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Background: The head and neck cancer (HNC) Patient Concerns Inventory (PCI) is a condition-specific prompt list that allows patients to raise concerns to cancer consultants that otherwise might be overlooked. Objective: This is the first economic evaluation of the PCI in patients with HNC investigating the costs and effects to the health service of not prioritising certain treatment pathways in addition to the primary cancer pathway. Additional costs can be accrued due to delayed referral to other appropriate services, e.g. hospital dentist. Economic evidence could influence future policy direction in this area globally. Methods: Alongside a 3-year clustered randomised controlled trial, an economic evaluation was undertaken with Client Service Receipt Inventory data collected at three different time points (baseline and 6 and 12 months post-baseline). Patients were identified by a multidisciplinary team at the trial clinics. This economic analysis compared the PCI intervention versus the non-PCI treatment pathway. A deterministic and probabilistic sensitivity analysis was conducted to investigate the cost per quality-adjusted life-year (QALY) gain of the PCI versus non-PCI intervention treatment pathways. Qualitative data were also collected from seven consultants to triangulate findings from the economic evaluation. Results: The analysis used data from 191 patients (66% of the full trial sample). The PCI inventory was low cost, at just over £13 per participant. The PCI intervention was cost effective and also cost saving, with an incremental cost difference of £295.91 over the 12-month follow-up period. The QALY values were higher in the PCI intervention strategy, with a value of 0.79, whereas the non-PCI group had a value of 0.76, thus the PCI intervention was dominant. The sensitivity analysis showed that, at a willingness-to-pay threshold of £20,000 per QALY gained, the probability of being cost effective was 0.85 (95% confidence interval [CI] 0.80–0.83). Qualitative results showed that consultants using the PCI reported an enhanced awareness of patients’ overall post-treatment needs. Discussion: The PCI provided an effective means to conduct clinical consultations by avoiding unnecessary healthcare costs and focussing on aspects of care most important to patients. The cost per QALY gain was within the National Institute for Health and Care Excellence guideline threshold. The economic evaluation showed that the PCI intervention strategy was dominant and therefore cost saving to the national health service (NHS) and was more effective in terms of treatment. Conclusion: The PCI appears to be a low-cost intervention that generates a cost-effective benefit to patients from a NHS perspective if rolled out as part of routine care. Qualitative evidence has shown that the use of the PCI is supported by consultants in routine practice. Trial Registration: Clinical Trials Identifier: NCT03086629.

ObjectivesThe English Bowel Cancer Screening Programme invites 55 year olds for a sigmoidoscopy (Bowel Scope Screening (BSS)), aiming to resect premalignant polyps, thus reducing cancer incidence. A national patient survey indicated higher procedural pain than anticipated, potentially impacting on screening compliance and effectiveness. We aimed to assess whether water-assisted sigmoidoscopy (WAS), as opposed to standard CO2technique, improved procedural pain and detection of adenomatous polyps.DesignThe WASh (Water-Assisted Sigmoidoscopy) trial was a multicentre, single-blind, randomised control trial for people undergoing BSS. Participants were randomised to either receive WAS or CO2from five sites across England. The primary outcome measure was patient-reported moderate/severe pain, as assessed by patients on a standard Likert scale post procedure prior to discharge. The key secondary outcome was adenoma detection rate (ADR). The costs of each technique were also measured.Results1123 participants (50% women, mean age 55) were randomised (561 WAS, 562 CO2). We found no difference in patient-reported moderate/severe pain between WAS and CO2(14% in WAS, 15% in CO2; p=0.47). ADR was 15% in the CO2arm and 11% in the WAS arm (p=0.03); however, it remained above the minimum national performance standard in both arms. There was no statistical difference in mean number of adenomas nor overall polyp detection rate. There was negligible cost difference between the two techniques.ConclusionIn the context of enema-prepared unsedated screening sigmoidoscopies performed by screening-accredited endoscopists, no difference in patient-reported pain was seen when using either a CO2or WAS intubation technique.Trial registration numberISRCTN81466870.

Type 2 diabetes is a public health priority for the UK. A growing body of evidence has indicated ethnic and socioeconomic disparities in rates of diabetes prevalence and complications. Attendance at diabetes follow-up checks is key to ensuring complications are identified and managed at an early stage. The aim of this rapid review was to identify and summarise evidence of ways to improve diabetes management in ethnic minority groups.

A social prescribing link worker is responsible for enabling and supporting individuals, by assessing their needs and co-producing solutions to make use of appropriate, local, non-clinical resources or interventions. Because the role is new, link workers might not have professional backgrounds in dealing with individuals with complex needs, which can affect their decision making for the referral of individuals to appropriate community assets to support their needs. The aim of this work was to explore link workers' level of education, and past and current training needs, and to ascertain how much link workers were willing to pay to access and complete training to improve their skill set.

Previous evidence suggests that co-production and co-design are effective approaches to engage stakeholders in the development and implementation of social prescribing (SP) interventions within community settings. SP initiatives can be enhanced from the outset, by drawing on stakeholder knowledge to design services that improve health and wellbeing outcomes for community members. The aim of this qualitative study was to engage with the residents of the Nantlle Valley, a rural community in North West Wales, UK, to gather perceptions regarding the need for co-design, co-produced SP interventions to meet the wellbeing needs and requirements of the community. In line with the Well-being of Future Generations Act (Wales) 2015, the current study also aimed to gather knowledge that would shape the sustainable development of SP interventions creating positive wellbeing outcomes for the future.

Head and neck cancer (HNC) patient concerns inventory (PCI) is a condition-specific prompt list that allows patients to raise concerns that might be overlooked. To our knowledge, this is the first economic evaluation of PCI in patients with HNC from a UK National Health Service (NHS) perspective, exploring the cost-effectiveness of the PCI in the treatment of patients with HNC. To triangulate our economic evaluation, we conducted qualitative interviews with a sample of consultants providing care.

Spencer and Hanley (2003) showed that Welsh-speaking children aged between 5 and 7 years who were learning to read Welsh (a transparent orthography) performed significantly better at reading both real words and nonwords than did English-speaking children living in Wales who were learning to read English (a deep orthography). In this study, the reading skills of these children were reexamined three years later, during their sixth year of formal reading instruction. The children learning to read English continued to perform poorly at reading low- and medium-frequency irregular words but no differences were observed in reading regular words or nonwords. These findings emphasize how long it takes to acquire a large sight vocabulary in English, but indicated that the reading skills of the majority of the English-speaking children had caught up with those of their Welsh-speaking counterparts. However, the poorest 25% of the English readers continued to perform much worse than the lowest performing 25% of Welsh readers on both words and nonwords. An underachieving tail of this kind was not observed in the reading performance of the Welsh-speaking group. Overall, these findings suggest that in the long term the detrimental effects of an opaque orthography are most damaging to the poorest readers.

Many environmental initiatives to improve the physical and mental health of the public are now being evaluated to determine the extent of their effect on quality of life and cost to public commissioners and decision makers. The aim of this systematic review was to investigate the econometric techniques and modelling used to estimate the value of the health benefits of engagement in physical activity in green and blue spaces.