Reforming the contract of UK consultants

The NHS Plan expressed the intention of government to "fundamentally overhaul" the national contract for UK hospital specialists to "reward and incentivise those who do most for the NHS." How can this be achieved

Challenges for the National Institute for Clinical Excellence

Rationing health care is inevitable, and NICE should inform NHS decision making. Adoption of new technologies by NHS clinicians should be informed by costs as well as effectiveness. The NHS needs better information from NICE on the equity implications of new and existing technologies. NICE appraisal should focus not only on service enhancement but also on withdrawal of existing ineffective or inefficient therapies. Giving NICE a real budget to fund its recommendations would encourage it to examine the effect of its decisions on the whole NHS

The liminality of loneliness: negotiating feminist ethics and intersectional affectivity

This paper draws on auto-ethnographic and creative material to disentangle loneliness as including moments of tension but also the potential for personal liberation. The analysis draws on intersectional reflexivity as a joint project building on feminist friendship and activist academic collaboration. Our collaborative critical auto-ethnography sought to reach the co-production of narratives of loneliness while embracing the diversities of our positionalities. Our differing points of departure and arrival were harnessed to understand our experiential perspectives on loneliness. We conceptualise through feminist and intersectional theories the liminalities of a ‘biopolitics’ of loneliness. We address ethical, affective and performative aspects of how loneliness is understood. We can then advance propositions for alternative analyses that can contribute to feminist studies of loneliness. In the analysis we clarify the often nebulous interconnections of materialisms, affectivities and ethical feminisms to disentangle loneliness from the ‘individual experience’ to a ‘social platform’ of wider collective responsibility in tackling some of its traumatic and destructive effects. We explore these issues in the emerging context of the unprecedented COVID-19 pandemic that has led to far reaching social, psychological, and physical impacts upon loneliness, in turn augmented by UK state policies

Impact of NICE guidance on laparoscopic surgery for inguinal hernias: analysis of interrupted time series

After the introduction of Bassini's procedure in the late 19th century, methods of repairing hernias changed little until the 1990s, when synthetic mesh and laparoscopic methods arrived. In contrast to the open mesh technique, laparoscopic surgery remains uncommon. In January 2001, the National Institute for Clinical Excellence (NICE) issued guidance that stated, "For repair of primary inguinal hernia, open [mesh] should be the preferred surgical procedure." We describe patterns of surgical repair of inguinal hernias and assess the impact of NICE's guidance

Why do people opt-out or not opt-out of automatic enrolment? A focus group study of automatic enrolment into a workplace pension in the United Kingdom

Automatic enrolment (AE) into a workplace pension is an important recent development in pension policy. An important question for this policy is why do people opt-out or not opt-out of AE? This question is important for understanding the power of suggestion associated with AE as well as responding to concerns that women might face undue pressure to opt-out. This article addresses this question through a focus group study into the United Kingdom’s new AE policy. Women were more likely than men to cite lack of affordability as a reason for opting out. Lack of information also seemed important for the power of suggestion associated with AE. Further research should explore how to make AE less gender blind as well as the types of information or advice that should be provided alongside AE

The effect of external inspections on safety in acute hospitals in the National Health Service in England: A controlled interrupted time-series analysis.

Objectives To evaluate the effect of Care Quality Commission external inspections of acute trusts on adverse event rates in the English National Health Service. Methods Interrupted time-series analysis including all acute NHS trusts in England (n = 155) using two control groups (new versus historical inspection regime and trusts not inspected). Multilevel random-coefficient modelling of (1) rates of falls with harm and (2) pressure ulcers, from April 2012 to June 2016, was undertaken using the new, resource-intensive regime of Care Quality Commission inspections as an intervention. Data used in the model included dates and type of inspection, patient safety indicators, demographic characteristics and financial risk of hospitals. Results In one year, Care Quality Commission inspected 66 acute trusts (42% of all English trusts) using their new regime and 46 (30%) using their previous one. Prior to inspections being announced, rates of falls with harm and pressure ulcers were improving in both intervention and control hospitals. The announcement of an inspection did not affect either indicator. After inspections, rates of falls with harm improved more slowly, and pressure ulcer rates no longer improved for trusts inspected using both regimes. Conclusions Neither form of external inspection was associated with positive, clinically significant effects on adverse event rates. Any improvement happening before the announced Care Quality Commission inspections slowed after the inspection

Low temperature exposure induces browning of bone marrow stem cell derived adipocytes in vitro

Brown and beige adipocytes are characterised as expressing the unique mitochondrial uncoupling protein (UCP)1 for which the primary stimulus in vivo is cold exposure. The extent to which cold-induced UCP1 activation can also be achieved in vitro, and therefore perform a comparable cellular function, is unknown. We report an in vitro model to induce adipocyte browning using bone marrow (BM) derived mesenchymal stem cells (MSC), which relies on differentiation at 32 °C instead of 37 °C. The low temperature promoted browning in adipogenic cultures, with increased adipocyte differentiation and upregulation of adipogenic and thermogenic factors, especially UCP1. Cells exhibited enhanced uncoupled respiration and metabolic adaptation. Cold-exposed differentiated cells showed a marked translocation of leptin to adipocyte nuclei, suggesting a previously unknown role for leptin in the browning process. These results indicate that BM-MSC can be driven to forming beige-like adipocytes in vitro by exposure to a reduced temperature. This in vitro model will provide a powerful tool to elucidate the precise role of leptin and related hormones in hitherto functions in the browning process

What young people want from health-related online resources: a focus group study

The growth of the Internet as an information source about health, particularly amongst young people, is well established. The aim of this study was to explore young people's perceptions and experiences of engaging with health-related online content, particularly through social media websites. Between February and July 2011 nine focus groups were facilitated across Scotland with young people aged between 14 and 18 years. Health-related user-generated content seems to be appreciated by young people as a useful, if not always trustworthy, source of accounts of other people's experiences. The reliability and quality of both user-generated content and official factual content about health appear to be concerns for young people, and they employ specialised strategies for negotiating both areas of the online environment. Young people's engagement with health online is a dynamic area for research. Their perceptions and experiences of health-related content seem based on their wider familiarity with the online environment and, as the online environment develops, so too do young people's strategies and conventions for accessing it