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World-class teaching and research that helps general practitioners and other health professionals deliver better care in the community.

  • Economic analysis of oral dexamethasone for symptom relief of sore throat: the UK TOAST study.

    18 May 2018

    OBJECTIVES: To undertake an economic analysis assessing the cost-effectiveness of a single dose of oral dexamethasone compared with placebo for the relief of sore throat. DESIGN: A UK-based, multicentre, two arm, individually randomised, double blind trial. SETTING AND POPULATION: Adults (≥18 years) with acute sore throat and painful swallowing judged to be infective in origin, recruited and randomised in primary care. INTERVENTION: a single dose of 10 mg oral dexamethasone compared with placebo given at primary care visit. MAIN OUTCOME: Incremental cost-effectiveness ratios (ICERs), cost per quality-adjusted symptom resolution using the EuroQol-five dimensions-five levels instrument, were estimated as part of a cost-utility analysis performed on an intention-to-treat cohort adopting a health payers perspective. RESULTS: Differences in health-related quality of life (HRQoL) over 7 days from baseline and at 24 hours in the dexamethasone compared with the placebo group (2.9% and 2.5% higher, respectively) were observed. After controlling for the baseline HRQoL imbalances, the economic impact of the intervention was not statistically significant: the quality-adjusted life year difference was -0.00005 (95% CI -0.0002 to 0.00011) equivalent to a loss in HRQoL of a half hour in the dexamethasone group. The average cost per patient associated in the dexamethasone and placebo groups in the basecase analysis was £73 and £69, respectively. In the basecase probabilistic analysis, the mean ICER was -£6440 (95% CI -£132 151 to £126 335) and the median ICER was -£304 (IQR-£5816 to £3877); suggesting considerable uncertainty. CONCLUSIONS AND RELEVANCE: The economic burden associated with sore throat is substantial and was estimated at £2.35 billion to the healthcare services payer based on reported resource use and 2015 UK unit costs. There is considerable uncertainty regarding the cost-effectiveness of a single dose of oral dexamethasone as a treatment strategy and therefore insufficient evidence to support its use in clinical practice. TRIAL REGISTRATION NUMBER: ISRCTN17435450; Post-results.

  • Problems people with dementia have with kitchen tasks: The challenge for pervasive computing

    23 April 2018

    Technologies from pervasive computing can be used to ameliorate the difficulties that people with dementia have with multi-step tasks. This paper is intended to inform the design of technologies that help people perform daily tasks, by prompting them when they have difficulties, thus fostering independence and quality of life. Six people with mild to moderate dementia were video recorded performing activities of their own choosing in the familiar context of their own kitchens. In total there were 22 video recordings. Activities included making a cup of tea or coffee, a bowl of soup, beans on toast, or coffee with toast. The video recordings were transcribed using an adapted version of the Action Coding System. Incidents, where prompting was judged to be needed were categorised using a data-driven analysis as problems in: Sequencing (intrusion, omission and repetition), Finding things (locating and identifying), Operation of appliances, and Incoherence (toying and inactivity). Detailed examples of each type of incident, and the contexts in which it occurred, are provided as a resource for the design of pervasive computing solutions. What needs to be detected and what form prompts might take is specified for each category. © 2010 Elsevier B.V. All rights reserved.