Publications by authors named "Phil Shackley"

Background: AAA is an enlargement in the aorta that can increase in size and rupture. In England, the National Health Service (NHS) AAA Screening Programme offers screening to all men aged 65 to identify those with an AAA. Men with small or medium sized aneurysm enter surveillance where they receive ultrasound scans annually or every three months respectively.

View Article and Find Full Text PDF

Background: Corticosteroids are a mainstay of the treatment of moderately severe relapses of ulcerative colitis, yet almost 50% of patients do not respond fully to these and risk prolonged steroid use and side effects. There is a lack of clarity about the definitions of steroid resistance, the optimum choice of treatment, and patient and health-care professional treatment preferences.

Objectives: The overall aim of this research was to understand how steroid-resistant ulcerative colitis is managed in adult secondary care and how current practice compares with patient and health-care professional preferences.

View Article and Find Full Text PDF

Background And Aims: There is widespread variation in venous leg ulcer (VLU) wound care contributing to inadequate service provision resulting in poor outcomes to patients. Little has been published on the perspectives of where treatments should be carried out. The aim of the study was to quantify respondents' preferences for the preferred place of treatment for VLU.

View Article and Find Full Text PDF

Background And Aim: Understanding treatment preferences in those patients who are not responding to corticosteroids for ulcerative colitis is important in informing treatment choices. This study aimed to assess the relative importance of treatment characteristics to patients by conducting a discrete-choice experiment.

Methods: Patients completed the questionnaire online.

View Article and Find Full Text PDF

Background: Peripheral vascular disease is a major cause of death and disability. The extent to which volume influences outcome of lower limb (LL) vascular surgery remains unclear. This review evaluated the relationship between hospital/surgeon volume and outcome in LL surgery.

View Article and Find Full Text PDF

Objectives: . Recent proposals for value-based assessment, made by the National Institute of Health and Care Excellence (NICE) in the United Kingdom, recommended that burden of illness (BOI) should replace end of life (EOL) as a factor for consideration when deciding on new health technologies. This article reports on a study eliciting societal preferences for 1) BOI from a medical condition, defined as quality-adjusted life year (QALY) loss due to premature mortality and prospective morbidity, and 2) EOL, defined as expected life expectancy of less than 2 years and expected life expectancy gain from new treatment of 3 months or more.

View Article and Find Full Text PDF

Aims And Objectives: To examine, from the perspective of staff, if obese patients have any additional care needs, and what the impact of these care requirements are on care provision. We have selected obese patients with venous leg ulceration as an example patient population to explore these questions.

Background: Anecdotal evidence indicates obesity can increase care requirements and have implications for obesity for care provision.

View Article and Find Full Text PDF

Willingness to pay (WTP) values derived from contingent valuation surveys are prone to a number of biases. Range bias occurs when the range of money values presented to respondents in a payment card affects their stated WTP values. This paper reports the results of an exploratory study whose aim was to investigate whether the effects of range bias can be reduced through the use of an alternative to the standard payment card method, namely, a random card sort method.

View Article and Find Full Text PDF

Stroke imposes significant burdens on health services and society, and as such there is a growing need to assess the cost-effectiveness of stroke treatment to ensure maximum benefit is derived from limited resources. This study compared the cost-effectiveness of treating post-stroke upper limb spasticity with botulinum toxin type A plus an upper limb therapy programme against the therapy programme alone. Data on resource use and health outcomes were prospectively collected for 333 patients with post-stroke upper limb spasticity taking part in a randomized trial and combined to estimate the incremental cost per quality adjusted life year (QALY) gained of botulinum toxin type A plus therapy relative to therapy alone.

View Article and Find Full Text PDF

Despite the increase in the number of inherited metabolic diseases that can be detected at birth using a single dried blood spot sample, the impact of false positive results on parents remains a concern. We used an economic approach - the contingent valuation method - which asks parents to give their maximum willingness to pay for an extension in a screening programme and the degree to which the potential for false positive results diminishes their valuations. 160 parents of a child or children under the age of 16 years were surveyed and given descriptions of the current screening programme in the UK, an extended programme and an extended programme with no false positives.

View Article and Find Full Text PDF

Background And Purpose: Botulinum toxin is increasingly used to treat upper limb spasticity due to stroke, but its impact on arm function is unclear. We evaluated botulinum toxin for upper limb spasticity and function poststroke.

Methods: Three hundred thirty-three patients with stroke with upper limb spasticity and reduced arm function participated in a multicenter randomized controlled trial.

View Article and Find Full Text PDF

Background: Since the inception of the National Institute for Health and Clinical Excellence (NICE) in England, there have been questions about the empirical basis for the cost-per-QALY threshold used by NICE and whether QALYs gained by different beneficiaries of health care should be weighted equally. The Social Value of a QALY (SVQ) project, reported in this paper, was commissioned to address these two questions. The results of SVQ were released during a time of considerable debate about the NICE threshold, and authors with differing perspectives have drawn on the SVQ results to support their cases.

View Article and Find Full Text PDF

Background: Following a stroke, 55-75% of patients experience upper limb problems in the longer term. Upper limb spasticity may cause pain, deformity and reduced function, affecting mood and independence. Botulinum toxin is used increasingly to treat focal spasticity, but its impact on upper limb function after stroke is unclear.

View Article and Find Full Text PDF

Background: Valproate is widely accepted as a drug of first choice for patients with generalised onset seizures, and its broad spectrum of efficacy means it is recommended for patients with seizures that are difficult to classify. Lamotrigine and topiramate are also thought to possess broad spectrum activity. The SANAD study aimed to compare the longer-term effects of these drugs in patients with generalised onset seizures or seizures that are difficult to classify.

View Article and Find Full Text PDF

Background: Carbamazepine is widely accepted as a drug of first choice for patients with partial onset seizures. Several newer drugs possess efficacy against these seizure types but previous randomised controlled trials have failed to inform a choice between these drugs. We aimed to assess efficacy with regards to longer-term outcomes, quality of life, and health economic outcomes.

View Article and Find Full Text PDF

Background: Access to primary care services is one of the key components of the NHS Plan which states that patients should be able to see a health professional within 24 hours and a GP within 48 hours. However, it is not clear how patients value speed of access in comparison with other aspects of primary care.

Aim: To investigate patient preferences when making an routine appointment for a GP, and to describe the trade-offs and relationships between speed of access, choice of time and choice of doctor in different patient groups.

View Article and Find Full Text PDF

The paper explores the merit of the willingness-to-pay (WTP) method as a way to elicit public preferences regarding health care priorities. The aim is to test the extent to which the implicit ranking inferred from the ordinal differences in WTP-values corresponds with respondents' explicit ranking of the same programmes. This issue of convergent validity is explored by face-to-face interviewing of population samples in six European countries-in total 1240 respondents.

View Article and Find Full Text PDF

When applying willingness-to-pay (WTP) in economic evaluations, there have been strong theoretical arguments for the use of ex ante insurance-based questions, which can be framed either as insurance premiums or taxation contributions. This paper suggests theoretical reasons why respondents may value a programme differently in these two different ex ante approaches, and inquires empirically into the potential existence of such differences. A split-sample interview study was undertaken in Denmark.

View Article and Find Full Text PDF

Despite the acceptance that health gain is the most important attribute of health care, other aspects of health care may affect utility. The aim of this paper is to report an experiment to test the impact of providing different levels of information in the context of the EuroWill study, a joint contingent valuation (CV) of multiple health programmes. Three hundred and three respondents were simultaneously asked for their willingness-to-pay (WTP) for three health care programmes: more heart operations, a new breast cancer treatment and a helicopter ambulance service.

View Article and Find Full Text PDF

Objectives: To assess public attitudes towards the fortification of flour with folic acid, and quantify their intensity of preference towards the proposed policy.

Design: Structured interviews describing the proposed policy of fortification followed by questions about the respondent's preferences towards fortification.

Setting And Participants: A United Kingdom community sample of 76 people interviewed at home.

View Article and Find Full Text PDF

We describe a willingness to pay (WTP) survey in which values were elicited from the public for three disparate health care programmes. Previous applications of WTP in this context have revealed a high proportion of preference reversals between WTP values and ordinal ranking of the programmes. In view of the doubts these findings raise over the use of WTP in this context, our aim was to develop a method of eliciting WTP values which we considered would improve consistency between respondents' explicit ranking of the programmes and their WTP values.

View Article and Find Full Text PDF

Willingness-to-pay studies are increasingly being used in the evaluation of health care programmes. However, there are methodological issues that need to be resolved before the potential of willingness-to-pay can be fully exploited as a tool for the economic evaluation of health care programmes. Of particular methodological interest are the consequences of varying the order in which willingness-to-pay questions are presented to respondents in contingent valuation studies.

View Article and Find Full Text PDF

OBJECTIVE: To demonstrate the application of conjoint analysis (CA) for eliciting the views of health service users. METHODS: A CA study was conducted alongside a randomized controlled trial evaluating the introduction of a patient health card (PHC). The PHC was evaluated with respect to three other aspects of general practice: number of days between making a non-urgent appointment and seeing a doctor; waiting time in reception between the time of the appointment and seeing a doctor; and whether the patient is usually seen by the doctor of their choice.

View Article and Find Full Text PDF

A PHP Error was encountered

Severity: Warning

Message: fopen(/var/lib/php/sessions/ci_session3kiod9j76q77t68ful1rkbifd17jpn08): Failed to open stream: No space left on device

Filename: drivers/Session_files_driver.php

Line Number: 177

Backtrace:

File: /var/www/html/index.php
Line: 316
Function: require_once

A PHP Error was encountered

Severity: Warning

Message: session_start(): Failed to read session data: user (path: /var/lib/php/sessions)

Filename: Session/Session.php

Line Number: 137

Backtrace:

File: /var/www/html/index.php
Line: 316
Function: require_once