King, M and Sibbald, B and Ward, E and Bower, P and Lloyd, M and Gabbay, M and Byford, S (2000) Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care. Health Technol Assess , 4 (19) 1 - 83.
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seen from the systematic review of women's views, imaging is popular with women (provided the appearance of the baby is normal). The study in Liverpool indicates that the average cost to the hospital of providing a 20-week anomaly scan is pound15. This seems modest in the UK but will be prohibitively high in many developing countries. (3) If routine ultrasound is to be offered before 24 weeks, what timing is optimal? The Royal College of Obstetricians and Gynaecologists' (RCOG) Working Party report of 1997 recommended a two-stage regimen of booking ultrasound at about 12 weeks, followed by a second ultrasound anomaly scan at 20 weeks - the regimen offered at Liverpool Women's Hospital. When this report was initially drafted, no comparative information was available about the clinical impact of different regimens. Since then, an RCT comparing the two-stage regimen with a 20-week scan alone has demonstrated less need for readjustment of dates at the mid-pregnancy scan in the two-stage group (with possible consequences for timing serum screen-ing, if available) and less anxiety among the women. Again, clinicians, women and health planners have to decide whether such benefits justify the costs. (4) The systematic review of the effectiveness of anomaly detection has highlighted substantial variation in, and limits to, detection rates of certain structural abnormalities. This information should be made available to clinicians and women, and may also be relevant to the medico-legal arena. Given these limits, the RCOG Working Party's recommendations, that ultrasound examinations should be conducted only by appropriately trained personnel and using equipment no more than 5 years old, seem appropriate. Quality control mechanisms should be set in place to audit performance. The system of reporting suspected anomalies to regional fetal anomaly registers should be encouraged where these exist. (5) A number of inefficiencies in the routine ultrasound screening programme were identified (including the need for repeat scans and that not all women book at early gestations), some of which are unavoidable, but which have implications for both its clinical and cost-effectiveness. CONCLUSIONS - RESEARCH RECOMMENDATIONS: Within each category below, the research recommendations are prioritised. CONCLUSI
|Title:||Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care|
|Additional information:||LA - Eng CY - ENGLAND|
|Keywords:||abnormalities, ABNORMALITY, ANOMALIES, Anxiety, As, audit, benefit, Book, Care, clinical, consequences, control, CONTROLLED TRIAL, cost, costs, counselling, depression, detection, developing, developing countries, Developing-Countries, fetal, gestation, health, imaging, impact, Management, May, MECHANISM, mechanisms, NUMBER, optimal, performance, PRIMARY CARE, psychiatry, QUALITY, Randomised controlled trial, Research, Review, SCAN, Science, screening, serum, SYSTEM, therapy, TRIAL, UK, ultrasound, WOMEN, Med Ed, Med Hum, HSR|
|UCL classification:||UCL > School of Life and Medical Sciences > SLMS Planning and Performance Unit > PDS Tutors|
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > Primary Care and Population Health
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