Nafees Din - Academia.edu (original) (raw)
Papers by Nafees Din
Health education journal, 2015
Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable ins... more Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals' perceptions of their role in promoting physical activity and experiences of a National Exercise Referral Scheme (NERS) in Wales. Qualitative semi-structured group interviews. General practice premises. Nine semi-structured group interviews involving 46 health professionals were conducted on general practice premises in six local health board areas. Purposive sampling taking into account area deprivation, practice size and referral rates was employed. Interviews were transcribed verbatim and analysed using the Framework method of thematic analysis. Health professionals described physical activity promotion as important, although many thought it was outside of their expertise and remit, and less important than other health promotion activities such as smokin...
Introduction and Aims: Exercise referral schemes (ERS) have been regarded as having limited impac... more Introduction and Aims: Exercise referral schemes (ERS) have been regarded as having limited impact on patients’ physical activity. Primary health care professionals (PHPs) are the first contact for entry of majority of patients into the scheme. Their referral behaviour may influence the success and rigorous evaluation of ERSs. The present study explores these issues and their experience of referring to a national ERS in Wales within a randomised controlled trial design. Methods: Semi-structured group interviews were conducted and audio taped in nine purposively sampled general practices in six LHB areas. Thematic analysis of transcripts was utilised to explore PHPs’ experiences and perceptions about the role of ERSs in public health and barriers and facilitators to referral within a rigorous evaluation of NERS. Results: The majority of participants regarded ERSs as having positive effects on the health of high risk groups of patients, but there were concerns that such schemes might ...
British Journal of Cancer, 2015
Background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with m... more Background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations.
BMC Public Health, 2010
Background: The benefits to health of a physically active lifestyle are well established and ther... more Background: The benefits to health of a physically active lifestyle are well established and there is evidence that a sedentary lifestyle plays a significant role in the onset and progression of chronic disease. Despite a recognised need for effective public health interventions encouraging sedentary people with a medical condition to become more active, there are few rigorous evaluations of their effectiveness. Following NICE guidance, the Welsh national exercise referral scheme was implemented within the context of a pragmatic randomised controlled trial.
PLOS ONE, 2015
Time from symptomatic presentation to cancer diagnosis (diagnostic interval) is an important, and... more Time from symptomatic presentation to cancer diagnosis (diagnostic interval) is an important, and modifiable, part of the patient's cancer pathway, and can be affected by various factors such as age, gender and type of presenting symptoms. The aim of this study was to quantify the relationships of diagnostic interval with these variables in 15 cancers diagnosed between 2007 and 2010 using routinely collected data from the Clinical Practice Research Datalink (CPRD) in the UK.
Pain, 2014
The aim of this paper is to estimate the relative cost-effectiveness of treatment regimens for ma... more The aim of this paper is to estimate the relative cost-effectiveness of treatment regimens for managing patients with sciatica. A deterministic model structure was constructed based on information from the findings from a systematic review of clinical effectiveness and cost-effectiveness, published sources of unit costs, and expert opinion. The assumption was that patients presenting with sciatica would be managed through one of 3 pathways (primary care, stepped approach, immediate referral to surgery). Results were expressed as incremental cost per patient with symptoms successfully resolved. Analysis also included incremental cost per utility gained over a 12-month period. One-way sensitivity analyses were used to address uncertainty. The model demonstrated that none of the strategies resulted in 100% success. For initial treatments, the most successful regime in the first pathway was nonopioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was nonopioids, followed by biological agents, followed by epidural/nerve block and disk surgery, with a probability of success of 0.996. Pathway 3 (immediate surgery) was not cost-effective. Sensitivity analyses identified that the use of the highest cost estimates results in a similar overall picture. While the estimates of cost per quality-adjusted life year are higher, the economic model demonstrated that stepped approaches based on initial treatment with nonopioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required.
The Spine Journal, 2013
BACKGROUND: There are numerous treatment approaches for sciatica. Previous systematic reviews hav... more BACKGROUND: There are numerous treatment approaches for sciatica. Previous systematic reviews have not compared all these strategies together. PURPOSE: To compare the clinical effectiveness of different treatment strategies for sciatica simultaneously. STUDY DESIGN: Systematic review and network meta-analysis. METHODS: We searched 28 electronic databases and online trial registries, along with bibliographies of previous reviews for comparative studies evaluating any intervention to treat sciatica in adults, with outcome data on global effect or pain intensity. Network meta-analysis methods were used to simultaneously compare all treatment strategies and allow indirect comparisons of treatments between studies. The study was funded by the UK National Institute for Health Research Health Technology Assessment program; there are no potential conflict of interests. RESULTS: We identified 122 relevant studies; 90 were randomized controlled trials (RCTs) or quasi-RCTs. Interventions were grouped into 21 treatment strategies. Internal and external validity of included studies was very low. For overall recovery as the outcome, compared with inactive control or conventional care, there was a statistically significant improvement following disc surgery, epidural injections, nonopioid analgesia, manipulation, and acupuncture. Traction, percutaneous discectomy, and exercise therapy were significantly inferior to epidural injections or surgery. For pain as the outcome, epidural injections and biological agents were significantly better than inactive control, but similar findings for disc surgery were not statistically significant. Biological agents were significantly better for pain reduction than bed rest, nonopioids, and opioids. Opioids, education/advice alone, bed rest, and percutaneous discectomy were inferior to most other treatment strategies; although these findings represented large effects, they were statistically equivocal. CONCLUSIONS: For the first time, many different treatment strategies for sciatica have been compared in the same systematic review and meta-analysis. This approach has provided new data FDA device/drug status: Not applicable.
Journal of Epidemiology & Community Health, 2012
Background The Wales National Exercise Referral Scheme (NERS) is a 16-week programme including mo... more Background The Wales National Exercise Referral Scheme (NERS) is a 16-week programme including motivational interviewing, goal setting and relapse prevention. Method A pragmatic randomised controlled trial with nested economic evaluation of 2160 inactive participants with coronary heart disease risk (CHD, 1559, 72%), mild to moderate depression, anxiety or stress (79, 4%) or both (522, 24%) randomised to receive (1) NERS or (2) normal care and brief written information. Outcome measures at 12 months included the 7-day physical activity recall, the hospital anxiety and depression scale. Results Ordinal regression identified increased physical activity among those randomised to NERS compared with those receiving normal care in all participants (OR 1.19, 95% CI 0.99 to 1.43), and among those referred for CHD only (OR 1.29, 95% CI 1.04 to 1.60). For those referred for mental health reason alone, or in combination with CHD, there were significantly lower levels of anxiety (OR À1.56, 95% CI À2.75 to À0.38) and depression (OR À1.39, 95% CI À2.60 to À0.18), but no effect on physical activity. The base-case incremental cost-effectiveness ratio was £12 111 per quality adjusted life year, falling to £9741 if participants were to contribute £2 per session. Conclusions NERS was effective in increasing physical activity among those referred for CHD risk only. Among mental health referrals, NERS did not influence physical activity but was associated with reduced anxiety and depression. Effects were dependent on adherence. NERS is likely to be cost effective with respect to prevailing payer thresholds. Trial registration Current Controlled Trials ISRCTN47680448.
BMC Public Health, 2010
Background: The benefits to health of a physically active lifestyle are well established and ther... more Background: The benefits to health of a physically active lifestyle are well established and there is evidence that a sedentary lifestyle plays a significant role in the onset and progression of chronic disease. Despite a recognised need for effective public health interventions encouraging sedentary people with a medical condition to become more active, there are few rigorous evaluations of their effectiveness. Following NICE guidance, the Welsh national exercise referral scheme was implemented within the context of a pragmatic randomised controlled trial.
The Lancet, 2013
Background Traditional systematic reviewing methods tend to focus on measurement and reporting of... more Background Traditional systematic reviewing methods tend to focus on measurement and reporting of programme eff ectiveness, or cost eff ectiveness in the case of health economic literature. Findings often show mixed results and do not provide a clear indication of why the invention worked under a certain setting. The realist research question is often summarised as "What works for whom, under what circumstances, how and why?" Programme theories are developed that make assumptions about how interventions work in practice. These programme theories are then tested against empirical evidence to populate a theoretical framework. The empirical evidence will support, contradict, or lead to modifi cation of the programme theories through a highly iterative process. With regards to complex social interventions, realist review methods can provide a rich, detailed understanding of the intervention itself, which can be utilised during planning and implementation stages. The aim of this review is to inform the development of a novel multidisciplinary intervention for rehabilitation after hip fracture in the elderly, as part of a larger feasibility trial.
Health education journal, 2015
Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable ins... more Referring clinicians' experiences of exercise referral schemes (ERS) can provide valuable insights into their uptake. However, most qualitative studies focus on patient views only. This paper explores health professionals' perceptions of their role in promoting physical activity and experiences of a National Exercise Referral Scheme (NERS) in Wales. Qualitative semi-structured group interviews. General practice premises. Nine semi-structured group interviews involving 46 health professionals were conducted on general practice premises in six local health board areas. Purposive sampling taking into account area deprivation, practice size and referral rates was employed. Interviews were transcribed verbatim and analysed using the Framework method of thematic analysis. Health professionals described physical activity promotion as important, although many thought it was outside of their expertise and remit, and less important than other health promotion activities such as smokin...
Introduction and Aims: Exercise referral schemes (ERS) have been regarded as having limited impac... more Introduction and Aims: Exercise referral schemes (ERS) have been regarded as having limited impact on patients’ physical activity. Primary health care professionals (PHPs) are the first contact for entry of majority of patients into the scheme. Their referral behaviour may influence the success and rigorous evaluation of ERSs. The present study explores these issues and their experience of referring to a national ERS in Wales within a randomised controlled trial design. Methods: Semi-structured group interviews were conducted and audio taped in nine purposively sampled general practices in six LHB areas. Thematic analysis of transcripts was utilised to explore PHPs’ experiences and perceptions about the role of ERSs in public health and barriers and facilitators to referral within a rigorous evaluation of NERS. Results: The majority of participants regarded ERSs as having positive effects on the health of high risk groups of patients, but there were concerns that such schemes might ...
British Journal of Cancer, 2015
Background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with m... more Background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations.
BMC Public Health, 2010
Background: The benefits to health of a physically active lifestyle are well established and ther... more Background: The benefits to health of a physically active lifestyle are well established and there is evidence that a sedentary lifestyle plays a significant role in the onset and progression of chronic disease. Despite a recognised need for effective public health interventions encouraging sedentary people with a medical condition to become more active, there are few rigorous evaluations of their effectiveness. Following NICE guidance, the Welsh national exercise referral scheme was implemented within the context of a pragmatic randomised controlled trial.
PLOS ONE, 2015
Time from symptomatic presentation to cancer diagnosis (diagnostic interval) is an important, and... more Time from symptomatic presentation to cancer diagnosis (diagnostic interval) is an important, and modifiable, part of the patient's cancer pathway, and can be affected by various factors such as age, gender and type of presenting symptoms. The aim of this study was to quantify the relationships of diagnostic interval with these variables in 15 cancers diagnosed between 2007 and 2010 using routinely collected data from the Clinical Practice Research Datalink (CPRD) in the UK.
Pain, 2014
The aim of this paper is to estimate the relative cost-effectiveness of treatment regimens for ma... more The aim of this paper is to estimate the relative cost-effectiveness of treatment regimens for managing patients with sciatica. A deterministic model structure was constructed based on information from the findings from a systematic review of clinical effectiveness and cost-effectiveness, published sources of unit costs, and expert opinion. The assumption was that patients presenting with sciatica would be managed through one of 3 pathways (primary care, stepped approach, immediate referral to surgery). Results were expressed as incremental cost per patient with symptoms successfully resolved. Analysis also included incremental cost per utility gained over a 12-month period. One-way sensitivity analyses were used to address uncertainty. The model demonstrated that none of the strategies resulted in 100% success. For initial treatments, the most successful regime in the first pathway was nonopioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was nonopioids, followed by biological agents, followed by epidural/nerve block and disk surgery, with a probability of success of 0.996. Pathway 3 (immediate surgery) was not cost-effective. Sensitivity analyses identified that the use of the highest cost estimates results in a similar overall picture. While the estimates of cost per quality-adjusted life year are higher, the economic model demonstrated that stepped approaches based on initial treatment with nonopioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required.
The Spine Journal, 2013
BACKGROUND: There are numerous treatment approaches for sciatica. Previous systematic reviews hav... more BACKGROUND: There are numerous treatment approaches for sciatica. Previous systematic reviews have not compared all these strategies together. PURPOSE: To compare the clinical effectiveness of different treatment strategies for sciatica simultaneously. STUDY DESIGN: Systematic review and network meta-analysis. METHODS: We searched 28 electronic databases and online trial registries, along with bibliographies of previous reviews for comparative studies evaluating any intervention to treat sciatica in adults, with outcome data on global effect or pain intensity. Network meta-analysis methods were used to simultaneously compare all treatment strategies and allow indirect comparisons of treatments between studies. The study was funded by the UK National Institute for Health Research Health Technology Assessment program; there are no potential conflict of interests. RESULTS: We identified 122 relevant studies; 90 were randomized controlled trials (RCTs) or quasi-RCTs. Interventions were grouped into 21 treatment strategies. Internal and external validity of included studies was very low. For overall recovery as the outcome, compared with inactive control or conventional care, there was a statistically significant improvement following disc surgery, epidural injections, nonopioid analgesia, manipulation, and acupuncture. Traction, percutaneous discectomy, and exercise therapy were significantly inferior to epidural injections or surgery. For pain as the outcome, epidural injections and biological agents were significantly better than inactive control, but similar findings for disc surgery were not statistically significant. Biological agents were significantly better for pain reduction than bed rest, nonopioids, and opioids. Opioids, education/advice alone, bed rest, and percutaneous discectomy were inferior to most other treatment strategies; although these findings represented large effects, they were statistically equivocal. CONCLUSIONS: For the first time, many different treatment strategies for sciatica have been compared in the same systematic review and meta-analysis. This approach has provided new data FDA device/drug status: Not applicable.
Journal of Epidemiology & Community Health, 2012
Background The Wales National Exercise Referral Scheme (NERS) is a 16-week programme including mo... more Background The Wales National Exercise Referral Scheme (NERS) is a 16-week programme including motivational interviewing, goal setting and relapse prevention. Method A pragmatic randomised controlled trial with nested economic evaluation of 2160 inactive participants with coronary heart disease risk (CHD, 1559, 72%), mild to moderate depression, anxiety or stress (79, 4%) or both (522, 24%) randomised to receive (1) NERS or (2) normal care and brief written information. Outcome measures at 12 months included the 7-day physical activity recall, the hospital anxiety and depression scale. Results Ordinal regression identified increased physical activity among those randomised to NERS compared with those receiving normal care in all participants (OR 1.19, 95% CI 0.99 to 1.43), and among those referred for CHD only (OR 1.29, 95% CI 1.04 to 1.60). For those referred for mental health reason alone, or in combination with CHD, there were significantly lower levels of anxiety (OR À1.56, 95% CI À2.75 to À0.38) and depression (OR À1.39, 95% CI À2.60 to À0.18), but no effect on physical activity. The base-case incremental cost-effectiveness ratio was £12 111 per quality adjusted life year, falling to £9741 if participants were to contribute £2 per session. Conclusions NERS was effective in increasing physical activity among those referred for CHD risk only. Among mental health referrals, NERS did not influence physical activity but was associated with reduced anxiety and depression. Effects were dependent on adherence. NERS is likely to be cost effective with respect to prevailing payer thresholds. Trial registration Current Controlled Trials ISRCTN47680448.
BMC Public Health, 2010
Background: The benefits to health of a physically active lifestyle are well established and ther... more Background: The benefits to health of a physically active lifestyle are well established and there is evidence that a sedentary lifestyle plays a significant role in the onset and progression of chronic disease. Despite a recognised need for effective public health interventions encouraging sedentary people with a medical condition to become more active, there are few rigorous evaluations of their effectiveness. Following NICE guidance, the Welsh national exercise referral scheme was implemented within the context of a pragmatic randomised controlled trial.
The Lancet, 2013
Background Traditional systematic reviewing methods tend to focus on measurement and reporting of... more Background Traditional systematic reviewing methods tend to focus on measurement and reporting of programme eff ectiveness, or cost eff ectiveness in the case of health economic literature. Findings often show mixed results and do not provide a clear indication of why the invention worked under a certain setting. The realist research question is often summarised as "What works for whom, under what circumstances, how and why?" Programme theories are developed that make assumptions about how interventions work in practice. These programme theories are then tested against empirical evidence to populate a theoretical framework. The empirical evidence will support, contradict, or lead to modifi cation of the programme theories through a highly iterative process. With regards to complex social interventions, realist review methods can provide a rich, detailed understanding of the intervention itself, which can be utilised during planning and implementation stages. The aim of this review is to inform the development of a novel multidisciplinary intervention for rehabilitation after hip fracture in the elderly, as part of a larger feasibility trial.