Celia A. Taylor

Systematic review of stepped wedge cluster randomized trials shows that design is particularly used to evaluate interventions during routine implementation

OBJECTIVE To describe the application of the stepped wedge cluster randomized controlled trial (CRCT) design. STUDY DESIGN AND SETTING Systematic review. We searched Medline, Embase, PsycINFO, HMIC, CINAHL, Cochrane Library, Web of Knowledge, and Current Controlled Trials Register for articles published up to January 2010. Stepped wedge CRCTs from all fields of research were included. Two authors independently reviewed and extracted data from the studies. RESULTS Twenty-five studies were included in the review. Motivations for using the design included ethical, logistical, financial, social, and political acceptability and methodological reasons. Most studies were evaluating an intervention during routine implementation. For most of the included studies, there was also a belief or empirical evidence suggesting that the intervention would do more good than harm. There was variation in data analysis methods and insufficient quality of reporting. CONCLUSIONS The stepped wedge CRCT design has been mainly used for evaluating interventions during routine implementation, particularly for interventions that have been shown to be effective in more controlled research settings, or where there is lack of evidence of effectiveness but there is a strong belief that they will do more good than harm. There is need for consistent data analysis and reporting.

Evaluating policy and service interventions: framework to guide selection and interpretation of study end points

The effect of many cost effective policy and service interventions cannot be detected at the level of the patient. This new framework could help improve the design (especially choice of primary end point) and interpretation of evaluative studies

There are some circumstances where the stepped-wedge cluster randomized trial is preferable to the alternative: no randomized trial at all. Response to the commentary by Kotz and colleagues

are some circumstances where the stepped-wedge cluster randomized trial is preferable to the alternative: no randomized trial at all. Response to the commentary by Kotz and colleagues. General rights This document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: Explore Bristol Research is a digital archive and the intention is that deposited content should not be removed. However, if you believe that this version of the work breaches copyright law please contact open-access@bristol.ac.uk and include the following information in your message: • Your contact details • Bibliographic details for the item, including a URL • An outline of the nature of the complaint On receipt of your message the Open Access Team will immediately investigate your claim, make an initial judgement of the validity of the claim and, where appropriate, withdraw the item in question from public view.

Evaluation of the effect of socio-economic status on performance in a Multiple Mini Interview for admission to medical school.

Abstract Introduction: Widening participation in Medicine is a key policy priority as it helps promote a diverse and representative workforce and improves patient care. The selection process employed can influence the socio-economic composition of the student cohort and this study therefore evaluated whether Multiple Mini Interview (MMI) performance was influenced by school type or area-level Higher Education (HE) participation rates. Methods: MMI performance for all UK applicants was recorded and consent to link performance with socio-economic data was requested using an applicant questionnaire. Station-level and total MMI scores, and offer rates were compared between applicants from non-selective, non-fee-paying schools and from selective and/or fee-paying schools; and between applicants from each quintile of area-level HE participation. Results: 793 applicants were included in the analysis. MMI performance and offer rates were slightly higher for applicants from non-selective, non-fee-paying schools and/or from lower HE participation quintiles, but the effects were small and not statistically significant. Conclusions: The MMI did not favour applicants from selective and/or fee-paying schools, or from areas with high HE participation rates. Work to evaluate whether the relationship between MMI and medical school performance is the same for all sub-groups of students is now required.

Early HTA to Inform Medical Device Development Decisions - The Headroom Method

The headroom method offers medical device developers a simple way to integrate health economics into the decision of whether or not to develop a medical device. By estimating the maximum reimbursable price (MRP) for a new device idea, and comparing this reimbursement opportunity with a developer’s expected costs, the method offers a way to ensure developers invest only in devices that are commercially viable. This paper explains the headroom method, and describes a study whose aim was to evaluate the method by applying it retrospectively to a large and diverse set of case studies. The method was applied systematically to 20 devices / diagnostics that were invented in the past (identified from the UK National Horizon Scanning Centre (NHSC)’s 2000 to 2009 database). Predicted ‘headroom’ was then compared with later UK National Health Service (NHS) uptake, in order to assess the performance of the method as a predictive tool. The headroom method predicted uptake with a sensitivity of 92% and a negative predictive value of 67%. When numerical headroom assessments were considered alongside the more qualitative factors identified (which generally reflected the clinical and market context), the method offered a good indication of commercial opportunity.

Development of a modified Cohen method of standard setting

Background: A new ‘Cohen’ approach to standard setting was recently described where the pass mark is calculated as 60% of the score of the student at the 95th percentile, after correcting for guessing. Aim: This article considers how two potential criticisms of the Cohen method can be addressed and proposes a modified version, with the assumptions tested using local data. Methods: The modified version removes the correction for guessing and uses the score of the 90th, rather than the 95th percentile student as the reference point, based on the cumulative density functions for 32 modules from one medical school; and incorporates an indirect criterion-referenced passing standard by changing the 60% multiplier to the ratio of the cut score to the score of the student at the 90th percentile on exams that have been standard set using modified Angoff. Results: The assumption that the performance of the 90th percentile student is consistent over time holds for multiple choice questions. Applying the modified Cohen method to the 32 modules generally reduced the variation in failure rate across modules, compared to a fixed pass mark of 50%. Conclusion: The results suggest that the modified Cohen method holds much promise as an economical approach to standard setting.

Evaluation of the Offender Liaison and Diversion Trial Schemes

Liaison and diversion (L&D) schemes operate primarily in police custody suites and courts and aim to identify and assess people with vulnerabilities as they pass through the criminal justice system, to ensure their needs are identified. L&D services have been operating in England for at least 25 years. Not all areas have L&D services and among those that do, there is considerable variation in the nature of the services. In 2009, Lord Bradley reviewed the provision of services for people with mental health problems and learning disabilities in the criminal justice system and recommended that a national L&D model be created. Between 2011 and 2013, the Department of Health was supported by an external partner, the Offender Health Collaborative, to develop a national L&D model.

Affordability of comprehensive community health worker programmes in rural sub-Saharan Africa

Introduction Community health worker (CHW) programmes have low costs per person served and are central to achieving universal healthcare. However, their total cost is high and the target of one million CHWs for sub-Saharan Africa by 2015 was not met. We consider the affordability of rural CHW programmes by estimating total programme costs relative to national healthcare expenditure at different CHW salaries and resources available for healthcare. Methods We combine an existing source of rural CHW programme costs with World Bank data to estimate relative CHW programme costs in 37 countries. We consider three ‘salaries’ (CHWs as volunteers, paid the local equivalent of US

Beyond Synthesis: Augmenting Systematic Review Procedures with Practical Principles to Optimise Impact and Uptake in Educational Policy and Practice.

80 per month and paid the national minimum wage) and four potential healthcare budgets (both actual and Abuja declaration allocations alone and increased by external funding received and potential foreign aid, respectively). Costs are shown in 2012 nominal US

Variation in passing standards for graduation-level knowledge items at UK medical schools

. Results With CHWs paid the local equivalent of US