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Richard J Milne

Publications and source records attributed to Richard J Milne.

6 recordsLinked to original sources
PubMed2006

Quality-of-life valuations of advanced breast cancer by New Zealand women.

OBJECTIVES: To obtain health-related quality-of-life (HR-QOL) valuations (or 'utilities') from New Zealand women for four health states representative of advanced (metastatic) breast cancer, suitable for use in cost-utility analysis, and to compare four valuation methodologies. METHODS: Written case descriptions of four health states representative of advanced breast cancer (hormonal therapy, chemotherapy, radiotherapy and hypercalcaemia) were developed in consultation with nine oncology professionals. Time trade-off (TTO) and visual analogue scale (VAS) valuations were obtained via interviews from a sample of 50 women, aged 25-69 years, randomly selected from the New Zealand general public and through informal networks. Representations of the four health states on the EQ-5D health state classification system were also obtained from the respondents and later valued using New Zealand and UK EQ-5D social tariffs. RESULTS: The four valuation methods ranked the four states' mean valuations identically: hormonal therapy > chemotherapy > or = radiotherapy > hypercalcaemia. All methods except the TTO distinguished between chemotherapy and radiotherapy. In order of the VAS and TTO methods and the EQ-5D with NZ and UK tariffs, respectively, the valuations [mean (95% CI)] were: hormonal therapy 0.54 (0.48, 0.59); 0.65 (0.57, 0.73); 0.54 (0.51, 0.58); 0.60 (0.54, 0.65); chemotherapy 0.46 (0.41, 0.51); 0.49 (0.40, 0.57); 0.48 (0.43, 0.53); 0.51 (0.43, 0.59); radiotherapy for severe bone pain 0.35 (0.30, 0.40); 0.45 (0.37, 0.54); 0.31 (0.27, 0.35); 0.25 (0.18, 0.33); and moderate to severe hypercalcaemia 0.13 (0.09, 0.17); -0.17 (-0.29, -0.05); -0.05 (-0.07, -0.03); -0.52 (-0.56, -0.48). The four valuation methods gave similar results for chemotherapy, but for the three other states the TTO valuations differed from those obtained from the VAS method and the NZ and UK EQ-5D tariffs. There were significant pairwise correlations between the four methods across all four health states, although the valuation for hypercalcaemia obtained from the UK EQ-5D tariff was very low compared with the three other methods, and the VAS valuation was positive rather than negative. CONCLUSION: Our study suggests that women in the New Zealand general public are able to consistently evaluate and value case descriptions of advanced breast cancer using either direct methods (VAS or TTO) or the EQ-5D health state classification system. Some of the valuations elicited using the four methods differ quantitatively, especially for hypercalcaemia. As our sample size was modest (50) and it turned out to be unrepresentative of the New Zealand female population, this study serves as a pilot study.

Adult↗
PubMed1989

Habituation to sham testing procedures modifies tail-flick latencies: effects on nociception rather than vasomotor tone.

Habituation of rats to the testing environment and procedures reduces flexor withdrawal latencies to those of spinalised animals. We have now recorded surface temperatures at 3 sites on the tail and tail-flick latencies simultaneously in experimentally naive (novice) rats and in habituated rats. At usual ambient temperatures (20 +/- 1 degree C), tail temperatures fluctuated in accordance with the predictions of an on-off controller. There was an inverse correlation between the tail-flick latency and the temperature at the site of noxious stimulation. A similar correlation was found when the pre-stimulus temperature of the tip of the tail was held at temperatures ranging from 21 degrees C to 35 degrees C. Habituated animals exhibited a similar linear regression slope factor but lower latencies than novice animals at each temperature. We conclude (1) that tail-flick latency is determined partly by the pre-stimulus temperature at the site of noxious thermal stimulation, and (2) that the effects of habituation on tail-flick latency are more likely to be explained by differences in nociception than in regional vasomotor tone.

Animals↗
PubMedDate not supplied

Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk.

In this review, we outline the rationale for targeting blood pressure and blood cholesterol lowering drug treatments to patients at high absolute cardiovascular risk, irrespective of their blood pressure or blood cholesterol levels. Because the specific levels of blood pressure and cholesterol are of little clinical relevance when considered in isolation from other risk factors, terms such as hypertension or hypercholesterolaemia have limited value. Separate management guidelines for raised blood pressure and blood cholesterol need to be replaced by integrated cardiovascular risk management guidelines, and absolute cardiovascular risk prediction scores should be used routinely. Since cardiovascular risk factors interact with each other, moderate reductions in several risk factors can be more effective than major reductions in one. An affordable daily pill combining low doses of various drugs could be useful for the many individuals with slightly abnormal cardiovascular risk factors.

Adult↗