Browsing by Author "Ramsay, Craig R"

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Ablative therapy for people with localised prostate cancer : a systematic review and economic evaluation
(2015-07-01) Ramsay, Craig R; Adewuyi, Temitope E; Gray, Joanne; Hislop, Jenni; Shirley, Mark Df; Jayakody, Shalmini; MacLennan, Graeme; Fraser, Cynthia; MacLennan, Sara; Brazzelli, Miriam; N'Dow, James; Pickard, Robert; Robertson, Clare; Rothnie, Kieran; Rushton, Stephen P; Vale, Luke; Lam, Thomas B; University of Aberdeen.Aberdeen Centre for Evaluation; University of Aberdeen.Institute of Applied Health Sciences; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Academic Urology Unit
Assessing methods to specify the target difference for a randomised controlled trial : DELTA (Difference ELicitation in TriAls) review
(2014-05-01) Cook, Jonathan Alistair; Hislop, Jennifer Margaret; Adewuyi, Temitope E; Harrild, Kirsten Ann; Altman, Douglas G; Ramsay, Craig R; Fraser, Cynthia; Buckley, Brian; Fayers, Peter; Harvey, Ian; Briggs, Andrew H; Norrie, John D; Fergusson, Dean; Ford, Ian; Vale, Luke David; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
A behavioural approach to specifying interventions : what insights can be gained for the reporting and implementation of interventions to reduce antibiotic use in hospitals?
(2020-05) Duncan, Eilidh M; Charani, Esmita; Clarkson, Janet E; Francis, Jill J; Gillies, Katie; Grimshaw, Jeremy M; Kern, Winfried V; Lorencatto, Fabiana; Marwick, Charis A; McEwen, Jo; Möhler, Ralph; Morris, Andrew M; Ramsay, Craig R; Rogers Van Katwyk, Susan; Rzewuska, Magdalena; Skodvin, Brita; Smith, Ingrid; Suh, Kathryn N; Davey, Peter G; University of Aberdeen.Aberdeen Centre for Evaluation; University of Aberdeen.Institute of Applied Health Sciences
‘Better’ clinical decisions do not necessarily require more time to make
(2017-02-01) McCleary, Nicola; Francis, Jill J; Campbell, Marion K; Ramsay, Craig R; Eccles, Martin P; Treweek, Shaun; Allan, Julia; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Aberdeen Centre for Evaluation; University of Aberdeen.Aberdeen Health Psychology Group; University of Aberdeen.Institute of Applied Health Sciences
Bowel dysfunction after transposition of intestinal segments into the urinary tract : 8-year prospective cohort study
(Elsevier, 2007) Somani, Bhaskar K.; Kumar, Vinod; Wong, Susan; Pickard, Robert; Ramsay, Craig R; Nabi, Ghulam; Grant, Adrian Maxwell; N'Dow, James Michael Olu; ABACUS Research Group
Purpose Bowel function may be disturbed after intestinal segments are transposed into the urinary tract to reconstruct or replace the bladder. In 1997, our group were the first to report major bowel dysfunction in a cohort of such patients: up to 42% of those who were asymptomatic preoperatively describing new bowel symptoms postoperatively including explosive diarrhoea, nocturnal diarrhoea, faecal urgency, faecal incontinence and flatus leakage . We now describe bowel symptoms in this same cohort eight years later (2005). Materials and Methods 116 patients were evaluable. Of the remaining 37 from the original report: 30 had died, five no longer wished to be involved, and two could not be traced. Patients were asked to complete postal questionnaires identical to those used in the first follow-up, assessing the severity of bowel symptoms and quality of life using two validated instruments. Responses were compared with those from the original study. The Nottingham Health Profile quality of life scores were also compared to age and sex matched norms. Results 96 (83%) completed eight-year follow-up questionnaires: 43 after ileal conduit diversion (Group 1), 17 after clam enterocystoplasty for overactive bladder (Group 2), 18 after reconstructed bladder for neurogenic bladder dysfunction (Group 3), and 18 with bladder replacement for non-neurogenic causes (Group 4). High prevalence rates of bowel symptoms persisted with no statistically significant differences between the two time points. Of those with symptoms in 2005, around 50% had reported similar symptoms in 1997. Clam enterocystoplasty patients (Group 2) still reported the highest prevalence (59%) of troublesome diarrhoea with one in two on regular anti-diarrhoeal medication. They also had high rates of faecal incontinence (47%), faecal urgency (41%) and nocturnal bowel movement (18%); with high proportions reporting a moderate or severe adverse effect on work (36%), social life (50%) and sex life (43%). High rates were also reported by neurogenic bladder dysfunction patients, including 50% with troublesome diarrhoea. This symptom was reported by 19% after ileal conduit and by 17% after bladder replacement for non-neurogenic causes. The impact of bowel symptoms on every-day activities and quality of life persisted, remaining most severe after clam enterocystoplasty, with 24% regretting undergoing the procedure because of subsequent bowel symptoms. Conclusions: After more than eight years, operations involving transposition of intestinal segments continue to be associated with high rates of bowel symptoms, which impact on everyday activities. These are particularly troublesome following enterocystoplasty for overactive bladder and bladder reconstruction for neurogenic bladder dysfunction. These risks should influence patient selection and potential patients should be warned prior to surgery.
Can't do it, won't do it! Developing a theoretically framed intervention to encourage better decontamination practice in Scottish dental practices
(BMC, 2009-06-05) Bonetti, Debbie; Young, Linda; Black, Irene; Cassie, Heather; Ramsay, Craig R; Clarkson, Jan
Background: Guidance on the cleaning of dental instruments in primary care has recently been published. The aims of this study are to determine if the publication of the guidance document was enough to influence decontamination best practice and to design an implementation intervention strategy, should it be required. Methods: A postal questionnaire assessing current decontamination practice and beliefs was sent to a random sample of 200 general dental practitioners. Results: Fifty-seven percent (N = 113) of general dental practitioners responded. The survey showed large variation in what dentists self-reported doing, perceived as necessary or practical to do, were willing to do, felt able to do, as well as what they planned to change. Only 15% self reported compliance with the five key guideline-recommended individual-level decontamination behaviours; only 2% reported compliance with all 11 key practice-level behaviours. The results also showed that our participants were almost equally split between dentists who were completely unmotivated to implement best decontamination practice or else highly motivated. The results suggested there was scope for further enhancing the implementation of decontamination guidance, and that an intervention with the greatest likelihood of success would require a tailored format, specifically targeting components of the theory of planned behaviour (attitude, perceived behavioural control, intention) and implementation intention theory (action planning). Conclusion: Considerable resources are devoted to encouraging clinicians to implement evidence-based practice using interventions with erratic success records, or no known applicability to a specific clinical behaviour, selected mainly by means of researchers' intuition or optimism. The methodology used to develop this implementation intervention is not limited to decontamination or to a single segment of primary care. It is also in accordance with the preliminary stages of the framework for evaluating complex interventions suggested by the medical research council. The next phases of this work are to test the intervention feasibility and evaluate its effectiveness in a randomised control trial.
Choosing appropriate patient-reported outcomes instrument for glaucoma research : a systematic review of vision instruments
(2011-09) Che Hamzah, Jemaima; Burr, Jennifer M; Ramsay, Craig R; Azuara-Blanco, Augusto; Prior, Maria; University of Aberdeen.Medicine, Medical Sciences & Nutrition; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins : results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial
(2015-04) Brittenden, Julie; Cotton, Seonaidh C; Elders, Andrew; Tassie, Emma; Scotland, Graham; Ramsay, Craig R; Norrie, John; Burr, Jennifer; Francis, Jill; Wileman, Samantha; Campbell, Bruce; Bachoo, Paul; Chetter, Ian; Gough, Michael; Earnshaw, Jonothan; Lees, Tim; Scott, Julian; Baker, Sara A; MacLennan, Graeme; Prior, Maria; Bolsover, Denise; Campbell, Marion K; University of Aberdeen.Applied Medicine; University of Aberdeen.Medical Sciences - Cardiovascular Group; University of Aberdeen.Aberdeen Centre for Evaluation; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Health Economics Research Unit; University of Aberdeen.Institute of Applied Health Sciences
Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]
(2015-10) Carr, Andrew J; Cooper, Cushla D; Campbell, Marion K; Rees, Jonathan L; Moser, Jane; Beard, David J; Fitzpatrick, Ray; Gray, Alastair; Dawson, Jill; Murphy, Jacqueline; Bruhn, Hanne; Cooper, David; Ramsay, Craig R; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences; University of Aberdeen.Health Economics Research Unit; University of Aberdeen.Aberdeen Centre for Evaluation
The clinical effectiveness and cost-effectiveness of point-of-care tests (CoaguChek system, INRatio2 PT/INR monitor and ProTime Microcoagulation system) for the self-monitoring of the coagulation status of people receiving long-term vitamin K antagonist therapy, compared with standard UK practice : systematic review and economic evaluation
(2015-06) Sharma, Pawana; Scotland, Graham Stewart; Cruickshank, Moira; Tassie, Emma; Fraser, Cynthia; Burton, Christopher David; Croal, Bernard; Ramsay, Craig R; Brazzelli, Miriam; University of Aberdeen.Aberdeen Centre for Evaluation; University of Aberdeen.Health Economics Research Unit; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma : a systematic review and economic evaluation
(Gray Publishing, 2007-10) Burr, Jennifer Margaret; Mowatt, Graham; Hernández, Rodolfo Andrés; Siddiqui, Muhammad Ardul Rehman; Cook, Jonathan Alistair; Lourenco, Tania; Ramsay, Craig R; Vale, Luke David; Fraser, Cynthia Mary; Azuara-Blanco, Augusto; Deeks, J.; Cairns, J.; Wormald, R.; McPherson, S.; Rabindranath, K.; Grant, Adrian Maxwell; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Objectives: To assess whether open angle glaucoma (OAG) screening meets the UK National Screening Committee criteria, to compare screening strategies with case finding, to estimate test parameters, to model estimates of cost and cost-effectiveness, and to identify areas for future research. Data sources: Major electronic databases were searched up to December 2005. Review methods: Screening strategies were developed by wide consultation. Markov submodels were developed to represent screening strategies. Parameter estimates were determined by systematic reviews of epidemiology, economic evaluations of screening, and effectiveness (test accuracy, screening and treatment). Tailored highly sensitive electronic searches were undertaken. Results: Most potential screening tests reviewed had an estimated specificity of 85% or higher. No test was clearly most accurate, with only a few, heterogeneous studies for each test. No randomised controlled trials (RCTs) of screening were identified. Based on two treatment RCTs, early treatment reduces the risk of progression. Extrapolating from this, and assuming accelerated progression with advancing disease severity, without treatment the mean time to blindness in at least one eye was approximately 23 years, compared to 35 years with treatment. Prevalence would have to be about 3–4% in 40 year olds with a screening interval of 10 years to approach costeffectiveness. It is predicted that screening might be cost-effective in a 50-year-old cohort at a prevalence of 4% with a 10-year screening interval. General population screening at any age, thus, appears not to be cost-effective. Selective screening of groups with higher prevalence (family history, black ethnicity) might be worthwhile, although this would only cover 6% of the population. Extension to include other at-risk cohorts (e.g. myopia and diabetes) would include 37% of the general population, but the prevalence is then too low for screening to be considered cost-effective. Screening using a test with initial automated classification followed by assessment by a specialised optometrist, for test positives, was more cost-effective than initial specialised optometric assessment. The cost-effectiveness of the screening programme was highly sensitive to the perspective on costs (NHS or societal). In the base-case model, the NHS costs of visual impairment were estimated as £669. If annual societal costs were £8800, then screening might be considered cost-effective for a 40-year-old cohort with 1% OAG prevalence assuming a willingness to pay of £30,000 per quality-adjusted life-year. Of lesser importance were changes to estimates of attendance for sight tests, incidence of OAG, rate of progression and utility values for each stage of OAG severity. Cost-effectiveness was not particularly sensitive to the accuracy of screening tests within the ranges observed. However, a highly specific test is required to reduce large numbers of false-positive referrals. The findings that population screening is unlikely to be cost-effective are based on an economic model whose parameter estimates have considerable uncertainty. In particular, if rate of progression and/or costs of visual impairment are higher than estimated then screening could be cost-effective. Conclusions: While population screening is not costeffective, the targeted screening of high-risk groups may be. Procedures for identifying those at risk, for quality assuring the programme, as well as adequate service provision for those screened positive would all be needed. Glaucoma detection can be improved by increasing attendance for eye examination, and improving the performance of current testing by either refining practice or adding in a technology-based first assessment, the latter being the more cost-effective option. This has implications for any future organisational changes in community eye-care services. Further research should aim to develop and provide quality data to populate the economic model, by conducting a feasibility study of interventions to improve detection, by obtaining further data on costs of blindness, risk of progression and health outcomes, and by conducting an RCT of interventions to improve the uptake of glaucoma testing.
Contamination in trials of educational interventions
(Gray Publishing, 2007-10) Keogh-Brown, M.R.; Bachmann, M.O.; Shepstone, L.; Hewitt, C.; Howe, A.; Ramsay, Craig R; Song, F; Miles, J.N.V.; Torgerson, D.J.; Miles, S.; Elbourne, Diana R.; Harvey, I.; Campbell, M.J.
Objectives: To consider the effects of contamination on the magnitude and statistical significance (or precision) of the estimated effect of an educational intervention, to investigate the mechanisms of contamination, and to consider how contamination can be avoided. Data sources: Major electronic databases were searched up to May 2005. Methods: An exploratory literature search was conducted. The results of trials included in previous relevant systematic reviews were then analysed to see whether studies that avoided contamination resulted in larger effect estimates than those that did not. Experts’ opinions were elicited about factors more or less likely to lead to contamination. We simulated contamination processes to compare contamination biases between cluster and individually randomised trials. Statistical adjustment was made for contamination using Complier Average Causal Effect analytic methods, using published and simulated data. The bias and power of cluster and individually randomised trials were compared, as were Complier Average Causal Effect, intention-to-treat and per protocol methods of analysis. Results: Few relevant studies quantified contamination. Experts largely agreed on where contamination was more or less likely. Simulation of contamination processes showed that, with various combinations of timing, intensity and baseline dependence of contamination, cluster randomised trials might produce biases greater than or similar to those of individually randomised trials. Complier Average Causal Effect analyses produced results that were less biased than intention-to-treat or per protocol analyses. They also showed that individually randomised trials would in most situations be more powerful than cluster randomised trials despite contamination. Conclusions: The probability, nature and process of contamination should be considered when designing and analysing controlled trials of educational interventions in health. Cluster randomisation may or may not be appropriate and should not be uncritically assumed always to be a solution. Complier Average Causal Effect models are an appropriate way to adjust for contamination if it can be measured. When conducting such trials in future, it is a priority to report the extent, nature and effects of contamination.
Determining information for inclusion in a decision-support intervention for clinical trial participation : A modified Delphi approach
(2013-12) Gillies, Kate; Skea, Zoë C; Maclennan, Sara J; Ramsay, Craig R; Campbell, Marion K; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Developing a core outcome set for periodontal trials
(2021-07-22) Lamont, Thomas J; Clarkson, Jan E; Ricketts, David N J; Heasman, Peter A; Ramsay, Craig R; Gillies, Katie; University of Aberdeen.Aberdeen Centre for Evaluation; University of Aberdeen.Institute of Applied Health Sciences
Developing the Intervention and Outcome Components of a Proposed Randomised Controlled trial (RCT) of a National Screening Programme for Open Angle Glaucoma (OAG) : Medical Research Council funded trial platform study (G0701759): Study protocol
(2008) Burr, Jennifer; Azuara-Blanco, Augusto; Hernández, Rodolfo Andrés; Ramsay, Craig R; Vale, Luke David; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Institute of Applied Health Sciences
Developing the specifications of an Open Angle Glaucoma screening intervention in the United Kingdom : a Delphi approach
(2012-12-05) Campbell, Susan E; Azuara-Blanco, Augusto; Campbell, Marion K; Francis, Jillian J; Greene, Alexandra C; Ramsay, Craig R; Burr, Jennifer M; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Vice Principals; University of Aberdeen.Institute of Applied Health Sciences; University of Aberdeen.Aberdeen Health Psychology Group; University of Aberdeen.Aberdeen Centre for Evaluation
The effect of enhanced feedback and brief educational reminder messages on laboratory test requesting in primary care: a cluster randomised trial.
(Elsevier, 2006-06-17) Thomas, Ruth Elizabeth; Croal, Bernard L.; Ramsay, Craig R; Eccles, Martin P.; Grimshaw, Jeremy
Effect of multivitamin and multimineral supplementation on cognitive function in men and women aged 65 years and over : a randomised controlled trial
(BMC, 2007-05-02) McNeil, Geraldine; Avenell, Alison; Campbell, Marion Kay; Cook, Jonathan Alistair; Hannaford, Philip Christopher; Kilonzo, Mary Mueni; Milne, Anne Catherine; Ramsay, Craig R; Seymour, David Gwyn; Stephen, Audrey Isabella; Vale, Luke David; MAVIS Trial Group; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
Background: Observational studies have frequently reported an association between cognitive function and nutrition in later life but randomised trials of B vitamins and antioxidant supplements have mostly found no beneficial effect. We examined the effect of daily supplementation with 11 vitamins and 5 minerals on cognitive function in older adults to assess the possibility that this could help to prevent cognitive decline. Methods: The study was carried out as part of a randomised double blind placebo controlled trial of micronutrient supplementation based in six primary care health centres in North East Scotland. 910 men and women aged 65 years and over living in the community were recruited and randomised: 456 to active treatment and 454 to placebo. The active treatment consisted of a single tablet containing eleven vitamins and five minerals in amounts ranging from 50–210 % of the UK Reference Nutrient Intake or matching placebo tablet taken daily for 12 months. Digit span forward and verbal fluency tests, which assess immediate memory and executive functioning respectively, were conducted at the start and end of the intervention period. Risk of micronutrient deficiency at baseline was assessed by a simple risk questionnaire. Results: For digit span forward there was no evidence of an effect of supplements in all participants or in sub-groups defined by age or risk of deficiency. For verbal fluency there was no evidence of a beneficial effect in the whole study population but there was weak evidence for a beneficial effect of supplementation in the two pre-specified subgroups: in those aged 75 years and over (n 290; mean difference between supplemented and placebo groups 2.8 (95% CI -0.6, 6.2) units) and in those at increased risk of micronutrient deficiency assessed by the risk questionnaire (n 260; mean difference between supplemented and placebo groups 2.5 (95% CI -1.0, 6.1) units). Conclusion: The results provide no evidence for a beneficial effect of daily multivitamin and multimineral supplements on these domains of cognitive function in community-living people over 65 years. However, the possibility of beneficial effects in older people and those at greater risk of nutritional deficiency deserves further attention.
The effectiveness and cost-effectiveness of minimal access surgery amongst people with gastro-oesophageal reflux disease – a UK collaborative study
(National Institute for Health Research, 2008-09) Grant, Adrian Maxwell; Wileman, Samantha Mary; Ramsay, Craig R; Bojke, Laura; Sculpher, Mark J.; Kilonzo, Mary Mueni; Vale, Luke David; Francis, Jillian Joy; Mowat, Ashley G.; Krukowski, Zygmunt H.; Campbell, Marion Kay; Epstein, David; Macran, Sue; Heading, Robert; Thursz, Mark; Russell, Ian; REFLUX Trial Group; University of Aberdeen, School of Medicine & Dentistry, Division of Applied Health Sciences
*Corresponding author randomised arm of the trial (178 allocated to surgical management,179 allocated to continued, but optimised,medical management) and 453 recruited to the parallel non-randomised preference arm (261 chose surgical management, 192 chose to continue with best medical management). The type of fundoplication was left to the discretion of the surgeon. Main outcome measures: Participants completed a baseline reflux questionnaire, developed specifically for this study, containing a disease-specific outcome measure, the Short Form with 36 Items (SF-36), the EuroQol-5 Dimensions (EQ-5D) and the Beliefs about Medicines and Surgery questionnaires (BMQ/BSQ).Postal questionnaires were completed at participant specific time intervals after joining the trial (equivalent to approximately 3 and 12 months after surgery).Intraoperative data were recorded by the surgeons and all other in-hospital data were collected by the research nurse. At the end of the study period, participants completed a discrete choice experiment questionnaire. Results: The randomised groups were well balanced at entry. Participants had been taking GORD medication for a median of 32 months; the mean age of participants was 46 years and 66% were men. Of 178 randomised to surgery, 111 (62%) actually had fundoplication.There was a mixture of clinical and personal reasons why some patients did not have surgery, sometimes Objectives: To evaluate the clinical effectiveness, costeffectiveness and safety of a policy of relatively early laparoscopic surgery compared with continued medical management amongst people with gastro-oesophageal reflux disease (GORD) judged suitable for both policies. Design: Relative clinical effectiveness was assessed by a randomised trial (with parallel non-randomised preference groups) comparing a laparoscopic surgerybased policy with a continued medical management policy. The economic evaluation compared the costeffectiveness of the two management policies in order to identify the most efficient provision of future care and describe the resource impact that various policies for fundoplication would have on the NHS.Setting: A total of 21 hospitals throughout the UK with a local partnership between surgeon(s) and gastroenterologist(s) who shared the secondary care of patients with GORD.Participants: The 810 participants, who were identified retrospectively or prospectively via their participating clinicians, had both documented evidence of GORD (endoscopy and/or manometry/24-hour pH monitoring) and symptoms for longer than 12 months. In addition,the recruiting clinician(s) was clinically uncertain about which management policy was best.Intervention: Of the 810 eligible patients who consented to participate, 357 were recruited to the related to long waiting times. A total or partial wrap procedure was performed depending on surgeon preference. Complications were uncommon and there were no deaths associated with surgery. By the equivalent of 12 months after surgery, 38% in the randomised surgical group (14% amongst those who had surgery) were taking reflux medication compared with 90% in the randomised medical group. There were substantial differences (one-third to one-half standard deviation) favouring the randomised surgical group across the health status measures, the size depending on assumptions about the proportion that actually had fundoplication. These differences were the same or somewhat smaller than differences observed at 3 months. The lower the reflux score, the worse the symptoms at trial entry and the larger the benefit observed after surgery. The preference surgical group had the lowest reflux scores at baseline. These scores improved substantially after surgery, and by 12 months they were better than those in the preference medical group. The BMQ/BSQ and discrete choice experiment did distinguish the preference groups from each other and from the randomised groups. The latter indicated that the risk of serious complications was the most important single attribute of a treatment option. A within trial cost-effectiveness analysis suggested that the surgery policy was more costly (mean £2049) but also more effective [+0.088 quality-adjusted life-years (QALYs)]. The estimated incremental cost per QALY was £19,000–£23,000, with a probability between 46% (when 62% received surgery) and 19% (when all received surgery) of cost-effectiveness at a threshold of £20,000 per QALY. Modelling plausible longer-term scenarios (such as lifetime benefit after surgery) indicated a greater likelihood (74%) of costeffectiveness at a threshold of £20,000, but applying a range of alternative scenarios indicated wide uncertainty.The expected value of perfect information was greatest for longer-term quality of life and proportions of surgical patients requiring medication.Conclusions: Amongst patients requiring long-term medication to control symptoms of GORD, surgical management significantly increases general and refluxspecific health-related quality of life measures, at least up to 12 months after surgery. Complications of surgery were rare. A surgical policy is, however, more costly than continued medical management. At a threshold of £20,000 per QALY it may well be cost-effective, especially when putative longer-term benefits are taken into account, but this is uncertain.The more troublesome the symptoms, the greater the potential benefit from surgery. Uncertainty about cost-effectiveness would be greatly reduced by more reliable information about relative longer-term costs and benefits of surgical and medical policies. This could be through extended follow-up of the reflux trial cohorts or of other cohorts of fundoplication patients.
Evaluating an audit and feedback intervention for reducing antibiotic prescribing behaviour in general dental practice (the RAPiD trial) : a partial factorial cluster randomised trial protocol
(2014-04-24) Prior, Maria; Elouafkaoui, Paula; Elders, Andrew; Young, Linda; Duncan, Eilidh M; Newlands, Rumana; Clarkson, Jan E; Ramsay, Craig R; Translation Research in a Dental Setting (TRiaDS) Research Methodology Group; University of Aberdeen.Other Applied Health Sciences; University of Aberdeen.Aberdeen Health Psychology Group; University of Aberdeen.Institute of Applied Health Sciences