Exploring the Use of Cost-Benefit Analysis to Compare Pharmaceutical Treatments for Menorrhagia

Background: The extra-welfarist theoretical framework tends to focus on health-related quality of life, whilst the welfarist framework captures a wider notion of well-being. EQ-5D and SF-6D are commonly used to value outcomes in chronic conditions with episodic symptoms, such as heavy menstrual bleeding (clinically termed menorrhagia). Because of their narrow-health focus and the condition’s periodic nature these measures may be unsuitable. A viable alternative measure is willingness to pay (WTP) from the welfarist framework. Objective: We explore the use of WTP in a preliminary cost-benefit analysis comparing pharmaceutical treatments for menorrhagia. Methods: A cost-benefit analysis was carried out based on an outcome of WTP. The analysis is based in the UK primary care setting over a 24-month time period, with a partial societal perspective. Ninety-nine women completed a WTP exercise from the ex-ante (pre-treatment/condition) perspective. Maximum average WTP values were elicited for two pharmaceutical treatments, levonorgestrel-releasing intrauterine system (LNG-IUS) and oral treatment. Cost data were offset against WTP and the net present value derived for treatment. Qualitative information explaining the WTP values was also collected. Results: Oral treatment was indicated to be the most cost-beneficial intervention costing £107 less than LNG-IUS and generating £7 more benefits. The mean incremental net present value for oral treatment compared with LNG-IUS was £113. The use of the WTP approach was acceptable as very few protests and non-responses were observed. Conclusion: The preliminary cost-benefit analysis results recommend oral treatment as the first-line treatment for menorrhagia. The WTP approach is a feasible alternative to the conventional EQ-5D/SF-6D approaches and offers advantages by capturing benefits beyond health, which is particularly relevant in menorrhagia

‘My mentor didn't speak to me for the first four weeks’: Perceived unfairness experienced by nursing students in clinical practice settings

Aims and Objectives To explore the perceived unfairness experienced by student nurses during their undergraduate clinical placements. Background It is important that student nurses feel supported by practice staff during their clinical placement education experiences. However, it has been reported that learners can feel ignored, unsupported and bullied by others in the clinical environment and this has a detrimental effect on their learning. It is important to understand the student nurse perspective and explore ways in which their feelings of belongingness might be enhanced in the clinical area. Design A descriptive narrative approach was utilised to explore the qualitative data generated by the survey and interviews. Limited closed-question survey data were acquired to explore a selection of quantified survey responses about placements and mentorship. Methods A survey was conducted with 1425 student nurses from adult and mental health degree nursing pathways, across 9 institutions in the North West of England, UK. Unstructured interviews were undertaken with 22 student nurses from across these 9 institutions. The data generated from both methods (free text survey responses and interview) were thematically analysed. Results There were times when student nurses felt that they had been treated unfairly by various members of the health care team during their clinical placements. Unfairness was related to being ignored and unsupported or being used as an ‘extra pair of hands’ and having their supernumerary status ignored. Student nurses want to have feelings of belongingness in the clinical area and value enthusiasm for teaching from mentors. Certain positive mentor qualities were identified through the data in this study. These have been used to inform a tiered model of mentorship, to inform future thinking about student nurse education. Conclusion Student nurses can feel like they are being treated unfairly in the clinical area in numerous ways. Identifying ways in which mentorship practice can be developed to adequately support education is important. This can lead to satisfaction and development on both sides of the student/educator relationship. Relevance to Practice Exploring student nurse perceptions of their learning is important when attempting to enhance educational practice in the clinical setting

Treatment of anorexia nervosa:A multimethod investigation translating experimental neuroscience into clinical practice

Background Anorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited. Objectives This programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness. Methods WP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England. Results WP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011. Conclusions This programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change. Trial registration Current Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621

Beyond and with the object: assessing the dissemination range of lantern slides and their imagery

This article proposes methods to trace media history through material objects that build on archival practices. It discusses the character of information derived from the object and other related sources, to outline possibilities for media-historical research connecting multiple collections to create large sets of data. The aim of this article is twofold: first, I share practical knowledge about identifying lantern slides of commercially distributed slide sets, to generalize an understanding of identification and evaluation from both an archival and a scholarly perspective. Combined documentation of information from various sources (catalogues, lantern slides, trade press, lecture material, readings, related media) is often necessary to correctly identify lantern slides. Second, I propose criteria for research infrastructures to incorporate data documentation towards comparative research designs. The enormous dispersion of lantern slides over many collections leads scholars to build their own corpora from objects held in various collections, which can be ameliorated with standardised descriptors across collections. Further, new research questions tracing synchronic and diachronic dispersion could be asked with the collaborative documentation of a larger set of data, for example, assessing the geographic distribution and popularity of slide sets, reconstructing trade networks or the migration of images across various media forms. Altogether, collaborative documentation and search could lead to knowledge about the formation of canons of shared visual knowledge. Research into the dissemination of slide sets and the popularity of displayed motifs cannot be restricted to either ‘distant readings’ or ‘close readings’ exclusively, and benefits from the ability to switch between close inspections of the object as well as networked sources

Gender Issues in Juvenile Justice

The federal JJDP legislation has had a differential impact on the pattern of admission of females and males to detention facilities and training schools, and also on the rate of admission relative to the total available youth population. These findings suggest a differential societal response, and also variable incidence of delinquency among females and males. Data from a self-report survey of high school youth corroborate the latter assumption and also findings that have been noted by others. Attachment to parents and normative institutions is an important constraint on delinquent behavior, but this bonding interacts differently for females and males. Thus, both explanatory and intervention theories of delinquency need to consider gender as a critical variable.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67430/2/10.1177_001112878302900304.pd

Spirituality and Religion: The Ninth CACREP Core Curriculum Area

On the basis of the ACA Code of Ethics (American Counseling Association [ACA], 2014) and ACA-endorsed competencies, the ability to address spirituality and religion is a recommended skill set of counselors. The Council for Accreditation of Counseling and Related Educational Programs (CACREP) addresses the “spirit” in the standards; however, in the training of students, additional focus could be placed on this competency. The authors introduce expert-reviewed standards to be considered as a 9th core curriculum area of the CACREP Standards (CACREP,) titled Spirituality and Religion. © 2017 by the American Counseling Association. All rights reserved

The clinical and cost-effectiveness of open mesh repairs in adults presenting with a clinically diagnosed unilateral, primary inguinal hernia who are operated in an elective setting : systematic review and economic evaluation

Source of funding This report was commissioned by the National Institute for Health Research HTA programme as project number 13/134/01. The Health Services Research Unit and Health Economics Research Unit are core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.Peer reviewedPublisher PD

Biological insights from 108 schizophrenia-associated genetic loci

Schizophrenia is a highly heritable disorder. Genetic risk is conferred by a large number of alleles, including common alleles of small effect that might be detected by genome-wide association studies. Here we report a multi-stage schizophrenia genome-wide association study of up to 36,989 cases and 113,075 controls. We identify 128 independent associations spanning 108 conservatively defined loci that meet genome-wide significance, 83 of which have not been previously reported. Associations were enriched among genes expressed in brain, providing biological plausibility for the findings. Many findings have the potential to provide entirely new insights into aetiology, but associations at DRD2 and several genes involved in glutamatergic neurotransmission highlight molecules of known and potential therapeutic relevance to schizophrenia, and are consistent with leading pathophysiological hypotheses. Independent of genes expressed in brain, associations were enriched among genes expressed in tissues that have important roles in immunity, providing support for the speculated link between the immune system and schizophrenia