Biomedical subjects

Anne Spencer

Publications and source records attributed to Anne Spencer.

7 recordsLinked to original sources

PubMed2006

Exploring challenges to TTO utilities: valuing states worse than dead.

The conventional time trade off (TTO) method relies on fundamentally different procedures to assess states better than and worse than dead. Arbitrary transformation mechanisms are then applied to worse than dead scores in order to achieve symmetry with those rated as better than dead. We use a 'life profile' approach along with a ranking procedure in order to show how states rated worse than dead may be assessed in exactly the same manner as better than dead scores. We then explore a common issue associated with states worse than dead that has received some attention recently: maximal endurable time. Our results showed that, although the severe health state was commonly rated as worse than dead, there were relatively few respondents that exhibited MET preferences. We discuss the implications of our findings for the use of the TTO method in deriving values for states that are worse than dead.

Attitude to Health↗

PubMed2005

Why modelling a complex intervention is an important precursor to trial design: lessons from studying an intervention to reduce falls-related injuries in older people.

OBJECTIVES: To develop a cost-effectiveness model of a complex intervention from pilot study data in order to inform the viability and design of a subsequent falls prevention trial. METHODS: We used two models; the first estimated the probability of falling over a 12-month period based on a probability tree; the second used Markov simulation to assess the impact of the programme over time. RESULTS: The first model indicated that our intervention would reduce the proportion falling by only 2.8% over a 12-month period. The major reason for this small effect was that less than a quarter of older people at risk of falling were assessed using our screening tool. Even if policy-makers were willing to spend 30,000 pounds per quality-adjusted life-year gained, there is only a 40% chance that the intervention would be cost-effective. Sensitivity analyses showed that the only scenarios that produced a substantial increase in the effect of the intervention were those in which all older people are assessed. CONCLUSIONS: The model-building approach described in this paper is vital when designing complex trials and where a trial is not possible. Information from the modelling can be used to re-design the intervention. The effectiveness of our proposed intervention appears very small due to its inability to reach those at risk of falling. It is most likely not to be cost-effective. If inability to reach the target group is a weakness common to other similar interventions, this suggests an area for further research.

Accidental Falls↗

PubMed2004

The implications of linking questions within the SG and TTO methods.

We consider the impact of introducing intermediate stages, chained together, into the standard gamble (SG) and time trade-off (TTO) methods. Less is known about the impact of intermediate stages, chained together, in the TTO method. We broadly replicate the patterns of responses observed in other SG studies which have been accounted for by loss aversion. We find that the TTO responses do not replicate the patterns found in the SG responses. The results support the notion that additional issues arise in the TTO method that counteract loss aversion.

Adult↗

PubMed2004

Virtual interactive practice: utilizing healthcare information systems to contextualize the skills associated with clinical decision making within nurse education.

This paper reports on a Virtual Interactive Practice (VIP) project that has the potential to revolutionise the educational delivery and learning of clinical skills complementing "real" practice. The focus is currently on nurse learning but the principles could equally be applied to multi and inter-professional learning and clinical decision-making. This project represents a new model to enhance clinical skill acquisition and clinical reasoning using a structured competency base. Integral to this is a strong partnership between education and practice utilising "real" live and recorded anonymised patient data from a critical care clinical information system (CIS) within a large district general hospital to structure scenarios fostering problem-based learning. This educational practice interface enables the synthesis of clinical data using virtual technology and sophisticated scenario-based simulation within a skills laboratory. The aim is to enhance the more ad hoc system of learning within conventional practice placements. Early findings suggest that VIP enhances practice providing a safe but challenging learning experience with the benefit of instant performance feedback to students.

Clinical Competence↗

PubMed2004

Virtual Interactive Practice: a strategy to enhance learning and competence in health care students.

This paper reports the processes and initial outcomes of a pilot study which investigated a week long 'virtual' children's ward experience for nursing students. Providing sufficient and meaningful experiences which enable students to quickly and effectively achieve competence in diverse areas of practice is often frustrated by the realities of available clinical experiences. Our response to this challenge was to more fully exploit and evaluate technologies which can be used to provide these learning experiences. Students experienced 'real time' scenario based work involving SIM-MAN; interactive information technology scenarios, critical incidents, master classes, video conferencing, and observational skill development exercises. Evaluation methodologies included observation of student performance, competence self rating scales; analysis of videotaped performance episodes and other data generated through the learning activities and lived experience accounts of participants. Initial findings indicate (1) statistically significant improvements in student competence measured through self reports; and (2) evidence of improvement gleaned from observed accounts, video analysis and qualitative evaluative comments. The final outcomes, including work with a control group, will be available for Conference.

Clinical Competence↗

PubMed2003

The TTO method and procedural invariance.

In a pilot study we investigate whether the inferences we draw about people's preferences towards health care treatments are altered if we vary the procedure that is used to elicit these preferences. In a conventional time trade-off (TTO) question, respondents express their preferences towards treatment by comparing a period of ill-health with a shorter period in a higher quality of life. In our less conventional TTO question, we vary the procedure by asking respondents their preferences towards treatment by comparing a period of ill-health with a longer period in a lower quality of life. The quantitative data are equivocal about whether preferences for treatment differ between the conventional and unconventional questions. The qualitative data support the notion of contrasting issues in the questions that involve prolonging time in a lower quality of life and appear to account for a failure to find quantitative differences in all of the questions.

Adult↗

PubMed2003

A test of the QALY model when health varies over time.

Quality-adjusted life years (QALYs) estimate the utility derived from health profiles by taking account of life expectancy and quality of life. In applying QALYs to situations where health varies over time, it is usual to assume that we can add the utilities from constituent health states. This paper investigates the QALY approach to combining health states over time using two tests. The first test rejects additive independence, the central assumption of the QALY model, for individual respondents. The second test is equivocal. The tests are, therefore, unable to conclusively reject the QALY approach to combining health states over time.

England↗