http://hdl.handle.net/10468/1680 2017-10-16T12:34:35Z 2017-10-16T12:34:35Z Fawsitt, Christopher G. Bourke, Jane Murphy, Aileen McElroy, Brendan Lutomski, Jennifer E. Murphy, Rosemary Greene, Richard A. http://hdl.handle.net/10468/4693 2017-09-12T18:00:58Z 2017-08-21T00:00:00Z

A cost-benefit analysis of two alternative models of maternity care in Ireland Fawsitt, Christopher G.; Bourke, Jane; Murphy, Aileen; McElroy, Brendan; Lutomski, Jennifer E.; Murphy, Rosemary; Greene, Richard A. Background: The Irish government has committed to expand midwifery-led care alongside consultant-led care nationally, although very little is known about the potential net benefits of this reconfiguration. Objectives: To formally compare the costs and benefits of the major models of care in Ireland, with a view to informing priority setting using the contingent valuation technique and cost-benefit analysis. Methods: A marginal payment scale willingness-to-pay question was adopted from an ex ante perspective. 450 pregnant women were invited to participate in the study. Cost estimates were collected primarily, describing the average cost of a package of care. Net benefit estimates were calculated over a 1-year cycle using a third-party payer perspective. Results: To avoid midwifery-led care, women were willing to pay €821.13 (95% CI 761.66–1150.41); to avoid consultant-led care, women were willing to pay €795.06 (95% CI 695.51–921.15). The average cost of a package of consultant- and midwifery-led care was €1,762.12 (95% CI 1496.73–2027.51) and €1018.47 (95% CI 916.61–1120.33), respectively. Midwifery-led care ranked as the best use of resources, generating a net benefit of €1491.22 (95% CI 989.35–1991.93), compared with €123.23 (95% CI −376.58 to 621.42) for consultant-led care. Conclusions: While both models of care are cost-beneficial, the decision to provide both alternatives may be constrained by resource issues. If only one alternative can be implemented then midwifery-led care should be undertaken for low-risk women, leaving consultant-led care for high-risk women. However, pursuing one alternative contradicts a key objective of government policy, which seeks to improve maternal choice. Ideally, multiple alternatives should be pursued.

2017-08-21T00:00:00Z Hofman, Cynthia S. Lutomski, Jennifer E. Boter, Han Buurman, Bianca M. de Craen, Anton J. M. Donders, Rogier Olde Rikkert, Marcel G. M. Makai, Peter Melis, René J. F. TOPICS-MDS research consortium http://hdl.handle.net/10468/3865 2017-04-10T11:00:42Z 2017-03-15T00:00:00Z

Examining the construct and known-group validity of a composite endpoint for The Older Persons and Informal Caregivers Survey Minimum Data Set (TOPICS-MDS); A large-scale data sharing initiative Hofman, Cynthia S.; Lutomski, Jennifer E.; Boter, Han; Buurman, Bianca M.; de Craen, Anton J. M.; Donders, Rogier; Olde Rikkert, Marcel G. M.; Makai, Peter; Melis, René J. F.; TOPICS-MDS research consortium Background: Preference-weighted multi-faceted endpoints have the potential to facilitate comparative effectiveness research that incorporates patient preferences. The Older Persons and Informal Caregivers Survey—Composite endpoint (TOPICS-CEP) is potentially a valuable outcome measure for evaluating interventions in geriatric care as it combines multiple outcomes relevant to older persons in a single metric. The objective of this study was to validate TOPICS-CEP across different study settings (general population, primary care and hospital). Methods: Data were extracted from TOPICS Minimum Dataset (MDS), a pooled public-access national database with information on older persons throughout the Netherlands. Data of 17,603 older persons were used. Meta-correlations were performed between TOPICS-CEP indexed scores, EuroQol5-D utility scores and Cantril’s ladder life satisfaction scores. Mixed linear regression analyses were performed to compare TOPICS-CEP indexed scores between known groups, e.g. persons with versus without depression. Results: In the complete sample and when stratified by study setting TOPICS-CEP and Cantril’s ladder were moderately correlated, whereas TOPICS-CEP and EQ-5D were highly correlated. Higher mean TOPICS-CEP scores were found in persons who were: married, lived independently and had an education at university level. Moreover, higher mean TOPICS-CEP scores were found in persons without dementia, depression, and dizziness with falls, respectively. Similar results were found when stratified by subgroup. Conclusion: This study supports that TOPICS-CEP is a robust measure which can potentially be used in broad settings to identify the effect of intervention or of prevention in elderly care.

2017-03-15T00:00:00Z Meaney, Sarah Corcoran, Paul Spillane, Niamh O'Donoghue, Keelin http://hdl.handle.net/10468/3905 2017-05-02T18:00:14Z 2017-03-01T00:00:00Z

Experience of miscarriage: an interpretative phenomenological analysis Meaney, Sarah; Corcoran, Paul; Spillane, Niamh; O'Donoghue, Keelin Objective: The objective of the study was to explore the experiences of those who have experienced miscarriage, focusing on men's and women's accounts of miscarriage. Design: This was a qualitative study using a phenomenological framework. Following in-depth semistructured interviews, analysis was undertaken in order to identify superordinate themes relating to their experience of miscarriage. Setting: A large tertiary-level maternity hospital in Ireland. Participants: A purposive sample of 16 participants, comprising 10 women and 6 men, was recruited. Results: 6 superordinate themes in relation to the participant's experience of miscarriage were identified: (1) acknowledgement of miscarriage as a valid loss; (2) misperceptions of miscarriage; (3) the hospital environment, management of miscarriage; (4) support and coping; (5) reproductive history; and (6) implications for future pregnancies. Conclusions: One of the key findings illustrates a need for increased awareness in relation to miscarriage. The study also indicates that the experience of miscarriage has a considerable impact on men and women. This study highlights that a thorough investigation of the underlying causes of miscarriage and continuity of care in subsequent pregnancies are priorities for those who experience miscarriage. Consideration should be given to the manner in which women who have not experienced recurrent miscarriage but have other potential risk factors for miscarriage could be followed up in clinical practice.

2017-03-01T00:00:00Z O'Neill, Sinéad M. Agerbo, Esben Khashan, Ali S. Kearney, Patricia M. Henriksen, Tine B. Greene, Richard A. Kenny, Louise C. http://hdl.handle.net/10468/3827 2017-08-28T14:38:11Z 2017-02-27T00:00:00Z

Trial of labour after caesarean section and the risk of neonatal and infant death: a nationwide cohort study O'Neill, Sinéad M.; Agerbo, Esben; Khashan, Ali S.; Kearney, Patricia M.; Henriksen, Tine B.; Greene, Richard A.; Kenny, Louise C. Background: Caesarean section (CS) rates are increasing worldwide and as a result repeat CS is common. The optimal mode of delivery in women with one previous CS is widely debated and the risks to the infant are understudied. The aim of the current study was to evaluate if women with a trial of labour after caesarean (TOLAC) had an increased odds of neonatal and infant death compared to women with an elective repeat CS (ERCS). Methods: A population register-based cohort study was conducted in Denmark between 1982 and 2010. All women with two deliveries [in which the first was a CS, and the second was an uncomplicated, term delivery (n = 61,626)] were included in the study. Logistic regression models were used to report adjusted odds ratios (AOR) and 95% confidence intervals (CI) of the odds of death according to mode of delivery. The main outcome measures were neonatal death (early and late) and infant death. Results: Women with a TOLAC had an increased odds of neonatal death (AOR 1 · 87, 95% CI 1 · 12 to 3 · 12) due to an increased risk of early neonatal death (AOR 2 · 06, 95% CI 1 · 19 to 3 · 56) and no effect on late neonatal death (AOR 0 · 97, 95% CI 0 · 22 to 4 · 32), or infant death (AOR 1 · 12, 95% CI 0 · 79 to 1 · 59) when compared to the reference group of women with an ERCS. There was evidence of a cohort effect as the increased odds of neonatal death (AOR 3 · 89, 95% CI 1 · 33 to 11 · 39) was most significant in the earlier years (1982–1991) and gradually disappeared (AOR 1 · 01, 95% CI 0 · 44 to 2 · 31) in the later years (2002–2010). Conclusions: Although an increased risk of neonatal death was found in women with a TOLAC, there was evidence of a cohort effect, which showed this increased odds disappearing over time. Advances in modern healthcare including improved monitoring and earlier detection of underlying pregnancy complications may explain the findings.

2017-02-27T00:00:00Z