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Biomedical subjects

J Brazier

Publications and source records attributed to J Brazier.

At least 37 records · Page 2Linked to original sources
PubMed1999

Longer-term clinical and economic benefits of offering acupuncture to patients with chronic low back pain assessed as suitable for primary care management.

This paper presents the research protocol for a pragmatic study of the benefits of providing an acupuncture service to patients in primary care with chronic low back pain. The proposal was written in response to a call for bids from the NHS Executive's centrally funded research programme for Health Technology Assessment (HTA). The research question posed was 'Does acupuncture have long-term effectiveness in the management of pain in primary care?' The present study was designed as a collaboration between an interdisciplinary team drawn from health services researchers at the University of Sheffield, acupuncture researchers from the Foundation for Traditional Chinese Medicine in York, and practitioners from general practice and acupuncture in York. The proposal presented here was submitted in response to an invitation from the Commissioning Board following a successful outline bid. It is reproduced here, largely as submitted in January 1998, using the headings under which information was requested. We also present an appendix describing methodological alterations made to the design in response the Commissioning Board's comments on the proposal. We present it in this format to give an idea of the evolution of the design and the process by which the research proposal was shaped. The final working protocol comprises a combination of these two elements.

Acupuncture Therapy↗
PubMed1999

A review of the use of health status measures in economic evaluation.

OBJECTIVE: To review the use of measures of health status in the assessment of benefits in economic evaluation, whether or not the measures were designed for this purpose. METHODS: The review was based on a systematic search of the literature. It provides a comprehensive assessment of the evidence where it exists and a balanced overview of opinion otherwise. RESULTS: Over 3000 papers were identified, of which 632 were found to be relevant. The review provides a set of recommendations. These include: a checklist of questions for selecting a measure for use in economic evaluation; a list of circumstances in which non-preference-based measures can be used; and recommendations surrounding the use of health state valuation techniques and multi-attribute utility scales. CONCLUSION: These recommendations should help to identify poor economic evaluations and hence guard against inefficient conclusions being drawn regarding the provision of health services.

Cost-Benefit Analysis↗
PubMed1999

[Laxity and functional results of Miller-Galante total knee prosthesis with posterior cruciate ligament sparing after a 6-year follow-up].

PURPOSE OF THE STUDY: The preservation of the posterior cruciate ligament (PCL) was introduced in total knee arthroplasty to improve the quadriceps efficiency and the range of flexion in stairs. The purpose of this study was to determine if these goals were achieved with the Miller-Galante total knee prothesis and to assess the relation between knee laxity and function. MATERIALS AND METHOD: We assessed retrospectively the results of 48 consecutive Miller-Galante with PCL retaining. Four patients were excluded: 2 died, 2 lost to follow-up. Forty-four prostheses were evaluated in 38 patients mean aged 65 (33-79). The preoperative HSS score was 41 +/- 12.4 [21-63]. All the components were cemented with patellar resurfacing (25 metal-backed, 19 polyethylene). Stressed X-rays with Telos device were performed to assess frontal and antero-posterior laxity. All radiographic measurements were carried out with a digitizer (Orthographics). RESULTS: After 6 years of follow-up, 8 prostheses (18.1 p. 100) were already revised because of: 1) 3 excessive anterior tibial translations and severe polyethylene wear; 2) 5 femoro-patellar disorders. These last 5 knees (4 patellar metal-backed) had a greater patellar thickness [(25 mm +/- 1.2) (p = 0.01)]. The mean HSS knee score for the 36 remaining prostheses was 73.8 +/- 11.3 (35-92). Only 5 patients were able to climb stairs without support. The mean mechanical axis was 2.3 degrees in varus, but 81 percent of the knees were at 5 degrees around neutral position. The mean laxity in valgus was 4 degrees +/- 2.3 degrees [1-10], and 4.1 degrees +/- 2.1 degrees [1-9] in varus. The mean anterior tibial translation was 5.3 mm +/- 5 [1-17] and posterior laxity was 4.7 mm +/- 2.5 [1-10]. HSS knee score was lowered by 9 points when frontal laxity (valgus + varus) was greater than 5 degrees (p = 0.01), and by 9.8 points when posterior laxity was 5 mm or more (p = 0.02). The mean thickness of the patella was 22 mm +/- 2.3 [16-27]. DISCUSSION: These results were unsatisfactory considering the high revision rate and the low functional score observed despite of a correct implant positioning. The major challenge for PCL retaining (i.e. free stair climbing) was achieved in few cases. The wide range of posterior laxity underlined the difficulties to control PCL tension. On the other hand, PCL tension has to be controlled as it could influence knee function. Patello-femoral disorders was the main reason for revision surgery and an insufficient patellar bone resection may be contributive. Sagittal anterior laxity was the second reason for revision and it should be carefully detected as it could drive to catastrophic polyethylene wear. CONCLUSION: The advantages of PCL retaining were not demonstrated with this low constrained design. Surgical control of PCL tension could give a wide range of posterior laxity. Sagittal femoral-tibial laxity and femoro-patellar disorders should be detected before severe polyethylene wear. These results advocates for: 1) more congruent designs with PCL retaining or for PCL substituting designs, 2) improvement of patello-femoral design.

Adult↗
PubMed1998

Testing the equivalence of translations of widely used response choice labels: results from the IQOLA Project. International Quality of Life Assessment.

The similarity in meaning assigned to response choice labels from the SF-36 Health Survey (SF-36) was evaluated across countries. Convenience samples of judges (range, 10 to 117; median = 48) from 13 countries rated translations of response choice labels, using a variation of the Thurstone method of equal appearing intervals. Judges marked a point on a 10-cm line-representing the magnitude of a response choice label (e.g., "good" relative to the anchors of "poor" and "excellent"). Ratings were evaluated to determine the ordinal consistency of response choice labels within a response scale; the degree to which differences between adjacent response choice labels were equal interval; and the amount of variance due to response choice label, country, judge, and interaction between response choice label and country. Results confirmed the hypothesized ordering of response choice labels; the percentage of ordinal pairs ranged from 88.7% to 100% (median = 98.2%) across countries and response scales. Examination of the average magnitudes of response choice labels supported the "quasi-interval" nature of the scales. Analysis of variance (ANOVA) results supported the generalizability of response choice magnitudes across countries; labels explained 64% to 77% of the variance in ratings, and country explained 1% to 3%. These results support the equivalence of SF-36 response choice labels across countries. Departures from the assumption of equal intervals, when observed, were similar across countries and were greatest for the two response scales that are recalibrated under standard SF-36 scoring. Results provide justification for scoring translations of individual items using standard SF-36 scoring; whether these items form the same scales in other countries as they do in the United States is evaluated with tests of scaling assumptions.

Analysis of Variance↗
PubMed1998

Deriving a preference-based single index from the UK SF-36 Health Survey.

This article presents the results of a study to derive a preference-based single index from the SF-36. The study was an attempt to reconcile a profile health status measure, the SF-36, with the "quality adjusted life years" approach. The study undertook a parsimonious restructuring of the SF-36 using explicit criteria to form the SF-6D health state classification. A sample of multidimensional health states defined by this classification were valued by a convenience sample of health professionals, managers, and patients, who responded to a set of visual analogue scale ratings and standard gamble questions, with highly complete and consistent answers. Statistical models were estimated to predict single index scores for all 9000 health states defined by the new classification. The resultant algorithms can be applied to existing SF-36 data sets and used in the assessment of the cost-effectiveness of health technologies. This preliminary work forms the basis of a larger study currently being undertaken in the UK.

Algorithms↗
PubMed1998

Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven countries: results from the IQOLA Project. International Quality of Life Assessment.

Data from general population samples in 11 countries (n = 1483 to 9151) were used to assess data quality and test the assumptions underlying the construction and scoring of multi-item scales from the SF-36 Health Survey. Across all countries, the rate of item-level missing data generally was low, although slightly higher for items printed in the grid format. In each country, item means generally were clustered as hypothesized within scales. Correlations between items and hypothesized scales were greater than 0.40 with one exception, supporting item internal consistency. Items generally correlated significantly higher with their own scale than with competing scales, supporting item discriminant validity. Scales could be constructed for 93-100% of respondents. Internal consistency reliability of the eight SF-36 scales was above 0.70 for all scales, with two exceptions. Floor effects were low for all except the two role functioning scales; ceiling effects were high for both role functioning scales and also were noteworthy for the Physical Functioning, Bodily Pain, and Social Functioning scales in some countries. These results support the construction and scoring of the SF-36 translations in these 11 countries using the method of summated ratings.

Cross-Cultural Comparison↗
PubMed1998

The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment.

Studies of the factor structure of the SF-36 Health Survey are an important step in its construct validation. Its structure is also the psychometric basis for scoring physical and mental health summary scales, which are proving useful in simplifying and interpreting statistical analyses. To test the generalizability of the SF-36 factor structure, product-moment correlations among the eight SF-36 Health Survey scales were estimated for representative samples of general populations in each of 10 countries. Matrices were independently factor analyzed using identical methods to test for hypothesized physical and mental health components, and results were compared with those published for the United States. Following simple orthogonal rotation of two principal components, they were easily interpreted as dimensions of physical and mental health in all countries. These components accounted for 76% to 85% of the reliable variance in scale scores across nine European countries, in comparison with 82% in the United States. Similar patterns of correlations between the eight scales and the components were observed across all countries and across age and gender subgroups within each country. Correlations with the physical component were highest (0.64 to 0.86) for the Physical Functioning, Role Physical, and Bodily Pain scales, whereas the Mental Health, Role Emotional, and Social Functioning scales correlated highest (0.62 to 0.91) with the mental component. Secondary correlations for both clusters of scales were much lower. Scales measuring General Health and Vitality correlated moderately with both physical and mental health components. These results support the construct validity of the SF-36 translations and the scoring of physical and mental health components in all countries studied.

Cross-Cultural Comparison↗
PubMed1998

The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. International Quality of Life Assessment.

Data from general population surveys (n = 1771 to 9151) in nine European countries (Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom) were analyzed to test the algorithms used to score physical and mental component summary measures (PCS-36/MCS-36) based on the SF-36 Health Survey. Scoring coefficients for principal components were estimated independently in each country using identical methods of factor extraction and orthogonal rotation. PCS-36 and MCS-36 scores were also estimated using standard (U.S.-derived) scoring algorithms, and results were compared. Product-moment correlations between scores estimated from standard and country-specific scoring coefficients were very high (0.98 to 1.00) for both physical and mental health components in all countries. As hypothesized for orthogonal components, correlations between physical and mental components within each country were very low (0.00 to 0.12) for both estimation methods. Mean scores for PCS-36 differed by as much as 3.0 points across countries using standard scoring, and mean scores for MCS-36 differed across countries by as much as 6.4 points. In view of the high degree of equivalence observed within each country, using standard and country-specific algorithms, we recommend use of standard scoring algorithms for purposes of multinational studies involving these 10 countries.

Algorithms↗
PubMed1998

Use of structural equation modeling to test the construct validity of the SF-36 Health Survey in ten countries: results from the IQOLA Project. International Quality of Life Assessment.

A crucial prerequisite to the use of the SF-36 Health Survey in multinational studies is the reproduction of the conceptual model underlying its scoring and interpretation. Structural equation modeling (SEM) was used to test these aspects of the construct validity of the SF-36 in ten IQOLA countries: Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, the United Kingdom, and the United States. Data came from general population surveys fielded to gather normative data. Measurement and structural models developed in the United States were cross-validated in random halves of the sample in each country. SEM analyses supported the eight first-order factor model of health that underlies the scoring of SF-36 scales and two second-order factors that are the basis for summary physical and mental health measures. A single third-order factor was also observed in support of the hypothesis that all responses to the SF-36 are generated by a single, underlying construct--health. In addition, a third second-order factors, interpreted as general well-being, was shown to improve the fit of the model. This model (including eight first-order factors, three second-order factors, and one third-order factor) was cross-validated using a holdout sample within the United States and in each of the nine other countries. These results confirm the hypothesized relationships between SF-36 items and scales and justify their scoring in each country using standard algorithms. Results also suggest that SF-36 scales and summary physical and mental health measures will have similar interpretations across countries. The practical implications of a third second-order SF-36 factor (general well-being) warrant further study.

Cross-Cultural Comparison↗
PubMed1998

The SF36 as an outcome measure of services for end stage renal failure.

OBJECTIVE: To evaluate the use of the short form 36 (SF36) as a measure of health related quality of life of patients with end stage renal failure, document the results, and investigate factors, including mode of treatment, which may influence it. DESIGN: Cross sectional survey of patients with end stage renal failure, with the standard United Kingdom version of the SF36 supplemented by specific questions for end stage renal failure. SETTING: A teaching hospital renal unit. SUBJECTS AND METHODS: 660 patients treated at the Sheffield Kidney Institute by haemodialysis, peritoneal dialysis, and transplantation. Internal consistency, percentage of maximal or minimal responses, SF36 scores, effect sizes, correlations between independent predictor variables and individual dimension scores of the SF36. Multiple regression analysis of the SF36 scores for the physical functioning, vitality, and mental health dimensions against treatment, age, risk (comorbidity) score, and other independent variables. RESULTS: A high response rate was achieved. Internal consistency was good. There were no floor or ceiling effects other than for the two "role" dimensions. Overall health related quality of life was poor compared with the general population. Having a functioning transplant was a significant predictor of higher score in the three dimensions (physical functioning, vitality, and mental health) for which multiple regression models were constructed. Age, sex, comorbidity, duration of treatment, level of social and emotional support, household numbers, and hospital dialysis were also (variably) significant predictors. CONCLUSIONS: The SF36 is a practical and consistent questionnaire in this context, and there is evidence to support its construct validity. Overall the health related quality of life of these patients is poor, although transplantation is associated with higher scores independently of the effect of age and comorbidity. Age, comorbidity, and sex are also predictive of the scores attained in the three dimensions studied. Further studies are required to ascertain whether altering those predictor variables which are under the influence of professional carers is associated with changes in health related quality of life, and thus confirm the value of this outcome as a measure of quality of care.

Data Collection↗
PubMed1998

The use of QALY and non-QALY measures of health-related quality of life. Assessing the state of the art.

There are now a large number of instruments available for assessing health-related quality of life, many of which are used within economic evaluations. When considering the use of quality-of-life instruments, meaningful questions need to be asked to determine whether an instrument has been used judiciously. Such questions should consider whether the instrument is valid and suitable for the particular study question, whether the instrument is compatible with the economic evaluation framework used, and subsequently whether the conclusions presented in the study are legitimate. In order to illustrate the value of these questions we have applied them to a number of economic evaluations. The studies used were identified via a systematic review of the health economics literature. In our assessment of a sample of published material, we found that reporting is frequently unhelpful and that the inappropriate use of instruments and techniques casts doubt on the conclusions of economic evaluations. Furthermore, our systematic review of the health economics literature has shown that the general format of reported economic evaluations falls short of the commonly accepted ideal. We examined the health economics literature for 1995 and only identified a handful of studies which satisfied the economic evaluation criteria as accepted by most economists. It is hoped that raising awareness of these issues will urge evaluators, referees and publishers not to lose sight of the needs of the decision-maker when considering the detail which should be present in a reported evaluation.

Economics↗
PubMed1997

Physical activity for the over-65s: could it be a cost-effective exercise for the NHS?

BACKGROUND: There is increasing interest in the health-promoting potential of physical activity in older adults. The objective of this study was to estimate the likely costs, health benefits and consequences for the National Health Service which might result from a publicly funded programme of regular exercise made available to a population of 10,000 people over the age of 65. METHODS: Risk education data from observational studies were used to calculate the possible impact of a community-based programme of activity on hospital admissions and deaths from coronary heart disease, stroke, diabetes, femoral neck fractures and mental disorders. The avoided costs of health care and net cost per life-year saved were estimated. RESULTS: Providing twice-weekly exercise classes for 10,000 participants would cost approximately 854,700 pounds per year, but would prevent 76 deaths and 230 in-patient episodes, avoiding annual health care costs of approximately 601,000 pounds. Assuming the mean expectation of life after 65 to be ten years, the programme would cost about 330 pounds per life-year saved. Under a range of more extreme assumptions, the cost per life-year saved would vary from 100 pounds to 1500 pounds. CONCLUSIONS: A publicly funded programme of regular moderate exercise for over-65-year-olds could achieve important health benefits at relatively low cost. The estimates provided by this analysis should now be tested in a rigorous randomized trial, and health commissioners should begin to think of purchasing exercise programmes alongside other health-promoting measures.

Aged↗
PubMed1996

[Articular fractures of the base of the first metacarpal. Comparative study of direct osteosynthesis and closed pinning].

The authors retrospectively studied 35 articular fractures of the base of the first metacarpal, with an average follow-up of 3 years. Treatment consisted of closed reduction and pinning in 19 cases, open reduction and rigid fixation in 16 cases. Results were estimated in terms of pain, range of movement (flexion-adduction arc and abduction-extension arc), strength and X-rays. There was no significant difference between the two groups, for age, sex, occupation, side and postoperative care. Only one significant difference between both procedures was found: flexion-adduction was better after osteosynthesis than after closed pinning (p = 0.03). The authors observed a better range of flexion-adduction and pinch strength after treatment of Bennett's fracture. Radiographic features were not different at follow-up between open and closed osteosynthesis.

Adolescent↗
PubMed1996

[Kapandji enlargement plasty of A1 pulley. Results in 15 primary trigger fingers with a 5 year (2-8 years) follow-up].

We retrospectively studied 15 enlargement plasties of the A1 pulley performed in a university orthopaedic department for trigger finger. The study objectives where: 1)to evaluate whether closure of the enlarged A1 pulley led to recurrent trigger finger; 2) to determine whether the complexity of the procedure was responsible for complications. Fifteen trigger fingers operated by enlargement of the A1 pulley according to Kapandji, instead of opening of the A1 pulley, were reviewed after 5 years of follow-up (2-8 years) by an observer who did not participate in surgery. These 15 fingers (6 thumbs, 7 ringer finger, 1 long finger and 1 index finger) were operated in 14 patients (11 females, 3 males) with a mean age of 55 years at surgery. All trigger fingers were primary (no patients had pathological conditions predisposing to trigger finger). After surgery, all symptoms resolved. No recurrence was observed during the follow-up period. No loss of range of motion or loss of sensation were observed. Reflex sympathetic dystrophy was observed in one case after surgery and resolved before the sixth postoperative month. The authors recommend this procedure, which doesn not lead to recurrence despite closure of the enlarged A1 pulley. Technically more demanding than simple A1 pulley opening, this procedure was safely performed in our department despite participation of junior surgeons.

Adult↗
PubMed1996

The cost and effectiveness of the London Helicopter Emergency Medical Service.

OBJECTIVES: To assess the incremental consequences of the London Helicopter Emergency Medical Service (HEMS) for the outcomes of survivors in terms of disability and health status, and cost. METHODS: Prospective comparison of outcomes in cohorts of seriously injured patients attended either by the HEMS or by paramedically crewed land ambulances. In survivors, disability was assessed using an 11-point disability scale, and general health status was measured by the six dimensions of the 100-point Nottingham Health Profile (NHP) assessed 6 months after the injury. Costs were estimated for the HEMS and associated facilities at the Royal London Hospital, and the extra admissions attributable to the HEMS. RESULTS: There was no evidence of reduced disability in HEMS survivors (estimate: +0.8 disability grades worse; 95% CI: 0, 1.6), and no evidence of improvement in the six NHP dimensions scores or in the mean number of problems with seven aspects of daily living (estimated difference: +0.5; 95% CI: -0.2, 1.2). The incremental costs of HEMS were estimated to be 2.0 Pounds million a year. CONCLUSION: As there is no evidence of any improvement in outcomes overall for the extra cost, the HEMS has not been found to be a cost-effective service.

Adolescent↗