BMJ : British medical journal
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Multicenter Study
Patients' experience and satisfaction in primary care: secondary analysis using multilevel modelling.
To explore whether responses to questions in surveys of patients that purport to assess the performance of general practices or doctors reflect differences between practices, doctors, or the patients themselves. ⋯ Analyses of surveys of patients should take account of the hierarchical nature of the data by using multilevel models. Measures related to patients' experience discriminate more effectively between practices than do measures of general satisfaction. Surveys of patients' satisfaction fail to distinguish effectively between individual doctors because most of the variation in doctors' reported performance is due to differences between patients and random error rather than differences between doctors. Although patients' reports of satisfaction and experience are systematically related to patients' characteristics such as age and sex, the effect of adjusting practices' scores for the characteristics of their patients is small.
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Multicenter Study
Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study.
To assess the association of Apgar score 5 minutes after birth with cerebral palsy in both normal weight and low birthweight children, and also the association with the cerebral palsy subdiagnoses of quadriplegia, diplegia, and hemiplegia. ⋯ Low Apgar score was strongly associated with cerebral palsy. This association was high in children with normal birth weight and modest in children with low birth weight. The strength of the association differed between subgroups of spastic cerebral palsy. Given that Apgar score is a measure of vitality shortly after birth, our findings suggest that the causes of cerebral palsy are closely linked to factors that reduce infant vitality.
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Randomized Controlled Trial Multicenter Study
Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis.
To assess the long term clinical and cost effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) intervention compared with usual care in people with newly diagnosed type 2 diabetes. ⋯ Our results suggest that the DESMOND intervention is likely to be cost effective compared with usual care, especially with respect to the real world cost of the intervention to primary care trusts, with reductions in weight and smoking being the main benefits delivered.
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Multicenter Study
Inequalities in premature mortality in Britain: observational study from 1921 to 2007.
To report on the extent of inequality in premature mortality as measured between geographical areas in Britain. ⋯ Inequalities in premature mortality between areas of Britain continued to rise steadily during the first decade of the 21st century. The last time in the long economic record that inequalities were almost as high was in the lead up to the economic crash of 1929 and the economic depression of the 1930s. The economic crash of 2008 might precede even greater inequalities in mortality between areas in Britain.
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Randomized Controlled Trial Multicenter Study
Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial.
To determine whether the provision of single lens distance glasses to older wearers of multifocal glasses reduces falls. ⋯ With appropriate counselling, provision of single lens glasses for older wearers of multifocal glasses who take part in regular outdoor activities is an effective falls prevention strategy. The intervention may be harmful, however, in multifocal glasses wearers with low levels of outdoor activity.