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Positioning strategy and ranking are critical issues in an increasingly competitive higher education landscape. Unless there is conceptual congruence between positioning strategies and rankings, the signals may become diffused and confusing for prospective students. This paper seeks the congruence between positioning strategies and ranking. Since without a validated typology of positioning strategies, such congruence cannot be sought, this paper firstly aims to develop an empirically derived typology of positioning strategies for HEIs. The population consists of HEIs in the UK. Content analysis was used to analyze the WebPages of HEIs to identify positioning bases, and congruence and contradictions between those positioning bases and ranking were identified by correspondence analysis. As a result, a new positioning typology consisting of eight bases, which are top of the range, campus life experience, internationalization, teaching excellence, research quality, graduates prospects, location, and value for money, was identified. In conclusion, HEIs are categorized into three different groups as Leaders and Challengers, Followers, and Nichers and Cost Leaders, and recommendations about how to guarantee congruence between positioning strategy and ranking were made. HEIs should choose positioning bases in line with their rankings since congruence strengthens the position in the minds.

This paper examines the potential earnings premium associated with a doctoral degree (PhDs, ISCED9) over postgraduate degrees (PGs, or Masters, ISCED7) in the UK. We assess this premium using a decade-worth of UK Labour Force Survey data (2011-2020). To explore the possible endogenous choice of post-graduate tracks, this paper deploys linear regression, (ordinary least squares, OLS), propensity score matching (PSM), and inverse probability weighting (IPWRA) to estimate the pay premium under varying identifying assumptions. The estimates show a positive return in terms of gross hourly pays in all models, along with a relevant role of managerial positions and degree of specialisation in employment position. Therefore, although a PhD is arguably mostly driven by taste for scientific pursuit, a PhD has on average also an economic pay-off. However, much of it depends on one's capacity to acquire leadership positions -- the most relevant factor disentangling those fulfilling or not their potential in terms of wages. We also provide a cost-benefit analysis over a life course showing that such a premium is overall modest, but subject to positive spikes for those in Science & Technology (STEM disciplines), getting managerial positions, and for women. Our findings suggest investigating further those personal and organisational factors that are conducive of unleashing highly educated potential.

This paper considers how teachers, psychologists and policymakers can respect the rights of all school students, through methods that are principled, humane, cost-effective and democratic. It examines how special educational needs and disability (SEND) services affect all school students and teachers, and their rights. The paper considers the history of rights, their meaning and purpose, and how and why they are important. Respect for rights can grow in several ways: in understanding the social and medical models of disability; in choices about SEND services; in educational psychology services; in the way 'normal' and 'special needs' students learn to live and work together, or else to live separate lives when it is then harder for disabled people to join in mainstream society as children and adults. The conclusion relates inclusive and special school policies to larger political concerns.

Purpose: Student welfare and wellbeing is crucial to successful postgraduate study, regardless of the global location in which the study is taking place, making it an international issue. This study sought to add to the conversations occurring globally on this topic, focusing particularly on exploring academic faculty participation in higher education postgraduate taught (PGT) student mentoring initiatives. Design/methodology/approach: By applying two theories, social exchange theory (SET) and equity theory (ET), faculty participation in postgraduate mentoring was explored and examined. A qualitative methodology, comprising 19 semi-structured interviews with faculty participating as mentors, was conducted. Data was analysed using template analysis, with SET and ET used to create thematic templates. Findings: The application of SET and ET enabled faculty participation to be understood in terms of the perceived equity, costs and rewards of mentoring. Costs can be significant, sometimes outweighing the benefits, thus endangering the viability and sustainability of the PGT mentoring initiative. Analysis suggested two distinct types of "mentor mindsets" exist, which influence the perception of investments, equity, costs and rewards. Originality/value: As higher education institutions face increasing pressure to support student welfare, it is imperative that personalised support is put under scrutiny so management practices can be established that support and encourage academic faculty participation in these support initiatives. This paper recommends how institutions can allay the costs of mentoring by considering mentor recruitment, selection, training and other supportive measures.

Background. Between 2015 and 2020, 1,578 care homes in the UK closed, displacing nearly 50,000 older and disabled people with very significant care and support needs. It is widely thought that relocation can have a significant impact on the health and well-being of older people. Yet, evidence is limited due to sensitivity and logistical difficulties with data collection. This study aimed to review the published literature in order to (i) identify evidence on the costs, consequences, and wider impacts of care home closures, for older people, family members, care home staff, and local authorities and (ii) understand the causes of and processes surrounding the closure of residential care homes in the UK. Methods. Eight electronic databases (Medline, Embase, Web of Science, Scopus, ASSIA, HMIC, AgeInfo, and SPP) were searched from 1st January 2000 to 9th February 2023; Google and Google Scholar were searched for guidance/policy documents from the grey literature. Data on the objectives, methods, and main results were extracted, and the findings were narratively reported. Results. Eighteen records, comprising guidance documents and academic publications (quantitative, qualitative, and mixed-method approaches), met the inclusion criteria. We found a lack of good quality evidence on costs of closure and no consideration of outcomes for staff. Studies reporting on outcomes for residents suggest there may not be any long-term adverse effects on their health, in contrast to often-expressed views that care home closures result in harm. Conclusion. Future research should consider the stress and anxiety experienced by staff and families as relevant outcomes and show caution with respect to the use of proxy reporting of resident health outcomes. Given that a sizable portion of the costs associated with care home closure falls on local authorities, an evidence-based approach to closures that includes an assessment of cost-effectiveness will help to improve future outcomes and guide the most efficient use of limited public resources. [ABSTRACT FROM AUTHOR]

It is clear from the literature that feedback is potentially the most powerful and potent part of the assessment cycle when it comes to improving further student learning. However, for some time, there has been a growing amount of research evidence that much feedback practice does not fulfil this potential to influence future student learning because it fails in a host of different ways. This dilemma of the disjuncture between theory and practice has been increasingly highlighted by the UK National Student Survey results. This paper uses a model of the assessment process cycle to frame understandings drawn from the literature, and argues that the problem with much current practice resides largely in a failure to effectively engage students with feedback. The paper goes on to explore how best to effectively engage students with assessment feedback, with evidenced examples of feedback strategies that have successfully overcome this problem.

The paper introduces the "UK Open Textbooks" project and discusses its success factors with regards to promoting open practice and open pedagogy. Textbooks remain a core part of educational provision in science. Open Textbooks are openly licensed academic textbooks, wherein the digital version is available freely, and the print version at reduced cost. They are a form of Open Educational Resource (OER). In recent years a number of openly-licensed textbooks have demonstrated high impact in countries including the USA, Canada and South Africa. The "UK Open Textbooks" project piloted several established approaches to the use and promotion open textbooks (focusing on STEM subjects) in a UK context between 2017 and 2018. The project had two main aims: to promote the adoption of open textbooks in the UK; and to investigate the transferability of the successful models of adoption that have emerged in North America. Through a number of workshops at a range of higher education institutions and targeted promotion at specific education conferences, the project successfully raised the profile of open textbooks within the UK. Several case studies report existing examples of open textbook use in UK science were recorded. There was considerable interest and appetite for open textbooks amongst UK academics. This was partly related to cost savings for students, but more significant factors were the freedom to adapt and develop textbooks and OER. This is consistent with a range of research that has taken place in other countries and suggests the potential for impact on UK science education is high.

Graduation rates in distance higher education are low compared with full-time higher education--often less than 20% compared with full-time UK rates of around 80%--the "distance education deficit". In the University of London International Programmes, the difference between the face-to-face graduation rate of 61.5% and the distance version at 15.7% is particularly marked. A previous paper in "Open Learning" reported evidence that "proactive motivational support" to distance students had some effect on their success rates. This paper reports an attempt in the International Programmes to use proactive motivational support in the form of "motivational emails" which found an increase in retention of 2.3%. Although this increase was small, it had a positive financial return on investment to the institution. The paper suggests that motivational emails could be made more effective through the use of interactivity, nudging and priming. However, it also argues that distance student retention will always depend less on technology and more on personal human support.

Nuclear energy produces low carbon, safe and reliable electricity so is it now time for the UK to invest in this proven technology or are the misplaced perceptions regarding its safety, cost and the quantities of radioactive waste produced causing us to overlook nuclear as a major component of our electricity mix? This paper discusses these issues and whether the negative opinion of nuclear energy which could hold back it's wider development in the UK, is justified in the 21st century. For the safe, secure and economic future of electricity can we afford to ignore the positive contributions nuclear energy can make any longer?

Quantifying the market size for cannabis is important given vigorous policy debates about how to intervene in this market. We develop a new approach to measuring the size of the cannabis market using forensic economics. The key insight is that cannabis consumption often requires the use of complementary legal inputs: roll‐your‐own tobacco and rolling papers. The forensic approach specifies how legal and illegal inputs are combined in the production of hand‐rolled cigarettes and cannabis joints. These input relationships, along with market adding‐up conditions, can be used to infer the size of the cannabis market. We provide proof‐of‐concept that this approach can be readily calibrated using: (i) point‐of‐sale data on legal inputs of roll‐your‐own tobacco and rolling papers; (ii) input parameter estimates drawn from a wide‐ranging interdisciplinary evidence base. We implement the approach using data from 2008–9. For those years, the forensic estimates for the UK cannabis market are near double those derived from standard demand‐side approaches. We make precise what drives the measurement gap between methods by establishing the adjustments needed to match estimates from alternative approaches. Our analysis develops an agenda on measurement and data collection that allows for credible cost–benefit analysis of policy interventions in illicit drug markets. [ABSTRACT FROM AUTHOR]

Historically, consent for treatment in the United Kingdom's National Health Service has been collected using traditional paper forms. For public health services, such as immunizations, this process involved significant time, space, paper, and staff resources. In a bid to provide a more modern, secure, cost‐effective and paperless service, an electronic consent (eConsent) form for the routine school aged immunization program was designed and successfully piloted for the HPV 1 vaccine in 25 schools during the summer of 2019, with an average of 80% return rate. This was not only significantly higher than paper consent returns, there was also a significantly quicker return rate. These factors resulted in the clinical record being updated more quickly than ever before which reduced clinical risk. Following the pilot, the program was launched countywide for all school aged immunizations in September 2020. Since its launch some minor issues have been identified but resolved quickly and efficiently. Although still in its early days it is felt that the eConsent system has promoted a more informed and easier collaboration across sectors and has reduced operating costs. Although the use of electronic consent needs to be used more widely, it is felt that this new practice is a success. [ABSTRACT FROM AUTHOR]

Introduction: Major trauma centre (MTC) care has been associated with improved outcomes for injured patients. English ambulance services and trauma networks currently use a range of triage tools to select patients for bypass to MTCs. A standardised national triage tool may improve triage accuracy, cost-effectiveness and the reproducibility of decision-making. Methods: We conducted an expert consensus process to derive and develop a major trauma triage tool for use in English trauma networks. A web-based Delphi survey was conducted to identify and confirm candidate triage tool predictors of major trauma. Facilitated roundtable consensus meetings were convened to confirm the proposed triage tool’s purpose, target diagnostic threshold, scope, intended population and structure, as well as the individual triage tool predictors and cut points. Public and patient involvement (PPI) focus groups were held to ensure triage tool acceptability to service users. Results: The Delphi survey reached consensus on nine triage variables in two domains, from 109 candidate variables after three rounds. Following a review of the relevant evidence during the consensus meetings, iterative rounds of discussion achieved consensus on the following aspects of the triage tool: reference standard, scope, target diagnostic accuracy and intended population. A three-step tool comprising physiology, anatomical injury and clinical judgement domains, with triage variables assessed in parallel, was recommended. The triage tool was received favourably by PPI focus groups. Conclusions: This paper presents a new expert consensus derived major trauma triage tool with defined purpose, scope, intended population, structure, constituent variables, variable definitions and thresholds. Prospective evaluation is required to determine clinical and cost-effectiveness, acceptability and usability. [ABSTRACT FROM AUTHOR]

In the UK, the Royal Aeronautical Society recommends the inclusion of practical flight exercises for accredited undergraduate aerospace engineering programmes to enhance learning and student experience. The majority of academic institutions teaching aerospace in the UK separate the theory and practice of flight dynamics with students attending a series of lectures supplemented by an intensive one-day flight exercise. Performance and/or handling qualities flight tests are performed in a dedicated aircraft fitted with specialist equipment for the recording and presentation of flight data. This paper describes an innovative approach to better integrate theory and practice and the use of portable Commercial-Off-The-Shelf (COTS) technologies to enable a range of standard, unmodified aircraft to be used. The integration of theory and practice has enriched learning and teaching, improved coursework grades and the student experience. The use of COTS and unmodified aircraft has reduced costs and enabled increased student participation.

Background: Telehealth for paediatric speech and language therapy became one of the most salient modes of service delivery during the COVID‐19 pandemic. Evidence for speech and language therapy services via telehealth in comparison to face‐to‐face delivery demonstrates promising outcomes, and studies have begun to explore practitioner and client experiences. However, across the literature, many critical elements of services are overlooked, and there is a need to frame the evidence base within a theoretical model that can draw out practical implications that consider the range of factors having an impact on clinical implementation in real‐world contexts. The APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria offer such a model. The current study explored practising UK speech and language therapists' (SLTs) clinical experience of telehealth through the lens of the APEASE criteria and aimed to identify recommendations for future service provision from the practitioner perspective. Methods: An online survey structured using the APEASE criteria was developed in collaboration with the UK Royal College of Speech and Language Therapists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using reflexive thematic analysis. Results: Four hundred and thirty‐eight qualified and practicing UK paediatric SLTs completed the survey. Telehealth was broadly acceptable and practicable to SLTs yet there remains some uncertainty about its efficacy and cost‐effectiveness compared to face‐to‐face interventions and how equitable it is for different population groups. SLTs reported that effective implementation of telehealth services was dependent upon several contextual factors; affordability was a perceived barrier to clients having access to telehealth resources, intervention via telehealth was perceived as more acceptable than assessment, and whilst many SLTs welcomed aspects of telehealth, there were concerns about the physical and mental health consequences for practitioners. Six themes for the future development of telehealth in paediatric speech and language therapy were identified: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. Conclusions: Outcomes highlight promising, concerning and uncertain aspects of telehealth in paediatric speech and language therapy. SLTs value a flexible and tailored approach to service delivery and recommend that effective leadership, clear communication, ongoing policy and guidance development, upskilling of users and careful evaluation of impact are required to ensure optimal implementation. The APEASE criteria offer a valuable opportunity to enhance and streamline practice and research to ensure sustainable implementation of telehealth in the paediatric speech and language therapy services of tomorrow. WHAT THIS PAPER ADDS: What is already known on this subject: The COVID‐19 pandemic led to the increased use of telehealth as a main mode of service delivery in paediatric speech and language therapy. Pre‐COVID‐19, evidence for the use of telehealth in this field included small‐scale experimental studies that reported on children with particular disorders and explored telehealth outcomes in comparison to face‐to‐face delivery. The realities of at‐scale clinical practice were not well‐represented, and critical elements of service such as cost‐effectiveness were often overlooked in the paediatric literature. Furthermore, despite emerging global evidence for temporary telehealth responses to the crisis in speech and language therapy, the long‐term and future use of telehealth remains unclear. What this paper adds to existing knowledge: The current study applied the lens of the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side‐effects, and Equity) criteria, which were used in this case to consider socioeconomic, ecological and cultural factors to capture an overarching understanding of the use of telehealth in paediatric speech and language therapy, and to inform the role of telehealth in future, longer‐term and at‐scale service development. Results indicated emerging trends in UK paediatric speech and language therapists' (SLTs') perceptions of telehealth and SLTs perceived a hybrid approach to service delivery, combining mostly face‐to‐face services with some telehealth, was likely to continue in the future. We identified six themes to guide the future development of telehealth in paediatric speech and language therapy services: (1) balanced and tailored services; (2) technology and equipment; (3) information and communication; (4) capacity building; (5) monitoring and evaluation; and (6) leadership and governance. What are the potential or actual clinical implications of this work?: UK SLTs believe that speech and language therapy services using telehealth should be reflective, tailored and flexible to meet the requirements and circumstances of the children, young people and families served, as well as the physical and emotional needs of practitioners. SLTs recommend that this service development is clearly communicated to all stakeholders and suggested that those using telehealth should be supported through appropriate training, and ongoing effectiveness should be monitored. Telehealth is here to stay and the APEASE criteria offer a unique opportunity to ensure sustainable models of service delivery; to support co‐ordinated leadership at the local, national and international levels and the development of policy and clinical guidance. [ABSTRACT FROM AUTHOR]

Aims: Previous cost‐effectiveness analysis suggests that CardioMEMS is cost‐effective compared with usual care for patients with persistent New York Heart Association class III symptoms and at least one heart failure (HF) hospitalization within 12 months. The aim of the paper is to perform an update of the cost‐effectiveness analysis of CardioMEMS using the most recent data from the published literature. Methods and results: A Microsoft Excel Markov model from a previous UK cost‐effectiveness study of CardioMEMS was updated using the clinical effectiveness of pulmonary artery pressure (PAP)‐guided treatment derived from the pivotal trials. The model included the device costs (and the implantation procedure and related complications), costs of remote monitoring, costs of HF‐related hospitalizations, and costs of usual care. Quality‐adjusted life years (QALYs) were estimated based on utilities from pivotal trials and published literature. Cost‐effectiveness results were estimated as incremental cost per QALY gained of CardioMEMS compared with usual care. Scenario analyses were also performed using data from real‐world studies that showed a significant decrease in HF‐related hospitalizations. In the base case analysis over a time horizon of 10 years, PAP‐guided HF therapy increased cost compared with usual care by £6337 (i.e. from £22 770 in usual care to £29 107 in PAP‐guided HF therapy) and the QALYs per patient for usual care and PAP‐guided patients were 2.62 and 2.94, respectively, reflecting an increase of 0.32 QALYs with PAP‐guided treatment. The resultant incremental cost‐effectiveness ratio (ICER), the ratio between incremental costs and the QALYs, is estimated at £19 761/QALY. Scenario analyses suggest that the ICER for CardioMEMS can range from being dominant to £27 910/QALY. Probabilistic sensitivity analyses suggested that PAP‐guided HF therapy has 81.9% probability of being cost‐effective at a threshold of £30 000/QALY. Conclusions: Our model suggests that CardioMEMS is likely to be cost‐effective in the United Kingdom, at the currently considered thresholds of £20 000–30 000/QALY. [ABSTRACT FROM AUTHOR]

Background: Influenza (flu) vaccination rates in UK care home staff are extremely low. Less than 40% of staff in care homes are vaccinated for influenza (flu), presenting risks to the health of frail residents and potential staff absence from cross-infection. Staff often do not perceive a need for vaccination and are unaware they are entitled to free flu vaccination. The FluCare study, a cluster randomised control trial (RCT), uses behavioural interventions to address barriers. Videos, posters, and leaflets are intended to raise awareness of flu vaccination benefits and debunk myths. On-site staff vaccination clinics increase accessibility. Financial incentives to care homes for improved vaccination rates and regular monitoring influence the environment. This paper outlines the planned process evaluation which will describe the intervention's mechanisms of action, explain any changes in outcomes, identify local adaptations, and inform design of the implementation phase. Methods/design: A mixed method process evaluation to inform the interpretation of trial findings. Objectives: • Describe the intervention as delivered in terms of dose and fidelity, including adaptations and variations across care homes. • Explore the effects of individual intervention components on primary outcomes. • Investigate the mechanisms of impact. • Describe the perceived effectiveness of relevant intervention components (including videos, leaflets, posters, and flu clinics) from participant perspectives (care home manager, care home staff, flu clinic providers). • Describe the characteristics of care homes and participants to assess reach. A purposive sample of twenty care homes (ten in the intervention arm, ten in the control arm) for inclusion in the process evaluation. Data will include (1) study records including care home site profiles, (2) responses to a mechanism of action questionnaire, and (3) semi-structured interviews with care home staff and clinic providers. Quantitative data will be descriptively reported. Interview data will be thematically analysed and then categories mapped to the Theoretical Domains Framework. Discussion: Adopting this systematic and comprehensive process evaluation approach will help ensure data is captured on all aspects of the trial, enabling a full understanding of the intervention implementation and RCT findings. Trial registration: ISRCTN ISRCTN22729870. Registered on 24 August 2022. [ABSTRACT FROM AUTHOR]

A systematic literature review (SLR) of economic evaluations (EE) conducted for interventions to screen, treat, and manage retinopathy of prematurity (ROP) in the United States (US), United Kingdom (UK), and Canada was performed. The SLR accessed the MEDLINE, Embase, Cochrane, Web of Science, Health Business Elite, Econ. Lit, NHS EED, and Google Scholar databases over the period 1st January 2000 to 4th August 2021. The key Medical Subject Heading (MeSH) search terms used included: Retinopathy of prematurity, Cost-effectiveness analysis, Cost-utility analysis, Cost of illness, Cost-benefit analysis, Cost minimization analysis, Incremental cost-effectiveness ratio, Quality adjusted life years, return on investment, burden of illness, disability adjusted life years, and Economic evaluation. Screening was conducted using Covidence, and the risk of bias was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Data extraction was performed using MS Excel. 1,527 articles were examined with nine (9) papers identified, one (1) from the UK; two (2) from Canada and six (6) from the US. Cost-effectiveness analysis was the main form of EE conducted (n = 5) and telemedicine screening (n = 3) was found to be highly cost-effective for ROP with the ICER values ranging from £446 to £4,240 per Quality Adjusted Life Year (QALY) in 2021 figures. 73% of included studies complied with the CHEERS checklist for EE. ROP screening and treatment strategies reviewed were highly cost-effective. This review may assist eye health policymakers in planning nationwide screening and treatment programs to combat vision loss and blindness due to ROP. [ABSTRACT FROM AUTHOR]

Trade-disseminated Phytophthora species are implicated in a recent upsurge of Phytophthora diseases in the UK and the establishment and spread of these pathogens in the wider UK environment via diseased propagation material. The costs and benefits of introducing best practices in the nursery sector and for society at large were explored in relation to avoiding potential impacts of introductions of new pathogens in the wider woodland environment. The analysis formed part of a wider project on the drivers of introduction and spread of Phytophthora species and opportunities for mitigation by plant nurseries. The effect in reducing the risk of introductions of new pathogens is not easily quantified, but the shorter the interval between avoided outbreaks, the greater the benefit of introducing best practices. The maximum interval between avoided outbreaks for the benefits to exceed the costs from a nursery perspective can be estimated. The results indicate that the benefits of introducing nursery best practices are unlikely to outweigh the costs from a nursery perspective where Phytophthora alone is considered. The analysis is extended by also considering benefits in reducing risks of Xylella. Scenario analysis based upon modelling harvested wood and carbon impacts is then used to investigate potential costs that would be expected to be borne by society in the event of the introduction and spread of a new Phytophthora species affecting either oak or Sitka spruce stands in Britain. The results indicate the magnitude of the externality involved, with the cost of an outbreak affecting oak estimated at around £500 million and one affecting Sitka spruce at £11 300 million. While approaches taken in the paper are exploratory, there seems a strong case for some social incentives or control in the nursery sector, to reduce the probability of new diseases infecting British forests. [ABSTRACT FROM AUTHOR]

This paper analyses the costs and benefits of lockdown policies in the face of COVID-19. What matters for people is the quality and length of lives and one should measure costs and benefits in terms of those things. That raises difficulties in measurement, particularly in valuing potential lives saved. We draw upon guidelines used in the UK for public health decisions, as well as other measures, which allow a comparison between health effects and other economic effects. We look at evidence on the effectiveness of past severe restrictions applied in European countries, focusing on the evidence from the UK. The paper considers policy options for the degree to which restrictions are eased. There is a need to normalise how we view COVID because its costs and risks are comparable to other health problems (such as cancer, heart problems, diabetes) where governments have made resource decisions for decades. The lockdown is a public health policy and we have valued its impact using the tools that guide health care decisions in the UK public health system. The evidence suggests that the costs of continuing severe restrictions in the UK are large relative to likely benefits so that a substantial easing in general restrictions in favour of more targeted measures is warranted. [ABSTRACT FROM AUTHOR]

Purpose: Loneliness and social isolation can occur at all stages of the life course and are recognized as a global health priority. The aim of this study was to review existing literature on the economic costs associated with loneliness and social isolation as well as evidence on the cost-effectiveness of interventions to prevent or address loneliness and social isolation.Methods: A bibliographic database search was undertaken in Medline, PsycINFO, CINAHL, and Embase, supplemented by a grey literature search and a reference list search. Papers were included that were published in English language in peer-reviewed literature in the past 10 years, reporting costs of loneliness and/or social isolation or economic evaluations of interventions whose primary purpose is to reduce loneliness and/or social isolation, including return on investment (ROI) or social return on investment (SROI) studies.Results: In total, 12 papers were included in this review, consisting of four cost-of-illness studies, seven economic evaluations and five ROI or SROI studies. Most studies were conducted in the UK and focused on older adults. Due to the inconsistent use of the terms loneliness and social isolation, as well as their measurement, the true economic burden can only be estimated to a certain extent and the comparability across economic evaluations and ROI studies is limited.Conclusions: The paucity of evidence that is available primarily evaluating the economic costs of loneliness indicates that more research is needed to assess the economic burden and identify cost-effective interventions to prevent or address loneliness and social isolation. [ABSTRACT FROM AUTHOR]

Background: The E-Freeze trial is a multi-centre randomised controlled trial of fresh versus frozen embryo transfer for women undergoing in vitro fertilisation. This paper describes the statistical analysis plan for the E-Freeze trial.Methods and Design: E-Freeze is a two-arm parallel-group, multi-centre, individually randomised controlled trial to determine if a policy of freezing embryos, followed by thawed frozen embryo transfer, results in a higher healthy baby rate when compared with the current policy of transferring fresh embryos. Couples undergoing their first, second or third cycle of in vitro fertilisation at fertility centres in the UK were randomised to either fresh or frozen embryo transfer. The primary outcome is a healthy baby, defined as a live singleton baby born at term with an appropriate weight for gestation. This paper describes the statistical analysis plan for the trial, including the analysis principles, definitions of outcomes, methods for primary analysis, pre-specified subgroup analysis and sensitivity analysis. This plan was finalised prior to completion of recruitment to the trial.Trial Registration: ISRCTN registry: ISRCTN61225414 . Registered on 29 December 2015. [ABSTRACT FROM AUTHOR]

Currently in the UK and Ireland, after a hip fracture most patients do not receive bone protection medication to reduce the risk of refracture. Yet randomised controlled trial data specifically examining patients with hip fracture have shown that intravenous zoledronate reduces refracture risk by a third. Despite this evidence, use of intravenous zoledronate is highly variable following a hip fracture; many hospitals are providing this treatment, whilst most are currently not. A range of clinical uncertainties, doubts over the evidence base and practical concerns are cited as reasons. This paper discusses these concerns and provides guidance from expert consensus, aiming to assist orthogeriatricians, pharmacists and health services managers establish local protocols to deliver this highly clinically and cost-effective treatment to patients before they leave hospital, in order to reduce costly re-fractures in this frail population. [ABSTRACT FROM AUTHOR]

Integrated working can be a means of providing efficient and cost-effective care, which benefits both service users and health professionals. However, it does require readiness of practitioners to work in new and innovative ways to achieve integration. This paper describes the findings of a qualitative study exploring the nature of practice-based education and training underpinning successful integrated care teams using an ecological systems theory lens. Nine teams in the West Midlands region of the United Kingdom (UK) participated in this study. A total of 27 participants were involved in semi-structured interviews during which they shared their views and experiences of learning in practice. Thematic analysis of interview transcripts highlighted the shifting context of working in integrated teams impacting on learning, the influence of leadership on education and training, the nature of in-service training, and the knowledge-sharing culture. The findings highlight that the learning climate is highly dependent on the leadership ethos in the practice context, which influences the allocation of time and resources for training and clinical supervision. Whilst formal education and training has an important role to play in fostering integrated working, informal learning is pivotal to successful integration and potentially has greater impact making it worthy of further study. [ABSTRACT FROM AUTHOR]

Background: Up to 20% of UK children experience socio-emotional difficulties which can have serious implications for themselves, their families and society. Stark socioeconomic and ethnic inequalities in children's well-being exist. Supporting parents to develop effective parenting skills is an important preventive strategy in reducing inequalities. Parenting interventions have been developed, which aim to reduce the severity and impact of these difficulties. However, most parenting interventions in the UK focus on early childhood (0-10 years) and often fail to engage families from ethnic minority groups and those living in poverty. Strengthening Families, Strengthening Communities (SFSC) is a parenting programme designed by the Race Equality Foundation, which aims to address this gap. Evidence from preliminary studies is encouraging, but no randomised controlled trials have been undertaken so far.Methods/design: The TOGETHER study is a multi-centre, waiting list controlled, randomised trial, which aims to test the effectiveness of SFSC in families with children aged 3-18 across seven urban areas in England with ethnically and socially diverse populations. The primary outcome is parental mental well-being (assessed by the Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes include child socio-emotional well-being, parenting practices, family relationships, self-efficacy, quality of life, and community engagement. Outcomes are assessed at baseline, post intervention, three- and six-months post intervention. Cost effectiveness will be estimated using a cost-utility analysis and cost-consequences analysis. The study is conducted in two stages. Stage 1 comprised a 6-month internal pilot to determine the feasibility of the trial. A set of progression criteria were developed to determine whether the stage 2 main trial should proceed. An embedded process evaluation will assess the fidelity and acceptability of the intervention.Discussion: In this paper we provide details of the study protocol for this trial. We also describe challenges to implementing the protocol and how these were addressed. Once completed, if beneficial effects on both parental and child outcomes are found, the impact, both immediate and longer term, are potentially significant. As the intervention focuses on supporting families living in poverty and those from minority ethnic communities, the intervention should also ultimately have a beneficial impact on reducing health inequalities.Trial Registration: Prospectively registered Randomised Controlled Trial ISRCTN15194500 . [ABSTRACT FROM AUTHOR]

Cost effectiveness of different visual screening modalities cannot be calculated without long-term outcome data. This paper reports detailed outcomes from a gold-standard UK recommended orthoptist-delivered screening (ODS) at 4–5 years in school, compared to a neighboring school-nurse delivered screening (SNDS), both feeding into the same treatment pathway. The target condition was reduced visual acuity (VA) of worse than logMAR 0.2 in either eye. Available records from screening databases and hospital records were analyzed, comparing the two services wherever possible. More screening data was available from the ODS. ODS: 5706 screened, 3.5% referred. False positives 6.5%, PPV 91.4%, sensitivity 97.9%, and specificity 99.8% for reduced VA. Cost per child with reduced vision detected £195.22, and per amblyope detected £683.28. The mean treatment cost per child with reduced VA was £331.68 and for amblyopia treatment was £458.65. SNDS: 5630 screened and 3.8% referred (plus some referrals to local optometrists lost to follow up). False positives 34%, PPV 53.2%, sensitivity and specificity estimated as 89.3% and 98.67%. Costs to secondary services of false positives were seven times greater. The cost per child with confirmed reduced vision seen at the hospital was 46% more; and per amblyope detected was 39% more. Outcomes for treatment post referral in both groups were similar and excellent. 86% of genuine referrals improved to within normal limits with glasses alone. Of 221 genuine referrals with final outcome data, all now have better than 0.2logMAR acuity in the better eye and only two (0.9%) have residual amblyopia in one eye worse than 0.4logMAR. About 14–18% of children with reduced VA would have passed AAPOS photoscreening referral criteria. An orthoptist-delivered single VA screen at 4–5 years is highly cost effective with good outcomes. The main contributing factors to success appear to be training and experience in accurate VA testing, the opportunity to rescreen equivocal results, and monitoring, audit, and feedback of outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Several forces are contributing to an increase in the number of people living with and surviving colorectal cancer (CRC). However, due to the lack of available data, little is known about the implications of these forces. In recent years, the use of administrative records to inform research has been increasing. The aim of this paper is to investigate the potential contribution that administrative data could have on the health economic research of CRC. Methods: To achieve this aim, we conducted a systematic review of the health economic CRC literature published in the United Kingdom and Europe within the last decade (2009–2019). Results: Thirty‐seven relevant studies were identified and divided into economic evaluations, cost of illness studies and cost consequence analyses. Conclusions: The use of administrative data, including cancer registry, screening and hospital records, within the health economic research of CRC is commonplace. However, we found that this data often come from regional databases, which reduces the generalisability of results. Further, administrative data appear less able to contribute towards understanding the wider and indirect costs associated with the disease. We explore several ways in which various sources of administrative data could enhance future research in this area. [ABSTRACT FROM AUTHOR]

The most widespread approach to transport appraisal is to combine cost-benefit analysis (CBA) with environmental assessments and public consultations. However, large-scale transport projects such as the HS2 high-speed rail system in the UK seem to have pushed this approach beyond its limits, leading to broad discontent with the appraisal process. There is a need both to develop new methods capable of integrating a wide range of perspectives in a systematic manner and to test these for large-scale projects. Multicriteria analysis (MCA) has proven useful in supporting transport decision-making by including a broader set of criteria in the appraisal process. Multiactor multicriteria analysis (MAMCA) has extended this approach to include multiple actors and stakeholders in the judgment and decision-making process. This paper builds on the MAMCA method and demonstrates its practicability and usability by applying it to the case of HS2. The purpose of this paper is not to reach a definitive conclusion on the desirability of various project options, but to complement existing transport appraisal methods by making different perspectives explicit. For example, the results for this case show contrasting views for different groups of transport professionals: a favorable assessment of HS2 among transport planners employed in government, but an unfavorable assessment among transport researchers with a background in sustainability. In terms of contribution to the development of data collection methods, this research demonstrates the usefulness of conducting semistructured interviews in conjunction with an online questionnaire for the assessment and weighting process within MCA. Because MCA results are expressed in terms of relative desirability of projects, the approach also effectively systematizes the inclusion and assessment of multiple options. Overall, the proposed method enhances the capacity to analyze conflicting views in large-scale transport project appraisal processes. [ABSTRACT FROM AUTHOR]

This article provides an analysis of the economic cost incurred by the world through the use of the fiat international reserve currency since the end of the 1971 gold standard system. The article uses the Quantity Theory of Money to provide an empirical manifestation of how reserve currency yields income to its issuing country through the provision of an inflation buffer, which is equivalent to what the article frames as an imperial rent of reserve currency. The article then provides a method to estimate the cumulative quantity of this rent by using data on the broad money supply, nominal GDP, and world total official foreign exchange holdings of the currency of the country in question. The article estimates that the quantity of the imperial rent of reserve currency that accrued to the four major reserve currency-issuing states (US, Euro area, UK, Japan) from the end of the gold standard until the end of 2021, which was accumulated through the official channel only, is of a value equivalent to 11.1 trillion USD, 71 % of this amount went to the US singly. [ABSTRACT FROM AUTHOR]

Substantial effort has been applied to researching government initiatives aimed at increasing efficiency and cost effectiveness within the U.K. healthcare system, particularly in terms of medical practice. However, little attention has been paid to the impact of these on the boundaries of authority within the setting of hospital pharmacies. This paper utilizes the sociology of the professions to analyze and report on hospital pharmacist prescribing in Scotland. The findings indicate a reduction in the authority of the medical profession and that medical practice can be subjected to rationalization in the same way as other occupations, which is of sociological importance. [ABSTRACT FROM AUTHOR]

Background: Infectious diseases prevention has been highly documented and applied. In the current article we analyse the intervention on chlamydia screening from a policy perspective. The National Chlamydia Screening Programme (NCSP) that was launched in the United Kingdom in 2003 serves as an example. Objectives: This on-desk research aims to critically analyse the Chlamydia Screening Policy in the UK to point out strength and weaknesses, and to draw recommendations for improvements. Methodology: To analyse the screening policy a selective and structured on-desk research was conducted. Systematic reviews, evaluation papers and official documents of main executive agencies as the Public Health England from the years 2000 to 2019 were included. Data were analysed by the Health Policy Triangle framework. Results: The NCSP is an opportunistic screening programme and aims to prevent transmission, to control and to early detect the chlamydia infections in the age group of 15 to 24-year-old sexually active people. Factors that lead to the implementation were mainly politically driven, rather than based on a sophisticated analysis of subpopulations in need and a cost-effectiveness analysis. Strengths are the local embedment in primary health care which provides a low threshold approach for those in need and clear guidance for health professionals. Evaluation however is executed mainly internal and monitors more than it critically evaluates the programme on a multidimensional level. Conclusion: Analysing the NCSP reveals lack of evidence in opportunistic screening of Chlamydia overall and the need of deeper research in terms of cost-effectiveness. A relaunch of the programme with a special focus on sub-population, the expansion of digital services and a multidimensional approach of prevention is required to legitimate the programme (e.g. Antibiotic Resistance, limited resources). [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to draw attention to commissioning and service structures enabling implementation of evidence-based cost-effective care as illustrated by the “1419” young people’s service treating mild to moderate severity mental health difficulties in teenagers old 14 to 19 years. The authors describe relevant local contextual factors: “relational commissioning”, demand capacity planning and a receptive and safe clinical context. Design/methodology/approach – The authors used a participant observer qualitative research design to describe commissioning and service design. Treatment outcomes were analysed using a quantitative design and found significant improvement in service user mental health and daily function. These results will be reported elsewhere. Findings – The dynamics and structures described here enabled clear shared goals between service user, service purchaser, service provider and service partners. The goals and design of the service were not static and were subject to ongoing development using routine outcome measures and conversations between referrers, commissioners, service users and within the team about what was and was not working. Research limitations/implications – The methods are limited by the lack of a prospective systematic evaluation of the implementation process and by the time limitations of the service. Practical implications – Implementation of whole system change such as that envisioned by Children and Young People’s Improving Access to Psychological Therapies requires consideration of local context and process of implementation. The authors suggest key factors: consideration of “relational commissioning” with purchasers, providers and service users designing services together; case-level collaboration between services and partner agencies; smaller child and adolescent mental health teams eliminating competing task demands, permitting speed of action, providing psychological safety for staff, promoting shared goals and innovation; rigorous demand/capacity planning to inform funding. Social implications – The failings of child and adolescent mental health services (CAMHS) are detailed in the Department of Health report “Future in mind: promoting, protecting and improving our children and young people’s mental health and wellbeing” (2015). The aims of the report are contingent on the ability of local health providers to implement its recommendations. The authors provide a theoretical approach to enable this implementation. Originality/value – To date there are no published papers addressing the key characteristics enabling implementation of evidence-based practice within CAMHS. The unique experience in forming the“1419” service has important implications nationally and brings together evidence of an effective service within a theoretical underpinned context. [ABSTRACT FROM AUTHOR]

Background: Rising cancer incidence, the cost of cancer pharmaceuticals and the introduction of the Cancer Drugs Fund in England, but not other United Kingdom(UK) countries means evidence of 'postcode prescribing' in cancer is important. There have been no systematic reviews considering access to cancer drugs by geographical characteristics in the UK.Methods: Studies describing receipt of cancer drugs, according to healthcare boundaries (e.g. cancer network [UK]) were identified through a systematic search of electronic databases and grey literature. Due to study heterogeneity a meta-analysis was not possible and a narrative synthesis was performed.Results: 8,780 unique studies were identified and twenty-six included following a systematic search last updated in 2015. The majority of papers demonstrated substantial variability in the likelihood of receiving chemotherapy between hospitals, health authorities, cancer networks and UK countries (England and Wales). After case-mix adjustment, there was up to a 4-5 fold difference in chemotherapy utilisation between the highest and lowest prescribing cancer networks. There was no strong evidence that rurality or distance travelled were associated with the likelihood of receiving chemotherapy and conflicting evidence for an effect of travel time.Conclusions: Considerable variation in chemotherapy prescribing between healthcare boundaries has been identified. The absence of associations with natural geographical characteristics (e.g. rurality) and receipt of chemotherapy suggests that local treatment habits, capacity and policy are more influential. [ABSTRACT FROM AUTHOR]

Upper limb impairment is common after stroke, with a significant impact on the stroke survivor's function, social participation and quality of life. Clinical guidelines are needed to inform clinical practise, tailor interventions to improve outcomes and address unresolved research questions. This review contributes to the evidence guiding clinical practise for upper limb motor recovery after stroke by summarising the recommendations from the UK rehabilitation guidelines (National Institute for Health and Care Excellence (NICE) and the Intercollegiate Stroke Working Party (ISWP)) and the European Stroke Organisation (ESO) guidelines, all published in 2023. All three guidelines target researchers, clinical practitioners, stroke survivors and their social networks. An important feature in all three guidelines was therapeutic intensity, with all guidelines recommending increased therapeutic intensity. Unlike the ESO, the NICE and ISWP additionally include specific research recommendations. While the NICE guidelines seem more holistic and target a wider audience, the three guidelines are complimentary. We recommend that a future consensus statement should be developed in partnership between all three organisations, agreeing on scope and using the same terminology, on recommendations to improve stroke rehabilitation in the UK and Europe. [ABSTRACT FROM AUTHOR]

Introduction. New Zealand's health care system faces significant shortages in health care workers. To address workforce challenges and meet the population's health needs, health care systems around the world have introduced new clinical roles, such as physician associates/assistants (PAs) into existing health care teams. Aim. This article aims to examine the benefits, challenges, and broader implications of regulating PAs in the context of New Zealand's primary care sector, with a specific emphasis on how it may impact general practice. Methods. A range of literature surrounding the role, impact, and perception of PAs were selected and included in this article. Results. The PA profession can significantly strengthen New Zealand's primary care workforce, improving patient access and continuity of care. However, the global deployment of PAs has faced scrutiny due to concerns about its potential risks to patient safety and the overall viability of such a role. Discussion. If regulated, the PA profession can reshape New Zealand's primary care, offering a partial solution to current medical staff shortages. Trained under a generalised medical model similar to doctors, PAs possess the necessary skills to perform both routine and non-routine medical tasks. This dual capability can significantly improve primary care service provision, reduce existing workloads, and allow for a more efficient deployment of doctor expertise. However, medico-legal issues and the supervisory burden can impede widespread integration into general practice. Despite challenges, the success of the PA role relies on mutual trust, respect, and support from other clinical team members within primary health care. [ABSTRACT FROM AUTHOR]

Background: In the UK, tens of millions of working days are lost due to work‐related ill health every year, costing billions of pounds. The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in the future using this traditional model, due to the declining number of OH‐trained doctors and nurses in the UK. Multi‐disciplinary models of OH delivery, including a more varied range of healthcare and non‐healthcare professionals, could provide a way to meet this new demand for OH services. There is a need to identify collaborative models of OH service delivery and review their effectiveness on return‐to work outcomes. There is an existing pool of systematic review evidence evaluating workplace based, multi‐disciplinary OH interventions, but it is difficult to identify which aspects of the content and/or delivery of these interventions may be associated with improved work‐related outcomes. Objectives: The aim of this evidence and gap map (EGM) was to provide an overview of the systematic review evidence that evaluates the effectiveness and cost‐effectiveness of multi‐disciplinary OH interventions intending to improve work‐related outcomes. Search Methods: In June 2021 we searched a selection of bibliographic databases and other academic literature resources covering a range of relevant disciplines, including health care and business studies, to identify systematic review evidence from a variety of sectors of employment. We also searched Google Search and a selection of topically relevant websites and consulted with stakeholders to identify reports already known to them. Searches were updated in February 2023. Selection Criteria: Systematic reviews needed to be about adults (16 years or over) in employment, who have had absence from work for any medical reason. Interventions needed to be multi‐disciplinary (including professionals from different backgrounds in clinical and non‐clinical professions) and designed to support employees and employers to manage health conditions in the workplace and/or to help employees with health conditions retain and/or return to work following medical absence. Effectiveness needed to be measured in terms of return to work, work retention or measures of absence, or economic evaluation outcomes. These criteria were applied to the title and abstract and full text of each systematic review independently by two reviewers, with disagreements resolved through discussion. We awarded each systematic review a rating of 'High', 'Medium' or 'Low' relevance to indicate the extent to which the populations, interventions and their contexts synthesised within the review were consistent with our research question. We also recorded the number of primary studies included within each of the 'High' and 'Medium' reviews that were relevant to research question using the same screening process applied at review level. Data Collection and Analysis: Summary data for each eligible review was extracted. The quality of the systematic reviews, rated as 'High' or 'Medium' relevance following full text screening, was appraised using the AMSTAR‐2 quality appraisal tool. All data were extracted by one reviewer and checked by a second, with disagreements being settled through discussion. Summary data for all eligible systematic reviews were tabulated and described narratively. The data extracted from reviews of 'High' and 'Medium' relevance was imported into EPPI‐Mapper software to create an EGM. Stakeholder Involvement: We worked alongside commissioners and policy makers from the Department of Health and Social Care (DHSC) and Department of Work and Pensions (DWP), OH personnel, and people with lived experience of accessing OH services themselves and/or supporting employees to access OH services. Individuals contributed to decision making at all stages of the project. This ensured our EGM reflects the needs of individuals who will use it. Main Results: We identified 98 systematic reviews that contained relevant interventions, which involved a variety of professionals and workplaces, and which measured effectiveness in terms of return to work (RTW). Of these, we focused on the 30 reviews where the population and intervention characteristics within the systematic reviews were considered to be of high or medium relevance to our research questions. The 30 reviews were of varying quality, split evenly between High/Moderate quality and Low/Critically‐Low quality ratings. We did not identify any relevant systematic review evidence on any other work‐related outcome of interest. Interventions were heterogenous, both within and across included systematic reviews. The EGM is structured according to the health condition experienced by participants, and the effectiveness of the interventions being evaluated, as reported within the included systematic reviews. It is possible to view (i) the quality and quantity of systematic review evidence for a given health condition, (ii) how review authors assessed the effectiveness or cost‐effectiveness of the interventions evaluated. The EGM also details the primary studies relevant to our research aim included within each review. Authors' Conclusions: This EGM map highlights the array of systematic review evidence that exists in relation to the effectiveness or cost‐effectiveness of multi‐disciplinary, workplace‐based OH interventions in supporting RTW. This evidence will allow policy makers and commissioners of services to determine which OH interventions may be most useful for supporting different population groups in different contexts. OH professionals may find the content of the EGM useful in identifying systematic review evidence to support their practice. The EGM also identifies where systematic review evidence in this area is lacking, or where existing evidence is of poor quality. These may represent areas where it may be particularly useful to conduct further systematic reviews. [ABSTRACT FROM AUTHOR]

The National Institute for Health and Care Excellence (NICE), as part of the institute's single technology appraisal (STA) process, invited the company that makes obinutuzumab (Roche Products Limited) to submit evidence of the clinical and cost effectiveness of the drug in combination with chemotherapy, with or without obinutuzumab as maintenance therapy for adult patients with untreated, advanced follicular lymphoma (FL) in the UK. Kleijnen Systematic Reviews Ltd (KSR), in collaboration with Erasmus University Rotterdam, was commissioned to act as the Evidence Review Group (ERG). This paper describes the company's submission, the ERG review, and NICE's subsequent decisions. The clinical evidence was derived from two phase III, company-sponsored, randomised, open-label studies. Most evidence on obinutuzumab was based on the GALLIUM trial that compared obinutuzumab in combination with chemotherapy as induction followed by obinutuzumab maintenance monotherapy with rituximab in combination with chemotherapy as induction followed by rituximab maintenance monotherapy in previously untreated patients with FL (grades 1-3a). Long-term clinical evidence was based on the PRIMA trial, studying the benefit of two years of rituximab maintenance after first-line treatment in patients with FL. The cost-effectiveness evidence submitted by the company relied on a partitioned survival cost-utility model, implemented in Microsoft® Excel. The base-case incremental cost-effectiveness ratio (ICER) presented in the company submission was <£20,000 per quality-adjusted life-year (QALY) gained. Although the ERG concluded that the economic model met the NICE reference case to a reasonable extent, some errors were identified and several assumptions made by the company were challenged. A new base-case scenario produced by the ERG suggested an ICER that was higher than the company base case, but still below £30,000 per QALY gained. However, some ERG scenario analyses were close to or even above the threshold. This was the case in particular for assuming a treatment effect that did not extend beyond trial follow-up. These results led to an initial negative recommendation by the appraisal committee. Subsequently, the company submitted a revised base case focusing on patients at intermediate or high risk of premature mortality. Simultaneously, a further price discount for obinutuzumab was granted. In addition to the company's revised base case, the ERG suggested a restriction of the treatment effect to 5 years and implemented biosimilar uptake and cheaper prices for rituximab. All of these adjustments did not exceed £30,000 per QALY gained and therefore the use of obinutuzumab for patients with advanced FL and a Follicular Lymphoma International Predictive Index (FLIPI) score of two or more could be recommended. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is a serious public health challenge and schools have been identified as an ideal place to implement prevention interventions. The aim of this study was to measure the cost-effectiveness of a multi-faceted school-based obesity prevention intervention targeting children aged 6–7 years when compared to ‘usual activities’. Methods: A cluster randomised controlled trial in 54 schools across the West Midlands (UK) was conducted. The 12-month intervention aimed to increase physical activity by 30 minutes per day and encourage healthy eating. Costs were captured from a public sector perspective and utility-based health related outcomes measured using the CHU-9D. Multiple imputation using chained equations was used to address missing data. The cost effectiveness was measured at 30 months from baseline using a hierarchical net-benefit regression framework, that controlled for clustering and prespecified covariates. Any uncertainty in the results was characterised using cost-effectiveness acceptability curves. Results: At 30 months, the total adjusted incremental mean cost of the intervention was £155 (95% confidence interval [CI]: £139, £171), and the incremental mean QALYs gained was 0.006 (95% CI: -0.024, 0.036), per child. The incremental cost-effectiveness at 30 months was £26,815 per QALY and using a standard willingness to pay threshold of £30,000 per QALY, there was a 52% chance that the intervention was cost-effective. Conclusions: The cost-effectiveness of the school-based WAVES intervention was subject to substantial uncertainty. We therefore recommend more research to explore obesity prevention within schools as part of a wider systems approach to obesity prevention. Trial registration: This paper uses data collected by the WAVES trial: Controlled trials (registered May 2010). [ABSTRACT FROM AUTHOR]

Objective: To examine the impact and cost associated with mental illness. Methods: A rapid review of the literature from Australia, New Zealand, UK and Canada was undertaken. The review included literature pertaining to the cost-of-illness and impact of mental illness as well as any modelling studies. Included studies were categorised according to impact on education, labour force engagement, earlier retirement or welfare dependency. The well-accepted Drummond 10-point economic appraisal checklist was used to assess the quality of the studies. Results: A total of 45 methodologically diverse studies were included. The studies highlight the significant burden mental illness places on all facets of society, including individuals, families, workplaces and the wider economy. Mental illness results in a greater chance of leaving school early, a lower probability of gaining full-time employment and a reduced quality of life. Research from Canada suggests that the total economic costs associated with mental illness will increase six-fold over the next 30 years with costs likely to exceed A$2.8 trillion (based on 2015 Australian dollars). Conclusions: Mental illness is associated with a high economic burden. Further research is required to develop a better understanding of the trajectory and burden of mental illness so that resources can be directed towards cost-effective interventions. What is known about the topic?: Although mental illness continues to be one of the leading contributors to the burden of disease, there is limited information on the economic impact that mental illness imposes on individuals, families, workplaces and the wider economy. What does this paper add?: This review provides a summary of the economic impact and cost of mental illness. The included literature highlights the significant burden mental illness places on individuals, families, workplaces, society and the economy in general. The review identified several areas for improvement. For example, only limited information is available on the impact of attention deficit hyperactivity disorder, anxiety, cognitive function, conduct disorder, eating disorder and psychological distress. There was also a dearth of evidence on the intangible elements of pain and suffering of people and their families with depressive disorders. More research is required to better understand the full extent of the impact of mental illness and strategies that may be implemented to minimise this harm. What are the implications for practitioners?: Knowing the current and future impact of mental illness highlights the imperative to develop an effective policy response. [ABSTRACT FROM AUTHOR]

Background: Exercise referral schemes are recommended by the National Institute for Clinical Excellence (NICE) for physical activity promotion among inactive patients with health conditions or risk factors. Whilst there is evidence for the initial effectiveness and cost-effectiveness of such schemes for increasing physical activity, evidence of long-term effects is limited. Techniques such as goal setting, self-monitoring and personalised feedback may support motivation for physical activity. Technologies such as activity monitoring devices provide an opportunity to enhance delivery of motivational techniques. This paper describes the PACERS study protocol, which aims to assess the feasibility and acceptability of implementing an activity monitor within the existing Welsh National Exercise Referral Scheme (NERS) and proposed evaluation methodology for a full-scale randomised controlled trial. Methods/design: The PACERS study consists of a pilot randomised controlled trial, process evaluation and exploratory economic analyses. Participants will be recruited from the generic pathway of the Welsh NERS and will be randomly assigned to receive the intervention or usual practice. Usual practice is a 16-week structured exercise programme; the intervention consists of an accelerometry-based activity monitor (MyWellnessKey) and an associated web platform (MyWellnessCloud). The primary outcomes are predefined progression criteria assessing the acceptability and feasibility of the intervention and feasibility of the proposed evaluation methodology. Postal questionnaires will be completed at baseline (time 0: T0), 16 weeks after T0 (T1) and 12 months after T0 (T2). Routinely collected data will also be accessed at the same time points. A sub-sample of intervention participants and exercise referral staff will be interviewed following initiation of intervention delivery and at the end of the study. Discussion: The PACERS study seeks to assess the feasibility of adding a novel motivational component to an existing effective intervention in order to enhance effects on physical activity and support longer-term maintenance. The study will provide insight into the acceptability of activity-monitoring technologies to an exercise referral population and delivery staff. Data from this study will be used to determine whether and how to proceed to a full-scale trial of effectiveness of the intervention, including any necessary refinements to intervention implementation or the proposed evaluation methodology. [ABSTRACT FROM AUTHOR]

This paper presents a study on the impacts of an inter-urban road development in the UK through a comprehensive investigation and clarification of the relationship between road-user benefits as a primary impact and changes in land values (CLVs) as a secondary impact. It seeks to offer a methodology aiming at coupling the conventional cost–benefit analysis (CBA) with aspects of economic impact analysis by avoiding double-counting of the results. The CBA model of an existing highway management tool was used to calculate road-user cost savings (RUCSs) of generated traffic, while CLVs were calculated over the same period using a statistical model newly developed for the purpose. A comparison of a 30-year time span was used to test similarities in trends of road-user benefits and CLVs. The main factors affecting the degree of similarity were found to be traffic and its prediction and, in particular, the traffic generated by the new road. It appears that over a 30-year period, a new road project has a positive effect on land values but a negative effect on RUCSs in the first years after construction. The latter increases for about 15 years and then follows a decreasing pattern in the last 10 years or so. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID‐19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health‐related quality of life and cost‐effectiveness. Design: Parallel two‐arm, cluster‐level randomized controlled trial. Methods: Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID‐19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient‐reported co‐primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention‐to‐treat analyses. Results: We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570–572 (98.1%–98.5%) patient participants in 14 clusters. We found no evidence of between‐group differences on any patient, nurse or economic outcomes. We found between‐group differences over time, in favour of the intervention, for three of our five co‐primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the 'other' ethnicity subgroup. Conclusion: We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non‐white British patients' experience of care. Implications for the Profession and/or Patient Care: We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required. Impact: Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non‐white British patients' experience of care. Reporting Method: CONSORT and CONSERVE. Patient or Public Contribution: Patients with experience of hospitalization with COVID‐19 were involved in guideline development and writing, trial management and interpretation of findings. [ABSTRACT FROM AUTHOR]

Background: Delayed response to clinical deterioration of hospital inpatients is common. Deployment of an electronic automated advisory vital signs monitoring and notification system to signal clinical deterioration is associated with significant improvements in clinical outcomes but there is no evidence on the cost-effectiveness compared with routine monitoring, in the National Health Service (NHS) in the United Kingdom (UK). Methods: A decision analytic model was developed to estimate the cost-effectiveness of an electronic automated advisory notification system versus standard care, in adults admitted to a district general hospital. Analyses considered: (1) the cost-effectiveness of the technology based on secondary analysis of patient level data of 3787 inpatients in a before-and-after study; and (2) the cost-utility (cost per quality-adjusted life-year (QALY)) over a lifetime horizon, extrapolated using published data. Analysis was conducted from the perspective of the NHS. Uncertainty in the model was assessed using a range of sensitivity analyses. Results: The study population had a mean age of 68 years, 48% male, with a median inpatient stay of 6 days. Expected life expectancy at discharge was assumed to be 17.74 years. (1) Cost-effectiveness analysis: The automated notification system was more effective (-0.027 reduction in mean events per patient) and provided a cost saving of -£12.17 (-182.07 to 154.80) per patient admission. (2) Cost-utility analysis: Over a lifetime horizon the automated notification system was dominant, demonstrating a positive incremental QALY gain (0.0287 QALYs, equivalent to ~10 days of perfect health) and a cost saving of £55.35. At a threshold of £20,000 per QALY, the probability of automated monitoring being cost-effective in the NHS was 81%. Increased use of cableless sensors may reduce cost-savings, however, the intervention remains cost-effective at 100% usage (ICER: £3,107/QALY). Stratified cost-effectiveness analysis by age, National Early Warning Score (NEWS) on admission, and primary diagnosis indicated the automated notification system was cost-effective for most strategies and that use representative of the patient population studied was the most cost-saving strategy. Conclusion: Automated notification system for adult patients admitted to general wards appears to be a cost-effective use in the NHS; adopting this technology could be good use of scarce resources with significance for patient safety. [ABSTRACT FROM AUTHOR]

Objectives: It has been estimated that vaccines can accrue a relatively large part of their value from patient and carer productivity. Yet, productivity value is not commonly or consistently considered in health economic evaluations of vaccines in several high-income countries. To contribute to a better understanding of the potential impact of including productivity value on the expected cost-effectiveness of vaccination, we illustrate the extent to which the incremental costs would change with and without productivity value incorporated. Methods: For two vaccines currently under development, one against Cloistridioides difficile (C. difficile) infection and one against respiratory syncytial disease (RSV), we estimated their incremental costs with and without productivity value included and compared the results. Results: In this analysis, reflecting a UK context, a C. difficile vaccination programme would prevent £12.3 in productivity costs for every person vaccinated. An RSV vaccination programme would prevent £49 in productivity costs for every vaccinated person. Conclusions: Considering productivity costs in future cost-effectiveness analyses of vaccines for C. difficile and RSV will contribute to better-informed reimbursement decisions from a societal perspective. [ABSTRACT FROM AUTHOR]

Simple Summary: Ovarian cancer is the leading cause of death due to gynecologic malignancies. Peritoneal metastases represent the most common pathway for the spread of OC, both at the time of initial diagnosis and at recurrence. Accurate mapping of peritoneal metastases helps in planning the appropriate therapeutic strategy, predicting the likelihood of optimal cytoreduction, and identifying potentially unresectable or difficult disease sites that may require surgical technique modifications. Preoperative diagnostic work-up with multidetector CT (MDCT), MRI, including diffusion-weighted imaging (DWI), or FDG PET/CT plays a vital role in the accurate assessment of the extent of peritoneal carcinomatosis. In this article, the aim was to update the role of MDCT, MRI, including DWI, and FDG PET/CT in the detection of peritoneal metastases in ovarian cancer by conducting a systematic review and meta-analysis of the existing literature. This review aims to compare the diagnostic performance of multidetector CT (MDCT), MRI, including diffusion-weighted imaging, and FDG PET/CT in the detection of peritoneal metastases (PMs) in ovarian cancer (OC). A comprehensive search was performed for articles published from 2000 to February 2023. The inclusion criteria were the following: diagnosis/suspicion of PMs in patients with ovarian/fallopian/primary peritoneal cancer; initial staging or suspicion of recurrence; MDCT, MRI and/or FDG PET/CT performed for the detection of PMs; population of at least 10 patients; surgical results, histopathologic analysis, and/or radiologic follow-up, used as reference standard; and per-patient and per-region data and data for calculating sensitivity and specificity reported. In total, 33 studies were assessed, including 487 women with OC and PMs. On a per-patient basis, MRI (p = 0.03) and FDG PET/CT (p < 0.01) had higher sensitivity compared to MDCT. MRI and PET/CT had comparable sensitivities (p = 0.84). On a per-lesion analysis, no differences in sensitivity estimates were noted between MDCT and MRI (p = 0.25), MDCT and FDG PET/CT (p = 0.68), and MRI and FDG PET/CT (p = 0.35). Based on our results, FDG PET/CT and MRI are the preferred imaging modalities for the detection of PMs in OC. However, the value of FDG PET/CT and MRI compared to MDCT needs to be determined. Future research to address the limitations of the existing studies and the need for standardization and to explore the cost-effectiveness of the three imaging modalities is required. [ABSTRACT FROM AUTHOR]

Aim: Optimal airway management during out-of-hospital cardiac arrest (OHCA) is uncertain. Complications from tracheal intubation (TI) may be avoided with supraglottic airway (SGA) devices. The AIRWAYS-2 cluster randomised controlled trial (ISRCTN08256118) compared the i-gel SGA with TI as the initial advanced airway management (AAM) strategy by paramedics treating adults with non-traumatic OHCA. This paper reports the trial cost-effectiveness analysis.Methods: A within-trial cost-effectiveness analysis of the i-gel compared with TI was conducted, with a six-month time horizon, from the perspective of the UK National Health Service (NHS) and personal social services. The primary outcome measure was quality-adjusted life years (QALYs), estimated using the EQ-5D-5L questionnaire. Multilevel linear regression modelling was used to account for clustering by paramedic when combining costs and outcomes.Results: 9296 eligible patients were attended by 1382 trial paramedics and enrolled in the AIRWAYS-2 trial (4410 TI, 4886 i-gel). Mean QALYs to six months were 0.03 in both groups (i-gel minus TI difference -0.0015, 95% CI -0.0059 to 0.0028). Total costs per participant up to six months post-OHCA were £3570 and £3413 in the i-gel and TI groups respectively (mean difference £157, 95% CI -£270 to £583). Based on mean difference point estimates, TI was more effective and less costly than i-gel; however differences were small and there was great uncertainty around these results.Conclusion: The small differences between groups in QALYs and costs shows no difference in the cost-effectiveness of the i-gel and TI when used as the initial AAM strategy in adults with non-traumatic OHCA. [ABSTRACT FROM AUTHOR]

AimAge UK Lancashire received Big Lottery funding to deliver an active lives programme from January 2012 to December 2014 to the population of West Lancashire aged over 50 years. The overall aims of the associated evaluation were to measure older people’s experiences of participating in the programme, identify the impacts on their health and well-being and their suggestions for services development, and establish the costs and benefits of the programme.BackgroundThe World Health Organisation recommends older people should be able to achieve physical, social and mental well-being throughout their lives, and that international, national and local policies should be developed to support older adults, promote their independence and well-being, and encourage physical exercise. Consequently, the West Lancashire programme was to establish preventative community support for older people to assist in improving their well-being and physical and mental health, particularly those isolated due to age-related illness or disability. It was to provide interventions not available from local social care providers.MethodsA mixed methods approach was adopted, with the qualitative evaluation utilising focus groups to establish people’s experiences, identify impacts on their health and well-being, and suggestions for services development. This paper describes the quantitative evaluation, which involved three surveys and a costs analysis. The surveys were scheduled to give timely feedback to management about programme delivery and content, and overall benefits of participation.FindingsThe active lives programme and groups offered a wide range of flexible and local activities that provided benefits for older people in terms of health and well-being, social well-being and quality of life, and reducing social isolation. There was interconnectivity between these benefits. The programme was delivered in an affordable and flexible manner. Such programmes should be made more widely available. [ABSTRACT FROM PUBLISHER]

Actually, COVID-19 and its variants present a big challenge for the public health security. COVID-19 is a new form of the coronaviruses characterized by a set of symptoms like laboratory and radiological symptoms, when the first case has confirmed in December 2019 in Wuhan City, as well as a new variant of this form has appeared in December 2020 in the United Kingdom. Internet of things (IoT) is a technological revolution employed in different areas in the aim to serve the asked purposes. The implementation of IoT solutions in healthcare area has several benefits such as reducing the cost of services and improving treatment results. In this paper, we present a review on the impact of IoT on this new health challenge (COVID-19 and its variants), we will focus this study on the impact of the use of IoT devices to reduce transmissions of COVID-19 and its variants. [ABSTRACT FROM AUTHOR]