctuate upon the possibility of shale gas fracturing. This paper examines the change in housing prices before and after the release of the 13th onshore oil and gas licensing round, which took place in 2008 when shale gas was increasingly being considered as the alternative to ease the United Kingdom’s dependency on coal. Results suggest that the 2008 licensing has caused a 3% decrease in housing price growth rate for the licensed areas.
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    Sustainability Planning for Baxter International Inc.: Climate Change Policies in the UK
    (2014-04-23) Fish, Jeffrey S; Kurkul, Kevin L
    Large, multinational companies are facing substantial costs and risks due to climate change-related government policies. While corporate sustainability efforts help reduce such costs and even create business opportunities, long-term policy impacts are rarely evaluated and internalized. This study quantifies future policy cost possibilities in three scenarios and provides modeling tools to assist in long-term corporate planning. Developed for Baxter International, a global medical products company, the analysis and model center on manufacturing facilities in the United Kingdom. The model projects energy costs, greenhouse gas emissions, and energy project viability for Baxter plants through 2030 using the developed scenarios and wholesale energy price sensitivity. Strategies to integrate long-term policy planning in other business aspects and markets are discussed. Together, these tools offer corporate decision makers approaches to interpret and capitalize on future climate change policies.
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    To smoke or to vape? E-cigarette regulation in the US, the UK, and Canada
    (2018-12-05) Sear, Amanda
    E-cigarettes are hailed by some as a positive development in the war against smoking and reviled by others as a weapon used to addict a new generation to nicotine. This dichotomy highlights an important debate about e-cigarette risk trade-offs: how can governments strike a balance between promoting e-cigarettes as a smoking cessation aid / reduced harm alternative for adult smokers and ensuring that e-cigarettes don’t act as “gateway drugs” to smoking for adolescents and other non-smokers? To this end, this thesis will specifically examine how the US, the UK, and Canada are regulating e-cigarettes. This thesis will show that policymakers often must grapple with risk trade-offs, even if they do not explicitly say as much. I also show that at least in the case of e-cigarette regulation, policymakers focus more on scientific evidence when business interests are fractured. Due to a lack of explicit risk trade-off analyses, however, their assessments of risks vary based on society-specific concerns, which then contributes to great variations in regulation. These variations thus emphasize the need for better cost-benefit analyses of risk-risk trade-offs.
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    Which factors should be included in triage? An online survey of the attitudes of the UK general public to pandemic triage dilemmas.
    (BMJ open, 2020-12-08) Wilkinson, Dominic; Zohny, Hazem; Kappes, Andreas; Sinnott-Armstrong, Walter; Savulescu, Julian

    Objective

    As cases of COVID-19 infections surge, concerns have renewed about intensive care units (ICUs) being overwhelmed and the need for specific triage protocols over winter. This study aimed to help inform triage guidance by exploring the views of lay people about factors to include in triage decisions.

    Design, setting and participants

    Online survey between 29th of May and 22nd of June 2020 based on hypothetical triage dilemmas. Participants recruited from existing market research panels, representative of the UK general population. Scenarios were presented in which a single ventilator is available, and two patients require ICU admission and ventilation. Patients differed in one of: chance of survival, life expectancy, age, expected length of treatment, disability and degree of frailty. Respondents were given the option of choosing one patient to treat or tossing a coin to decide.

    Results

    Seven hundred and sixty-three participated. A majority of respondents prioritised patients who would have a higher chance of survival (72%-93%), longer life expectancy (78%-83%), required shorter duration of treatment (88%-94%), were younger (71%-79%) or had a lesser degree of frailty (60%-69%, all p<0.001). Where there was a small difference between two patients, a larger proportion elected to toss a coin to decide which patient to treat. A majority (58%-86%) were prepared to withdraw treatment from a patient in intensive care who had a lower chance of survival than another patient currently presenting with COVID-19. Respondents also indicated a willingness to give higher priority to healthcare workers and to patients with young children.

    Conclusion

    Members of the UK general public potentially support a broadly utilitarian approach to ICU triage in the face of overwhelming need. Survey respondents endorsed the relevance of patient factors currently included in triage guidance, but also factors not currently included. They supported the permissibility of reallocating treatment in a pandemic.