scholarly journals The Department of Health perspective on handling uncertainties in health sciences

2011 ◽  
Vol 369 (1956) ◽  
pp. 4853-4863 ◽  
Author(s):  
Glenn Wells ◽  
Sandra Williams ◽  
Sally C. Davies
Keyword(s):  
Clinical Practice ◽  
High Standard ◽  
Standard Of Care ◽  
Evidence Base ◽  
Decision Makers ◽  
Government Response ◽  
Department Of Health ◽  
Wide Range ◽  
Policy Making Process ◽  
The Government

Recognizing and working with uncertainty in handling risk are part of both clinical practice and the policy-making process. The Department of Health recognizes the inherent challenges that uncertainty brings and employs a wide range of research mechanisms, drawing on a diverse set of disciplines, to provide an evidence base to inform both policy creation and implementation, and clinical practice. This paper describes a variety of situations and the Government response to them, each time highlighting the use of science to reduce unknowns and to support decision-making. It highlights the need for a strong research infrastructure to support the Department's requirements, and those of the NHS, both in real time to respond to emergencies and to establish a high standard of care. However, although science provides a powerful tool to reduce uncertainty, it will not always produce definitive answers and often provides the start point for a dialogue between decision makers and researchers.

The Rise of Aggressive Psychopharmacology

2020 ◽  
pp. 139-148
Author(s):  
Joel Paris
Keyword(s):  
Clinical Practice ◽  
Major Depression ◽  
Pharmaceutical Industry ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Base ◽  
Weak Evidence ◽  
Wide Range

Aggressive psychopharmacology describes the current practice of prescribing a large number of medications to patients with almost any mental disorder. While there is some evidence for this approach in severe and, persistent mental disorders, it has spread to common disorders, most particularly major depression. Clinical practice guidelines, which offer a wide range options for patients who are resistant to standard treatments, are being interpreted as promoting polypharmacy for a very broad group of patient. These practices have a surprisingly weak evidence base, and tend to take psychotherapy options off the table. Aggressive psychoharmacology is driven by overdiagnosis and is strongly encouraged by the pharmaceutical industry.

scholarly journals Working for psychiatric patients?

1989 ◽  
Vol 13 (8) ◽  
pp. 407-408 ◽  
Author(s):  
Edward Peck
Keyword(s):  
Health Care ◽  
Community Care ◽  
Psychiatric Patients ◽  
White Paper ◽  
Psychiatric Services ◽  
Fundamental Change ◽  
Government Response ◽  
Department Of Health ◽  
The Government ◽  
Surgical Conditions

Working for Patients and the subsequent Working Papers mention psychiatric services explicitly only twice. The proposals have been formulated for patients requiring tests and treatment for elective surgical conditions. They are the conditions which are believed to be predictable and therefore the most receptive to contractual specification and pricing. The health care contract is to be central to the new NHS. It is the device by which the Department of Health hopes to produce a fundamental change in attitude by both doctors and managers. Kenneth Clarke seems much more concerned with this attitudinal shift than with the detail of what the NHS might resemble a decade from now. This omission of overt consideration of psychiatric services does not allow us to ignore the White Paper. I intend to focus on the potential implications of the proposed themes for psychiatric services, particularly in the context of what they might indicate about the Government response to Community Care: Agenda for Action.

scholarly journals India-United States Dialogue on Traditional Medicine: Toward Collaborative Research and Generation of an Evidence Base

2018 ◽  
pp. 1-10 ◽  
Author(s):  
Jeffrey D. White ◽  
Barry R. O’Keefe ◽  
Jitendra Sharma ◽  
Ghazala Javed ◽  
Vid Nukala ◽  
...  
Keyword(s):  
United States ◽  
Traditional Medicine ◽  
The United States ◽  
Evidence Base ◽  
New Delhi ◽  
Medical Systems ◽  
Medical Practitioners ◽  
Department Of Health ◽  
The Government ◽  
Global Affairs

Therapies originating from traditional medical systems are widely used by patients in both India and the United States. The first India-US Workshop on Traditional Medicine was held in New Delhi, India, on March 3 and 4, 2016, as a collaboration between the Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) of the Government of India, the US National Cancer Institute (NCI), National Institutes of Health, and the Office of Global Affairs, US Department of Health and Human Services. It was attended by Indian and US policymakers, scientists, academics, and medical practitioners from various disciplines. The workshop provided an opportunity to open a dialogue between AYUSH and NCI to identify promising research results and potential topics for Indo-US collaboration. Recommendations that emerged from the workshop underlined the importance of applying rational and scientific approaches for drug development; standardizing traditional medicine products and procedures to ensure reliability and reproducibility; promotion of collaboration between Indian traditional medicine practitioners and researchers and US researchers; greater integration of evidence-based traditional medicine practices with mainstream medical practices in India; and development of training programs between AYUSH and NCI to facilitate crosstraining. Several positive developments took place after the thought-provoking deliberations.

scholarly journals Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e036192 ◽  
Author(s):  
Catrin Evans ◽  
Brenda Poku ◽  
Ruth Pearce ◽  
Jeanette Eldridge ◽  
Paul Hendrick ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Scoping Review ◽  
Health Workforce ◽  
Grey Literature ◽  
Evidence Base ◽  
Current Evidence ◽  
Multiprofessional Team ◽  
Wide Range ◽  
Current Evidence Base ◽  
The Uk

IntroductionA global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinical, service and patient perspective.Methods and analysisThis scoping review is registered with the Open Science Framework (https://osf.io/tzpe5). The review will follow Joanna Briggs Institute guidance and involves a multidisciplinary and multiprofessional team, including a public representative. A wide range of electronic databases and grey literature sources will be searched from 2005 to the present. The review will include primary data from any relevant research, audit or evaluation studies. All review steps will involve two or more reviewers. Data extraction, charting and summary will be guided by a template derived from an established framework used internationally to evaluate ACP (the Participatory Evidence-Informed Patient-Centred Process-Plus framework).DisseminationThe review will produce important new information on existing activity, outcomes, implementation challenges and key areas for future research around ACP in the UK, which, in the context of global workforce transformations, will be of international, as well as local, significance. The findings will be disseminated through professional and NHS bodies, employer organisations, conferences and research papers.

Determining priority of access to physiotherapy at Victorian community health services

2011 ◽  
Vol 35 (2) ◽  
pp. 178 ◽  
Author(s):  
Alison M. C. Brown ◽  
Marie Pirotta
Keyword(s):  
Health Services ◽  
Community Health ◽  
Allied Health ◽  
Evidence Base ◽  
Community Health Services ◽  
Client Outcomes ◽  
Priority Service ◽  
Department Of Health ◽  
Wide Range ◽  
Victorian Department

Prioritisation of clients requesting physiotherapy in Victorian community health services has occurred in the absence of a uniform evidence-based prioritisation process. The effect of the varying prioritisation procedures on client outcomes is unknown. This two-part study sought to answer two questions: what are the current prioritisation practices? And what is the evidence for prioritisation? Staff of Victorian community health services offering physiotherapy (n = 67) were sent a structured questionnaire regarding their prioritisation practices. The questionnaire data revealed a wide range of poorly defined criteria and methods of assessment for prioritisation. The evidence for prioritisation and the use of specific prioritisation criteria were examined via a literature search. The literature suggested the use of acute severe pain, interference with activities of daily living and falls as indicators of need for priority service. The lack of uniformity found in determining priority of access reflects the complexity of determining need and the lack of research and validated tools to assist decision making. Further research into prioritisation criteria is required to determine their validity and if their use in a prioritisation tool would actually improve outcomes for clients. What is known about the topic? Although there is some research on medical prioritisation of clients awaiting surgery little is known about prioritisation practices in allied health in general and physiotherapy in particular. There is also little known about client outcomes when clients are either not prioritised or have been incorrectly prioritised. The literature provides expert opinion on the potential usefulness of prioritisation criteria in determining client need. What does this paper add? This paper highlights the discrepancy between the various poorly defined and complex physiotherapy prioritisation practices that occurred in Victorian Community Health Services at the time of the study and the literature regarding the assessment of need. The underpinning evidence base for uniform prioritisation criteria is explored. Further research is required into the risks and effect on client outcomes of prioritisation. What are the implications for practitioners? Although practitioners, in the absence of any guidelines, have developed their own prioritisation protocols, the Victorian Department of Health has recently mandated the use of a uniform community health prioritisation procedure for physiotherapy and other allied health services, developed from the findings of this research. This study provides practitioners with an understanding of the evidence base for prioritisation criteria and approaches for assessing criteria in practice.

THE VALUE OF LOVE IN THE SYSTEM OF FORMATION OF THE PROFESSIONAL MATURITY OF THE EDUCATOR

2020 ◽  
Vol 1 (10(79)) ◽  
pp. 12-18
Author(s):  
G. Bubyreva
Keyword(s):  
Russian Federation ◽  
The State ◽  
Educational Process ◽  
Wide Range ◽  
The Family ◽  
The Russian Federation ◽  
The Government ◽  
The Individual ◽  
The Right

The existing legislation determines the education as "an integral and focused process of teaching and upbringing, which represents a socially important value and shall be implemented so as to meet the interests of the individual, the family, the society and the state". However, even in this part, the meaning of the notion ‘socially significant benefit is not specified and allows for a wide range of interpretation [2]. Yet the more inconcrete is the answer to the question – "who and how should determine the interests of the individual, the family and even the state?" The national doctrine of education in the Russian Federation, which determined the goals of teaching and upbringing, the ways to attain them by means of the state policy regulating the field of education, the target achievements of the development of the educational system for the period up to 2025, approved by the Decree of the Government of the Russian Federation of October 4, 2000 #751, was abrogated by the Decree of the Government of the Russian Federation of March 29, 2014 #245 [7]. The new doctrine has not been developed so far. The RAE Academician A.B. Khutorsky believes that the absence of the national doctrine of education presents a threat to national security and a violation of the right of citizens to quality education. Accordingly, the teacher has to solve the problem of achieving the harmony of interests of the individual, the family, the society and the government on their own, which, however, judging by the officially published results, is the task that exceeds the abilities of the participants of the educational process.  The particular concern about the results of the patriotic upbringing served as a basis for the legislative initiative of the RF President V. V. Putin, who introduced the project of an amendment to the Law of RF "About Education of the Russian Federation" to the State Duma in 2020, regarding the quality of patriotic upbringing [3]. Patriotism, considered by the President of RF V. V. Putin as the only possible idea to unite the nation is "THE FEELING OF LOVE OF THE MOTHERLAND" and the readiness for every sacrifice and heroic deed for the sake of the interests of your Motherland. However, the practicing educators experience shortfalls in efficient methodologies of patriotic upbringing, which should let them bring up citizens, loving their Motherland more than themselves. The article is dedicated to solution to this problem based on the Value-sense paradigm of upbringing educational dynasty of the Kurbatovs [15].

Selecting a PRO-CTCAE based subset for patient reported symptom monitoring during lung cancer treatment (Preprint)

2020 ◽  
Author(s):  
Evalien Veldhuijzen ◽  
Iris Walraven ◽  
Jose Belderbos
Keyword(s):  
Lung Cancer ◽  
Clinical Practice ◽  
Cancer Patients ◽  
Treatment Modalities ◽  
European Organization ◽  
Specific Patient ◽  
Symptom Monitoring ◽  
Lung Cancer Patients ◽  
Wide Range ◽  
Patient Reported

BACKGROUND The Patient Reported Outcomes Version of the Common Terminology Criteria of Adverse Events (PRO-CTCAE) item library covers a wide range of symptoms relevant for oncology care. To enable implementation of PRO-CTCAE-based symptom monitoring in clinical practice, there is a need to select a subset of items relevant for specific patient populations. OBJECTIVE The aim of this study was to develop a PRO-CTCAE subset relevant for patients with lung cancer. METHODS The PRO-CTCAE-based subset for lung cancer patients was generated using a mixed methods approach based on the European Organization for Research and Treatment of Cancer (EORTC) guidelines for developing questionnaires, consisting of a literature review and semi-structured interviews with both lung cancer patients and health care practitioners (HCPs). Both patients and HCPs were queried on the relevance and impact of all PRO-CTCAE items. Results were summarized and, after a final round of expert review, a selection of clinically relevant items for lung cancer patients was made. RESULTS A heterogeneous group of lung cancer patients (n=25) from different treatment modalities and HCPs (n=22) participated in the study. A final list of eight relevant PRO-CTCAE items was created: decreased appetite, cough, shortness of breath, fatigue, constipation, nausea, sadness, and pain (general). CONCLUSIONS Based on literature and both professional and patient input, a subset of PRO-CTCAE items has been identified for use in lung cancer patients in clinical practice. Future work is needed to confirm the validity and effectiveness of this PRO-CTCAE lung cancer subset internationally, and in the real-world clinical practice setting.

scholarly journals Public governance, agility and pandemics: a case study of the UK response to COVID-19

2021 ◽  
pp. 002085232098340
Author(s):  
Paul Joyce
Keyword(s):  
Leadership Role ◽  
Public Confidence ◽  
Strategic Decisions ◽  
Public Governance ◽  
Local Initiative ◽  
Government Response ◽  
Local Resources ◽  
The Government ◽  
The One ◽  
The Uk

The UK government’s leaders initially believed that it was among the best-prepared governments for a pandemic. By June 2020, the outcome of the collision between the government’s initial confidence, on the one hand, and the aggressiveness and virulence of COVID-19, on the other, was evident. The UK had one of the worst COVID-19 mortality rates in the world. This article explores the UK government’s response to COVID-19 from a public administration and governance perspective. Using factual information and statistical data, it considers the government’s preparedness and strategic decisions, the delivery of the government response, and public confidence in the government. Points for practitioners Possible lessons for testing through application include: Use the precautionary principle to set planning assumptions in government strategies to create the possibility of government agility during a pandemic. Use central government’s leadership role to facilitate and enable local initiative and operational responses, as well as to take advantage of local resources and assets. Choose smart government responses that address tensions between the goal of saving lives and other government goals, and beware choices that are unsatisfactory compromises.

scholarly journals A Phase II Safety and Efficacy Study on Prognosis of Moderate Pneumonia in COVID-19 patients with Regular Intravenous Immunoglobulin Therapy

2021 ◽  
Author(s):  
Raman R S ◽  
Vijaykumar Bhagwan Barge ◽  
Anil Kumar Darivenula ◽  
Himanshu Dandu ◽  
Rakesh R Kartha ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Randomized Study ◽  
Standard Of Care ◽  
Immunoglobulin Therapy ◽  
Clinical Trial Registry ◽  
Open Label ◽  
Intravenous Immunoglobulin Therapy ◽  
Safety And Efficacy ◽  
Therapeutic Benefits ◽  
Wide Range

Abstract Background Currently, there is no specific drug for the treatment of COVID-19. Therapeutic benefits of intravenous immunoglobin (IVIG) have been demonstrated in wide range of diseases. The present study is conducted to evaluate the safety and efficacy of IVIG in the treatment of COVID-19 patients with moderate pneumonia. Methods An open-label, multicenter, comparative, randomized study was conducted on COVID-19 patients with moderate pneumonia. 100 eligible patients were randomized in 1:1 ratio either to receive IVIG + standard of care (SOC) or SOC. Results Duration of hospital stay was significantly shorter in IVIG group to that of SOC alone (7.7 Vs. 17.5 days). Duration for normalization of body temperature, oxygen saturation and mechanical ventilation were significantly shorter in IVIG compared to SOC. Percentages of patients on mechanical ventilation in two groups were not significantly different (24% Vs. 38%). Median time to RT-PCR negativity was significantly shorter with IVIG than SOC (7 Vs.18 days). There were only mild to moderate adverse events in both groups except for one patient (2%), who died in SOC. Conclusions IVIG was safe and efficacious as an adjuvant with other antiviral drugs in the treatment of COVID-19. The trial was registered under Clinical Trial Registry, India (CTRI/2020/06/026222).

scholarly journals 1174. Phase 2 STRIVE Clinical Trial of Rezafungin for Treatment of Candidemia and/or Invasive Candidiasis Demonstrates Consistent Trough Concentrations Across Diverse Patient Populations

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S612-S613
Author(s):  
Shawn Flanagan ◽  
Christopher M Rubino ◽  
Taylor Sandison
Keyword(s):  
Body Weight ◽  
Invasive Candidiasis ◽  
Fungal Infections ◽  
Standard Of Care ◽  
Geographic Region ◽  
Continuous Variables ◽  
Phase 2 ◽  
Double Blind ◽  
Wide Range ◽  
Diverse Patient Populations

Abstract Background Rezafungin is a novel echinocandin antifungal in development for treatment as well as prevention (prophylaxis) of invasive fungal infections. STRIVE (NCT02734862) is a global, randomized, double-blind, placebo-controlled, Phase 2 trial evaluating safety and efficacy of IV rezafungin once weekly (QWk) for treatment of candidemia and/or invasive candidiasis compared with standard-of-care (IV caspofungin once daily with optional oral stepdown). Here we report pharmacokinetic (PK) data from the completed STRIVE trial analyzed by patient demographics at baseline. Methods Rezafungin Day 8 trough (Cmin) concentrations from patients treated with rezafungin were summarized categorically by race (black or white), sex (male or female), and geographic region (North America [NA], or Europe [EU]), or plotted versus continuous variables of age, body weight, body mass index (BMI), and body surface area (BSA). As the first dose of rezafungin was 400 mg for all rezafungin-treated patients, data from both dose groups (Group 1: 400 mg QWk; Group 2: 400 mg in Week 1 followed by 200 mg QWk) were combined in this analysis. Results Rezafungin mean Cmin (SD) values were 1.8 (0.7) and 2.3 (1.2) in black and white patients, 1.9 (1.0) and 2.6 (1.2) in males and females, and 1.9 (0.6) and 2.4 (1.3) in patients from NA and EU. There were small differences in point estimates between the groups, but there was a great deal of overlap and the differences are not expected to be clinically meaningful (Figure). Similarly, no trends in Cmin values were observed across a range of ages (20-80 years), weights (~40-155 kg), BMI (~15-65 kg/m2), and BSA (~1.4-2.4 m2). Figure Conclusion No meaningful differences in rezafungin Cmin values were observed in patients grouped by sex, race, or geographic region, or across a wide range of patient factors, including age and body weight and size. These findings indicate that a single rezafungin dose regimen can be expected to provide consistent PK across diverse patient populations. Disclosures Shawn Flanagan, PhD, Cidara Therapeutics, Inc. (Employee, Shareholder) Christopher M. Rubino, PharMD, Institute for Clinical Pharmacodynamics, Inc. (Employee)Spero Therapeutics (Grant/Research Support) Taylor Sandison, MD, MPH, Cidara Therapeutics, Inc. (Employee, Shareholder)

Sign in / Sign up

Export Citation Format

Share Document