27 results on '"Timlin, L."'
Search Results
2. Evaluation of exenatide vs. insulin glargine in type 2 diabetes: cost-effectiveness analysis in the German setting
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Mittendorf, T., Smith-Palmer, J., Timlin, L., Happich, M., and Goodall, G.
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- 2009
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3. PARENTS 2 study: consensus report for parental engagement in the perinatal mortality review process
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Bakhbakhi, D, Siassakos, D, Lynch, M, Timlin, L, Storey, C, Heazell, A, Burden, C, Parents Collaborative Group, Redshaw, M, Bevan, C, Kurinczuk, J, Redshaw, M, Bevan, C, and Kurinczuk, J
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Male ,Parents ,Consensus ,Delphi Technique ,Attitude of Health Personnel ,Health Personnel ,Perinatal Death ,Delphi method ,perinatal mortality review process ,Computer-assisted web interviewing ,Likert scale ,Patient safety ,parental engagement ,Obstetrics and gynaecology ,Stakeholder Participation ,Surveys and Questionnaires ,patient safety ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Grading (education) ,Perinatal Mortality ,Medical education ,Original Paper ,neonatal death ,Radiological and Ultrasound Technology ,business.industry ,Communication ,Infant, Newborn ,Obstetrics and Gynecology ,General Medicine ,Focus Groups ,Stillbirth ,Focus group ,Original Papers ,United Kingdom ,healthcare improvement ,Reproductive Medicine ,Content analysis ,perinatal death ,stillbirth ,Female ,business - Abstract
OBJECTIVES:Following a perinatal death, a standardised multidisciplinary review should take place. Learning from these deaths and engaging parents in this process could help prevent future perinatal deaths in line with United Kingdom (UK) national and international targets to reduce the number of such deaths by 2020. Moreover, it would support parents in understanding events around the death of their baby. An earlier study (Parents' Active Role and ENgagement in The review of their Stillbirth/perinatal death - PARENTS 1 study) found that parents would endorse the opportunity to give feedback into the perinatal mortality review process (PNMR). In subsequent focus groups, healthcare professionals were positive about parental engagement, although they considered there may be significant challenges. The objective of this study was to develop core principles and recommendations for parental engagement in PNMR in the UK.METHODS:We followed a two-round Delphi technique to reach a consensus on core principles; including a national consensus workshop and an online questionnaire. The consensus meeting was attended by a national panel of stakeholders (clinical and academic experts, parent support groups, managers and commissioners) in stillbirth, neonatal and bereavement care (n=22). To develop recommendations for parental engagement, participants discussed four key areas including: receiving feedback from parents; format of the PNMR meeting; the parental pathway; and challenging aspects of engaging with parents in reviews. Content analysis was conducted to generate recommendations from the meeting for a subsequent, anonymous web-based survey. Attendees of the consensus workshop and members of the PARENTS 2 Project Advisory Board were asked to rank recommendations using a 9-point Likert scale from 1 (not important) to 9 (critical). It had been agreed a priori, in compliance with established Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, that 'Consensus' would be achieved if over 70% scored the principle as 'critical' (score 7 to 9) and less than 15% scored the principle as 'not important' (score 1 to 3). Principles where Consensus was achieved would be included in the core recommendations.RESULTS:Twenty-five of the 29 invited stakeholders participated in the consensus meeting and the subsequent online questionnaire in June 2017 (86.2% response rate). Consensus was agreed on 12 core principles. Ninety-six percent agreed that it was of critical importance that there should be a face-to-face explanation of the PNMR process; 72% considered parents should be offered the opportunity to nominate a suitable advocate; 92% believed responses to parents' comments should be formally documented; 96% indicated that it was vital for action plans to be translated into lessons learnt and that this process is monitored; and 100% of stakeholders voted that a plain English summary should be produced for the parents following the meeting. There was good agreement on a further seven principles.CONCLUSIONS:Key national stakeholders were unanimously supportive of parental engagement and agreed on core principles to make it feasible, meaningful and robust process. A six-month pilot of parental engagement in the perinatal mortality review process (PARENTS 2 Study) in two UK units took place after the consensus on core principles. In collaboration with the National Perinatal Epidemiology Unit, findings will inform the national standardised perinatal mortality review tool (PMRT).
- Published
- 2019
4. A network meta-analysis to compare glycaemic control in patients with type 2 diabetes treated with exenatide once weekly or liraglutide once daily in comparison with insulin glargine, exenatide twice daily or placebo
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Scott, D. A., primary, Boye, K. S., additional, Timlin, L., additional, Clark, J. F., additional, and Best, J. H., additional
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- 2012
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5. PDB8 A Network Meta Analysis to Compare Glycaemic Control in Patients with Type 2 Diabetes Treated with Exenatide Once Weekly or Liraglutide
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Scott, D., primary, Boye, K.S., additional, Timlin, L., additional, Best, J.H., additional, and Clark, J., additional
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- 2011
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6. PDB27 Projected Cost-Effectiveness of Exenatide Once Weekly Versus Exenatide Bid for the Treatment of Type 2 Diabetes in the UK
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Wilson, B.P., primary, Beaudet, A., additional, Caputo, J., additional, and Timlin, L., additional
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- 2011
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7. PDB26 Projected Long-Term Clinical and Economic Outcomes of Exenatide Once Weekly Versus Sitagliptin for the Treatment of Type 2 Diabetes in the UK
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Beaudet, A., primary, Wilson, B., additional, Caputo, J., additional, and Timlin, L., additional
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- 2011
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8. PMD11 IDENTIFYING POTENTIAL DRIVERS OF COST SAVINGS WITH INSULIN ADMINISTRATION DEVICES IN TYPE-2 DIABETES IN THE UNITED STATES
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Pollock, R.F., primary, Curtis, B., additional, Boye, K.S., additional, Timlin, L., additional, and Valentine, W.J., additional
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- 2011
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9. PDB9 LONG-TERM CLINICAL OUTCOMES OF EXENATIDE ONCE-WEEKLY VERSUS INSULIN GLARGINE FOR THE TREATMENT OF TYPE 2 DIABETES PROJECTED USING THE CORE DIABETES MODEL
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Timlin, L, primary, Beaudet, A, additional, Wilson, B, additional, Bruhn, D, additional, Boye, KS, additional, Palmer, JL, additional, and Lloyd, A, additional
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- 2010
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10. ED3 DIFFERENCES IN HEALTH RELATED RESOURCE USE IN THE 6 MONTHS PRIOR TO AND AFTER INSULIN INITIATION IN PATIENTS WITHTYPE 2 DIABETES IN GERMANY AND UNITED KINGDOM: DATA FROMTHE INSTIGATE STUDY
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Timlin, L, primary, Tynan, A, additional, Simpson, A, additional, Jones, S, additional, and Liebl, A, additional
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- 2007
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11. PDB42 COSTS ASSOCIATED WITH THE FIRST SIX MONTHS OF INSULIN THERAPY IN PATIENTS WITH TYPE 2 DIABETES IN GERMANY ANDTHE UNITED KINGDOM: DATA FROM THE INSTIGATE STUDY
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Timlin, L, primary, Tynan, A, additional, Simpson, A, additional, Liebl, A, additional, and Jones, S, additional
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- 2007
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12. PR6 PATIENT CHARACTERISTICS IMPACTING QUALITY OF LIFE (EQ-5D) OF FEMALES WITH STRESS URINARY INCONTINENCE SYMPTOMS
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Tincello, D, primary, Sculpher, M, additional, Tunn, R, additional, Quail, D, additional, Timlin, L, additional, and Manning, M, additional
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- 2007
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13. DB3 CLINICAL AND PATIENT REPORTED OUTCOMES OVER THE FIRST 6 MONTHS OF INSULIN THERAPY IN PATIENTS WITH TYPE 2 DIABETES IN GERMANY ANDTHE UNITED KINGDOM: DATA FROMTHE INSTIGATE STUDY
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Timlin, L, primary, Tynan, A, additional, Simpson, A, additional, Liebl, A, additional, and Jones, S, additional
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- 2007
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14. Insulin Titration – Gaining an Understanding of the Burden of Type 2 Diabetes in Europe (INSTIGATE Study): Behandlungspfade mit oralen Antidiabetika vor Umstellung auf Insulin und Auswahl der Insulintherapie-Regime
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Liebl, A, primary, Happich, M, additional, Cleall, S, additional, and Timlin, L, additional
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- 2007
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15. Insulin Titration – Gaining an Understanding of the Burden of Type 2 Diabetes in Europe (INSTIGATE Study): Studiendesign, Basischarakteristika, HbA1c-Verlauf und Risikoprofil der Patienten in Deutschland vor Start einer Insulintherapie
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Liebl, A, primary, Happich, M, additional, Cleall, S, additional, and Timlin, L, additional
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- 2007
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16. Characteristics of patients with type 2 diabetes mellitus initiating insulin therapy: baseline data from the INSTIGATE study.
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Jones S, Benroubi M, Castell C, Goday A, Liebl A, Timlin L, Nicolay C, Simpson A, Tynan A, Jones, Stephen, Benroubi, Marian, Castell, Conxa, Goday, Albert, Liebl, Andreas, Timlin, Louise, Nicolay, Claudia, Simpson, Alexander, and Tynan, Aodan
- Abstract
Objective: To describe the characteristics at baseline of patients with type 2 diabetes mellitus who are initiating insulin.Methods: Prospective, observational multi-centre, open-label study in five European countries of patients with type 2 diabetes who were initiating insulin as part of their usual care.Results: A total of 1172 patients were enrolled, with mean age 63.3 years and body mass index 29.9 kg/m(2). The majority (90%) of patients were taking one or more oral anti-diabetic agents; the percentage not taking anti-diabetic medication in the previous four weeks was highest in Germany (23.4%) and Spain (15.1%). The prevalence of microvascular diseases (range: 16.1%-36.1%) varied considerably between countries but for macrovascular (30.4%-38.6%) and other diabetes-related diagnoses (72.6%-76.6%) such as hypertension and dyslipidaemia the differences were less pronounced. In Germany, reported use of lipid-lowering (26.7%) and anti-platelet (27.1%) therapies was much less than in other countries (ranges: 53.2%-78.1% and 48.3%-61.1%, respectively). The majority of evaluable patients in each country had demonstrated poor control over a long period of time. Prior to initiating insulin, the most recent mean (+/-SD) HbA1(c) was 9.58 +/- 1.81%, fasting plasma glucose was 12.18 +/- 4.32 mmol/L and 78.5% had metabolic syndrome. IDF targets for HDL- and LDL-cholesterol, and blood pressure were met in 76.8%, 33.1% and 18.9% of patients, respectively.Conclusions: Insulin treatment was only initiated after HbA1(c) values were considerably higher than recommended in treatment guidelines for a sustained period of time. [ABSTRACT FROM AUTHOR]- Published
- 2009
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17. Protocol for a multi-site randomised controlled feasibility study investigating intermittently scanned blood continuous glucose monitoring use for gestational diabetes: the RECOGNISE study.
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Davies A, Lenguerrand E, Scott E, Kandiyali R, Douek I, Norman J, Loose A, Sawyer L, Timlin L, and Burden C
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Background: Incidence of gestational diabetes mellitus (GDM) is increasing and is associated with adverse perinatal outcomes including macrosomia, pre-eclampsia, and pre-term delivery. Optimum glycaemic control can reduce these adverse perinatal outcomes. Continuous glucose monitoring (CGM) informs users about interstitial glucose levels allowing early detection of glycaemic excursions and pharmacological or behavioural intervention. Few adequately powered RCTs to evaluate the impact of using CGM in women with GDM on perinatal outcomes have been undertaken. We aim to establish the feasibility of a multi-site RCT to evaluate the clinical- and cost-effectiveness of an intermittently scanned continuous glucose monitor (isCGM) compared with self-monitored blood glucose (SMBG) in women with GDM for reducing fetal macrosomia and improving maternal and fetal outcomes. We will evaluate recruitment and retention rates, adherence to device requirements, adequacy of data capture and acceptability of trial design and isCGM devices., Methods: Open-label multicentre randomised controlled feasibility trial., Inclusion Criteria: pregnant women, singleton pregnancy, recent diagnosis of GDM (within 14 days of commencing medication, up to 34 weeks gestation) prescribed metformin and/or insulin. Women will be consecutively recruited and randomised to isCGM (FreestyleLibre2) or SMBG. At every antenatal visit, glucose measurements will be evaluated. The SMBG group will use blinded isCGM for 14 days at baseline (~ 12-32 weeks) and ~ 34-36 weeks. The primary outcome is the recruitment rate and absolute number of women participating. Clinical assessments of maternal and fetal/infant health will be undertaken at baseline, birth, up to ~ 13 weeks post-natal. Psychological, behavioural and health economic measures will be assessed at baseline and ~ 34-36 weeks gestation. Qualitative interviews will be undertaken with study decliners, participants, and professionals to explore trial acceptability, of using isCGM and SMBG., Discussion: GDM can be associated with adverse pregnancy outcomes. isCGM could offer a timely, easy-to-engage-with intervention, to improve glycaemic control, potentially reducing adverse pregnancy, birth and long-term health outcomes for mother and child. This study will determine the feasibility of conducting a large-scale multisite RCT of isCGM in women with GDM., Trial Registration: This study has been registered with the ISRCTN (reference: ISRCTN42125256 , Date registered: 07/11/2022)., (© 2023. The Author(s).)
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- 2023
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18. Protocol for the development of a core outcome set for stillbirth care research (iCHOOSE Study).
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Bakhbakhi D, Fraser A, Siasakos D, Hinton L, Davies A, Merriel A, Duffy JMN, Redshaw M, Lynch M, Timlin L, Flenady V, Heazell AE, Downe S, Slade P, Brookes S, Wojcieszek A, Murphy M, de Oliveira Salgado H, Pollock D, Aggarwal N, Attachie I, Leisher S, Kihusa W, Mulley K, Wimmer L, and Burden C
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- Consensus, Delphi Technique, Female, Humans, Outcome Assessment, Health Care methods, Pregnancy, Surveys and Questionnaires, Systematic Reviews as Topic, Research Design, Stillbirth
- Abstract
Introduction: Stillbirth is associated with significant physical, psychosocial and economic consequences for parents, families, wider society and the healthcare system. There is emerging momentum to design and evaluate interventions for care after stillbirth and in subsequent pregnancies. However, there is insufficient evidence to inform clinical practice compounded by inconsistent outcome reporting in research studies. To address this paucity of evidence, we plan to develop a core outcome set for stillbirth care research, through an international consensus process with key stakeholders including parents, healthcare professionals and researchers., Methods and Analysis: The development of this core outcome set will be divided into five distinct phases: (1) Identifying potential outcomes from a mixed-methods systematic review and analysis of interviews with parents who have experienced stillbirth; (2) Creating a comprehensive outcome long-list and piloting of a Delphi questionnaire using think-aloud interviews; (3) Choosing the most important outcomes by conducting an international two-round Delphi survey including high-income, middle-income and low-income countries; (4) Deciding the core outcome set by consensus meetings with key stakeholders and (5) Dissemination and promotion of the core outcome set. A parent and public involvement panel and international steering committee has been convened to coproduce every stage of the development of this core outcome set., Ethics and Dissemination: Ethical approval for the qualitative interviews has been approved by Berkshire Ethics Committee REC Reference 12/SC/0495. Ethical approval for the think-aloud interviews, Delphi survey and consensus meetings has been awarded from the University of Bristol Faculty of Health Sciences Research Ethics Committee (Reference number: 116535). The dissemination strategy is being developed with the parent and public involvement panel and steering committee. Results will be published in peer-reviewed specialty journals, shared at national and international conferences and promoted through parent organisations and charities., Prospero Registration Number: CRD42018087748., Competing Interests: Competing interests: AW has received consulting fees from the Sillbirth CRE., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2022
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19. Parents' Active Role and ENgagement in The review of their Stillbirth/perinatal death 2 (PARENTS 2) study: a mixed-methods study of implementation.
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Burden C, Bakhbakhi D, Heazell AE, Lynch M, Timlin L, Bevan C, Storey C, Kurinczuk JJ, and Siassakos D
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- Female, Humans, Pregnancy, Focus Groups, Perinatal Mortality, Infant, Newborn, Parents, Perinatal Death prevention & control, Stillbirth, Peer Review, Health Care methods
- Abstract
Objective: When a formal review of care takes places after the death of a baby, parents are largely unaware it takes place and are often not meaningfully involved in the review process. Parent engagement in the process is likely to be essential for a successful review and to improve patient safety. This study aimed to evaluate an intervention process of parental engagement in perinatal mortality review (PNMR) and to identify barriers and facilitators to its implementation., Design: Mixed-methods study of parents' engagement in PNMR., Setting: Single tertiary maternity unit in the UK., Participants: Bereaved parents and healthcare professionals (HCPs)., Interventions: Parent engagement in the PNMR (intervention) was based on principles derived through national consensus and qualitative research with parents, HCPs and stakeholders in the UK., Outcomes: Recruitment rates, bereaved parents and HCPs' perceptions., Results: Eighty-one per cent of bereaved parents approached (13/16) agreed to participate in the study. Two focus groups with bereaved parents (n=11) and HCP (n=7) were carried out postimplementation to investigate their perceptions of the process.Overarching findings were improved dialogue and continuity of care with parents, and improvements in the PNMR process and patient safety. Bereaved parents agreed that engagement in the PNMR process was invaluable and helped them in their grieving. HCP perceived that parent involvement improved the review process and lessons learnt from the deaths; information to understand the impact of aspects of care on the baby's death were often only found in the parents' recollections., Conclusions: Parental engagement in the PNMR process is achievable and useful for parents and HCP alike, and critically can improve patient safety and future care for mothers and babies. To learn and prevent perinatal deaths effectively, all hospitals should give parents the option to engage with the review of their baby's death., Competing Interests: Competing interests: Authors include the chair and members of the national Perinatal Mortality Review Tool (PMRT) group., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2021
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20. Simulation TRaining for Operative vaginal Birth Evaluation: study protocol for an observational stepped-wedge interrupted time-series study (STROBE).
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O'Brien S, Lenguerrand E, Jordan S, Cornthwaite K, Burden C, Timlin L, and Siassakos D
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- Adult, Delivery, Obstetric methods, Female, Humans, Interrupted Time Series Analysis methods, Non-Randomized Controlled Trials as Topic, Observational Studies as Topic, Pregnancy, Research Design, Vagina, Delivery, Obstetric education, Obstetrics education, Simulation Training methods
- Abstract
Background: Operative vaginal birth is a common procedure used to expedite birth after full cervical dilatation where there is a clinical need to do so (15% of births in the UK in 2016). The acquisition of skills for operative vaginal birth is dependent on the exposure of junior obstetricians to situations in which they can undertake directly supervised learning from senior accouchers. The Royal College of Obstetricians and Gynaecologists has recently introduced the first structured course in operative vaginal birth. To date, there have been no attempts to determine the clinical impact of a structured training package for operative vaginal birth., Methods: The STROBE study is a quasi-experimental before-after interrupted time-series study of the effect of simulation training in operative vaginal birth for obstetricians on clinical outcomes of women and babies following operative vaginal birth. Similar to a stepped-wedge design, the intervention will be gradually implemented in all participating units but at different time periods. The primary outcome is failed operative vaginal birth with the first intended instrument. Secondary maternal outcomes are; use of second instrument to achieve operative vaginal birth, caesarean section, episiotomy, perineal trauma (1st, 2nd, 3rd, 4th degree tear), cervical tear requiring suturing, general anaesthesia and estimated blood loss. Secondary neonatal outcomes are; Apgar score at one, five, and ten minutes, Umbilical artery pH, shoulder dystocia, admission to Neonatal Intensive Care Unit and death within 28 days of birth. The analysis will be intention-to-treat (per unit) on the primary and secondary outcomes. The STROBE study received approval from the Health Research Authority and is sponsored by North Bristol NHS Trust. Results will be published in an open-access peer-reviewed medical journal within one year of completion of data gathering., Discussion: The STROBE study will help establish our understanding of the effectiveness of locally-delivered simulation training for operative vaginal birth. Robust evidence supporting the effectiveness of such an approach would add weight to the argument supporting regular, local training for junior obstetricians in operative vaginal birth., Trial Registration: ISRCTN11760611 05/03/2018 (retrospectively registered).
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- 2019
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21. PARENTS 2 Study: a qualitative study of the views of healthcare professionals and stakeholders on parental engagement in the perinatal mortality review-from 'bottom of the pile' to joint learning.
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Bakhbakhi D, Burden C, Storey C, Heazell AE, Lynch M, Timlin L, Gold K, and Siassakos D
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- Adult, Communication, Female, Focus Groups, Health Personnel education, Hospice Care, Hospital-Patient Relations, Hospitals, Maternity, Humans, Infant, Newborn, Interviews as Topic, Male, Patient Satisfaction, Physician-Patient Relations, Pregnancy, Qualitative Research, Surveys and Questionnaires, United Kingdom, Attitude of Health Personnel, Bereavement, Parents, Patient Participation, Perinatal Death prevention & control, Perinatal Mortality
- Abstract
Objective: Engaging bereaved parents in the review process that examines their care before and after a perinatal death might help parents deal with their grief more effectively and drive improvements in patient safety. The objective of this study is to explore whether healthcare professionals would accept or support parent engagement in the perinatal mortality review process., Design: Qualitative focus group interviews. Transcripts were analysed with an inductive thematic approach., Setting: Two geographically distinct tertiary maternity hospitals in the UK., Participants: Five focus groups were conducted with clinical staff including midwives, obstetricians, neonatologists, nursing staff and chaplaincy services., Results: Twenty-seven healthcare professionals unanimously agreed that parents' involvement in the perinatal mortality review process is useful and necessary. Six key themes emerged including: parental engagement; need for formal follow-up; critical structure of perinatal mortality review meeting; coordination and streamlining of care; advocacy for parents including role of the bereavement care lead; and requirement for training and support for staff to enable parental engagement., Conclusions: Healthcare professionals strongly advocated engaging bereaved parents in the perinatal mortality review: empowering parents to ask questions, providing feedback on care, helping generate lessons and providing them with the opportunity to discuss a summary of the review conclusions with their primary healthcare professional contact. The participants agreed it is time to move on from 'a group of doctors reviewing notes' to active learning and improvement together with parents, to enable better care and prevention of perinatal death., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
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22. PARENTS 2 study protocol: pilot of Parents' Active Role and ENgagement in the review of Their Stillbirth/perinatal death.
- Author
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Bakhbakhi D, Siassakos D, Storey C, Heazell A, Lynch M, Timlin L, and Burden C
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- Adult, Attitude of Health Personnel, Communication, Female, Focus Groups, Hospice Care, Hospitals, Humans, Infant, Newborn, Male, Patient Satisfaction, Physician-Patient Relations, Pilot Projects, Pregnancy, Qualitative Research, Research Design, Surveys and Questionnaires, Bereavement, Hospital-Patient Relations, Parents, Patient Participation, Perinatal Death, Stillbirth
- Abstract
Background: The perinatal mortality review meeting that takes place within the hospital following a stillbirth or neonatal death enables clinicians to learn vital lessons to improve care for women and their families for the future. Recent evidence suggests that parents are unaware that a formal review following the death of their baby takes place. Many would welcome the opportunity to feedback into the meeting itself. Parental involvement in the perinatal mortality review meeting has the potential to improve patient satisfaction, drive improvements in patient safety and promote an open culture within healthcare. Yet evidence on the feasibility of involving bereaved parents in the review process is lacking. This paper describes the protocol for the Parents' Active Role and Engangement iN the review of their Stillbirth/perinatal death study (PARENTS 2) , whereby healthcare professionals' and stakeholders' perceptions of parental involvement will be investigated, and parental involvement in the perinatal mortality review will be piloted and evaluated at two hospitals., Methods and Analysis: We will investigate perceptions of parental involvement in the perinatal mortality review process by conducting four focus groups. A three-round modified Delphi technique will be employed to gain a consensus on principles of parental involvement in the perinatal mortality review process. We will use three sequential rounds, including a national consensus meeting workshop with experts in stillbirth, neonatal death and bereavement care, and a two-stage anonymous online questionnaire. We will pilot a new perinatal mortality review process with parental involvement over a 6-month study period. The impact of the new process will be evaluated by assessing parents' experiences of their care and parents' and staff perceptions of their involvement in the process by conducting further focus groups and using a Parent Generated Index questionnaire., Ethics and Dissemination: This study has ethical approval from the UK Health Research Authority. We will disseminate the findings through national and international conferences and international peer-reviewed journals., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Published
- 2018
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23. [Cost-effectiveness of exenatide versus insulin glargine in Spanish patients with obesity and type 2 diabetes mellitus].
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Goodall G, Costi M, Timlin L, Reviriego J, Sacristán JA, Smith-Palmer J, and Dilla T
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- Cost-Benefit Analysis, Exenatide, Female, Humans, Insulin Glargine, Male, Middle Aged, Diabetes Mellitus, Type 2 complications, Hypoglycemic Agents economics, Hypoglycemic Agents therapeutic use, Insulin, Long-Acting economics, Insulin, Long-Acting therapeutic use, Obesity complications, Peptides economics, Peptides therapeutic use, Venoms economics, Venoms therapeutic use
- Abstract
Background and Objectives: Exenatide, a GLP-1 receptor agonist for adjuvant treatment of type 2 diabetes mellitus (T2DM), has been shown to be as effective as insulin glargine (IG) for reducing glycated hemoglobin levels combined with metformin or/and sulphonylureas. Exenatide is associated to weight reduction and a higher incidence of gastrointestinal adverse events. The objective of this study was to assess the cost-effectiveness of exenatide as compared to IG in obese patients with T2DM not achieving an adequate blood glucose control from the perspective of the Spanish healthcare system., Methods: Pharmacoeconomic model inputs were obtained from an obese subpopulation (BMI ≥ 30 k/m(2)) of an international, randomized, controlled clinical trial comparing exenatide with IG in poorly controlled T2DM patients, and were supplemented with country-specific data., Results: Exenatide was associated to improvements in life-years gained and quality-adjusted life years (QALYs) by 0.11 and 0.62 respectively versus IG. Direct costs were € 9,306 higher as compared to IG (€ 47,010 versus € 37,704, with increased pharmacy costs as the main driver). Exenatideís incremental cost-effectiveness ratio was € 15,068 per QALY gained versus IG., Conclusions: Exenatide was associated to greater clinical benefits and higher costs in obese T2DM patients as compared to IG. Considering a willingness-to-pay threshold of € 30,000 per QALY gained in the Spanish setting, exenatide represents an efficient option in comparison with IG., (Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.)
- Published
- 2011
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24. Cost-utility of exenatide once weekly compared with insulin glargine in patients with type 2 diabetes in the UK.
- Author
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Beaudet A, Palmer JL, Timlin L, Wilson B, Bruhn D, Boye KS, and Lloyd A
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- Cost-Benefit Analysis, Diabetes Complications economics, Exenatide, Female, Humans, Hypoglycemic Agents therapeutic use, Insulin administration & dosage, Insulin economics, Insulin therapeutic use, Insulin Glargine, Insulin, Long-Acting, Male, Middle Aged, Peptides therapeutic use, State Medicine, United Kingdom, Venoms therapeutic use, Diabetes Mellitus, Type 2 drug therapy, Hypoglycemic Agents administration & dosage, Hypoglycemic Agents economics, Insulin analogs & derivatives, Peptides administration & dosage, Peptides economics, Venoms administration & dosage, Venoms economics
- Abstract
Objective: To compare the cost-utility of exenatide once weekly (EQW) and insulin glargine in patients with type 2 diabetes in the United Kingdom (UK)., Research Design and Methods: The IMS CORE Diabetes Model was used to project clinical and economic outcomes for patients with type 2 diabetes treated with EQW or insulin glargine. Treatment effects and patient baseline characteristics (mean age: 58 years, mean glycohaemoglobin: 8.3%) were taken from the DURATION-3 study. Unit costs and health state utility values were derived from published sources. As the price of EQW is not yet known, the prices of two currently available glucagon-like peptide-1 products were used as benchmarks. To reflect diabetes progression, patients started on EQW switched to insulin glargine after 5 years. The analysis was conducted from the perspective of the UK National Health Service over a time horizon of 50 years with costs and outcomes discounted at 3.5%. Sensitivity analyses explored the impact of changes in input data and assumptions and investigated the cost utility of EQW in specific body mass index (BMI) subgroups., Main Outcome Measures: Incremental cost-effectiveness ratio (ICER) for EQW compared with insulin glargine., Results: At a price equivalent to liraglutide 1.2 mg, EQW was more effective and more costly than insulin glargine, with a base case ICER of £10,597 per quality-adjusted life-year (QALY) gained. EQW was associated with an increased time to development of any diabetes-related complication of 0.21 years, compared with insulin glargine. Three BMI subgroups investigated (<30, 30-35 and >35 kg/m(2)) reported ICERs for EQW compared with insulin glargine ranging from £9425 to £12,956 per QALY gained., Conclusions: At the prices investigated, the cost per QALY gained for EQW when compared with insulin glargine in type 2 diabetes in the UK setting, was within the range normally considered cost effective by NICE. Cost effectiveness in practice will depend on the final price of EQW and the extent to which benefits observed in short-term randomised trials are replicated in long-term use.
- Published
- 2011
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25. Cost-effectiveness of duloxetine: the Stress Urinary Incontinence Treatment (SUIT) study.
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Mihaylova B, Pitman R, Tincello D, van der Vaart H, Tunn R, Timlin L, Quail D, Johns A, and Sculpher M
- Subjects
- Adrenergic Uptake Inhibitors therapeutic use, Cohort Studies, Cost-Benefit Analysis, Duloxetine Hydrochloride, Female, Health Resources economics, Health Resources statistics & numerical data, Health Status Indicators, Humans, Internationality, Middle Aged, Multivariate Analysis, Outcome Assessment, Health Care, Propensity Score, Prospective Studies, Quality of Life psychology, Quality-Adjusted Life Years, Regression Analysis, Thiophenes therapeutic use, United Kingdom, Urinary Incontinence, Stress psychology, Women's Health, Adrenergic Uptake Inhibitors economics, Thiophenes economics, Urinary Incontinence, Stress drug therapy, Urinary Incontinence, Stress economics
- Abstract
Objective: To assess the cost-effectiveness of duloxetine compared with conservative therapy in women with stress urinary incontinence (SUI)., Methods: Cost and outcome data were taken from the Stress Urinary Incontinence Treatment (SUIT) study, a 12-month, prospective, observational, naturalistic, multicenter, multicountry study. Costs were assessed in UK pound and outcomes in quality adjusted life years using responses to the EuroQol (EQ-5D); numbers of urine leaks were also estimated. Potential selection bias was countered using multivariate regression and propensity score analysis., Results: Duloxetine alone, duloxetine in combination with conservative treatment, and conservative treatment alone were associated with roughly two fewer leaks per week compared with no treatment. Duloxetine alone and with conservative treatment for SUI were associated with incremental quality-adjusted life-years (QALYs) of about 0.03 over a year compared with no treatment or with conservative treatment alone. Conservative treatment alone did not show an effect on QALYs. None of the interventions appeared to have marked impacts on costs over a year. Depending on the form of matching, duloxetine either dominated or had an incremental cost-effectiveness ratio (ICER) below pound900 per QALY gained compared with no treatment and with conservative treatment alone. Duloxetine plus conservative therapy had an ICER below pound5500 compared with no treatment or conservative treatment alone. Duloxetine compared with duloxetine plus conservative therapy showed similar outcomes but an additional cost for the combined intervention., Conclusions: Although the limitations of the use of SUIT's observational data for this purpose need to be acknowledged, the study suggests that initiating duloxetine therapy in SUI is a cost-effective treatment alternative.
- Published
- 2010
- Full Text
- View/download PDF
26. Patient reported outcomes tools in an observational study of female stress urinary incontinence.
- Author
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van de Vaart H, Falconer C, Quail D, Timlin L, Manning M, Tincello D, and Tunn R
- Subjects
- Female, Humans, Longitudinal Studies, Middle Aged, Quality of Life, Severity of Illness Index, Surveys and Questionnaires, Urinary Incontinence, Stress diagnosis
- Abstract
Aims: To determine which patient characteristics, incontinence and non-incontinence related, are associated with the symptom severity scores of the Urogenital Distress Inventory (UDI) and the International Consultation on Incontinence Questionnaire Urinary Incontinence (ICIQ-UI); and to determine the association of both patient characteristics and symptom severity scores with quality-of-life scores of the Incontinence Impact Questionnaire (IIQ) and the Incontinence-Quality of Life (I-QOL) questionnaire., Methods: Women presenting with stress urinary incontinence (SUI) symptoms in primary and secondary care entered the Stress Urinary Incontinence Treatment Study (SUIT), an observational study evaluating the cost-effectiveness of duloxetine compared to other non-surgical treatments for SUI. At enrollment patients completed the UDI-6, the short form ICIQ-UI, the IIQ-7 and the I-QOL. Multivariate linear regressions were performed with the UDI-6, ICIQ-UI SF, IIQ-7, and I-QOL as outcomes., Results: The total number of incontinence episodes is the most significant explanatory variable of the two symptom questionnaire scores, but the UDI-6 score also reflects the type of incontinence. The variability of the condition-specific quality-of-life questionnaires is primarily explained by the symptom severity questionnaire scores. Although there is a high intercorrelation, both these symptom questionnaires independently contributed significantly to the IIQ-7 and I-QOL total scores., Conclusions: The UDI-6 and ICIQ-UI SF can be regarded as scientifically sound symptom questionnaires in UI evaluation; but they have differences. Since the UDI-6 and ICIQ-UI SF independently contribute to the quality-of-life scores, this suggests that in incontinence research symptom questionnaires should not focus only on incontinence, but on a broader range of urogenital symptoms., ((c) 2009 Wiley-Liss, Inc.)
- Published
- 2010
- Full Text
- View/download PDF
27. Patient characteristics impacting health state index scores, measured by the EQ-5D of females with stress urinary incontinence symptoms.
- Author
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Tincello D, Sculpher M, Tunn R, Quail D, van der Vaart H, Falconer C, Manning M, and Timlin L
- Subjects
- Antidiuretic Agents economics, Antidiuretic Agents therapeutic use, Comorbidity, Cost-Benefit Analysis, Cross-Cultural Comparison, Duloxetine Hydrochloride, Female, Humans, Longitudinal Studies, Middle Aged, Overweight epidemiology, Quality-Adjusted Life Years, Severity of Illness Index, Sickness Impact Profile, Thiophenes economics, Thiophenes therapeutic use, Treatment Outcome, Health Status Indicators, Urinary Incontinence, Stress economics, Urinary Incontinence, Stress psychology, Urinary Incontinence, Stress therapy
- Abstract
Objective: To describe the characteristics of women seeking treatment for symptoms of stress urinary incontinence (SUI) and to investigate the association of SUI symptoms with generic health-related quality of life (HRQoL) as measured by the EuroQol (EQ-5D) instrument., Methods: The Stress Urinary Incontinence Treatment (SUIT) study was a 12-month observational study in four European countries that evaluated the cost-effectiveness of duloxetine compared with other forms of nonsurgical intervention in the treatment of the symptoms of SUI. Four hundred thirty-one physicians observed women seeking treatment for their SUI, and recorded the care provided and the outcomes of that care at enrollment and at 3, 6 and 12 months afterward The impact of SUI on baseline HRQoL as expressed by the EQ-5D index score was assessed by linear and logistic regression., Results: Three thousand seven hundred sixty-two women were enrolled into SUIT, with the largest patient group from Germany. Overall, the majority of women were postmenopausal, had a mean age of 58.0 years, were not current smokers, and tended to be overweight (mean body mass index [BMI]=27.7 kg/m2), with at least one comorbidity. The health state index scores were significantly and independently influenced by the presence of comorbidity(ies) affecting quality of life, total number of stress and urge incontinence episodes, urinary incontinence subtype, comorbidity(ies) affecting incontinence, BMI, socioeconomic status, educational status, age, and country., Conclusion: This article describes the characteristics of patients at the SUIT enrollment visit, and demonstrates that the number of incontinence episodes has a significant impact on the EQ-5D index score.
- Published
- 2010
- Full Text
- View/download PDF
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