Protocol for a systematic review of preference-based instruments for measuring care-related outcomes and their suitability for the palliative care setting

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ INTRODUCTION: Despite informal caregivers' integral role in supporting people affected by disease or disability, economic evaluations often ignore the costs and benefits experienced by this group, especially in the palliative setting. The purpose of this systematic review is to identify preference-based instruments for measuring care-related outcomes and provide guidance on the selection of instrument in palliative care economic evaluations.METHODS AND ANALYSIS: A comprehensive search of the literature will be conducted from database inception (ASSIA; CINAHL; Cochrane library including DARE, NHS EED, HTA; Econlit; Embase; PsychINFO; PubMed). Published peer-reviewed, English-language articles reporting preference-based instruments for measuring care-related outcomes in any clinical area will be included. One researcher will complete the searches and screen the results for potentially eligible studies. A randomly selected subset of 10% citations will be independently screened by two researchers. Any disagreement will be resolved by consensus among the research team. Subsequently, a supplementary search will identify studies detailing the development, valuation, validation and application of the identified instruments. The degree of suitability of the instruments for palliative economic evaluations will be assessed using criteria in the International Society for Quality of Life Research minimum standards for patient-reported outcome measures, the checklist for reporting valuation studies of multiattribute utility-based instruments and information on the development of the instrument in the palliative setting. A narrative summary of the included studies and instruments will be provided; similarities and differences will be described and possible reasons for variations explored. Recommendations for practice on selection of instruments in palliative care economic analyses will be provided.ETHICS AND DISSEMINATION: This is a planned systematic review of published literature. Therefore, ethics approval to conduct this research is not required. Findings will be presented at leading palliative care and health economic conferences and published in a peer-reviewed journal.TRIAL REGISTRATION NUMBER: CRD42016034188

Regional Boundary Gradient Strategic Sensors Characterizations

The purpose of this paper is to characterize regional boundary gradient strategic sensors notions for different cases of regional boundary gradient observation to be achieved. Then, the characterizations based on how to a cross from internal gradient region to the boundary gradient region. Thus, the obtained results are applied in two dimensional linear infinite distributed systems in Hilbert space where the dynamics are governed by strongly continuous semi-group. Moreover, we give the relation between the regional gradient observability on a subregion  of the spatial domain  with the regional boundary gradient observability on a subregion  of the boundary  of . Finally, sufficient conditions of regional boundary gradient strategic sensors notions are explored, analyzed and discussed in connection with the regional boundary gradient of exact (weak) observability, positive definite observability operator and rank conditions

REGIONAL GRADIENT STRATEGIC SENSORS CHARACTERIZATIONS

In the present paper, the characterizations of regional gradient strategic sensors notions have been given for different cases of regional gradient observability. The results obtained are applied to two dimensional linear infinite distributed system in Hilbert space where the dynamic is governed by strongly continuous semi-group. Various cases of regional strategic sensors are considered and analyzed in connection with regional gradient strategic sensors concepts. Also, we show that there is a various sensors which are not gradient strategic in usual sense for the considered systems, but may be regionally gradient strategic of this system

Scoring the ICECAP-A capability instrument. Estimation of a UK general population tariff

This paper reports the results of a best–worst scaling (BWS) study to value the Investigating Choice Experiments Capability Measure for Adults (ICECAP-A), a new capability measure among adults, in a UK setting. A main effects plan plus its foldover was used to estimate weights for each of the four levels of all five attributes. The BWS study was administered to 413 randomly sampled individuals, together with sociodemographic and other questions. Scale-adjusted latent class analyses identified two preference and two (variance) scale classes. Ability to characterize preference and scale heterogene-ity was limited, but data quality was good, and the final model exhibited a high pseudo-r-squared. After adjusting for heterogeneity, a population tariff was estimated. This showed that ‘attachment ’ and ‘stability ’ each account for around 22 % of the space, and ‘autonomy’, ‘achievement ’ and ‘enjoyment ’ account for around 18 % each. Across all attributes, greater value was placed on the difference between the lowest levels of capability than between the highest. This tariff will enable ICECAP-A to be used in economic evaluation both within the field of health and across public policy generally. © 2013 The Authors. Health Economics published by John Wiley & Sons Ltd

Evaluation of Vascular Endothelial Growth Factor-A (VEGF-A) in Iraqi patients with urinary bladder cancer

Abstract:Objective: The aim of this work is to study the alterations in the vascular endothelial growth factor (VEGF-A), and its role in pathogenicity of bladder cancer in serum of men who are initially diagnosed with this disease.Methods: The current study was applied in pathology department of British United Kingdom kings college hospital during April 2112 to August 2113 by using Enzyme Linked Immuno Assay (ELISA) on serum taken from 42 men infected with bladder cancer , and other 33 benign considered as a control group to detect vascular endothelial growth factor type A (VEGF-A).Data analysis: SPSS computerizing system has been used for statistically analysis of data.Results: The results revealed a highly significant (P<1.15) level of VEGF-A in serum of patients in comparison with the control group.Conclusion:It was concluded from the results of the present study that VEGF-A was good prognostic biomarker for urinary bladder cancer in men ,and these results significantly correlate with the early stages of disease.Recommendation : It may be recommended that using VEGF-A to predict and diagnosis the bladder cancer.Key words:VEGF-A, bladder cancer

Ring Footing Bearing Capacity Erected on Dry Gypseous Soil

This study investigates the behavior of ring footing erected on gypseous soil and compares it with the circular footing, including conducting (24) experiments of loading ring footings, where the inner and external diameter ratio was (Din./Dout. = 0, 0.2, 0.3 and 0.4), resting on two types of Gypseous soil, for the circular footing the external diameter was (150mm) and thickness (15mm) made from solid steel. The results for study showed the ring footings were best than the circular footings. The ratio (Din./Dout. = 0.4) was beast for all ratios of (Df/D). Capacity of bearing increased when the ratio (Df/D) increase. Bearing capacity for high-gypsum content soil showed good results compared to the low-gypsum content soil. The first was high content of gypsum (63.42%) obtained from the Tikrit University, and the second was low content of gypsum (8.15%) from the Baiji area. The tests were doing inside box have dimensions (900×900×700 mm). The experiments were divided into twelve tests for dry gypsum soil condition with high gypsum content using density of (13.76 kN/m3), and twelve tests for dry soil with low gypsum content using density of (14.87 kN/m3). Experiments were conducted for different ratios (Df/D=0, 0.5, and 1)

Six mechanisms behind carer wellbeing effects: A qualitative study of healthcare delivery

YesHealth and care services for patients may improve or harm the wellbeing of their family carers. Formal consideration of these effects (also known as spillovers) in decision-making is advocated, but, to date, little is known about how they occur. This paper presents the first empirical study to determine the mechanisms by which health and care services affect family carers' wellbeing. The study focused on three major health conditions: dementia, stroke, and mental health. Focus groups and interviews were conducted with 49 purposefully sampled care professionals and family carers in the UK between December 2016 and September 2017. Transcripts were coded and analysed thematically, using descriptive accounts and an explanatory account. The analysis generated six over-arching mechanisms by which health and care services affect family carers' wellbeing, through: (i) information (degree to which service delivery informs and trains family carers); (ii) management of care (shifts of responsibility for care between formal and family sectors); (iii) patient outcomes (services changing patient outcomes); (iv) alienation (feelings of alienation or inclusion created by service delivery); (v) compliance (barriers to patients complying and engaging with services); and (vi) timing or location (changes in the timing or location of services). Each mechanism was associated with sub-themes relating to both positive and negative spillovers on the family carers. The six mechanisms can be summarised with the mnemonic ‘IMPACT’. The IMPACT mechanisms may be useful in designing and evaluating services to optimise the wellbeing of carers as well as patients.Hareth Al-Janabi is funded by a National Institute for Health Research (NIHR) Career Development Fellowship (CDF-2015-08-025) for this research project. Mel Calvert is partially funded by the NIHR Birmingham Biomedical Research Centre and the NIHR Surgical Reconstruction and Microbiology Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. This paper presents independent research funded by the National Institute for Health Research (NIHR)