ORCID Profile
0000-0002-6546-3685
Current Organisations
University of Manchester
,
The University of Edinburgh
,
University College Dublin
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Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.JCLINEPI.2010.01.010
Abstract: A survey of randomized controlled trials found that almost a quarter of trials had more than 10% of responses missing for the primary outcome. There are a number of ways in which data could be missing: the subject is unable to provide it, or they withdraw, or become lost to follow-up. Such attrition means that balance in baseline characteristics for those randomized may not be maintained in the subs le who has outcome data. For in idual trials, if the attrition is systematic and linked to outcome, then this will result in biased estimates of the overall effect. It then follows that if such trials are combined in a meta-analysis, it will result in a biased estimate of the overall effect and be misleading. The aim of this study was to investigate the impact of attrition on baseline imbalance within in idual trials and across multiple trials. In this article, we used in idual patient data from a convenience s le of 10 trials evaluating interventions for the treatment of musculoskeletal disorders. Meta-analyses using the mean difference at baseline between the trial arms were carried out using in idual patient data from these trials. The analyses were first carried out using all randomized participants and secondly only including participants with outcome data on the quality-of-life score. Meta-regression was carried out to evaluate whether the level of baseline imbalance was associated with the level of attrition. The overall attrition rates for the quality-of-life score ranged between 4% and 28% of the total randomized patients. All trials showed some level of differential attrition between the treatment arms, ranging from 1% to 14%. Attrition within the control group ranged from 3% to 25% and within the intervention group, it ranged from 0% to 31%. For in idual trials, there was no indication that attrition altered the results in favor of either the treatment or the control. Forest plots highlighted that the attrition had some impact on the baseline imbalance for the primary outcome score as more heterogeneity was introduced (I-squared value of 0.4% for the initial data set vs. I-squared value of 16.9% for the analyzed data set). However, the standardized mean difference increased only slightly (from 0.01 to 0.03 with 95% confidence interval [CI]: -0.05, 0.10). Meta-regression showed little or no evidence of a significant dose-response relationship between the level of attrition and the baseline imbalance (coefficient 0.73, 95% CI: -0.81, 2.28). Although, in theory, attrition can introduce selection bias in randomized trials, we did not find sufficient evidence to support this claim in our convenience s le of trials. However, the number of trials included was relatively small, which may have led to small but important differences in outcomes being missed. In addition, only 2 of 10 trials included had attrition levels greater than 15% suggesting a low level of potential bias. Meta-analyses and systematic reviews should always consider the impact of attrition on baseline imbalances and where possible any baseline imbalances in the analyzed data set and their impact on the outcomes reported.
Publisher: Elsevier BV
Date: 02-2009
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.IJNURSTU.2011.10.014
Abstract: To undertake a systematic review of the effectiveness of pressure redistributing support surfaces in the prevention of pressure ulcers. Systematic review and meta-analysis. Cochrane Wound Group Specialised Register, The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL. The reference sections of included trials were searched for further trials. Randomised controlled trials and quasi-randomised trials, published or unpublished, which assessed the effects of support surfaces in preventing pressure ulcers (of any grade), in any patient group, in any setting compared to any other support surface, were sought. Two reviewers extracted and summarised details of eligible trials using a standardised form and assessed the methodological quality of each trial using the Cochrane risk of bias tool. Fifty-three eligible trials were identified with a total of 16,285 study participants. Overall the risk of bias in the included trials was high. Pooled analysis showed that: (i) foam alternatives to the standard hospital foam mattress reduce the incidence of pressure ulcers in people at risk (RR 0.40, 95% CI 0.21-0.74) and Australian standard medical sheepskins prevent pressure ulcers compared to standard care (RR 0.48, 95% CI 0.31-0.74). Pressure-redistributing overlays on the operating table compared to standard care reduce postoperative pressure ulcer incidence (RR 0.53, 95% CI 0.33-0.85). While there is good evidence that higher specification foam mattresses, sheepskins, and that some overlays in the operative setting are effective in preventing pressure ulcers, there is insufficient evidence to draw conclusions on the value of seat cushions, limb protectors and various constant low pressure devices. The relative merits of higher-tech constant low pressure and alternating pressure for prevention are unclear. More robust trials are required to address these research gaps.
Publisher: FapUNIFESP (SciELO)
Date: 10-2015
Publisher: Wiley
Date: 17-02-2015
Publisher: John Wiley & Sons, Ltd
Date: 27-08-2014
Publisher: John Wiley & Sons, Ltd
Date: 18-10-2014
Publisher: Wiley
Date: 16-08-2021
Publisher: Wiley
Date: 07-05-2021
Publisher: Hindawi Limited
Date: 29-04-2022
DOI: 10.1111/JONM.13638
Publisher: Wiley
Date: 26-03-2019
Publisher: Wiley
Date: 26-07-2021
DOI: 10.1111/JAN.14989
Abstract: Frontline nurses’ willingness to work has significant implications for maintaining workforce stability and quality of care during the COVID‐19 pandemic however, few studies have investigated their willingness and the corresponding reasons. This study aims to examine frontline nurses’ willingness to work, identify its predictors and explore its corresponding reasons. A mixed‐methods design was conducted. Based on a multilevel behavioural‐diagnostic model, a questionnaire survey was used to collect quantitative and qualitative data concurrently from 13 February to 24 February 2020 to explore frontline nurses’ willingness to work and the corresponding reasons in two hospitals in Wuhan, China. One was a designated hospital which only received COVID‐19 patients, and the other was built up temporarily for COVID‐19 patients. Of the 2014 participants, most ( n = 1950, 96.8%) indicated their willingness to work, and a few ( n = 64, 3.2%) expressed their unwillingness. Binary logistic regression analysis identified five predictors of participants’ willingness to work, including monthly family income, average working hours per shift, belief in their colleagues’ preparedness, belief in their hospitals’ preparedness and levels of depression. These indicators explained 27% of the variance ( p .05). Frontline nurses’ willingness to work mainly arose from professional commitment, patriotism and faith, while unwillingness to do so primarily stemmed from safety concerns and family responsibility. Most frontline nurses were willing to work and showed great professional commitment. Professional commitment and patriotism were two important in idual‐level factors affecting frontline nurses’ willingness to work during a pandemic. Strategies should be implemented, such as appreciating and acknowledging their contribution, rewarding their valuable work, arranging reasonable working hours, enhancing colleagues’ and hospitals’ preparedness, and providing emotional support. Moreover, adequate personal protective equipment, self‐protection training and social support should be ensured to address frontline nurses’ safety concerns and family responsibility.
Publisher: Wiley
Date: 19-05-2020
Publisher: Wiley
Date: 19-05-2020
Publisher: John Wiley & Sons, Ltd
Date: 29-07-2014
Publisher: Oxford University Press (OUP)
Date: 08-01-2007
Abstract: Rapid Access Chest Pain Clinics have recently been introduced to assist in the management of primary care patients experiencing suspected cardiac chest pain. To study the longer term outcome for patients referred to a Rapid Access Chest Pain Clinic and then given a non-cardiac diagnosis. The study collected retrospective data from a cohort of all patients attending the Rapid Access Chest Pain Clinic based in the cardiorespiratory Department at the York District Hospital, England. Questionnaires were sent to all patients who attended the Rapid Access Chest Pain Clinic during the previous 14 months and were diagnosed with non-cardiac chest pain. Participants reported on their chest pain, subsequent episodes of primary and secondary care and their beliefs about causation of pain. Of the patients referred to the Rapid Access Chest Pain Clinic, 235 (52%) did not have cardiac chest pain. Of these patients, 161 (69%) returned the questionnaire, nearly half of whom reported ongoing chest pain. The mean time since Clinic attendance was approximately 8 months and the median duration of ongoing chest pain was 5.4 months. Women were twice as likely as men to continue to be experiencing pain but did not report more frequent or severe pain on average. More than 50% of the non-cardiac group were not convinced by their negative cardiac diagnosis. There is an ongoing challenge to support patients with non-cardiac chest pain, including the provision of reassurance that their pain is very unlikely to be caused by their heart.
Publisher: Wiley
Date: 19-05-2020
Publisher: Wiley
Date: 03-09-2015
Publisher: John Wiley & Sons, Ltd
Date: 08-10-2008
Publisher: Wiley
Date: 06-05-2021
Publisher: Wiley
Date: 10-05-2021
Publisher: Wiley
Date: 20-10-2020
Publisher: Wiley
Date: 19-05-2020
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.IJNURSTU.2012.05.008
Abstract: To examine the effects on healing of pressure relieving support surfaces in the treatment of pressure injury. Systematic review. Cochrane Wound Group Specialised Register, The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL. The reference sections of included trials were searched for further trials. Randomised controlled trials, published or unpublished, assessing the effect of support surfaces in treating all pressure injuries were sought. All included studies had to have reported objective measures of pressure injury healing. Where possible, findings from in idual trials were calculated using risk ratio estimates or mean difference with 95% confidence intervals. Eighteen eligible trials involving 1309 participants were identified. There was no statistically significant effect on pressure injury size with low air loss devices compared with foam alternatives. One small trial at high risk of bias found that sheepskin positioned under the legs significantly reduced redness and a very small subgroup analysis favoured a profiling bed when compared with a standard bed in terms of the healing of grade 1 pressure injuries. Overall, there was an absence of good evidence to support the superiority of any pressure relieving device in the treatment of pressure injuries. This review highlights that the current evidence base requires improving by undertaking robust trials to ascertain which support surfaces are most effective for the treatment of pressure injuries.
Publisher: Wiley
Date: 21-05-2015
Publisher: Wiley
Date: 06-05-2021
Publisher: BMJ
Date: 2022
DOI: 10.1136/BMJOPEN-2021-056790
Abstract: To estimate and examine the direct healthcare costs of treating people with open venous leg ulcers in the UK. Cost-of-illness study. A cross-sectional survey of nine National Health Service community locales over 2-week periods in 2015/2016. We examined the resource use and prevalence of venous leg ulcer treatment in the community. Examination of variation in these obtained costs was performed by ordinary least squares regression. We used additional resource use information from a randomised control trial and extrapolated costs to the UK for an annual period. The average 2-week per person cost of treating patients where a venous leg ulceration was the primary (most severe) wound was estimated at £166.39 (95% CI £157.78 to £175.00) with community staff time making up over half of this amount. Costs were higher where antimicrobial dressings were used and where wound care was delivered in the home. Among those with any recorded venous leg ulcer (primary and non-primary), we derived a point prevalence of 3.2 per 10 000 population and estimated that the annual prevalence could be no greater than 82.4 per 10 000 population. We estimated that the national cost of treating a venous leg ulcer was £102 million with a per person annual cost at £4787.70. Our point prevalence figures are in line with the literature. However, our annual prevalence estimations and costs are far lower than those reported in recent literature which suggests that the costs of treating venous leg ulcers are lower than previously thought. Movement towards routinely collected and useable community care activity would help provide a transparent and deeper understanding of the scale and cost of wound care in the UK.
Publisher: Wiley
Date: 10-05-2021
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: Ireland
No related grants have been discovered for Jo Dumville.