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Purpose To determine the incremental cost-effectiveness of portable electronic vision enhancement system (p- EVES) devices compared with optical low vision aids ( LVAs), for improving near vision visual function, quality of life and well-being of people with a visual impairment. Methods An AB/ BA randomized crossover trial design was used. Eighty-two participants completed the study. Participants were current users of optical LVAs who had not tried a p- EVES device before and had a stable visual impairment. The trial intervention was the addition of a p- EVES device to the participant's existing optical LVA(s) for 2 months, and the control intervention was optical LVA use only, for 2 months. Cost-effectiveness and cost-utility analyses were conducted from a societal perspective. Results The mean cost of the p- EVES intervention was £448. Carer costs were £30 (4.46 hr) less for the p- EVES intervention compared with the LVA only control. The mean difference in total costs was £417. Bootstrapping gave an incremental cost-effectiveness ratio (ICER) of £736 (95% CI £481 to £1525) for a 7% improvement in near vision visual function. Cost per quality-adjusted life year ( QALY) ranged from £56 991 (lower 95% CI = £19 801) to £66 490 (lower 95% CI = £23 055). Sensitivity analysis varying the commercial price of the p- EVES device reduced ICERs by up to 75%, with cost per QALYs falling below £30 000. Conclusion Portable electronic vision enhancement system (p- EVES) devices are likely to be a cost-effective use of healthcare resources for improving near vision visual function, but this does not translate into cost-effective improvements in quality of life, capability or well-being. [ABSTRACT FROM AUTHOR]

Background: Joint reminiscence groups, involving people with dementia and family carers together, are popular, but the evidence-base is limited. This study aimed to assess the effectiveness and cost-effectiveness of joint reminiscence groups as compared to usual care. Methods: This multi-centre, pragmatic randomised controlled trial had two parallel arms: intervention group and usual-care control group. A restricted dynamic method of randomisation was used, with an overall allocation ratio of 1:1, restricted to ensure viable sized intervention groups. Assessments, blind to treatment allocation, were carried out at baseline, three months and ten months (primary end-point), usually in the person's home. Participants were recruited in eight centres, mainly through NHS Memory Clinics and NHS community mental health teams. Included participants were community resident people with mild to moderate dementia (DSM-IV), who had a relative or other care-giver in regular contact, to act as informant and willing and able to participate in intervention. 71% carers were spouses. 488 people with dementia (mean age 77.5)were randomised: 268 intervention, 220 control; 350 dyads completed the study (206 intervention, 144 control). The intervention evaluated was joint reminiscence groups (with up to 12 dyads) weekly for twelve weeks; monthly maintenance sessions for further seven months. Sessions followed a published treatment manual and were held in a variety of community settings. Two trained facilitators in each centre were supported by volunteers. Primary outcome measures were self-reported quality of life for the person with dementia (QoL-AD), psychological distress for the carer (General Health Questionnaire, GHQ-28). Secondary outcome measures included: autobiographical memory and activities of daily living for the person with dementia; carer stress for the carer; mood, relationship quality and service use and costs for both. Results: The intention to treat analysis (ANCOVA) identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes (self-reported QoL-AD mean difference 0.07 (-1.21 to 1.35), F = 0.48, p = 0.53). Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a General Health Questionnaire-28 sub-scale at the ten month end-point (mean difference 1.25 (0.25 to 2.26), F = 8.28, p = 0.04). Compliance analyses suggested improved autobiographical memory, quality of life and relationship quality for people with dementia attending more reminiscence sessions, however carers attending more groups showed increased care-giving stress. Economic analyses from a public sector perspective indicated that joint reminiscence groups are unlikely to be cost-effective. There were no significant adverse effects attributed to the intervention. Potential limitations of the study include less than optimal attendance at the group sessions—only 57% of participants attended at least half of the intervention sessions over the 10 month period, and a higher rate of study withdrawal in the control group. Conclusions: This trial does not support the clinical effectiveness or cost-effectiveness of joint reminiscence groups. Possible beneficial effects for people with dementia who attend sessions as planned are offset by raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further, and may necessitate reappraisal of the movement towards joint interventions. Trial Registration: ISRCTN Registry [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To evaluate the effectiveness of a parenting / programme as a preventive intervention with parents of preschool children considered to be at risk of developing- conduct disorder. 'Design Pragmatic randomised controlled trial using a ~ block design with allocation by area. Setting Eleven Sure Start areas in north and mid-Wales. Participants 153 parents from socially disadvantaged areas,- with children aged 36-59 months at risk of conduct disorder defined by scoring over the clinical cut off on the Eyberg child behaviour inventory. Participants were randomised on a 2:1 basis, 104 to intervention and 49 to remaining on the wait listing (control). Twenty (13%) were lost to follow-up six months later, 18 from the intervention group. Intervention The Webster-Stratton Incredible Years basic parenting programme, a 12 week group based intervention. Main outcome measures Problem behaviour in children and parenting skills assessed by self reports from parents and by direct observation in the home. Parents' self reported parenting competence, stress, and depression. Standardised and well validated instruments were used throughout. Results At follow-up, most of the measures of parenting and problem behaviour in children showed significant improvement in the intervention group. The intention to treat analysis for the primary outcome measure, the Eyberg child behaviour inventory, showed a mean difference between groups of 4. 4 points (95% confidence interval 2. 0 to 6. 9, P<0. 001) on the problem scale with an effect size of 0. 63, and a mean difference of 25. 1 (14. 9 to 35. 2, P<0. 001) on the intensity scale with an effect size of 0. 89. Conclusion This community based study showed the effectiveness of an evidence based parenting intervention delivered with fidelity by regular Sure Start staff. It has influenced policy within Wales and provides lessons for England where, to date, Sure Start programmes have not been effective. Trial registration ISRCTN46984318. [ABSTRACT FROM AUTHOR]

The article discusses a cost-effectiveness analysis together with a pragmatic randomised controlled trial of improving ventilation in the homes of children with moderate to severe asthma. Chidlren 5 to 14 years of age were recruited and allocated to a delayed intervention control group who received housing modification. It indicates that the installation of a ventilation system are cost effective and improved the respiratory health and quality of life of children with moderate to severe asthma.

The article discusses a pragmatic randomised controlled trial to evaluate the effectiveness of installing ventilation systems and improving central heating in homes of children with moderate or severe asthma. Its main objective is to test whether said improvements change the asthma-specific quality of life. It indicates that the installation of ventilation and central heating where necessary moderately improved for at least 12 months parent-reported asthma-specific quality of life in children.

The article discusses a study of the feasibility of conducting a larger definitive randomised controlled trial (RCT) of the booklet "The Hip & Knee Book: Helping You Cope With Osteoarthritis." The study involved individuals more than 50 years of age with hip or knee osteoarthritis in North East Wales. Fourteen percent of patients in the control group demonstrate improved their physical activity level. Results showed the feasibility of the trial methods in terms of recruitment and follow-up.