scholarly journals Awareness of the cost of psychotropic medication among doctors: a service evaluation

2010 ◽  
Vol 34 (9) ◽  
pp. 364-366 ◽  
Author(s):  
Dhananjay Kumar Singh ◽  
Shakil Khawaja ◽  
Ishaq Pala ◽  
Jaleel Khaja ◽  
Ray Krishnanu ◽  
...  
Keyword(s):  
Cost Effective ◽  
Service Evaluation ◽  
Financial Resources ◽  
Clinical Implications ◽  
North East ◽  
The North ◽  
Old Age Psychiatry ◽  
Level Of Knowledge ◽  
The Cost ◽  
Structured Questionnaire

Aims and methodCost-effective prescribing is an increasingly important aspect of our practice. A service evaluation was carried out to assess the level of awareness and knowledge of different aspects of cost-effective prescribing among doctors working in the North East London Foundation Trust. A semi-structured questionnaire was used to benchmark knowledge against six standards.ResultsThe survey was completed by 71% of doctors working in adult or old age psychiatry. A total of 2% of doctors stated that they should always take into consideration the price of the drug when prescribing and only 5% of doctors claimed to know the price of medications they prescribe most frequently.Clinical implicationsStrategies to improve the poor level of knowledge and awareness in this area of clinical practice would be of benefit in making the best use of limited financial resources without any detriment to patient care.

scholarly journals Caveat emptor NICE: biased use of cost-effectiveness is inefficient and inequitable

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 1078 ◽  
Author(s):  
Jack Dowie ◽  
Mette Kjer Kaltoft ◽  
Jesper Bo Nielsen ◽  
Glenn Salkeld
Keyword(s):  
Cost Effectiveness ◽  
Health Gain ◽  
Cost Effective ◽  
The South ◽  
Constrained System ◽  
North East ◽  
The North ◽  
South West ◽  
Undesirable Consequence ◽  
The Cost

Concern with the threshold applied in cost-effectiveness analyses by bodies such as NICE distracts attention from their biased use of the principle. The bias results from the prior requirement that an intervention be effective (usually 'clinically effective') before its cost-effectiveness is considered. The underlying justification for the use of cost-effectiveness as a criterion, whatever the threshold adopted, is that decisions in a resource-constrained system have opportunity costs. Their existence rules out any restriction to those interventions that are 'incrementally cost-effective' at a chosen threshold and requires acceptance of those that are 'decrementally cost-effective' at the same threshold. Interventions that fall under the linear ICER line in the South-West quadrant of the cost-effectiveness plane are cost-effective because they create net health benefits, as do those in the North-East quadrant. If there is objection to the fact that they are cost-effective by reducing effectiveness as well as costs, it is possible to reject them, but only on policy grounds other than their failure to be cost-effective. Having established this, the paper considers and seeks to counter the arguments based on these other grounds. Most notably these include those proposing a different threshold in the South-West quadrant from the North-East one, i.e. propose a 'kinked ICER'. Another undesirable consequence of the biased use of cost-effectiveness is the failure to stimulate innovations that would increase overall health gain by being less effective in the condition concerned, but generate more benefits elsewhere. NICE can only reward innovations that cost more.

scholarly journals Spotting the Differences: The CEAC vs. CEAFC vs. CERAC

2021 ◽  
Author(s):  
Pedram Sendi ◽  
Klazien Matter-Walstra ◽  
Matthias Schwenkglenks
Keyword(s):  
Cost Effectiveness ◽  
Risk Aversion ◽  
Joint Distribution ◽  
Joint Probability ◽  
Cost Effective ◽  
Policy Makers ◽  
North East ◽  
The North ◽  
Program Costs ◽  
The Cost

Methods to handle uncertainty in economic evaluation have gained much attention in the literature and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarize and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some researchers have emphasized the limitations of the CEAC for informing decision and policy makers as the CEAC is insensitive to radial shifts of the joint distribution of incremental costs and effects in the North-East and South-West quadrants of the cost-effective plane (CEP). Furthermore, it has been pointed out that the CEAC does not incorporate risk-aversion in valuing uncertain costs and effects. In the present article we show that the cost-effectiveness affordability curve (CEAFC) captures both dimensions of the joint distribution of incremental costs and effects on the CEP and is therefore sensitive to radial shifts of the joint distribution on the CEP. Furthermore, the CEAFC also informs about the budget impact of a new intervention as it estimates the joint probability an intervention is both affordable and cost-effective. Moreover, we show that the cost-effectiveness risk-aversion curve (CERAC) allows to incorporate risk-aversion into the analysis and can therefore be used to inform decision-makers who are risk-averse. We use data from a published cost-effectiveness model of palbociclib in addition to letrozole versus letrozole alone for the treatment of oestrogen-receptor positive, HER-2 negative, advanced breast cancer to demonstrate the differences between CEAC, CEAFC and CERAC and show how these can jointly be used to inform decision and policy makers.

Hangings attended by ambulance clinicians in the North East of England

2021 ◽  
Vol 6 (3) ◽  
pp. 49-57
Author(s):  
Gary Shaw ◽  
Lee Thompson ◽  
Graham McClelland
Keyword(s):  
Mental Health ◽  
Cardiac Arrest ◽  
Suicide Attempts ◽  
Service Evaluation ◽  
Health Issues ◽  
Hospital Data ◽  
North East ◽  
The North ◽  
Acute Hospitals ◽  
Future Work

Introduction: Suicide rates have risen in England over the last decade and hanging, a highly lethal method of suicide, has been the most common method. Previous work in this area identified a lack of literature discussing emergency medical services (EMS) attendance at hangings. This article aims to describe hangings attended by EMS in the North East of England in order to inform future work in this area.Methods: A retrospective service evaluation was conducted using existing data from a comprehensive pre-hospital trauma audit database to describe patients with hanging documented in their records who were attended by ambulance clinicians between 1 December 2018 and 31 November 2020.Results: Hanging was recorded in 604 incidents. Most cases (n = 579/604) involved adults (aged 18 years or older) with a median age of 35 years (IQR 27‐45 years), who were male (n = 410/579, 71%). Just over half (n = 341/579, 59%) of adult hangings resulted in cardiac arrest and of these, 10% (n = 33/341) were resuscitated and survived to hospital admission. Threatened and non-fatal hangings appear to have increased dramatically in the latter half of 2020. Previous suicide attempts and mental health issues were frequently reported across this population.Conclusion: Hangings are a method of suicide which frequently result in a cardiac arrest. In the North East of England the ambulance service attends approximately one hanging per day and one fatal hanging every two days. When fatal hangings were resuscitated, pre-hospital outcomes were similar to other causes of cardiac arrest, highlighting that despite the traumatic nature of these cases resuscitation is not futile. In order to better understand this patient group and improve care, pre-hospital data need to be linked to data from other services such as mental health services and acute hospitals.

Innovative method for gathering river stage data using only the sound of the water

2021 ◽  
Author(s):  
William Alexander Osborne ◽  
Rebecca Hodge ◽  
Gordon Love ◽  
Peter Hawkin ◽  
Ruth Hawkin
Keyword(s):  
Winter Season ◽  
Cost Effective ◽  
Storm Events ◽  
River Bank ◽  
Power Efficient ◽  
River Flooding ◽  
River Stage ◽  
North East ◽  
The North ◽  
Environment Agency

<p>Splosh, gurgle, burble are all terms that can be used to describe how a river sounds as we stand on the bank. We have developed a new approach that uses the passive sound generated by a river, to gauge the current stage of the river, and generate (sono)hydrographs from the safety of the river bank. Our approach offers a cost-effective, power-efficient and flexible means to install flood monitors. We have developed a method of how to take the sound from around a river and translate it into a useful gauging tool without the need to listen to individual recordings. Using an internet of things approach we have developed a system of sound monitors that can be placed anywhere in the vicinity of a river. We aim to target the lesser studied parts of a river catchment, the headwaters, which are often data scarce environments. These environments are an opportunity to identify the real time responses of sub-catchments. The ultimate goal of our research is to enable community level flood monitoring, in areas that may be susceptible to river flooding, but are not yet actively gauged.</p><p> </p><p>We hypothesise that the sound generated by a river is a direct response to the obstacles found within the channel and the turbulence they cause. Sound is generated by the increase of energy available in the channel, being transformed into sound energy through turbulence generating structures, i.e. boulders. Data gathered over a winter season from several rivers in the North East of England, during Storm Ciara and Dennis, has shown sound to be a reliable method for determining rapid changes in river stage and is comparable to what the official Environment Agency gauges measured. Through an innovative approach, we have begun to understand the limits on sound data and the calibration of sound to the channel properties. Utilising a 7.5 m wide flume at a white water course we have recreated controlled environments and simulated different discharges and their effect on sound.</p><p> </p><p>Overall, we have found that sound is an opportunity to be taken to measure river stage in areas that are seldom studied. We have identified that sound works during extreme conditions, and being placed on the banks of the channel our monitors have a lower risk of being damaged during storm events and are easy and safe to install. We present the first means of using sound from a river to actively gauge a river and the full workflow from collection, analysis and dissemination of results.</p>

Testing for pharyngeal gonorrhoea in heterosexual men: should we revisit national guidelines?

2020 ◽  
pp. 095646242091344
Author(s):  
Melissa Dresser ◽  
Jane Hussey
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Persistent Infection ◽  
Service Evaluation ◽  
Heterosexual Men ◽  
National Guidelines ◽  
North East ◽  
The North ◽  
Current Guidelines

Pharyngeal testing for Neisseria gonorrhoeae (gonorrhoea) in heterosexual men is not currently recommended in UK guidelines; however, it was being undertaken in a service in the North East of England for those presenting with urethral infection or as contacts of gonorrhoea. This service evaluation was performed to see if this practice should continue, or cease in line with national recommendations. The results revealed that 10% of contacts were positive in the pharynx only. Had this test not been performed, it would have left these patients without any treatment, as the current guidelines now discourage epidemiological treatment of contacts. Twenty-seven per cent of all heterosexual men diagnosed with urethral infection also had oropharyngeal gonorrhoea, with implications for persistent infection, had testing not been performed followed by a test of cure.

Cost-effectiveness of a Specialised Medium Secure Personality Disorder Service

2017 ◽  
Vol 41 (S1) ◽  
pp. S87-S88
Author(s):  
R. Woodward ◽  
R. Lingam ◽  
F. Papouli
Keyword(s):  
Cost Effectiveness ◽  
Personality Disorder ◽  
Current Model ◽  
Primary Objective ◽  
Service Development ◽  
North East ◽  
The North ◽  
Episodes Of Care ◽  
Competing Interest ◽  
The Cost

IntroductionThe Oswin unit located in the North East of England is commissioned primarily for offenders screened on the offender personality disorder (OPD) pathway based on measures of personality disorder being linked to moderate to high risks to other persons.ObjectivesThe Oswin Unit was re-designed in early 2014 meeting commissioning specifications to meet objectives based on access, measuring quality and reducing. The primary objective of this pathway is to ensure personality Disorder offenders have access to “community-to-community”, joint-up care and monitoring of risks. The Oswin unit implemented a re-designed service offering individuals formulation based assessments and risk management embedded in the OPD pathway. The overall objective of this project is to evaluate the effectiveness and risk amelioration of this hospital-based service.AimAs part of a broader service development and evaluation project, the cost-effectiveness of the current model of the unit was compared to that of the unit prior to the redesign of the service.MethodCollection of data on number of admission and length of stay and calculation of expenses per capita. Retrospective analysis of costs of care.ResultsAnalysis of comparative figures post-implementation of this new model of care found 41% more episodes of care. Cost-analysis indicated a saving of £200,000.ConclusionThe new Oswin Model meets commissioning objectives in offering access to hospital-based care and focused treatments for prisoners ‘stuck’ in prison pathways. This finding led to further investigation using thematic measures of quality of care to evaluate the effectiveness of this service and risk amelioration.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The first 6 weeks – setting up a UK urgent dental care centre during the COVID-19 pandemic

2020 ◽  
Author(s):  
Emily Carter ◽  
Charlotte C Currie ◽  
Abisola Asuni ◽  
Rachel Goldsmith ◽  
Grace Toon ◽  
...  
Keyword(s):  
Dental Care ◽  
Care Service ◽  
Clinical Care ◽  
Service Evaluation ◽  
Urgent Care ◽  
List Type ◽  
Care Centre ◽  
North East ◽  
The North ◽  
Patient Pathways

AbstractIntroductionThe COVID-19 pandemic has posed many challenges, including provision of urgent dental care. This paper presents a prospective service evaluation during establishment of urgent dental care in the North-East of England over a six-week period.AimTo monitor patient volumes, demographics and outcomes at the North-East urgent dental care service and confirm appropriate care pathways.Main Outcome MethodsData were collected on key characteristics of patients accessing urgent care from 23rd March to 3rd May 2020. Analysis was with descriptive statistics.ResultsThere were 1746 patient triages, (1595 telephone and 151 face-to-face) resulting in 1322 clinical consultations. The most common diagnoses were: symptomatic irreversible pulpitis or apical periodontitis. 65% of clinical consultations resulted in extractions, 0.5% an aerosol generating procedure. Patients travelled 25km on average to access care, however this reduced as more urgent care centres were established. The majority of patients were asymptomatic of COVID-19 and to our knowledge no staff acquired infection due to occupational exposure.ConclusionThe urgent dental care centre effectively managed urgent and emergency dental care, with appropriate patient pathways established over the 6-week period. Dental preparedness for future pandemic crisis could be improved and informed by this data.Three In Brief PointsA summary is given of how urgent dental care was established in the North East of England during the COVID-19 pandemic which may help with future preparedness for pandemics.Aerosol generating procedures were almost always avoided in the delivery of urgent dental careA telephone triage system was effectively used to determine who needed clinical care, and to separate symptomatic, asymptomatic and shielding patients, with very few failures in triage noted.

scholarly journals Handling Uncertainty in Cost-Effectiveness Analysis: Budget Impact and Risk Aversion

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1419
Author(s):  
Pedram Sendi ◽  
Klazien Matter-Walstra ◽  
Matthias Schwenkglenks
Keyword(s):  
Cost Effectiveness ◽  
Risk Aversion ◽  
Joint Distribution ◽  
Budget Impact ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Policy Makers ◽  
North East ◽  
Effectiveness Analysis ◽  
The Cost

Methods to handle uncertainty in economic evaluation have gained much attention in the literature, and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarise and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some researchers have emphasised the limitations of the CEAC for informing decision and policy makers, as the CEAC is insensitive to radial shifts of the joint distribution of incremental costs and effects in the North-East and South-West quadrants of the cost-effective plane (CEP). Furthermore, it has been pointed out that the CEAC does not incorporate risk-aversion in valuing uncertain costs and effects. In the present article, we show that the cost-effectiveness affordability curve (CEAFC) captures both dimensions of the joint distribution of incremental costs and effects on the CEP and is, therefore, sensitive to radial shifts of the joint distribution on the CEP. Furthermore, the CEAFC also informs about the budget impact of a new intervention, as it can be used to estimate the joint probability that an intervention is both affordable and cost-effective. Moreover, we show that the cost-effectiveness risk-aversion curve (CERAC) allows the analyst to incorporate different levels of risk-aversion into the analysis and can, therefore, be used to inform decision-makers who are risk-averse. We use data from a published cost-effectiveness model of palbociclib in addition to letrozole versus letrozole alone for the treatment of oestrogen-receptor positive, HER-2 negative, advanced breast cancer to demonstrate the differences between CEAC, CEAFC and CERAC, and show how these can jointly be used to inform decision and policy makers.

A service evaluation of a dedicated pre-hospital cardiac arrest response unit in the North East of England

2016 ◽  
Vol 1 (2) ◽  
pp. 35-41 ◽  
Author(s):  
Graham McClelland ◽  
Paul Younger ◽  
Daniel Haworth ◽  
Amy Gospel ◽  
Paul Aitken-Fell
Keyword(s):  
Cardiac Arrest ◽  
Service Evaluation ◽  
Response Unit ◽  
North East ◽  
The North ◽  
Hospital Cardiac Arrest

scholarly journals PILOT STUDY ON THE INCIDENCE OF BREAST CANCER AMONG THE POPULATION OF THE NORTH EAST REGION OF BULGARIA

2021 ◽  
Vol 27 (3) ◽  
pp. 3868-3872
Author(s):  
Antoaneta Tsvetkova ◽  
Keyword(s):  
Breast Cancer ◽  
Survival Rates ◽  
Treatment Strategies ◽  
Indirect Costs ◽  
Premature Death ◽  
Breast Cancer Patients ◽  
North East ◽  
The North ◽  
Therapeutic Outcomes ◽  
The Cost

Purpose: According to the Bulgarian National Cancer Registry of 2017, breast cancer accounted for 26.8% of all malignancies among women. The actual incidence rate was 108.1 per 100 000. Materials/ Methods: An observational retrospective study was conducted among breast cancer patients diagnosed and treated at Dr Marko Markov Specialised Hospital for Treatment of Oncologic Diseases (SHTOD) - Varna, between 2016 and 2019. Descriptive statistics and collected data included demographic characteristics, clinical data (survival rates) and type of pharmacotherapy. Results: In terms of gender distribution, significantly more women were affected, accounting for approximately 99.05%. Patients from cities were almost 7 times more than those from villages. Patients aged between 61 and 70 represented the largest number, which accounted for 28.04% of all included in the study. Conclusion: Taking into consideration not only the efficiency but also the cost-effectiveness of available treatment strategies can lead to considerably better therapeutic outcomes. There is no pharmacoeconomic data analysis in Bulgaria. A further study of all direct and indirect costs is required in order to estimate the cost of premature death, reduced working capacity and disability.

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