Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems.

This article presents an ethnographic study of regulatory decision-making regarding the cost-effectiveness of expensive medicines at the National Institute for Health and Care Excellence (NICE) in England. We explored trust as one important mechanism by which problems of complexity and uncertainty were resolved. Existing studies note the salience of trust for regulatory decisions, by which the appraisal of people becomes a proxy for appraising technologies themselves. Although such (dis)trust in manufacturers was one important influence, we describe a more intricate web of (dis)trust relations also involving various expert advisors, fellow committee members and committee Chairs. Within these complex chains of relations, we found examples of both more blind-acquiescent and more critical-investigative forms of trust as well as, at times, pronounced distrust. Difficulties in overcoming uncertainty through other means obliged trust in some contexts, although not in others. (Dis)trust was constructed through inferences involving abstract systems alongside actors’ oral and written presentations-of-self. Systemic features and ‘forced options’ to trust indicate potential insidious processes of regulatory capture

Development of Trust in an Online Breast Cancer Forum: A Qualitative Study

Background: Online health forums provide peer support for a range of medical conditions, including life-threatening and terminal illnesses. Trust is an important component of peer-to-peer support, although relatively little is known about how trust forms within online health forums. Objective: The aim of this paper is to examine how trust develops and influences sharing among users of an online breast cancer forum. Methods: An interpretive qualitative approach was adopted. Data were collected from forum posts from 135 threads on nine boards on the UK charity, Breast Cancer Care (BCC). Semi-structured interviews were conducted with 14 BCC forum users. Both datasets were analysed thematically using Braun and Clarke’s [2006] approach and combined to triangulate analysis. Results: Trust operates in three dimensions, structural, relational and temporal, which intersect with each other and do not operate in isolation. The structural dimension relates to how the affordances and formal rules of the site affected trust. The relational dimension refers to how trust was necessarily experienced in interactions with other forum users: it emerged within relationships and was a social phenomenon. The temporal dimension relates to how trust changed over time and was influenced by the length of time users spent on the forum. Conclusions: Trust is a process that changes over time, and which is influenced by structural features of the forum and informal but collectively understood relational interactions among forum users. The study provides a better understanding of how the intersecting structural, relational and temporal aspects that support the development of trust facilitate sharing in online environments. These findings will help organisations developing online health forums

The Adapt Study: adaptation of evidence-informed complex population health interventions for implementation and/or re-evaluation in new contexts: protocol for a Delphi consensus exercise to develop guidance.

Introduction: Complex population health interventions that are effective in one context may not be effective elsewhere, and may even be harmful. As such, an intervention may require adaptation to ensure it fits with a new context. To date, there is no overarching guidance to help researchers to adapt and evaluate interventions in new contexts, and no criteria to support research funders or journals assess proposed or reported adaptations or evaluation. There is limited assistance for policy-makers and practitioners to decide if evidence-informed interventions are appropriate to their context, or if adaptation and further evaluation is needed. This Delphi exercise will contribute to the development of guidance for these communities to support the adaptation, implementation and/or re-evaluation of complex population health interventions in new contexts. Methods: We will conduct a Delphi consensus exercise to gather expert opinion from researchers, research funders, journal editors and policy-makers. Expert opinion will be sought on: appropriate definitions and concepts, identifying key methodological considerations and establishing adaptations and processes to be undertaken during adaptation of complex population health interventions in new contexts. Ethics and dissemination: Ethics approval for the Delphi exercise has been obtained from the University of Glasgow and and the RAND institutional research board. Dissemination of the results of this study will be through peer-reviewed publications, workshops at national and international conferences, and a summary of the guidance developed for key organisations and stakeholders

The “Class Ration” and Food Reserves during the Civil War

The article was submitted on 30.11.2020.Рассматривается эволюция системы нормированного снабжения продовольствием в России. Автор акцентирует внимание на таких специфических формах распределения продуктов, существовавших в годы Гражданской войны, как «классовый паек» и бронированное снабжение. Подчеркивается, что карточная система в России действовала уже в годы Первой мировой войны, а практики установления твердых цен на хлеб и обеспечения особыми нормами продовольствия отдельных категорий рабочих начали складываться задолго до прихода к власти большевиков. Характеризуя введение в 1918 г. «классового пайка» в Петрограде, автор полагает, что это начинание в значительной степени было обусловлено попытками власти смягчить нараставший кризис в отношениях большевиков с частью рабочих промышленных предприятий. Несмотря на то, что «классовый паек» доминировал среди принципов распределения продовольствия, его экономическое значение не следует переоценивать – даже лишение «эксплуататоров» продовольствия не могло значительно улучшить питание трудовой части населения. С этой точки зрения введение «классового пайка» имело лишь политическое значение. Продовольственные органы на местах в большинстве случаев оказались не в состоянии выработать понятные критерии, в соответствии с которыми население могло быть разделено на категории. Используя документы из фондов РГАЭ, автор показывает, что свое развитие идея «классового пайка» получила после создания в ноябре 1919 г. специальной Комиссии по снабжению рабочих при Наркомате продовольствия. Образование комиссии стало следствием курса политической власти на централизацию всех сторон жизни советского общества. Получив от правительства чрезвычайные полномочия в деле снабжения населения продовольствием, она ежемесячно формировала списки заводов и фабрик, определяла группы предприятий в различных отраслях экономики. Именно для них в первоочередном порядке происходило бронирование запасов продовольствия с целью обеспечения рабочих. Однако нормы государственного снабжения реализовывались не всегда и были значительно ниже потребностей населения. Отказ от идеи «классового пайка» произошел лишь после принятия декрета 30 апреля 1920 г., декларировавшего переход к новой форме стимулирования рабочих – трудовому пайку.This article examines the evolution of the system of rationed food supplies in Russia. The author focuses on specific forms of food distribution during the Civil War, such as “class rations” and food reserves. At the same time, it is emphasised that a rationing system was already in effect in Russia during World War I, and the practice of fixing prices for bread and providing special food norms for certain categories of workers had begun taking shape long before the Bolsheviks came to power. Describing the introduction in 1918 of the “class ration” in Petrograd, the author proposes that the initiative was largely due to the authorities’ attempts to mitigate the growing crisis between the Bolsheviks and some industrial workers. Although the “class ration” dominated among the principles of food distribution, its economic importance should not be overestimated – even the deprivation of the “exploiters” of food could not significantly improve the nutrition of the working population. From this point of view, the introduction of “class rations” only had political significance. In most cases, the local food authorities failed to develop clear criteria to categorise the population. Using documents from the Russian State Archive of the Economy, the author demonstrates that the idea of “class rations” was developed after the establishment in November 1919 of a special commission for the supply of workers at the People’s Commissariat of Food Industry. The formation of the commission was a consequence of policies meant to centralise all aspects of life in Soviet society. Having received emergency powers from the government in supplying the population with food, the commission formed monthly lists of plants and factories and determined groups of enterprises in various sectors of the economy. As a matter of priority, the reservation of food supplies was made to provide workers. However, the norms of state supply were not always implemented and were significantly lower than the needs of the population. The idea of “class rations” was rejected only after the adoption of a decree on 30 April 1920, which declared the transition to a new form of incentives for workers, labour rations

ADAPT study: adaptation of evidence-informed complex population health interventions for implementation and/or re-evaluation in new contexts: protocol for a Delphi consensus exercise to develop guidance

Introduction Complex population health interventions that are effective in one context may not be effective elsewhere, and may even be harmful. As such, an intervention may require adaptation to ensure it fits with a new context. To date, there is no overarching guidance to help researchers to adapt and evaluate interventions in new contexts, and no criteria to support research funders or journals assess proposed or reported adaptations or evaluation. There is limited assistance for policy-makers and practitioners to decide if evidence-informed interventions are appropriate to their context, or if adaptation and further evaluation is needed. This Delphi exercise will contribute to the development of guidance for these communities to support the adaptation, implementation and/or re-evaluation of complex population health interventions in new contexts. Methods We will conduct a Delphi consensus exercise to gather expert opinion from researchers, research funders, journal editors and policy-makers. Expert opinion will be sought on: appropriate definitions and concepts, identifying key methodological considerations and establishing adaptations and processes to be undertaken during adaptation of complex population health interventions in new contexts. Ethics and dissemination Ethics approval for the Delphi exercise has been obtained from the University of Glasgow and and the RAND institutional research board. Dissemination of the results of this study will be through peer-reviewed publications, workshops at national and international conferences, and a summary of the guidance developed for key organisations and stakeholders

Prioritizing Needs and Outcomes for Adolescent Substance Use Treatment Planning: An Online Modified-Delphi Process

Key stakeholders can have differing views about which information is essential to inform placement decisions for all patients. This study examined consensus across stakeholder groups on the most important individual needs and treatment outcomes for informing decisions specifically about the level of care for an adolescent in substance use treatment. Methods: We conducted an online modified-Delphi process with treatment providers, policymakers, researchers, and parents of adolescents who have received substance use treatment. Participants rated 48 individual needs from the Global Appraisal of Individual Needs–Initial that were mapped onto the 6 dimensions of the American Society of Addiction Medicine Criteria. In addition, participants rated 10 treatment outcomes from the Substance Abuse and Mental Health Services Administration's National Outcome Measures. We assessed consensus within stakeholder groups using the RAND/UCLA Appropriateness Method. We considered the items reaching consensus with the highest ratings across stakeholder groups as the most important individual needs and treatment outcomes. Results: We recruited 194 participants (81 providers, 54 policymakers, 32 researchers, 27 parents). Participants identified suicidality and severity of substance use disorder symptoms as the most important individual needs, and reduction in substance use as the most important treatment outcome. Conclusions: Standardized procedures for matching adolescents to levels of care for substance use treatment should at a minimum be based on assessments of suicidality and severity of substance use disorder symptoms, and consider reduction in substance use as a primary treatment outcome. These findings can progress the development of “level-of-care” decision rules specifically for adolescents

Влияние на поляризацию образцов поливинилхлорида компонентов моторного масла

It has been studied how semi-synthetic motor oil affects the polarization of polyvinyl chloride samples. It has been defined that the oil components influence the process of polyvinyl chloride polarization. We have showed that the input and exhaust motor oil contains polar components which bring to the density growth of the polyvinyl chloride charge being guided by the electric field direction. The injected charges initiate a chemical interaction of oil components. The water higher rate containing in the exhaust oil is reflected in the parameters of charge density of the samples, as well as of the activation energy of the electrically active defects.Изучено влияние на поляризацию образцов поливинилхлорида (ПВХ) полусинтетического моторного масла. Установлено, что компоненты масла оказывают влияние на процессы поляризации ПВХ. Показано, что исходное и работавшее моторное масло содержат полярные компоненты, которые, ориентируясь по направлению электрического поля, приводят к росту плотности заряда ПВХ. Инжектируемые извне заряды инициируют химическое взаимодействие между компонентами масла. Наличие в работавшем моторном масле воды выше нормативных показателей отражается в параметрах как плотности заряда образцов, так и энергии активации электрически активных дефектов

The RAND/PPMD Patient-Centeredness Method: a novel online approach to engaging patients and their representatives in guideline development

Although clinical practice guidelines (CPGs) provide recommendations for how best to treat a typical patient with a given condition, patients and their representatives are not always engaged in CPG development. Despite the agreement that patient participation may improve the quality and utility of CPGs, there is no systematic, scalable method for engaging patients and their representatives, as well as no consensus on what exactly patients and their representatives should be asked to do during CPG development. To address these gaps, an interdisciplinary team of researchers, patient representatives, and clinicians developed the RAND/PPMD Patient-Centeredness Method (RPM) - a novel online approach to engaging patients and their representatives in CPG development. The RPM is an iterative approach that allows patients and their representatives to provide input by (1) generating ideas; (2) rating draft recommendations on two criteria (importance and acceptability); (3) explaining and discussing their ratings with other participants using online, asynchronous, anonymous, moderated discussion boards, and (4) revising their responses if needed. The RPM was designed to be consistent with the RAND/UCLA Appropriateness Method used by clinicians and researchers to develop CPG, while helping patients and their representative rate outcome importance and recommendation acceptability - two key components of the GRADE Evidence to Decision (EtD) framework. With slight modifications, the RPM has the potential to explore consensus among key stakeholders on other dimensions of the EtD, including feasibility, equity, and resource use

Participant Experiences with a New Online Modified-Delphi Approach for Engaging Patients and Caregivers in Developing Clinical Guidelines

Background Patient engagement in clinical practice guideline (CPG) development has increased significantly in recent years. However, only a few patients and caregivers join CPG development groups. Objective To describe participant experiences with a novel online, scalable approach for patient and caregiver engagement in CPG development. Design We developed and tested the RAND/PPMD Patient-Centeredness Method (RPM), a novel online modified-Delphi approach to patient engagement in CPG development that consists of an optional idea generation round and two rating rounds interspersed with an online discussion round. Setting and Participants Using the online ExpertLens™ system, we ran 2 concurrent panels of patients and caregivers of individuals with Duchenne Muscular Dystrophy (DMD). Main Outcome Measures We surveyed all 95 panel participants about their participation and satisfaction with the process. We also conducted telephone interviews with 25 participants. Results Participants expressed satisfaction with various ExpertLens™ features, noting that the system fostered lively interaction among them. Panelists also appreciated participating in an educational, interactive and convenient discussion forum that allowed them to share their opinions on the importance and acceptability of different recommendations. The RPM was viewed as empowering by patients and their caregivers who felt it would be useful for CPG developers. Discussion and Conclusion The results of our study show the overall participant satisfaction with a novel, scalable, online approach to engaging patients and caregivers in CPG development, which allows them to share their perspectives and lived experiences using a rigorous, systematic and iterative way that is similar to how clinicians provide their input

Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the Institute for Health Improvement’s Project JOINTS

Background: A decade ago, the Institute for Healthcare Improvement pioneered a quality improvement (QI) campaign, leveraging organizational and personal social networks to disseminate new practices. There have been few rigorous studies of the QI campaign approach. Methods: Project JOINTS (Joining Organizations IN Tackling SSIs) engaged a network of state-based organizations and professionals in a 6-month QI campaign promoting adherence to three new evidence-based practices known to reduce the risk of infection after joint replacement. We conducted a cluster-randomized trial including ten states (five campaign states and five non-campaign states) with 188 hospitals providing joint replacement to Medicare. We measured adherence to the evidence-based practices before and after the campaign using a survey of surgical staff and a difference-in-difference design with multivariable adjustment to compare adherence to each of the relevant practices and an all-or-none composite measure of the three new practices. Results: In the campaign states, there were statistically significant increases in adherence to the three new evidence-based practices promoted by the campaign. Compared to the non-campaign states, the relative increase in adherence to the three new practices in the campaign states ranged between 1.9 and 15.9 percentage points, but only one of these changes (pre-operative nasal screening for Staphylococcus aureus carriage and decolonization prior to surgery) was statistically significant (p < 0.05). On the all-or-none composite measure, adherence to all three evidence-based practices increased from 19.6 to 37.9% in the campaign states, but declined slightly in the comparison states, yielding a relative increase of 23 percentage points (p = 0.004). In the non-campaign states, changes in adherence were not statistically significant. Conclusions: Within 6 months, in a cluster-randomized trial, a multi-state campaign targeting hospitals and professionals involved in surgical care and infection control was associated with an increase in adherence to evidence-based practices that can reduce surgical site infection. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0579-7) contains supplementary material, which is available to authorized users