When does NICE recommend the use of health technologies within a programme of evidence development?

This article is made available through the Brunel Open Access Publishing Fund. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.This article has been made available through the Brunel Open Access Publishing Fund.Background: There is growing interest internationally in linking reimbursement decisions with recommendations for further research. In the UK, the National Institute for Health and Clinical Excellence (NICE) can issue guidance to approve the routine use of a health intervention, reject routine use or recommend use within a research programme. These latter recommendations have restricted use to ‘only in research’ (OIR) or have recommended further research alongside routine use (‘approval with research’ or AWR). However, it is not currently clear when such recommendations are likely to be made. Objectives: This study aims to identify NICE technology appraisals where OIR or AWR recommendations were made and to examine the key considerations that led to those decisions. Methods: Draft and final guidance including OIR/AWR recommendations were identified. The documents were reviewed to establish the characteristics of the technology appraisal, the cost effectiveness of the technologies, the key considerations that led to the recommendations and the types of research required. Results: In total, 29 final and 31 draft guidance documents included OIR/AWR recommendations up to January 2010. Overall, 86 % of final guidance included OIR recommendations. Of these, the majority were for technologies considered to be cost ineffective (83 %) and the majority of final guidance (66 %) specified the need for further evidence on relative effectiveness. The use of OIR/AWR recommendations is decreasing over time and they have rarely been used in appraisals conducted through the single technology appraisal process. Conclusion: NICE has used its ability to recommend technologies within research programmes, although predominantly within the multiple technology appraisal process. OIR recommendations have been most frequently issued for technologies considered cost ineffective and the most frequently cited consideration is uncertainty related to relative effectiveness. Key considerations cited for most AWR recommendations and some OIR recommendations included a need for further evidence on long-term outcomes and adverse effects of treatment.Medical Research Counci

Engagement and observation: a review of local policies in England and Wales

© 2020, Emerald Publishing Limited. Purpose: The purpose of this paper is to report on the content of local policies on engagement and observation written by National Health Service (NHS) organisations in England and Wales. Design/methodology/approach: Engagement and observation policies were obtained from all (n = 61) NHS mental health trusts in England and health boards in Wales via a Freedom of Information Act 2000 request. Data were analysed using content analysis. Findings: All organisations had a specific policy referring to either “observation and engagement” or “observation”. The policies varied considerably in quality, length, breadth and depth of the information provided. Significant variations existed in the terminology used to describe the different types of enhanced observation. Inconsistencies were also noted between organisations regarding: which members of the clinical team could initiate, increase, decrease and terminate observation; who could undertake the intervention (for example students); and the reasons for using it. Finally, despite rhetoric to the contrary, the emphasis of policies was on observation and not engagement. Research limitations/implications: This research has demonstrated the value of examining local policies for identifying inconsistencies in guidance given to practitioners on the implementation of engagement and observation. Further research should be undertaken to explore the impact of local policies on practice. Practical implications: Local policies remain variable in content and quality and do not reflect contemporary research. There is a need to produce evidence-based national standards that organisations are required to comply with. Originality/value: To the best of the author’s knowledge, this is the first research in 20 years examining the local policy framework for the implementation of engagement and observation

Improving the psychological evaluation of exercise referral: psychometric properties of the Exercise Referral Quality of Life Scale

There is a growing need to assess the psychological outcomes of exercise referral and the National Institute of Health and Care Excellence has called for the routine assessment of life-quality. However, a quality of life scale specific to the requirements of exercise referral is currently unavailable. Therefore, the aim of this study was to produce a quality of life measure for this purpose. The Exercise Referral Quality of Life Scale is a 22-item measure comprising three domains: mental and physical health, injury pain and illness and physical activity facilitators. Exploratory factor analysis determined the initial factor structure and was subsequently confirmed by confirmatory factor analysis. Additional scale properties were also assessed. The scale contributes to the global need for improved consistent psychological outcome assessment of exercise referral

Prescribing opioid analgesics for chronic non-malignant pain in general practice - a survey of attitudes and practice

Background: This study replicates a previous postal survey of general practitioners (GPs) to explore whether attitudes to opioid prescribing have changed at a time when the number of opioid prescriptions issued in primary care has increased. Methods: With permission, a 57-item survey instrument previously utilised with GPs in the South-west of England was circulated to 214 GPs in city-centre practices in the East Midlands. The survey instrument included items relating to practice context, prescribing patterns and attitudes about analgesic medication, perceived prescribing frequency and reluctance to prescribe. Results: Responses were received from 94 GPs (45%). Almost three-quarters (72.7%) of GPs reported that they sometimes or frequently prescribed strong opioids for chronic non-cancer pain. Over two-thirds (67.8%) reported that they were sometimes or frequently reluctant to prescribe strong opioids for chronic non-cancer pain. No significant relationships were observed between perceived frequency of prescribing and a range of demographic factors; however, concerns about ‘physical dependence’, ‘long-term commitment to prescribing’ and ‘media reports’ were associated with less frequent reported prescribing of, and greater reluctance to prescribe, strong opioids. Discussion: Given the national trend for increased opioid prescriptions, it is unsurprising that more frequent self-reported prescribing is reported here; however, increased frequency does not translate into less reluctance about prescribing. The effectiveness of strong opioids for chronic pain is recognised, but concerns about addiction, dependence and misuse inform a reluctance to use strong opioids. These juxtapositions highlight a continued need for clearer understanding of GPs’ perceptions of strong opioids and point to the potential benefit of dedicated guidelines or specialist education and training to address their uncertainties

A midwives guide to Turner Syndrome

Turner syndrome (TS) is a cross-cultural genetic disorder that affects around 1 in 2500 women and is predominately associated with short stature and infertility. Classic TS occurs when one sex chromosome is missing (written as 45,X). In mosaic TS, there is a mix of cells, some with 45 chromosomes—missing one X chromosome, and some with all 46 chromosomes—missing part of the X chromosome. TS is characterised by short stature and non-functioning ovaries, which leads to impaired pubertal development and infertility. The majority of women with TS present with no behavioural or physical attributes that would distinguish them as different to the general population, and can be expected to live long and healthy lives. A midwife may have to care for a woman whose fetus has been diagnosed with TS, recognise and manage a newborn with TS, or manage a woman with TS who is pregnant with a donor ovum. To equip midwives with relevant knowledge, the objectives of this paper are to explain what TS is, how it may be recognised, and discuss medical and midwifery management of events

Prescribing for patients at the end of life

Approximately 550 000 people in the UK die each year, and mortality rates are set to rise. It is anticipated that the annual number of deaths per year in the UK will have increased by 17% by the year 2030. This rise is attributed largely to an aging population. The three main causes of death within the UK are circulatory disease, respiratory disease, and cancer (Office for National Statistics, 2017). The NHS plays a large part in the care of people who are dying; this care includes enabling people to choose where they would like to be in their last days of life. Place of death is particularly important to many people who receive a diagnosis of a terminal condition and research suggests that most people want to die at home—around 63%. Just 28% of people wish to die in a hospice, 8% in hospitals and 1% in nursing or residential care (Help the Hospices et al, 2013). The cost of caring for people at the end of life is financially expensive to the NHS but is indisputably a vital part of the patient and family's journey and the human cost when this is not achieved may be immeasurable. The financial cost to the NHS in the last 90 days of life can vary dependant on the care setting; however, on average, £4500 is spent on hospital stays per person, hospice care is estimated at around £550 per day and the average cost of community nurse visits is estimated at £278 per day (NHS Confederation, 2017)