The development of a preference based paediatric health related quality of life measure for use in economic evaluation.

Use of economic evaluation to aid decision making is widespread and has increased in the UK especially since the introduction of the National Institute for Health and Clinical Excellence (NICE). Cost utility analysis, a form of economic evaluation, allows comparison of interventions within and between disease areas by using outcome measures that combine length and quality of life into a single summary measure, conventionally the quality adjusted life year (QALY). Generic preference based health related quality of life (HRQoL) measures have been developed for adults for this purpose, but research in paediatric populations is more limited. A review of the literature of generic paediatric quality of life measures showed that no preference based measure existed which used children to develop the descriptive system. There was also very little methodological guidance on key issues in the development of new measures and no evidence was found on whether children share similar HRQoL frameworks across age. This thesis presents work which has developed a new preference based paediatric HRQoL measure designed for use in economic evaluation. The descriptive system was developed from interviews with over 70 children in order to determine what dimensions of HRQoL were included. These were then used as the basis for developing the descriptive system by undertaking further analysis and empirical fieldwork with children. This descriptive system was piloted with children with schools and hospital and the results used to refine the descriptive system to be suitable for valuation. Preference weights were obtained by valuing a sample of health states with the UK general population and then modelling to obtain values for all the health states defined by the descriptive system. The results demonstrated that it is feasible to value this descriptive system and the new measure is starting to be used in health care evaluation studies worldwide

Cost-effectiveness of structured education in children with type-1 diabetes mellitus

Objectives: Kids in Control OF Food (KICk-OFF) is a 5-day structured education program for 11- to 16-year-olds with type 1 diabetes mellitus (T1DM) who are using multiple daily insulin injections. This study evaluates the cost-effectiveness of the KICk-OFF education program compared with the usual care using data from the KICk-OFF trial. Methods: The short-term within-trial analysis covers the 2-year postintervention period. Data on glycated hemoglobin (HbA1c), severe hypoglycemia, and diabetic ketoacidosis (DKA) were collected over a 2-year follow-up period. Sub-group analyses have been defined on the basis of baseline HbA1c being below 7.5 percent (58.5 mmol/mol) (low group), between 7.5 percent and 9.5 percent (80.3 mmol/mol) (medium group), and over 9.5 percent (high group). The long-term cost-effectiveness evaluation has been conducted by using The Sheffield Type 1 Diabetes Policy Model, which is a patient-level simulation model on T1DM. It includes long-term microvascular (retinopathy, neuropathy, and nephropathy) and macrovascular (myocardial infarction, stroke, revascularization, and angina) diabetes-related complications and acute adverse events (severe hypoglycemia and DKA). Results: The most favorable within-trial scenario for the KICk-OFF arm led to an incremental cost-effectiveness ratio (ICER) of £23,688 (base year 2009) with a cost-effectiveness probability of 41.3 percent. Simulating the long-term complications using the full cohort data, the mean ICER for the base case was £28,813 (base year 2011) and the probability of the KICk-OFF intervention being cost-effective at £20,000/QALY threshold was 42.6 percent, with considerable variation due to treatment effect duration. For the high HbA1c sub-group, the KICk-OFF arm was “dominant” (meaning it provided better health gains at lower costs than usual care) over the usual care arm in each scenario considered. Conclusions: For the whole study population, the cost-effectiveness of KICk-OFF depends on the assumption for treatment effect duration. For the high baseline HbA1c sub-group, KICk-OFF arm was estimated to be dominant over the usual care arm regardless of the assumption on the treatment effect duration

Empowering junior doctors: a qualitative study of a QI programme in South West England

Aim To explore how the South-West Foundation Doctor Quality Improvement programme affected foundation year 1 (F1) doctors’ attitudes and ability to implement change in healthcare. Methods Twenty-two qualitative interviews were carried out with two cohorts of doctors. The first F1 group before and after their participation in the QI programme; the second group comprised those who had completed the programme between 1 and 5 years earlier. Qualitative data were analysed using thematic analysis techniques. Results Prior to taking part in the QI programme, junior doctors’ attitudes towards QI were mixed. Although there was agreement on the importance of QI in terms of patient safety, not all shared enthusiasm for engaging in QI, while some were sceptical that they could bring about any change. Following participation in the programme, attitudes towards QI and the ability to effect change were significantly transformed. Whether their projects were considered a success or not, all juniors reported that they valued the skills learnt and the overall experience they gained through carrying out QI projects. Participants reported feeling more empowered in their role as junior doctors, with several describing how they felt ‘listened to’ and able to ‘have a voice’, that they were beginning to see things ‘at systems level’ and learning to ‘engage more critically’ in their working environment. Conclusions Junior doctors are ideally placed to engage in QI. Training in QI at the start of their medical careers may enable a new generation of doctors to acquire the skills necessary to improve patient safety and quality of care

The Advantages and Disadvantages of Different Models of Organising Adult Safeguarding

Professionals express divergent views about whether adults at risk are best served by safeguarding work being incorporated into social workers’ casework or being undertaken by specialist workers within local area or centralised teams. This paper draws on findings from the final two phases of a three-phase study which aimed to identify a typology of different models of organising adult safeguarding and compare the advantages and disadvantages of these. We used mixed-methods to investigate four different models of organising adult safeguarding which we termed: A) Dispersed-Generic, B) Dispersed-Specialist, C) Partly-Centralised-Specialist and D) Fully-Centralised-Specialist. In each model, we analysed staff interviews (n = 38), staff survey responses (n = 206), feedback interviews (with care home managers, solicitors and Independent Mental Capacity Advocates) (n = 28), Abuse of Vulnerable Adults (AVA) Returns, Adult Social Care User Survey Returns (ASCS) and service costs. This paper focuses on qualitative data from staff and feedback interviews and the staff survey. Our findings focus on safeguarding as a specialism, safeguarding practice (including multi-agency working, prioritisation, tensions, handover, staff confidence and deskilling) and managing safeguarding. Local authority (LA) participants described and commented on the advantages and disadvantages of their organisational model. Feedback interviews offered different perspectives on safeguarding services and implications of different models

The environment power system analysis tool development program

The Environment Power System Analysis Tool (EPSAT) is being developed to provide space power system design engineers with an analysis tool for determining system performance of power systems in both naturally occurring and self-induced environments. The program is producing an easy to use computer aided engineering (CAE) tool general enough to provide a vehicle for technology transfer from space scientists and engineers to power system design engineers. The results of the project after two years of a three year development program are given. The EPSAT approach separates the CAE tool into three distinct functional units: a modern user interface to present information, a data dictionary interpreter to coordinate analysis; and a data base for storing system designs and results of analysis

Tell el-Amarna Site Management Plan 2020

The archaeological landscape of Egypt is rich in tombs and temples but offers little in the way of intelligible and easily accessible places where ancient Egyptians actually lived. In Tell el-Amarna (Amarna for short) we have the greater part of a major city: its public buildings, its housing neighbourhoods, the decorated tombs of its governing class and the cemeteries of the ordinary people. Having been occupied for only about twenty years it preserves unique evidence for how people lived in the past. As the creation of Pharaoh Akhenaten, it also serves as a powerful introduction to the individual and his ideas. Archaeologists have worked at Amarna for over a century. But the place needs more than their expert attentions. Like many sites around the world, Amarna is threatened by the effects of rapid modernisation and population growth. The Site Management Plan presented here seeks to anchor Amarna more firmly to the current development policies of the Egyptian government. These emphasise the importance of cooperation amongst the varied sectors of Egyptian society, both those of the government and those constituted by local communities. The Plan seeks to guide the decision-making of the future in the hope of securing Amarna as an educational resource for generations to come. The Plan itself has been an exercise in co-operation. We wish to thank all those who have assisted. They comprise the many officials of the Ministry of Tourism and Antiquities, in Cairo and in the inspectorates of El-Minya Province, local community leaders at Amarna and, not least, representatives of the local inhabitants including those of school age

A comparison of adolescent and adult health state values for the Child Health Utility-9D using profile case best worst scaling

The main objective of this study was to compare and contrast adolescent and adult values for the Child Health Utility-9D (CHU9D), a new generic preference based measure of health related quality of life designed for application in the economic evaluation of treatment and preventive programmes for children and adolescents. Previous studies have indicated that there may be systematic differences in adolescent and adult values for identical health states but have failed to use a common valuation technique. An on-line survey including a series of best worst scaling discrete choice experiment questions for health states defined by the CHU9D, was administered to two general population samples comprising adults and adolescents respectively. The results highlight potentially important age related differences in the values attached to CHU9D dimensions. Adults, in general, placed less weight upon impairments in mental health (worried, sad, annoyed) and more weight upon moderate to severe levels of pain relative to adolescents. The source of values (adults or adolescents) has important implications for economic evaluation and may impact significantly upon health care policy. Profile case best worst scaling offers a promising approach for the elicitation and comparison of health state values across population groups.Financial support from a Flinders University seeding grant and an Australian NHMRC Project Grant 1021899 entitled 'Adolescent values for the economic evaluation of adolescent health care treatment and preventive programs' is gratefully acknowledged