22 research outputs found

    Cost-effectiveness of innovations in pathology services in relation to cancer diagnosis and treatment management

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    Pathology plays an important role in cancer diagnosis and treatment management, results from the pathology lab guide clinicians’ diagnosis and inform patient care plans. Pathology digitisation is expected to maximise lab efficiency when handling tissue specimens, enhance speed, provide novel information to be used by clinicians when making treatment decisions and potentially improve test accuracy. Early cancer diagnosis and personalised treatment are key players in enhancing patients’ clinical outcomes and improving quality of life. Whilst research has shown digitisation of pathology labs to be an effective intervention for better management and reporting on tissue specimens, no evaluation has reported on the economic implications of the adoption of digital systems in an NHS with limited resources. Breast cancers are the most common cancer type in the UK so any advances in accuracy or time to diagnosis due to digital pathology are expected to have a large impact on this group of patients. This thesis investigates the cost-effectiveness of digital pathology through its impacts on breast cancer patients. A discrete event simulation model representing the breast cancer pathway was constructed and used to analyse the impacts of digitisation. There was evidence of both time and cost savings for breast cancer patients as a result of pathology digitisation. A systematic review and meta-analysis compared the diagnostic accuracy of the HER2 biomarker pre- and post- the introduction of digital pathology. There was evidence of reporting precision but not of improved accuracy. Finally, a cost-effectiveness analysis comparing the two approaches found digital pathology not to be cost-effective when compared to conventional microscopes for scoring the HER2 biomarker

    A Study of Palatal Rugae Patterns and Maxillary Inter-Canine Distance in a Jordanian Population Sample

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    The study of palatal rugae has an important role in establishing personal identity and facilitating population identification. The current work analyzed the pattern of palatal rugae among an adult Jordanian population and searched for any gender differences. A total of 100 random dental casts were included in this study. Number and pattern of palatal rugae regarding length, shape, direction, and unification of rugae were identified. In addition, measurement of maxillary intercanine widths (MIW) using digital Vernier caliper was done. Palatal rugae on the right side outnumbered those on the left side. Males had more rugae in general than females. The commonest rugae in both sexes were serpiginous. Primary and forward rugae showed the highest frequency. A diverging form of unification was more prevalent than a converging form. Apart from a total number of convergent, divergent and secondary rugae, the total number of other rugae differs significantly between males and females. The study showed characteristics of palatal rugae in a Jordanian population which could be gender specific, facilitating their identification. It revealed the presence of sexual dimorphism, and sex can be predicted using either logistic regression equation or CART model

    A Study of morphological features of footprints in Egyptian and Malaysian population

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    Determination of sex and ethnicity is one of the main tasks in building the biological profile of individuals. Keen examination of footprints that may be found at the crime scene can give valuable clues in forensic identification. The current work aimed to study the footprint morphological features and their relation to sex and population difference. The study was conducted on 200 adult volunteers. They were divided into two equal racial groups: Malaysians and Egyptians. The collected footprints were classified into four types based on relative morphological toes lengths. Toes inter-distance, phalangeal marks position and number, humps count and Chippaux-Smirak index (CSI) were examined. The frequency of these characteristics was analyzed statistically using regression analysis. Among the studied morphological features, it was found that t3-t4 inter-distance, phalangeal marks number, humps count and CSI differed significantly between males and females. As regards ethnicity, all footprints characteristics differed significantly between Egyptians and Malaysians except CSI

    The views of local authorities in England on how to prevent children being in care

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    Purpose: The rates of children looked after by local authorities in England have been rising for more than two decades. This study was conducted to determine what approaches local authorities have adopted that they perceive to be the most effective in preventing the need for children to come into care. It also considers how they evaluate these approaches and how they assess cost-effectiveness. Methods: An online survey was distributed to leaders of children’s social services departments in England in 2018 (n = 152). Findings: Sixty (39.5%) local authorities completed the survey. Respondents were asked to select up to three types of services or approaches they deemed most effective in preventing the need for children to come into care. The most popular was a whole-system approach selected by 81.7%, with Signs of Safety most commonly cited. This was followed by edge-of-care services (61.7%), early help (56.7%), family group conferences (43.3%), parenting programmes (18.3%), short break services (15.0%) and “other” services (20.0%). Local authorities who had experienced increases in the numbers of children in care were more likely to discuss approaches introduced relatively recently. Whole-system approaches and parenting programmes were the approaches most likely to have had independent evaluations. Whilst most local authorities reported the use of economic analysis methods as part of their evaluation, there was insufficient detail for a full assessment of cost-effectiveness. Originality: This paper provides a description of contemporary attitudes amongst leaders of children’s services to approaches that aim to keep children out of care. It also describes approaches taken by local authorities to evaluation and assessing cost-effectiveness

    Intensive family preservaton services to prevent out-of-home placement of children: a systematic review and meta-analysis

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    Background Intensive Family Preservation Services (IFPS) are in-home crisis intervention services designed to help families with children at imminent risk of out-of-home placement. Objectives To assess the evidence of the effectiveness and cost-effectiveness of IFPS in reducing the need for children to enter out-of-home care. Participants and setting Children <18 years and their families in the home setting. Methods A systematic review and meta-analysis was carried out by searching 12 databases and 16 websites for publications up to January 2019. Results 1948 potentially relevant papers were identified, of which 37 papers, relating to 33 studies, met our inclusion criteria. Studies reported outcomes at child or family level. There were significant reductions in relative risk (RR) of out-of-home placements in children who received IFPS compared with controls at child level at three, six, 12 and 24 months’ follow-up (RR 0.57, 95 % CI 0.35 to 0.93, RR 0.51, 95 % CI 0.27 to 0.96, RR 0.60, 95 % CI 0.48 to 0.76, RR 0.51, 95 % CI 0.30 to 0.87 respectively). At family level, there was not a significant reduction in RR of placement. Economic evidence was limited to cost analyses or cost-cost offset analyses. Conclusion The available evidence, at child level, suggests that IFPS are effective in preventing children from entering care up to 24 months after the intervention. Placement outcomes reported at family level did not demonstrate a significant reduction in out-of-home placements. The economic analyses suggest that IFPS could be cost-saving; however, evidence of cost-effectiveness generated by full economic evaluations is needed
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