Search

Background Back pain and musculoskeletal conditions negatively affect the health-related quality of life (HRQL) of employees and generate substantial costs to employers. Aims To assess the cost-effectiveness of yoga for managing musculoskeletal conditions. Methods A randomized controlled trial evaluated an 8-week yoga programme, with a 6-month follow-up, for National Health Service (NHS) employees. Effectiveness in managing musculoskeletal conditions was assessed using repeated-measures generalized linear modelling for the Roland-Morris Disability Questionnaire (RDQ) and the Keele STarT Back Screening Tool. Cost-effectiveness was determined using area-under-the-curve linear regression for assessing HRQL from healthcare and societal perspectives. The incremental cost per quality-adjusted life year (QALY) was also calculated. Sickness absence was measured using electronic staff records at 6 months. Results There were 151 participants. At 6 months, mean differences between groups favouring yoga were observed for RDQ [-0.63 (95% CI, -1.78, 0.48)], Keele STarT [-0.28 (95% CI, -0.97, 0.07)] and HRQL (0.016 QALY gain). From a healthcare perspective, yoga yielded an incremental cost-effectiveness ratio of £2103 per QALY. Given a willingness to pay for an additional QALY of £20 000, the probability of yoga being cost-effective was 95%. From a societal perspective, yoga was the dominant treatment compared with usual care. At 6 months, electronic staff records showed that yoga participants missed a total of 2 working days due to musculoskeletal conditions compared with 43 days for usual care participants. Conclusions Yoga for NHS employees may enhance HRQL, reduce disability associated with back pain, lower sickness absence due to musculoskeletal conditions and is likely to be cost-effective. [ABSTRACT FROM AUTHOR]

Background Since the global financial crisis, UK NHS spending has reduced considerably. Respiratory care is a large cost driver for Betsi Cadwaladr University Health Board, the largest health board in Wales. Under the remit of 'prudent healthcare' championed by the Welsh Health Minister, a Programme Budgeting Marginal Analysis (PBMA) of the North Wales respiratory care pathway was conducted. Methods A PBMA panel of directors of medicines management, therapies finance, planning, public health and healthcare professionals used electronic voting to establish criteria for decision-making and vote on candidate interventions in which to disinvest and invest. Results A sum of £86.9 million was spent on respiratory care in 2012-13. Following extensive discussion of 13 proposed candidate interventions facilitated by a chairperson, 4 candidates received recommendations to disinvest, 7 to invest and 2 to maintain current activity. Marginal analysis prioritized mucolytics and high antibiotic prescribing as areas for disinvestment, and medicines waste management and pulmonary rehabilitation for investment. Conclusions This exercise demonstrates the potential for health boards to use evidence-based approaches to reach potentially controversial disinvestment and investment decisions. Initial progress has begun with communication from the Medical Director in relation to the disinvestment in mucolytics prescribing and possible redirection of funding options being explored. [ABSTRACT FROM AUTHOR]

Background Stress and back pain are two key factors leading to sickness absence at work. Recent research indicates that yoga can be effective for reducing perceived stress, alleviating back pain, and improving psychological well-being. Aims To determine the effectiveness of a yoga-based intervention for reducing perceived stress and back pain at work. Methods Participants were recruited from a British local government authority and randomized into a yoga group who received one 50min Dru Yoga session each week for 8 weeks and a 20min DVD for home practice and a control group who received no intervention. Baseline and end-programme measurements of self-reported stress, back pain and psychological well-being were assessed with the Perceived Stress Scale, Roland Morris Disability Questionnaire and the Positive and Negative Affect Scale. Results There were 37 participants in each group. Analysis of variance and multiple linear regression showed that in comparison to the control group, the yoga group reported significant reductions in perceived stress and back pain, and a substantial improvement in psychological well-being. When compared with the control group at the end of the programme, the yoga group scores were significantly lower for perceived stress, back pain, sadness and hostility, and substantially higher for feeling self-assured, attentive and serene. Conclusions The results indicate that a workplace yoga intervention can reduce perceived stress and back pain and improve psychological well-being. Larger randomized controlled trials are needed to determine the broader efficacy of yoga for improving workplace productivity and reducing sickness absence. [ABSTRACT FROM PUBLISHER]

tempo2 is a new software package for the analysis of pulsar pulse times of arrival. In this paper, we describe in detail the timing model used bytempo2, and discuss limitations on the attainable precision. In addition to the intrinsic slow-down behaviour of the pulsar,tempo2 accounts for the effects of a binary orbital motion, the secular motion of the pulsar or binary system, interstellar, Solar system and ionospheric dispersion, observatory motion (including Earth rotation, precession, nutation, polar motion and orbital motion), tropospheric propagation delay, and gravitational time-dilation due to binary companions and Solar system bodies. We believe that the timing model is accurate in its description of predictable systematic timing effects to better than 1 ns, except in the case of relativistic binary systems where further theoretical development is needed. The largest remaining sources of potential error are measurement error, interstellar scattering, Solar system ephemeris errors, atomic clock instability and gravitational waves. [ABSTRACT FROM AUTHOR]

Contemporary pulsar-timing experiments have reached a sensitivity level where systematic errors introduced by existing analysis procedures are limiting the achievable science. We have developedtempo2, a new pulsar-timing package that contains propagation and other relevant effects implemented at the 1-ns level of precision (a factor of ∼100 more precise than previously obtainable). In contrast with earlier timing packages,tempo2 is compliant with the general relativistic framework of the IAU 1991 and 2000 resolutions and hence uses the International Celestial Reference System, Barycentric Coordinate Time and up-to-date precession, nutation and polar motion models.tempo2 provides a generic and extensible set of tools to aid in the analysis and visualization of pulsar-timing data. We provide an overview of the timing model, its accuracy and differences relative to earlier work. We also present a new scheme for predictive use of the timing model that removes existing processing artefacts by properly modelling the frequency dependence of pulse phase. [ABSTRACT FROM AUTHOR]

Two hundred and eighty-eight patients with colorectal cancer over the age of 65 years admitted to either the geriatric unit or a surgical unit have been compared. Significant differences in presentation and outcome were found and are discussed. Despite adverse factors, acceptable results were obtained for surgical treatment in the geriatric group. [ABSTRACT FROM PUBLISHER]

A US company is now marketing worldwide, via the Internet, genetic testing for predisposition to breast and ovarian cancer. This paper explores some of the divergent concerns about the implications of private genetic testing for the United States and United Kingdom, with their differing health care systems. As the UK National Health Service faces calls for expansion in its genetic services to meet growing demand, there is now a need for evaluation of the costs and effectiveness of such services so that they may be efficiently targeted to those women who can benefit most from them. In the cases of breast and ovarian cancer, it is relatively straightforward to calculate the benefits in terms of added life expectancy and health-related quality of life resulting from earlier diagnosis and treatment of affected women, but these women are likely to be a small proportion of the total number of women who are referred or self-refer to genetic services. This paper asks how we are to measure and value the benefits of information about risk of cancer to a particular woman or to members of her family; how we are to measure and value the benefits of effective counselling, which encourages autonomous, informed decision-making about whether or not to undergo genetic testing, and which facilitates comprehension of complex results; and ultimately, in the face of advances in genetic science, how we are to steer the NHS around the genetic iceberg. [ABSTRACT FROM PUBLISHER]