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Freddie Stening shares the challenges he faced while coming to terms with his wife’s unexpected death
Journal Article
Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial
Back pain remains a challenge for primary care internationally. One model that has not been tested is stratification of the management according to the patient's prognosis (low, medium, or high risk). We compared the clinical effectiveness and cost-effectiveness of stratified primary care (intervention) with non-stratified current best practice (control).
1573 adults (aged ≥18 years) with back pain (with or without radiculopathy) consultations at ten general practices in England responded to invitations to attend an assessment clinic. Eligible participants were randomly assigned by use of computer-generated stratified blocks with a 2:1 ratio to intervention or control group. Primary outcome was the effect of treatment on the Roland Morris Disability Questionnaire (RMDQ) score at 12 months. In the economic evaluation, we focused on estimating incremental quality-adjusted life years (QALYs) and health-care costs related to back pain. Analysis was by intention to treat. This study is registered, number ISRCTN37113406.
851 patients were assigned to the intervention (n=568) and control groups (n=283). Overall, adjusted mean changes in RMDQ scores were significantly higher in the intervention group than in the control group at 4 months (4·7 [SD 5·9]
vs 3·0 [5·9], between-group difference 1·81 [95% CI 1·06–2·57]) and at 12 months (4·3 [6·4]
vs 3·3 [6·2], 1·06 [0·25–1·86]), equating to effect sizes of 0·32 (0·19–0·45) and 0·19 (0·04–0·33), respectively. At 12 months, stratified care was associated with a mean increase in generic health benefit (0·039 additional QALYs) and cost savings (£240·01
vs £274·40) compared with the control group.
The results show that a stratified approach, by use of prognostic screening with matched pathways, will have important implications for the future management of back pain in primary care.
Arthritis Research UK.
Journal Article
The politics of parliamentary debate : parties, rebels and representation
This book explains how parties and their members of parliament (MPs) structure parliamentary debate. Parties may actively seek to prevent some members from taking the floor while promoting opportunities for others. In doing so, they attempt to control the message that their partisans convey in parliament. The authors provide a theoretical model to explain the design of procedural rules in parliament, how the party leadership interacts with rebel backbenchers, and how MPs represent voters. The book explores political institutions, intra-party politics, electoral politics and legislative behavior. It develops and tests a new theory of parliamentary debate, using data from the UK, Germany, New Zealand and the European Parliament.
Book
Robert's Rules for dummies
A guide to mastering \"Roberts Rules of Order\" breaks down the various rules and procedures of the popular and long-lived manual for running meetings, electing officers, and setting up committees.
Book
