Notes
Article history
The research reported in this issue of the journal was commissioned and funded by the HTA programme on behalf of NICE as project number 08/50/01. The protocol was agreed in March 2009. The assessment report began editorial review in August 2009 and was accepted for publication in August 2009. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ report and would like to thank the referees for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.
Declared competing interests of authors
None
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Chapter 1 Background
Description of the health problem
Prevalence
Overweight and obesity in the UK are increasing. 1,2 A systematic review has indicated that the roots of adult obesity lie in the preschool years3 where the problems of overweight and obesity are escalating. 4–6
The prevalence of childhood obesity in England has risen between 1995 and 2007 for children aged 2–15 years, from 11% to 17% for boys and from 12% to 16% for girls. 7 Overall, in the UK, 10% of preschool children are obese,4 with a quarter of children aged 2–5 years being either overweight or obese. 1,5 Recent data from the National Child Measurement Programme show that in 2006–7, 23% of children in reception classes were overweight or obese. 8 These figures reflect almost a doubling of obese 4–5 year olds since 1990 and a 30% increase in those overweight in this age group, using the ≥ 85th and ≥ 95th percentile cut-offs. 8 Table 1 lists different definitions of overweight and obesity.
Overweight | Obese | Source |
---|---|---|
≥ 85th and < 95th UK National BMI percentile, relevant to the UK 1990 reference data | ≥ 95th UK National BMI percentile, relevant to the UK 1990 reference data | Cole et al.9,10 For use in population monitoring |
Specific age and sex cut-offs for ages 2–18 years, based on centile curves from data from six countries | Specific age and sex cut-offs for ages 2–18 years, based on centile curves from data from six countries | International Obesity Task Force11 |
BMI > 91st centile of UK 1990 reference chart for age and sex | BMI > 98th centile of UK 1990 reference chart for age and sex |
Institute of Child Health12 NICE Guideline 4313 |
Risk factors associated with childhood obesity
There are a number of identified factors that affect the risk of a child becoming overweight or obese by the age of 5 years:
-
maternal smoking during pregnancy15
-
parental overweight or obesity15
-
being in the highest fifth of weight gain between birth and 5 months15
-
body mass index (BMI)> 95th percentile at 1 year of age18
-
age-adjusted BMI > 25 at 2.5 years of age18
-
having a Black Caribbean, Black African or Asian background. 19
Conversely, breastfeeding and habitual physical activity in the preschool years may be protection against obesity. 4,20–22
Aetiology
The aetiology of childhood obesity is complex. Obesity results from an energy imbalance, so that the body uses less energy than it receives. 4 A contributing factor may be the increasingly sedentary behaviour of young children who are spending more time occupied by visual displays of various sorts than in physical activity. 2,23 However, a causal link between less active children and increased obesity has not been established. While there is evidence to show that less active children are more likely to have excess fat in late infancy,24 the strength of this association has been questioned. 25,26
The UK Early Bird longitudinal study of early weight gain has concluded that most excess weight before puberty is gained before 5 years of age. 27 This may be influenced by parental feeding practices. 28 Other work has shown that patterns of diet and exercise established in the early years may continue throughout life. 29–31
Significance for patients including quality of life
The effects of early childhood obesity include an increased risk of obesity in later childhood27 and later life,32,33 with an associated increased likelihood of developing heart disease, diabetes or cancer. 34 In childhood, obese and overweight children are at a greater risk of developing insulin resistance, hyperlipidemia, hypertension, hyperinsulinaemia, Type 2 diabetes, cardiovascular disease, depression, eating disorders, obstructive sleep apnoea, asthma, fatty liver and orthopaedic complications. 35,36
Our systematic searches found no studies reporting the quality of life for overweight and obese under fives. However, seven studies were found that considered these issues in older children,37–43 with the exception of Hughes and colleagues41 (who found that in clinical samples of obese children, health-related quality of life was lower than in lean children, especially when rated by their parents) these were uncontrolled studies or reviews whose findings should be treated with caution. Furthermore, how far the findings from these studies can be extrapolated to a younger and less cognitively mature population is open to debate as quality of life deficits might be reduced in younger children (see Table 2).
Study | Year | Country | Design | Context | Age | Definition of obesity | Outcome measures: all self-reported | Conclusions |
---|---|---|---|---|---|---|---|---|
Kurth;40 n = 17,641 | 2008 | Germany | Survey | Community setting | > 11 years | BMI reference values of Kromeyer-Hauschild, 2001 | KINDL-R | Genuinely obese adolescents have a better HRQoL than those who only think of themselves as overweight |
Zhang;42 n = 297 | 2008 | USA | Survey | Community setting | 5–10 years | Overweight, ≥ 85th <95th percentile; obese, ≥ 95th percentile | SF-10 for children (parent proxy) | As BMI increased psycho-social summary scores decreased |
Hughes;41 n = 197 | 2007 | UK | Controlled trial | Clinical | 5–7 years | Obese, ≥ 95th percentile | PedsQL | Obese children’s HRQoL in clinical samples is rated worse than that of lean children, especially by their parents |
Warschburger37 | 2005 | Germany | Review | Not reported | Not reported | Not defined | Stigmatisation, mental health, school performance, HRQoL | Obesity is associated with poorer psychosocial functioning than chronic diseases |
Flodmark38 | 2005 | Sweden | Review | Clinical and community | Unclear | Not defined | PedsQL, KINDL, ITIA, Self-Perception Profile for Children | Children studied in community settings reported better quality of life than those in clinical settings |
Schwimmer;39 n = 106 | 2003 | USA | Cross-section | Clinical | 5–18 years | Obese, ≥ 95th percentile | PedsQL | Severely obese children have lower HRQoL than healthy children, and similar to those with a diagnosis of cancer |
Current guidance
The National Institute for Health and Clinical Excellence (NICE) recommends in Clinical Guideline 43, 2006, ‘Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children’, that tailored clinical interventions should be considered for children with a BMI at or above the 91st centile, depending on the needs of the individual child and family, and that an assessment of comorbidity should be considered for children with a BMI at or above the 98th centile. 13 Furthermore, its guidance for early years states that:
The preschool years (ages 2–5) are a key time for shaping lifelong attitudes and behaviours. Childcare providers can create opportunities for children to be active and develop healthy eating habits, and can act as positive role models.
BMI is recommended as a practical estimate of overweight in children but needs to be interpreted with caution, because it is not a direct measure of adiposity. Waist circumference is not recommended as a routine measure.
All action aimed at preventing excess weight gain, improving diet (and reducing energy intake) and increasing activity levels in children should involve parents and carers.
Family programmes should provide ongoing tailored support; incorporate a range of behaviour change techniques; and have a clear aim to improve weight management.
More recently, in Public Health Guidance 17, ‘Promoting physical activity, active play and sport for pre-school and school-age children and young people in family, pre-school school and community settings’,44 NICE recommends with reference to moderate to vigorous intensity physical activity:
Children and young people should undertake a range of activities at this level for at least 60 minutes over the course of a day. At least twice a week this should include weight-bearing activities that produce high physical stresses to improve bone health, muscle strength and flexibility. This amount of physical activity can be achieved in a number of short, 10-minute (minimum) bouts. Moderate-intensity activity increases breathing and heart rates to a level where the pulse can be felt and the person feels warmer. It might make someone sweat on a hot or humid day (or when indoors). Vigorous activity results in being out of breath or sweating.
Opportunities for moderate to vigorous physical activity include everything from competitive sport and formal exercise to active play and other physically demanding activities (such as dancing, swimming or skateboarding). They also include some of the actions that can be involved in daily life (such as walking, cycling or using other modes of travel involving physical activity). 44
Measurement of health
Body mass index and body fat
The most common measure of obesity is the BMI. However, to use this as a universal tool is not without problems; it may be more accurate to consider the proportion of fat in the body as a measure of obesity, which shows a closer correlation to associated morbidities, such as diabetes, than does BMI. 45–47 There are also clear ethnic differences in the relationship between BMI, body fat and related disease. Although more than 30% of US citizens have a BMI of 30 or higher, only 8% of the total population have diabetes, while in India, where only 1% of the population have a BMI greater than 30, 5.8% of the total population (32.7 million) have diabetes. 47 It is possible for two people with the same BMI to have very different percentage body fat levels. 47
These ethnic differences have also been found in children. Deurenberg and colleagues48 have shown that the relationship between body fat and BMI is different between Asian and Caucasian children, with Asian children having a significantly higher percentage body fat for the same BMI – mean ± SD (standard deviation) (24.6 ± 0.7 versus 20.03 ± 0.7 kg/m2). So it is the level of body fat, rather than simply body weight, that is the more important marker of health and potential morbidity. However, highly accurate measures of body fat are more complex (e.g. underwater weighing and bioelectrical impedance) and therefore more expensive to collect than BMI. Therefore, BMI has been the measure of choice for most obesity trials.
There is some variation in how overweight and obesity are defined in children. Typically, measures account for the changing height-to-weight ratio and the different growth patterns of girls and boys to calculate the BMI. Three definitions of childhood overweight and obesity are commonly used in the UK (see Table 1).
Current service provision
There is no nationally agreed model for weight management services for children in England and Wales; although the Department of Health has set out detailed guidance for the commissioning of services in its publication ‘Healthy weight, healthy lives: commissioning weight management services for children and young people, 2008’. 49
In 2005, the Department of Health published ‘Obesity training courses for primary care’. Dieticians working in obesity management were commissioned to produce this directory for primary care trusts, identifying and analysing some existing training packages on obesity prevention and management. The directory listed five training courses with a focus on childhood obesity. Only one of these includes under fives and it has not been externally evaluated (Weight Management Centre, Preventing Childhood Obesity, www.wmc.uk.com).
The HENRY programme (Health Exercise Nutrition for the Really Young) also offers a taught course and an e-learning course. These have been piloted, and assessed in Sure Start Children’s Centres. 50 The National Child Measurement Programme weighs and measures children in reception year (4/5 year olds) and Year 6 (10/11 year olds) to assess overweight and obesity levels. All parents of participating children will receive their child’s results (unless they request not to); so demand for interventions for the two age groups concerned are likely to rise.
Description of the intervention
The aims of weight management schemes include universal prevention, targeted prevention, weight loss, management of weight gain and the treatment of obesity and overweight. Weight loss may not, however, be an appropriate outcome for schemes aimed at the under fives. Rapid changes in BMI can occur during normal growth and there is great potential to reduce excessive weight gain in childhood. Rapid weight loss and strict dieting are not appropriate for growing children unless under specialist care, as there is a potential danger of compromising growth and intellectual function if weight management is too extreme. A sustainable healthy lifestyle may be the primary goal of management.
The Scottish Intercollegiate Guidelines Network guidelines (2003) agree that a strategy of weight loss should be limited to those children being cared for by secondary care services. For children who are overweight and most children who are obese, weight maintenance is an acceptable goal. In time it is hoped that, to some degree, overweight and obese children might ‘grow into their weight’. 51
The majority of research into the prevention of childhood obesity has been conducted with children between the ages of 8 and 12 years, an age at which children have begun to determine their own eating habits. It has been suggested that true preventive and early treatment interventions should occur at an age when children’s eating patterns may be more easily influenced by parents and environmental changes. 33,52
The preschool years present a window of opportunity to intervene in the lives of children and babies to prevent later morbidity and premature mortality,53 to intervene early where treatment is appropriate and to meet the NICE Guidelines’ target of halting the annual rise in obesity in children under 11 by 2010. 13 The Government has set itself a new ambition:
Of being the first major country to reverse the rising tide of obesity and overweight in the population by ensuring that all individuals are able to maintain a healthy weight. Our initial focus is on children: by 2020 we will have reduced the proportion of overweight and obese children to 2000 levels. 54
Questions addressed by this review
This systematic review addresses the issue of overweight and obesity in the under fives in terms of prevention in those of normal weight and treatment of those overweight or obese. Specifically, the review seeks randomised controlled trials (RCTs) or non-RCTs of schemes and interventions able to maintain appropriate weight for age and/or achieve weight loss. This evidence is sought in comparison with normal practice or active controls not related to weight management, e.g. safety in the home. The success of the schemes is measured objectively by weight and weight maintenance outcomes, health outcomes, quality of life and cost and cost-effectiveness. The context for the schemes is limited to Organisation for Economic Co-operation and Development (OECD) countries in clinical, community or home settings. The question addressed is:
What is the evidence for the effectiveness and cost-effectiveness for weight management schemes for the under fives?
Chapter 2 Clinical effectiveness
Methods of reviewing clinical effectiveness
The clinical effectiveness of methods for weight management schemes was assessed by a systematic review of research evidence. The review was undertaken following the principles published by the NHS Centre for Reviews and Dissemination (CRD). 55
Identification of studies
Search strategy
A comprehensive search strategy evaluating the clinical effectiveness of weight management in the under fives was formulated in collaboration with the research team by an experienced information scientist (KWe). Searches were conducted in the following electronic bibliographic databases: MEDLINE [Ovid], MEDLINE In-Process (MEIP) [Ovid], EMBASE [Ovid], CAB [Ovid], Health Management Information Consortium (HMIC) [Ovid], The Cochrane Database of Systematic Reviews (CDSR), Cochrane Register of Controlled Trials (Central), Science Citation Index Expanded (ISI) [Web of Science], Conference Proceedings Citation Index (CPCI) [The Web of Science], Database of Abstract Reviews (DARE) [CRD], HTA [CRD], PsycINFO [Ebsco], NHS CRD.
Searches were restricted by date from 1990 to February 2009 and by language to English. A cut-off of 1990 was chosen because of resource limitations. The references were managed in reference manager.
Searches for ongoing trials were conducted in March 2009 using the following range of sources: National Institute for Health Research Clinical Research Network Coordinating Centre (NIHR CRN CC) Portfolio Database, ControlledTrials.com and ClinicalTrials.gov.
Full details of the search strategies can be found in Appendix 1.
Relevant studies were identified in two stages. Titles and abstracts returned by the search strategy were examined independently by three researchers (MB, KWy and JL) and screened for possible inclusion. Disagreements were resolved by discussion. Full texts of the identified studies were obtained. Three researchers (MB, KWy and JL) examined these independently for inclusion or exclusion, and disagreements were again resolved by discussion. For a flow chart of studies through the assessment, see Appendix 2.
Inclusion and exclusion criteria
Study design
Inclusion
For the review of clinical effectiveness, systematic reviews of RCTs, RCTs and non-randomised controlled designs are included.
Exclusion
-
Uncontrolled studies.
-
Animal models.
-
Narrative reviews, editorials, opinions.
-
Studies of children with morbidities that have a causal association with overweight and obesity, e.g. Prader–Willi syndrome.
-
Non-English language papers.
-
Reports published as meeting abstracts only, or where insufficient methodological details are reported to allow critical appraisal of study quality.
Interventions
The interventions considered are weight management schemes that are designed to maintain appropriate weight and/or achieve weight loss. The schemes include those aimed at universal prevention (i.e. all under fives regardless of weight), targeted prevention (i.e. only overweight or obese under fives), weight loss, management of weight gain and treatment of those already overweight or obese.
Comparators
These include normal practice or non-diet or non-exercise interventions (e.g. educational programmes about safety in the home).
Population
The population for this assessment is under fives in OECD countries; this is to ensure that study findings will be transferable to the UK context.
Outcomes
The main outcome measures are BMI and weight; each clinical effectiveness study must include at least one measure of adiposity (e.g. BMI, BMI z-score or weight). Other outcome measures are health outcomes, quality of life, objective measures of health behaviour such as accelerometry (not self-reported outcomes), and cost-effectiveness.
Self-reported outcomes are excluded because the results they produce may be unreliable as participants may over-report their physical activity,2,56 or under-report dietary intake57,58 and so exaggerate the benefits of the intervention. Cochrane reviews of childhood obesity have concluded that such reviews have been weakened by the lack of objective measures. 33,59
Data extraction
Data were extracted by MB and checked by KWy and JL. Data extraction forms of included studies are available in Appendix 3.
Critical appraisal
Assessments of study quality were performed using the indicators shown below. Results were tabulated and these aspects described in Table 4 and in the data extraction forms.
Internal validity
Consideration of internal validity addressed:
-
Sample size:
-
power calculation at design
-
-
Selection bias:
-
explicit eligibility criteria
-
proper randomisation and allocation concealment, for RCTs
-
similarity of groups at baseline
-
-
Performance bias:
-
similarity of treatment other than the intervention across groups
-
-
Attrition bias:
-
all participants are accounted for
-
number of withdrawals specified and reasons described
-
-
Intervention integrity:
-
what percent of the population received the intervention?
-
was the consistency of the intervention measured?
-
likelihood that participants received a ‘contaminated’ intervention
-
-
Detection bias:
-
blinding
-
objective outcome measures
-
-
Analysis:
-
what is the unit of allocation?
-
what is the unit of analysis?
-
appropriate data analysis?
-
is analysis by intention to treat (ITT)?
-
is clustering accounted for?
-
External validity
External validity is judged according to the ability of a reader to consider the applicability of findings to a patient group and service setting. Study findings can be generalisable only if they describe a cohort that is representative of the affected population at large. For the purpose of this review, studies that appeared representative of the UK under fives population with regard to these considerations are judged to be externally valid.
Methods of data synthesis
Public health interventions are frequently diverse and complex; careful consideration is needed of issues of heterogeneity. In this case, in addition to the usual sources of heterogeneity (i.e. population, outcomes, intervention and comparators), differences in definitions of obesity, the context in which the intervention is delivered and any theory underpinning the study need to be taken into account.
Heterogeneity is explored through qualitative assessment of study populations, methods and interventions. In this case the included studies were assessed to be too heterogeneous to pool the data, therefore statistical heterogeneity was not explored.
Results
Quantity of research available
The systematic review of electronic databases for clinical effectiveness studies produced 1874 titles and abstracts, of which 1841 were judged not to meet our inclusion criteria and were excluded.
Number of studies included
Thirty-three full text papers were reviewed to assess if they met the inclusion criteria. In addition, 17 further papers were retrieved from references, giving 50 papers in all that underwent paper level review. From these, 28 papers were excluded; details of these papers can be found in Appendix 4 with reasons for their exclusion. This left 22 articles included in this systematic review; 16 of these were systematic reviews or meta-analyses and six were RCT papers (reporting on three trials). No non-randomised trials were found. The included systematic reviews and meta-analyses are listed in Appendix 5. We also searched for ongoing trials of interventions to prevent and treat obesity in the under fives, a list of these can be found in Appendix 6.
Assessment of quality and effectiveness
Systematic reviews
Sixteen systematic reviews or meta-analyses had inclusion criteria that overlapped our inclusion criteria. 33,59–72 However, the majority of these (n = 14) included children of all ages up to 18 years, with most studies of children of 5 years or older. Only two systematic reviews were of preschool children (Bluford and colleagues61 and Campbell and Hesketh62), although both these reviews included studies of 5 year olds, uncontrolled studies and self-reported outcomes.
Bluford and colleagues61 reviewed interventions to prevent or treat obesity in preschool children. They searched for studies between 1966 and 2005 with interventions of physical activity or nutritional strategies of at least 3 months’ duration, and outcomes of weight, BMI or body fat. Only case reports or case series were excluded as designs and studies were included regardless of whether or not their aim was to change weight. These exclusion criteria differ from ours; we have excluded all uncontrolled designs, studies whose aim is not weight management or not set in OECD countries. Bluford and colleagues found seven studies, only two of these (Hip-Hop Jr73 and Harvey-Berino and Rourke74) met our inclusion criteria. These two studies are considered fully in Randomised controlled trials.
Bluford and colleagues61 is a moderately good systematic review. They have used a clearly focused research question to identify studies. However, they found only one of three papers reporting on the Hip-Hop Jr trial, this may be due to not searching the Cochrane, CINAHL or EMBASE electronic databases. Bluford and colleagues also failed to comment on the validity of the studies they included and, on discussing the results, made no reference to the differing robustness of results from RCTs, uncontrolled designs and self-report measures. Therefore, the unqualified conclusions they draw, that four of their included studies show effective interventions, are not completely supported by the evidence. Overall, Bluford and colleagues concluded that multi-component programmes were most successful, particularly if parents were involved; this conclusion appears to be largely based on the strength of the Hip-Hop Jr RCT.
In contrast, Campbell and Hesketh’s62 lower quality review considered research produced between 1995 and 2006. Their focus was on interventions to prevent obesity, promote healthy eating and/or physical activity or reduce sedentary behaviour in 0–5 year olds. This review is less robust than Bluford and colleagues’:61 only one person selected the studies searched; these were from limited data sources and inclusion criteria are not formally described. Therefore it is not possible to say whether appropriate studies have been included; although the scope appears to be very broad. However, the objectives are clearly focused. Campbell and Hesketh62 included nine studies with a range of controlled and uncontrolled designs; the critiquing of these studies was minimal with no attempt to assess validity or discussion of the limitations of the non-RCTs. They found that the self-reported outcomes mostly showed positive change, but only one objective measure (BMI z-scores in Hip-Hop Jr, see Study results) did the same. They conclude that ‘parents are receptive to and capable of behavioural changes that may promote a healthy weight in young children’; it is not clear how they reached this conclusion as these factors were not directly measured by the studies. Only two of the studies they included matched our inclusion criteria: Hip-Hop Jr73 and Harvey-Berino and Rourke. 74
The conclusions from these systematic reviews should be treated with caution as they included uncontrolled studies and self-report measures. A summary of the characteristics and quality of the systematic reviews of preschool children is shown below in Table 3.
Study | Bluford et al. 200761 | Campbell and Hesketh 200762 |
---|---|---|
Inclusion criteria | ||
Population | 2 to < 6 year olds | 0–5 year olds |
Type of intervention | Physical activity and nutritional strategies | Prevent obesity, promote healthy eating and/or physical activity or reduce sedentary behaviour |
Study designs | All except case reports and case series and with at least 3 months’ follow-up. Included uncontrolled studies | Unspecified, included uncontrolled |
Type of outcomes | Weight status, BMI or body fat and self-report | Unspecified, included self-report |
Settings | Unspecified | Home, group, primary care, preschool/childcare and mixed settings |
Number of included studies | Seven | Nine |
Search dates | 01/1966 to 03/2005 | 01/1995 to 06/2006 |
Results | ||
Direction of change | Four studies showed positive change in weight status or body fat. Self-report measures showed both significant and non-significant results | Only one objective measure, BMI, showed a positive significant result in one study. All studies showed some effectiveness on some self-report measures |
Quality of review | ||
Structured abstract? | Yes | No |
Focused question? | Yes | Yes |
Explicit and appropriate inclusion criteria? | Yes | Unclear |
Comprehensive search strategy? | Yes | Unclear |
Appropriate methods of study selection? | Yes | Abstract screening by only one reviewer; further reviewing by two |
Appropriate methods of data extraction? | Not reported | Not reported |
Validity of studies assessed adequately? | No | No |
Flow diagram of studies, table of study characteristics and synthesis (narrative or quantitative)? | No flow chart | No flow chart |
Do conclusions follow from results? | Not convincingly | Not convincingly |
Summary of key findings provided? | No | No |
Recommendations linked to the strength of evidence? | Yes | No recommendations made |
The three papers that contained meta-analyses were of all age children and did not conduct their analyses by age group,34,69,70 so it is not possible to comment on the under five population.
Randomised controlled trials
Quality and characteristics
Three RCTs were found that met our inclusion criteria, these were all preventative studies. One of the trials was in the UK, Reilly and colleagues’ MAGIC (Movement and Activity Glasgow Intervention in Children) trial,75 and two were in the USA, Hip-Hop to Health Jr73,76–78 and Harvey-Berino and Rourke. 74 Details of these studies can be found in the data extraction tables in Appendix 3 and are summarised below. Additionally, tables provide an overall summary of study characteristics (Table 4), details of interventions (Table 5) and quality indicators (Table 6).
Trial | Country | n | Definition of obesity | Participants | Intervention | Comparator | Outcomes | Length of follow-up | Setting | Theory | Source of funding |
---|---|---|---|---|---|---|---|---|---|---|---|
MAGIC Reilly et al. 200675 |
UK | 545 | ≥ 95th UK National BMI percentile | 36 nurseries children in preschool year mean (SD) age 4.2 (0.2) years, plus parents | Physical activity at nursery plus home-based health education | Usual care | BMI (UK curves) accelerometry | 12 months | Nursery and home | Not explicit | British Heart Foundation, Glasgow City Council, Caledonian Research Foundation |
Hip-Hop to Health Jr Fitzgibbon et al. 2002;76 Stolley et al. 2003;78 Fitzgibbon et al. 2005;73 Fitzgibbon et al. 200677 |
USA | 778 | ≥ 95th percentile: US growth curves | 24 preschools children aged 3–5 yrs, mean (SD) 30.8 (8.7) months, plus parents | Diet and physical activity in preschool plus educational component at home | General health education in preschool and a related newsletter at home | BMI (US curves) weight height | 5 years | Preschool and home | Social learning theory, self-determination theory and the transtheoretical model | National Heart Lung and Blood Institute |
Harvey-Berino and Rourke 200374 |
USA | 40 | ≥ 95th percentile: US growth curves | Children 9 months – 3 years, mean (SD) 22 (8) months, plus mothers | Home-based parenting skills course to improve diet and increase exercise + comparator intervention | Home-based parenting skills course to improve behaviour | BMI (US curves) weight accelerometry | 16 weeks | Home | Not explicit | National Institute of Health |
Study | Intervention | Control | |||
---|---|---|---|---|---|
Nursery | Home | Nursery | Home | ||
Physical activity | Education | ||||
Reilly et al.75 | 3 × 30 minutes per week × 24 weeks | – | Resource pack to encourage physical activity and information about the benefits of physical activity and reducing TV watching | – | – |
Hip-Hop Jr73,76–78 | 3 × 20 minutes per week × 14 weeks | Nutrition activities 3 × 20 minutes per week × 14 weeks | Weekly newsletter related to nursery activities, plus homework for parents with financial incentive for completion | Once weekly × 20 minutes × 14 weeks general health education | Weekly related newsletter |
Harvey-Berino74 | – | – | Once weekly × 16 weeks parenting skills programme about healthy eating and exercise | – | Once weekly × 16 weeks parenting skills programme about behavioural goals |
Indicator | Reilly et al.75 | Hip-Hop to Health Jr73,76–78 | Harvey-Berino74 |
---|---|---|---|
Power calculation | ✓ | ✓ | ✗ |
Explicit eligibility criteria | ✓ | ✓ | ✓ |
Adequate randomisation | Method not reported | Method not reported | Method not reported |
Adequate allocation concealment | ✓ | Not reported | Not reported |
Outcome assessors blinded | ✓ | Unclear | ✓ |
Groups similar at baseline | ✓ | ✗ | ✓ |
All participants accounted for | ✓ | ✓ | ✓ |
Withdrawals specified | ✓ | ✓ | ✓ |
Clear description of intervention | ✓ | ✓ | ✓ |
Consistency of intervention measured | ✓ | Unclear | Unclear |
Objective outcome measures | ✓ | ✓ | ✓ |
Unit of allocation | Group and individual | Group | Individual |
Unit of analysis | Individual | Individual | Individual |
Appropriate method of analysis | ✓ | ✓ | ✓ |
Analysis by ITT | ✓ | ✓ | ✓ |
Are results generalisable? | ✓ | Partly: ethnic minority | Partly: ethnic minority |
Rationale for clustering given | ✓ | ✓ | Not applicable |
Effects of clustering in sample size | ✓ | ✓ | Not applicable |
Effects of clustering in analysis | ✓ | Unclear | Not applicable |
Flow diagram include clusters and individuals | ✓ | No flow diagram | No flow diagram |
Reilly and colleagues’75 2006 study was a good quality cluster randomised trial of 545 children (intervention group n = 268, control group n = 277) less than 5 years old, set in 36 nurseries and in the home, in Glasgow, UK. The aim of the study was to assess whether a physical activity intervention for children combined with healthy living education for parents would reduce the BMI of young children.
The intervention was aimed at children, parents/carers and nursery staff, and consisted of an enhanced physical activity programme of three 30-minute sessions a week for 24 weeks. Two nursery staff members were trained in the intervention and an unblinded researcher monitored the intervention for consistency. This nursery-based activity was combined with a home intervention consisting of a resource pack with guidance linking physical play at the nursery and home, and two health education leaflets about the benefits of physical activity and encouraging alternatives to television watching, with the aim of increasing physically active play and reducing the amount of television watched. The children in the control group received the usual programme of activities from their nursery and the head teachers agreed not to enhance their physical development and movement curriculum during the trial period.
The primary outcome measure was BMI. Weight and physical activity measured by accelerometry were secondary outcomes (obesity was defined as being ≥ 95th UK national BMI percentile). Outcomes were reported at baseline, and at 6 and 12 months follow-up.
Although no explicit theory underpins this study, the implicit theory is that increasing physical activity in very young children, combined with a parental education programme about healthy lifestyles, will have a preventative effect on obesity.
Reilly and colleagues’ study was a decent quality and adequately powered cluster RCT, with adequate allocation concealment and blinding of assessors. The intervention was monitored for consistency. The data were analysed appropriately by multilevel modelling, to take account of the clustered design and used ITT analysis. However, there was no description of the method of random sequence generation (see Table 6).
Our second study, Hip-Hop to Health Jr73,76–78 (2002–6), was a cluster RCT of a combined nutrition education and exercise intervention, designed to reduce gains in BMI in 778 preschool minority children in the USA (African American sites, intervention group n = 197, control group n = 212; Latino sites, intervention group n = 202, control group n = 199). This community-based intervention targeted African American and Latino preschool children in the Chicago area who attended Head Start preschools. Randomisation was between preschools and within each of these ethnic communities. The aim of the programme was to divert the trend towards overweight and obesity in these ethnic minority groups, who have a greater than average prevalence of weight problems in the USA. 79 The weight control component consisted of a 14-week programme (three times weekly) of diet and physical activity delivered by trained early childhood educators in 24 Head Start preschools and in the children’s homes. Twelve of the preschools were in predominantly African American communities and 12 were in predominantly Latino communities. Each preschool session consisted of 20 minutes of a nutrition activity followed by 20 minutes of moderate to vigorous aerobic activity. The home-based element included a weekly newsletter that mirrored the children’s curriculum with homework designed to reinforce concepts presented in the newsletters. Parents were also asked to write down specific ways to increase fruit and vegetables and reduce fat in their family’s diet. If the homework was completed and returned, parents received a small monetary reward (US$5.00 grocery voucher). Parents were also offered twice weekly low-impact aerobic classes at their children’s preschools.
Children in preschools, randomised to the control group, received a once weekly 20-minute educational session for 14 weeks that taught general health concepts, e.g. seat-belt safety, immunisation and dental health. The home component consisted of a weekly related newsletter, there were no homework assignments or financial rewards.
The primary outcome measure was BMI, with overweight being defined as BMI ≥ 85th percentile and obesity as BMI ≥ 95th percentile of the US National Centre for Health Statistics growth curves. Weight and height were also recorded. Children were followed up for 24 months.
This scheme was theoretically underpinned by social learning theory,80 self-determination theory81 and the transtheoretical model that includes stages of change. 82 The implicit theory behind this scheme is that obesity can be prevented by reducing dietary fat, increasing dietary fibre, an increase in physical activity, inclusion of the family and consideration of the individual developmental needs of the participants.
This was a moderate quality cluster RCT. Although the study’s sample size was based on a power calculation that accounted for the effects of clustering, the method of randomisation was not reported. This is of some concern as the Latino preschool groups were not entirely similar at baseline, with the children in the control group being more likely to be overweight than those in the intervention group, 51% versus 40% (p = 0.019), or obese, 31% versus 30% (p = 0.033), and have a higher mean BMI z-score, mean (SD): 1.13 (1.06) versus 0.87 (1.24) (p = 0.03). Similarly, in the African American preschool groups, the children in the control group were older than those in the intervention group by a mean of 2.2 months (p < 0.001). Furthermore, it is unclear whether the assessors were blinded to treatment allocation or whether the consistency of the intervention was monitored. However, the data were appropriately analysed using multilevel modelling and ITT methods.
The third RCT, Harvey-Berino and Rourke74 (2003), was of 40 Native American children aged between 9 months and 3 years in the USA and Canada. The aim of this home-based study was to find out if including mothers, with a BMI > 25 kg/m2, in an obesity prevention programme, in addition to more general parenting support, would reduce the risk of obesity in their children when compared with similar children whose mothers were receiving general parenting support alone. Participants were recruited from three sites: New York state, Ontario and Quebec.
Children were randomised individually to intervention or control. The control group received a home-based parenting support programme which emphasised physiological and behavioural goals, teaching effective parenting styles and age-appropriate discipline and routines and rules. The intervention group (n = 20) received the same home-based support plus a parenting support programme about nutrition and exercise, also in their homes. This consisted of a 16-week programme (one lesson per week), to show how improved parenting skills could facilitate the development of appropriate eating and exercise habits in children. The idea being that having parents modelling healthy behaviours would encourage a healthy diet and greater physical activity in their children.
The main outcome measure was BMI, with obesity defined as ≥ 95th percentile of the US National Centre for Health Statistics growth curve. Participants were followed up for 16 weeks. The implicit theory supporting this trial was that involving mothers in a home-based educational intervention to improve eating and exercise combined with a parent support programme would have a preventative effect, to reduce obesity in young children.
It is difficult to comment comprehensively on the quality of this small RCT, as a number of key quality indicators were not reported. It can only be assumed that is because they were not in place. There appears to have been no power calculation to determine the sample size, and the method of randomisation, sequence generation and concealment were not reported. However, groups were similar at baseline and assessors were blinded to allocation. The consistency of the intervention does not appear to have been monitored, although the analysis was by ITT. The methods for analysing the data were appropriate with t-tests for within-group changes and analysis of variance (ANOVA) for between-group changes.
Study results
Body mass index
All three studies measured BMI. However, their results are not directly comparable as the children were at different ages when measures were taken. Only one study, Hip-Hop Jr, showed any significant differences between groups. 73
The positive result from Hip-Hop Jr was found only in the African American study sites, where the children in the intervention group showed significantly smaller increases in BMI from baseline than those in the control group. At 24 months the mean (SD) BMI was 17.1 (2.5) kg/m2 for the intervention group and 17.9 (3.3) kg/m2 for the control group, with the increase in means 0.48 (SD 0.14) kg/m2 in the intervention group and 1.14 (SD 0.14) kg/m2 in the control group (p = 0.008). When these raw BMI scores were adjusted for age, baseline value and location, the values continued to show significance at p < 0.05.
Hip-Hop Jr was one of two studies that had a physical activity component in the intervention. The other study was Reilly and colleagues75 who actually had longer activity sessions for a greater amount of weeks in their intervention than Hip-Hop Jr, but found no statistically significant benefit from the intervention. Nevertheless, it should be noted that Reilly and colleagues had only 12 months’ follow-up and, although the differences were not statistically significant, at 6 months the BMI z-scores, mean (SD), were slightly higher in the intervention group: intervention = 0.46 (1.05), control = 0.43 (1.08). This direction had switched at 12 months with the control group showing a slighter lower BMI z-score than the intervention group: intervention = 0.41 (1.05), control = 0.43 (1.10). Speculative explanations for these differences in results between studies include that the Hip-Hop Jr intervention was delivered more effectively by the preschool staff; the activity component of Hip-Hop Jr was more vigorous; or the home element in Hip-Hop Jr was more effective as this included homework for the parents, with a financial incentive, rather than an informative resource pack.
However, the Latino sites of Hip-Hop Jr (which had 24 months’ follow-up) also showed no significant differences in BMI. Although, at 12 months the rate of increase in BMI was slightly less for the control group [mean (SD), intervention = 0.50 (0.7) and control = 0.4 (0.4)] and at 24 months the rate of increase was the same in both groups 0.60 (0.8). Although, this result may have been confounded by factors related to ethnic group, as the mothers were reported to have low integration into the prevailing cultural norms. Overall, it remains unclear why these differences should occur.
Harvey-Berino and Rourke’s participants were followed up for only 16 weeks; while the change in z-score decreased for the intervention group and increased for the control group during this time, the results failed to reach statistical significance.
Table 7 below gives the BMI results for the included studies.
Study | Metric | Baseline | 16 weeks | 6 months | 12 months | 24 months | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Intervention | Control | p | Intervention | Control | p | Intervention | Control | p | Intervention | Control | p | Intervention | Control | p | ||
Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | |||||||
Reilly et al. 75 n = 545 (I = 268, C = 277); mean (SD) age, 4.2 (0.2) years |
kg/m² | 16.3 (1.5) | 16.4 (1.5) | NS | ||||||||||||
z-score | 0.39 (0.98) | 0.41 (1.0) | NS | 0.46 (1.05) | 0.43 (1.08) | NS | 0.41 (1.05) | 0.43 (1.10) | NS | |||||||
n = 778; mean (SD) age, 4.2 (4.9) years |
||||||||||||||||
African American sites n = 409 (I = 197, C = 212) | kg/m² | 16.50 (1.50) | 16.70 (2.0) | NS | 16.6 (2.1) | 17.4 (3.1) | 0.002 | 17.1 (2.5) | 17.9 (3.3) | 0.008 | ||||||
z-score | 0.62 (0.9) | 0.67 (2.0) | NS | 0.06 (0.05) | 0.13 (0.05) | 0.024 | 0.02 (0.04) | 0.16 (0.04) | 0.021 | |||||||
Adjusted change from baseline (kg/m²) | 0.06 (0.12) | 0.59 (0.12) | 0.012 | 0.54 (0.14) | 1.08 (0.14) | 0.022 | ||||||||||
Latino sites n = 401 (I = 202, C = 199) | kg/m² | 17.00 (2.8) | 17.50 (2.2) | 0.1 | 17.5 (3.50 | 17.9 (2.6) | 0.46 | 17.6 (3.6) | 18.1 (3.0) | 0.34 | ||||||
z-score | 0.87 (1.24) | 1.13 (1.06) | 0.023 | 0.00 (0.09) | 0.07 (0.09) | 0.56 | –0.13 (0.09) | 0.00 (0.09) | 0.34 | |||||||
Adjusted change from baseline (kg/m²) | 0.31 (0.16) | 0.44 (0.17) | 0.6 | 0.46 (0.19) | 0.66 (0.20) | 0.49 | ||||||||||
Harvey-Berino 74 n = 40 (I = 20, C = 20) Mean (SD) age 22 (4.9) months |
z-score | 0.79 (1.70) | 0.67 (1.60) | NS | 0.52 (1.10) | 0.98 (1.4) | NS |
Weight
Two studies, Hip-Hop Jr and Harvey-Berino and Rourke, measured weight at baseline and follow-up. 73,74,77 Hip-Hop Jr’s results showed a smaller increase in weight in the intervention than control groups at 12 and 24 months, but did not report whether these results were significant or not. Harvey-Berino and Rourke74 found a non-significantly greater increase in weight in the control group after 16 weeks. The results can be seen in Table 8.
Study | Metric | Baseline | 16 weeks | 1 year | 2 years | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
I | C | p | I | C | p | I | C | p | I | C | p | ||
Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | ||||||
n = 778; mean (SD) age, 30.8 (8.7) months |
Change from baseline | Change from baseline | |||||||||||
African American sites n = 409 (I = 197, C = 212) | kg | 17.6 (2.9) | 18.3 (3.4) | 0.014 | 3.79 (0.20) | 4.65 (0.20) | NR | 6.84 (0.32) | 7.95 (0.31) | NR | |||
Latino sites n = 401 (I = 202, C = 199) | kg | 18.6 (4.1) | 18.8 (3.8) | NS | 3.84 (0.19) | 3.98 (0.20) | NR | 5.91 (0.31) | 6.18 (0.32) | NR | |||
Harvey-Berino 74 n = 40 (I = 20, C = 20); mean (SD) age, 22 (4.9) months |
kg | 12.2 (2.4) | 12.3 (2.9) | NS | 13.1 (2.4) | 13.8 (3.6) | NS |
Physical activity
Two studies used an objective measure, accelerometry, to measure physical activity (Reilly and colleagues75 and Harvey-Berino and Rourke74). An accelerometer is a small device that is worn by a child on his or her hip or wrist and measures movement and inactivity. It is able to differentiate between being sedentary but with arm movement, walking and running. 83 Neither study found any statistically significant differences between groups.
Furthermore, Reilly and colleagues75 also measured sedentary behaviour (no trunk movement; accelerometer count < 1100 per minute) and the proportion of hours spent in moderate to vigorous exercise (accelerometer count > 3200 per minute) and found a slightly higher (but non-significant) level of exercise in the control group. These results are shown in Table 9.
Study | Metric | Baseline | 16 weeks | 6 months | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Intervention | Control | p | Intervention | Control | p | Intervention | Control | p | ||
Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | |||||
Reilly et al. 75 n = 545 (I = 268, C = 277); mean (SD) age, 4.2 (0.2) years |
Physical activity count per minute | 732 (163) | 809 (209) | NS | 809 (179) | 899 (218) | NS | |||
Sendentary behaviour median (range)% monitored sedentary time | 69.3 (50.4–68.6) | 66.9 (45.6–88.7) | NS | 67.0 (47.0–86.0) | 62.9 (43.1–81.6) | NS | ||||
MVPA median (range)% monitored MVPA time | 2.6 (0.4–11.1) | 3.0 (0.3–13.0) | NS | 3.5 (0.5–12.4) | 4.1 (0.6–12.1) | NS | ||||
Harvey-Berino 74 n = 40 (I = 20, C = 20); mean (SD) age, 22 (4.9) months |
Physical activity (Vmag/h) | 20,457 (8670) | 19,417 (5735) | NS | 17,886 (6746) | 17,637 (8151) | NS |
Barriers and facilitators
The included studies did not directly address the issue of barriers and facilitators to weight management. However, a number of matters arising from the studies may have affected their success or failure to show a treatment effect. For instance, the Hip-Hop Jr study was careful to be sensitive to the cultural background and limited financial resources of the families it recruited. This study also engaged parents more fully than Reilly and colleagues, by giving them homework which required more active engagement. It is likely that greater parental engagement increased the possibility of success. Although Hip-Hop Jr parents also had a financial incentive to carry out the homework, which should be taken into account if similar research is pursued.
Other evidence suggests that children of physically active parents are more likely to be active than children of non-active parents,84 as parental activity levels correlate significantly with those of their children. 85 Therefore, involving parents in the physical activity component of an intervention is likely to make it more effective as parents act as role models for children.
Another aspect that requires careful consideration is the delivery of the intervention. Both Reilly and colleagues and the Hip-Hop study commented on the need for properly trained staff to carry out the physical activity component. Reilly and colleagues75 reported that in their pilot study (which had shown significantly increased accelerometry output of 40%)72 the intervention was carried out by nursery head teachers, but in the trial (to aid generalisability) the intervention was provided by nursery staff and was possibly less rigorous. The physical activity component of Hip-Hop Jr was delivered by trained preschool staff. With many curriculum demands being placed on the time of under fives’ care providers, clearly, adequate training in age-appropriate physical exercise needs to be carefully considered.
Indeed, the Childcare Act 2006 lays down requirements for learning and development for all early years (0–5 years) care providers. 86 All infants and children must experience a range of activities that promote their personal literacy, numeracy, understanding, and creative and physical development. While the physical development component includes physical activity it does not mention moderate to vigorous exercise or simply running around. 87 It is beyond the scope of this systematic review to investigate what effects (if any) the Practice Guidance for the Early Years Foundation Stage may have had on the levels of physical activity in nurseries and playgroups and at childminders. Nevertheless, it would be interesting to know if providers of these services believed that this guidance allowed time for more or less moderate to vigorous play than before it was instigated.
Summary
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The searches produced 1874 titles and abstracts, from these, three RCTs were included.
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The included RCTs were of good to moderate quality and were aimed at preventing obesity.
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No trials were found for the treatment of obesity or overweight in under fives.
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One study (Hip-Hop Jr, African American sites) found significant differences in BMI at 1- and 2-year follow-up in favour of the intervention.
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No other significant differences were found with any other outcome measure in any trial.
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Trends in the BMI and weight favoured the intervention groups.
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Trends in accelerometry results favoured the control groups.
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Speculative reasons for the success of the Hip-Hop Jr in affecting BMI include:
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– Possibly a more effective delivery of the intervention by the preschool staff.
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– The effect of the greater involvement of parents by actively engaging them with homework in the Hip-Hop Jr study (than in Reilly and colleagues) may have provided sufficient reinforcement of the preschool component to render the intervention effective.
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– Targeting nutrition education directly at the children may have engaged them more fully in this aspect of the intervention.
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– The financial rewarding of mothers in Hip-Hop Jr for completing homework may have been an incentive to stay in the study and engage with its messages.
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– The Latino sites in Hip-Hop Jr may have failed to show a positive impact from the intervention because the parents had low cultural integration.
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– Although Reilly and colleagues intervention activity time was longer, it may not have been so intense.
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– There may not have been as great a difference between the activity levels of the control group and the intervention group in Reilly and colleagues’ trial.
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Chapter 3 Cost-effectiveness
Methods of reviewing cost-effectiveness
Search strategy
A comprehensive search strategy evaluating the cost-effectiveness of weight management in the under fives was formulated in collaboration with the research team by an experienced information scientist (KWe). A cost search filter was included in the strategy. It was applied in the following electronic bibliographic databases: MEDLINE [Ovid], MEIP [Ovid], EMBASE [Ovid], CAB [Ovid], HMIC [Ovid], CDSR, Central, ISI [Web of Science], CPCI [The Web of Science], DARE [CRD], NHS Economic Evaluation Database (EED) [CRD], HTA [CRD] and PsycINFO [Ebsco].
Searches were restricted by date from 1990 to February 2009, and by language to English.
Searches for ongoing trials were conducted in March 2009 using the following range of sources: NIHR CRN CC Portfolio Database, ControlledTrials.com and ClinicalTrials.gov. A general supplementary internet search was run to identify further conference abstracts.
Full details of the search strategies can be found in Appendix 1.
Inclusion and exclusion criteria
The inclusion and exclusion criteria for economic evaluations were identical to those for the systematic review of clinical effectiveness except:
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Non-randomised studies were included (e.g. decision-model based analysis or analysis of person-level cost and effectiveness data alongside observational studies).
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Full cost-effectiveness analyses, cost–utility analyses, cost–benefit analyses and cost–consequence analyses will be included. Stand alone UK cost analysis will also be sought and appraised.
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Titles and abstracts returned by the search strategy were examined independently by two researchers (MB and RT) and screened for possible inclusion.
Study quality assessment
The methodological quality of economic evaluations would have been assessed according to internationally accepted criteria such as the Consensus on Health Economic Criteria list questions developed by Evers and colleagues. 88 Any studies based on decision models would have been assessed against the International Society for Pharmacoeconomics and Outcomes Research guidelines for good practice in decision analytic modelling. 89
Results
The searches returned 595 titles and abstracts. No studies were found that matched the inclusion criteria for this systematic review. However, one ongoing US cost-effectiveness trial was found but the population was 8–12 year olds and their overweight parents (clinicaltrials.gov/ct2/show/NCT00717132).
The RCT by Reilly and colleagues, included in the effectiveness systematic review, included the cost of the nursery component capital cost: <£200, €297 or US$377. The resource pack for the home element of the intervention cost £16, €24 or US$30. 75
Chapter 4 Discussion
Statement of principal findings
Our searches produced 1874 titles and abstracts for review. After these had been assessed three RCTs were included in the systematic review. 74–76 No studies were found aimed at the treatment of overweight or obesity in the under fives. No studies of costs or cost-effectiveness were found. This lack of evidence makes explicit conclusions difficult.
Across the three RCTs included in this systematic review, only one study’s BMI outcome reached statistical significance; this was in the African American subgroup of the Hip-Hop Jr trial. Nevertheless, the other trials and the Latino subgroup of Hip-Hop Jr consistently showed that intervention groups compared with control groups were associated with trends towards greater improvement in BMI and weight over 6–24 months. However, in the studies that measured physical activity (Reilly and colleagues75 and Harvey-Berino and Rourke74), the accelerometry results supported the control group. It should also be noted that no adverse effects were reported from any of these trials.
The first question that arises is why should there be differences in the results between the African American and Latino communities in the Hip-Hop Jr trial? The answer could be because the Latino mothers were found to be less assimilated into US culture than the African American mothers and may therefore have found it harder to engage with the intervention. However, there could be a range of cultural differences causing this disparity in results.
Secondly, why should the African American Hip-Hop study show a positive effect when Reilly and colleagues’ study had a longer physical activity component (30 minutes versus 20 minutes)? There are a number of speculative answers:
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Possibly the intervention was delivered more effectively in Hip Hop Jr.
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The effect of the greater involvement of parents by actively engaging them with homework in the Hip-Hop Jr study may have provided sufficient reinforcement of the preschool component to render the intervention effective.
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Targeting of nutrition education directly at the children may have engaged them more fully in this aspect of the intervention.
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The financial rewarding of mothers in Hip-Hop Jr for completing homework may have been an incentive to stay in the study and engage with its messages.
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Although Reilly and colleagues’ activity time was longer, it may not have been so intense and therefore had a lower overall calorific demand.
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There may not have been so great a difference between the activity levels of the control group and the intervention group in Reilly and colleagues’ trial.
It is not possible to definitively say which, if any, of these factors may have influenced the outcomes.
It is perhaps easier to see why the Harvey-Barino and Rourke trial did not find an intervention effect. This was a small (n = 40), and likely to be underpowered, RCT with a very short follow-up time (16 weeks). Also, there was no physical activity component to the study intervention that was aimed at parent education rather than directly at the children. A Finnish trial looking at atherosclerosis prevention with a nutrition education intervention has followed up participants for 14 years from 7 months old, demonstrating that such long-term follow-up is possible in health/education trials. 90
The included studies did not formally collect information about the process of the research, although this was touched on in their discussions. As the success of such an intervention is dependent on the degree of acceptance and engagement of the parents and/or preschool staff, it is important to understand their attitudes to and beliefs about overweight and the intervention of interest. A qualitative component addressing these issues would have enhanced all three studies.
Comparison to previous systematic reviews
There is disparity between some of our findings and those of the systematic reviews of Bluford and colleagues61 and Campbell and Hesketh. 62 Overall they found four studies that showed a positive effect on BMI or weight or body fat, only one of these studies (Hip-Hop Jr) met our inclusion criteria. All three of the other studies were in children older than 5 years, two of the studies were uncontrolled and the other was an evaluation of a food supplying service. This difference reflects the inclusion of uncontrolled evidence which is known to introduce bias and confounding, and may produce results more likely to favour the intervention. 91,92
Implications for policy
Despite the paucity of evidence and mixed findings of our included studies, key messages focusing on the theoretical principle of balancing food intake and energy expenditure (the energy balance) should continue to drive interventions. Indeed, interventions with older children that have included combined diet and child physical activity have been shown to be successful. 93,94
It is possible that the three included trials did not provide enough/sufficiently vigorous physical activity and/or dietary change and parental engagement to make a consistent difference in weight-related outcomes. However, the importance of the people delivering the intervention should not be underestimated; an important factor may be the training and enthusiasm of these staff for the intervention.
In the UK, where the timetabling of activities of even infants in the care of child minders is strictly governed by a national curriculum, it may be difficult for those who care for such children to allow sufficient time for physical activities. Nonetheless, Connelly and colleagues’64 systematic review of obesity interventions, of all age children, found that the key distinguishing factor between interventions that ‘worked’ and those that did not was the compulsory nature of the physical activity component.
Furthermore, the only study to show a significant benefit from the intervention was the one that most heavily involved parents and included nutrition education for children and parents. 73 This supports a recent review of family involvement in paediatric obesity management by Nowicka and Flodmark95 that found that the majority of studies endorsed the use of family-based treatment; similarly, Moore and colleagues’84 study has shown that parents act as models for their children in terms of levels of physical activity and diet.
It is therefore probable that interventions that combine the ingredients of: sufficient training and time for the staff delivering the intervention; compulsory regular moderate to vigorous exercise; nutrition education for children and parents; and active engagement of parents as participants and role models of a healthy lifestyle would help manage weight in younger children and set healthy patterns of physical activity and diet in place.
Contextual issues
The differing results from the Hip-Hop Jr communities indicate the importance of sensitivity to the cultural context. This trial took great care to be culturally sensitive to the minority groups it was working with. The Hip-Hop Jr authors identified several components from their pilot work that were important in engaging these families: easy and safe access to the programme; being situated in the preschool that the children were already attending; having the parental element take place in the home; encouraging identification between those delivering the intervention and participants; addressing cognitive and environmental barriers to exercise and dietary change; emphasis on modelling lifestyle change; and consideration of all levels of literacy. 76
Strengths and limitations of the assessment
The strengths of this assessment are that it is comprehensive, systematic and up-to-date, used objectively assessed outcome measures and was conducted by an independent research team.
The limitations are that:
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The searches were limited to the English language. This might have meant that otherwise includable controlled trials were omitted. However, Bluford and colleagues’61 searches were not restricted in this way and did not find any includable non-English language studies.
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The searches went back only to 1990, so we may have missed includable studies. Although Bluford and colleagues’ searches went back to 1966, none of the studies they found prior to 1990 would have been includable in our systematic review.
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The inclusion criteria were limited to OECD countries. This was on the grounds of transferability of findings to a UK context.
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Only controlled studies were included. This was to assure that only high quality studies with minimal bias and confounding were included.
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Only three RCTs were found, one of which was small. The trials were too heterogeneous to allow pooling of data.
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No cost or cost-effectiveness studies were found.
Chapter 5 Conclusions
Controlled trial evidence of weight management schemes and interventions aimed at the prevention of obesity for the under fives is scarce. No controlled trials addressing the issue of treating obesity or evidence of cost-effectiveness studies in this population were found. What evidence exists, from prevention studies, is difficult to draw clear conclusions from as, apart from a subgroup in the Hip-Hop Jr trial (African American sites), studies showed no statistically significant differences in weight measures between the intervention and control groups (although there was some evidence of positive trends). It should also be noted that these conclusions are based on only three dissimilar studies, two in low-income ethnic minority groups, in different contexts and settings, thereby making the drawing of firm conclusions difficult. A closer inspection of included studies shows that there may be elements that future interventions should consider:
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effective training of the staff delivering the intervention
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cultural sensitivity
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sustained moderate to vigorous physical activity and nutritional advice components for children
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active engagement of parents/carers in reinforcing the messages to the children, combined with education about healthy diets and exercise.
Suggested research priorities
The lack of evidence on which to base service commissioning indicates that research is urgently needed, in particular:
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Further well-designed UK-based RCTs of weight management schemes aimed at the prevention of obesity that combine with cost-effectiveness studies targeted at preschool children (under fives) with long-term follow-up (> 12 months).
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Well-designed UK-based RCTs of weight management schemes that address the issue of treatment of overweight and obesity in the under fives that combine with cost-effectiveness studies targeted at preschool children (under fives) with long-term follow-up (> 12 months).
These RCTs should specifically consider:
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Elements of interventions:
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– Effective training of the staff delivering the intervention.
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– Cultural sensitivity.
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– Sustained moderate to vigorous physical activity and nutritional advice components for children.
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– Active engagement of parents/carers in reinforcing the messages to the children combined with education about healthy diets and exercise.
-
-
Outcomes:
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– Body density, skinfold thickness, waist circumference, BMI, weight, physical activity, health behaviour and cost outcomes.
-
-
Process:
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– Studies should also have a qualitative component to investigate the barriers and facilitators to successful engagement of children, parents and preschool staff in weight management interventions. Questions of interest include:
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– Parental views of the intervention; do they believe there is an overweight problem for under fives? Do they believe the intervention will ‘work’? What are the best ways of engaging parents fully?
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– What are nursery/preschool staff attitudes to the intervention? Do they view it as an imposition or a help? How does the intervention fit in with the curriculum? Does it put pressure on the staff?
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– Do the children enjoy taking part in intervention activities?
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-
Acknowledgements
About PenTAG
The Peninsula Technology Assessment Group (PenTAG) is part of the Institute of Health Service Research at the Peninsula Medical School. PenTAG was established in 2000 and carries out independent health technology assessments for the UK Health Technology Assessment (HTA) programme, systematic reviews and economic analyses for the NICE Centre for Public Health Excellence, and systematic reviews as part of the Cochrane Collaboration Heart Group, as well as for other local and national decision-makers. The group is multidisciplinary and draws on individuals’ backgrounds in public health, health services research, computing and decision analysis, systematic reviewing, statistics, and health economics. The Peninsula Medical School is a school within the Universities of Plymouth and Exeter. The Institute of Health Research is made up of discrete, but methodologically-related research groups, among which health technology assessment is a strong and recurring theme. Projects to date include:
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Screening for hepatitis C among injecting drug users and in genitourinary medicine clinics: systematic reviews of effectiveness, modelling study and national survey of current practice. Health Technol Assess 2002;6(31).
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The effectiveness and cost-effectiveness of imatinib in chronic myeloid leukaemia: a systematic review. Health Technol Assess 2002;6(33).
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Systematic review of endoscopic sinus surgery for nasal polyps. Health Technol Assess 2003;6(33).
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The effectiveness and cost-effectiveness of microwave and thermal balloon endometrial ablation for heavy menstrual bleeding: a systematic review and economic modelling. Health Technol Assess 2004;8(3).
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Effectiveness and cost-effectiveness of imatinib for first-line treatment of chronic myeloid leukaemia in chronic phase: a systematic review and economic analysis. Health Technol Assess 2004;8(28).
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Do the findings of case series studies vary significantly according to methodological characteristics? Health Technol Assess 2005;9(2).
-
The effectiveness and cost-effectiveness of pimecrolimus and tacrolimus for atopic eczema: a systematic review and economic evaluation. Health Technol Assess 2005;9(29).
-
The effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber pacemakers for bradycardia due to atrioventricular block or sick sinus syndrome: systematic review and economic evaluation. Health Technol Assess 2005;9(43).
-
Surveillance of Barrett’s oesophagus: exploring the uncertainty through systematic review, expert workshop and economic modelling. Health Technol Assess 2006;10(8).
-
The cost-effectiveness of testing for hepatitis C in former injecting drug users. Health Technol Assess 2006;10(32).
-
The effectiveness and cost-effectiveness of cinacalcet for secondary hyperparathyroidism in end-stage renal disease patients on dialysis: a systematic review and economic evaluation. Health Technol Assess 2007;11(18).
-
The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation. Health Technol Assess 2007;11(45).
-
The clinical effectiveness and cost-effectiveness of cardiac resynchronisation (biventricular pacing) for heart failure: systematic review and economic model. Health Technol Assess 2007;11(47).
-
Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over. Health Technol Assess 2008;12(19).
-
Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in children under the age of 12 years. Health Technol Assess 2008;12(20).
-
The effectiveness and cost-effectiveness of methods of storing donated kidneys from deceased donors: a systematic review and economic model. Health Technol Assess 2009;13(38).
-
The effectiveness and cost-effectiveness of cochlear implants for severe to profound deafness in children and adults: a systematic review and economic model. Health Technol Assess 2009;13(44).
We would like to acknowledge the help of Jo Perry for her administrative support.
We would particularly like to thank our expert advisors for their help throughout the project.
Expert advisory group
Professor John J. Reilly, Professor of Paediatric Energy Metabolism, University of Glasgow. Dr Richard Tomlinson, Consultant Paediatrician, Royal Devon and Exeter Foundation Trust Hospital.
Contribution of authors
Mary Bond provided overall project management, wrote the protocol, assessed abstracts and titles and papers for inclusion and exclusion in both systematic reviews, led the clinical effectiveness and cost-effectiveness systematic reviews, wrote the report and contributed to its editing. Katrina Wyatt assessed abstracts, titles and papers for inclusion and exclusion in the effectiveness systematic review, she also contributed to the clinical effectiveness systematic review and to the editing of the report. Jenny Lloyd assessed abstracts, titles and papers for inclusion and exclusion, she also contributed to the clinical effectiveness systematic review and to the editing of the report. Karen Welch compiled and ran the search strategies for clinical effectiveness and cost-effectiveness. Rod Taylor assessed abstracts, titles and papers for inclusion and exclusion in the cost-effectiveness systematic review; he contributed to the editing of the report and was overall director of the project and guarantor of the report.
Disclaimers
The views expressed in this publication are those of the authors and not necessarily those of the HTA programme or the Department of Health.
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Appendix 1 Literature search strategies
Clinical searches
MEDLINE (OVID) 1990–2009
-
exp Obesity/
-
exp weight gain/
-
exp weight loss/
-
Overweight/
-
(overweight or over weight or overeat* or over eat* or overfeed* or over feed*).ti,ab.
-
(weight gain or weight loss).ti,ab.
-
((bmi or body mass index) adj5 (gain or loss or change)).ti,ab.
-
obes*.ti,ab.
-
or/1–8
-
Child, Preschool/
-
Infant/
-
(baby or babies or toddler* or infant* or newborn* or neonat* or preschool* or pre school* or playschool* or playgroup* or kindergarten* or kindergarden*).ti,ab.
-
infant newborn/
-
or/10–13
-
family therapy/
-
Health Knowledge, Attitudes, Practice/
-
Diet Therapy/
-
Obesity/dh [Diet Therapy]
-
Diet, Fat-Restricted/
-
Diet, Reducing/
-
diet therapy/
-
(diet or diets or dieting).ti,ab.
-
Professional-Family Relations/
-
health behavior/
-
parenting/px
-
caregivers/px
-
Schools, Nursery/st [Standards]
-
Nutrition Policy/
-
Preventive Health Services/
-
obesity/pc
-
child care/st
-
Nurseries/st [Standards]
-
Community Health Planning/or Community Health Services/
-
Counseling/
-
(low calorie or calorie control* or healthy eating).ti,ab.
-
(diet* adj (modific* or therapy or intervention* or strateg* or program* or management or scheme*)).ti,ab.
-
exercise/
-
exercise therapy/
-
“Play and Playthings”/
-
(aerobic* or physical therap* or physical activit* or physical inactivity).ti,ab.
-
(fitness adj (class or regime* or program* or group* or session* or scheme*)).ti,ab.
-
sedentary behavio?r reduction.ti,ab.
-
reduc* sedentary behavio?r.ti,ab.
-
dance.mp. and (therapy or activity or class* or program* or group* or session* or scheme*).ti,ab.
-
((playschool or communit* or toddler* or kindergarten) adj2 (program* or scheme*)).ti,ab.)
-
(family* scheme* or families scheme* parent* scheme* or carer* scheme* or guardian* scheme*).ti,ab.
-
(family* intervention* or families intervention* parent* intervention* or carer* intervention* or guardian* intervention*).ti,ab.
-
(parent adj2 (behavio?r or involvement or control* or attitude* or education*)).ti,ab.
-
(group adj (therapy or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
(community adj (therapy or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
(health polic* or preschool polic* or playschool polic* or food polic* or nutrition polic*).ti,ab.
-
primary prevention/
-
(preventive measure* or preventative measure*).ti,ab.
-
(individual* adj (therapy or intervention* or program* or strateg* or management)).ti,ab.
-
(exercise and (therapy or activity or class* or program* or group* or session* or scheme*)).ti,ab.
-
(population adj (therapy or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
Health Education/
-
health promotion/
-
secondary prevention/
-
health scheme*.ti,ab.
-
(weight adj2 manag*).ti,ab.
-
(weight adj2 scheme*).ti,ab.
-
(weight adj2 interven*).ti,ab.
-
or/15–63
-
Randomized Controlled Trials as Topic/or Clinical Trials as Topic/or Random Allocation/
-
Controlled Clinical Trial/
-
controlled clinical trial.pt.
-
randomized controlled trial.pt.
-
Random Allocation/
-
double blind method/or single blind method/
-
((singl* or doubl* or trebl* or tripl*) adj (blind* or mask*)).ti,ab.
-
research design/
-
((random* or control*) adj5 (trial* or stud*)).ti,ab.
-
(randomised or randomized).ti,ab.
-
Comparative Study/
-
Evaluation Studies as Topic/
-
(matched communities or matched populations).mp.
-
(control* adj (trial* or stud* or evaluation*)).mp.
-
(comparison group* or control* group*).mp.
-
Matched-Pair Analysis/
-
matched pair*.ti,ab.
-
(nonrandomi?ed or non randomi?ed or pseudo randomi?ed).ti,ab.
-
Meta-Analysis/
-
meta analy*.ti,ab.
-
“Outcome Assessment (Health Care)”/
-
outcome stud*.ti,ab.
-
Intervention Studies/
-
Prospective Studies/
-
follow up studies/
-
exp clinical trial/
-
or/65–90
-
9 and 14 and 64 and 91
-
limit 92 to (english language and humans)
-
imit 93 to yr=“1990 – 2009”
MEDLINE In-Process (OVID) 1990–2009
Strategy as per MEDLINE (using only free text terms)
EMBASE (OVID) 1990–2009
-
exp Obesity/
-
exp Weight Gain/
-
exp Weight Reduction/
-
(overweight or over weight or overeat* or over eat* or overfeed* or over feed*).ti,ab.
-
(weight gain or weight loss).ti,ab.
-
((bmi or body mass index) adj5 (gain* or loss* or change*)).ti,ab.
-
obes*.ti,ab.
-
or/1–7
-
Preschool Child/
-
Infant/
-
Toddler/
-
(baby or babies or toddler* or infant* or newborn* or neonat* or preschool* or pre school* or playschool* or playgroup* or kindergarten* or kindergarden*).ti,ab. (299389)
-
Infant/
-
Newborn/
-
(“under 5” adj3 age).ti,ab.
-
16 (“under 5” adj3 year*).ti,ab.
-
“under 5’s”.ti,ab.
-
“aged under 5”.ti,ab.
-
“under 5 yr”.ti,ab.
-
or/9–19
-
family therapy/
-
Health Behavior/or Attitude to Health/
-
exp Diet Therapy/
-
Low Fat Diet/
-
Low Calory Diet/
-
(diet or diets or dieting).ti,ab.
-
Health Care Policy/
-
community care/
-
Parent Counseling/or Counseling/or Nutritional Counseling/
-
(low calorie or calorie control* or healthy eating).ti,ab.
-
(obes* adj2 prevent*).ti,ab.
-
(obes* adj2 guidance).ti,ab.
-
(obes* adj2 manag*).ti,ab.
-
(obes* adj5 interven*).ti,ab.
-
(weight adj2 manag*).ti,ab.
-
(weight adj2 scheme*).ti,ab.
-
(weight adj2 interven*).ti,ab.
-
nutrition polic*.ti,ab.
-
nutrition strateg*.ti,ab.
-
Preventive Health Service/
-
public health/
-
exp Exercise/or Aerobic Exercise/
-
(aerobic* or physical therap* or physical activit* or physical inactivity).ti,ab.
-
(fitness adj (class or regime* or program* or group* or session* or scheme*)).ti,ab.
-
(sedentary behavio?r adj2 reduc*).ti,ab.
-
dance.mp. and (therap* or activit* or class* or program* or group* or session* or scheme*).ti,ab.
-
(exercis* adj3 (therap* or activit* or class* or program* or group* or session* or scheme*)).ti,ab.
-
((playschool or communit* or toddler* or kindergarten) adj2 (program* or scheme*)).ti,ab.
-
(family* scheme* or families scheme* parent* scheme* or carer* scheme* or guardian* scheme*).ti,ab.
-
(family* intervention* or families intervention* parent* intervention* or carer* intervention* or guardian* intervention*).ti,ab.
-
(parent adj2 (behavio?r or involvement or control* or attitude* or education*)).ti,ab.
-
(group adj (therapy or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
(community adj (therapy or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
(health polic* or healthcare polic* or preschool polic* or playschool polic* or food polic* or nutrition polic*).ti,ab.
-
Primary Prevention/
-
(preventive measure* or preventative measure*).ti,ab.
-
(individual* adj (therapy or intervention* or program* or strateg* or management)).ti,ab.
-
(population adj (therapy or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
health education/
-
health promotion/
-
secondary prevention/
-
health scheme*.ti,ab.
-
or/21–62
-
exp Randomized Controlled Trial/
-
Controlled Clinical Trial/
-
Randomization/
-
Double Blind Procedure/
-
Single Blind Procedure/
-
placebo/
-
((singl* or doubl* or trebl* or tripl*) adj (blind* or mask*)).ti,ab.
-
placebo*.ti,ab.
-
((random* or control*) adj5 (trial* or stud*)).ti,ab.
-
(randomized or randomised).ti,ab.
-
Comparative Study/
-
Evaluation/
-
(matched communities or matched populations).mp.
-
(control* adj (trial* or study or studies or evaluation*)).mp.
-
(comparison group* or comparative group* or control* group*).mp.
-
statistical analysis/
-
matched pair*.ti,ab.
-
(nonrandomi?ed or non randomi?ed or pseudo randomi?ed).ti,ab.
-
Meta Analysis/
-
meta analy*.ti,ab.
-
Outcome Assessment/
-
outcome stud*.ti,ab.
-
Intervention Study/
-
Prospective Study/
-
Follow Up/
-
(medline or medlars or embase or scisearch or cinahl).ti,ab,sh.
-
“Systematic Review”/
-
(systematic* adj5 review*).mp.
-
(systematic adj5 overview*).mp.
-
(methodolog* adj5 review).mp.
-
(methodolog* adj5 overview*).mp.
-
(methodolog* adj5 research).mp.
-
((hand adj5 search*) or (manual* adj5 search)).mp.
-
(electronic* database* or bibliographic* database* or computer* database* or online database*).mp.
-
(Health Technology Assessment* or Medical Technology Assessment*).ti,ab,in.
-
exp Methodology/
-
or/64–99
-
8 and 20 and 63 and 100
-
obesity/dt
-
102 and 20 and 100
-
101 or 103
-
limit 104 to (human and english language and yr=“1990 – 2009”)
CAB ABSTRACTS (OVID) 1990–2009
-
exp pre school children/or (toddler* or baby or babies or preschool or pre school or newborn* or infant* or neonat* or playschool* or playgroup* or kindergarten* or kindergarden*).mp.
-
exp OBESITY/25258
-
exp preventive measures/or (policy or policies or prevention or evaluation* or intervention* or program* or strateg* or management or scheme*).mp.
-
1 and 2 and 3
-
exp CLINICAL TRIALS/or exp randomized controlled trials/
-
(trial* or study* or studies).ti,ab.
-
4 and (5 or 6)
-
limit 7 to yr=“1990 – 2009”
-
child nutrition.sh.
-
and 2 and 9
-
10 and (5 or 6)
-
or 11
-
limit 12 to (english language and yr=“1990 – 2009”)
Health Management Information Consortium (OVID) 1990–2009
-
exp pre school children/or (toddler* or baby or babies or preschool or pre school or newborn* or infant* or neonat* or playschool* or playgroup* or kindergarten* or kindergarden*).mp.
-
exp OBESITY/
-
exp preventive measures/or (policy or policies or prevention or evaluation* or intervention* or program* or strateg* or management or scheme*).mp.
-
1 and 2 and 3 25
-
exp CLINICAL TRIALS/or exp randomized controlled trials/
-
(trial* or study* or studies).ti,ab.
-
4 and (5 or 6)
-
limit 7 to yr=“1990 – 2009”
Science Citation Index Expanded & Conference Proceedings Citation Index (web of science) 1990–2009
-
TS=(obes* OR overweight OR “weight gain”)
-
TS=((diet or nutrition or food) SAME (scheme* or therapy OR interven* or strateg* OR program* or management or modif* OR reduc* OR policy OR policies))
-
TS=((lifestyle or behaviour OR behavior) SAME (scheme* or therapy OR interven* or strateg* OR program* or management or modif* OR reduc* OR policy OR policies))
-
TS=((exercis* OR fitness OR aerobic* OR dance OR “physical therapy” OR “physical therapies”) SAME (class* OR regime* OR group* or session* OR scheme* or therapy OR interven* or strateg* OR program* or management or modif* OR reduc* OR policy OR policies))
-
TS=((parent OR family or families or guardian* or carer*) SAME (educat* or scheme* OR intervent* or program*))
-
TS=(weight management OR weight maintain* OR weight modific* OR weight control* OR weight reduc*)
-
TS=(toddler* OR preschool or pre-school or “pre school” OR infant*) >100,000
-
(#1 and #7)
-
(#2 OR #3 OR #4 OR #5 OR #6)
-
#8 and #9
-
TS=((random* or placebo* or control* or blind*) SAME (trial or study or studies))
-
TS=(systematic review*)
-
TS=(meta analy*)
-
TS=(controlled trial)
-
TS=(randomized controlled trial)
-
#11 OR #12 OR #13 OR #14 OR #15
-
#10 AND #16
-
TI=(obes* and trial*) AND TI=(toddler* or infant* or preschool or pre-school or “pre school”)
-
TI=(weight or overweight OR “over weight” OR “over-weight”) AND TI=(trial* OR study or studies) AND TI=(toddler* or infant* or preschool or pre-school or “pre school”)
-
TI=(“low birthweight”) or (“low birth weight”)
-
#19 NOT #20
-
#17 OR #18 OR #21
PsycINFO (EBSCO) 1990–2009
Search Limiters – English; language: English; age groups: neonatal (birth–1 month), infancy (2–23 months), preschool age (2–5 years); population group: human
-
S1 exp obesity/
-
S2 TX obesity
-
S3 KW obesity
-
S4 KW overweight
-
S5 TX overweight or over weight
-
S6 TX overeat* or over eat* or overfeed* or over feed
-
S7 MJ obesity
-
S8 (S1 or S2 or S3 or S4 or S5 or S6 or S7)
-
S9 DE “Random Sampling” or MM “Clinical Trials”
-
S10 TX random* or placebo*
-
S11 DE “Experiment Controls”
-
S12 s8 and (s9 or s10 or s11
-
S13 TX weight management
-
S14 TX s12 or s13
-
S15 TX exercise or play or fitness or physical
-
S16 s8 and s15
-
S17 TX trial and (random* or blind* or mask*)
-
S18 TX study and (random* or blind* or mask*)
-
S19 TX studies and (random* or blind* or mask*)
-
S20 s16 and (s9 or s10 or s11 or s17 or 18 or 19
-
S21 TX diet* and (modif* or therap* or intervention* or strateg* or program* or scheme* or management*)
-
S22 TX behav* and (modif* or therap* or intervention* or strateg* or program* or scheme* or management*)
-
S23 TX s8 and (s21 or s22)
-
S24 s23 and (s9 or S10 or S11 or S17 or S18 or S19)
-
S25 s12 or s20 or s24
Cochrane CENTRAL & Cochrane Database of Systematic Reviews
-
MeSH descriptor Obesity explode all trees with qualifiers: TH,DH
-
MeSH descriptor Overweight explode all trees with qualifiers: DH,TH
-
(preschool or infant* or toddler* or baby or babies)
-
“under 5”
-
(#3 OR #4)
-
(#1 OR #2)
-
(#5 AND #6)
-
(obes* or overweight or over next weight or weight next gain or over next eat* or overeat*)
-
(bmi or body next mass next index) near (gain or loss or change)
-
(#8 OR #9)
-
child-preschool:kw
-
infant:kw
-
(#10 AND (#5 OR #11 OR #12))
-
(management or scheme* or program* or reduc* or class or classes or service* or therap* or intervention* or strateg* or counsel* or modif* or support)
-
(lifestyle or life style) adj (chang* or intervention* or modific*)
-
family therapy:kw
-
(#13 AND (#14 OR #15 OR #16))
-
(health next promotion or health next prevention)
-
(#13 AND #18)
-
(#17 OR #19)
-
(random* or placebo*):ti,ab
-
MeSH descriptor Controlled Clinical Trials as Topic, this term only
-
MeSH descriptor Randomized Controlled Trials as Topic explode all trees
-
meta analy*:ti,ab,kw
-
systematic:ti,ab,kw
-
(singl* blind* or doubl* blind* or tripl* blind* or trebl* blind*)
-
(singl* mask* or doubl* mask* or tripl* mask* or trebl* mask*)
-
“controlled clinical trial”:kw
-
controlled study:kw
-
random allocation:kw
-
(#21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30)
-
(#20 AND #31)
CRD HTA, CRD DARE
-
MeSH Obesity EXPLODE
-
MeSH Overweight EXPLODE
-
MeSH Weight Gain EXPLODE
-
weight AND maintenance
-
MeSH Weight Loss EXPLODE
-
obes*
-
“weightgain” OR “weight gain*” OR “weight loss*”
-
#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7
-
MeSH Child, Preschool EXPLODE
-
(toddler* OR preschool OR pre?school OR pre-school OR infant* OR baby OR babies)
-
(“under 5” OR “under 5’s”)
-
#9 or #10 OR #11
-
#8 and #12
Economic searches
MEDLINE (OVID) 1990–2009
-
exp economics/
-
exp economics hospital/
-
exp economics pharmaceutical/
-
exp economics nursing/
-
exp economics medical/
-
exp “Costs and Cost Analysis”/
-
Cost Benefit Analysis/
-
value of life/
-
exp models economic/
-
exp fees/and charges/
-
exp budgets/
-
(value adj2 (money or monetary)).tw.
-
(economic adj2 burden).tw.
-
(expenditure* not energy).tw.
-
budget*.tw.
-
(economic* or price* or pricing or financ* or fee* or pharmacoeconomic* or pharma economic* or pharmaco-economic*).tw.
-
(decision adj1 (tree* or analys* or model*)).tw.
-
Resource Allocation/
-
(unit cost or unit-cost or unit-costs or unit costs or drug cost or drug costs or hospital costs or health-care costs or health care cost or medical cost or medical costs).tw.
-
((value or values or valuation) adj2 (money or monetary or life or lives or costs or cost)).tw.
-
Markov Chains/
-
Monte Carlo Method/
-
exp Decision Support Techniques/
-
(resource adj2 (use* or utili* or allocat*)).tw.
-
(cost adj2 (util* or effective* or efficac* or benefit* or consequence* or analys* or minimi* or saving* or breakdown* or lowering or estimate* or variable* or allocation* or control* or illness* or affordable* or instrument* or technolog* or fee* or charge* or charges)).tw.
-
or/1–25
-
limit 26 to (comment or editorial or letter)
-
26 not 27
-
exp Obesity/
-
exp weight gain/
-
overweight/
-
(overweight or over weight or overeat* or over eat* or overfeed* or over feed*).ti,ab.
-
(weight adj1 gain*).ti,ab.
-
((bmi or body mass index) adj5 (gain* or loss* or chang*)).ti,ab.
-
((bmi or body mass index) adj5 (gain* or chang*)).ti,ab.
-
obes*.ti,ab.
-
or/29–36
-
child preschool/
-
infant/
-
(baby or babies or toddler* or infant* or newborn* or neonat* or preschool* or pre school* playschool* or playgroup* or kindergarten* or kindergarden*).ti,ab.
-
infant newborn/
-
(age adj5 “under 5”).ti,ab.
-
(age adj5 “under 5’s”).ti,ab.
-
(year* adj5 “under 5”).ti,ab.
-
(year* adj5 “under 5’s”).ti,ab.
-
or/38–45
-
family therapy/
-
Health Knowledge, Attitudes, Practice/
-
diet therapy/
-
Obesity/dh, th [Diet Therapy, Therapy]
-
diet fat restricted/
-
diet reducing/
-
diet therapy/
-
(diet or diets or dieting).ti,ab.
-
professional family relations/
-
health behavior/
-
parenting/px
-
caregivers/px
-
Schools, Nursery/st [Standards]
-
nutrition policy/
-
Preventive Health Services/
-
obesity/pc
-
child care/st
-
nurseries/st
-
Community Health Planning/or Community Health Services/
-
counseling/
-
(low calorie or calorie control* or healthy eating).ti,ab.
-
(eat* adj1 health*).ti,ab.
-
(diet* adj2 (modific* or therap* or intervention* or strateg* or program* or management or scheme*)).ti,ab.
-
exercise/or exercise therapy/
-
“Play and Playthings”/
-
(aerobic* or physical therap* or physical activit* or physical inactivity).ti,ab.
-
(fitness adj (class or regime* or program* or group* or session* or scheme* or therap*)).ti,ab.
-
(sedentary behavio?r adj2 reduc*).ti,ab.
-
(reduc* adj2 sedentary).ti,ab.
-
dance.mp. and (therap* or activit* or class* or program* or group* or session* or scheme*).ti,ab.
-
Dance Therapy/
-
dancing/and (therap* or activit* or class* or program* or group* or session* or scheme*).ti,ab.
-
((playschool or communit* or toddler* or kindergarten) adj2 (program* or scheme*)).ti,ab.
-
(family* scheme* or families scheme* parent* scheme* or carer* scheme* or guardian* scheme*).ti,ab.
-
(family* intervention* or families intervention* parent* intervention* or carer* intervention* or guardian* intervention*).ti,ab.
-
(parent adj2 (behavio?r or involvement or control* or attitude* or education*)).ti,ab.
-
(group adj (therap* or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
(community adj (therap* or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
(health polic* or preschool polic* or playschool polic* or food polic* or nutrition polic*).ti,ab.
-
primary prevention/
-
(preventive measure* or preventative measure*).ti,ab.
-
(individual* adj (therap* or intervention* or program* or strateg* or management)).ti,ab.
-
(exercise and (therap* or activity or class* or program* or group* or session* or scheme*)).ti,ab.
-
(population adj (therap* or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
health education/or health promotion/
-
secondary prevention/
-
(health scheme* or health program*).ti,ab.
-
(weight adj2 manag*).ti,ab.
-
(obes* adj2 manag*).ti,ab.
-
(weight adj5 scheme*).ti,ab.
-
(weight adj5 interven*).ti,ab.
-
or/47–97
-
28 and 37 and 46 and 98
-
limit 99 to (english language and humans and yr=“1990 – 2009”)
MEDLINE In-Process (OVID) 1990–2009
Strategy as per MEDLINE (using only free text terms)
EMBASE (OVID) 1990–2009
-
exp Obesity/
-
exp Weight Gain/
-
exp Weight Reduction/
-
(overweight or over weight or overeat* or over eat* or overfeed* or over feed*).ti,ab.
-
(weight gain or weight loss).ti,ab.
-
((bmi or body mass index) adj5 (gain* or loss* or change*)).ti,ab.
-
obes*.ti,ab.
-
or/1–7
-
Preschool Child/
-
Infant/
-
Toddler/
-
(baby or babies or toddler* or infant* or newborn* or neonat* or preschool* or pre school* playschool* or playgroup* or kindergarten* or kindergarden*).ti,ab.
-
Infant/
-
Newborn/
-
(“under 5” adj3 age*).ti,ab.
-
(“under 5” adj3 year*).ti,ab.
-
“under 5’s”.ti,ab.
-
“aged under 5”.ti,ab.
-
(“under 5 yr” or “under 5 yrs”).ti,ab.
-
or/9–19
-
family therapy/
-
Health Behavior/or Attitude to Health/
-
exp Diet Therapy/
-
Low Fat Diet/
-
Low Calory Diet/
-
(diet or diets or dieting).ti,ab.
-
Health Care Policy/
-
community care/
-
Parent Counseling/or Counseling/or Nutritional Counseling/
-
(low calorie or calorie control* or healthy eating).ti,ab.
-
(obes* adj2 prevent*).ti,ab.
-
(obes* adj2 guidance).ti,ab.
-
(obes* adj2 manag*).ti,ab.
-
(obes* adj5 interven*).ti,ab.
-
(obes* adj5 program*).ti,ab.
-
(weight adj2 manag*).ti,ab.
-
(weight adj5 scheme*).ti,ab.
-
(weight adj5 interven*).ti,ab.
-
nutrition polic*.ti,ab.
-
nutrition strateg*.ti,ab.
-
Preventive Health Service/
-
public health/and (therap* or intervention* or program* or strateg*).ti,ab.
-
exp Exercise/or Aerobic Exercise/
-
(aerobic* or physical therap* or physical activit* or physical inactivity or physical education*).ti,ab.
-
(fitness adj (class or regime* or program* or group* or session* or scheme*)).ti,ab.
-
(sedentary behavio?r adj2 reduc*).ti,ab.
-
dance.mp. and (therap* or activit* or class* or program* or group* or session* or scheme*).ti,ab.
-
(exercis* adj3 (therap* or activit* or class* or program* or group* or session* or scheme*)).ti,ab.
-
((playschool or communit* or toddler* or kindergarten) adj2 (program* or scheme*)).ti,ab.
-
(family* scheme* or families scheme* parent* scheme* or carer* scheme* or guardian* scheme*).ti,ab.
-
(family* intervention* or families intervention* parent* intervention* or carer* intervention* or guardian* intervention*).ti,ab.
-
(parent adj2 (behavio?r or involvement or control* or attitude* or education*)).ti,ab.
-
(group adj2 (therap* or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
(community adj (therap* or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
(health polic* or healthcare polic* or preschool polic* or playschool polic* or food polic* or nutrition polic*).ti,ab.
-
Primary Prevention/
-
(preventive measure* or preventative measure*).ti,ab.
-
(individual* adj (therap* or intervention* or program* or strateg* or management)).ti,ab.
-
(population adj (therap* or intervention* or program* or strateg* or management or scheme*)).ti,ab.
-
health education/
-
health promotion/
-
secondary prevention/
-
health scheme*.ti,ab.
-
(health* adj2 program*).ti,ab.
-
(health* adj2 intervention*).ti,ab.
-
or/21–65
-
exp Health Economics/
-
*economics/
-
monte carlo method/
-
cost*.ti.
-
cost minimization analysis/
-
cost of illness/
-
cost utility analysis/
-
health care cost/
-
economic evaluation/
-
pharmacoeconomics/
-
budget/
-
(econom* or pharmacoeconomic* or pharmaco economic* or cost or costs or costly or costing or costed or expenditure* or budget*).ti,ab.
-
markov.mp.
-
(resource adj2 (use* or utili* or allocat*)).ti,ab.
-
(cost adj2 (util* or effective* or efficac* or benefit* or consequence* or analys* or minimi* or saving* or breakdown* or lowering or estimate* or variable* or allocation* or control* or illness* or affordable* or instrument* or technolog* or fee* or charge* or charges)).ti,ab.
-
((value or values or valuation) adj2 (money or monetary or life or lives or costs or cost)).tw.
-
or/67–82
-
8 and 20 and 66 and 83
-
limit 84 to (human and english language and yr=“1990 – 2009”)
-
limit 85 to (editorial or letter)
-
85 not 86
CAB abstracts (OVID) 1990–2009
-
exp pre school children/or (toddler* or baby or babies or preschool or pre school or newborn* or infant* or neonat* or playschool* or playgroup* or kindergarten* or kindergarden*).mp
-
exp OBESITY/
-
exp preventive measures/or (policy or policies or prevention or evaluation* or intervention* or program* or strateg* or management or scheme*).mp.
-
1 and 2 and 3
-
child nutrition.sh.
-
1 and 3 and 5
-
(overweight or over weight or overeat* or over eat* or overfeed* or over feed*).ti,ab
-
(weight gain* or weight loss* or weight management).ti,ab.
-
((bmi or body mass index) adj5 (gain* or loss* or change*)).ti,ab.
-
weight reduction/
-
or/7–10
-
1 and 3 and 11
-
4 or 6 or 12
-
(costs or economic analysis or “cost benefit analysis”).sh.
-
13 and 14
Health Management Information Consortium (OVID) 1990–2009
-
exp pre school children/or (toddler* or baby or babies or preschool or pre school or newborn* or infant* or neonat* or playschool* or playgroup* or kindergarten* or kindergarden*).mp.
-
exp OBESITY/
-
exp preventive measures/or (policy or policies or prevention or evaluation* or intervention* or program* or strateg* or management or scheme*).mp.
-
1 and 2 and 3
-
(overweight or over weight or overeat* or over eat* or overfeed* or over feed*).ti,ab.
-
(weight gain* or weight loss* or weight management).ti,ab.
-
((bmi or body mass index) adj5 (gain* or loss* or change*)).ti,ab.
-
exp WEIGHT WATCHING/
-
exp BODY WEIGHT/or exp CLINICAL WEIGHT MEASUREMENT/or exp WEIGHT
-
or/5–9
-
1 and 2 and 10
-
4 or 11
-
exp HEALTH ECONOMICS/
-
exp TREATMENT COSTS/
-
exp “COST BENEFIT ANALYSIS”/
-
(cost adj2 (util* or effective* or efficac* or benefit* or consequence* or analys* or minimi* or saving* or breakdown* or lowering or estimate* or variable* or allocation* or control* or illness* or affordable* or instrument* or technolog* or fee* or charge* or charges)).ti,ab.
-
(resource adj2 (use* or utili* or allocat*)).ti,ab.
-
exp MODELS/
-
exp ECONOMIC EVALUATION/
-
markov.ti,ab.
-
(economic* or budget*).ti,ab.
-
or/13–21
-
12 and 22
Science Citation Index Expanded & Conference Proceedings Citation Index (web of science) 1990–2009
Search Restricted to Document Type=(Article OR Meeting Abstract OR Meeting Summary OR Meeting-Abstract OR Proceedings Paper) AND Language=(English)
-
TS=(toddler* OR preschool or pre-school or “pre school” OR infant*)
-
TS=(obes* OR overweight OR “weight gain” or “weight loss”)
-
TS=(cost or economic* or markov or “monte carlo”)
-
TS=(scheme* or program* or therapy or therapies or intervention* or strategy or strategies)
-
#1 and #2 and #3 and #4
-
TS=(“cost benefit analysis” or “cost benefit analyses”)
-
TS=(“health economics”)
-
#6 or #7
-
#1 and #2 and #4 and #8
-
#5 or #9
-
TI=(obes*) and TI=(cost*)
-
TI=(overweight)and TI=(cost*)
-
#11 or #12
-
1 #1 and #13
-
#10 or #14
Cochrane CENTRAL & Cochrane Database Of Systematic Reviews
-
MeSH descriptor Obesity explode all trees
-
MeSH descriptor Overweight explode all trees
-
(#1 OR #2)
-
(preschool or infant* or toddler* or baby or babies)
-
(#3 AND #4)
-
Obes*:ti,ab,kw
-
(#4 AND #6)
-
(#5 OR #7)
-
(management or scheme* or program* or reduc* or class or classes or service* or therap* or intervention* or strateg* or counsel* or modif* or support)
-
(#8 AND #9)
-
MeSH descriptor Economics explode tree
-
MeSH descriptor Costs and Cost Analysis explode all trees
-
MeSH descriptor Models, Economic explode trees 1, 2 and 4
-
cost-effective*
-
MeSH descriptor Resource Allocation explode all trees
-
“economic evaluation”
-
(#11 OR #12 OR #13 OR #14 OR #15 OR #16)
-
(#10 AND #17)
-
cost*:ti or economic*:ti 22117
-
(#8 AND #19)
-
(#20 AND NOT #18)
-
(#18 OR #21) 11
NHS EED, HTA, DARE, (CRD)
-
MeSH Obesity EXPLODE
-
MeSH Overweight EXPLODE
-
MeSH Weight Gain EXPLODE
-
weight AND maintenance
-
MeSH Weight Loss EXPLODE
-
obes*
-
“weightgain” OR “weight gain*” OR “weight loss*”
-
#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7
-
MeSH Child, Preschool EXPLODE
-
(toddler* OR preschool OR pre?school OR pre-school OR infant* OR baby OR babies)
-
(“under 5” OR “under 5’s”)
-
#9 or #10 OR #11
-
#8 and #12
-
MeSH Economics, Medical EXPLODE 1 241
-
MeSH Cost of Illness EXPLODE 1 2 2632
-
cost AND benefit AND analysis 6515
-
MeSH Cost-Benefit Analysis EXPLODE 1 11354
-
MeSH Health Care Costs EXPLODE 1 2 9189
-
MeSH Models, Economic EXPLODE 1 2 3 4 1763
-
“cost effectiveness” 10411
-
#14 OR 15 OR 16 OR 17 OR 18 OR 19 OR 20
-
22#13 AND 21
-
RESTRICT YR 1990 2009
PsycINFO (EBSCO) 1990–2009
-
(((DE “Obesity”) or (DE “Overweight”))) or (DE “Weight Gain”)
-
DE “Costs and Cost Analysis”
-
TX scheme* or TX program* or TX group* or TX therapy or TX therapies or TX activity or TX activities or TX intervention* or TX management
-
s1 and s2 and s3
-
TX weight n5 manag* or TX “weight loss” n5 manag* or TX “weight gain” n5 manag*
-
TX obes* n5 manag* or TX obes* n5 manag* or TX obes* n5 manag*
-
s5 OR s6
-
s2 AND s7
-
s4 OR s8
-
TX exercise or TX aerobic* or TX dance or TX dancing or TX gym* or TX play*
-
s1 and s2 and s10
-
TX obes*
-
TX preschool or TX “pre school” or TX infant* or TX baby or TX babies or TX tot* or TX “under 5” or TX newborn* or TX neonat* or playschool* or playgroup* or kindergar?en
-
s12 and s13
-
TX cost* or TX economic* or TX markov
-
s14 and s15
-
s14 and s15 Narrow by Age0: – Preschool Age (2–5 yrs)
-
s9 or s11 or s17
Quality of life searches
MEDLINE (OVID) 1990–2009
-
exp obesity/
-
exp weight gain/
-
overweight/
-
Child, Preschool/)
-
(“under 5” adj5 age*).ti,ab.
-
“under 5’s”.ti,ab.
-
“under 5 years of age”.ti,ab.
-
(baby or babies or toddler* or infant*).ti,ab.
-
or/1–3
-
or/4–8
-
9 and 10
-
value of life/
-
quality adjusted life year/
-
quality adjusted life.ti,ab.
-
(qaly* or qald* or qale* or qtime*).ti,ab.
-
disability adjusted life.ti,ab.
-
daly*.ti,ab.
-
health status indicators/
-
(sf36 or sf 36 or short form 36 or shortform 36 or sf thirtysix or sf thirty six or shortform thirtysix or shortform thirty six or short form thirty six or short form thirtysix).ti,ab.
-
(sf6 or sf 6 or short form 6 or shortform 6 or sf six or sfsix or shortform six or short form six).ti,ab.
-
(sf12 or sf 12 or short form 12 or shortform 12 or sf twelve or sftwelve or shortform twelve or short form twelve).ti,ab.
-
(sf16 or sf 16 or short form 16 or shortform 16 or sf sixteen or sfsixteen or shortform sixteen or short form sixteen).ti,ab.
-
(sf20 or sf 20 or short form 20 or shortform 20 or sf twenty or sftwenty or shortform twenty or short form twenty).ti,ab.
-
(euroqol or euro qol or eq5d or eq 5d).ti,ab.
-
(hql or hqol or h qol or hrqol or hr qol).ti,ab.
-
(hye or hyes).ti,ab.
-
health* year* equivalent*.ti,ab.
-
health utilit*.ti,ab.
-
(hui or hui1 or hui2 or hui3).ti,ab.
-
disutil*.ti,ab.
-
rosser.ti,ab.
-
quality of well being.ti,ab.
-
quality of wellbeing.ti,ab.
-
qwb.ti,ab.
-
willingness to pay.ti,ab.
-
standard gamble*.ti,ab.
-
time trade off.ti,ab.
-
time tradeoff.ti,ab.
-
tto.ti,ab.
-
(quality adj2 well being).mp.
-
(index adj2 well being).mp.
-
(health adj3 util* ind*).mp.
-
((multiattribute* or multi attribute*) adj3 (health ind* or theor* or health state* or utilit* or analys*)).mp.
-
quality adjusted life year*.mp.
-
(15D or 15 dimension*).mp.
-
(12D or 12 dimension*).mp.
-
rating scale*.mp
-
linear scale*.mp.
-
linear analog*.mp.
-
visual analog*.mp.
-
(categor* adj2 scale*).mp.
-
(obes* and child*).mp. and scale*.ti.
-
from 52 keep 1–14
-
(scale* adj2 measur*).ti,ab.
-
Pediatrics/px, is [Psychology, Instrumentation]
-
psychometrics/
-
Sickness Impact Profile/
-
“children’s physical self-concept scale”.ti,ab.
-
“pedsQL”.ti,ab.
-
(pediatric* adj2 quality of life).ti,ab.
-
(paediatric* adj2 quality of life).ti,ab.
-
(child* adj2 quality of life).ti,ab.
-
(child* adj2 qol).ti,ab.
-
(pediatric adj2 qol).ti,ab.
-
(paediatric* adj2 qol).ti,ab.
-
or/12–65
-
11 and 66
-
(letter or editorial or comment).ti,ab.
-
67 not 68
-
limit 69 to (english language and humans and yr=“1990 – 2009”)
MEDLINE In-Process (OVID) 1990–2009
Strategy as per MEDLINE (using only free text terms)
EMBASE (OVID) 1990–2009
-
exp obesity/
-
exp weight gain/
-
(overweight or obes* or “over weight”).ti,ab.
-
child preschool/or (Preschool or pre-school).ti,ab.
-
(“under 5” adj5 age*).ti,ab.
-
“under 5’s”.ti,ab.
-
“under 5 years of age”.ti,ab.
-
(baby or babies or toddler* or infant*).ti,ab.
-
or/1–3
-
or/4–8
-
9 and 10
-
“value of life”.mp.
-
quality adjusted life year/
-
quality adjusted life.ti,ab.
-
(qaly* or qald* or qale* or qtime*).ti,ab.
-
disability adjusted life.ti,ab.
-
daly*.ti,ab.
-
health status indicator*.ti,ab.
-
(sf36 or sf 36 or short form 36 or shortform 36 or sf thirtysix or sf thirty six or shortform thirtysix or shortform thirty six or short form thirty six or short form thirtysix).ti,ab.
-
(sf6 or sf 6 or short form 6 or shortform 6 or sf six or sfsix or shortform six or short form six).ti,ab.
-
(sf12 or sf 12 or short form 12 or shortform 12 or sf twelve or sftwelve or shortform twelve or short form twelve).ti,ab.
-
(sf16 or sf 16 or short form 16 or shortform 16 or sf sixteen or sfsixteen or shortform sixteen or short form sixteen).ti,ab.
-
(sf20 or sf 20 or short form 20 or shortform 20 or sf twenty or sftwenty or shortform twenty or short form twenty).ti,ab.
-
(euroqol or euro qol or eq5d or eq 5d).ti,ab.
-
(hql or hqol or h qol or hrqol or hr qol).ti,ab.
-
(hye or hyes).ti,ab.
-
health* year* equivalent*.ti,ab.
-
health utilit*.ti,ab.
-
(hui or hui1 or hui2 or hui3).ti,ab.
-
disutil*.ti,ab.
-
rosser.ti,ab.
-
quality of well being.ti,ab.
-
quality of wellbeing.ti,ab.
-
qwb.ti,ab.
-
willingness to pay.ti,ab.
-
standard gamble*.ti,ab.
-
time trade off.ti,ab.
-
time tradeoff.ti,ab.
-
tto.ti,ab.
-
(quality adj2 well being).mp.
-
(index adj2 well being).mp.
-
(health adj3 util* ind*).mp.
-
((multiattribute* or multi attribute*) adj3 (health ind* or theor* or health state* or utilit* or analys*)).mp.
-
quality adjusted life year*.mp.
-
(15D or 15 dimension*).mp.
-
(12D or 12 dimension*).mprating scale*.mp.
-
linear scale*.mp.
-
linear analog*.mp.
-
visual analog*.mp.
-
(categor* adj2 scale*).mp.
-
(obes* and child*).mp. and scale*.ti.
-
quality of life.ti,ab.
-
(scale* adj2 measur*).ti,ab.
-
[Pediatrics/px, is [Psychology, Instrumentation]]
-
psychometric*.ti,ab.
-
(Sickness adj2 impact*).ti,ab.
-
“children’s physical self-concept scale”.ti,ab.
-
“pedsQL”.ti,ab.
-
(pediatric* adj2 quality of life).ti,ab.
-
(paediatric* adj2 quality of life).ti,ab.
-
(child* adj2 quality of life).ti,ab.
-
(child* adj2 qol).ti,ab.
-
(pediatric adj2 qol).ti,ab.
-
(paediatric* adj2 qol).ti,ab.
-
or/12–65
-
11 and 66
-
(letter or editorial or comment).ti,ab.
-
67 not 68
Science Citation Index Expanded & Conference Proceedings Citation Index (web of science) 1990–2009
-
TS=(obes* OR overweight OR “weight gain”)
-
TS=(toddler* OR preschool or pre-school or “pre school” OR infant*)
-
TS=(“quality adjusted life”)
-
TS=(“quality indicator*”)
-
TS=(qaly* or qald* or qale* or qtime* or daly or euroqol or “euro qol” or eq5d or “eq 5d” or hql or hqol or “h qol” or hrqol or “hr qol”)
-
TS=(health utilit*)
-
TS=(“health utilit*”)
-
TI=(“quality of life” or “life quality” or qol)
-
TS=(“rating scale” same quality)
-
TS=(child* same “quality of life”)
-
TS=(child* same qol)
-
TS=(paediatric* SAME “quality of life”) OR TS=(pediatric* SAME “quality of life”) OR TS=(paediatric* SAME QOL) or TS=(pediatric* SAME qol)
-
TS=(obes* SAME child*) AND TS=(rating same measur*)
-
TS=(obes* SAME child*) AND TS=(scale* same measur*)
-
TS=(obes* SAME stigma*)
-
TS=(15D or “15 dimension” or 12D or “12 dimension” or hui or “hui1” or “hui2” or “hui3” or rosser)
-
#1 AND #2
-
(#3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16)
-
#17 and #18
PsycINFO (EBSCO) 1990–2009
Adapted from MEDLINE search
-
DE obesity or DE overweight or DE weight gain
-
TX obes*
-
s1 OR s2
-
TX preschool or TX “pre school” or TX “under 5” or TX baby or TX babies or TX infan* or TX “tot” or TX “tots”
-
s3 AND s4
-
MM “Quality of Life”
-
TX “quality adjusted life” or TX “quality indicator*” or TX “health utilit*” or TX Rosser
-
DE “Rating Scales” OR DE “Likert Scales”
-
TX euroqol or TX euro qol or TX eq5d or TX eq 5d or TX hql or TX hqol or TX h qol or TX hrqol or TX hr qol or TX hye or TX hyes
-
TX quality of wellbeing or TX quality of well being
-
TX SF 36 or TX SF36 or TX SF 12 or TX SF12 or TX SF 6 or TX SF6 or TX SF 16 or TX SF16 or TX SF 20 or TX SF20
-
TI quality of life
-
DE “Ability Level”
-
TX stigma* N5 obes*
-
TX impact* N5 obes*
-
TX emotion* N5 obes*
-
DE “Body Image” OR DE “Body Image Disturbances”
-
DE “Learning Ability”
-
DE “Self Esteem” or DE “Self Confidence” or DE “Conduct Disorder” or DE “Self Concept” or DE “Self Perception”
-
(s6 or s7 or s8 or s9 or s10 or s11 or s12 or s13 or s14 or s15 or s16 or s17 or s18 or s19)
-
s5 and s20
-
TX preschool or TX “pre school” or TX baby or TX babies or TX infant or TX infants or TX “tot” or TX “tots”
-
s3 and s20 and s22
-
TX “under 5” N3 age or TX “under 5” N3 years
-
s3 and s20 and s24
-
s23 or s25 Results (Limited to 1990–2009 & English language)
Cochrane CENTRAL & Cochrane Database Of Systematic Reviews
-
MeSH descriptor Obesity explode
-
MeSH descriptor Overweight explode
-
(#1 OR #2)
-
(“preschool” or “pre-school” or “pre school” or toddler* or infant* or baby or babies or “tot” or “tots”)
-
“young child” or “young children”
-
(#4 OR #5) 39277
-
MeSH descriptor Quality of Life explode all trees
-
(euroqol or “euro qol” or “eq5d” or “eq 5d” or hql or “hqol” or “h qol” or “hrqol” or “hr qol” or hye or hyes)
-
(“SF 36” or “SF36” or “SF 12” or “SF12” or “SF 6” or “SF6” or “SF 16” or “SF16” or “SF 20” or “SF20”)
-
(hui” OR “hui1” OR “hui2” OR “hui3” or rosser)
-
(QALY* OR QUALY*)
-
MeSH descriptor Sickness Impact Profile explode
-
(stigma*)
-
(impact* and quality)
-
“quality of life”
-
“quality indicator”
-
“quality indicators”
-
(#7 OR #8 OR #9 OR #10 OR 11 OR #12 OR 13 OR #14 OR #15 OR #16 OR 17)
-
(#3 AND #6 AND #18)
CRD HTA, CRD DARE
-
MeSH Obesity EXPLODE
-
MeSH Overweight EXPLODE
-
MeSH Weight Gain EXPLODE
-
MeSH Weight Loss EXPLODE
-
weight AND maintenance
-
obes*
-
weightgain OR “weight gain” OR “weight loss”
-
#1 or #2 or #3 or #4 or #5 or #6 or #7
-
MeSH Child, Preschool EXPLODE
-
preschool OR “pre-school” OR “pre school”
-
baby OR babies OR toddler OR toddlers OR tot OR tots OR infant*
-
“under 5”
-
“under 5’s”
-
young AND child
-
young AND children
-
#9 or #10 or #11 or #12 or #13 or #14 or #15
-
#8 and #16
-
quality AND life
-
MeSH Quality of Life EXPLODE
-
“quality adjusted life”
-
“quality indicator” AND “quality indicators”
-
“quality of wellbeing” OR “quality of well being”
-
“quality-of-life”
-
stigma* OR impact*
-
“SF 36” OR “SF36” OR “SF 12” OR “SF12” OR “SF6” OR “SF 16” OR “SF16” OR “SF 20” OR “SF20”
-
“euroqol” OR “euro qol” OR “eq5d” OR “eq 5d” OR “hql” OR “hqol” OR “hqol” OR “h qol” OR “hrqol” OR “hr qol” OR “hye” OR “hyes”
-
“hui” OR “hui1” OR “hui2” OR “hui3” OR “rosser”
-
MeSH Sickness Impact Profile EXPLODE
-
“health state” AND “health states”
-
QALY OR QUALY
-
#18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 or 32
-
#17 and #31
Appendix 2 Flow of studies
Appendix 3 Data extraction tables
Reilly and colleagues75
Study | Population | Outcomes | Context | Theory | Notes | Arms | OUTCOMES |
---|---|---|---|---|---|---|---|
ID: Reilly et al. 75 MAGIC trial: Movement and activity Glasgow intervention in children Date of publication: 2006 Design: cluster RCT Country: UK Definition of overweight: not reported Definition of obesity: ≥ 95th UK National BMI percentile Ethnic group: not reported Source of funding: British Heart Foundation, Glasgow City Council, and the Caledonian Research Foundation |
n = 545 Age of children: mean age 4.2 (SD 0.2) years Intervention target population: children, parents and staff |
BMI: ✗ Weight: ✗ Health outcomes: not measured Height: ✗ Quality of life: not measured Length of follow-up: 12 months |
Community: the context of this intervention was in the nursery and in the home Home: ✗ |
Implicit: the implicit theory behind this trial is that increasing physical activity in very young children will have a preventative effect on obesity | Additional comment: this is a high quality cluster randomised controlled trial |
Arm No: 1 Name: intervention child level n = 268 Description: an enhanced physical activity programme, in the nursery, of three 30-minute sessions of physical activity each week for 24 weeks. Two members of staff were trained in the intervention and an unblinded researcher monitored the intervention. This was combined with a home intervention consisting of a resource pack with guidance linking physical play at the nursery and home and two health education leaflets about the benefits of physical activity and encouraging alternatives to television watching, with the aim of increasing physically active play and reducing the amount of television watched Arm No: 2 Name: control child level n = 277 Description: usual care; the head teachers agreed not to enhance their physical development and movement curriculum |
BMI SD score at 6 months SD score at 12 months Accelerometry count per minute % monitored time sedentary % monitored time in MVPA |
Baseline characteristics
Intervention child level | Control child level | ∆ | p | |||||
---|---|---|---|---|---|---|---|---|
n | k | Mean | n | k | Mean | |||
Age (years) | 268 | 4.2 (SD 0.3) | 277 | 4.1 (SD 0.3) | ||||
Number (%) overweight | 268 | 62 | 277 | 61 | ||||
Number (%) obese | 268 | 62 | 277 | 28 | ||||
Accelerometry per minute | 268 | 732 (SD 163) | 277 | 809 (SD 209) | MD = –77.000 (SE 16.026) | < 0.001a | ||
% monitored time sedentary (median) | 268 | 69.3 (rng 50.4–86.6) | 277 | 66.9 (rng 45.6–88.7) | ||||
% monitored time MVPA (median) | 268 | 2.6 (rng 0.4–11.1) | 277 | 3 (rng 0.3–13) | ||||
BMI | ||||||||
kg/m2 | 268 | 16.3 (SD 1.5) | 277 | 16.4 (SD 1.5) | MD= –0.100 (SE 0.129) | 0.437a | ||
SD score | 268 | 0.39 (SD 0.98) | 277 | 0.41 (SD 1) | MD = –0.020 (SE 0.085) | 0.814a |
Results
Intervention child level | Control child level | ∆ | p | |||||
---|---|---|---|---|---|---|---|---|
n | k | Mean | n | k | Mean | |||
Accelerometry count per minute | 231 | 809 (SD 179) | 250 | 899 (SD 218) | MD = –90.000 (SE 18.133) | < 0.001a | ||
% monitored time sedentary (median) | 231 | 67 (rng 47–86) | 250 | 62.9 (rng 43.1–81.6) | ||||
% monitored time in MVPA (median) | 231 | 3.5 (rng 0.5–12.4) | 250 | 4.1 (rng 0.6–12.1) | ||||
BMI | ||||||||
SD score at 6 months | 231 | 0.46 (SD 1.03) | 250 | 0.43 (SD 1.08) | MD = 0.030 (SE 0.096) | 0.756a | ||
SD score at 12 months | 231 | 0.41 (SD 1.05) | 250 | 0.43 (SD 1.1) | MD = –0.020 (SE 0.098) | 0.839a |
Quality appraisal
1.1. Was the sample size based on a power calculation? YES 1.2. Are the eligibility criteria explicit? YES 1.3. Was the randomisation to groups adequate? NOT REPORTED. Randomisation was stratified but the method used was not specified 1.4. Was the intervention allocation concealed adequately? YES 1.5. Were the groups similar at baseline? YES 1.6. Did the groups receive similar treatment other than the intervention? NOT REPORTED 1.7. Were outcome assessors blinded to treatment allocation? YES 1.8. Were all participants accounted for? YES 1.9. Were the number of withdrawals specified? YES 1.10. Was the percentage of the population who received the intervention reported? YES 1.11. Was the consistency of the intervention measured? YES. An unblinded researcher visited nurseries to monitor the intervention 1.12. Was the likelihood of participants receiving a ‘contaminated’ intervention reported? NO 1.13. Were the outcome measures objective? YES 1.14. What was the unit of allocation? GROUP AND INDIVIDUAL 1.15. What was the unit of analysis? INDIVIDUAL AND GROUP 1.16. Was the method of data analysis appropriate? YES. Multilevel modelling, using iterative generalised least squares for model fitting 1.17. Was the analysis by ITT? YES 1.18. Are the results generalisable? YES 1.19. Were appropriate methods used to account for missing data? UNCLEAR 1.20. CLUSTER TRIALS ONLY – was a rationale for the design given? YES 1.21. CLUSTER TRIALS ONLY – are the effects of clustering included in the sample size calculation? YES 1.22. CLUSTER TRIALS ONLY – were the effects of clustering incorporated into the analysis? YES 1.23. CLUSTER TRIALS ONLY – does the flow diagram include both clusters and individuals? YES |
Hip-Hop Jr
Study | Population | Outcomes | Context | Theory | Notes |
---|---|---|---|---|---|
ID: Protocol for the Hip-Hop to Health research programme76 Date of publication: 2002 Design: cluster RCT Country: USA Definition of overweight: BMI ≥ 85th percentile Definition of obesity: BMI ≥ 95th percentile Ethnic group: African American and Latino |
Age of children: 3–5 years Intervention target population: children and parents |
BMI: ✗ Weight: ✗ Health outcomes: - Height: ✗ Quality of life: - Length of follow-up: 5 years |
Community: the context for this intervention was 12 Head Start preschools aimed at supporting low income families Home: ✗ |
Implicit: the implicit theory behind this scheme is that obesity can be prevented by reducing dietary fat and increasing dietary fibre, and by an increase in physical activity and inclusion of the family Explicit: this scheme was theoretically underpinned by social learning theory, self-determination theory and the transtheoretical model |
Additional comment: This paper is the study protocol |
Study | Population | Outcomes | Context | Theory | Notes | Arms |
---|---|---|---|---|---|---|
ID: Stolley et al. 78 Hip-Hop to Health Jr Baseline characteristics Date of publication: 2003 Design: Cluster RCT Country: USA Definition of overweight: BMI ≥ 85th percentile Definition of obesity: BMI ≥ 95th percentile Ethnic group: African American and Latino Source of funding: National Heart Lung and Blood Institute |
n = 778 Age of children: mean age (SD) at entry 4.2 (4.9) years Intervention target population: children and parents |
BMI: ✗ Weight: ✗ Health outcomes: - Height: ✗ Quality of life: Not reported Length of follow-up: baseline data only |
Community: the context for this intervention was 24 Head Start preschools aimed at supporting low income families (12 in mainly African American sites and 12 in mainly Latino sites) Home: ✗ |
Implicit: the implicit theory behind this scheme is that obesity can be prevented by reducing dietary fat and increasing dietary fibre, and by an increase in physical activity and inclusion of the family Explicit: this scheme was theoretically underpinned by social learning theory, self-determination theory and the transtheoretical model |
Additional comment: as this paper only reports on baseline characteristics the quality assessment for the study has not been completed as this is reported in the associated papers by Fitzgibbon et al. 200573 and 200677 | Description: this paper only reports baseline characteristics |
Study | Population | Outcomes | Context | Theory | Notes | Arms | OUTCOMES |
---|---|---|---|---|---|---|---|
ID: Fitzgibbon et al. 73 Hip-Hop to health Jr. African American Date of publication: 2005 Design: cluster RCT Country: USA Definition of overweight: BMI ≥ 85th percentile Definition of obesity: BMI ≥ 95th percentile Ethnic group: African American Source of funding: National Heart Lung and Blood Institute |
n = 409 Age of children: mean age 4.2 (SD 4.9) years Intervention target population: children and parents |
BMI: ✗ Weight: ✗ Health outcomes: - Height: ✗ Quality of life: not measured Length of follow-up: 24 months |
Community: the context for this intervention was 12 Head Start preschools aimed at supporting low income families. Home: ✗ |
Implicit: the implicit theory behind this scheme is that obesity can be prevented by reducing dietary fat and increasing dietary fibre, and by an increase in physical activity and inclusion of the family Explicit: this scheme was theoretically underpinned by social learning theory, self-determination theory and the transtheoretical model |
Additional comment: this study was aimed at preventing obesity and did not target overweight children but sought to take young children off a path towards obesity as they grew older |
Arm No: 1 Name: intervention n = 197 Description: child intervention: Hip-Hop to health is a combined diet and exercise intervention designed to reduce gains in BMI in preschool minority children in the USA. The weight control component consists of a 14-week (3 times weekly) programme of diet and physical activity delivered by trained early childhood educators. Each session consists of 20 minutes of a nutrition activity followed by 20 minutes of moderate to vigorous aerobic activity Parent intervention: this consists of a weekly newsletter that mirrors the children’s curriculum with homework designed to reinforce concepts presented in the newsletters. Parents are also asked to write down specific ways to increase fruit and vegetables in their family’s diet. If the homework is completed they receive a small monetary reward Arm No: 2 Name: control n = 212 Description: the control group received a 14-week (once a week) for 20 minutes session that taught general health concepts, e.g. seat belt safety, immunisation and dental health. The parent component consists of a weekly related newsletter, there were no homework assignments |
Post-intervention: BMI (kg/m2) Adjusted BMI (kg/m2) BMI z-score Adjusted BMI z-score Weight (kg) Height (cm) 12 months’ follow-up: BMI (kg/m2) Adjusted BMI (kg/m2) BMI z-score Adjusted BMI z-score Weight (kg) Height (cm) 24 months’ follow-up: BMI (kg/m2) Adjusted BMI (kg/m2) BMI z-score Adjusted BMI z-score Weight (kg) Height (cm) High-density lipoprotein cholesterol (mmol/l) |
Baseline characteristics
Intervention child level | Control child level | ∆ | p | |||||
---|---|---|---|---|---|---|---|---|
n | k | Mean | n | k | Mean | |||
Age (years) | 197 | 4.1 (SD 0.6) | 212 | 4.2 (SD 0.5) | ||||
Height (cm) | 197 | 102.8 (SD 6.4) | 212 | 104.6 (SD 5.9) | ||||
Gender (% female) | 197 | 50 | (24.1%) | 212 | 51 | (25.4%) | ||
Black (%) | 197 | 99 | (38.2%) | 212 | 81 | (50.3%) | ||
Hispanic (%) | 197 | 0 | (6.1%) | 212 | 13 | (0.0%) | ||
Other (%) | 197 | 1 | (3.3%) | 212 | 7 | (0.5%) | ||
kg/m2 | 197 | 16.5 (SD 1.5) | 212 | 16.7 (SD 2) | ||||
z-score for age and sex | 197 | 0.62 (SD 0.9) | 212 | 0.67 (SD 1.11) | ||||
≥ 85th percentile (%) | 197 | 32 | (17.0%) | 212 | 36 | (16.2%) | ||
< 85th percentile | 197 | 15.7 (SD 0.7) | 212 | 15.6 (SD 0.9) | ||||
≥ 85th percentile | 197 | 18.2 (SD 1.3) | 212 | 18.5 (SD 2) | ||||
Age 7 months: weight (kg) | 197 | 17.6 (SD 2.9) | 212 | 18.3 (SD 3.4) |
Results
Intervention child level | Control child level | ∆ | p | |||||
---|---|---|---|---|---|---|---|---|
n | k | Mean | n | k | Mean | |||
Post-intervention | ||||||||
BMI (kg/m2) | 197 | 0.05 (SD 0.05) | 212 | 0.14 (SD 0.05) | MD = –0.090 (SE 0.005) | < 0.001a | ||
Adjusted BMI (kg/m2) | 197 | 0.06 (SD 0.05) | 212 | 0.13 (SD 0.05) | MD = –0.070 (SE 0.005) | < 0.001a | ||
BMI z-score | 197 | 0.06 (SD 0.03) | 212 | 0.08 (SD 0.03) | MD = –0.020 (SE 0.003) | < 0.001a | ||
Adjusted BMI z-score | 197 | 0.05 (SD 0.04) | 212 | 0.08 (SD 0.04) | MD = –0.030 (SE 0.004) | < 0.001a | ||
Weight (kg) | 197 | 1.14 (SD 0.06) | 212 | 1.2 (SD 0.06) | MD = –0.060 (SE 0.006) | < 0.001a | ||
Height (cm) | 197 | 3.04 (SD 0.14) | 212 | 2.92 (SD 0.14) | MD = 0.120 (SE 0.014) | < 0.001a | ||
12 months’ follow-up | ||||||||
BMI (kg/m2) | 197 | 0.02 (SD 0.11) | 212 | 0.64 (SD 0.11) | MD = –0.620 (SE 0.011) | < 0.001a | ||
Adjusted BMI (kg/m2) | 197 | 0.06 (SD 0.12) | 212 | 0.59 (SD 0.12) | MD = –0.530 (SE 0.012) | < 0.001a | ||
BMI z-score | 197 | –0.06 (SD 0.05) | 212 | 0.13 (SD 0.05) | MD = –0.190 (SE 0.005) | < 0.001a | ||
Adjusted BMI z-score | 197 | –0.08 (SD 0.05) | 212 | 0.16 (SD 0.05) | MD = –0.240 (SE 0.005) | < 0.001a | ||
Weight (kg) | 197 | 3.79 (SD 0.2) | 212 | 4.65 (SD 0.2) | MD = –0.860 (SE 0.020) | < 0.001a | ||
Height (cm) | 197 | 10.37 (SD 0.3) | 212 | 10.1 (SD 0.3) | MD = 0.270 (SE 0.030) | < 0.001a | ||
24 months’ follow-up | ||||||||
BMI (kg/m2) | 197 | 0.48 (SD 0.14) | 212 | 1.14 (SD 0.14) | MD = –0.660 (SE 0.014) | < 0.001a | ||
Adjusted BMI (kg/m2) | 197 | 0.54 (SD 0.14) | 212 | 1.08 (SD 0.14) | MD = –0.540 (SE 0.014) | < 0.001a | ||
BMI z-score | 197 | 0.02 (SD 0.04) | 212 | 0.16 (SD 0.04) | MD = –0.140 (SE 0.004) | < 0.001a | ||
Adjusted BMI z-score | 197 | 0 (SD 0.04) | 212 | 0.17 (SD 0.04) | MD = –0.170 (SE 0.004) | < 0.001a | ||
Weight (kg) | 197 | 6.84 (SD 0.32) | 212 | 7.95 (SD 0.31) | MD = –1.110 (SE 0.031) | < 0.001a | ||
Height (cm) | 197 | 16.36 (SD 0.37) | 212 | 16.08 (SD 0.36) | MD = 0.280 (SE 0.036) | < 0.001a |
Quality appraisal
1.1. Was the sample size based on a power calculation? YES 1.2. Are the eligibility criteria explicit? YES 1.3. Was the randomisation to groups adequate? NOT REPORTED 1.4. Was the intervention allocation concealed adequately? NOT REPORTED 1.5. Were the groups similar at baseline? NO. The children in the control arm were older by 2.2 months (p = 0.001), they were also taller (p < 0.01) and weighed more (p = 0.014) 1.6. Did the groups receive similar treatment other than the intervention? UNCLEAR 1.7. Were outcome assessors blinded to treatment allocation? UNCLEAR 1.8. Were all participants accounted for? NO 1.9. Were the number of withdrawals specified? YES 1.10. Was the percentage of the population who received the intervention reported? YES 1.11. Was the consistency of the intervention measured? NO 1.12. Was the likelihood of participants receiving a ‘contaminated’ intervention reported? NO 1.13. Were the outcome measures objective? YES 1.14. What was the unit of allocation? GROUP 1.15. What was the unit of analysis? INDIVIDUAL 1.16. Was the method of data analysis appropriate? UNCLEAR. t-test to assess baseline data, other methods of assessment not given 1.17. Was the analysis by ITT? NO 1.18. Are the results generalisable? PARTLY. The population were from minority Latino and African American groups 1.19. Were appropriate methods used to account for missing data? UNCLEAR 1.20. CLUSTER TRIALS ONLY – was a rationale for the design given? YES 1.21. CLUSTER TRIALS ONLY – are the effects of clustering included in the sample size calculation? YES 1.22. CLUSTER TRIALS ONLY – were the effects of clustering incorporated into the analysis? NO 1.23. CLUSTER TRIALS ONLY – does the flow diagram include both clusters and individuals? NO. No flow diagram is presented |
Study | Population | Outcomes | Context | Theory | Notes | Arms | OUTCOMES |
---|---|---|---|---|---|---|---|
ID: Fitzgibbon et al. 77 Hip-Hop to Health Jr Latino Date of publication: 2006 Design: cluster RCT Country: USA Definition of overweight: BMI ≥ 85th percentile Definition of obesity: BMI ≥ 95th percentile Ethnic group: Latino Source of funding: National Heart Lung and Blood Institute |
n = 401 Age of children: mean age 4.2 (SD 4.9) years Intervention target population: children and parents |
BMI: ✗ Weight: ✗ Health outcomes: - Height: ✗ Quality of life: not reported Length of follow-up: 24 months |
Community: the context for this intervention was 12 Head Start preschools aimed at supporting low income families Home: ✗ |
Implicit: The implicit theory behind this scheme is that obesity can be prevented by reducing dietary fat and increasing dietary fibre, and by an increase in physical activity and inclusion of the family Explicit: this scheme was theoretically underpinned by social learning theory, self-determination theory and the transtheoretical model |
Additional comment: this study was aimed at preventing obesity and did not target overweight children but sought to take young children off a path towards obesity as they grew older |
Arm No: 1 Name: Intervention n = 202 Description: child intervention: Hip-Hop to health is a combined diet and exercise intervention designed to reduce gains in BMI in preschool minority children in the USA. The weight control component consists of a 14-week (3 times weekly) programme of diet and physical activity delivered by trained early childhood educators. Each session consists of 20 minutes of a nutrition activity followed by 20 minutes of moderate to vigorous aerobic activity Parent intervention: this consists of a weekly newsletter that mirrors the children’s curriculum with homework designed to encourage active interaction between children and parents. Parents receive 12 homework assignments during the 14-week intervention, if these are completed they receive a small monetary reward Arm No: 2 Name: control n = 199 Description: The control group received a 14-week (once a week) for 20 minutes session that taught general health concepts, e.g. seat belt safety, immunisation and dental health. The parent component consists of a weekly related newsletter, there were no homework assignments |
Post-intervention: BMI (kg/m2) [the unadjusted mean (SD) for BMI at baseline was 17.1 (2.8) kg/m2 for the intervention group and 17.4 (2.2) kg/m2 for the control group] Adjusted BMI (kg/m2) (adjusted for baseline age quartile, baseline value, months from baseline and Head Start site) BMI z-score (deviation from the mean BMI for age and sex for the reference population divided by the age- and sex-specific SD for the reference population) Adjusted BMI z-score Weight (kg) Height (cm) (outcomes were adjusted for group randomisation by Head Start site and months from baseline) 12 months’ follow-up: BMI (kg/m2) Adjusted BMI (kg/m2) BMI z-score Adjusted BMI z-score Weight (kg) Height (cm) 24 months’ follow-up: BMI (kg/m2) Adjusted BMI (kg/m2) BMI z-score Adjusted BMI z-score Weight (kg) Height (cm) |
Baseline characteristics
Intervention | Control | ∆ | p | |||||
---|---|---|---|---|---|---|---|---|
n | k | Mean | n | k | Mean | |||
Age (years) | 202 | 148 | 4.2 (SD 0.6) | 199 | 4.3 (SD 0.6) | |||
Height (cm) | 202 | 104 (SD 5.9) | 199 | 103.3 (SD 6.1) | ||||
Black (%) | 202 | 16 | (3.5%) | 199 | 7 | (7.9%) | ||
Hispanic (%) | 202 | 73 | (44.7%) | 199 | 89 | (36.1%) | ||
White (%) | 202 | 199 | ||||||
Other (%) | 202 | 11 | (2.0%) | 199 | 4 | (5.4%) | ||
kg/m2 | 202 | 17 (SD 2.8) | 199 | 17.5 (SD 2.2) | ||||
z-score for age and sex | 202 | 0.87 (SD 1.24) | 199 | 1.13 (SD 1.06) | ||||
≥ 85th percentile (%) | 202 | 40 | (25.6%) | 199 | 51 | (19.8%) | ||
≥ 95th percentile (%) | 202 | 22 | (15.6%) | 199 | 31 | (10.9%) | ||
Age 7 months: weight (kg) | 202 | 18.6 (SD 4.1) | 199 | 18.8 (SD 3.8) |
Results
Intervention | Control | ∆ | p | |||||
---|---|---|---|---|---|---|---|---|
n | k | Mean | n | k | Mean | |||
Post-intervention | ||||||||
BMI (kg/m2) | 202 | 0.11 (SD 1.56) | 199 | 0.13 (SD 0.11) | ||||
Adjusted BMI (kg/m2) | 202 | 0.12 (SD 1.56) | 199 | 0.12 (SD 0.11) | ||||
BMI z-score | 202 | 0.07 (SD 0.99) | 199 | 0.05 (SD 0.07) | ||||
Adjusted BMI z-score | 202 | 0.07 (SD 0.85) | 199 | 0.07 (SD 0.06) | ||||
Weight (kg) | 202 | 1.13 (SD 1.70) | 199 | 1.2 (SD 0.12) | ||||
Height (cm) | 202 | 2.69 (SD 1.85) | 199 | 2.79 (SD 0.13) | ||||
12 months’ follow-up | ||||||||
BMI (kg/m2) | 202 | 17.5 (SD 3.5) | 199 | 17.9 (SD 2.6) | ||||
Adjusted BMI (kg/m2) | 202 | 0.31 (SD 2.27) | 199 | 0.44 (SD 2.40) | ||||
BMI z-score | 202 | 0 (SD 0.09) | 199 | 0.07 (SD 0.09) | ||||
Adjusted BMI z-score | 202 | –0.01 (SD 0.99) | 199 | 0.11 (SD 0.07) | ||||
Weight (kg) | 202 | 3.84 (SD 0.19) | 199 | 3.98 (SD 0.2) | ||||
Height (cm) | 202 | 8.97 (SD 0.16) | 199 | 8.77 (SD 0.16) | ||||
24 months’ follow-up | ||||||||
BMI (kg/m2) | 202 | 17.6 (SD 3.6) | 199 | 18.1 (SD 3) | ||||
Adjusted BMI (kg/m2) | 202 | 0.46 (SD 0.19) | 199 | 0.66 (SD 0.2) | ||||
BMI z-score | 202 | –0.13 (SD 0.09) | 199 | 0 (SD 0.09) | ||||
Adjusted BMI z-score | 202 | –0.13 (SD 0.07) | 199 | 0.02 (SD 0.07) | ||||
Weight (kg) | 202 | 5.91 (SD 0.31) | 199 | 6.18 (SD 0.32) | ||||
Height (cm) | 202 | 13.49 (SD 0.2) | 199 | 13.34 (SD 0.2) |
Quality appraisal
1.1. Was the sample size based on a power calculation? YES 1.2. Are the eligibility criteria explicit? YES 1.3. Was the randomisation to groups adequate? NOT REPORTED. Unclear, merely states that 12 schools were randomly assigned 1.4. Was the intervention allocation concealed adequately? NOT REPORTED 1.5. Were the groups similar at baseline? NO. Children in the control group were more likely to be overweight (p = 0.019) or obese (p = 0.033) and have a higher mean BMI z-score (p = 0.023) 1.6. Did the groups receive similar treatment other than the intervention? NOT REPORTED 1.7. Were outcome assessors blinded to treatment allocation? UNCLEAR. Not reported 1.8. Were all participants accounted for? YES 1.9. Were the number of withdrawals specified? YES 1.10. Was the percentage of the population who received the intervention reported? YES 1.11. Was the consistency of the intervention measured? UNCLEAR 1.12. Was the likelihood of participants receiving a ‘contaminated’ intervention reported? NO 1.13. Were the outcome measures objective? YES 1.14. What was the unit of allocation? GROUP 1.15. What was the unit of analysis? INDIVIDUAL 1.16. Was the method of data analysis appropriate? UNCLEAR. t-test to assess baseline data, other methods of assessment not given 1.17. Was the analysis by ITT? NO 1.18. Are the results generalisable? PARTLY. The population was from minority Latino and African American groups 1.19. Were appropriate methods used to account for missing data? UNCLEAR. Missing data were not reported 1.20. CLUSTER TRIALS ONLY – was a rationale for the design given? YES 1.21. CLUSTER TRIALS ONLY – are the effects of clustering included in the sample size calculation? YES 1.22. CLUSTER TRIALS ONLY – were the effects of clustering incorporated into the analysis? UNCLEAR 1.23. CLUSTER TRIALS ONLY – does the flow diagram include both clusters and individuals? NO. Not reported |
Harvey-Berino and Rourke74
Study | Population | Outcomes | Context | Theory | Notes | Arms | OUTCOMES |
---|---|---|---|---|---|---|---|
ID: Harvey-Berino et al. 74 Date of publication: 2003 Design: RCT Country: USA Definition of overweight: not reported Definition of obesity: BMI ≥ 95th percentile Ethnic group: Native American Source of funding: NIH Grant R03 DK56290 |
n = 40 Age of children: 9 months – 3 years Intervention target population: children and parents |
BMI: ✗ Weight: ✗ Health outcomes: Physical activity as accelerometry Height: ✗ Length of follow-up: 16 weeks |
Community: - Home: ✗ |
Implicit: that involving mothers in a home-based educational intervention to improve eating and exercise would have a preventative effect, to reduce obesity, in young children | Additional comment: the 16-week follow-up is too short to reliably show any long-term benefits from this intervention |
Arm No: 1 Name: intervention n = 20 Description: obesity prevention plus parenting support. A 16-week programme in the home of the participant, to show how improved parenting skills could facilitate the development of appropriate eating and exercise habits in their children Arm No: 2 Name: control n = 20 Description: parenting skills lessons. A 16-week programme in the home of the participant, to show how improved parenting skills could help develop behavioural goals |
BMI z-score Weight (kg) ≥ 85th ≥ 95th Physical activity (Vmag/h) |
Baseline characteristics
Intervention | Control | ∆ | p | |||||
---|---|---|---|---|---|---|---|---|
n | k | Mean | n | k | Mean | |||
Weight (kg) | 20 | 12.2 (SD 2.4) | 20 | 12.3 (SD 2.9) | ||||
BMI z-score | 20 | 0.79 (SD 1.2) | 20 | 0.67 (SD 1.6) | ||||
≥ 85th percentile | 20 | 5 | (15.0%) | 20 | 3 | (25.0%) | ||
≥ 95th percentile | 20 | 3 | (25.0%) | 20 | 5 | (15.0%) | ||
Physical activity (Vmag/h) | 20 | 20,457 (SD 8670) | 20 | 19,417 (SD 5735) |
Results
Intervention | Control | ∆ | p | |||||
---|---|---|---|---|---|---|---|---|
n | k | Mean | n | k | Mean | |||
Post-intervention | ||||||||
BMI z-score | 20 | 0.52 (SD 1.1) | 20 | 0.98 (SD 1.4) | ||||
Weight (kg) | 20 | 13.1 (SD 2.4) | 20 | 13.8 (SD 3.6) | ||||
≥ 85th percentile | 20 | 3 | (15.0%) | 20 | 3 | (15.0%) | ||
≥ 95th percentile | 20 | 1 | (30.0%) | 20 | 6 | (5.0%) | ||
Physical activity (Vmag/h) | 20 | 17,886 (SD 6746) | 20 | 17,637 (SD 8151) |
Quality appraisal
1.1. Was the sample size based on a power calculation? NO 1.2. Are the eligibility criteria explicit? YES 1.3. Was the randomisation to groups adequate? NOT REPORTED 1.4. Was the intervention allocation concealed adequately? NOT REPORTED 1.5. Were the groups similar at baseline? YES 1.6. Did the groups receive similar treatment other than the intervention? YES 1.7. Were outcome assessors blinded to treatment allocation? YES 1.8. Were all participants accounted for? YES 1.9. Were the number of withdrawals specified? YES 1.10. Was the percentage of the population who received the intervention reported? YES 1.11. Was the consistency of the intervention measured? UNCLEAR 1.12. Was the likelihood of participants receiving a ‘contaminated’ intervention reported? NO 1.13. Were the outcome measures objective? YES 1.14. What was the unit of allocation? INDIVIDUAL 1.15. What was the unit of analysis? INDIVIDUAL 1.16. Was the method of data analysis appropriate? YES. t-tests for changes within groups and ANOVA for changes between groups 1.17. Was the analysis by ITT? YES 1.18. Are the results generalisable? PARTLY. The population was Native American and the intervention was culturally adapted 1.19. Were appropriate methods used to account for missing data? UNCLEAR 1.20. CLUSTER TRIALS ONLY – was a rationale for the design given? 1.21. CLUSTER TRIALS ONLY – are the effects of clustering included in the sample size calculation? 1.22. CLUSTER TRIALS ONLY – were the effects of clustering incorporated into the analysis? 1.23. CLUSTER TRIALS ONLY – does the flow diagram include both clusters and individuals? |
Appendix 4 Table of excluded studies
Study | Reason for exclusion |
---|---|
Adams J, Dixon J, Pettit J, Zask A. Tooty fruity vegie in preschools Program Report. 2008. New South Wales, Australia: North Coast Area Health Service. | No usable data |
Baird J, Fisher D, Lucas P, Kleijnen J, Roberts H, Law C. Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ 2005;331:929. | Not about weight management |
Chau J. A review of physical activity interventions for children from 2 to 5 year of age. CPAH06–003. 2007. New South Wales Centre for Physical Activity and Health. | Not a systematic review |
Cottrell L, Spangler-Murphy E, Minor V, Downes A, Nicholson P, Neal WA. A kindergarten cardiovascular risk surveillance study: CARDIAC-Kinder. Am J Health Behav 2005;29:595–606. | Follow-up not long enough |
Dennison BA, Russo TJ, Burdick PA, Jenkins PL. An intervention to reduce television viewing by preschool children. Arch Pediatr Adolesc Med 2004;158:170–6. | Wrong intervention |
Epstein LH, Roemmich JN, Robinson JL, Paluch RA, Winiewicz DD, Fuerch JH, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med 2008;162:239–45. | Wrong population, includes over fives |
Hakanen M, Lagstrom H, Kaitosaari T, Niinikoski H, Nanto-Salonen K, Jokinen E, et al. Development of overweight in an atherosclerosis prevention trial starting in early childhood. The STRIP study. Int J Obes 2006;30:618–26. | No usable data |
Kaitosaari T, Ronnemaa T, Raitakari O, Talvia S, Kallio K, Volanen I, et al. Effect of 7-year infancy-onset dietary intervention on serum lipoproteins and lipoprotein subclasses in healthy children in the prospective, randomized Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) Study. Circulation 2003;108:672–7. | Not about weight management |
Kamath CC, Vickers KS, Ehrlich A, McGovern L, Johnson J, Singhal V, et al. Clinical review: behavioral interventions to prevent childhood obesity: a systematic review and metaanalyses of randomized trials. J Clin Endocrinol Metab 2008;93:4606–15. | Wrong outcomes |
Lagstrom H, Jokinen E, Seppanen R, Ronnemaa T, Viikari J, Valimaki I, et al. Nutrient intakes by young children in a prospective randomized trial of a low-saturated fat, low-cholesterol diet. The STRIP Baby Project. Special Turku Coronary Risk Factor Intervention Project for Babies. Arch Pediatr Adolesc Med 1997;151:181–8. | Wrong outcomes |
Lapinleimu H, Viikari J, Jokinen E, Salo P, Routi T, Leino A, et al. Prospective randomised trial in 1062 infants of diet low in saturated fat and cholesterol. Lancet 1995;345:471–6. | Not about weight management |
Niinikoski H, Viikari J, Ronnemaa T, Lapinleimu H, Jokinen E, Salo P, et al. Prospective randomized trial of low-saturated-fat, low-cholesterol diet during the first 3 years of life. The STRIP baby project. Circulation 1996;94:1386–93. | Not about weight management |
Niinikoski H, Viikari J, Ronnemaa T, Helenius H, Jokinen E, Lapinleimu H, et al. Regulation of growth of 7- to 36-month-old children by energy and fat intake in the prospective, randomized STRIP baby trial. Pediatrics 1997;100:810–16. | Not about weight management |
Niinikoski H, Lagstrom H, Jokinen E, Siltala M, Ronnemaa T, Viikari J, et al. Impact of Repeated Dietary Counseling Between Infancy and 14 Years of Age on Dietary Intakes and Serum Lipids and Lipoproteins: The STRIP Study. Circulation 2007;116:1032–40. | Not about weight management |
Nova A, Russo A, Sala E. Long-term management of obesity in paediatric office practice: experimental evaluation of two different types of intervention. Ambulatory Child Health 2001;7:239–47. | Wrong population, includes over fives |
Parsons TJ, Power C, Logan S, Summerbell CD. Childhood predictors of adult obesity: a systematic review. Int J Obes Relat Metab Disord 1999;23(Suppl. 8):S1–107. | Not about weight management |
Rask-Nissila L, Jokinen E, Ronnemaa T, Viikari J, Tammi A, Niinikoski H, et al. Prospective, randomized, infancy-onset trial of the effects of a low-saturated-fat, low-cholesterol diet on serum lipids and lipoproteins before school age: The Special Turku Coronary Risk Factor Intervention Project (STRIP). Circulation 2000;102:1477–83. | Not about weight management |
Rogers L, Gerner B, Wake M. LEAP trial. Aust Fam Physician 2007;36:887–8. | Wrong population, includes over fives |
Sanigorski AM, Bell AC, Kremer PJ, Cuttler R, Swinburn BA. Reducing unhealthy weight gain in children through community capacity-building: results of a quasi-experimental intervention program, Be Active Eat Well. Int J Obes 2008;32:1060–7. | Wrong population, includes over fives |
Saarilehto S, Lapinleimu H, Keskinen S, Helenius H, Simell O. Body satisfaction in 8-year-old children after long-term dietary counseling in a prospective randomized atherosclerosis prevention trial. Arch Pediatr Adolesc Med 2003;157:753–8. | Not about weight management |
Shelton D, Le GK, Norton L, Stanton-Cook S, Morgan J, Masterman P. Randomised controlled trial: A parent-based group education programme for overweight children. J Paediatr Child Health 2007;43:799–805. | Wrong population, includes over fives |
Shutter L, Garell DC. Obesity in children and adolescents: a double-blind study with cross-over. J Sch Health 1966;36:273–5. | No usable data |
Tanas R, Marcolongo R, Pedretti S, Gilli G. A family-based education program for obesity: a three-year study. BMC Pediatr 2007;7:33. | Wrong population, includes over fives |
Tedstone A, Dunce N, Aviles M, Shetty P, Daniels L. Effectiveness of interventions to promote healthy feeding of infants under one year of age. Meyrick J, editor. 1998. Health Education Authority. | Not about weight management |
Tedstone A, Aviles M, Shetty P, Daniels L. Effectiveness of interventions to promote healthy eating in preschool children aged 1 to 5 years. Meyrick J, editor. 1998. Health Education Authority. | Not about weight management |
Williams CL, Strobino BA. Childhood diet, overweight, and CVD risk factors: the Healthy Start project. Prev Cardiol 2008;11:11–20. | No control group |
Williams CL, Strobino BA, Bollella M, Brotanek J. Cardiovascular Risk Reduction in Preschool Children: The “Healthy Start” Project. J Am Coll Nutr 2004;23:117–23. | Wrong intervention |
Wofford LG. Systematic review of childhood obesity prevention. J Pediatr Nurs 2008;23:5–19. | Literature review |
Appendix 5 Included systematic reviews
-
Bautista-Castana I, Doreste J, Serra-Majem L. Effectiveness of interventions in the prevention of childhood obesity. Eur J Epidemiol 2004;19:617–22.
-
Bluford DA, Sherry B, Scanlon KS. Interventions to prevent or treat obesity in preschool children: a review of evaluated programs. Obesity 2007;15:1356–72.
-
Campbell KJ, Hesketh KD. Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from nought to five years. A systematic review of the literature. Obes Rev 2007;8:327–38.
-
Collins CE, Warren J, Neve M, McCoy P, Stokes BJ. Measuring effectiveness of dietetic interventions in child obesity: a systematic review of randomized trials. Arch Pediatr Adolesc Med 2006;160:906–22.
-
Connelly JB, Duaso MJ, Butler G. A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: a realistic synthesis of the evidence. Public Health 2007;121:510–17.
-
DeMattia L, Lemont L, Meurer L. Do interventions to limit sedentary behaviours change behaviour and reduce childhood obesity: a critical review of the literature. Obes Rev 2007;8:69–81.
-
Flodmark CE, Marcus C, Britton M. Interventions to prevent obesity in children and adolescents: a systematic literature review. Int J Obes 2006;30:579–89.
-
Flynn MA, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, et al. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’ recommendations. Obes Rev 2006;7(Suppl. 1):7–66.
-
Gibson LJ, Peto J, Warren JM, Silva IdS. Lack of evidence on diets for obesity for children: a systematic review. Int J Epidemiol 2006;35:1544–52.
-
Kamath CC, Vickers KS, Ehrlich A, McGovern L, Johnson J, Singhal V, et al. Clinical review: behavioural interventions to prevent childhood obesity: a systematic review and meta-analyses of randomized trials. J Clin Endocrinol Metab 2008;93:4606–15.
-
McGovern L, Johnson JN, Paulo R, Hettinger A, Singhal V, Kamath C, et al. Clinical review: treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J Clin Endocrinol Metab 2008;93:4600–5.
-
Oude LH, Baur L, Jansen H, Shrewsbury VA, O’Malley C, Stolk RP, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009;(1):CD001872.
-
Reilly JJ, Wilson ML, Summerbell CD, Wilson DC. Obesity: diagnosis, prevention, and treatment; evidence based answers to common questions. Arch Dis Child 2002;86:392–4.
-
Reilly JJ, McDowell Z. Physical activity interventions in the prevention and treatment of paediatric obesity: systematic review and critical appraisal. Proc Nutr Soc 2003;62:611–19.
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Summerbell CD, Waters E, Edmunds LD, Kelly S, Brown T, Campbell KJ. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2005;(3):CD001871.
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Wilfley DE, Tibbs TL, Van Buren DJ, Reach KP, Walker MS, Epstein LH. Lifestyle interventions in the treatment of childhood overweight: a meta-analytic review of randomized controlled trials. Health Psychol 2007;26:521–32.
Appendix 6 Ongoing trials
NIHR CRN CC Portfolio database (UKCRN)
http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=4880
EMPOWER
Empowering parents to prevent obesity at weaning – exploratory research: RCPCH pilot and feasibility study
Research summary
Study type: interventional
Design type:
Disease(s): public health research
Phase: pilot/feasibility
Current status: open
Closure date: 30 September 2008
Sample size: 64
Accrual to date: 62%
Geographical scope: UK multicentre
Lead country: England
Open to new sites: unknown
Main inclusion criteria: unknown
Main exclusion criteria: unknown
Chief investigator(s): Professor Jane Barlow
Further details, please contact:
Ms Sandra Whitlock
Warwick Medical School
Gibbet Hill Road
Coventry
West Midlands
CV4 7AL
UK
Tel: 02476 574270
s.whitlock@warwick.ac.uk
Funder(s): Department of Health – NSF for Children, Young People and Maternity Services
http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=5067
EPPOC
Early prediction and prevention of obesity in childhood
Study type: observational
Design type:
Disease(s): all diseases
Phase: experimental medicine
Current status: open
Closure date: 31 December 2008
Sample size: 186
Geographical scope: UK multicentre
Lead country: England
Open to new sites: no
Main inclusion criteria: health professionals consulting with parents of children < 1 year; parents of children < 1 year
Main exclusion criteria: health professionals who do not consult with children; parents of children > 1 year
Chief investigator(s): Dr Sarah Redsell
Further details, please contact:
Dr Sarah Redsell
University of Nottingham
School of Nursing A Floor
South Block Link
Queens Medical Centre
Nottingham
Nottinghamshire
NG7 2HA
UK
Tel: 0115 8230809
Sarah.Redsell@nottingham.ac.uk
Funder(s): Burdett Trust for Nursing
Sponsor(s): University of Nottingham
http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=5125
The metabolic and environmental determinants of obesity: observational and intervention studies in children and young people
Disease(s): metabolic & endocrine (not diabetes)
Phase: II/III
Current status: open
Closure date: 1 January 2010
Sample size: 30
Accrual to date: 3%
Geographical scope: single centre
Lead country: England
Open to new sites: unknown
Main inclusion criteria: unknown
Main exclusion criteria: unknown
Chief investigator(s): Tim Barrett
Further details, please contact
Tim Barrett
t.g.barrett@bham.ac.uk
Funder(s): Wellcome Trust
http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=6192
The Cambridge Baby Growth Study
Study of antenatal, nutritional and common genetic factors on infant weight gain, body composition and fat distribution: The Cambridge Baby Growth Study
Research summary
Study type: observational
Design type:
Disease(s): reproductive health and childbirth
Phase: N/A
Current status: open
Closure date: 31 May 2016
Sample size: 4000
Geographical scope: single centre
Lead country: England
Chief investigator(s): Dr Kenneth Ong
Further details, please contact:
Dr Jill Landsbaugh
Addenbrooke’s Hospital
MRC Epidemiology Unit Institute of Metabolic Science Box 285
Hills Road
Cambridge
Cambridgeshire
CB2 0QQ
UK
Tel: 01223769173
jill.landsbaugh@mrc-epid.cam.ac.uk
Funder(s): Medical Research Council
ControlledTrials.com
The effectiveness of multidisciplinary treatment in young overweight children
http://www.controlled-trials.com/ISRCTN47185691
GECKO outpatients clinic, a randomised controlled trial
Source of record: ISRCTN Register
ISRCTN: ISRCTN47185691
Date ISRCTN assigned: 8 February 2007
Local reference number(s): N/A
Public title: the effectiveness of multidisciplinary treatment in young overweight children: GECKO outpatients clinic, a randomised controlled trial
Scientific title:
Acronym: N/A
Disease/condition/study domain: obesity, overweight
Hypothesis: does a multidisciplinary treatment program consisting of dietary advice, life style activity and psychological counselling, aimed at preschool overweight children, as well as their parents, influence the progression of body mass index (BMI)?
Design/methodology: randomised, active-controlled, parallel group, single blinded trial
Anticipated start date: 10 October 2006
Anticipated end date: 1 August 2009
Status of trial: ongoing
Target number of participants: 180
Sources of funding:
-
Menzis Zorgverzekeraar (the Netherlands)
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A.S. Watson (Europe) Holding BV (the Netherlands)
Sponsor name: University Medical Centre Groningen (UMCG) (the Netherlands)
Sponsor details:
Beatrix Children’s Hospital
P.O. Box 30001
Groningen
Netherlands
9700 RB
Sponsor website: www.rug.nl/umcg/index?lang=en
Contact name: Dr H Oude Luttikhuis
Contact details:
Universitair Medisch Centrum Groningen (UMCG)
Beatrix Kinderkliniek
P.O. Box 30001
Groningen
Netherlands
9700 RB
Contact telephone: +31 (0)50 361 0585
Contact email: h.oudeluttikhuis@bkk.umcg.nl
More information: For more up-to-date information please go to the ISRCTN link below.
Link to record in ISRCTN Register: ISRCTN47185691
Date last extracted from ISRCTN register: 5 March 2009
Clinicaltrials.gov – search ongoing studies
http://clinicaltrials.gov/ct2/show/NCT00675662
Trim Tots preschool obesity prevention programme
Study type: interventional
Study design: prevention, randomised, single-blind (investigator), factorial assignment
Ages eligible for study: 12–72 months
Genders eligible for study: both
Estimated enrolment: 96
Study start date: April 2008
Estimated primary completion date: September 2009 (Final data collection date for primary outcome measure)
Improving primary care to prevent childhood obesity
This study is currently recruiting participants.
Study type: interventional
Study design: prevention, randomized, double-blind, active control, single group assignment, efficacy study
Estimated enrolment: 500
Ages eligible for study: 2–6 years
Genders eligible for study: both
Accepts healthy volunteers: no
Study start date: September 2006
Estimated study completion date: September 2009
KAN-DO: a family-based intervention to prevent childhood obesity
This study is currently recruiting participants.
Study Type: interventional
Study Design: prevention, randomised, open label, active control, parallel assignment, efficacy study
Estimated enrolment: 800
Study start date: October 2007
Estimated study completion date: March 2012
Estimated primary completion date: September 2011 (Final data collection date for primary outcome measure)
Inclusion criteria:
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Recent delivery of a baby (∼2 months ago)
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A preschooler in the home (2–5 years old), and a current BMI ≥ 25 (with confirmatory BMI ≥ 25 measured at baseline).
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Knowledge of English.
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Regular access to a telephone and mailing address.
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Mother’s age of 18 or older.
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Willingness to participate in a healthy lifestyle correspondence and telephone intervention.
Feeding Young Children Study: bottle weaning intervention (FYCS)
Study type: interventional
Study design: prevention, randomised, single-blind (outcomes assessor), active control, parallel assignment
Estimated enrolment: 464
Study start date: October 2008
Estimated study completion date: December 2010
Estimated primary completion date: March 2010 (final data collection date for primary outcome measure)
Ages eligible for study: 12–13 months
Genders eligible for study: Both
Diet, exercise and body fat in 3–5 year olds
Study type: observational
Study design: cohort, prospective
Official title: relationship of dietary factors and physical activity to body fat in 3- to 5-year-old children
Estimated enrolment: 65
Study start date: June 2007
Estimated study completion date: September 2009
Estimated primary completion date: September 2009 (final data collection date for primary outcome measure)
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3-year-old children
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4-year-old children
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5-year-old children
Child Health Initiative for Lifelong Eating and Exercise (CHILE)
Study type: interventional
Study design: prevention, randomised, open label, factorial assignment, efficacy study
Official title: site specific approaches to prevention or management of paediatric obesity: child health initiative for lifelong eating and exercise – CHILE
Ages eligible for study: 3–5 years
Genders eligible for study: both
Accepts healthy volunteers: yes
Estimated enrolment: 640
Study start date: March 2006
Estimated study completion date: June 2010
Estimated primary completion date: June 2010 (final data collection date for primary outcome measure)
Team PLAY (positive lifestyles for active youngsters)
Study type: interventional
Study design: treatment, randomised, single-blind (outcomes assessor), active control, parallel assignment, efficacy study
Official title: treating childhood obesity with family lifestyle change
Estimated enrolment: 240
Study start date: September 2006
Estimated study completion date: March 2012
Ages eligible for study: 4–7 years
Nutrition intervention and play group exercise for low income Latinas (CHICOS)
Study type: interventional
Study design: prevention, randomised, single-blind, active control, parallel assignment, efficacy study
Official title: home-based nutrition intervention and play group exercise for low-income Latinas
Estimated enrolment: 250
Study start date: March 2007
Estimated study completion date: August 2009
Inclusion criteria:
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Mother is of Mexican descent.
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Mother has a child between the ages of 3 and 4.9 years.
Prevention of childhood obesity
Study type: observational
Study design: prospective
Official title: the development of an early intervention for the prevention of childhood obesity
Estimated enrolment: 320
Study start date: August 2008
Inclusion criteria: For study 1, 60 families (120 parents) with a child between the age of 2–4 years will be entered to the study. Children of these families will be at risk for overweight because the family will contain at least one obese parent. For study 2, 100 families (200 parents) will be entered to the study. Children of these families will be at risk for overweight and have a reactive temperament. The reason for using this population is that a combination of parental obesity and a child with a reactive temperament appears to put the child at high risk for the development of overweight
Cost-effectiveness of family based paediatric obesity treatment
Study type: interventional
Study design: treatment, randomised, single-blind (subject), dose comparison, parallel assignment
Estimated enrolment: 50
Study start date: October 2007
Estimated study completion date: November 2009
Estimated primary completion date: November 2009 (final data collection date for primary outcome measure)
Randomised controlled trial of dietary advice in primary care to promote healthy feeding of infants
Study type: interventional
Study design: health services research, randomised, single-blind (investigator), parallel assignment, efficacy study
Official title: randomised controlled trial of dietary advice in primary care to promote healthy feeding of infants
Estimated enrolment: 2000
Study start date: April 2008
Estimated study completion date: November 2009
Estimated primary completion date: October 2008 (Final data collection date for primary outcome measure)
Inclusion criteria: all pregnant women with gestational age of 30 weeks and more, who are registered in the participating PSF centres
Clinicaltrials.gov – or ongoing and no longer recruiting patients
http://clinicaltrials.gov/ct2/show/NCT00674544
Influence of a multidisciplinary lifestyle intervention in kindergarten children on body mass index (BMI), body fatness, fitness, physical activity and psychological parameters (Ballabeina)
This study is ongoing, but not recruiting participants
Study type: interventional
Study design: prevention, randomised, double-blind (subject, investigator, outcomes assessor), placebo control, parallel assignment, efficacy study
Estimated enrolment: 650
Study start date: May 2008
Estimated study completion date: July 2012
Estimated primary completion date: July 2011 (final data collection date for primary outcome measure)
Ages eligible for study: 3–7 years
Genders eligible for study: both
Accepts healthy volunteers: yes
http://clinicaltrials.gov/ct2/show/NCT00259324
Childhood obesity treatment targeting specific behaviours
This study is ongoing, but not recruiting participants
Study type: interventional
Study design: treatment, randomised, single-blind (outcomes assessor), active control, parallel assignment
Estimated enrolment: 135
Study start date: September 2005
Estimated study completion date: February 2009
Age between 4 and 9 years. We propose to use this age group as parents are in control of the eating and exercise choices of such children, and thus a program that focuses on parenting behaviours (i.e. positive reinforcement, stimulus control, parental modelling) should be developmentally appropriate. This age group also meets the Expert Committee’s goal of intervening early; moreover, children aged 4–8 years have similar nutritional needs
Population-based intervention to prevent obesity in kindergartens (TigerKids)
Estimated enrolment: 30,000
Study start date: October 2003
Estimated study completion date: July 2009
Primary completion date: May 2006 (final data collection date for primary outcome measure)
Ages eligible for study: 3–7 years
Genders eligible for study: both
Accepts healthy volunteers: yes
Preschool-based obesity prevention effectiveness trial
This study is ongoing, but not recruiting participants
Study type: interventional
Study design: prevention, randomised, open label, placebo control, parallel assignment
Estimated enrolment: 648
Study start date: September 2006
Estimated study completion date: May 2009
Estimated primary completion date: May 2009 (final data collection date for primary outcome measure
Ages eligible for study: 3–5 years
Genders eligible for study: both
Accepts healthy volunteers: no
Changing eating behaviours in young children: should healthy foods be increased or unhealthy foods decreased?
This study is ongoing, but not recruiting participants
Study type: interventional
Study design: treatment, randomised, open label, active control, parallel assignment
Official title: changing eating behaviours in young children: should healthy foods be increased or unhealthy foods decreased?
Estimated enrolment: 210
Study start date: July 2005
Estimated study completion date: July 2009
Ages eligible for study: 4–9 years
Genders eligible for study: both
Accepts healthy volunteers: yes
Modifying the home television watching environment
This study has been completed
Study type: interventional
Study design: prevention, randomised, open label, active control, parallel assignment, efficacy study
Enrolment: 70
Study start date: September 2002
Study completion date: May 2007
Ages eligible for study: 4–7 years
The SLeeping and Intake Methods Taught to Infants and Mothers Early in Life (SLIMTIME) Project
This study is ongoing, but not recruiting participants
Study type: interventional
Study design: randomised, open label, active control, crossover assignment, efficacy study
Official title: primary prevention of obesity through infancy interventions
Ages eligible for study: up to 12 months
Genders eligible for study: both
Accepts healthy volunteers: yes
Prevention through Activity in Kindergarten Trial (PAKT)
This study is ongoing, but not recruiting participants
Study type: interventional
Study design: prevention, randomised, open label, parallel assignment, efficacy study
Official title: prevention through activity in kindergarten trial
Ages eligible for study: 43–67 months
Genders eligible for study: both
Accepts healthy volunteers: yes
Starting Healthy Staying Healthy Pilot Trial
This study is ongoing, but not recruiting participants
Study type: interventional
Study design: prevention, randomised, open label, active control, parallel assignment, efficacy study
Estimated enrolment: 70
Study start date: July 2007
Estimated study completion date: July 2008
Primary completion date: February 2008 (final data collection date for primary outcome measure)
Ages eligible for study: 2–5 years
Genders eligible for study: both
Accepts healthy volunteers: yes
European Childhood Obesity Project
This study is ongoing, but not recruiting participants
Study type: interventional
Study design: prevention, randomised, double blind (subject, caregiver, investigator, outcomes assessor), dose comparison, parallel assignment, efficacy study
Official title: childhood obesity – programming by infant nutrition
Estimated enrolment: 1759
Study start date: October 2002
Estimated study completion date: March 2013
Primary completion date: August 2006 (Final data collection date for primary outcome measure)
Ages eligible for study: up to 8 weeks
Genders eligible for study: both
Accepts healthy volunteers: yes
Preschool-based obesity prevention effectiveness trial
The purpose of this study is to compare changes in body mass index (BMI) among 3- to 5-year-old minority children randomised to a weight control intervention (WCI) or a general health control intervention
Estimated enrolment: 648
Study start date: September 2006
Estimated study completion date: May 2009
Estimated primary completion date: May 2009 (final data collection date for primary outcome measure)
This study builds upon the findings of the ‘Hip-Hop to Health’ programme. The primary aim of Hip-Hop was to compare changes in body mass index [BMI (kg/m2)] in two groups of 3- to 5-year-old minority children randomised to a weight control intervention (WCI) or a general health control intervention (GHI). Results for the children at the Year 1 and 2 follow-ups showed that children in the WCI had significantly smaller relative changes in BMI than children in the GHI control group. The success was among the schools that served predominantly Black children. Hip-Hop to Health was an efficacy trial delivered by trained specialists in early childhood education, and the first efficacy trial to document change in BMI in preschool children
This study will test a 14-week teacher-delivered weight control intervention (TD-WCI) to a 14-week teacher delivered general health control intervention (TD-GHI) in a randomised community trial occurring in 16 preschools in the Chicago school district. The study has the following aims: (1) to compare children in these two conditions on changes in BMI post intervention and at year 1 follow-up; (2) to compare children in these two conditions on changes in television viewing, physical activity, and fat, fibre, fruit and vegetable intake at post-intervention and year 1 follow-up; and (3) to compare classroom teachers in these two conditions on nutrition and exercise knowledge, nutrition attitudes, and support for healthy eating at post-intervention and year 1 follow-up
No publications provided
Responsible party:
Office of Research Services, University of Illinois at Chicago (Eric Gislason)
Study ID numbers: 334, R01 HL81645
Study first received: 17 October 2005
Last updated: 18 January 2008
ClinicalTrials.gov identifier: NCT00241878 history of changes (http://clinicaltrials.gov/ct2/show/NCT00241878)
Health authority: United States; Federal Government
Glossary
- Adiposity rebound
- The second rise in body mass index (BMI) kg/m2 that occurs between the ages of 3 and 7 years.
- Obese (children)
- ≥ 95th UK National BMI percentile, relevant to the UK 1990 reference data; specific age and sex cut-offs for ages 2–18 years, based on centile curves from data from six countries; or BMI > 98th centile of UK 1990 reference chart for age and sex.
- Overweight (children)
- ≥ 85th and < 95th UK National BMI percentile, relevant to the UK 1990 reference data; specific age and sex cut-offs for ages 2–18 years, based on centile curves from data from six countries; or BMI > 91st centile of UK 1990 reference chart for age and sex.
- Energy balance
- Energy intake = internal heat produced + external work + energy storage
List of abbreviations
- ANOVA
- analysis of variance
- BMI
- body mass index
- CRD
- Centre for Reviews and Dissemination
- ITT
- intention to treat
- NICE
- National Institute for Health and Clinical Excellence
- OECD
- Organisation for Economic Co-operation and Development
- PenTAG
- Peninsula Technology Assessment Group
- RCT(s)
- randomised controlled trial(s)
- SD
- standard deviation
All abbreviations that have been used in this report are listed here unless the abbreviation is well known (e.g. NHS), or it has been used only once, or it is a non-standard abbreviation used only in figures/tables/appendices, in which case the abbreviation is defined in the figure legend or in the notes at the end of the table.
Notes
Health Technology Assessment reports published to date
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Home parenteral nutrition: a systematic review.
By Richards DM, Deeks JJ, Sheldon TA, Shaffer JL.
-
Diagnosis, management and screening of early localised prostate cancer.
A review by Selley S, Donovan J, Faulkner A, Coast J, Gillatt D.
-
The diagnosis, management, treatment and costs of prostate cancer in England and Wales.
A review by Chamberlain J, Melia J, Moss S, Brown J.
-
Screening for fragile X syndrome.
A review by Murray J, Cuckle H, Taylor G, Hewison J.
-
A review of near patient testing in primary care.
By Hobbs FDR, Delaney BC, Fitzmaurice DA, Wilson S, Hyde CJ, Thorpe GH, et al.
-
Systematic review of outpatient services for chronic pain control.
By McQuay HJ, Moore RA, Eccleston C, Morley S, de C Williams AC.
-
Neonatal screening for inborn errors of metabolism: cost, yield and outcome.
A review by Pollitt RJ, Green A, McCabe CJ, Booth A, Cooper NJ, Leonard JV, et al.
-
Preschool vision screening.
A review by Snowdon SK, Stewart-Brown SL.
-
Implications of socio-cultural contexts for the ethics of clinical trials.
A review by Ashcroft RE, Chadwick DW, Clark SRL, Edwards RHT, Frith L, Hutton JL.
-
A critical review of the role of neonatal hearing screening in the detection of congenital hearing impairment.
By Davis A, Bamford J, Wilson I, Ramkalawan T, Forshaw M, Wright S.
-
Newborn screening for inborn errors of metabolism: a systematic review.
By Seymour CA, Thomason MJ, Chalmers RA, Addison GM, Bain MD, Cockburn F, et al.
-
Routine preoperative testing: a systematic review of the evidence.
By Munro J, Booth A, Nicholl J.
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Systematic review of the effectiveness of laxatives in the elderly.
By Petticrew M, Watt I, Sheldon T.
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When and how to assess fast-changing technologies: a comparative study of medical applications of four generic technologies.
A review by Mowatt G, Bower DJ, Brebner JA, Cairns JA, Grant AM, McKee L.
-
Antenatal screening for Down’s syndrome.
A review by Wald NJ, Kennard A, Hackshaw A, McGuire A.
-
Screening for ovarian cancer: a systematic review.
By Bell R, Petticrew M, Luengo S, Sheldon TA.
-
Consensus development methods, and their use in clinical guideline development.
A review by Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CFB, Askham J, et al.
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A cost–utility analysis of interferon beta for multiple sclerosis.
By Parkin D, McNamee P, Jacoby A, Miller P, Thomas S, Bates D.
-
Effectiveness and efficiency of methods of dialysis therapy for end-stage renal disease: systematic reviews.
By MacLeod A, Grant A, Donaldson C, Khan I, Campbell M, Daly C, et al.
-
Effectiveness of hip prostheses in primary total hip replacement: a critical review of evidence and an economic model.
By Faulkner A, Kennedy LG, Baxter K, Donovan J, Wilkinson M, Bevan G.
-
Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomised controlled trials.
By Song F, Glenny AM.
-
Bone marrow and peripheral blood stem cell transplantation for malignancy.
A review by Johnson PWM, Simnett SJ, Sweetenham JW, Morgan GJ, Stewart LA.
-
Screening for speech and language delay: a systematic review of the literature.
By Law J, Boyle J, Harris F, Harkness A, Nye C.
-
Resource allocation for chronic stable angina: a systematic review of effectiveness, costs and cost-effectiveness of alternative interventions.
By Sculpher MJ, Petticrew M, Kelland JL, Elliott RA, Holdright DR, Buxton MJ.
-
Detection, adherence and control of hypertension for the prevention of stroke: a systematic review.
By Ebrahim S.
-
Postoperative analgesia and vomiting, with special reference to day-case surgery: a systematic review.
By McQuay HJ, Moore RA.
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Choosing between randomised and nonrandomised studies: a systematic review.
By Britton A, McKee M, Black N, McPherson K, Sanderson C, Bain C.
-
Evaluating patient-based outcome measures for use in clinical trials.
A review by Fitzpatrick R, Davey C, Buxton MJ, Jones DR.
-
Ethical issues in the design and conduct of randomised controlled trials.
A review by Edwards SJL, Lilford RJ, Braunholtz DA, Jackson JC, Hewison J, Thornton J.
-
Qualitative research methods in health technology assessment: a review of the literature.
By Murphy E, Dingwall R, Greatbatch D, Parker S, Watson P.
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The costs and benefits of paramedic skills in pre-hospital trauma care.
By Nicholl J, Hughes S, Dixon S, Turner J, Yates D.
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Systematic review of endoscopic ultrasound in gastro-oesophageal cancer.
By Harris KM, Kelly S, Berry E, Hutton J, Roderick P, Cullingworth J, et al.
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Systematic reviews of trials and other studies.
By Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F.
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Primary total hip replacement surgery: a systematic review of outcomes and modelling of cost-effectiveness associated with different prostheses.
A review by Fitzpatrick R, Shortall E, Sculpher M, Murray D, Morris R, Lodge M, et al.
-
Informed decision making: an annotated bibliography and systematic review.
By Bekker H, Thornton JG, Airey CM, Connelly JB, Hewison J, Robinson MB, et al.
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Handling uncertainty when performing economic evaluation of healthcare interventions.
A review by Briggs AH, Gray AM.
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The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review.
By Crow R, Gage H, Hampson S, Hart J, Kimber A, Thomas H.
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A randomised controlled trial of different approaches to universal antenatal HIV testing: uptake and acceptability. Annex: Antenatal HIV testing – assessment of a routine voluntary approach.
By Simpson WM, Johnstone FD, Boyd FM, Goldberg DJ, Hart GJ, Gormley SM, et al.
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Methods for evaluating area-wide and organisation-based interventions in health and health care: a systematic review.
By Ukoumunne OC, Gulliford MC, Chinn S, Sterne JAC, Burney PGJ.
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Assessing the costs of healthcare technologies in clinical trials.
A review by Johnston K, Buxton MJ, Jones DR, Fitzpatrick R.
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Cooperatives and their primary care emergency centres: organisation and impact.
By Hallam L, Henthorne K.
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Screening for cystic fibrosis.
A review by Murray J, Cuckle H, Taylor G, Littlewood J, Hewison J.
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A review of the use of health status measures in economic evaluation.
By Brazier J, Deverill M, Green C, Harper R, Booth A.
-
Methods for the analysis of quality-of-life and survival data in health technology assessment.
A review by Billingham LJ, Abrams KR, Jones DR.
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Antenatal and neonatal haemoglobinopathy screening in the UK: review and economic analysis.
By Zeuner D, Ades AE, Karnon J, Brown J, Dezateux C, Anionwu EN.
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Assessing the quality of reports of randomised trials: implications for the conduct of meta-analyses.
A review by Moher D, Cook DJ, Jadad AR, Tugwell P, Moher M, Jones A, et al.
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‘Early warning systems’ for identifying new healthcare technologies.
By Robert G, Stevens A, Gabbay J.
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A systematic review of the role of human papillomavirus testing within a cervical screening programme.
By Cuzick J, Sasieni P, Davies P, Adams J, Normand C, Frater A, et al.
-
Near patient testing in diabetes clinics: appraising the costs and outcomes.
By Grieve R, Beech R, Vincent J, Mazurkiewicz J.
-
Positron emission tomography: establishing priorities for health technology assessment.
A review by Robert G, Milne R.
-
The debridement of chronic wounds: a systematic review.
By Bradley M, Cullum N, Sheldon T.
-
Systematic reviews of wound care management: (2) Dressings and topical agents used in the healing of chronic wounds.
By Bradley M, Cullum N, Nelson EA, Petticrew M, Sheldon T, Torgerson D.
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A systematic literature review of spiral and electron beam computed tomography: with particular reference to clinical applications in hepatic lesions, pulmonary embolus and coronary artery disease.
By Berry E, Kelly S, Hutton J, Harris KM, Roderick P, Boyce JC, et al.
-
What role for statins? A review and economic model.
By Ebrahim S, Davey Smith G, McCabe C, Payne N, Pickin M, Sheldon TA, et al.
-
Factors that limit the quality, number and progress of randomised controlled trials.
A review by Prescott RJ, Counsell CE, Gillespie WJ, Grant AM, Russell IT, Kiauka S, et al.
-
Antimicrobial prophylaxis in total hip replacement: a systematic review.
By Glenny AM, Song F.
-
Health promoting schools and health promotion in schools: two systematic reviews.
By Lister-Sharp D, Chapman S, Stewart-Brown S, Sowden A.
-
Economic evaluation of a primary care-based education programme for patients with osteoarthritis of the knee.
A review by Lord J, Victor C, Littlejohns P, Ross FM, Axford JS.
-
The estimation of marginal time preference in a UK-wide sample (TEMPUS) project.
A review by Cairns JA, van der Pol MM.
-
Geriatric rehabilitation following fractures in older people: a systematic review.
By Cameron I, Crotty M, Currie C, Finnegan T, Gillespie L, Gillespie W, et al.
-
Screening for sickle cell disease and thalassaemia: a systematic review with supplementary research.
By Davies SC, Cronin E, Gill M, Greengross P, Hickman M, Normand C.
-
Community provision of hearing aids and related audiology services.
A review by Reeves DJ, Alborz A, Hickson FS, Bamford JM.
-
False-negative results in screening programmes: systematic review of impact and implications.
By Petticrew MP, Sowden AJ, Lister-Sharp D, Wright K.
-
Costs and benefits of community postnatal support workers: a randomised controlled trial.
By Morrell CJ, Spiby H, Stewart P, Walters S, Morgan A.
-
Implantable contraceptives (subdermal implants and hormonally impregnated intrauterine systems) versus other forms of reversible contraceptives: two systematic reviews to assess relative effectiveness, acceptability, tolerability and cost-effectiveness.
By French RS, Cowan FM, Mansour DJA, Morris S, Procter T, Hughes D, et al.
-
An introduction to statistical methods for health technology assessment.
A review by White SJ, Ashby D, Brown PJ.
-
Disease-modifying drugs for multiple sclerosis: a rapid and systematic review.
By Clegg A, Bryant J, Milne R.
-
Publication and related biases.
A review by Song F, Eastwood AJ, Gilbody S, Duley L, Sutton AJ.
-
Cost and outcome implications of the organisation of vascular services.
By Michaels J, Brazier J, Palfreyman S, Shackley P, Slack R.
-
Monitoring blood glucose control in diabetes mellitus: a systematic review.
By Coster S, Gulliford MC, Seed PT, Powrie JK, Swaminathan R.
-
The effectiveness of domiciliary health visiting: a systematic review of international studies and a selective review of the British literature.
By Elkan R, Kendrick D, Hewitt M, Robinson JJA, Tolley K, Blair M, et al.
-
The determinants of screening uptake and interventions for increasing uptake: a systematic review.
By Jepson R, Clegg A, Forbes C, Lewis R, Sowden A, Kleijnen J.
-
The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth.
A rapid review by Song F, O’Meara S, Wilson P, Golder S, Kleijnen J.
-
Ultrasound screening in pregnancy: a systematic review of the clinical effectiveness, cost-effectiveness and women’s views.
By Bricker L, Garcia J, Henderson J, Mugford M, Neilson J, Roberts T, et al.
-
A rapid and systematic review of the effectiveness and cost-effectiveness of the taxanes used in the treatment of advanced breast and ovarian cancer.
By Lister-Sharp D, McDonagh MS, Khan KS, Kleijnen J.
-
Liquid-based cytology in cervical screening: a rapid and systematic review.
By Payne N, Chilcott J, McGoogan E.
-
Randomised controlled trial of non-directive counselling, cognitive–behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care.
By King M, Sibbald B, Ward E, Bower P, Lloyd M, Gabbay M, et al.
-
Routine referral for radiography of patients presenting with low back pain: is patients’ outcome influenced by GPs’ referral for plain radiography?
By Kerry S, Hilton S, Patel S, Dundas D, Rink E, Lord J.
-
Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration.
By O’Meara S, Cullum N, Majid M, Sheldon T.
-
Using routine data to complement and enhance the results of randomised controlled trials.
By Lewsey JD, Leyland AH, Murray GD, Boddy FA.
-
Coronary artery stents in the treatment of ischaemic heart disease: a rapid and systematic review.
By Meads C, Cummins C, Jolly K, Stevens A, Burls A, Hyde C.
-
Outcome measures for adult critical care: a systematic review.
By Hayes JA, Black NA, Jenkinson C, Young JD, Rowan KM, Daly K, et al.
-
A systematic review to evaluate the effectiveness of interventions to promote the initiation of breastfeeding.
By Fairbank L, O’Meara S, Renfrew MJ, Woolridge M, Sowden AJ, Lister-Sharp D.
-
Implantable cardioverter defibrillators: arrhythmias. A rapid and systematic review.
By Parkes J, Bryant J, Milne R.
-
Treatments for fatigue in multiple sclerosis: a rapid and systematic review.
By Brañas P, Jordan R, Fry-Smith A, Burls A, Hyde C.
-
Early asthma prophylaxis, natural history, skeletal development and economy (EASE): a pilot randomised controlled trial.
By Baxter-Jones ADG, Helms PJ, Russell G, Grant A, Ross S, Cairns JA, et al.
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Screening for hypercholesterolaemia versus case finding for familial hypercholesterolaemia: a systematic review and cost-effectiveness analysis.
By Marks D, Wonderling D, Thorogood M, Lambert H, Humphries SE, Neil HAW.
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A rapid and systematic review of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists in the medical management of unstable angina.
By McDonagh MS, Bachmann LM, Golder S, Kleijnen J, ter Riet G.
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A randomised controlled trial of prehospital intravenous fluid replacement therapy in serious trauma.
By Turner J, Nicholl J, Webber L, Cox H, Dixon S, Yates D.
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Intrathecal pumps for giving opioids in chronic pain: a systematic review.
By Williams JE, Louw G, Towlerton G.
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Combination therapy (interferon alfa and ribavirin) in the treatment of chronic hepatitis C: a rapid and systematic review.
By Shepherd J, Waugh N, Hewitson P.
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A systematic review of comparisons of effect sizes derived from randomised and non-randomised studies.
By MacLehose RR, Reeves BC, Harvey IM, Sheldon TA, Russell IT, Black AMS.
-
Intravascular ultrasound-guided interventions in coronary artery disease: a systematic literature review, with decision-analytic modelling, of outcomes and cost-effectiveness.
By Berry E, Kelly S, Hutton J, Lindsay HSJ, Blaxill JM, Evans JA, et al.
-
A randomised controlled trial to evaluate the effectiveness and cost-effectiveness of counselling patients with chronic depression.
By Simpson S, Corney R, Fitzgerald P, Beecham J.
-
Systematic review of treatments for atopic eczema.
By Hoare C, Li Wan Po A, Williams H.
-
Bayesian methods in health technology assessment: a review.
By Spiegelhalter DJ, Myles JP, Jones DR, Abrams KR.
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The management of dyspepsia: a systematic review.
By Delaney B, Moayyedi P, Deeks J, Innes M, Soo S, Barton P, et al.
-
A systematic review of treatments for severe psoriasis.
By Griffiths CEM, Clark CM, Chalmers RJG, Li Wan Po A, Williams HC.
-
Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer’s disease: a rapid and systematic review.
By Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, et al.
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The clinical effectiveness and cost-effectiveness of riluzole for motor neurone disease: a rapid and systematic review.
By Stewart A, Sandercock J, Bryan S, Hyde C, Barton PM, Fry-Smith A, et al.
-
Equity and the economic evaluation of healthcare.
By Sassi F, Archard L, Le Grand J.
-
Quality-of-life measures in chronic diseases of childhood.
By Eiser C, Morse R.
-
Eliciting public preferences for healthcare: a systematic review of techniques.
By Ryan M, Scott DA, Reeves C, Bate A, van Teijlingen ER, Russell EM, et al.
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General health status measures for people with cognitive impairment: learning disability and acquired brain injury.
By Riemsma RP, Forbes CA, Glanville JM, Eastwood AJ, Kleijnen J.
-
An assessment of screening strategies for fragile X syndrome in the UK.
By Pembrey ME, Barnicoat AJ, Carmichael B, Bobrow M, Turner G.
-
Issues in methodological research: perspectives from researchers and commissioners.
By Lilford RJ, Richardson A, Stevens A, Fitzpatrick R, Edwards S, Rock F, et al.
-
Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy.
By Cullum N, Nelson EA, Flemming K, Sheldon T.
-
Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review.
By Hampson SE, Skinner TC, Hart J, Storey L, Gage H, Foxcroft D, et al.
-
Effectiveness of autologous chondrocyte transplantation for hyaline cartilage defects in knees: a rapid and systematic review.
By Jobanputra P, Parry D, Fry-Smith A, Burls A.
-
Statistical assessment of the learning curves of health technologies.
By Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT.
-
The effectiveness and cost-effectiveness of temozolomide for the treatment of recurrent malignant glioma: a rapid and systematic review.
By Dinnes J, Cave C, Huang S, Major K, Milne R.
-
A rapid and systematic review of the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention.
By Lewis R, Whiting P, ter Riet G, O’Meara S, Glanville J.
-
Home treatment for mental health problems: a systematic review.
By Burns T, Knapp M, Catty J, Healey A, Henderson J, Watt H, et al.
-
How to develop cost-conscious guidelines.
By Eccles M, Mason J.
-
The role of specialist nurses in multiple sclerosis: a rapid and systematic review.
By De Broe S, Christopher F, Waugh N.
-
A rapid and systematic review of the clinical effectiveness and cost-effectiveness of orlistat in the management of obesity.
By O’Meara S, Riemsma R, Shirran L, Mather L, ter Riet G.
-
The clinical effectiveness and cost-effectiveness of pioglitazone for type 2 diabetes mellitus: a rapid and systematic review.
By Chilcott J, Wight J, Lloyd Jones M, Tappenden P.
-
Extended scope of nursing practice: a multicentre randomised controlled trial of appropriately trained nurses and preregistration house officers in preoperative assessment in elective general surgery.
By Kinley H, Czoski-Murray C, George S, McCabe C, Primrose J, Reilly C, et al.
-
Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) Acute day hospital versus admission; (2) Vocational rehabilitation; (3) Day hospital versus outpatient care.
By Marshall M, Crowther R, Almaraz- Serrano A, Creed F, Sledge W, Kluiter H, et al.
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The measurement and monitoring of surgical adverse events.
By Bruce J, Russell EM, Mollison J, Krukowski ZH.
-
Action research: a systematic review and guidance for assessment.
By Waterman H, Tillen D, Dickson R, de Koning K.
-
A rapid and systematic review of the clinical effectiveness and cost-effectiveness of gemcitabine for the treatment of pancreatic cancer.
By Ward S, Morris E, Bansback N, Calvert N, Crellin A, Forman D, et al.
-
A rapid and systematic review of the evidence for the clinical effectiveness and cost-effectiveness of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer.
By Lloyd Jones M, Hummel S, Bansback N, Orr B, Seymour M.
-
Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature.
By Brocklebank D, Ram F, Wright J, Barry P, Cates C, Davies L, et al.
-
The cost-effectiveness of magnetic resonance imaging for investigation of the knee joint.
By Bryan S, Weatherburn G, Bungay H, Hatrick C, Salas C, Parry D, et al.
-
A rapid and systematic review of the clinical effectiveness and cost-effectiveness of topotecan for ovarian cancer.
By Forbes C, Shirran L, Bagnall A-M, Duffy S, ter Riet G.
-
Superseded by a report published in a later volume.
-
The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomised (unblinded) controlled trial.
By Kendrick D, Fielding K, Bentley E, Miller P, Kerslake R, Pringle M.
-
Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients.
By McColl E, Jacoby A, Thomas L, Soutter J, Bamford C, Steen N, et al.
-
A rapid and systematic review of the clinical effectiveness and cost-effectiveness of paclitaxel, docetaxel, gemcitabine and vinorelbine in non-small-cell lung cancer.
By Clegg A, Scott DA, Sidhu M, Hewitson P, Waugh N.
-
Subgroup analyses in randomised controlled trials: quantifying the risks of false-positives and false-negatives.
By Brookes ST, Whitley E, Peters TJ, Mulheran PA, Egger M, Davey Smith G.
-
Depot antipsychotic medication in the treatment of patients with schizophrenia: (1) Meta-review; (2) Patient and nurse attitudes.
By David AS, Adams C.
-
A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression.
By Churchill R, Hunot V, Corney R, Knapp M, McGuire H, Tylee A, et al.
-
Cost analysis of child health surveillance.
By Sanderson D, Wright D, Acton C, Duree D.
-
A study of the methods used to select review criteria for clinical audit.
By Hearnshaw H, Harker R, Cheater F, Baker R, Grimshaw G.
-
Fludarabine as second-line therapy for B cell chronic lymphocytic leukaemia: a technology assessment.
By Hyde C, Wake B, Bryan S, Barton P, Fry-Smith A, Davenport C, et al.
-
Rituximab as third-line treatment for refractory or recurrent Stage III or IV follicular non-Hodgkin’s lymphoma: a systematic review and economic evaluation.
By Wake B, Hyde C, Bryan S, Barton P, Song F, Fry-Smith A, et al.
-
A systematic review of discharge arrangements for older people.
By Parker SG, Peet SM, McPherson A, Cannaby AM, Baker R, Wilson A, et al.
-
The clinical effectiveness and cost-effectiveness of inhaler devices used in the routine management of chronic asthma in older children: a systematic review and economic evaluation.
By Peters J, Stevenson M, Beverley C, Lim J, Smith S.
-
The clinical effectiveness and cost-effectiveness of sibutramine in the management of obesity: a technology assessment.
By O’Meara S, Riemsma R, Shirran L, Mather L, ter Riet G.
-
The cost-effectiveness of magnetic resonance angiography for carotid artery stenosis and peripheral vascular disease: a systematic review.
By Berry E, Kelly S, Westwood ME, Davies LM, Gough MJ, Bamford JM, et al.
-
Promoting physical activity in South Asian Muslim women through ‘exercise on prescription’.
By Carroll B, Ali N, Azam N.
-
Zanamivir for the treatment of influenza in adults: a systematic review and economic evaluation.
By Burls A, Clark W, Stewart T, Preston C, Bryan S, Jefferson T, et al.
-
A review of the natural history and epidemiology of multiple sclerosis: implications for resource allocation and health economic models.
By Richards RG, Sampson FC, Beard SM, Tappenden P.
-
Screening for gestational diabetes: a systematic review and economic evaluation.
By Scott DA, Loveman E, McIntyre L, Waugh N.
-
The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation.
By Clegg AJ, Colquitt J, Sidhu MK, Royle P, Loveman E, Walker A.
-
The clinical effectiveness of trastuzumab for breast cancer: a systematic review.
By Lewis R, Bagnall A-M, Forbes C, Shirran E, Duffy S, Kleijnen J, et al.
-
The clinical effectiveness and cost-effectiveness of vinorelbine for breast cancer: a systematic review and economic evaluation.
By Lewis R, Bagnall A-M, King S, Woolacott N, Forbes C, Shirran L, et al.
-
A systematic review of the effectiveness and cost-effectiveness of metal-on-metal hip resurfacing arthroplasty for treatment of hip disease.
By Vale L, Wyness L, McCormack K, McKenzie L, Brazzelli M, Stearns SC.
-
The clinical effectiveness and cost-effectiveness of bupropion and nicotine replacement therapy for smoking cessation: a systematic review and economic evaluation.
By Woolacott NF, Jones L, Forbes CA, Mather LC, Sowden AJ, Song FJ, et al.
-
A systematic review of effectiveness and economic evaluation of new drug treatments for juvenile idiopathic arthritis: etanercept.
By Cummins C, Connock M, Fry-Smith A, Burls A.
-
Clinical effectiveness and cost-effectiveness of growth hormone in children: a systematic review and economic evaluation.
By Bryant J, Cave C, Mihaylova B, Chase D, McIntyre L, Gerard K, et al.
-
Clinical effectiveness and cost-effectiveness of growth hormone in adults in relation to impact on quality of life: a systematic review and economic evaluation.
By Bryant J, Loveman E, Chase D, Mihaylova B, Cave C, Gerard K, et al.
-
Clinical medication review by a pharmacist of patients on repeat prescriptions in general practice: a randomised controlled trial.
By Zermansky AG, Petty DR, Raynor DK, Lowe CJ, Freementle N, Vail A.
-
The effectiveness of infliximab and etanercept for the treatment of rheumatoid arthritis: a systematic review and economic evaluation.
By Jobanputra P, Barton P, Bryan S, Burls A.
-
A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety.
By Kaltenthaler E, Shackley P, Stevens K, Beverley C, Parry G, Chilcott J.
-
A systematic review and economic evaluation of pegylated liposomal doxorubicin hydrochloride for ovarian cancer.
By Forbes C, Wilby J, Richardson G, Sculpher M, Mather L, Reimsma R.
-
A systematic review of the effectiveness of interventions based on a stages-of-change approach to promote individual behaviour change.
By Riemsma RP, Pattenden J, Bridle C, Sowden AJ, Mather L, Watt IS, et al.
-
A systematic review update of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists.
By Robinson M, Ginnelly L, Sculpher M, Jones L, Riemsma R, Palmer S, et al.
-
A systematic review of the effectiveness, cost-effectiveness and barriers to implementation of thrombolytic and neuroprotective therapy for acute ischaemic stroke in the NHS.
By Sandercock P, Berge E, Dennis M, Forbes J, Hand P, Kwan J, et al.
-
A randomised controlled crossover trial of nurse practitioner versus doctor-led outpatient care in a bronchiectasis clinic.
By Caine N, Sharples LD, Hollingworth W, French J, Keogan M, Exley A, et al.
-
Clinical effectiveness and cost – consequences of selective serotonin reuptake inhibitors in the treatment of sex offenders.
By Adi Y, Ashcroft D, Browne K, Beech A, Fry-Smith A, Hyde C.
-
Treatment of established osteoporosis: a systematic review and cost–utility analysis.
By Kanis JA, Brazier JE, Stevenson M, Calvert NW, Lloyd Jones M.
-
Which anaesthetic agents are cost-effective in day surgery? Literature review, national survey of practice and randomised controlled trial.
By Elliott RA Payne K, Moore JK, Davies LM, Harper NJN, St Leger AS, et al.
-
Screening for hepatitis C among injecting drug users and in genitourinary medicine clinics: systematic reviews of effectiveness, modelling study and national survey of current practice.
By Stein K, Dalziel K, Walker A, McIntyre L, Jenkins B, Horne J, et al.
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The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature.
By Crow R, Gage H, Hampson S, Hart J, Kimber A, Storey L, et al.
-
The effectiveness and cost-effectiveness of imatinib in chronic myeloid leukaemia: a systematic review.
By Garside R, Round A, Dalziel K, Stein K, Royle R.
-
A comparative study of hypertonic saline, daily and alternate-day rhDNase in children with cystic fibrosis.
By Suri R, Wallis C, Bush A, Thompson S, Normand C, Flather M, et al.
-
A systematic review of the costs and effectiveness of different models of paediatric home care.
By Parker G, Bhakta P, Lovett CA, Paisley S, Olsen R, Turner D, et al.
-
How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study.
By Egger M, Jüni P, Bartlett C, Holenstein F, Sterne J.
-
Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of home versus hospital or satellite unit haemodialysis for people with end-stage renal failure.
By Mowatt G, Vale L, Perez J, Wyness L, Fraser C, MacLeod A, et al.
-
Systematic review and economic evaluation of the effectiveness of infliximab for the treatment of Crohn’s disease.
By Clark W, Raftery J, Barton P, Song F, Fry-Smith A, Burls A.
-
A review of the clinical effectiveness and cost-effectiveness of routine anti-D prophylaxis for pregnant women who are rhesus negative.
By Chilcott J, Lloyd Jones M, Wight J, Forman K, Wray J, Beverley C, et al.
-
Systematic review and evaluation of the use of tumour markers in paediatric oncology: Ewing’s sarcoma and neuroblastoma.
By Riley RD, Burchill SA, Abrams KR, Heney D, Lambert PC, Jones DR, et al.
-
The cost-effectiveness of screening for Helicobacter pylori to reduce mortality and morbidity from gastric cancer and peptic ulcer disease: a discrete-event simulation model.
By Roderick P, Davies R, Raftery J, Crabbe D, Pearce R, Bhandari P, et al.
-
The clinical effectiveness and cost-effectiveness of routine dental checks: a systematic review and economic evaluation.
By Davenport C, Elley K, Salas C, Taylor-Weetman CL, Fry-Smith A, Bryan S, et al.
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A multicentre randomised controlled trial assessing the costs and benefits of using structured information and analysis of women’s preferences in the management of menorrhagia.
By Kennedy ADM, Sculpher MJ, Coulter A, Dwyer N, Rees M, Horsley S, et al.
-
Clinical effectiveness and cost–utility of photodynamic therapy for wet age-related macular degeneration: a systematic review and economic evaluation.
By Meads C, Salas C, Roberts T, Moore D, Fry-Smith A, Hyde C.
-
Evaluation of molecular tests for prenatal diagnosis of chromosome abnormalities.
By Grimshaw GM, Szczepura A, Hultén M, MacDonald F, Nevin NC, Sutton F, et al.
-
First and second trimester antenatal screening for Down’s syndrome: the results of the Serum, Urine and Ultrasound Screening Study (SURUSS).
By Wald NJ, Rodeck C, Hackshaw AK, Walters J, Chitty L, Mackinson AM.
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The effectiveness and cost-effectiveness of ultrasound locating devices for central venous access: a systematic review and economic evaluation.
By Calvert N, Hind D, McWilliams RG, Thomas SM, Beverley C, Davidson A.
-
A systematic review of atypical antipsychotics in schizophrenia.
By Bagnall A-M, Jones L, Lewis R, Ginnelly L, Glanville J, Torgerson D, et al.
-
Prostate Testing for Cancer and Treatment (ProtecT) feasibility study.
By Donovan J, Hamdy F, Neal D, Peters T, Oliver S, Brindle L, et al.
-
Early thrombolysis for the treatment of acute myocardial infarction: a systematic review and economic evaluation.
By Boland A, Dundar Y, Bagust A, Haycox A, Hill R, Mujica Mota R, et al.
-
Screening for fragile X syndrome: a literature review and modelling.
By Song FJ, Barton P, Sleightholme V, Yao GL, Fry-Smith A.
-
Systematic review of endoscopic sinus surgery for nasal polyps.
By Dalziel K, Stein K, Round A, Garside R, Royle P.
-
Towards efficient guidelines: how to monitor guideline use in primary care.
By Hutchinson A, McIntosh A, Cox S, Gilbert C.
-
Effectiveness and cost-effectiveness of acute hospital-based spinal cord injuries services: systematic review.
By Bagnall A-M, Jones L, Richardson G, Duffy S, Riemsma R.
-
Prioritisation of health technology assessment. The PATHS model: methods and case studies.
By Townsend J, Buxton M, Harper G.
-
Systematic review of the clinical effectiveness and cost-effectiveness of tension-free vaginal tape for treatment of urinary stress incontinence.
By Cody J, Wyness L, Wallace S, Glazener C, Kilonzo M, Stearns S, et al.
-
The clinical and cost-effectiveness of patient education models for diabetes: a systematic review and economic evaluation.
By Loveman E, Cave C, Green C, Royle P, Dunn N, Waugh N.
-
The role of modelling in prioritising and planning clinical trials.
By Chilcott J, Brennan A, Booth A, Karnon J, Tappenden P.
-
Cost–benefit evaluation of routine influenza immunisation in people 65–74 years of age.
By Allsup S, Gosney M, Haycox A, Regan M.
-
The clinical and cost-effectiveness of pulsatile machine perfusion versus cold storage of kidneys for transplantation retrieved from heart-beating and non-heart-beating donors.
By Wight J, Chilcott J, Holmes M, Brewer N.
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Can randomised trials rely on existing electronic data? A feasibility study to explore the value of routine data in health technology assessment.
By Williams JG, Cheung WY, Cohen DR, Hutchings HA, Longo MF, Russell IT.
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Evaluating non-randomised intervention studies.
By Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, et al.
-
A randomised controlled trial to assess the impact of a package comprising a patient-orientated, evidence-based self- help guidebook and patient-centred consultations on disease management and satisfaction in inflammatory bowel disease.
By Kennedy A, Nelson E, Reeves D, Richardson G, Roberts C, Robinson A, et al.
-
The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review.
By Dinnes J, Loveman E, McIntyre L, Waugh N.
-
The value of digital imaging in diabetic retinopathy.
By Sharp PF, Olson J, Strachan F, Hipwell J, Ludbrook A, O’Donnell M, et al.
-
Lowering blood pressure to prevent myocardial infarction and stroke: a new preventive strategy.
By Law M, Wald N, Morris J.
-
Clinical and cost-effectiveness of capecitabine and tegafur with uracil for the treatment of metastatic colorectal cancer: systematic review and economic evaluation.
By Ward S, Kaltenthaler E, Cowan J, Brewer N.
-
Clinical and cost-effectiveness of new and emerging technologies for early localised prostate cancer: a systematic review.
By Hummel S, Paisley S, Morgan A, Currie E, Brewer N.
-
Literature searching for clinical and cost-effectiveness studies used in health technology assessment reports carried out for the National Institute for Clinical Excellence appraisal system.
By Royle P, Waugh N.
-
Systematic review and economic decision modelling for the prevention and treatment of influenza A and B.
By Turner D, Wailoo A, Nicholson K, Cooper N, Sutton A, Abrams K.
-
A randomised controlled trial to evaluate the clinical and cost-effectiveness of Hickman line insertions in adult cancer patients by nurses.
By Boland A, Haycox A, Bagust A, Fitzsimmons L.
-
Redesigning postnatal care: a randomised controlled trial of protocol-based midwifery-led care focused on individual women’s physical and psychological health needs.
By MacArthur C, Winter HR, Bick DE, Lilford RJ, Lancashire RJ, Knowles H, et al.
-
Estimating implied rates of discount in healthcare decision-making.
By West RR, McNabb R, Thompson AGH, Sheldon TA, Grimley Evans J.
-
Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling.
By Cooper BS, Stone SP, Kibbler CC, Cookson BD, Roberts JA, Medley GF, et al.
-
Treatments for spasticity and pain in multiple sclerosis: a systematic review.
By Beard S, Hunn A, Wight J.
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The inclusion of reports of randomised trials published in languages other than English in systematic reviews.
By Moher D, Pham B, Lawson ML, Klassen TP.
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The impact of screening on future health-promoting behaviours and health beliefs: a systematic review.
By Bankhead CR, Brett J, Bukach C, Webster P, Stewart-Brown S, Munafo M, et al.
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What is the best imaging strategy for acute stroke?
By Wardlaw JM, Keir SL, Seymour J, Lewis S, Sandercock PAG, Dennis MS, et al.
-
Systematic review and modelling of the investigation of acute and chronic chest pain presenting in primary care.
By Mant J, McManus RJ, Oakes RAL, Delaney BC, Barton PM, Deeks JJ, et al.
-
The effectiveness and cost-effectiveness of microwave and thermal balloon endometrial ablation for heavy menstrual bleeding: a systematic review and economic modelling.
By Garside R, Stein K, Wyatt K, Round A, Price A.
-
A systematic review of the role of bisphosphonates in metastatic disease.
By Ross JR, Saunders Y, Edmonds PM, Patel S, Wonderling D, Normand C, et al.
-
Systematic review of the clinical effectiveness and cost-effectiveness of capecitabine (Xeloda®) for locally advanced and/or metastatic breast cancer.
By Jones L, Hawkins N, Westwood M, Wright K, Richardson G, Riemsma R.
-
Effectiveness and efficiency of guideline dissemination and implementation strategies.
By Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al.
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Clinical effectiveness and costs of the Sugarbaker procedure for the treatment of pseudomyxoma peritonei.
By Bryant J, Clegg AJ, Sidhu MK, Brodin H, Royle P, Davidson P.
-
Psychological treatment for insomnia in the regulation of long-term hypnotic drug use.
By Morgan K, Dixon S, Mathers N, Thompson J, Tomeny M.
-
Improving the evaluation of therapeutic interventions in multiple sclerosis: development of a patient-based measure of outcome.
By Hobart JC, Riazi A, Lamping DL, Fitzpatrick R, Thompson AJ.
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A systematic review and economic evaluation of magnetic resonance cholangiopancreatography compared with diagnostic endoscopic retrograde cholangiopancreatography.
By Kaltenthaler E, Bravo Vergel Y, Chilcott J, Thomas S, Blakeborough T, Walters SJ, et al.
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The use of modelling to evaluate new drugs for patients with a chronic condition: the case of antibodies against tumour necrosis factor in rheumatoid arthritis.
By Barton P, Jobanputra P, Wilson J, Bryan S, Burls A.
-
Clinical effectiveness and cost-effectiveness of neonatal screening for inborn errors of metabolism using tandem mass spectrometry: a systematic review.
By Pandor A, Eastham J, Beverley C, Chilcott J, Paisley S.
-
Clinical effectiveness and cost-effectiveness of pioglitazone and rosiglitazone in the treatment of type 2 diabetes: a systematic review and economic evaluation.
By Czoski-Murray C, Warren E, Chilcott J, Beverley C, Psyllaki MA, Cowan J.
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Routine examination of the newborn: the EMREN study. Evaluation of an extension of the midwife role including a randomised controlled trial of appropriately trained midwives and paediatric senior house officers.
By Townsend J, Wolke D, Hayes J, Davé S, Rogers C, Bloomfield L, et al.
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Involving consumers in research and development agenda setting for the NHS: developing an evidence-based approach.
By Oliver S, Clarke-Jones L, Rees R, Milne R, Buchanan P, Gabbay J, et al.
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A multi-centre randomised controlled trial of minimally invasive direct coronary bypass grafting versus percutaneous transluminal coronary angioplasty with stenting for proximal stenosis of the left anterior descending coronary artery.
By Reeves BC, Angelini GD, Bryan AJ, Taylor FC, Cripps T, Spyt TJ, et al.
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Does early magnetic resonance imaging influence management or improve outcome in patients referred to secondary care with low back pain? A pragmatic randomised controlled trial.
By Gilbert FJ, Grant AM, Gillan MGC, Vale L, Scott NW, Campbell MK, et al.
-
The clinical and cost-effectiveness of anakinra for the treatment of rheumatoid arthritis in adults: a systematic review and economic analysis.
By Clark W, Jobanputra P, Barton P, Burls A.
-
A rapid and systematic review and economic evaluation of the clinical and cost-effectiveness of newer drugs for treatment of mania associated with bipolar affective disorder.
By Bridle C, Palmer S, Bagnall A-M, Darba J, Duffy S, Sculpher M, et al.
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Liquid-based cytology in cervical screening: an updated rapid and systematic review and economic analysis.
By Karnon J, Peters J, Platt J, Chilcott J, McGoogan E, Brewer N.
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Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement.
By Avenell A, Broom J, Brown TJ, Poobalan A, Aucott L, Stearns SC, et al.
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Autoantibody testing in children with newly diagnosed type 1 diabetes mellitus.
By Dretzke J, Cummins C, Sandercock J, Fry-Smith A, Barrett T, Burls A.
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Clinical effectiveness and cost-effectiveness of prehospital intravenous fluids in trauma patients.
By Dretzke J, Sandercock J, Bayliss S, Burls A.
-
Newer hypnotic drugs for the short-term management of insomnia: a systematic review and economic evaluation.
By Dündar Y, Boland A, Strobl J, Dodd S, Haycox A, Bagust A, et al.
-
Development and validation of methods for assessing the quality of diagnostic accuracy studies.
By Whiting P, Rutjes AWS, Dinnes J, Reitsma JB, Bossuyt PMM, Kleijnen J.
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EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy.
By Garry R, Fountain J, Brown J, Manca A, Mason S, Sculpher M, et al.
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Methods for expected value of information analysis in complex health economic models: developments on the health economics of interferon-β and glatiramer acetate for multiple sclerosis.
By Tappenden P, Chilcott JB, Eggington S, Oakley J, McCabe C.
-
Effectiveness and cost-effectiveness of imatinib for first-line treatment of chronic myeloid leukaemia in chronic phase: a systematic review and economic analysis.
By Dalziel K, Round A, Stein K, Garside R, Price A.
-
VenUS I: a randomised controlled trial of two types of bandage for treating venous leg ulcers.
By Iglesias C, Nelson EA, Cullum NA, Torgerson DJ, on behalf of the VenUS Team.
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Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction.
By Mowatt G, Vale L, Brazzelli M, Hernandez R, Murray A, Scott N, et al.
-
A pilot study on the use of decision theory and value of information analysis as part of the NHS Health Technology Assessment programme.
By Claxton K, Ginnelly L, Sculpher M, Philips Z, Palmer S.
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The Social Support and Family Health Study: a randomised controlled trial and economic evaluation of two alternative forms of postnatal support for mothers living in disadvantaged inner-city areas.
By Wiggins M, Oakley A, Roberts I, Turner H, Rajan L, Austerberry H, et al.
-
Psychosocial aspects of genetic screening of pregnant women and newborns: a systematic review.
By Green JM, Hewison J, Bekker HL, Bryant, Cuckle HS.
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Evaluation of abnormal uterine bleeding: comparison of three outpatient procedures within cohorts defined by age and menopausal status.
By Critchley HOD, Warner P, Lee AJ, Brechin S, Guise J, Graham B.
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Coronary artery stents: a rapid systematic review and economic evaluation.
By Hill R, Bagust A, Bakhai A, Dickson R, Dündar Y, Haycox A, et al.
-
Review of guidelines for good practice in decision-analytic modelling in health technology assessment.
By Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al.
-
Rituximab (MabThera®) for aggressive non-Hodgkin’s lymphoma: systematic review and economic evaluation.
By Knight C, Hind D, Brewer N, Abbott V.
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Clinical effectiveness and cost-effectiveness of clopidogrel and modified-release dipyridamole in the secondary prevention of occlusive vascular events: a systematic review and economic evaluation.
By Jones L, Griffin S, Palmer S, Main C, Orton V, Sculpher M, et al.
-
Pegylated interferon α-2a and -2b in combination with ribavirin in the treatment of chronic hepatitis C: a systematic review and economic evaluation.
By Shepherd J, Brodin H, Cave C, Waugh N, Price A, Gabbay J.
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Clopidogrel used in combination with aspirin compared with aspirin alone in the treatment of non-ST-segment- elevation acute coronary syndromes: a systematic review and economic evaluation.
By Main C, Palmer S, Griffin S, Jones L, Orton V, Sculpher M, et al.
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Provision, uptake and cost of cardiac rehabilitation programmes: improving services to under-represented groups.
By Beswick AD, Rees K, Griebsch I, Taylor FC, Burke M, West RR, et al.
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Involving South Asian patients in clinical trials.
By Hussain-Gambles M, Leese B, Atkin K, Brown J, Mason S, Tovey P.
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Clinical and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes.
By Colquitt JL, Green C, Sidhu MK, Hartwell D, Waugh N.
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Identification and assessment of ongoing trials in health technology assessment reviews.
By Song FJ, Fry-Smith A, Davenport C, Bayliss S, Adi Y, Wilson JS, et al.
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Systematic review and economic evaluation of a long-acting insulin analogue, insulin glargine
By Warren E, Weatherley-Jones E, Chilcott J, Beverley C.
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Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
By McCarthy CJ, Mills PM, Pullen R, Richardson G, Hawkins N, Roberts CR, et al.
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Clinical and cost-effectiveness of once-daily versus more frequent use of same potency topical corticosteroids for atopic eczema: a systematic review and economic evaluation.
By Green C, Colquitt JL, Kirby J, Davidson P, Payne E.
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Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis.
By Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, et al.
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Generalisability in economic evaluation studies in healthcare: a review and case studies.
By Sculpher MJ, Pang FS, Manca A, Drummond MF, Golder S, Urdahl H, et al.
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Virtual outreach: a randomised controlled trial and economic evaluation of joint teleconferenced medical consultations.
By Wallace P, Barber J, Clayton W, Currell R, Fleming K, Garner P, et al.
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Randomised controlled multiple treatment comparison to provide a cost-effectiveness rationale for the selection of antimicrobial therapy in acne.
By Ozolins M, Eady EA, Avery A, Cunliffe WJ, O’Neill C, Simpson NB, et al.
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Do the findings of case series studies vary significantly according to methodological characteristics?
By Dalziel K, Round A, Stein K, Garside R, Castelnuovo E, Payne L.
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Improving the referral process for familial breast cancer genetic counselling: findings of three randomised controlled trials of two interventions.
By Wilson BJ, Torrance N, Mollison J, Wordsworth S, Gray JR, Haites NE, et al.
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Randomised evaluation of alternative electrosurgical modalities to treat bladder outflow obstruction in men with benign prostatic hyperplasia.
By Fowler C, McAllister W, Plail R, Karim O, Yang Q.
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A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer.
By Shenfine J, McNamee P, Steen N, Bond J, Griffin SM.
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Impact of computer-aided detection prompts on the sensitivity and specificity of screening mammography.
By Taylor P, Champness J, Given- Wilson R, Johnston K, Potts H.
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Issues in data monitoring and interim analysis of trials.
By Grant AM, Altman DG, Babiker AB, Campbell MK, Clemens FJ, Darbyshire JH, et al.
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Lay public’s understanding of equipoise and randomisation in randomised controlled trials.
By Robinson EJ, Kerr CEP, Stevens AJ, Lilford RJ, Braunholtz DA, Edwards SJ, et al.
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Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies.
By Greenhalgh J, Knight C, Hind D, Beverley C, Walters S.
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Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology.
By Smith SC, Lamping DL, Banerjee S, Harwood R, Foley B, Smith P, et al.
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Clinical effectiveness and cost-effectiveness of drotrecogin alfa (activated) (Xigris®) for the treatment of severe sepsis in adults: a systematic review and economic evaluation.
By Green C, Dinnes J, Takeda A, Shepherd J, Hartwell D, Cave C, et al.
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A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy.
By Dinnes J, Deeks J, Kirby J, Roderick P.
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Cervical screening programmes: can automation help? Evidence from systematic reviews, an economic analysis and a simulation modelling exercise applied to the UK.
By Willis BH, Barton P, Pearmain P, Bryan S, Hyde C.
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Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation.
By McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, et al.
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Clinical effectiveness, tolerability and cost-effectiveness of newer drugs for epilepsy in adults: a systematic review and economic evaluation.
By Wilby J, Kainth A, Hawkins N, Epstein D, McIntosh H, McDaid C, et al.
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A randomised controlled trial to compare the cost-effectiveness of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine.
By Peveler R, Kendrick T, Buxton M, Longworth L, Baldwin D, Moore M, et al.
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Clinical effectiveness and cost-effectiveness of immediate angioplasty for acute myocardial infarction: systematic review and economic evaluation.
By Hartwell D, Colquitt J, Loveman E, Clegg AJ, Brodin H, Waugh N, et al.
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A randomised controlled comparison of alternative strategies in stroke care.
By Kalra L, Evans A, Perez I, Knapp M, Swift C, Donaldson N.
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The investigation and analysis of critical incidents and adverse events in healthcare.
By Woloshynowych M, Rogers S, Taylor-Adams S, Vincent C.
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Potential use of routine databases in health technology assessment.
By Raftery J, Roderick P, Stevens A.
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Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study.
By Woodroffe R, Yao GL, Meads C, Bayliss S, Ready A, Raftery J, et al.
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A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis.
By Stevenson M, Lloyd Jones M, De Nigris E, Brewer N, Davis S, Oakley J.
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A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma.
By Smith JR, Mugford M, Holland R, Candy B, Noble MJ, Harrison BDW, et al.
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An evaluation of the costs, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales.
By Roderick P, Nicholson T, Armitage A, Mehta R, Mullee M, Gerard K, et al.
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Imatinib for the treatment of patients with unresectable and/or metastatic gastrointestinal stromal tumours: systematic review and economic evaluation.
By Wilson J, Connock M, Song F, Yao G, Fry-Smith A, Raftery J, et al.
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Indirect comparisons of competing interventions.
By Glenny AM, Altman DG, Song F, Sakarovitch C, Deeks JJ, D’Amico R, et al.
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Cost-effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: systematic review and decision-analytical modelling.
By Robinson M, Palmer S, Sculpher M, Philips Z, Ginnelly L, Bowens A, et al.
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Outcomes of electrically stimulated gracilis neosphincter surgery.
By Tillin T, Chambers M, Feldman R.
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The effectiveness and cost-effectiveness of pimecrolimus and tacrolimus for atopic eczema: a systematic review and economic evaluation.
By Garside R, Stein K, Castelnuovo E, Pitt M, Ashcroft D, Dimmock P, et al.
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Systematic review on urine albumin testing for early detection of diabetic complications.
By Newman DJ, Mattock MB, Dawnay ABS, Kerry S, McGuire A, Yaqoob M, et al.
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Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis.
By Cochrane T, Davey RC, Matthes Edwards SM.
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Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain.
By Thomas KJ, MacPherson H, Ratcliffe J, Thorpe L, Brazier J, Campbell M, et al.
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Cost-effectiveness and safety of epidural steroids in the management of sciatica.
By Price C, Arden N, Coglan L, Rogers P.
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The British Rheumatoid Outcome Study Group (BROSG) randomised controlled trial to compare the effectiveness and cost-effectiveness of aggressive versus symptomatic therapy in established rheumatoid arthritis.
By Symmons D, Tricker K, Roberts C, Davies L, Dawes P, Scott DL.
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Conceptual framework and systematic review of the effects of participants’ and professionals’ preferences in randomised controlled trials.
By King M, Nazareth I, Lampe F, Bower P, Chandler M, Morou M, et al.
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The clinical and cost-effectiveness of implantable cardioverter defibrillators: a systematic review.
By Bryant J, Brodin H, Loveman E, Payne E, Clegg A.
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A trial of problem-solving by community mental health nurses for anxiety, depression and life difficulties among general practice patients. The CPN-GP study.
By Kendrick T, Simons L, Mynors-Wallis L, Gray A, Lathlean J, Pickering R, et al.
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The causes and effects of socio-demographic exclusions from clinical trials.
By Bartlett C, Doyal L, Ebrahim S, Davey P, Bachmann M, Egger M, et al.
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Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis.
By Epps H, Ginnelly L, Utley M, Southwood T, Gallivan S, Sculpher M, et al.
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A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study.
By Hobbs FDR, Fitzmaurice DA, Mant J, Murray E, Jowett S, Bryan S, et al.
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Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty.
By Keating JF, Grant A, Masson M, Scott NW, Forbes JF.
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Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland.
By Durham RC, Chambers JA, Power KG, Sharp DM, Macdonald RR, Major KA, et al.
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The effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber pacemakers for bradycardia due to atrioventricular block or sick sinus syndrome: systematic review and economic evaluation.
By Castelnuovo E, Stein K, Pitt M, Garside R, Payne E.
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Newborn screening for congenital heart defects: a systematic review and cost-effectiveness analysis.
By Knowles R, Griebsch I, Dezateux C, Brown J, Bull C, Wren C.
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The clinical and cost-effectiveness of left ventricular assist devices for end-stage heart failure: a systematic review and economic evaluation.
By Clegg AJ, Scott DA, Loveman E, Colquitt J, Hutchinson J, Royle P, et al.
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The effectiveness of the Heidelberg Retina Tomograph and laser diagnostic glaucoma scanning system (GDx) in detecting and monitoring glaucoma.
By Kwartz AJ, Henson DB, Harper RA, Spencer AF, McLeod D.
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Clinical and cost-effectiveness of autologous chondrocyte implantation for cartilage defects in knee joints: systematic review and economic evaluation.
By Clar C, Cummins E, McIntyre L, Thomas S, Lamb J, Bain L, et al.
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Systematic review of effectiveness of different treatments for childhood retinoblastoma.
By McDaid C, Hartley S, Bagnall A-M, Ritchie G, Light K, Riemsma R.
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Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis.
By Roderick P, Ferris G, Wilson K, Halls H, Jackson D, Collins R, et al.
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The effectiveness and cost-effectiveness of parent training/education programmes for the treatment of conduct disorder, including oppositional defiant disorder, in children.
By Dretzke J, Frew E, Davenport C, Barlow J, Stewart-Brown S, Sandercock J, et al.
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The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer’s disease.
By Loveman E, Green C, Kirby J, Takeda A, Picot J, Payne E, et al.
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FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke.
By Dennis M, Lewis S, Cranswick G, Forbes J.
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The clinical effectiveness and cost-effectiveness of computed tomography screening for lung cancer: systematic reviews.
By Black C, Bagust A, Boland A, Walker S, McLeod C, De Verteuil R, et al.
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A systematic review of the effectiveness and cost-effectiveness of neuroimaging assessments used to visualise the seizure focus in people with refractory epilepsy being considered for surgery.
By Whiting P, Gupta R, Burch J, Mujica Mota RE, Wright K, Marson A, et al.
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Comparison of conference abstracts and presentations with full-text articles in the health technology assessments of rapidly evolving technologies.
By Dundar Y, Dodd S, Dickson R, Walley T, Haycox A, Williamson PR.
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Systematic review and evaluation of methods of assessing urinary incontinence.
By Martin JL, Williams KS, Abrams KR, Turner DA, Sutton AJ, Chapple C, et al.
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The clinical effectiveness and cost-effectiveness of newer drugs for children with epilepsy. A systematic review.
By Connock M, Frew E, Evans B-W, Bryan S, Cummins C, Fry-Smith A, et al.
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Surveillance of Barrett’s oesophagus: exploring the uncertainty through systematic review, expert workshop and economic modelling.
By Garside R, Pitt M, Somerville M, Stein K, Price A, Gilbert N.
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Topotecan, pegylated liposomal doxorubicin hydrochloride and paclitaxel for second-line or subsequent treatment of advanced ovarian cancer: a systematic review and economic evaluation.
By Main C, Bojke L, Griffin S, Norman G, Barbieri M, Mather L, et al.
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Evaluation of molecular techniques in prediction and diagnosis of cytomegalovirus disease in immunocompromised patients.
By Szczepura A, Westmoreland D, Vinogradova Y, Fox J, Clark M.
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Screening for thrombophilia in high-risk situations: systematic review and cost-effectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study.
By Wu O, Robertson L, Twaddle S, Lowe GDO, Clark P, Greaves M, et al.
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A series of systematic reviews to inform a decision analysis for sampling and treating infected diabetic foot ulcers.
By Nelson EA, O’Meara S, Craig D, Iglesias C, Golder S, Dalton J, et al.
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Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial).
By Michaels JA, Campbell WB, Brazier JE, MacIntyre JB, Palfreyman SJ, Ratcliffe J, et al.
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The cost-effectiveness of screening for oral cancer in primary care.
By Speight PM, Palmer S, Moles DR, Downer MC, Smith DH, Henriksson M, et al.
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Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis.
By Goodacre S, Sampson F, Stevenson M, Wailoo A, Sutton A, Thomas S, et al.
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Systematic review of the effectiveness and cost-effectiveness of HealOzone® for the treatment of occlusal pit/fissure caries and root caries.
By Brazzelli M, McKenzie L, Fielding S, Fraser C, Clarkson J, Kilonzo M, et al.
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Randomised controlled trials of conventional antipsychotic versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of, current drug treatment.
By Lewis SW, Davies L, Jones PB, Barnes TRE, Murray RM, Kerwin R, et al.
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Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation.
By Rodgers M, Nixon J, Hempel S, Aho T, Kelly J, Neal D, et al.
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Cognitive behavioural therapy in addition to antispasmodic therapy for irritable bowel syndrome in primary care: randomised controlled trial.
By Kennedy TM, Chalder T, McCrone P, Darnley S, Knapp M, Jones RH, et al.
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A systematic review of the clinical effectiveness and cost-effectiveness of enzyme replacement therapies for Fabry’s disease and mucopolysaccharidosis type 1.
By Connock M, Juarez-Garcia A, Frew E, Mans A, Dretzke J, Fry-Smith A, et al.
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Health benefits of antiviral therapy for mild chronic hepatitis C: randomised controlled trial and economic evaluation.
By Wright M, Grieve R, Roberts J, Main J, Thomas HC, on behalf of the UK Mild Hepatitis C Trial Investigators.
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Pressure relieving support surfaces: a randomised evaluation.
By Nixon J, Nelson EA, Cranny G, Iglesias CP, Hawkins K, Cullum NA, et al.
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A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents.
By King S, Griffin S, Hodges Z, Weatherly H, Asseburg C, Richardson G, et al.
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The clinical effectiveness and cost-effectiveness of enzyme replacement therapy for Gaucher’s disease: a systematic review.
By Connock M, Burls A, Frew E, Fry-Smith A, Juarez-Garcia A, McCabe C, et al.
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Effectiveness and cost-effectiveness of salicylic acid and cryotherapy for cutaneous warts. An economic decision model.
By Thomas KS, Keogh-Brown MR, Chalmers JR, Fordham RJ, Holland RC, Armstrong SJ, et al.
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A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use.
By Robinson L, Hutchings D, Corner L, Beyer F, Dickinson H, Vanoli A, et al.
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A review of the evidence on the effects and costs of implantable cardioverter defibrillator therapy in different patient groups, and modelling of cost-effectiveness and cost–utility for these groups in a UK context.
By Buxton M, Caine N, Chase D, Connelly D, Grace A, Jackson C, et al.
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Adefovir dipivoxil and pegylated interferon alfa-2a for the treatment of chronic hepatitis B: a systematic review and economic evaluation.
By Shepherd J, Jones J, Takeda A, Davidson P, Price A.
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An evaluation of the clinical and cost-effectiveness of pulmonary artery catheters in patient management in intensive care: a systematic review and a randomised controlled trial.
By Harvey S, Stevens K, Harrison D, Young D, Brampton W, McCabe C, et al.
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Accurate, practical and cost-effective assessment of carotid stenosis in the UK.
By Wardlaw JM, Chappell FM, Stevenson M, De Nigris E, Thomas S, Gillard J, et al.
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Etanercept and infliximab for the treatment of psoriatic arthritis: a systematic review and economic evaluation.
By Woolacott N, Bravo Vergel Y, Hawkins N, Kainth A, Khadjesari Z, Misso K, et al.
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The cost-effectiveness of testing for hepatitis C in former injecting drug users.
By Castelnuovo E, Thompson-Coon J, Pitt M, Cramp M, Siebert U, Price A, et al.
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Computerised cognitive behaviour therapy for depression and anxiety update: a systematic review and economic evaluation.
By Kaltenthaler E, Brazier J, De Nigris E, Tumur I, Ferriter M, Beverley C, et al.
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Cost-effectiveness of using prognostic information to select women with breast cancer for adjuvant systemic therapy.
By Williams C, Brunskill S, Altman D, Briggs A, Campbell H, Clarke M, et al.
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Psychological therapies including dialectical behaviour therapy for borderline personality disorder: a systematic review and preliminary economic evaluation.
By Brazier J, Tumur I, Holmes M, Ferriter M, Parry G, Dent-Brown K, et al.
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Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model.
By Whiting P, Westwood M, Bojke L, Palmer S, Richardson G, Cooper J, et al.
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Cognitive behavioural therapy in chronic fatigue syndrome: a randomised controlled trial of an outpatient group programme.
By O’Dowd H, Gladwell P, Rogers CA, Hollinghurst S, Gregory A.
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A comparison of the cost-effectiveness of five strategies for the prevention of nonsteroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling.
By Brown TJ, Hooper L, Elliott RA, Payne K, Webb R, Roberts C, et al.
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The effectiveness and cost-effectiveness of computed tomography screening for coronary artery disease: systematic review.
By Waugh N, Black C, Walker S, McIntyre L, Cummins E, Hillis G.
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What are the clinical outcome and cost-effectiveness of endoscopy undertaken by nurses when compared with doctors? A Multi-Institution Nurse Endoscopy Trial (MINuET).
By Williams J, Russell I, Durai D, Cheung W-Y, Farrin A, Bloor K, et al.
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The clinical and cost-effectiveness of oxaliplatin and capecitabine for the adjuvant treatment of colon cancer: systematic review and economic evaluation.
By Pandor A, Eggington S, Paisley S, Tappenden P, Sutcliffe P.
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A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness.
By Chen Y-F, Jobanputra P, Barton P, Jowett S, Bryan S, Clark W, et al.
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Telemedicine in dermatology: a randomised controlled trial.
By Bowns IR, Collins K, Walters SJ, McDonagh AJG.
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Cost-effectiveness of cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: a systematic review and economic model.
By Davies L, Brown TJ, Haynes S, Payne K, Elliott RA, McCollum C.
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Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation.
By Murray A, Lourenco T, de Verteuil R, Hernandez R, Fraser C, McKinley A, et al.
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Etanercept and efalizumab for the treatment of psoriasis: a systematic review.
By Woolacott N, Hawkins N, Mason A, Kainth A, Khadjesari Z, Bravo Vergel Y, et al.
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Systematic reviews of clinical decision tools for acute abdominal pain.
By Liu JLY, Wyatt JC, Deeks JJ, Clamp S, Keen J, Verde P, et al.
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Evaluation of the ventricular assist device programme in the UK.
By Sharples L, Buxton M, Caine N, Cafferty F, Demiris N, Dyer M, et al.
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A systematic review and economic model of the clinical and cost-effectiveness of immunosuppressive therapy for renal transplantation in children.
By Yao G, Albon E, Adi Y, Milford D, Bayliss S, Ready A, et al.
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Amniocentesis results: investigation of anxiety. The ARIA trial.
By Hewison J, Nixon J, Fountain J, Cocks K, Jones C, Mason G, et al.
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Pemetrexed disodium for the treatment of malignant pleural mesothelioma: a systematic review and economic evaluation.
By Dundar Y, Bagust A, Dickson R, Dodd S, Green J, Haycox A, et al.
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A systematic review and economic model of the clinical effectiveness and cost-effectiveness of docetaxel in combination with prednisone or prednisolone for the treatment of hormone-refractory metastatic prostate cancer.
By Collins R, Fenwick E, Trowman R, Perard R, Norman G, Light K, et al.
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A systematic review of rapid diagnostic tests for the detection of tuberculosis infection.
By Dinnes J, Deeks J, Kunst H, Gibson A, Cummins E, Waugh N, et al.
-
The clinical effectiveness and cost-effectiveness of strontium ranelate for the prevention of osteoporotic fragility fractures in postmenopausal women.
By Stevenson M, Davis S, Lloyd-Jones M, Beverley C.
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A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines.
By Raynor DK, Blenkinsopp A, Knapp P, Grime J, Nicolson DJ, Pollock K, et al.
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Oral naltrexone as a treatment for relapse prevention in formerly opioid-dependent drug users: a systematic review and economic evaluation.
By Adi Y, Juarez-Garcia A, Wang D, Jowett S, Frew E, Day E, et al.
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Glucocorticoid-induced osteoporosis: a systematic review and cost–utility analysis.
By Kanis JA, Stevenson M, McCloskey EV, Davis S, Lloyd-Jones M.
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Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection.
By Low N, McCarthy A, Macleod J, Salisbury C, Campbell R, Roberts TE, et al.
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Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation.
By Connock M, Juarez-Garcia A, Jowett S, Frew E, Liu Z, Taylor RJ, et al.
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Exercise Evaluation Randomised Trial (EXERT): a randomised trial comparing GP referral for leisure centre-based exercise, community-based walking and advice only.
By Isaacs AJ, Critchley JA, See Tai S, Buckingham K, Westley D, Harridge SDR, et al.
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Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of mild chronic hepatitis C: a systematic review and economic evaluation.
By Shepherd J, Jones J, Hartwell D, Davidson P, Price A, Waugh N.
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Systematic review and economic evaluation of bevacizumab and cetuximab for the treatment of metastatic colorectal cancer.
By Tappenden P, Jones R, Paisley S, Carroll C.
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A systematic review and economic evaluation of epoetin alfa, epoetin beta and darbepoetin alfa in anaemia associated with cancer, especially that attributable to cancer treatment.
By Wilson J, Yao GL, Raftery J, Bohlius J, Brunskill S, Sandercock J, et al.
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A systematic review and economic evaluation of statins for the prevention of coronary events.
By Ward S, Lloyd Jones M, Pandor A, Holmes M, Ara R, Ryan A, et al.
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A systematic review of the effectiveness and cost-effectiveness of different models of community-based respite care for frail older people and their carers.
By Mason A, Weatherly H, Spilsbury K, Arksey H, Golder S, Adamson J, et al.
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Additional therapy for young children with spastic cerebral palsy: a randomised controlled trial.
By Weindling AM, Cunningham CC, Glenn SM, Edwards RT, Reeves DJ.
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Screening for type 2 diabetes: literature review and economic modelling.
By Waugh N, Scotland G, McNamee P, Gillett M, Brennan A, Goyder E, et al.
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The effectiveness and cost-effectiveness of cinacalcet for secondary hyperparathyroidism in end-stage renal disease patients on dialysis: a systematic review and economic evaluation.
By Garside R, Pitt M, Anderson R, Mealing S, Roome C, Snaith A, et al.
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The clinical effectiveness and cost-effectiveness of gemcitabine for metastatic breast cancer: a systematic review and economic evaluation.
By Takeda AL, Jones J, Loveman E, Tan SC, Clegg AJ.
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A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease.
By Collins R, Cranny G, Burch J, Aguiar-Ibáñez R, Craig D, Wright K, et al.
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The clinical effectiveness and cost-effectiveness of treatments for children with idiopathic steroid-resistant nephrotic syndrome: a systematic review.
By Colquitt JL, Kirby J, Green C, Cooper K, Trompeter RS.
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A systematic review of the routine monitoring of growth in children of primary school age to identify growth-related conditions.
By Fayter D, Nixon J, Hartley S, Rithalia A, Butler G, Rudolf M, et al.
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Systematic review of the effectiveness of preventing and treating Staphylococcus aureus carriage in reducing peritoneal catheter-related infections.
By McCormack K, Rabindranath K, Kilonzo M, Vale L, Fraser C, McIntyre L, et al.
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The clinical effectiveness and cost of repetitive transcranial magnetic stimulation versus electroconvulsive therapy in severe depression: a multicentre pragmatic randomised controlled trial and economic analysis.
By McLoughlin DM, Mogg A, Eranti S, Pluck G, Purvis R, Edwards D, et al.
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A randomised controlled trial and economic evaluation of direct versus indirect and individual versus group modes of speech and language therapy for children with primary language impairment.
By Boyle J, McCartney E, Forbes J, O’Hare A.
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Hormonal therapies for early breast cancer: systematic review and economic evaluation.
By Hind D, Ward S, De Nigris E, Simpson E, Carroll C, Wyld L.
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Cardioprotection against the toxic effects of anthracyclines given to children with cancer: a systematic review.
By Bryant J, Picot J, Levitt G, Sullivan I, Baxter L, Clegg A.
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Adalimumab, etanercept and infliximab for the treatment of ankylosing spondylitis: a systematic review and economic evaluation.
By McLeod C, Bagust A, Boland A, Dagenais P, Dickson R, Dundar Y, et al.
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Prenatal screening and treatment strategies to prevent group B streptococcal and other bacterial infections in early infancy: cost-effectiveness and expected value of information analyses.
By Colbourn T, Asseburg C, Bojke L, Philips Z, Claxton K, Ades AE, et al.
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Clinical effectiveness and cost-effectiveness of bone morphogenetic proteins in the non-healing of fractures and spinal fusion: a systematic review.
By Garrison KR, Donell S, Ryder J, Shemilt I, Mugford M, Harvey I, et al.
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A randomised controlled trial of postoperative radiotherapy following breast-conserving surgery in a minimum-risk older population. The PRIME trial.
By Prescott RJ, Kunkler IH, Williams LJ, King CC, Jack W, van der Pol M, et al.
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Current practice, accuracy, effectiveness and cost-effectiveness of the school entry hearing screen.
By Bamford J, Fortnum H, Bristow K, Smith J, Vamvakas G, Davies L, et al.
-
The clinical effectiveness and cost-effectiveness of inhaled insulin in diabetes mellitus: a systematic review and economic evaluation.
By Black C, Cummins E, Royle P, Philip S, Waugh N.
-
Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis.
By Thompson Coon J, Rogers G, Hewson P, Wright D, Anderson R, Cramp M, et al.
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The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Homebased compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence.
By Jolly K, Taylor R, Lip GYH, Greenfield S, Raftery J, Mant J, et al.
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A systematic review of the clinical, public health and cost-effectiveness of rapid diagnostic tests for the detection and identification of bacterial intestinal pathogens in faeces and food.
By Abubakar I, Irvine L, Aldus CF, Wyatt GM, Fordham R, Schelenz S, et al.
-
A randomised controlled trial examining the longer-term outcomes of standard versus new antiepileptic drugs. The SANAD trial.
By Marson AG, Appleton R, Baker GA, Chadwick DW, Doughty J, Eaton B, et al.
-
Clinical effectiveness and cost-effectiveness of different models of managing long-term oral anti-coagulation therapy: a systematic review and economic modelling.
By Connock M, Stevens C, Fry-Smith A, Jowett S, Fitzmaurice D, Moore D, et al.
-
A systematic review and economic model of the clinical effectiveness and cost-effectiveness of interventions for preventing relapse in people with bipolar disorder.
By Soares-Weiser K, Bravo Vergel Y, Beynon S, Dunn G, Barbieri M, Duffy S, et al.
-
Taxanes for the adjuvant treatment of early breast cancer: systematic review and economic evaluation.
By Ward S, Simpson E, Davis S, Hind D, Rees A, Wilkinson A.
-
The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation.
By Burr JM, Mowatt G, Hernández R, Siddiqui MAR, Cook J, Lourenco T, et al.
-
Acceptability, benefit and costs of early screening for hearing disability: a study of potential screening tests and models.
By Davis A, Smith P, Ferguson M, Stephens D, Gianopoulos I.
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Contamination in trials of educational interventions.
By Keogh-Brown MR, Bachmann MO, Shepstone L, Hewitt C, Howe A, Ramsay CR, et al.
-
Overview of the clinical effectiveness of positron emission tomography imaging in selected cancers.
By Facey K, Bradbury I, Laking G, Payne E.
-
The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation.
By Garside R, Pitt M, Anderson R, Rogers G, Dyer M, Mealing S, et al.
-
Drug-eluting stents: a systematic review and economic evaluation.
By Hill RA, Boland A, Dickson R, Dündar Y, Haycox A, McLeod C, et al.
-
The clinical effectiveness and cost-effectiveness of cardiac resynchronisation (biventricular pacing) for heart failure: systematic review and economic model.
By Fox M, Mealing S, Anderson R, Dean J, Stein K, Price A, et al.
-
Recruitment to randomised trials: strategies for trial enrolment and participation study. The STEPS study.
By Campbell MK, Snowdon C, Francis D, Elbourne D, McDonald AM, Knight R, et al.
-
Cost-effectiveness of functional cardiac testing in the diagnosis and management of coronary artery disease: a randomised controlled trial. The CECaT trial.
By Sharples L, Hughes V, Crean A, Dyer M, Buxton M, Goldsmith K, et al.
-
Evaluation of diagnostic tests when there is no gold standard. A review of methods.
By Rutjes AWS, Reitsma JB, Coomarasamy A, Khan KS, Bossuyt PMM.
-
Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding.
By Leontiadis GI, Sreedharan A, Dorward S, Barton P, Delaney B, Howden CW, et al.
-
A review and critique of modelling in prioritising and designing screening programmes.
By Karnon J, Goyder E, Tappenden P, McPhie S, Towers I, Brazier J, et al.
-
An assessment of the impact of the NHS Health Technology Assessment Programme.
By Hanney S, Buxton M, Green C, Coulson D, Raftery J.
-
A systematic review and economic model of switching from nonglycopeptide to glycopeptide antibiotic prophylaxis for surgery.
By Cranny G, Elliott R, Weatherly H, Chambers D, Hawkins N, Myers L, et al.
-
‘Cut down to quit’ with nicotine replacement therapies in smoking cessation: a systematic review of effectiveness and economic analysis.
By Wang D, Connock M, Barton P, Fry-Smith A, Aveyard P, Moore D.
-
A systematic review of the effectiveness of strategies for reducing fracture risk in children with juvenile idiopathic arthritis with additional data on long-term risk of fracture and cost of disease management.
By Thornton J, Ashcroft D, O’Neill T, Elliott R, Adams J, Roberts C, et al.
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Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial.
By Charlesworth G, Shepstone L, Wilson E, Thalanany M, Mugford M, Poland F.
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A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids. The HOPEFUL study.
By Hirst A, Dutton S, Wu O, Briggs A, Edwards C, Waldenmaier L, et al.
-
Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling.
By Meads CA, Cnossen JS, Meher S, Juarez-Garcia A, ter Riet G, Duley L, et al.
-
The use of economic evaluations in NHS decision-making: a review and empirical investigation.
By Williams I, McIver S, Moore D, Bryan S.
-
Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids: a systematic review and economic evaluation.
By Burch J, Epstein D, Baba-Akbari A, Weatherly H, Fox D, Golder S, et al.
-
The clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review.
By Loveman E, Frampton GK, Clegg AJ.
-
Payment to healthcare professionals for patient recruitment to trials: systematic review and qualitative study.
By Raftery J, Bryant J, Powell J, Kerr C, Hawker S.
-
Cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation.
By Chen Y-F, Jobanputra P, Barton P, Bryan S, Fry-Smith A, Harris G, et al.
-
The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation.
By Hockenhull JC, Dwan K, Boland A, Smith G, Bagust A, Dundar Y, et al.
-
Stepped treatment of older adults on laxatives. The STOOL trial.
By Mihaylov S, Stark C, McColl E, Steen N, Vanoli A, Rubin G, et al.
-
A randomised controlled trial of cognitive behaviour therapy in adolescents with major depression treated by selective serotonin reuptake inhibitors. The ADAPT trial.
By Goodyer IM, Dubicka B, Wilkinson P, Kelvin R, Roberts C, Byford S, et al.
-
The use of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer: systematic review and economic evaluation.
By Hind D, Tappenden P, Tumur I, Eggington E, Sutcliffe P, Ryan A.
-
Ranibizumab and pegaptanib for the treatment of age-related macular degeneration: a systematic review and economic evaluation.
By Colquitt JL, Jones J, Tan SC, Takeda A, Clegg AJ, Price A.
-
Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease.
By Mowatt G, Cummins E, Waugh N, Walker S, Cook J, Jia X, et al.
-
Structural neuroimaging in psychosis: a systematic review and economic evaluation.
By Albon E, Tsourapas A, Frew E, Davenport C, Oyebode F, Bayliss S, et al.
-
Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over.
By Shepherd J, Rogers G, Anderson R, Main C, Thompson-Coon J, Hartwell D, et al.
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Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in children under the age of 12 years.
By Main C, Shepherd J, Anderson R, Rogers G, Thompson-Coon J, Liu Z, et al.
-
Ezetimibe for the treatment of hypercholesterolaemia: a systematic review and economic evaluation.
By Ara R, Tumur I, Pandor A, Duenas A, Williams R, Wilkinson A, et al.
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Topical or oral ibuprofen for chronic knee pain in older people. The TOIB study.
By Underwood M, Ashby D, Carnes D, Castelnuovo E, Cross P, Harding G, et al.
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A prospective randomised comparison of minor surgery in primary and secondary care. The MiSTIC trial.
By George S, Pockney P, Primrose J, Smith H, Little P, Kinley H, et al.
-
A review and critical appraisal of measures of therapist–patient interactions in mental health settings.
By Cahill J, Barkham M, Hardy G, Gilbody S, Richards D, Bower P, et al.
-
The clinical effectiveness and cost-effectiveness of screening programmes for amblyopia and strabismus in children up to the age of 4–5 years: a systematic review and economic evaluation.
By Carlton J, Karnon J, Czoski-Murray C, Smith KJ, Marr J.
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A systematic review of the clinical effectiveness and cost-effectiveness and economic modelling of minimal incision total hip replacement approaches in the management of arthritic disease of the hip.
By de Verteuil R, Imamura M, Zhu S, Glazener C, Fraser C, Munro N, et al.
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A preliminary model-based assessment of the cost–utility of a screening programme for early age-related macular degeneration.
By Karnon J, Czoski-Murray C, Smith K, Brand C, Chakravarthy U, Davis S, et al.
-
Intravenous magnesium sulphate and sotalol for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and economic evaluation.
By Shepherd J, Jones J, Frampton GK, Tanajewski L, Turner D, Price A.
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Absorbent products for urinary/faecal incontinence: a comparative evaluation of key product categories.
By Fader M, Cottenden A, Getliffe K, Gage H, Clarke-O’Neill S, Jamieson K, et al.
-
A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness.
By French B, Leathley M, Sutton C, McAdam J, Thomas L, Forster A, et al.
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The effectiveness and cost-effectivness of minimal access surgery amongst people with gastro-oesophageal reflux disease – a UK collaborative study. The reflux trial.
By Grant A, Wileman S, Ramsay C, Bojke L, Epstein D, Sculpher M, et al.
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Time to full publication of studies of anti-cancer medicines for breast cancer and the potential for publication bias: a short systematic review.
By Takeda A, Loveman E, Harris P, Hartwell D, Welch K.
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Performance of screening tests for child physical abuse in accident and emergency departments.
By Woodman J, Pitt M, Wentz R, Taylor B, Hodes D, Gilbert RE.
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Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation.
By Rodgers M, McKenna C, Palmer S, Chambers D, Van Hout S, Golder S, et al.
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Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement.
By Lourenco T, Armstrong N, N’Dow J, Nabi G, Deverill M, Pickard R, et al.
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Immunoprophylaxis against respiratory syncytial virus (RSV) with palivizumab in children: a systematic review and economic evaluation.
By Wang D, Cummins C, Bayliss S, Sandercock J, Burls A.
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Deferasirox for the treatment of iron overload associated with regular blood transfusions (transfusional haemosiderosis) in patients suffering with chronic anaemia: a systematic review and economic evaluation.
By McLeod C, Fleeman N, Kirkham J, Bagust A, Boland A, Chu P, et al.
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Thrombophilia testing in people with venous thromboembolism: systematic review and cost-effectiveness analysis.
By Simpson EL, Stevenson MD, Rawdin A, Papaioannou D.
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Surgical procedures and non-surgical devices for the management of non-apnoeic snoring: a systematic review of clinical effects and associated treatment costs.
By Main C, Liu Z, Welch K, Weiner G, Quentin Jones S, Stein K.
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Continuous positive airway pressure devices for the treatment of obstructive sleep apnoea–hypopnoea syndrome: a systematic review and economic analysis.
By McDaid C, Griffin S, Weatherly H, Durée K, van der Burgt M, van Hout S, Akers J, et al.
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Use of classical and novel biomarkers as prognostic risk factors for localised prostate cancer: a systematic review.
By Sutcliffe P, Hummel S, Simpson E, Young T, Rees A, Wilkinson A, et al.
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The harmful health effects of recreational ecstasy: a systematic review of observational evidence.
By Rogers G, Elston J, Garside R, Roome C, Taylor R, Younger P, et al.
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Systematic review of the clinical effectiveness and cost-effectiveness of oesophageal Doppler monitoring in critically ill and high-risk surgical patients.
By Mowatt G, Houston G, Hernández R, de Verteuil R, Fraser C, Cuthbertson B, et al.
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The use of surrogate outcomes in model-based cost-effectiveness analyses: a survey of UK Health Technology Assessment reports.
By Taylor RS, Elston J.
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Controlling Hypertension and Hypotension Immediately Post Stroke (CHHIPS) – a randomised controlled trial.
By Potter J, Mistri A, Brodie F, Chernova J, Wilson E, Jagger C, et al.
-
Routine antenatal anti-D prophylaxis for RhD-negative women: a systematic review and economic evaluation.
By Pilgrim H, Lloyd-Jones M, Rees A.
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Amantadine, oseltamivir and zanamivir for the prophylaxis of influenza (including a review of existing guidance no. 67): a systematic review and economic evaluation.
By Tappenden P, Jackson R, Cooper K, Rees A, Simpson E, Read R, et al.
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Improving the evaluation of therapeutic interventions in multiple sclerosis: the role of new psychometric methods.
By Hobart J, Cano S.
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Treatment of severe ankle sprain: a pragmatic randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of three types of mechanical ankle support with tubular bandage. The CAST trial.
By Cooke MW, Marsh JL, Clark M, Nakash R, Jarvis RM, Hutton JL, et al. , on behalf of the CAST trial group.
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Non-occupational postexposure prophylaxis for HIV: a systematic review.
By Bryant J, Baxter L, Hird S.
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Blood glucose self-monitoring in type 2 diabetes: a randomised controlled trial.
By Farmer AJ, Wade AN, French DP, Simon J, Yudkin P, Gray A, et al.
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How far does screening women for domestic (partner) violence in different health-care settings meet criteria for a screening programme? Systematic reviews of nine UK National Screening Committee criteria.
By Feder G, Ramsay J, Dunne D, Rose M, Arsene C, Norman R, et al.
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Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: systematic review and economic evaluation.
By Simpson, EL, Duenas A, Holmes MW, Papaioannou D, Chilcott J.
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The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: a systematic review of clinical and costeffectiveness and natural history.
By Fortnum H, O’Neill C, Taylor R, Lenthall R, Nikolopoulos T, Lightfoot G, et al.
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Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study.
By Little P, Turner S, Rumsby K, Warner G, Moore M, Lowes JA, et al.
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Systematic review of respite care in the frail elderly.
By Shaw C, McNamara R, Abrams K, Cannings-John R, Hood K, Longo M, et al.
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Neuroleptics in the treatment of aggressive challenging behaviour for people with intellectual disabilities: a randomised controlled trial (NACHBID).
By Tyrer P, Oliver-Africano P, Romeo R, Knapp M, Dickens S, Bouras N, et al.
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Randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of selective serotonin reuptake inhibitors plus supportive care, versus supportive care alone, for mild to moderate depression with somatic symptoms in primary care: the THREAD (THREshold for AntiDepressant response) study.
By Kendrick T, Chatwin J, Dowrick C, Tylee A, Morriss R, Peveler R, et al.
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Diagnostic strategies using DNA testing for hereditary haemochromatosis in at-risk populations: a systematic review and economic evaluation.
By Bryant J, Cooper K, Picot J, Clegg A, Roderick P, Rosenberg W, et al.
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Enhanced external counterpulsation for the treatment of stable angina and heart failure: a systematic review and economic analysis.
By McKenna C, McDaid C, Suekarran S, Hawkins N, Claxton K, Light K, et al.
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Development of a decision support tool for primary care management of patients with abnormal liver function tests without clinically apparent liver disease: a record-linkage population cohort study and decision analysis (ALFIE).
By Donnan PT, McLernon D, Dillon JF, Ryder S, Roderick P, Sullivan F, et al.
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A systematic review of presumed consent systems for deceased organ donation.
By Rithalia A, McDaid C, Suekarran S, Norman G, Myers L, Sowden A.
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Paracetamol and ibuprofen for the treatment of fever in children: the PITCH randomised controlled trial.
By Hay AD, Redmond NM, Costelloe C, Montgomery AA, Fletcher M, Hollinghurst S, et al.
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A randomised controlled trial to compare minimally invasive glucose monitoring devices with conventional monitoring in the management of insulin-treated diabetes mellitus (MITRE).
By Newman SP, Cooke D, Casbard A, Walker S, Meredith S, Nunn A, et al.
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Sensitivity analysis in economic evaluation: an audit of NICE current practice and a review of its use and value in decision-making.
By Andronis L, Barton P, Bryan S.
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Trastuzumab for the treatment of primary breast cancer in HER2-positive women: a single technology appraisal.
By Ward S, Pilgrim H, Hind D.
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Docetaxel for the adjuvant treatment of early node-positive breast cancer: a single technology appraisal.
By Chilcott J, Lloyd Jones M, Wilkinson A.
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The use of paclitaxel in the management of early stage breast cancer.
By Griffin S, Dunn G, Palmer S, Macfarlane K, Brent S, Dyker A, et al.
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Rituximab for the first-line treatment of stage III/IV follicular non-Hodgkin’s lymphoma.
By Dundar Y, Bagust A, Hounsome J, McLeod C, Boland A, Davis H, et al.
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Bortezomib for the treatment of multiple myeloma patients.
By Green C, Bryant J, Takeda A, Cooper K, Clegg A, Smith A, et al.
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Fludarabine phosphate for the firstline treatment of chronic lymphocytic leukaemia.
By Walker S, Palmer S, Erhorn S, Brent S, Dyker A, Ferrie L, et al.
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Erlotinib for the treatment of relapsed non-small cell lung cancer.
By McLeod C, Bagust A, Boland A, Hockenhull J, Dundar Y, Proudlove C, et al.
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Cetuximab plus radiotherapy for the treatment of locally advanced squamous cell carcinoma of the head and neck.
By Griffin S, Walker S, Sculpher M, White S, Erhorn S, Brent S, et al.
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Infliximab for the treatment of adults with psoriasis.
By Loveman E, Turner D, Hartwell D, Cooper K, Clegg A
-
Psychological interventions for postnatal depression: cluster randomised trial and economic evaluation. The PoNDER trial.
By Morrell CJ, Warner R, Slade P, Dixon S, Walters S, Paley G, et al.
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The effect of different treatment durations of clopidogrel in patients with non-ST-segment elevation acute coronary syndromes: a systematic review and value of information analysis.
By Rogowski R, Burch J, Palmer S, Craigs C, Golder S, Woolacott N.
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Systematic review and individual patient data meta-analysis of diagnosis of heart failure, with modelling of implications of different diagnostic strategies in primary care.
By Mant J, Doust J, Roalfe A, Barton P, Cowie MR, Glasziou P, et al.
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A multicentre randomised controlled trial of the use of continuous positive airway pressure and non-invasive positive pressure ventilation in the early treatment of patients presenting to the emergency department with severe acute cardiogenic pulmonary oedema: the 3CPO trial.
By Gray AJ, Goodacre S, Newby DE, Masson MA, Sampson F, Dixon S, et al. , on behalf of the 3CPO study investigators.
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Early high-dose lipid-lowering therapy to avoid cardiac events: a systematic review and economic evaluation.
By Ara R, Pandor A, Stevens J, Rees A, Rafia R.
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Adefovir dipivoxil and pegylated interferon alpha for the treatment of chronic hepatitis B: an updated systematic review and economic evaluation.
By Jones J, Shepherd J, Baxter L, Gospodarevskaya E, Hartwell D, Harris P, et al.
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Methods to identify postnatal depression in primary care: an integrated evidence synthesis and value of information analysis.
By Hewitt CE, Gilbody SM, Brealey S, Paulden M, Palmer S, Mann R, et al.
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A double-blind randomised placebocontrolled trial of topical intranasal corticosteroids in 4- to 11-year-old children with persistent bilateral otitis media with effusion in primary care.
By Williamson I, Benge S, Barton S, Petrou S, Letley L, Fasey N, et al.
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The effectiveness and cost-effectiveness of methods of storing donated kidneys from deceased donors: a systematic review and economic model.
By Bond M, Pitt M, Akoh J, Moxham T, Hoyle M, Anderson R.
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Rehabilitation of older patients: day hospital compared with rehabilitation at home. A randomised controlled trial.
By Parker SG, Oliver P, Pennington M, Bond J, Jagger C, Enderby PM, et al.
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Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis.
By Renfrew MJ, Craig D, Dyson L, McCormick F, Rice S, King SE, et al.
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The clinical effectiveness and costeffectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation.
By Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, et al.
-
Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness.
By Daniels J, Gray J, Pattison H, Roberts T, Edwards E, Milner P, et al.
-
Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling.
By Honest H, Forbes CA, Durée KH, Norman G, Duffy SB, Tsourapas A, et al.
-
The effectiveness and cost-effectiveness of cochlear implants for severe to profound deafness in children and adults: a systematic review and economic model.
By Bond M, Mealing S, Anderson R, Elston J, Weiner G, Taylor RS, et al.
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Gemcitabine for the treatment of metastatic breast cancer.
By Jones J, Takeda A, Tan SC, Cooper K, Loveman E, Clegg A.
-
Varenicline in the management of smoking cessation: a single technology appraisal.
By Hind D, Tappenden P, Peters J, Kenjegalieva K.
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Alteplase for the treatment of acute ischaemic stroke: a single technology appraisal.
By Lloyd Jones M, Holmes M.
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Rituximab for the treatment of rheumatoid arthritis.
By Bagust A, Boland A, Hockenhull J, Fleeman N, Greenhalgh J, Dundar Y, et al.
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Omalizumab for the treatment of severe persistent allergic asthma.
By Jones J, Shepherd J, Hartwell D, Harris P, Cooper K, Takeda A, et al.
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Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma.
By Boland A, Bagust A, Hockenhull J, Davis H, Chu P, Dickson R.
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Adalimumab for the treatment of psoriasis.
By Turner D, Picot J, Cooper K, Loveman E.
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Dabigatran etexilate for the prevention of venous thromboembolism in patients undergoing elective hip and knee surgery: a single technology appraisal.
By Holmes M, C Carroll C, Papaioannou D.
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Romiplostim for the treatment of chronic immune or idiopathic thrombocytopenic purpura: a single technology appraisal.
By Mowatt G, Boachie C, Crowther M, Fraser C, Hernández R, Jia X, et al.
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Sunitinib for the treatment of gastrointestinal stromal tumours: a critique of the submission from Pfizer.
By Bond M, Hoyle M, Moxham T, Napier M, Anderson R.
-
Vitamin K to prevent fractures in older women: systematic review and economic evaluation.
By Stevenson M, Lloyd-Jones M, Papaioannou D.
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The effects of biofeedback for the treatment of essential hypertension: a systematic review.
By Greenhalgh J, Dickson R, Dundar Y.
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A randomised controlled trial of the use of aciclovir and/or prednisolone for the early treatment of Bell’s palsy: the BELLS study.
By Sullivan FM, Swan IRC, Donnan PT, Morrison JM, Smith BH, McKinstry B, et al.
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Lapatinib for the treatment of HER2-overexpressing breast cancer.
By Jones J, Takeda A, Picot J, von Keyserlingk C, Clegg A.
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Infliximab for the treatment of ulcerative colitis.
By Hyde C, Bryan S, Juarez-Garcia A, Andronis L, Fry-Smith A.
-
Rimonabant for the treatment of overweight and obese people.
By Burch J, McKenna C, Palmer S, Norman G, Glanville J, Sculpher M, et al.
-
Telbivudine for the treatment of chronic hepatitis B infection.
By Hartwell D, Jones J, Harris P, Cooper K.
-
Entecavir for the treatment of chronic hepatitis B infection.
By Shepherd J, Gospodarevskaya E, Frampton G, Cooper, K.
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Febuxostat for the treatment of hyperuricaemia in people with gout: a single technology appraisal.
By Stevenson M, Pandor A.
-
Rivaroxaban for the prevention of venous thromboembolism: a single technology appraisal.
By Stevenson M, Scope A, Holmes M, Rees A, Kaltenthaler E.
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Cetuximab for the treatment of recurrent and/or metastatic squamous cell carcinoma of the head and neck.
By Greenhalgh J, Bagust A, Boland A, Fleeman N, McLeod C, Dundar Y, et al.
-
Mifamurtide for the treatment of osteosarcoma: a single technology appraisal.
By Pandor A, Fitzgerald P, Stevenson M, Papaioannou D.
-
Ustekinumab for the treatment of moderate to severe psoriasis.
By Gospodarevskaya E, Picot J, Cooper K, Loveman E, Takeda A.
-
Endovascular stents for abdominal aortic aneurysms: a systematic review and economic model.
By Chambers D, Epstein D, Walker S, Fayter D, Paton F, Wright K, et al.
-
Clinical and cost-effectiveness of epoprostenol, iloprost, bosentan, sitaxentan and sildenafil for pulmonary arterial hypertension within their licensed indications: a systematic review and economic evaluation.
By Chen Y-F, Jowett S, Barton P, Malottki K, Hyde C, Gibbs JSR, et al.
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Cessation of attention deficit hyperactivity disorder drugs in the young (CADDY) – a pharmacoepidemiological and qualitative study.
By Wong ICK, Asherson P, Bilbow A, Clifford S, Coghill D, R DeSoysa R, et al.
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ARTISTIC: a randomised trial of human papillomavirus (HPV) testing in primary cervical screening.
By Kitchener HC, Almonte M, Gilham C, Dowie R, Stoykova B, Sargent A, et al.
-
The clinical effectiveness of glucosamine and chondroitin supplements in slowing or arresting progression of osteoarthritis of the knee: a systematic review and economic evaluation.
By Black C, Clar C, Henderson R, MacEachern C, McNamee P, Quayyum Z, et al.
-
Randomised preference trial of medical versus surgical termination of pregnancy less than 14 weeks’ gestation (TOPS).
By Robson SC, Kelly T, Howel D, Deverill M, Hewison J, Lie MLS, et al.
-
Randomised controlled trial of the use of three dressing preparations in the management of chronic ulceration of the foot in diabetes.
By Jeffcoate WJ, Price PE, Phillips CJ, Game FL, Mudge E, Davies S, et al.
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VenUS II: a randomised controlled trial of larval therapy in the management of leg ulcers.
By Dumville JC, Worthy G, Soares MO, Bland JM, Cullum N, Dowson C, et al.
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A prospective randomised controlled trial and economic modelling of antimicrobial silver dressings versus non-adherent control dressings for venous leg ulcers: the VULCAN trial
By Michaels JA, Campbell WB, King BM, MacIntyre J, Palfreyman SJ, Shackley P, et al.
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Communication of carrier status information following universal newborn screening for sickle cell disorders and cystic fibrosis: qualitative study of experience and practice.
By Kai J, Ulph F, Cullinan T, Qureshi N.
-
Antiviral drugs for the treatment of influenza: a systematic review and economic evaluation.
By Burch J, Paulden M, Conti S, Stock C, Corbett M, Welton NJ, et al.
-
Development of a toolkit and glossary to aid in the adaptation of health technology assessment (HTA) reports for use in different contexts.
By Chase D, Rosten C, Turner S, Hicks N, Milne R.
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Colour vision testing for diabetic retinopathy: a systematic review of diagnostic accuracy and economic evaluation.
By Rodgers M, Hodges R, Hawkins J, Hollingworth W, Duffy S, McKibbin M, et al.
Health Technology Assessment programme
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Director, NIHR HTA programme, Professor of Clinical Pharmacology, University of Liverpool
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Director, Medical Care Research Unit, University of Sheffield
Prioritisation Strategy Group
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Director, NIHR HTA programme, Professor of Clinical Pharmacology, University of Liverpool
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Director, Medical Care Research Unit, University of Sheffield
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Dr Bob Coates, Consultant Advisor, NETSCC, HTA
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Dr Andrew Cook, Consultant Advisor, NETSCC, HTA
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Dr Peter Davidson, Director of Science Support, NETSCC, HTA
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Professor Robin E Ferner, Consultant Physician and Director, West Midlands Centre for Adverse Drug Reactions, City Hospital NHS Trust, Birmingham
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Professor Paul Glasziou, Professor of Evidence-Based Medicine, University of Oxford
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Dr Nick Hicks, Director of NHS Support, NETSCC, HTA
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Dr Edmund Jessop, Medical Adviser, National Specialist, National Commissioning Group (NCG), Department of Health, London
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Ms Lynn Kerridge, Chief Executive Officer, NETSCC and NETSCC, HTA
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Dr Ruairidh Milne, Director of Strategy and Development, NETSCC
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Ms Kay Pattison, Section Head, NHS R&D Programme, Department of Health
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Ms Pamela Young, Specialist Programme Manager, NETSCC, HTA
HTA Commissioning Board
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Director, NIHR HTA programme, Professor of Clinical Pharmacology, University of Liverpool
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Director, Medical Care Research Unit, University of Sheffield
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Senior Lecturer in General Practice, Department of Primary Health Care, University of Oxford
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Professor Ann Ashburn, Professor of Rehabilitation and Head of Research, Southampton General Hospital
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Professor Deborah Ashby, Professor of Medical Statistics, Queen Mary, University of London
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Professor John Cairns, Professor of Health Economics, London School of Hygiene and Tropical Medicine
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Professor Peter Croft, Director of Primary Care Sciences Research Centre, Keele University
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Professor Nicky Cullum, Director of Centre for Evidence-Based Nursing, University of York
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Professor Jenny Donovan, Professor of Social Medicine, University of Bristol
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Professor Steve Halligan, Professor of Gastrointestinal Radiology, University College Hospital, London
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Professor Freddie Hamdy, Professor of Urology, University of Sheffield
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Professor Allan House, Professor of Liaison Psychiatry, University of Leeds
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Dr Martin J Landray, Reader in Epidemiology, Honorary Consultant Physician, Clinical Trial Service Unit, University of Oxford?
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Professor Stuart Logan, Director of Health & Social Care Research, The Peninsula Medical School, Universities of Exeter and Plymouth
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Dr Rafael Perera, Lecturer in Medical Statisitics, Department of Primary Health Care, Univeristy of Oxford
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Professor Ian Roberts, Professor of Epidemiology & Public Health, London School of Hygiene and Tropical Medicine
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Professor Mark Sculpher, Professor of Health Economics, University of York
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Professor Helen Smith, Professor of Primary Care, University of Brighton
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Professor Kate Thomas, Professor of Complementary & Alternative Medicine Research, University of Leeds
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Professor David John Torgerson, Director of York Trials Unit, University of York
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Professor Hywel Williams, Professor of Dermato-Epidemiology, University of Nottingham
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Ms Kay Pattison, Section Head, NHS R&D Programme, Department of Health
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Dr Morven Roberts, Clinical Trials Manager, Medical Research Council
Diagnostic Technologies & Screening Panel
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Professor of Evidence-Based Medicine, University of Oxford
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Consultant Paediatrician and Honorary Senior Lecturer, Great Ormond Street Hospital, London
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Professor Judith E Adams, Consultant Radiologist, Manchester Royal Infirmary, Central Manchester & Manchester Children’s University Hospitals NHS Trust, and Professor of Diagnostic Radiology, Imaging Science and Biomedical Engineering, Cancer & Imaging Sciences, University of Manchester
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Ms Jane Bates, Consultant Ultrasound Practitioner, Ultrasound Department, Leeds Teaching Hospital NHS Trust
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Dr Stephanie Dancer, Consultant Microbiologist, Hairmyres Hospital, East Kilbride
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Professor Glyn Elwyn, Primary Medical Care Research Group, Swansea Clinical School, University of Wales
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Dr Ron Gray, Consultant Clinical Epidemiologist, Department of Public Health, University of Oxford
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Professor Paul D Griffiths, Professor of Radiology, University of Sheffield
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Dr Jennifer J Kurinczuk, Consultant Clinical Epidemiologist, National Perinatal Epidemiology Unit, Oxford
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Dr Susanne M Ludgate, Medical Director, Medicines & Healthcare Products Regulatory Agency, London
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Dr Anne Mackie, Director of Programmes, UK National Screening Committee
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Dr Michael Millar, Consultant Senior Lecturer in Microbiology, Barts and The London NHS Trust, Royal London Hospital
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Mr Stephen Pilling, Director, Centre for Outcomes, Research & Effectiveness, Joint Director, National Collaborating Centre for Mental Health, University College London
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Mrs Una Rennard, Service User Representative
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Dr Phil Shackley, Senior Lecturer in Health Economics, School of Population and Health Sciences, University of Newcastle upon Tyne
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Dr W Stuart A Smellie, Consultant in Chemical Pathology, Bishop Auckland General Hospital
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Dr Nicholas Summerton, Consultant Clinical and Public Health Advisor, NICE
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Ms Dawn Talbot, Service User Representative
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Dr Graham Taylor, Scientific Advisor, Regional DNA Laboratory, St James’s University Hospital, Leeds
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Professor Lindsay Wilson Turnbull, Scientific Director of the Centre for Magnetic Resonance Investigations and YCR Professor of Radiology, Hull Royal Infirmary
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Dr Tim Elliott, Team Leader, Cancer Screening, Department of Health
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Dr Catherine Moody, Programme Manager, Neuroscience and Mental Health Board
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Dr Ursula Wells, Principal Research Officer, Department of Health
Pharmaceuticals Panel
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Consultant Physician and Director, West Midlands Centre for Adverse Drug Reactions, City Hospital NHS Trust, Birmingham
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Professor in Child Health, University of Nottingham
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Mrs Nicola Carey, Senior Research Fellow, School of Health and Social Care, The University of Reading
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Mr John Chapman, Service User Representative
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Dr Peter Elton, Director of Public Health, Bury Primary Care Trust
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Dr Ben Goldacre, Research Fellow, Division of Psychological Medicine and Psychiatry, King’s College London
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Mrs Barbara Greggains, Service User Representative
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Dr Bill Gutteridge, Medical Adviser, London Strategic Health Authority
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Dr Dyfrig Hughes, Reader in Pharmacoeconomics and Deputy Director, Centre for Economics and Policy in Health, IMSCaR, Bangor University
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Professor Jonathan Ledermann, Professor of Medical Oncology and Director of the Cancer Research UK and University College London Cancer Trials Centre
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Dr Yoon K Loke, Senior Lecturer in Clinical Pharmacology, University of East Anglia
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Professor Femi Oyebode, Consultant Psychiatrist and Head of Department, University of Birmingham
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Dr Andrew Prentice, Senior Lecturer and Consultant Obstetrician and Gynaecologist, The Rosie Hospital, University of Cambridge
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Dr Martin Shelly, General Practitioner, Leeds, and Associate Director, NHS Clinical Governance Support Team, Leicester
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Dr Gillian Shepherd, Director, Health and Clinical Excellence, Merck Serono Ltd
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Mrs Katrina Simister, Assistant Director New Medicines, National Prescribing Centre, Liverpool
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Mr David Symes, Service User Representative
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Dr Lesley Wise, Unit Manager, Pharmacoepidemiology Research Unit, VRMM, Medicines & Healthcare Products Regulatory Agency
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Ms Kay Pattison, Section Head, NHS R&D Programme, Department of Health
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Mr Simon Reeve, Head of Clinical and Cost-Effectiveness, Medicines, Pharmacy and Industry Group, Department of Health
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Dr Heike Weber, Programme Manager, Medical Research Council
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Dr Ursula Wells, Principal Research Officer, Department of Health
Therapeutic Procedures Panel
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Consultant Physician, North Bristol NHS Trust
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Professor of Psychiatry, Division of Health in the Community, University of Warwick, Coventry
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Professor Jane Barlow, Professor of Public Health in the Early Years, Health Sciences Research Institute, Warwick Medical School, Coventry
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Ms Maree Barnett, Acting Branch Head of Vascular Programme, Department of Health
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Mrs Val Carlill, Service User Representative
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Mrs Anthea De Barton-Watson, Service User Representative
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Mr Mark Emberton, Senior Lecturer in Oncological Urology, Institute of Urology, University College Hospital, London
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Professor Steve Goodacre, Professor of Emergency Medicine, University of Sheffield
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Professor Christopher Griffiths, Professor of Primary Care, Barts and The London School of Medicine and Dentistry
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Mr Paul Hilton, Consultant Gynaecologist and Urogynaecologist, Royal Victoria Infirmary, Newcastle upon Tyne
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Professor Nicholas James, Professor of Clinical Oncology, University of Birmingham, and Consultant in Clinical Oncology, Queen Elizabeth Hospital
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Dr Peter Martin, Consultant Neurologist, Addenbrooke’s Hospital, Cambridge
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Dr Kate Radford, Senior Lecturer (Research), Clinical Practice Research Unit, University of Central Lancashire, Preston
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Mr Jim Reece Service User Representative
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Dr Karen Roberts, Nurse Consultant, Dunston Hill Hospital Cottages
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Dr Phillip Leech, Principal Medical Officer for Primary Care, Department of Health
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Ms Kay Pattison, Section Head, NHS R&D Programme, Department of Health
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Dr Morven Roberts, Clinical Trials Manager, Medical Research Council
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Professor Tom Walley, Director, NIHR HTA programme, Professor of Clinical Pharmacology, University of Liverpool
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Dr Ursula Wells, Principal Research Officer, Department of Health
Disease Prevention Panel
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Medical Adviser, National Specialist, National Commissioning Group (NCG), London
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Director, NHS Sustainable Development Unit, Cambridge
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Dr Elizabeth Fellow-Smith, Medical Director, West London Mental Health Trust, Middlesex
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Dr John Jackson, General Practitioner, Parkway Medical Centre, Newcastle upon Tyne
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Professor Mike Kelly, Director, Centre for Public Health Excellence, NICE, London
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Dr Chris McCall, General Practitioner, The Hadleigh Practice, Corfe Mullen, Dorset
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Ms Jeanett Martin, Director of Nursing, BarnDoc Limited, Lewisham Primary Care Trust
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Dr Julie Mytton, Locum Consultant in Public Health Medicine, Bristol Primary Care Trust
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Miss Nicky Mullany, Service User Representative
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Professor Ian Roberts, Professor of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine
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Professor Ken Stein, Senior Clinical Lecturer in Public Health, University of Exeter
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Dr Kieran Sweeney, Honorary Clinical Senior Lecturer, Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth
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Professor Carol Tannahill, Glasgow Centre for Population Health
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Professor Margaret Thorogood, Professor of Epidemiology, University of Warwick Medical School, Coventry
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Ms Christine McGuire, Research & Development, Department of Health
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Dr Caroline Stone, Programme Manager, Medical Research Council
Expert Advisory Network
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Professor Douglas Altman, Professor of Statistics in Medicine, Centre for Statistics in Medicine, University of Oxford
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Professor John Bond, Professor of Social Gerontology & Health Services Research, University of Newcastle upon Tyne
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Professor Andrew Bradbury, Professor of Vascular Surgery, Solihull Hospital, Birmingham
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Mr Shaun Brogan, Chief Executive, Ridgeway Primary Care Group, Aylesbury
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Mrs Stella Burnside OBE, Chief Executive, Regulation and Improvement Authority, Belfast
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Ms Tracy Bury, Project Manager, World Confederation for Physical Therapy, London
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Professor Iain T Cameron, Professor of Obstetrics and Gynaecology and Head of the School of Medicine, University of Southampton
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Dr Christine Clark, Medical Writer and Consultant Pharmacist, Rossendale
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Professor Collette Clifford, Professor of Nursing and Head of Research, The Medical School, University of Birmingham
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Professor Barry Cookson, Director, Laboratory of Hospital Infection, Public Health Laboratory Service, London
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Dr Carl Counsell, Clinical Senior Lecturer in Neurology, University of Aberdeen
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Professor Howard Cuckle, Professor of Reproductive Epidemiology, Department of Paediatrics, Obstetrics & Gynaecology, University of Leeds
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Dr Katherine Darton, Information Unit, MIND – The Mental Health Charity, London
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Professor Carol Dezateux, Professor of Paediatric Epidemiology, Institute of Child Health, London
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Mr John Dunning, Consultant Cardiothoracic Surgeon, Papworth Hospital NHS Trust, Cambridge
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Mr Jonothan Earnshaw, Consultant Vascular Surgeon, Gloucestershire Royal Hospital, Gloucester
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Professor Martin Eccles, Professor of Clinical Effectiveness, Centre for Health Services Research, University of Newcastle upon Tyne
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Professor Pam Enderby, Dean of Faculty of Medicine, Institute of General Practice and Primary Care, University of Sheffield
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Professor Gene Feder, Professor of Primary Care Research & Development, Centre for Health Sciences, Barts and The London School of Medicine and Dentistry
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Mr Leonard R Fenwick, Chief Executive, Freeman Hospital, Newcastle upon Tyne
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Mrs Gillian Fletcher, Antenatal Teacher and Tutor and President, National Childbirth Trust, Henfield
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Professor Jayne Franklyn, Professor of Medicine, University of Birmingham
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Mr Tam Fry, Honorary Chairman, Child Growth Foundation, London
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Professor Fiona Gilbert, Consultant Radiologist and NCRN Member, University of Aberdeen
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Professor Paul Gregg, Professor of Orthopaedic Surgical Science, South Tees Hospital NHS Trust
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Bec Hanley, Co-director, TwoCan Associates, West Sussex
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Dr Maryann L Hardy, Senior Lecturer, University of Bradford
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Mrs Sharon Hart, Healthcare Management Consultant, Reading
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Professor Robert E Hawkins, CRC Professor and Director of Medical Oncology, Christie CRC Research Centre, Christie Hospital NHS Trust, Manchester
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Professor Richard Hobbs, Head of Department of Primary Care & General Practice, University of Birmingham
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Professor Alan Horwich, Dean and Section Chairman, The Institute of Cancer Research, London
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Professor Allen Hutchinson, Director of Public Health and Deputy Dean of ScHARR, University of Sheffield
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Professor Peter Jones, Professor of Psychiatry, University of Cambridge, Cambridge
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Professor Stan Kaye, Cancer Research UK Professor of Medical Oncology, Royal Marsden Hospital and Institute of Cancer Research, Surrey
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Dr Duncan Keeley, General Practitioner (Dr Burch & Ptnrs), The Health Centre, Thame
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Dr Donna Lamping, Research Degrees Programme Director and Reader in Psychology, Health Services Research Unit, London School of Hygiene and Tropical Medicine, London
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Mr George Levvy, Chief Executive, Motor Neurone Disease Association, Northampton
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Professor James Lindesay, Professor of Psychiatry for the Elderly, University of Leicester
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Professor Julian Little, Professor of Human Genome Epidemiology, University of Ottawa
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Professor Alistaire McGuire, Professor of Health Economics, London School of Economics
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Professor Rajan Madhok, Medical Director and Director of Public Health, Directorate of Clinical Strategy & Public Health, North & East Yorkshire & Northern Lincolnshire Health Authority, York
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Professor Alexander Markham, Director, Molecular Medicine Unit, St James’s University Hospital, Leeds
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Dr Peter Moore, Freelance Science Writer, Ashtead
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Dr Andrew Mortimore, Public Health Director, Southampton City Primary Care Trust
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Dr Sue Moss, Associate Director, Cancer Screening Evaluation Unit, Institute of Cancer Research, Sutton
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Professor Miranda Mugford, Professor of Health Economics and Group Co-ordinator, University of East Anglia
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Professor Jim Neilson, Head of School of Reproductive & Developmental Medicine and Professor of Obstetrics and Gynaecology, University of Liverpool
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Mrs Julietta Patnick, National Co-ordinator, NHS Cancer Screening Programmes, Sheffield
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Professor Robert Peveler, Professor of Liaison Psychiatry, Royal South Hants Hospital, Southampton
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Professor Chris Price, Director of Clinical Research, Bayer Diagnostics Europe, Stoke Poges
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Professor William Rosenberg, Professor of Hepatology and Consultant Physician, University of Southampton
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Professor Peter Sandercock, Professor of Medical Neurology, Department of Clinical Neurosciences, University of Edinburgh
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Dr Susan Schonfield, Consultant in Public Health, Hillingdon Primary Care Trust, Middlesex
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Dr Eamonn Sheridan, Consultant in Clinical Genetics, St James’s University Hospital, Leeds
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Dr Margaret Somerville, Director of Public Health Learning, Peninsula Medical School, University of Plymouth
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Professor Sarah Stewart-Brown, Professor of Public Health, Division of Health in the Community, University of Warwick, Coventry
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Professor Ala Szczepura, Professor of Health Service Research, Centre for Health Services Studies, University of Warwick, Coventry
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Mrs Joan Webster, Consumer Member, Southern Derbyshire Community Health Council
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Professor Martin Whittle, Clinical Co-director, National Co-ordinating Centre for Women’s and Children’s Health, Lymington