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The different countries that death and dying researchers reside within often shape not only research agendas but also research methodologies. The United Kingdom and the United States are two examples of countries that share a common language and intellectual history but their discourses on death have been very different. These differences are partly explained through cultural practices, and also government funding of research, definitions of death and end-of-life planning education. In this article, we argue that early death scholarship in the United States impacted death research and outcomes in both the US and the UK, but that recent scholarship in both countries has caused the two countries to diverge in two major areas: (1) the methodological approaches to death studies and (2) the educational training of medical and hospice personnel in direct contact with the dying. We argue that in order for death studies to fully benefit from trans-Atlantic dialogue on death, both countries need to move towards a more integrated trans-disciplinary model. [ABSTRACT FROM PUBLISHER]

Background: The extent to which trial-level factors differentially influence accrual to trials has not been comprehensively studied. Our objective was to evaluate the empirical relationship and predictive properties of putative risk factors for low accrual in the National Cancer Institute's (NCI's) Cooperative Group Program, now the National Clinical Trials Network (NCTN).Methods: Data from 787 phase II/III adult NCTN-sponsored trials launched between 2000 and 2011 were used to develop a logistic regression model to predict low accrual, defined as trials that closed with or were accruing at less than 50% of target; 46 trials opened between 2012 and 2013 were used for prospective validation. Candidate predictors were identified from a literature review and expert interviews; final predictors were selected using stepwise regression. Model performance was evaluated by calibration and discrimination via the area under the curve (AUC). All statistical tests were two-sided.Results: Eighteen percent (n = 145) of NCTN-sponsored trials closed with low accrual or were accruing at less than 50% of target three years or more after initiation. A multivariable model of twelve trial-level risk factors had good calibration and discrimination for predicting trials with low accrual (AUC in trials launched 2000-2011 = 0.739, 95% confidence interval [CI] = 0.696 to 0.783]; 2012-2013: AUC = 0.732, 95% CI = 0.547 to 0.917). Results were robust to different definitions of low accrual and predictor selection strategies.Conclusions: We identified multiple characteristics of NCTN-sponsored trials associated with low accrual, several of which have not been previously empirically described, and developed a prediction model that can provide a useful estimate of accrual risk based on these factors. Future work should assess the role of such prediction tools in trial design and prioritization decisions. [ABSTRACT FROM AUTHOR]

Comparative effectiveness research (CER) has the potential to slow health care spending growth by focusing resources on health interventions that provide the most value. In this article, we discuss issues surrounding CER and its implementation and apply these methods to a salient clinical example: treatment of prostate cancer. Physicians have several options for treating patients recently diagnosed with localized disease, including removal of the prostate (radical prostatectomy), treatment with radioactive seeds (brachytherapy), radiation therapy (IMRT), or--if none of these are pursued--active surveillance. Using a commercial health insurance claims database and after adjustment for comorbid conditions, we estimate that the additional cost of treatment with radical prostatectomy is $7,300, while other alternatives are more expensive--$19,000 for brachytherapy and $46,900 for IMRT. However a review of the clinical literature uncovers no evidence that justifies the use of these more expensive approaches. These results imply that if patient management strategies were shifted to those supported by CER-based criteria, an estimated $1.7 to $3.0 billion (2009 present value) could be saved each year. [ABSTRACT FROM AUTHOR]

Background: Previously published research by the authors found that returns on research and development (R&D) for drugs introduced into the US market in the 1970s and 1980s were highly skewed and that the top decile of new drugs accounted for close to half the overall market value. In the 1990s, however, the R&D environment for new medicines underwent a number of changes including the following: the rapid growth of managed-care organisations; indications that R&D costs were rising at a rate faster than that of overall inflation; new market strategies of major firms aimed at simultaneous launches across world markets; and the increased attention focused on the pharmaceutical industry in the political arena.Objective: The aim of this study was to examine the worldwide returns on R&D for drugs introduced into the US market in the first half of the 1990s, given that there have been significant changes to the R&D environment for new medicines over the past decade or so.Results: Analysis of new drugs entering the market from 1990 to 1994 resulted in findings similar to those of the earlier research - pharmaceutical R&D is characterised by a highly skewed distribution of returns and a mean industry internal rate of return modestly in excess of the cost of capital.Conclusions: Although the distribution of returns on R&D for new drugs continues to be highly skewed, the analysis reveals that a number of dynamic forces are currently at work in the industry. In particular, R&D costs as well as new drug introductions, sales and contribution margins increased significantly compared with their 1980s values. [ABSTRACT FROM AUTHOR]

We describe past NIH funding for tobacco/nicotine-related research, using data from the CRISP computerized database of NIH grants awarded in 1975, 1980, 1985, 1990, and 1995 (last year available). Two independent raters identified extramural grants whose investigators listed a nicotine/tobacco-related keyword as a primary descriptor for 1975, 1980, 1985, 1990, and 1995. From 1975 to 1985 extramural funding for nicotine/tobacco research (corrected for inflation) increased almost fourfold. From 1985 to 1995, funding increased minimally (< 20%). In 1995, NIH expended $92.1 million on research whose primary interest was nicotine or tobacco. This represented 1.1% of the overall NIH extramural budget. Over time, when contract funding increased, investigator-initiated R01 funding decreased. Nicotine/tobacco research was spread across 18 institutes. Although tobacco use accounts for 20% of all US mortality, historically only 1% of the NIH's budget has focused on nicotine or tobacco. Among nicotine/tobacco grants funded, investigator-initiated research appears to have been limited due to large contracts for clinical trials. Nicotine/tobacco research has no home institute. Funding for nicotine/tobacco research needs to be increased and better coordinated. [ABSTRACT FROM AUTHOR]