Is there overutilisation of cataract surgery in England?

<b>Objectives:</b> Following a 3.7-fold increase in the rate of cataract surgery in the UK between 1989 and 2004, concern has been raised as to whether this has been accompanied by an excessive decline in the threshold such that some operations are inappropriate. The objective was to measure the impact of surgery on a representative sample of patients so as to determine whether or not overutilisation of surgery is occurring. <b>Design:</b> Prospective cohort assessed before and 3 months after surgery. <b>Setting:</b> Ten providers (four NHS hospitals, three NHS treatment centres, three independent sector treatment centres) from across England. <b>Participants:</b> 861 patients undergoing first eye (569) or second eye (292) cataract surgery provided preoperative data of whom 745 (87%) completed postoperative questionnaires. <b>Main outcome measures:</b> Patient-reported visual function (VF-14); general health status and quality of life (EQ5D); postoperative complications; overall view of the operation and its impact. <b>Results:</b> Overall, visual function improved (mean VF-14 score increased from 83.2 (SD 17.3) to 93.7 (SD 13.2)). Self-reported general health status deteriorated (20.3% fair or poor before surgery compared with 25% afterwards) which was reflected in the mean EQ5D score (0.82 vs 0.79; p = 0.003). At least one complication was reported by 66 (8.9%) patients, though this probably overestimated the true incidence. If the appropriateness of surgery is based on an increase in VF-14 score of 5.5 (that corresponds to patients’ reporting being "a little better"), 30% of operations would be deemed inappropriate. If an increase of 12.2 (patients’ reports of being "much better") is adopted, the proportion inappropriate is 49%. Using a different approach to determining a minimally important difference, the proportion inappropriate would be closer to 20%. Although visual function (VF-14) scores were unchanged or deteriorated in 25% of patients, 93.1% rated the results of the operation as "good," "very good" or "excellent," and 93.5% felt their eye problem was "better." This partly reflects inadequacies in the validity of the VF-14. <b>Conclusions:</b> Improvement in the provision of cataract surgery has been accompanied by a reduction in the visual function threshold. However, methodological difficulties in measuring the impact of cataract surgery on visual function and quality of life mean it is impossible to determine whether or not overutilisation of cataract surgery is occurring. N Black1, J Browne1, J van der Meulen1, L Jamieson2, L Copley2 and J Lewsey

Resultaat en financiering

Het Landbouw-Economisch Bericht 2009 biedt een verklarend overzicht van de gang van zaken in de Nederlandse agrosector. Tegen de achtergrond van de internationale en nationale economische en politieke ontwikkelingen, wordt ingegaan op ontwikkelingen in de landbouw en het landbouwbeleid in respectievelijk de wereld en de Europese Unie. Vervolgens staat de Nederlandse agrosector centraal, met aandacht voor consumptie en de voedings- en genotmiddelenindustrie. Hierna wordt aandacht besteed aan het landelijk gebied, de landbouwmilieuproblematiek en de structuur van de agrosector. De publicatie wordt afgerond met een beschouwing over de inkomensontwikkelingen in de onderscheiden delen van het agrocomplex. This report presents a survey of the economic state of Dutch agribusiness. First, attention is paid to general economic and political developments, followed by an overview of the changes in the EU policy for the agricultural sector. Next the report deals with the developments in the Dutch agricultural complex and food industry, followed by chapters describing changes in the Dutch rural area and environmental issues. Following a description of the production structure and production factors in agriculture, profi tability and income formation in the various sub sectors are analysed. The complete report is only available in Dutch, a separate English summary is available

Posterior Consistency via Precision Operators for Bayesian Nonparametric Drift Estimation in SDEs

We study a Bayesian approach to nonparametric estimation of the periodic drift function of a one-dimensional diffusion from continuous-time data. Rewriting the likelihood in terms of local time of the process, and specifying a Gaussian prior with precision operator of differential form, we show that the posterior is also Gaussian with precision operator also of differential form. The resulting expressions are explicit and lead to algorithms which are readily implementable. Using new functional limit theorems for the local time of diffusions on the circle, we bound the rate at which the posterior contracts around the true drift function

GLB-scenario’s Noord-Nederland : In opdracht van de provincies Groningen, Fryslân en Drenthe

In welke mate zijn de akkerbouw- en melkveebedrijven in Noord-Nederland afhankelijk van de directe betalingen in het GLB en in welke mate zullen die betalingen bij verschillende scenario’s richting 2020 afnemen

Resultaat en financiering primaire landbouw

Dit hoofdstuk behandelt de resultaten van de sector land-en tuinbouw als geheel en van de verschillende typen land-en tuinbouwbedrijven