Chalkidou K.,National Institute for Health and Clinical Excellence |
Lord J.,Brunel University |
Obeidat N.A.,Health Outcomes Sciences |
Alabbadi I.A.,University of Jordan |
And 7 more authors.
International Journal of Technology Assessment in Health Care | Year: 2011
Objectives: The UK's National Institute for Health and Clinical Excellence (NICE) and the Jordan office of the Medicines Transparency Alliance embarked on a pilot project to design an evidence-based guideline for cost-effective pharmacological treatment of essential hypertension in Jordan. The project's objectives were to directly address a major health problem for Jordan by producing a guideline; and to delineate the strengths and weaknesses of Jordan's healthcare process to allow similar future efforts to be planned more efficiently. Methods: The pilot spanned a period of approximately 8 months. Activities were overseen by local technical and guideline development teams, as well as experts from NICE. NICE's hypertension guidelines and economic model were used as a starting point. Parameters in the economic model were adjusted according to input and feedback from local experts with regards to Jordanian physician and patient practices, resource costs, and quality of life estimates. The results of the economic model were integrated with the updated available clinical trial literature. Results: The outputs of the economic model were used to inform recommendations, in the form of a clinical algorithm. A report of the process and the strengths and weaknesses observed was developed, and recommendations for improvements were made. Conclusions: The pilot represented the start of what is intended to be a healthcare process change for the country of Jordan. Issues emerged which can inform strategies to ensure a more cohesive and comprehensive approach to the cost-effective use of appropriate drugs in managing chronic disease in Jordan and countries operating in a similarly resource-constrained environment. Furthermore, our pilot highlights how richer countries with relevant experience in evidence-informed healthcare policy making can assist others in strengthening their decision-making methods and processes. © 2011 Cambridge University Press.
Hughes R.,National Clinical Guidelines Center |
Wonderling D.,Freeman Hospital |
Li B.,London School of Hygiene and Tropical Medicine |
Higgins B.,National Clinical Guidelines Center
Respiratory Medicine | Year: 2012
Background: There is wide variation in the techniques deployed to diagnose tuberculosis in the UK, with little agreement on which tools or strategies are cost effective. This analysis therefore comprehensively evaluated the cost effectiveness of currently available diagnostic strategies for routine diagnosis of TB in the NHS. Methods: The analysis compared strategies consisting of Nucleic Acid Amplification Techniques, culture and microscopy. A decision tree was used to estimate costs and Quality-Adjusted Life Years (QALYs) from a UK health service perspective. The sensitivity and specificity of each test determined the true and false positive and negative results in patients suspected of having active tuberculosis. These results led to either early, correct diagnosis or delayed diagnosis and the associated costs and QALYs. The presence of active tuberculosis combined with the side effects of treatment was associated with reduction in quality of life. Costs included were test costs, drug costs and the management of tuberculosis. Drug costs were based on generic UK list prices. Uncertainty in the model was explored through probabilistic and deterministic sensitivity analyses. Results/conclusions: The cost effective strategy at threshold of £20,000 per QALY was a strategy using only sputum microscopy and culture routinely, meaning Nucleic Acid Amplification Techniques are not cost effective at baseline. When the prevalence of tuberculosis was increased, however, nucleic acid amplification became cost effective at the same threshold. Aside from the prevalence, the results were shown to be robust. At low tuberculosis prevalence, Nucleic Acid Amplification Techniques may not be cost effective but their potential in higher prevalence situations is considerable. © 2011 Elsevier Ltd. All rights reserved.
Boyd A.,King's College |
Dworzynski K.,National Clinical Guidelines Center |
Howell P.,University College London
Journal of Clinical Psychopharmacology | Year: 2011
Stuttering affects approximately 5% of children up to the teenage years. There are many possible forms of intervention, one of which is pharmacotherapy. No review about the treatment of stuttering with pharmacological agents in children and adolescents has been undertaken. The objectives of this review were to determine the extent of previous research in this area and to assess the success of pharmacological agents in reducing the frequency of disfluency in child and adolescent stutterers (<18 years). A systematic search of MEDLINE, PsychInfo, Embase, and Cochrane Systematic Review databases was carried out to identify potential studies for the review. Studies that met specified criteria were selected for detailed examination, and the quality of evidence they provided was assessed according to 7 criteria that pertained to study design and data provision. Seven publications met the inclusion criteria for the review. Only 1 publication was classified as strong evidence quality, and this reported that clonidine did not reduce the frequency of disfluency in a group of 25 individuals who stuttered. All further publications were classified as either very low or low evidence quality. The agents examined were risperidone, olanzapine, clonidine, tiapride, haloperidol, and chlorpromazine. © 2011 by Lippincott Williams & Wilkins.
Stewart S.,Materials Misericordiae University Hospital |
Swain S.,National Clinical Guidelines Center
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2012
Alcohol dependence is common among patients attending acute hospitals. It can be the major reason for attendance or a significant cofactor. Assessment of these patients in the acute setting can be challenging owing to the multidisciplinary approach required. Doctors in acute hospitals are often inexperienced in managing dependence, a mental health problem. They might focus on the physical harms or the withdrawal, a consequence of the dependence. For this reason, assessment of dependence and prevention and management of acute alcohol withdrawal are often suboptimal. There is little existing guidance on how to manage this patient population, especially in non-specialist settings. With recently published National Institute for Health and Clinical Excellence (NICE) guidance on the management of dependence and withdrawal, now is the perfect time to produce concise guidelines in the hope that a more succinct suite of guidance can reach a larger audience. © Royal College of Physicians, 2012. All rights reserved.
Treasure T.,Guideline |
Treasure T.,University College London |
Chong L.-Y.,Guideline |
Chong L.-Y.,National Clinical Guidelines Center |
And 8 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2010
Following the publication in 2007 of the guidelines from the National Institute for Health and Clinical Excellence (NICE) for prophylaxis against venous thromboembolism (VTE) for patients undergoing surgery, concerns were raised by British orthopaedic surgeons as to the appropriateness of the recommendations for their clinical practice. In order to address these concerns NICE and the British Orthopaedic Association agreed to engage a representative panel of orthopaedic surgeons in the process of developing expanded VTE guidelines applicable to all patients admitted to hospital. The functions of this panel were to review the evidence and to consider the applicability and implications in orthopaedic practice in order to advise the main Guideline Development Group in framing recommendations. The panel considered both direct and indirect evidence of the safety and efficacy, the cost-effectiveness of prophylaxis and its implication in clinical practice for orthopaedic patients. We describe the process of selection of the orthopaedic panel, the evidence considered and the contribution of the panel to the latest guidelines from NICE on the prophylaxis against VTE, published in January 2010. ©2010 British Editorial Society of Bone and Joint Surgery.
Williams J.,Queen Mary, University of London |
Tzortziou-Brown V.,Queen Mary, University of London |
Malliaras P.,Queen Mary, University of London |
Perry M.,Queen Mary, University of London |
And 2 more authors.
Clinical Journal of Sport Medicine | Year: 2012
OBJECTIVE: To explore the hydration strategies of marathon runners, their sources of information and knowledge about fluid intake in the marathon, and their understanding of exercise-associated hyponatremia (EAH). DESIGN: Anonymized questionnaire. SETTING: London Marathon. PARTICIPANTS: Marathon race participants. MAIN OUTCOME MEASURES: Responses regarding planned fluid consumption, volume to be consumed, volume of water and sports drink bottles, and the number of stations from which planning to take a drink. In addition, sources of information about appropriate drinking and understanding of hyponatremia. RESULTS: In total, 93.1% of the runners had read or been told about drinking fluids on marathon day and 95.8% of competitors had a plan regarding fluid intake. However, 12% planned to drink a volume large enough to put them at higher risk of EAH. Only 21.7% knew the volumes of water and sports drink bottles available on the course; 20.7% were planning to take a drink from all 24 water stations. Only 25.3% planned to drink according to thirst. Although 68.0% of the runners had heard of hyponatremia or low sodium levels, only 35.5% had a basic understanding of its cause and effects. CONCLUSIONS: Marathon runners lack knowledge about appropriate fluid intake to prevent hyponatremia on race day. Twelve percent reported drinking strategies that put them at risk of EAH. Effective educational interventions are still necessary to prevent overdrinking during marathons. © 2012 Lippincott Williams & Wilkins, Inc.
PubMed | National Clinical Guidelines Center
Type: Journal Article | Journal: Clinical medicine (London, England) | Year: 2014
Acute kidney injury (AKI) is considered a silent disease that commonly occurs in patients with acute illness; however, given that it has few specific symptoms and signs in its early stages, detection can be delayed. AKI can also occur in patients with no obvious acute illness or secondary to more rare causes. In both these scenarios, patients are often under the care of specialists outside of nephrology, who might fail to detect that AKI is developing and might not be familiar with its optimum management. Therefore, there is a need to increase the awareness of AKI among many different healthcare specialists. In this article, we summarise the key recommendations from the National Institute for Health and Care Excellence (NICE) AKI guideline. The guideline provides recommendations for adult and paediatric patients on the prevention, early detection and management of AKI, as well as information on AKI and sources of support. Implementation of this guideline will contribute to improving patient safety and saving lives.