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148 Appendix 6 TABLE 68 contd Summary of adult patient-based outcomes studies Study Investigations Outcome Results Conclusions and Reviewers’ comments and subjects measures grade of evidence Brandner et al., Varicose vein (1) Preoperative More dreaming in TIVA No difference in sexual Grade I 1997, 170 UK surgery anxiety score group than in thiopentone content of dreams; (VAS) induction group (p = 0.01). slight significance Study conformed RCT (1) TIVA TIVA group felt more (p < 0.0038) of less sick to checklist (36 patients) (2) Hall and sick (p < 0.0038) and and more happy states van der Castle felt happy (p < 0.0038) with those receiving Validity of emotion scale (2) Propofol emotion scale TIVA. Conclude that validated by other authors induction propofol did not induce followed by (3) Bodily and sexual behaviour or Conclusions correct inhalational biological states hallucinations when anaesthesia (Zancy) compared to with N 2 and thiopentone isoflurane (4) Ben-Horin’s (37 patients) overt sexuality scale (3) Thiopentone induction followed by inhalational anaesthesia with N 2O and isoflurane (39 patients) Chung et al., 1017 patients Postoperative 76% response rate Postoperative pain, Grade IV 1996, 171 Canada undergoing symptoms and (778/1017). Incisional pain nausea/vomiting, ambulatory return to daily was most frequently drowsiness, dizziness, Good response rate in Telephone surgery in a living function reported (27%), followed headache are the most a relatively large group survey Toronto hospital by headache and drowsi- frequent postoperative ness (12%). PONV was symptoms. The type of reported by 7%. Incidence surgical procedure did of postoperative pain and influence the type of PONV was higher in postoperative symptoms patients undergoing laparoscopy, orthopaedic and general surgery rather than eye surgery or D&C Cripps and Patient Questionnaire: 74% acceptable pain levels; Found patients satisfied Grade IV Bevan, 1996, 172 satisfaction in choice of four 4% patients dissatisfied with information; 25% UK day surgery faces (happiest; with perioperative of patients’ pain levels Audit: questionnaire survey (3000 replies) not so happy; information; 86% not were unacceptable Audit: question- slightly unhappy; upset by nausea and Large group naire survey very unhappy) vomiting; 12% found it discomforting De Amici et al., Influence of (1) GHQ before Median baseline GHQ Study indicates that Grade II–1b 2000, 173 Italy ‘being under randomisation score computed as 1 given the same observation’ (IQR, 0 to 4.5) in routine information about Unclear about method of RCT on patients’ (2) Primary information group and 2 anaesthesia and its randomisation; size of effect psychological endpoint: Italian (IQR, 0 to 5) in the undesired effects, is small. Preliminary findings well-being; version of GHQ additional information interest as a result of only. Study shows that acceptability of group preoperatively inclusion in a research patients scheduled for locoregional (3) Postoperative project has positive surgery may change their anaesthesia pain, nausea, psychological and behaviour simply because headache (VAS) physiological con- of being the subject of sequences for patients particular interest and attention continued
TABLE 68 contd Summary of adult patient-based outcomes studies © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 Study Investigations Outcome Results Conclusions and Reviewers’ comments and subjects measures grade of evidence Elliott et al., Pilot study Willingness 73% preferred propofol Pilot study to develop Grade IV; pilot study only 2000, 33 UK (40 women) to pay for induction.Willingness- willingness to pay to-pay values, mean of scenarios for use Descriptive £208 for propofol and in an RCT study £105 for sevoflurane. 100% preferred propofol for maintenance, with a mean willingness to pay of £157. 85% of respondents understood what they were being asked to value Enlund et al., Termination Time for patient Sick leave (0–2 days): Study indicated a Grade I 1996, 174 Sweden of pregnancy to be fully PA group 19/20 patients, potential gain in costs recovered; TN group 13/19 patients; of changing from Small groups. Premedication RCT (1) Propofol + sick leave p < 0.05. Mean difference thiopental + N 2O to could have contributed to alfentanil in sick leave per patient propofol-alfentanil delayed recovery (20 patients) between groups was anaesthesia 0.8 days (2) Thiopental + N 2O (19 patients) Fenton-Lee Assess patient Interview at 1, No statistical tests High level of patient Audit. Management of et al., 1994, 175 acceptability and 7 and 30 days performed. See satisfaction with service, postoperative pain after UK outcome of day conclusions pain control, anaes- day surgery still presents surgery before Patient thesia, patient a challenge; patient Audit and after acceptability information, medical satisfaction high; no changes to assessed and nursing care and statistical tests performed surgery using NHS ward privacy. Reduction questionnaire in wound complication rate occurred in the second 6 months when operations were performed by SpR as compared to SHO. Wound infection rate was used as a measure of the quality of surgery performed Gan et al, Patients’ Interactive Patients were willing to Patients associated Grade IV 2001, 176 USA willingness to computer pay US $56 (US $26–97) a value with the pay to avoid questionnaire for an anti-emetic that avoidance of PONV Survey Descriptive PONV (n = 80) would completely prevent study PONV. Patients who More information on developed nausea (26%) the methodological and vomiting (11%) were development of the survey willing to pay US $73 instrument required (US $44–110) and US $100 (US $61–200) respectively Ghosh and Patients’ feelings Questionnaire 87.3% of GPs felt that Information about Audit. Provided information Kershaw, and satisfaction survey an increasing number patients’ attitudes about patients’ attitudes 1991, 177 UK on having day of patients treated on towards day surgery. towards day surgery surgery a day-care basis would Patients felt day surgery Audit result in stretching their had advantages over own district and com- inpatient treatment. munity nurses. 79.36% of Areas of concern were: GPs were willing to see adequate postoperative more patients requiring a pain relief and proper basket of 20 procedures nursing/medical care treated in day surgery at home continued 149
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Which anaesthetic agents are costef
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Which anaesthetic agents are costef
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NHS R&D HTA Programme The NHS R&D H
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Contents Appendix 6 Adult patient-b
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Background The aim of the project w
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• The incidence of PONV was low d
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2 Introduction dizziness or disorie
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4 Introduction a reduced incidence
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6 Introduction willingness to pay f
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8 Literature review included in the
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10 Literature review TABLE 1 Compar
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12 Literature review intermediate a
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18 Literature review Patient-based
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20 Literature review TABLE 5 contd
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22 Literature review No studies fol
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24 Literature review (30%) and meth
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26 Literature review • There are
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28 National survey of anaesthetic p
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36 Economic evaluation methods (inc
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38 Economic evaluation methods The
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40 Economic evaluation methods Tabl
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42 Economic evaluation methods simi
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44 Economic evaluation methods Prob
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Recruitment to the CESA RCT The stu
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Clinical outcome data PONV by anaes
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The findings from the logistic regr
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TABLE 29 The length of stay and pri
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140 120 100 80 60 40 20 0 No. of pa
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250 200 150 100 50 0 No. of patient
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TABLE 37 Deterministic sensitivity
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20 15 10 5 0 -5 Difference in varia
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Patient admitted for day surgery an
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500 400 300 200 100 0 -100 -200 -30
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Recruitment to the CESA RCT The stu
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TABLE 49 The occurrence of any PONV
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60 50 40 30 20 10 0 No. of patients
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a scale effect for scenario A, but
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The mean CVs for avoidance of PONV
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1.80 The new variable cost and tota
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100 90 80 70 60 50 40 30 20 10 0 Su
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The structure and content of this d
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nurses to have an in-depth knowledg
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agent used (see appendix 18). It wa
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Furthermore, anaesthetists operate
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The CESA project was designed to as
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practice, such as the use of midazo
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1. Royal College of Surgeons of Eng
Page 111 and 112: 60. Cheng KI, Chu KS, Fang YR, Su K
Page 113 and 114: 112. Raeder J, Gupta A, Pedersen FM
Page 115 and 116: 162. Viitanen H, Baer G, Annila P.
Page 117 and 118: 220. Rosenberg KM, Bridge P, Brown
Page 119 and 120: The range of databases interrogated
Page 121: 24. preferen$.mp. [mp=title, abstra
Page 124 and 125: 110 Appendix 2 TABLE 65 contd Summa
Page 126 and 127: 112 Appendix 3 Quality assessment o
Page 173 and 174: TABLE 69 Summary of paediatric pati
Page 175 and 176: TABLE 69 contd Summary of paediatri
Page 177 and 178: TABLE 70 Characteristics of cost or
Page 179 and 180: TABLE 71 Quality of cost or economi
Page 181 and 182: TABLE 71 contd Quality of cost or e
Page 189 and 190: Abbott J, Abbott P. Psychological a
Page 191 and 192: Hall JE, Stewart JIM, Harmer M. Sin
Page 193: Struys M, Versichelen L, Thas O, He
Page 196 and 197: 182 Appendix 11
Page 205 and 206: The aim of this study was to develo
Page 207 and 208: anaesthetics in day surgery, using
Page 209: © Queen’s Printer and Controller
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Background The empirical study quan
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Satisfaction with care Nearly all (
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TABLE 76 Reason given for preferenc
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TABLE 79 Comparisons with previous
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TABLE 80 Reason given for preferenc
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TABLE 81 Reason given for willingne
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Background Variable costs account f
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TABLE 85 Unit costs for the purchas
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Background The empirical study requ
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Ethical approval This was covered b
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20 15 10 5 0 -5 -10 -15 True weight
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15 10 5 0 -5 -10 True weight - Dion
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224 Appendix 19 • patients aged o
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All staff unit costs were for the y
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Background Fixed costs account for
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232 Appendix 22 March, Tuesday 15 A
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234 Appendix 23 TABLE 96 Reasons fo
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Patients were coded using the OPCS
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Q03.4 punch biopsy of cervix Q03.5
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This section displays the associati
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given in Table 103 confirm the age
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TABLE 107 Occurrence of PONV by dur
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248 Appendix 27 TABLE 113 Frequency
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This section displays the associati
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The adverse events observed in the
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262 Health Technology Assessment Pr
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264 Health Technology Assessment Pr
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