SEARCH · PubMed Health

Results for “prioritisation”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources

PubMed2003

What to tell dementia caregivers--the rule of threes.

OBJECTIVES: To determine and prioritise what information dementia caregivers wish to know at the time of diagnosis and later on in the illness, and in what form this information should be presented. METHOD: 100 carers were recruited from community mental health teams (CMHT) and a memory clinic (MC). A semi-structured Carer Interview was administered covering possible symptoms and management. RESULTS: Carers requested as much information as possible. There was no significant difference between CMHTs and the MC. After carers prioritised the information they wished to receive, we proposed a 'rule of threes'. At diagnosis, carers want information about what dementia is, medications available and behavioural and psychiatric symptoms of dementia. In an early follow-up appointment, they want information about services, the course of the illness and what to do in a crisis. In a later follow-up appointment, they want information about support groups, benefits, and financial and legal issues. At a later stage, they want information about psychological therapies, the effects of the illness on carers and complementary treatments. Most carers wish to receive information from a health professional, backed up by written information. CONCLUSIONS: The 'rule of threes' enables health professionals to make informed decisions about primacy of information and strategies to prevent carers becoming overloaded. Information should also be provided in written form and from support groups.

Aged↗

PubMed2001

The routine assessment of severity amongst people with mental illness.

BACKGROUND: Specialist mental health services are required to prioritise their work. To help this process numerous definitions of severe mental illness have been suggested. Such definitions vary, and are not necessarily valid or reliable. This investigation examined whether there was agreement over who constituted the most severely ill patients, amongst the case load of a community mental health team (CMHT). METHOD: Suggested guidelines for the prioritisation of patients were adapted after consultation and pilot reliability studies, and were then used by CMHT staff to rate their case loads (n=299). Test re-test, and inter-rater reliability studies were then conducted. A random sub-sample (n=120) was selected for further analysis to measure concurrent validity with respect to assessment of need, functioning and quality of life; and criterion validity. RESULTS: There was consistency in individual key worker decisions over time, and key worker ratings were valid in terms of disability, need and quality of life. Patients with a psychotic diagnosis were more likely to be rated as a high priority than those with a non-psychotic diagnosis. Agreement amongst different staff (inter-rater reliability) was poor, especially when ratings from CMHT staff were compared to external ratings. CONCLUSIONS: Our findings highlight the difficulties inherent in trying to agree on who constitute the severely mentally ill, and warn against the indiscriminate use of guidelines to determine access to services.

Adult↗

PubMed2001

Existential support in brain tumour patients and their spouses.

UNLABELLED: Caring for patients with brain tumours raises existential questions. The aims of this study were to describe the opinions of nurses, patients and next-of-kin on existential support and how this is prioritised. PATIENTS AND METHOD: a total of 20 brain tumour patients, 16 family members and 16 nurses underwent explorative, tape-recorded, semi-structured interviews about existential issues. RESULTS: the nurses' opinions about the importance and prioritisation of existential support could be divided into four main groups: 1) religion, 2) "a diffuse picture", 3) conversation, and 4) questions of vital importance. They generally had a favourable attitude towards existential issues but thought those issues were difficult to deal with in practice due to lack of time, lack of knowledge and fear. Without exception, patients and family members were satisfied with the medical and physical treatment, but not with the existential support. They had, to a great extent, wished for existential support, and especially for the opportunity of talking about the existential threat that had arisen. Obstacles to this were thought to be due to the staff being under much stress, being afraid and unskilled. The importance of closeness and presence, which decreased existential isolation, was emphasised.

Adult↗

PubMed1996

Screening the environmental fate of organic contaminants in sewage sludges applied to agricultural soils: 1. The potential for downward movement to groundwaters.

The potential for organic contaminants present in sewage sludge to leach and cause groundwater contamination following sludge application to agricultural land has been assessed. Models used to predict compound mobility in soil on the basis of physico-chemical parameters were applied to a range of contaminants prioritised and/or detected in sludge and a provisional list of potential "leachers' compiled. In addition, theoretical soil water concentrations following sludge application were calculated using mean reported sludge contaminant concentrations and soil/water partition coefficients. These estimated aqueous phase concentrations were compared with Dutch groundwater quality standards in the absence of appropriate UK standards to identify those compounds which could be present in groundwater at levels of concern. The two prioritised lists were used to identify compounds in sludge which could pose a possible threat to groundwater. Appropriate experimental data were not available to qualify model results. However, the screening exercise indicated that under routine operation practice with typical sludge application rates, and the usual range of compound concentrations detected in sludge, groundwater quality standards were unlikely to be exceeded. However, data variability, reliability and scarcity limited the usefulness of this screening approach.

Agriculture↗

PubMed1993

The trade-off between severity of illness and treatment effect in cost-value analysis of health care.

Social appreciation of health care programs is a function of the severity of the patients' initial state as well as of treatment effect. Prioritising on the basis of cost-per-QALY misses the former point. The trade-off between severity and treatment effect can be expressed in terms of equivalence of numbers for different outcomes. The present study suggests that this trade-off can be modeled mathematically with reasonable accuracy. A table that expresses social equivalence numbers as a function of severity and treatment effect could be used together with guidelines for adjusting for age, duration and risk to estimate the social value of any outcome. In this valuation, saving a young person from dying to a life as healthy (= 1 SAVE) is suggested as the unit of measurement. Cost per SAVE may then be useful as a guiding criterion in prioritising.

Cost-Benefit Analysis↗

PubMed2006

Surgeons and scars: differences between patients and surgeons in the perceived requirement for reconstructive surgery following burn injury.

BACKGROUND: Reconstruction of the burn patient presents a challenge to the burns surgeon. The variety of issues and the timing of surgery can be a daunting task. A group of 11 patients who were injured 1 year previously at the time of the Bali bomb blast were reviewed. METHODS: A customised assessment form was developed in order to quantify the patient's perceived need for reconstruction. Each patient was asked to prioritise, in order of preference any injured area they might consider for further surgery. These patients were then assessed independently by a consultant plastic and reconstructive surgeon and a senior trainee, using an identical form. The surgeons were asked to prioritise, in order of preference any area they might consider for further surgery and to indicate from a list the procedure they would employ. This list ranged from simple excision to free flap encompassing the entire reconstructive ladder. RESULTS: The patients all showed a strong reluctance to undergo further reconstruction. However there was a strong correlation between the surgeons, concurring on issues of function but there were discrepancies regarding "aesthetic" reconstruction. CONCLUSIONS: This study highlights the absolute need for secondary burns reconstruction to be a patient driven service.

Adult↗

PubMed2004

Consumer involvement in decisions about what health-related research is funded.

OBJECTIVES: To consider whether, why and how research funders involve consumers in decisions about what health-related research is funded. METHODS: Postal survey and semi-structured interviews with UK funders of health-related research. RESULTS: Organisations that fund research have diverse goals and remits, and perceive themselves to be accountable in different ways and to different groups. They have a variety of reasons for involving consumers in decisions about what research is funded, but also a number of concerns about doing so-particularly about the ways in which consumer input might 'distort' the research agenda. Research funders use several types of decision-making structures and processes to identify and prioritise topics in which they want to invest and to select between research proposals. They involve consumers in these structures and processes in diverse ways. Little is known about the actual effects of this involvement, but the nature and extent of consumer influence on the research agenda is likely to be moderated by a number of factors, including the types of consumers involved, the particular structures and processes in which they are involved, the timing of their input and the different ways in which they are asked to contribute in relation to others. CONCLUSIONS: Diverse research funding organisations are now involving consumers in the various approaches that they take to identify and prioritise research topics and to decide which proposals they will fund. The future development of their activities could usefully be informed by careful consideration not just of consumer involvement but of the implications of the various structures and processes that shape research agendas. The appropriateness of particular forms of consumer involvement should be considered in the broader context of the features of the whole research funding system, including the values implicit within it.

Community Participation↗

PubMed2005

What is important to measure in the last months and weeks of life?: A modified nominal group study.

BACKGROUND: Identifying the most important issues for palliative care patients and their families, and assessing whether services address these appropriately is important. Little is known about the views of United Kingdom service users and whether, and in what ways, they differ from those in the published literature from other countries, or from health professionals. AIMS: To investigate what is important to measure at the end of life from the perspectives of United Kingdom patients, bereaved relatives and health care professionals. METHODS: Ten focus groups, using a modified nominal group technique, with a total of 75 participants (10 patients, 35 professionals and 30 bereaved relatives) enabled issues participants thought important to measure at the end of life to be identified and prioritised using ratings and rankings. Thematic analysis of the data was conducted to enable cross-group comparison. FINDINGS: Seven themes were identified as most important to participants: symptom management; choice and control; dignity; quality of life; preparation; relationships; and co-ordination and continuity. Bereaved relatives and professionals emphasised symptom management, relationships and quality of life, whilst patients prioritised issues around preparation. CONCLUSIONS: The study was successful in identifying aspects of end of life care that are important to patients, families and health professionals in the United Kingdom. Although participants were not representative of the wider population in the United Kingdom, the degree of concordance with published studies from outside the United Kingdom increases the credibility of the findings. Quality assurance initiatives need to ensure that they act on information such as this on users' priorities. Further research is needed to test out the findings in other settings in the United Kingdom, to build on the findings about different participants' views and to identify similarities and variations between countries.

Activities of Daily Living↗

PubMed2006

User and carer involvement in the training and education of health professionals: a review of the literature.

BACKGROUND: Health policy requires consumer involvement in services, research and education but little is known about how consumers are being involved in healthcare education, the effect on learning and practice, nor how involvement initiatives are being evaluated. OBJECTIVES: To describe methods of involving consumers in healthcare education, discuss ways in which initiatives have been evaluated, and identify areas for development in education, practice and research. DESIGN: All papers reporting specific initiatives involving consumers in health care worker training and education were included. Viewpoint articles and studies of consumers training consumers were excluded. DATA SOURCES: Cinahl, Medline, Assia, PsycINFO, British Nursing Index, Social Science Citation Index, citations from reference lists, relevant websites and personal communication with key people known to be working in this area. REVIEW METHODS: A narrative approach was taken with categorisation of data to reflect objectives of selected studies; method of involvement; process issues and evaluation. RESULTS: Thirty-eight papers were included; most provide small-scale qualitative studies of mental health service users and focus on process rather than outcome. Various methods of involvement are described and consumers consistently prioritise the need for training in interpersonal skills over 'technical' skills. There is little research into organisational strategies and no studies investigate the effect of consumer involvement on practice. Two studies indicated that students exposed to consumer involvement demonstrate more empathic understanding and better communication skills. CONCLUSIONS: There is tentative evidence that consumer involvement in training enhances workers' skills in the manner prioritised by consumers. However, if consumer involvement in training and education is to facilitate services that reflect the priorities of the people using them, it must be developed in partnership with service providers; further research is needed to explore the impact of consumer involvement and to track the development of organisational consumer involvement strategies, also systems for supporting consumers need to be established, including training for both consumers and staff.

Attitude of Health Personnel↗

PubMed2006

Bone remodelling algorithms incorporating both strain and microdamage stimuli.

Biomechanical theories to predict bone remodelling have used either mechanical strain or microdamage as the stimulus driving cellular responses. Even though experimental data have implicated both stimuli in bone cell regulation, a mechano-regulatory system incorporating both stimuli has not yet been proposed. In this paper, we test the hypothesis that bone remodelling may be regulated by signals due to both strain and microdamage. Four mechano-regulation algorithms are studied where the stimulus is: strain, damage, combined strain/damage, and either strain or damage with damage-adaptive remodelling prioritised when damage is above a critical level. Each algorithm is implemented with both bone lining cell (surface) sensors and osteocyte cell (internal) sensors. Each algorithm is applied to prediction of a bone multicellular unit (BMU) remodelling on the surface of a bone trabecula. It is predicted that a regulatory system capable of responding to changes in either strain or microdamage but which prioritises removal of damaged bone when damage is above a critical level, is the only one that provides a plausible prediction of BMU behaviour. A mechanism for this may be that, below a certain damage threshold, osteocyte processes can sense changes in strain and fluid flow but above the threshold damage interferes with the signalling mechanism, or causes osteocyte apoptosis so that a remodelling response occurs to remove the dead osteocytes.

Animals↗

PubMed2003

The setting of standards for agricultural nitrogen emissions: a case study of the Delphi technique.

The Delphi technique is a means of aggregating the judgement of a panel of experts in order to improve the quality of decision-making. This paper provides a case study of the technique by undertaking a three-round Delphi study to determine a package of best available techniques to reduce nitrogen emissions from a poultry unit under the Integrated Pollution Prevention and Control Directive (IPPC). Forms of nitrogen addressed included ammonia (NH3), nitrous oxide (N2O) nitrogen oxides (NOx), dusts and nitrate (NO3-), with the study providing a means to prioritise the pollution concerns on different spatial scales. The priority pollutant issues were the contribution of NH3 to eutrophication, the global cooling effect of NH4+ aerosol, the role of NH4+ as a vector for atmospheric transport of NOx and SO2, the contribution of N2O to global warming, and NO3- leaching. Reduced nitrogen (NHx) was rated as a priority on all scales, while N2O and NO3- were rated as priorities only on global and local scales, respectively. The study indicated the need for abatement techniques at each stage of poultry rearing and waste management, with particular attention to reduce NH3 emissions, reflecting the priority pollutant concerns. Measures identified by the panel include maintenance of dry litter, low emission removal of litter from housing and storage of litter under cover. Once the litter has left the farm, this should either be used as a biofuel for electricity generation or rapidly incorporated into agricultural soils. The amounts and timing of manure application should be tuned to crop needs. Uncertainties in the Delphi technique limit its suitability as a stand-alone decision making tool. However, the Delphi technique proved useful in identifying priority pollutant issues, areas of agreement, disagreement and where information is lacking. This demonstrates its use when dealing with the complex issues of prioritising pollution issues and abatement approaches.

Air Pollutants↗

PubMed2026

Osteoarthritis Year in Review 2026: Genetics, genomics and epigenetics.

OBJECTIVE: The purpose of this narrative review is to highlight advances made over the past 12 months in the field of osteoarthritis (OA) genetics, genomics and epigenomics, with a particular focus on the interpretation of OA risk loci through functional genomic and regulatory approaches. DESIGN: PubMed and Europe PMC were searched to identify studies relevant to OA genetics, genomics and epigenomics published between 1st March 2025 and 30th April 2026. Searches used combinations of terms relating to genetics, genomics, epigenomics, functional genomics, molecular quantitative trait loci, chromatin accessibility and enhancer biology. Studies were limited to human subjects and English-language publications, with additional articles identified through citation screening and expert knowledge of the field. RESULTS: Over the past year, the field has continued to transition from large-scale locus discovery towards biological interpretation of OA genetic risk. Major advances included the largest OA genome-wide association study to date, further development of polygenic risk score approaches, and increasing integration of molecular quantitative trait loci, chromatin accessibility, and enhancer biology datasets to prioritise effector genes and elucidate regulatory mechanisms. Several studies highlighted the highly context-dependent nature of OA genetic risk mechanisms, demonstrating that distinct tissues, cell types, and regulatory layers can identify different candidate effector genes at the same locus. Additional developments included increasing application of singlecell and multi-omic technologies to study OA-relevant tissues. CONCLUSION: Recent advances in OA genetics have shifted the field from locus discovery towards mechanistic interpretation. Emerging evidence demonstrates that the biological consequences of genetic variation are highly dependent upon tissue, cell state and disease context, with different functional genomic approaches often prioritising distinct candidate genes and regulatory mechanisms at the same susceptibility locus. Together, these findings suggest that OA risk loci should increasingly be viewed as dynamic regulatory systems rather than simple variant-to-gene relationships, providing a framework for future studies aimed at resolving causal mechanisms, defining disease endotypes, and identifying therapeutic targets.

Genetics↗

PubMed2005

The use of a GIS-based inventory to provide a national assessment of standing waters at risk from eutrophication in Great Britain.

A three-tiered, hierarchical, risk-based prioritisation system was developed to assess the number of standing waters in Great Britain (GB) at risk from eutrophication. The scheme is based on four properties: importance, hazard, sensitivity to enrichment and sensitivity to recovery. Lake size, conservation status and legislative requirements were used to assess importance. The anthropogenic total phosphorus (P) load estimated from land cover, livestock and population data was used as a measure of the eutrophication hazard. Lakes with a retention time >3 days were considered to be sensitive to enrichment. The Wederburn depth (an estimate of the average summer thermocline depth) was used to predict the potential response of a lake to nutrient reduction. Lakes which were mainly stratified or fully stratified during the summer were expected to respond quickly to remediation. An initial Tier 1 risk assessment was made for all standing waters in GB (approximately 14,300 with surface area greater than 1 ha), using the four parameters derived from nationally available, GIS-based data sources held in the GB Lakes Inventory. Of the 2362 important lakes in GB, the system identified 1736 with low hazard but under potential threat because of their high sensitivity to enrichment. The system assessed that the ecology of 212 was likely to be damaged by eutrophication owing to high hazard and high sensitivity but with relatively poor chance of recovery following remediation. A further 332 lakes were considered to be damaged but were likely to respond to rehabilitation. In summary, the risk-based prioritisation system performed well and provides a useful tool for assessing standing waters at risk of eutrophication on a national basis. Inevitably, however, the need for nationally available datasets at Risk Tier 1 results in data resolution issues and errors may occur. The results highlight the importance of data validation using lake-specific information at Risk Tier 2.

Conservation of Natural Resources↗

PubMed2006

Life cycle assessment of wastewater treatment technologies treating petroleum process waters.

This paper describes the implementation of life cycle assessment to investigate the environmental impact of 20 technologies suitable for treating extensive volumes of water produced during the oil and gas extraction processes. Data on the physical and operational attributes of technologies under consideration were assembled and their life cycle environmental impacts estimated over 15 year time period. The results were then incorporated in a decision support system which allows identification and prioritisation of potential technology combinations capable of producing water for nine designated industrial and agricultural end uses. In total, more than 618 technology combinations were investigated for their environmental impacts. The identification and prioritisation of technologies were done on the basis of their environmental and technical performance. This analysis showed that dissolved air flotation, absorbents, dual media filtration and reverse osmosis technologies offer relatively low environmental impact parts of systems for cleaning such process waters. Furthermore, the environmental assessment combined within the decision support system has revealed potentially valuable indirect downstream "benefits" from effects such as evaporative losses from wetlands in terms of the overall environmental impact of a treatment system.

Extraction and Processing Industry↗

PubMed1999

The ability of non-ergonomists in the health care setting to make manual handling risk assessments and implement changes.

The health care setting presents particular risks from manual handling and it is known that training in manual handling techniques is ineffective in reducing these risks when used as a stand-alone measure. The 'Manual Handling Operations Regulations 1992' requires employers to consider hazardous manual handling, advising the use of an ergonomics approach. However, it is not known how well-equipped non-ergonomists in the health care setting are to deal with this approach. Therefore, the ability of non-ergonomists to make manual handling risk assessments, with or without additional training, and to implement changes to the work environment was investigated. Twenty-five pairs of subjects from a broad cross section of departments in a busy teaching hospital were studied; training and a guide book were provided for one of each pair and the guide book only for the other. Subjects then independently prioritised three tasks in their department and undertook a full assessment of a specified task. All work was repeated by an ergonomist and the subjects' assessments were scored in comparison with the ergonomist. Each department was followed up after six months to assess progress with implementing recommendations. Trends in the data indicated that both groups appeared able to identify hazards though not necessarily to prioritise the tasks. The trained group tended to score better in assessments although wide variation existed within both groups and inter-group differences were not significant at the 5% level. Approximately half of staff assessments were considered 'adequate' to 'very good', in comparison with the ergonomist. Implementation of assessment recommendations ranged from nil to almost full compliance. Incomplete implementation seemed to be related to an apparent confusion in some departments over who was responsible for making changes, a lack of finances for changes and overstretched managers having other priorities.

Ergonomics↗

PubMed2006

Strategies for reducing maternal mortality: getting on with what works.

The concept of knowing what works in terms of reducing maternal mortality is complicated by a huge diversity of country contexts and of determinants of maternal health. Here we aim to show that, despite this complexity, only a few strategic choices need to be made to reduce maternal mortality. We begin by presenting the logic that informs our strategic choices. This logic suggests that implementation of an effective intrapartum-care strategy is an overwhelming priority. We also discuss the alternative configurations of such a strategy and, using the best available evidence, prioritise one strategy based on delivery in primary-level institutions (health centres), backed up by access to referral-level facilities. We then go on to discuss strategies that complement intrapartum care. We conclude by discussing the inexplicable hesitation in decision-making after nearly 20 years of safe motherhood programming: if the fifth Millennium Development Goal is to be achieved, then what needs to be prioritised is obvious. Further delays in getting on with what works begs questions about the commitment of decision-makers to this goal.

Adult↗

PubMed2001

[Improving care for victims of domestic violence. Impact of a priority intervention].

OBJECTIVE: To evaluate the impact of a priority intervention in the care given to women who are victims of domestic violence and their children. DESIGN: Non-randomised intervention study. SETTING: Urban health centre. PATIENTS: Women and children living at a reception centre for families suffering domestic violence and who had clinical records opened at the health centre. Pre-intervention group (December 1997-July 1999): 36 women, 70 children. Post-intervention group (August 1999-June 2000): 35 women and 41 children.Interventions. Allocation to a single family doctor and paediatrician. Elimination of bureaucratic obstacles and prioritised care. Social/family assessment by the social worker. Preferential inclusion in programmes: Women: family planning, hepatitis B vaccination, pregnancy control, early diagnosis of breast cancer (women > 50), same for cervical cancer. Children: child health (< 5) (priority activities: psychomotor development and somatometry) and vaccinations. This intervention started in August 1999. MEASUREMENTS AND MAIN RESULTS: Measurement of the impact of the intervention: bivariant analysis through Chi2 test for qualitative variables and Student's t test and U Mann-Whitney test for quantitative variables (alpha 0.05) in the pre- and post-intervention groups. Statistically significant differences in participation were detected between the pre- and post-intervention groups in the following activities: number of visits to programmes (0.49, SD 0.95; 1.01, SD 1.24, respectively), social and family assessment (83%/100%), family planning (14%/51.4%), hepatitis B vaccination (19%/48.7%), early cervical cancer diagnosis (0/25.7%), child health (33.4%/70%), vaccinations (26.34%/64%), somametric assessment (25%/100%) and psychomotor development assessment (41.6%/94%). CONCLUSIONS: Prioritised intervention in families that are victims of domestic violence improves their participation in preventive activities.

Adult↗

PubMed2003

Involving the general public in priority setting: experiences from Australia.

The discussion over whether community preferences have a legitimate role to play in priority setting has been highly polarised. Skeptics warn of the risk of establishing a 'dictatorship of the uninformed', while advocates proclaim the legitimacy of the participatory process. The one group who appears not to be consulted in this debate is the citizens themselves. In this study, a convenience sample of 373 citizens attending two medical clinics in central Sydney were surveyed about whether the general public has a legitimate role to play in informing priority setting in health care. Respondents were presented with three different levels of priority setting: across health care programmes, across medical procedures, and at a global level. To assist respondents in understanding the choices and trade-offs involved, they were given information about current levels of funding and the cost-effectiveness of each alternative. Respondents were asked whether they felt the preferences of the general public should be used to inform priority setting at each level. Of particular interest was the question of whether their willingness to use public preferences depended on the level of priority setting. Respondents were also asked about who else's preferences should be used to inform priority setting at each level. The results suggest that the public overwhelmingly want their preferences to inform priority-setting decisions in health care. This was seen to be particularly important in informing decisions about how to prioritise across broad health care programmes and about the criteria to be used to allocate funds across different population groups. In contrast, the preferences of medical professionals and health service managers were rated most highly in relation to the prioritisation of different treatments and medical procedures. In most cases, however, respondents did not advocate the use of one particular group's preferences. Even when the preferences of the general public were considered most important, it was felt that any decision-making process needed to be informed by the preferences of a range of groups. The preferences of politicians were viewed as least important to processes of priority setting in health care.

Adolescent↗