Biomedical subjects

Tim J Peters

Publications and source records attributed to Tim J Peters.

58 records · Page 4Linked to original sources

PubMed2002

Recruitment strategies in a cluster randomized trial--cost implications.

The presence of a non-zero intracluster correlation coefficient in cluster randomized trial data has well-known statistical implications for trial design, in particular, inflating the required sample size for given specifications. However, problems in recruitment are common in such trials and there may be different costs of recruitment resulting from different recruitment strategies. Examples of how such differences arise are taken from cluster randomized trials and more intuitive methods of describing clustering are summarized which, in conjunction with such cost issues, may provide a framework that enables triallists to consider explicitly the trade-off between power and cost that is often inherent in such trials.

Adolescent↗

PubMed2002

Transurethral prostate resection, noncontact laser therapy or conservative management in men with symptoms of benign prostatic enlargement? An economic evaluation.

PURPOSE: We evaluated the cost-effectiveness of noncontact laser therapy compared with transurethral prostate resection and conservative treatment in men with symptoms associated with benign prostatic enlargement. MATERIALS AND METHODS: A total of 340 men with uncomplicated lower urinary tract symptoms participated in a large multicenter pragmatic randomized trial called the CLasP (Conservative management, Laser therapy, transurethral resection of the Prostate) study. Costs to the United Kingdom National Health Service and patients were determined from the time of randomization to the 7.5-month followup. Incremental cost-effectiveness ratios using conservative management as the base case were calculated for certain trial outcomes, including International Prostate Symptom Score (I-PSS), I-PSS quality of life score, maximum urinary flow, post-void residual urine volume, quality adjusted life-years and a composite measure of success based on I-PSS and maximum urinary flow. One-way sensitivity analysis of the basic costs and incremental cost-effectiveness ratios were done from the NHS viewpoint. RESULTS: Mean costs per patient were greatest for noncontact laser therapy and least for conservative management. The incremental cost-effectiveness ratios showed that transurethral prostate resection was more cost-effective than noncontact laser treatment for all primary trial outcomes. The incremental cost-effectiveness ratios of transurethral prostate resection compared with conservative management were pound 81 per unit decrease in the I-PSS score and pound 1,338 per additional successful case per 100 patients. Sensitivity analysis showed that the initial results were robust. CONCLUSIONS: Noncontact laser was the mostly costly treatment option. Transurethral prostate resection was more cost-effective than noncontact laser therapy in terms of symptomatic improvement. In men wishing to delay treatment conservative treatment appears to provide a cost-effective alternative in the short term.

Adult↗

PubMed2002

A multimethod approach to the evaluation of community preschool speech and language therapy provision.

OBJECTIVES: The paper presents a research study investigating the effectiveness and acceptability of community speech and language therapy provision for preschool children with early speech/language delays. As a 'worked example', it demonstrates the value of a multimethod approach to evaluation. METHODS: The paper examines how the research findings of a pragmatic randomized controlled trial (RCT), a survey questionnaire and qualitative in-depth interviews, which were the methods used in the evaluation, overlap and complement each other. RESULTS: There was little evidence to establish the effectiveness of the speech and language therapy provided in the trial. This lack of difference was reflected in responses of parents to items on the questionnaire. The findings of the RCT, questionnaire and interviews all cast considerable doubt on the prospect of spontaneous resolution of the children's difficulties. Although the RCT showed few differences between the children allocated to immediate therapy or 'watchful waiting', the questionnaire and interviews revealed the circumstances in which the parents felt that these intervention strategies had been acceptable and unacceptable. CONCLUSIONS: Although the trial provided information about the progress of the children, the questionnaire and interview components highlighted the advantages and limitations of the intervention from the viewpoint of parents, thereby helping to explain the RCT findings. Thus, the study demonstrates how a multimethod approach to evaluation can yield useful information to explain the findings of RCTs.

Child Welfare↗

PubMed2002

Effectiveness of pain relief during perineal suturing.

The amount of pain women experience during perineal suturing is previously unreported, although anecdotal evidence suggests that the procedure can be associated with considerable pain. Of 68 women who participated in this descriptive study, 16.5% reported 'distressing', 'horrible' or 'excruciating' pain while receiving perineal sutures. Contrary to expectations, pain scores did not diminish as the time between suturing and pain reporting increased. Regional analgesia was associated with lower reported pain. The findings of this small study suggest that further detailed investigation of this aspect of care is urgently required.

Adult↗