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Biomedical subjects

Rosalind Raine

Publications and source records attributed to Rosalind Raine.

At least 19 recordsLinked to original sources
PubMed2006

The effect of age on referral to and use of specialist palliative care services in adult cancer patients: a systematic review.

OBJECTIVE: To investigate variations in the use of specialist palliative care (SPC) services for adult cancer patients, in relation to age. DESIGN: Systematic review of studies examining use of or referral to SPC services in adult cancer patients. SEARCH STRATEGY AND SELECTION CRITERIA: Six electronic databases (Medline, Embase, Web of Science, HMIC, SIGLE and AgeInfo) were searched for studies published between 1966 and March 2005, and references in the articles identified were also examined. Inclusion criteria were all studies which provided data on age in relation to use of or referral to SPC. Two reviewers independently selected studies, extracted data and assessed methodological quality according to defined criteria. MAIN OUTCOME MEASURES: Use of or referral to SPC services, determined from all sources of report (patient, informal carer, health care professional, health care records). RESULTS: 14 Studies were identified. All reported a statistically significant lower use of SPC among older cancer patients (65 and above or older) at a univariate level [crude odds ratios ranged from 0.33 (0.15-0.72) to 0.82 (0.80-0.82)]. However, there were important methodological weaknesses in all of the studies identified; most crucially, studies failed to consider variations in use in relation to need for SPC. CONCLUSIONS: There is some evidence that older people are less likely to be referred to, or to use, SPC. These findings require confirmation in studies using prospectively collected data which control for patient's need for SPC.

Adult↗
PubMed2006

A systematic review of factors affecting the judgments produced by formal consensus development methods in health care.

OBJECTIVES: Formal consensus development methods are ways of obtaining and synthesising views of experts, opinion leaders and other stakeholders, and are increasingly being used to develop clinical practice guidelines. Our objective was to examine the impact that the characteristics of individual participants, groups and the consensus process have on the judgments produced by formal consensus development methods in health care. METHODS: Studies were identified from an earlier methodological review and a search of five bibliographic databases for the period January 1996 to December 2004. Studies were eligible if they involved formal consensus development methods and reported differences in judgments between groups or participants. For studies comparing two or more groups overall percentage agreement, the kappa coefficient and the odds ratio for differences in judgments were calculated. RESULTS: There were 22 studies comparing the impact of the characteristics of individual participants within groups and 30 studies comparing the results produced by two or more groups. Practitioners who perform a procedure tend to emphasise the appropriateness of the procedure compared with non-performing practitioners, and individuals from groups that were subject to performance criteria are more critical of those criteria than individuals from other groups. There was no clear pattern for the differences in judgments produced by participants and groups from different countries. CONCLUSIONS: Except for participant specialty there is little general evidence for how the characteristics of participants and groups influence the judgments produced in formal consensus development methods. Multi-specialty groups are preferable to single-specialty groups because of their potential for taking account of a wider range of opinions.

Consensus↗
PubMed2006

A comparison of formal consensus methods used for developing clinical guidelines.

OBJECTIVES: To compare two consensus development methods commonly used for developing clinical guidelines in terms of the judgments produced, closeness of consensus, amount of change between rounds, concordance with research evidence and reliability. METHODS: In all, 213 general practitioners and mental health professionals from England participated in four Delphi and four nominal groups. They rated the appropriateness of four treatments (cognitive behavioural therapy [CBT], behavioural therapy [BT], brief psychodynamic interpersonal therapy [BPIT] and antidepressants) for three conditions. First, participants rated the appropriateness of interventions independently, using a postal questionnaire. For nominal groups, the ratings were fed back and discussed at a meeting, and then group members privately completed the questionnaire again. For Delphi groups, there was feedback but no discussion, and the entire process was conducted by postal questionnaire. RESULTS: The effect of consensus method on final ratings varied with therapeutic intervention, with nominal groups rating CBT and antidepressants more favourably than Delphi groups. Consensus was closer in the nominal than in the Delphi groups in both rounds. There was no overall difference between groups in their concordance with research evidence (odds ratio 1.13, 95% confidence interval 0.79-1.61). In this study, the Delphi method was more reliable (kappa coefficients 0.88 and 0.89 compared with 0.41 and 0.65 for nominal groups). CONCLUSIONS: The advantages of nominal groups (more consensus; greater understanding of reasons for disagreement) could be combined with the greater reliability of the Delphi approach by developing a hybrid method.

Chronic Disease↗
PubMed2005

'Referral into a void': opinions of general practitioners and others on single point of access to mental health care.

In the past, British general practitioners (GPs) have referred patients to individual consultants. There is now a trend towards generic referral, whereby the specialist team is consulted via a single point of access. We examined the impact of this innovation on the relationship between GPs and specialists in mental health care. Sixteen groups of randomly selected GPs and mental health professionals (MHPs) in England discussed clinical scenarios involving the use of mental health interventions for patients with functional somatic symptoms. The meetings were audiotaped, transcribed and analysed to the point at which no major new themes were emerging. The final analysis was confined to a purposive sample of six of the sixteen groups, comprising 54 GPs and 15 MHPs. Although the rationale for the single point of access was clear to both GPs and MHPs, the approach erected boundaries because it impeded the establishment of professional relationships and transfer of knowledge. GPs thought the system reduced their capacity to be accountable to their patients and limited the potential for their own professional development. MHPs did not seem to be aware of GPs' concerns. Effective interprofessional management of individual patients depends upon confidence in colleagues' skills and good communication. Factors that hamper these must be addressed in the development of this system of referral.

Attitude of Health Personnel↗
PubMed2004

General practitioners' perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study.

OBJECTIVES: To compare general practitioners' perceptions of chronic fatigue syndrome and irritable bowel syndrome and to consider the implications of their perceptions for treatment. DESIGN: Qualitative analysis of transcripts of group discussions. PARTICIPANTS AND SETTING: A randomly selected sample of 46 general practitioners in England. RESULTS: The participants tended to stereotype patients with chronic fatigue syndrome as having certain undesirable traits. This stereotyping was due to the lack of a precise bodily location; the reclassification of the syndrome over time; transgression of social roles, with patients seen as failing to conform to the work ethic and "sick role" and conflict between doctor and patient over causes and management. These factors led to difficulties for many general practitioners in managing patients with chronic fatigue syndrome. For both conditions many participants would not consider referral for mental health interventions, even though the doctors recognised social and psychological factors, because they were not familiar with the interventions or thought them unavailable or unnecessary. CONCLUSIONS: Barriers to the effective clinical management of patients with irritable bowel syndrome and chronic fatigue syndrome are partly due to doctors' beliefs, which result in negative stereotyping of patients with chronic fatigue syndrome and the use of management strategies for both syndromes that may not take into account the best available evidence.

Attitude of Health Personnel↗
PubMed2004

Is publicly funded health care really distributed according to need? The example of cardiac rehabilitation in the UK.

OBJECTIVES: To demonstrate the importance of measuring both the horizontal and vertical components of equity in order to examine whether patients are receiving the health care that they need. METHODS DESIGN: A theoretical demonstration followed by analysis of a prospectively collected national random sample of acute cardiac admissions to 94 hospitals in the UK. PATIENTS: 1064 patients under 70 years old. ANALYSIS: The association between use of cardiac rehabilitation and gender (after adjusting for clinical need) was measured using multivariable analysis with effect modification. RESULTS: Hypertensive males were nearly twice as likely to undergo rehabilitation compared to hypertensive females (OR 1.76, 95% CI 1.03-3.02). Hyertensive patients were less likely to undergo rehabilitation than normotensive patients (OR 0.67, 95% CI 0.50-0.89) but this treatment difference did not apply in the same way to both men and women. Hypertensive women were half as likely to undergo rehabilitation compared with normotensive women (OR 0.48, 95% CI 0.30-0.78), whereas hypertensive men were as likely as normotensive men to receive rehabilitation (OR 1.00. 95% CI 0.63-1.60). CONCLUSIONS: Horizontal inequity was demonstrated because male and female hypertensive patients with equal needs were not treated equally. There was also vertical inequity because although patients with hypertension were treated differently to normotensive patients, this treatment difference was not the same for men and women.

Coronary Artery Disease↗
PubMed2004

Socioeconomic status and outcome from intensive care in England and Wales.

OBJECTIVE: The objective of this study was to estimate the association between socioeconomic status (SES) and outcome for admissions to intensive care. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: We studied 51,572 admissions to 99 intensive-care units in England and Wales between 1995 and 2000. MEASURES: The SES of admissions was measured using Carstairs deprivation scores. Outcome was hospital mortality after adjustment for case mix using the APACHE II method. RESULTS: Admissions of lower SES were, on average, younger and less likely to be following surgery. There was evidence of a SES gradient for hospital mortality in admissions after elective surgery after adjusting for case mix (test for trend P <0.001), with higher SES associated with lower mortality. In the least-deprived quintile of SES, the odds ratio for hospital mortality was 0.70 (95% confidence interval, 0.58-0.84) compared with the most deprived quintile. There was no evidence of a SES gradient for hospital mortality in nonsurgical or emergency surgical admissions, and the decision to withdraw active treatment did not differ by SES. CONCLUSIONS: There is a SES gradient for hospital mortality in elective surgical admissions that is not explained by differences in case mix or the withdrawal of active treatment. Further research is required to establish if this finding can be explained by unmeasured differences in health status at admission to an intensive-care unit or differences in care and to establish the potential impact these results may have on interpreting comparative surgical performance data.

APACHE↗
PubMed2003

A consensus process to adapt the World Health Organization selected practice recommendations for UK use.

The nominal group technique for consensus development was used to consider the World Health Organization Selected Practice Recommendations for Contraceptive Use for adoption or adaptation in the United Kingdom. The nominal group comprised 11 opinion leaders who agreed that 74% of the WHO recommendations were consistent with current UK practice. Of 63 recommendations considered by the group to be at odds with current practice, 23 were adopted with advice that United Kingdom practice should change in line with WHO. Twenty-five were adopted because, although the group felt that the WHO recommendation differed from practice in the UK, it was unable to reach a consensus on an alternative recommendation. Thirteen WHO recommendations underwent minor revision for UK use. The group rejected two further WHO recommendations [on the timing of starting low-dose progestogen-only contraception (POC) during lactation] but was unable to reach consensus on any alternative guidance. It was agreed clinicians should be left to decide for themselves how to advise breastfeeding women about when to start low-dose POC. A UK version of the WHO Selected Practice Recommendations should help to standardize practice and improve the quality of care for couples using contraception.

Contraception↗
PubMed2003

Is publicly funded health care really distributed according to need? The example of cardiac rehabilitation in the UK.

OBJECTIVES: To demonstrate the importance of measuring both the horizontal and vertical components of equity in order to examine whether patients are receiving the health care that they need. METHODS DESIGN: A theoretical demonstration followed by analysis of a prospectively collected national random sample of acute cardiac admissions to 94 hospitals in the UK. PATIENTS: One thousand and sixty-four patients under 70 years old. ANALYSIS: The association between use of cardiac rehabilitation and gender (after adjusting for clinical need) was measured using multivariable analysis with effect modification. RESULTS: Hypertensive males were nearly twice as likely to undergo rehabilitation compared with hypertensive females (OR 1.76, 95%CI 1.03-3.02). Hyertensive patients were less likely to undergo rehabilitation than normotensive patients (OR 0.67, 95% CI 0.50-0.89) but this treatment difference did not apply in the same way to both men and women. Hypertensive women were half as likely to undergo rehabilitation compared with normotensive women (OR 0.48, 95% CI 0.30-0.78), whereas hypertensive men were as likely as normotensive men to receive rehabilitation (OR 1.00. 95%CI 0.63-1.60). CONCLUSIONS: Horizontal inequity was demonstrated because male and female hypertensive patients with equal needs were not treated equally. There was also vertical inequity because although patients with hypertension were treated differently to normotensive patients, this treatment difference was not the same for men and women.

Acute Disease↗
PubMed2002

Systematic review of mental health interventions for patients with common somatic symptoms: can research evidence from secondary care be extrapolated to primary care?

OBJECTIVES: To determine the strength of evidence for the effectiveness of mental health interventions for patients with three common somatic conditions (chronic fatigue syndrome, irritable bowel syndrome, and chronic back pain). To assess whether results obtained in secondary care can be extrapolated to primary care and suggest how future trials should be designed to provide more rigorous evidence. DESIGN: Systematic review. DATA SOURCES: Five electronic databases, key texts, references in the articles identified, and citations from expert clinicians. STUDY SELECTION: Randomised controlled trials including participants with one of the three conditions for which no physical cause could be found. Two reviewers screened sources and independently extracted data and assessed quality. RESULTS: Sixty one studies were identified; 20 were classified as primary care and 41 as secondary care. For some interventions, such as brief psychodynamic interpersonal therapy, little research was identified. However, results of meta-analyses and of randomised controlled trials suggest that cognitive behaviour therapy and behaviour therapy are effective for chronic back pain and chronic fatigue syndrome and that antidepressants are effective for irritable bowel syndrome. Cognitive behaviour therapy and behaviour therapy were effective in both primary and secondary care in patients with back pain, although the evidence is more consistent and the effect size larger for secondary care. Antidepressants seem effective in irritable bowel syndrome in both settings but ineffective in chronic fatigue syndrome. CONCLUSIONS: Treatment seems to be more effective in patients in secondary care than in primary care. This may be because secondary care patients have more severe disease, they receive a different treatment regimen, or the intervention is more closely supervised. However, conclusions of effectiveness should be considered in the light of the methodological weaknesses of the studies. Large pragmatic trials are needed of interventions delivered in primary care by appropriately trained primary care staff.

Antidepressive Agents↗
PubMed2002

Cost data for individual patients included in clinical studies: no amount of statistical analysis can compensate for inadequate costing methods.

This work examines the quality of the cost methods used to derive patient level costs in 45 economic evaluations conducted alongside randomised controlled trials. The perspective of the cost analysis, the methods used to determine quantities and values of resources and how the cost data were reported are examined. The reported costing methods were found to be of poor quality, highlighting the need for greater rigour. Researchers to date appear more concerned with whether cost data have been subjected to the appropriate statistical analysis. For the results of clinical studies to be valid both cost methods and the methods used for the statistical analysis of cost data should be of a high quality.

Cost-Benefit Analysis↗