5 research outputs found
Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic
The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study
Background: Reconfiguration of trauma services, with direct transport of traumatic brain injury (TBI) patients to neuroscience centres (NCs), bypassing non-specialist acute hospitals (NSAHs), could potentially improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) and the difficulties in reliably identifying TBI at scene may make this practice deleterious compared with selective secondary transfer from nearest NSAH to NC. National Institute for Health and Care Excellence guidance and systematic reviews suggested equipoise and poor-quality evidence â with regard to âearly neurosurgeryâ in this cohort â which we sought to address. Methods: Pilot cluster randomised controlled trial of bypass to NC conducted in two ambulance services with the ambulance station (nâ=â74) as unit of cluster [Lancashire/Cumbria in the North West Ambulance Service (NWAS) and the North East Ambulance Service (NEAS)]. Adult patients with signs of isolated TBI [Glasgow Coma Scale (GCS) score ofââ0.05) in the 273 (159/113) patients with data available. There were no apparent differences in staff and patient preferences for either pathway, with satisfaction high with both. Very low responses to invitations to consent for follow-up in the large number of mild head injury-enrolled patients meant that only 20% of patients had 6-month outcomes. The trial-based economic evaluation could not focus on early neurosurgery because of these low numbers but instead investigated the comparative cost-effectiveness of bypass compared with selective secondary transfer for eligible patients at the scene of injury. Conclusions: Current NHS England practice of bypassing patients with suspected TBI to neuroscience centres gives overtriage ratios of 13â:â1 for neurosurgery and 4â:â1 for TBI. This important finding makes studying the impact of bypass to facilitate early neurosurgery not plausible using this study design. Future research should explore an efficient comparative effectiveness design for evaluating âearly neurosurgery through bypassâ and address the challenge of reliable TBI diagnosis at the scene of injury. Trial registration: Current Controlled Trials ISRCTN68087745. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 1. See the NIHR Journals Library website for further project information
Editoriale. CiĂČ che la Psicologia ci dice delle scienze del nostro tempo
This is the final version of the article. Available from the publisher via the DOI in this record.Background: Chronic musculoskeletal pain is a common problem that is difficult to treat.
Self-management support interventions may help people to manage this condition better; however, there
is limited evidence showing that they improve clinical outcomes. Our overarching research question was
âDoes a self-management support programme improve outcomes for people living with chronic
musculoskeletal pain?â.
Aim: To develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically
grounded self-management support intervention for people living with chronic musculoskeletal pain.
Methods: In phase 1 we carried out two systematic reviews to synthesise the evidence base for
self-management course content and delivery styles likely to help those with chronic pain. We also
considered the psychological theories that might underpin behaviour change and pain management
principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in
Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session
after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with
experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the
literature on potential outcome domains and measures and consulted widely with patients, tutors and
experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English
and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community.
In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of
adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain
toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and
musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire.
We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs,
health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression
Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by
participants were extracted from NHS electronic records.
Results: We recruited 703 participants with a mean age of 60 years (range 19â94 years); 81% were white
and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and
anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants
received 85% of the course content. At 12 months there was no difference between treatment groups in
our primary outcome of pain-related disability [difference â1.0 intervention vs. control, 95% confidence
interval (CI) â4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration
all improved more in the intervention group at 6 months. At 1 year these differences remained for
depression (â0.7, 95% CI â1.2 to â0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS
intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold
of ÂŁ30,000 per quality-adjusted life-year.
Conclusions: Although the COPERS intervention did not affect our primary outcome of pain-related
disability, it improved psychological well-being and is likely to be cost-effective according to current
National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a
substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective
interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed.The project was funded by the National Institute for Health Research Programme Grants for
Applied Research programme and will be published in full in Programme Grants for Applied Research;
Vol. 4, No. 14. See the NIHR Journals Library website for further project information