NHS research ethics committees : still need more common sense and less bureaucracy

National Health Service research ethics committees exist to ensure that research performed within the NHS complies with recognised ethical standards and to protect the rights, safety, and dignity of all actual or potential participants. In the past decade the operation of research ethics committees has come under, and continues to come under, close scrutiny. Researchers now consider the process of acquiring ethical approval to be so onerous that it is compromising clinical research. Medical educators also think that the process is too unwieldy to allow undergraduate students to acquire research experience, an essential learning outcome required by the General Medical Council

Initial experience in self-monitoring of intraocular pressure.

Background/aims: Diurnal variation in intraocular pressure (IOP) is a routine assessment in glaucoma management. Providing patients the opportunity to perform self-tonometry might empower them and free hospital resource. We previously demonstrated that 74% of patients can use the Icare® HOME tonometer. This study further explores Icare® HOME patient self-monitoring. Methods: Patients were trained by standard protocol to use the Icare® HOME rebound tonometer. Patient self-tonometry was compared to Goldmann applanation tonometry (GAT) over one clinical day. Following this, each patient was instructed to undertake further data collection that evening and over the subsequent two days. Results: Eighteen patients (35 eyes) participated. Good agreement was demonstrated between GAT and Icare® HOME for IOPs up to 15 mm Hg. Above this IOP the Icare® tended to over-read, largely explained by 2 patients with corneal thickness >600 um. The mean peak IOP during ‘clinic hours’ phasing was 16.7 mm Hg and 18.5 mm Hg (p = 0.24) over three days. An average range of 5.0, 7.0 and 9.8 mm Hg was shown during single day clinic, single day home and three day home phasing respectively (p =<0.001). The range of IOP was lower in eyes with prior trabeculectomy (6.1 mm Hg vs 12.2 mm Hg). All patients undertook one reading in the early morning at home with an average of 4.8 readings during, and 3.1 readings after office hours. Conclusions: This small study shows that self-tonometry is feasible. The findings from home phasing demonstrated higher peak and trough IOPs, providing additional clinical information. Home phasing is a viable alternative. The cost-effectiveness of this approach has yet to be addressed

Question design in nurse-led and GP-led telephone triage for same-day appointment requests: a comparative investigation

Objective: To compare doctors’ and nurses’ communication with patients in primary care telephone triage consultations. Design: Qualitative comparative study of content and form of questions in 51 telephone triage encounters between practitioners (general practitioners (GPs)=29; nurses=22) and patients requesting a same-day appointment in primary care. Audio-recordings of nurse-led calls were synchronised with video recordings of nurse's use of computer decision support software (CDSS) during triage. Setting: 2 GP practices in Devon and Warwickshire, UK. Participants: 4 GPs and 29 patients; and 4 nurses and 22 patients requesting a same-day face-to-face appointment with a GP. Main outcome measure: Form and content of practitioner-initiated questions and patient responses during clinical assessment. Results: A total of 484 question–response sequences were coded (160 GP; 324 N). Despite average call lengths being similar (GP=4 min, 37 s, (SD=1 min, 26 s); N=4 min, 39 s, (SD=2 min, 22 s)), GPs and nurses differed in the average number (GP=5.51, (SD=4.66); N=14.72, (SD=6.42)), content and form of questions asked. A higher frequency of questioning in nurse-led triage was found to be due to nurses’ use of CDSS to guide telephone triage. 89% of nurse questions were oriented to asking patients about their reported symptoms or to wider-information gathering, compared to 54% of GP questions. 43% of GP questions involved eliciting patient concerns or expectations, and obtaining details of medical history, compared to 11% of nurse questions. Nurses using CDSS frequently delivered questions designed as declarative statements requesting confirmation and which typically preferred a ‘no problem’ response. In contrast, GPs asked a higher proportion of interrogative questions designed to request information. Conclusions: Nurses and GPs emphasise different aspects of the clinical assessment process during telephone triage. These different styles of triage have implications for the type of information available following nurse-led or doctor-led triage, and for how patients experience triage

Gated metabolic myocardial imaging, a surrogate for dual perfusion-metabolism imaging by positron emission tomography

Acknowledgments The authors are grateful for the help from Dr H Ali and Dr A Dawson. Funding: This study was performed using a research grant from the Aberdeen Royal Hospitals Trust's Endowment Fund, with further support from the Department of Medical Physics at the University of Aberdeen, for which the authors express their gratitude.Peer reviewedPublisher PD

Competing Explanations for Parallel Conduct: Lessons from the Australian Detergent Case (Colgate-Palmolive)

Parallel conduct by competing firms is an almost unavoidable phenomenon in the real world. Of course, parallel conduct can be the result of completely independent and uncontroversial behaviour, such as when all suppliers are affected by and respond unilaterally to an identical increase in costs. Few would suggest that, in such circumstances, the firms’ conduct should be subject to sanctions. At the other extreme, parallel conduct can be the result of interdependent and deliberately coordinated behaviour, such as when all suppliers meet in the proverbial smoke-filled room and agree to fix prices. Few would hesitate to condemn such conduct under antitrust law or competition policy. But as economists have been telling us for decades, there is a vast middle ground, where the parallel conduct stems from some degree of interdependence and some behaviour short of the hard-core cartel described above. This is especially likely to be the case when the industry is relatively concentrated or oligopolistic in structure and firms have a history of interacting in the marketplace. Understanding the reasons for the parallel behaviour and deciding what to do about it is a central element of modern antitrust law and policy. New forces at work will increase the challenge of distinguishing acceptable and unacceptable parallel conduct. For example, the likely effect of the 2017 revisions to Australia’s Competition and Consumer Act that were intended to increase deterrence of coordinated behaviour will be to bring additional behaviour under antitrust scrutiny and may broaden the grey area of what is permitted and what is not. In addition, use of artificial intelligence such as algorithmic models used in decision making may reinforce interdependence among firms and thus introduce new sources of coordinated behaviour to be evaluated through an antitrust lens. At the end of the day, an understanding of how interdependence and conduct interact will be an essential part of the exercise. This paper is intended to assist in understanding that interaction

Optimising node selection probabilities in multi-hop M/D/1 queuing networks to reduce latency of Tor

In this paper the expected cell latency for multi-hop M/D/1 queuing networks, where users choose nodes randomly according to some distribution, is derived. It is shown that the resulting optimisation surface is convex, and thus gradient based methods can be used to find the optimal node assignment probabilities. This is applied to a typical snapshot of the Tor anonymity network at 50%usage, and leads to a reduction in expected cell latency from 11.7 ms using the original method of assigning node selection probabilities to 1.3 ms. It is also shown that even if the usage is not known exactly, the proposed method still leads to an improvement.This is the accepted manuscript version. The final version is available from IET at http://digital-library.theiet.org/content/journals/10.1049/el.2014.2136

A Tale of Two Cities: From Davids Holdings to Metcash

In 1994, the Full Federal Court upheld the decision of the trial judge to prevent the acquisition of QIW by Davids, on the grounds that, Davids would become the only supplier of groceries to independent retailers in the geographic market. While the independent retailers faced significant competition in the downstream (retail) business from the integrated retail chains, the Court found that such competition would not be sufficient to prevent the exercise of monopoly power in the upstream (wholesale) business. In 2011, the Full Federal Court upheld the decision of the trial judge not to prevent the acquisition by Metcash of Franklins. The acquisition had been opposed by the ACCC on the grounds that it would leave Metcash as effectively the only wholesale supplier of packaged groceries to independent retailers in New South Wales. The Court rejected the Commission’s claim, finding that the merged firm would not be able to exercise market power due to the constraining presence downstream of the integrated retail chains. Two cases with apparently similar facts. What explains the different outcomes? In this article, we try to identify a critical analytical difference in the way that the cases were presented to the Court and will suggest that this difference may have had a significant influence on the outcomes

A Tale of Two Cities: From Davids Holdings to Metcash

In 1994, the Full Federal Court upheld the decision of the trial judge to prevent the acquisition of QIW by Davids, on the grounds that, Davids would become the only supplier of groceries to independent retailers in the geographic market. While the independent retailers faced significant competition in the downstream (retail) business from the integrated retail chains, the Court found that such competition would not be sufficient to prevent the exercise of monopoly power in the upstream (wholesale) business. In 2011, the Full Federal Court upheld the decision of the trial judge not to prevent the acquisition by Metcash of Franklins. The acquisition had been opposed by the ACCC on the grounds that it would leave Metcash as effectively the only wholesale supplier of packaged groceries to independent retailers in New South Wales. The Court rejected the Commission’s claim, finding that the merged firm would not be able to exercise market power due to the constraining presence downstream of the integrated retail chains. Two cases with apparently similar facts. What explains the different outcomes? In this article, we try to identify a critical analytical difference in the way that the cases were presented to the Court and will suggest that this difference may have had a significant influence on the outcomes