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Deborah Marshall

Publications and source records attributed to Deborah Marshall.

7 recordsLinked to original sources
PubMed2006

A review of studies examining stated preferences for cancer screening.

INTRODUCTION: Stated preference studies for cancer screening programs are used to understand how the programs can be improved to maximize usage. Our objectives were to conduct a systematic review of stated preference studies for cancer screening, identify gaps in the literature, and determine which types of research should be conducted in the future. METHODS: We considered all studies in the PubMed database through May 2005 that measured utility-based stated preferences for cancer screening using contingent valuation or conjoint analysis. We abstracted data on 1) study characteristics and 2) study results and policy implications. RESULTS: We found eight (of 84 identified) preference studies for cancer screening. The most commonly studied cancer was breast cancer, and the most commonly used method was contingent valuation. We found no studies for prostate cancer or physician preferences. Studies demonstrated that although individuals are able to state their preferences for cancer screening, they do not weigh test benefits and harms, and a significant percentage would choose to have no screening at all. Several studies found that test accuracy and reduction in mortality risk were important for determining preferences. CONCLUSION: Few studies of cancer screening preferences exist. The available studies examine only a few types of cancer and do not explore practice and policy implications in depth. The results of this review will be useful in identifying the focus of future research, identifying which screening methods may be more preferred to increase use of the programs, and developing interventions and policies that could facilitate informed and shared decision making for screening.

Humans↗
PubMed2006

Impact of administrative restrictions on antibiotic use and expenditure in Ontario: time series analysis.

OBJECTIVE: In a potential attempt to guide antibiotic prescribing based on current clinical evidence and mitigate the spread of antibiotic resistance, in March 2001 the Ontario Drug Benefit programme restricted reimbursement of two fluoroquinolone antibiotics--ciprofloxacin and ofloxacin--to its beneficiaries. Our objective was to determine the impact of this policy on the volume and cost of antibiotic prescribing. METHOD: Weekly administrative data on antibiotic prescribing volumes and expenditures were analysed between January 1999 and September 2002 to estimate the effect of the policy changes using time series analysis. RESULTS: The policy changes were associated with a statistically significant shift downwards for the fluoroquinolones as a category (1905 fewer prescriptions each week, representing a saving of Can$105,707 a week), driven by a decrease in prescriptions for ciprofloxacin (2084 fewer prescriptions a week, saving Can$129,421 a week). Nitrofurantoin (200 more prescriptions a week, costing an extra Can$2082 a week) and trimethoprim-sulphamethoxazole (532 more prescriptions a week, costing an extra Can$1473 a week) demonstrated a statistically significant shift upwards. The latter also showed a decrease in trend and nitrofurantoin an increase in trend during the time period. There was no statistically significant change in either the total number of antibiotic prescriptions or expenditures associated with the policy of limiting their use. CONCLUSIONS: Although no direct cause and effect can be shown with these observational data, the results suggest that the change in reimbursement policy to restrict prescribing of fluoroquinolones decreased their use and associated expenditures. These decreases were offset by increases in the use of other antibiotics. The balance of consequent benefit and harm of these shifts in prescribing patterns needs to be examined carefully. Alternative solutions to encourage appropriate use of antibiotics deserve exploration.

Aged↗
PubMed2004

Survival after transfusion as assessed in a large multistate US cohort.

BACKGROUND: The only survival and mortality data on a general population of transfused patients in the United States is more than two decades old. More contemporary data are needed to reflect more current patient populations and transfusion practices. STUDY DESIGN AND METHODS: Data were extracted from Constella Health Strategies Sciences' managed-care administrative claims database that contains private health care claims. Patients were selected if they had at least one professional or facility claim indicating transfusion in 1995. Only the first transfusion in the time period was included so that each patient was counted only once and all claims were unduplicated. Survival for five years after transfusion was the primary outcome measure. RESULTS: A total of 6779 patients were included in the analysis. A total of 4658 (69%) patients were alive 1 year after transfusion, 4056 (60%) were alive at 2 years, and 3092 (46%) were alive 5 years after transfusion. Overall annual mortality was 31 percent in Year 1 after transfusion, 14 percent in Year 2, and 10 percent in each of Years 3 through 5. Transfusion mortality was much higher in recipients older than age 65 at the time of transfusion, who comprised 60 percent of transfused patients. CONCLUSION: These data from the mid 1990s can be used in models of the effectiveness of risk reduction interventions and in models of the disease consequences of infections transmitted through blood transfusions.

Adolescent↗
PubMed2003

Health technology assessment, research, and implementation within a health region in Alberta, Canada.

OBJECTIVES: To determine the need for and implement health technology assessment (HTA) to inform decision making and policy within a regional health care system in Calgary (Alberta, Canada). METHODS: Published literature and organizational materials for the Calgary Health Region (CHR) and HTA units worldwide were reviewed. Key individuals within the provincial health ministry (Alberta Health and Wellness), CHR, the University of Calgary (U of C), funding agencies, and HTA organizations were consulted in a structured fashion. A structure for a regional HTA program was developed, taking into account relationships between these organizations. RESULTS: A locally focused HTA and implementation unit was deemed desirable. The Calgary Health Technology Implementation Unit (CaHTIU) was established. The CaHTIU was designed to efficiently integrate with CHR planning as well as undertake independent research activities. HTA activities focus primarily on CHR needs and are managed by a Health Technology Advisory Committee (HTAC) that consists of CHR management and other key individuals. Working groups contribute to and coordinate HTAs and implementation under the leadership of the unit Director, and include content as well as management individuals. The unit cooperates where appropriate with extant Canadian HTA organizations. CONCLUSIONS: The Calgary HTA unit is unique in Canada, because it functions within a regional health care system as well as a research institution. Advantages include a local focus in terms of applied HTAs, a systematic process for implementation of recommendations, and a collaborative atmosphere for research within the U of C.

Alberta↗
PubMed2003

T cell generation including positive and negative selection ex vivo in a three-dimensional matrix.

The prevailing paradigm is that T cell differentiation is dependent on interactions between stem cells and neuroectodermal thymic cells in the context of a three-dimensional environment. We evaluated the utility of a three-dimensional matrix, the Cytomatrix, to facilitate T cell differentiation. Thymus stroma grown on the Cytomatrix and seeded with hematopoietic progenitors was observed to support the development of both CD4(+) and CD8(+) T cells. Murine transgenic models used to address T cell selection demonstrated that both positive and negative selection was maintained in the context of MHC Class I. These data demonstrate that this in vitro system using neuroectoderm tissue is capable of the efficient production of T cells from hematopoietic progenitors and presents the possibility of generating and adoptively transferring immune cells to patients.

Animals↗
PubMed2003

Rapid increase in statins newly dispensed to Ontario seniors between 1994 and 2000.

BACKGROUND: The Ontario government spent approximately 10% (CDN $148 million) of the provincial medication budget on statins in 1998. This number can be expected to grow in light of new guidelines from the United States recommending that three times as many patients should be receiving antihyperlipidemic therapy. There is scant population-based information on the age and sex distributions of patients receiving these medications. OBJECTIVES: To estimate the rates of new use of statin medications among community-dwelling elderly adults in Ontario between 1994 and 2000. METHODS: Data from the Ontario Drug Benefit program were used on all medications dispensed to noninstitutionalized Ontarians over 65 years of age to estimate age- and sex-specific annual rates of patients newly dispensed a statin. Changes in rates were estimated using Poisson regression. RESULTS: The number of elderly Ontarians newly dispensed a statin increased rapidly between 1994 and 2000, with age-standardized rates rising from approximately 840 to 2600/100,000 women and from 810 to about 3100/100,000 men. The highest rates of new use were observed among patients of both sexes aged 65 to 74 years. However, the rate of change increased with advancing age so that the biggest increase was observed among those aged 85 years and above, among whom there was an 8.5-fold increase among women and a 12-fold increase among men. CONCLUSIONS: Statins have been shown to be safe, efficacious and cost effective in reducing the risk of sudden cardiac death and other acute coronary events among middle-aged patients with pre-existing cardiovascular disease. The present study showed that there was a rapid increase in the rate of statins newly dispensed to elderly patients in Ontario, among whom estimates of safety, efficacy and cost effectiveness are not well quantified. Better estimates of these parameters in the elderly are required because of the high costs and benefits and potential unintended beneficial and harmful effects of statins.

Aged↗