effectiveness

12 07, 2019

Paper of the Week 12th July 2019: Why are we wasting precious resources to deliver low value at the end of life?

2019-07-12T10:02:02+00:00

Warraich, H. J., & Meier, D. E. (2019). Serious-Illness Care 2.0 — Meeting the Needs of Patients with Heart Failure. New England Journal of Medicine, 380(26), 2492–2494. https://doi.org/10.1056/NEJMp1900584 WEB LINK TO PAPER   This week's paper of the week is brought to you by Dr Tim Wilson, Managing Director   Authors conclusion Heart failure is the most common cause of hospitalizations among elderly Americans, and despite much medical and scientific progress, it remains a source of substantial suffering, expense, and caregiver burden. Palliative care can improve quality of life, symptoms, and functioning for people with serious illnesses, and a recent observational study in patients with heart failure showed that enrollment in home hospice was associated with fewer emergency [...]

Paper of the Week 12th July 2019: Why are we wasting precious resources to deliver low value at the end of life?2019-07-12T10:02:02+00:00
5 07, 2019

Paper of the Week 5th July 2019: The inverse care law continues to thrive in the NHS for vascular surgery (and probably more)

2019-07-05T17:19:32+00:00

Giuseppe Moscelli, Luigi Siciliani, Nils Gutacker, Richard Cookson (2018) Socioeconomic inequality of access to healthcare: Does choice explain the gradient? Journal of Health Economics, 57, 290–314.   This week's blog is brought to you by: Dr Tim Wilson   Bottom Line For planned vascular surgery, there is inequity in NHS provision for people living in the poorest and wealthiest neighbourhoods, representing an addressable cause of lower value.   Authors conclusion Equity of access is a key policy objective in publicly-funded healthcare systems. However, observed inequalities of access by socioeconomic status may result from differences in patients’ choices. Using data on non-emergency coronary revascularisation procedures in the English National Health Service, we found substantive differences in waiting times within [...]

Paper of the Week 5th July 2019: The inverse care law continues to thrive in the NHS for vascular surgery (and probably more)2019-07-05T17:19:32+00:00
28 06, 2019

Paper of the Week 28th June 2019: The Precision of Evidence Needed to Practice “Precision Medicine”

2019-06-28T12:29:34+00:00

    This weeks Paper of the Week is brought to you by: Professor Sir Muir Gray   Author’s Conclusion “In July 2018, the Journal published the results of TAILORx (Trial Assigning Individualized Option for Treatment).1 This randomized trial conducted by Sparano et al. showed the noninferiority of endocrine therapy to chemoendocrine therapy with respect to invasive disease–free survival among women with hormone-receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative, axillary node–negative breast cancer who had a recurrence score (based on a 21-gene assay) of 11 to 25 (scores range from 0 to 100, with higher scores predicting a higher risk of distant recurrence)… Less than a year later, we are publishing additional results from the same data [...]

Paper of the Week 28th June 2019: The Precision of Evidence Needed to Practice “Precision Medicine”2019-06-28T12:29:34+00:00
21 06, 2019

Paper of the Week 21st June 2019: What Are Polygenic Scores and Why Are They Important?

2019-06-21T09:24:07+00:00

Full reference: Sugrue L.P. and Rahul S. Desikan, R.S JAMA May 14, 2019 Volume 321, Number 18 1820 -1821 This weeks blog is brought to you by: Professor Sir Muir Gray WEB LINK TO PAPER Authors conclusion - Text from the paper chosen by 3VH Value “The value of polygenic risk scores cannot be assessed until the clinical utility has been established through research studies that evaluate their use in clinical practice and therapeutic trials. Companies are already offering these tests directly to consumers at costs ranging from one to a few hundred dollars. As whole-exomesequencing and whole genomesequencing become less expensive and more widely available, it should be possible to compute any polygenic score from an individual’s [...]

Paper of the Week 21st June 2019: What Are Polygenic Scores and Why Are They Important?2019-06-21T09:24:07+00:00
14 06, 2019

Paper of the Week: The health equity measurement framework: a comprehensive model to measure social inequities in health

2019-06-14T11:26:50+00:00

Full reference: Dover D.C. and Belon A.P.(2019) International Journal for Equity in Health 18;36 WEB LINK TO PAPER   This weeks blog is brought to you by: Professor Sir Muir Gray, Founding Director   Authors conclusion; Text from the paper chosen by 3VH. This paper presented a complex, overarching measurement framework for health equity.  The HEMF is a synthesis of existing SDOH (Social Determinants of Health) and health system utilisation frameworks and current literature.  Yet, its purpose extends to focus on measurement. It is specifically designed to help identify and measure the interrelationships between political and socio-cultural context, health system-related policies and programs, material and social circumstances, environment, biological and psychosocial factors, perceived and evaluated needs, social location, [...]

Paper of the Week: The health equity measurement framework: a comprehensive model to measure social inequities in health2019-06-14T11:26:50+00:00
7 06, 2019

Paper of the Week: Optimality in cancer redefined for the 21st century

2019-06-07T08:00:07+00:00

This weeks blog is brought to you by: Sir Muir Gray, Founding Director   Authors conclusion “I’ve always had a peculiar fascination for the receiver-operating characteristic (ROC) curve. As a researcher, I appreciate that the area under the curve can be precisely mapped, so that different screening or diagnostic tests can be meaningfully compared. This lovely interweaving of my clinical and academic perspectives took an unexpected turn just over a year ago, when I was diagnosed with breast cancer. I hadn’t reckoned on the price of treatment. The complications. The treatment of complications. The side effects of the treatment of complications. The sepsis. The relapsing, migratory pneumonia from radiation-induced lung injury. The sleep deprivation, agitation, and bone loss [...]

Paper of the Week: Optimality in cancer redefined for the 21st century2019-06-07T08:00:07+00:00
29 05, 2019

Paper of the Week: Knights and Knaves; even with the “wrong” incentives, most clinicians exhibit a culture of stewardship

2019-05-29T12:35:12+00:00

Full reference: Guida, S. et al Testing the myth of fee‐for‐service and overprovision in health care. Health Economics. 2019;28:717–722. This week's paper of the week is brought to you by Dr Tim Wilson, Managing Director   Bottom line When it comes to improving value-based population health, nurturing a culture of stewardship reminds more important than clever design of payment systems. This study shows that the wrong payment system might increase over-provision of care. But importantly, because of an inherent culture of stewardship, patient value and system sustainability trump personal financial gain. Summary from authors We observe that decreasing the fee size has an effect on over-provision under both market conditions. We also observe that patients who are harmed [...]

Paper of the Week: Knights and Knaves; even with the “wrong” incentives, most clinicians exhibit a culture of stewardship2019-05-29T12:35:12+00:00
26 04, 2019

Paper of the Week: 26th April 2019: Shared Decision Making and the Importance of Time

2019-04-26T12:46:40+00:00

  For many professionals, and almost all patients , the value of time is more precious than money Full reference: Pieterse A.M., Stiggelbout A.M.,  Montori V.M. JAMA. Published online April 19, 2019. doi:10.1001/jama.2019.3785 This weeks Paper of the Week is brought to you by Sir Muir Gray, Founding Director. WEB LINK TO PAPER Authors conclusion “health care professionals, patient advocates, health care systems, and policy makers need to recognise that time is not simply a resource, its minutes indifferent and interchangeable like dollars or euros. A minute spent in providing information may turn out to be less important than a minute spent waiting silently for patient questions, or a minute responding emphatically to angst and loss, or a [...]

Paper of the Week: 26th April 2019: Shared Decision Making and the Importance of Time2019-04-26T12:46:40+00:00
11 04, 2019

Paper of the Week: 11.04.2019: Breast Cancer Treatment, what to start, what to stop?

2019-04-11T17:36:53+00:00

Full Reference: Overall Survival with Fulvestrant plus Anastrozole in Metastatic Breast Cancer, Rita S. Mehta, Et al, N Engl J Med 2019; 380:1226-1234, DOI: 10.1056/NEJMoa1811714 Web link to Paper  This week’s blog is brought to you by: Dr Tim Wilson Authors conclusion In this trial, we found that combination therapy with anastrozole plus fulvestrant significantly prolonged, as compared with treatment with anastrozole alone, the primary and secondary end points of progression-free survival (P=0.007) and long-term overall survival (P=0.03) when used as first-line therapy for hormone-receptor–positive metastatic breast cancer in postmenopausal women. 3VH - Implications for value Another promising treatment emerges for breast cancer. Not a cure, but one that prolongs survival from 42 to 49.8 months in women [...]

Paper of the Week: 11.04.2019: Breast Cancer Treatment, what to start, what to stop?2019-04-11T17:36:53+00:00
21 03, 2019

Paper of the Week 21.03.2019: Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years

2019-03-21T16:17:14+00:00

  This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V's Founding Director. Bottom line, chosen by Muir from the paper Among patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis. The conclusion is This study shows that in the case of CABG more in healthcare is often no better. Once again Avedis Donabedian’s illustration about optimality has been demonstrated. Implications for value improvement  This is another example of the principle first described by Avedis Donabedian and expressed through his diagrammatic representation [...]

Paper of the Week 21.03.2019: Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years2019-03-21T16:17:14+00:00
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