PubMed Health⌕ Search

Biomedical subjects

N Mays

Publications and source records attributed to N Mays.

10 recordsLinked to original sources
PubMed1992

Interregional variations in measures of health from the Health and Lifestyle Survey and their relation with indicators of health care need in England.

STUDY OBJECTIVE: The aim was to assess the extent to which a range of routinely available need indicators which have been suggested for use in NHS spatial resource allocation formulas were associated geographically in England with the different dimensions of population health status collected in the 1985/86 Health and Lifestyle Survey (HLS). DESIGN: Regional health authorities were ranked according to each of the HLS health variables which varied significantly between authorities. The HLS health variables were regressed on a selection from the range of routinely available morbidity and socioeconomic indicators available from the 1981 census. The potential need indicators were also regressed on the health variables. SETTING: The analyses were undertaken at individual level and at regional health authority level in England. SUBJECTS: The study comprised the English component of the HLS random sample representative of the population in private households in Great Britain. MAIN RESULTS: The different HLS health variables did not yield consistent regional health authority rankings. Among the variables, forced expiratory volume in one second (FEV1) and self assessed health appeared to be associated with most of the other health and need variables except longstanding illness. Longstanding illness was not strongly associated with any of the other HLS health variables but appeared to show some association with three deprivation indices constructed from the 1981 Census. CONCLUSIONS: There may be a case for including a measure of chronic ill health in the new NHS system of capitated finance in addition to the all cause standardised mortality ratio which is used currently as a measure of need for health care.

Chronic Disease↗
PubMed1992

Results of one and two year follow-up in a clinical comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy in the treatment of renal calculi.

The results of 12 and 24 month follow-up of two groups of similar patients with renal and ureteric calculi treated by percutaneous nephrolithotomy (PCN) and related techniques versus first generation, Dornier extracorporeal shock wave lithotripsy (ESWL) alone or in combination with PCN and/or endoscopy indicated few major differences in the side-effects (complications, readmissions, further procedures) of the two approaches to renal stone treatment up to two years from treatment. However, PCN patients exhibited consistently higher rates of stone clearance whether this was measured cross-sectionally or cumulatively. The higher prevalence of retained fragments in the ESWL group indicates the importance of long-term monitoring of both groups to discover whether there are any significant differences in stone growth and retreatment rates associated with the observed difference in stone-free rates.

Adolescent↗
PubMed1991

Relative costs and cost-effectiveness of extracorporeal shock-wave lithotripsy versus percutaneous nephrolithotomy in the treatment of renal and ureteric stones.

This paper presents empirical data from the United Kingdom National Health Service on the comparative mean hospital costs per patient of first generation extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCN) in the treatment of kidney stones. These results were subjected to a sensitivity analysis and related to evidence on the health effects of the two approaches to treatment. The hospital costs of PCN were found to be lower than for ESWL in the empirical comparison and in most but not all the scenarios developed in the sensitivity analysis. The direction of the comparison was reversed when a high throughput was assumed for ESWL and a significantly higher per diem cost for PCN than ESWL. The relative cost-effectiveness of the two modes of treatment depended on whether successful treatment was defined in terms of rendering the patient free of stones (the traditional endpoint of treatment) or the rate at which patients returned to their normal activities.

Adolescent↗
PubMed1989

Working for which patients and at what cost?

The Government's white-paper Working for Patients proposes introducing a system in which publicly financed resources for hospital and community health services will be distributed to districts and general practitioners with practice budgets for them to choose between competing providers from both the public and private sectors. The NHS Management Board in 1986 observed that such a system would be costly and impractical and would require careful pilot work in situations where its benefits are likely to outweight its costs. This paper shows that there is no reason for changing that judgement.

Adult↗
PubMed1989

NHS resource allocation after the 1989 white paper: a critique of the research for the RAWP review.

The Government White Paper on the NHS, 'Working for Patients', abolished the Resource Allocation Working Party (RAWP) formula in name, but retained its general approach of ensuring geographical equity through funding health authorities by a system of weighted capitation. As a result, the longstanding debate about the appropriate need indicators to include in RAWP, which was tackled afresh in the recent NHS Management Board review of RAWP, will remain highly pertinent to NHS resource allocation in the 1990s. Yet, the research carried out for the RAWP review, on which its principal proposals for change to the need indicators were based, is inadequate for developing a new method of resource allocation after RAWP. The paper describes the research and sets out its main conceptual limitations and problems of method.

Catchment Area, Health↗
PubMed1989

Relation between all cause standardised mortality ratios and two indices of deprivation at regional and district level in England.

The use of mortality data in the form of standardised mortality ratios (SMRs) to measure the need for health care resources in the Resource Allocation Working Party (RAWP) formula in England has been criticised for underestimating the wider effects of adverse socioeconomic conditions on need, particularly in inner city areas. To assess this criticism, we explored the relationships at NHS Regional and District levels in England between two indicators of illness from the 1981 Census, two contrasting indices of deprivation based on the 1981 Census (the Jarman 8 Underprivileged Area (UPA) score and Townsend's Index of Material Deprivation) and their constituent variables, and all cause SMRs for 1982-3. All cause SMRs were highly correlated at Regional and District level with permanent and temporary sickness rates. At Regional level, three of the Thames Regions showed relatively high deprivation scores in relation to their SMRs, in comparison to the remaining Regions where the relative level of deprivation closely matched the Region's mortality ranking. District level analyses of the relations between SMRs and the deprivation indices and their constituent variables showed that the Thames/non-Thames dichotomy was accounted for by the 14 Districts in inner London. These findings suggest that although there may be a prima facie case for including an allowance for deprivation in RAWP, it is still not clear how the deprivation variables available in the Census relate empirically to the need for additional health service resources. The analysis raises questions about the appropriate definition of need in this context and whether the Census is a suitable source for the construction of a deprivation weighting for use in national RAWP.

Community Health Services↗
PubMed1988

Clinical comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy in treating renal calculi.

STUDY OBJECTIVE: To compare extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for efficacy in treating renal calculi. DESIGN: Non-randomised multicentre cohort study with 3 month follow up and 13 month data collection period. SETTING: Lithotripter centre in London, tertiary referral hospital, and urological clinics in several secondary and tertiary care centres. PATIENTS: 933 of 1001 patients treated by lithotripsy at the lithotripter centre were compared with 195 treated by nephrolithotomy. Missing patients were due to incomplete collection of data. Age and sex distributions and characteristics of the stones were similar in the two treatment groups. Two patients died in the lithotripsy group. Three month follow up was achieved in about 84% of both groups (783/933 for lithotripsy; 163/195 for nephrolithotomy). INTERVENTIONS: The nephrolithotomy group had surgical nephrolithotomy alone. In the lithotripsy group 83% (774/933) had lithotripsy alone, 11% (103/933) had combined lithotripsy and nephrolithotomy, and 6% (56/933) had lithotripsy plus ureteroscopy. Single and combined lithotripter treatments were analysed as one group and compared with nephrolithotomy. END POINT: Presence of stones three months after treatment. MEASUREMENTS AND MAIN RESULTS: Presence of residual stones was assessed by plain radiography, ultrasonography, or intravenous urography. After adjustment for age and size and position of stone for patients with single stones the likelihood of being free of stones three months after treatment was significantly greater in the nephrolithotomy group than the lithotripsy group (odds ratio 6.6; 95% confidence interval 3.0 to 14.6) and the response was particularly pronounced with staghorn calculi (62% (8/13) v 15% (141/96) patients free of stones after nephrolithotomy and lithotripsy, respectively). OTHER FINDINGS: 19%(146/775) of patients who had had lithotripsy had to be readmitted within three months after treatment compared with 14%(23/162) who had nephrolithotomy; and 64%(94/146) of readmissions after lithotripsy were for complications compared with 30%(7/23) of readmissions after nephrolithotomy. CONCLUSIONS: Nephrolithotomy may be preferable to lithotripsy for treating renal stones and it may not be wise to invest heavily in lithotripsy facilities.

Adolescent↗
PubMed1987

Measuring morbidity for resource allocation.

The RAWP (Resource Allocation Working Party) report used population weightings based on standardised mortality ratios (SMRs) as a proxy measure of differences in morbidity (and therefore in the need for health care resources) that existed between geographical areas after allowing for the age and sex structure of their populations. The adequacy of SMRs as a proxy for morbidity has aroused controversy, particularly from RAWP losers in London, and is one of the main themes of the National Health Service Management Board's current review of RAWP. Critics have argued, firstly, that the nature of the relation between morbidity and mortality is unknown; and, secondly, that SMRs are incomplete because they fail to take account of the effect of social deprivation on the need for health care. As a result several alternative proxies for morbidity based on social indicators have been proposed. One of their principal drawbacks is that their use is justified by their relation to measures of use of services known to be affected by the prevailing level of supply. Furthermore, the evidence suggests that mortality data actually correlate quite well with the available measures of both morbidity and social deprivation. But without access to comprehensive morbidity data the SMR debate is bound to remain inconclusive. As measures of health need, however, SMRs have the twin merits of being (a) independent of supply, and (b) more direct measures of health state than social indicators.

Health Resources↗