VP41 NICE Interventional Procedures Advisory Committee Recommendations

2019 ◽  
Vol 35 (S1) ◽  
pp. 86-87
Author(s):  
Christopher Carroll ◽  
Rumona Dickson ◽  
Angela Boland ◽  
Rachel Houten ◽  
Matthew Walton
Keyword(s):  
Interventional Procedure ◽  
Evidence Base ◽  
Descriptive Statistics ◽  
Regression Analyses ◽  
Clear Trend ◽  
Standard Normal ◽  
Procedure Guidance ◽  
Time Standard ◽  
Positive Recommendation ◽  
Over Time

IntroductionThis study explores the factors (principally evidential) that predict guidance recommendations by this NICE committee. There are three main types of recommendations: Standard/normal arrangements (can be done without restriction in the NHS); Special arrangements (can be done under certain conditions); and Research only.MethodsThe following data were extracted from all published pieces of Interventional Procedure Guidance (IPGs) produced by this committee: year, IPG number, recommendations, evidence base (numbers and types of included studies, numbers of included patients etc.). All data were extracted independently by two researchers, and any disagreements clarified by consensus. Data were tabulated and descriptive statistics produced. Regression analyses will be performed using these data to identify any statistically significant predictors of recommendations.ResultsIPG recommendations (n = 496); year range: 2003-2018. Proportion of IPGs by each recommendation: 50% Standard; 38% Special; 11% Research Only; 2% Do Not Do. Proportion of IPGs with highest level evidence (i.e. systematic review and/or RCT) by recommendation type: Standard = 64% (152/239); Special = 43% (77/180); Research Only = 48% (26/54); Do Not Do = 75% (6/8). Mean numbers of patients by recommendation type: Standard = 7,838; Special = 3,935; Research Only = 2,423. There is also a clear trend over time: Standard recommendations decrease for all IPGs from 63% in 2003-2009 to 40% in 2014-2018; and the evidence threshold for Standard recommendations increases over time from 56% based on systematic reviews and/or RCTs in 2003-2009 to 85% in 2014-2018; mean numbers of patients per Standard recommendation also increase from 2,002 to 6,098 over this period.ConclusionsHigher levels evidence and numbers of patients increase the likelihood of the most positive recommendation. However, this evidence might still lack sufficient quality or certainty to answer a policy question. The evidence threshold to achieve a Standard recommendation has also increased markedly over time. As with other NICE committees, factors other than cost and perceived hierarchies of evidence clearly act as drivers of decisions.

VP22 Applying The IDEAL Framework To NICE Interventional Procedure Guidance

2019 ◽  
Vol 35 (S1) ◽  
pp. 80-81
Author(s):  
Sharika Anjum ◽  
John Powell ◽  
Kevin Harris
Keyword(s):  
Interventional Procedure ◽  
Evidence Base ◽  
Primary Outcome Measure ◽  
Population Characteristics ◽  
Surgical Innovation ◽  
Equity Issues ◽  
Stage 4 ◽  
Procedure Guidance ◽  
Ideal Framework ◽  
The Ideal

IntroductionThe IDEAL (Idea, Development, Exploration, Assessment, Learning) Framework measures the maturity of evidence base behind surgical innovation. The NICE Interventional Procedures (IP) programme issues guidance for the United Kingdom National Health Service (NHS) on use of surgical innovation. One of four recommendations can be made: (a) standard arrangements, (b) special arrangements, (c) research only, and (d) do not use. This study aimed to investigate whether the recommendation of NICE IP guidance corresponded with the stage of innovation as determined by IDEAL, thus IDEAL's role in informing future guidance production.MethodsA retrospective sample of 103 pieces of guidance issued between 2015 and 2018 was analysed. One researcher examined the evidence base and determined the corresponding stage of the IDEAL framework, numbered 1, 2, 2a, 3 and 4. The primary outcome measure was the association between stage of evidence on IDEAL framework and the recommendation of published NICE IP guidance.ResultsThere were twenty-one (20 percent), thirty-three (32 percent), three (3 percent), forty (39 percent) and six (6 percent) procedures at IDEAL stages 1, 2, 2a, 3 and 4, respectively. Of those at stage 1 (idea), 48 percent were given research only arrangements, 43 percent special arrangements, and 10 percent standard. Many of the procedures at stages 2 (development) and 2a (exploration) were given standard arrangements (39 percent and 67 percent respectively). Forty-three percent of stage 3 (assessment) and 67 percent of stage 4 (learning) guidance were identified standard. At stage 4 none were given a ‘research only’ recommendation.ConclusionsProcedures given ‘standard’ arrangements guidance are more likely have a mature and robust evidence base as determined by IDEAL. Those with limited evidence are more likely to be given a more cautious ‘research only’ guidance. Routine use of this framework could help inform future guidance production however cannot replace the decision-making function of the NICE committee which also involves patient experiences, population characteristics, risk of serious safety events, and equity issues.

scholarly journals Introduction to the special issue: multiple jobholding in Europe

2021 ◽  
Vol 27 (2) ◽  
pp. 141-147
Author(s):  
Wieteke Conen ◽  
Karin Schulze Buschoff
Keyword(s):  
Labour Market ◽  
Social Protection ◽  
Special Issue ◽  
Clear Trend ◽  
Policy Makers ◽  
Quality Of Work ◽  
Labour Market Flexibility ◽  
Employment Situation ◽  
Over Time

In a number of European countries there is a clear trend towards increased multiple jobholding. As things stand, however, little is known about the structure and the potential consequences of this increase, notably in terms of quality of work and social protection. This special issue focuses on contemporary forms of multiple jobholding in Europe. Have the structure, nature and dynamics of multiple jobholding changed over time? What are the roles of labour market flexibility, technological change and work fragmentation in the development of multiple jobholding? And do multiple jobholders benefit from similar and adequate employment terms, conditions and protections compared with single jobholders, or are they worse off as a consequence of their (fragmented) employment situation? What implications do these findings have for unions, policy-makers and the regulation of work? The collection of articles in this special issue adds to the literature on emerging forms of employment in the digital age and challenges for social protection, also in light of the COVID-19 pandemic. This introduction initiates a discussion of central debates on multiple jobholding and presents a synopsis of the articles in this issue.

Pioneers in International Administration: A Prosopography of the Directors of the League of Nations Secretariat

2019 ◽  
Vol 13 (2) ◽  
pp. 190-227 ◽  
Author(s):  
Torsten Kahlert
Keyword(s):  
International Organizations ◽  
Large Scale ◽  
Second World War ◽  
League Of Nations ◽  
World War ◽  
Clear Trend ◽  
Organizational Contexts ◽  
Career Trajectories ◽  
Second World ◽  
Over Time

AbstractThis article investigates interwar internationalism from the perspective of the highest personnel of the first large-scale international administration, the League of Nations Secretariat. It applies a prosopographical approach in order to map out the development of the composition of the group of the section directors of the Secretariat over time in terms of its social and cultural characteristics and career trajectories. The analysis of gender, age, nationality, as well as educational and professional backgrounds and careers after their service for the League’s Secretariat gives insight on how this group changed over time and what it tells us about interwar internationalism. I have three key findings to offer in this article: First, the Secretariat was far from being a static organization. On the contrary, the Secretariat’s directors developed in three generations each with distinct characteristics. Second, my analysis demonstrates a clear trend towards professionalization and growing maturity of the administration over time. Third, the careers of the directors show a clear pattern of continuity across the Second World War and beyond. Even though the careers continued in different organizational contexts, the majority of the directors remained closely connected to the world of internationalism of the League, the UN world and its surrounding organizations. On a methodological level, the article offers an example of how prosopographical analysis can be used to study international organizations.

Neighborhood Firearm Victimization Rates and Social Capital Over Time

2015 ◽  
Vol 30 (1) ◽  
pp. 81-96 ◽  
Author(s):  
Justin C. Medina
Keyword(s):  
Social Capital ◽  
Longitudinal Data ◽  
Theoretical Framework ◽  
Policy Planning ◽  
Regression Analyses ◽  
Neighborhood Social Capital ◽  
The Relationship ◽  
The U.S ◽  
Over Time ◽  
Victimization Rates

Distribution of firearm victimization is not equal within cities. Victimization can persistently concentrate in a small number of neighborhoods, while others experience very little violence. Theorists have pointed to one possible explanation as the ability of groups to control violence using social capital. Researchers have shown this association at the U.S. county, state, and national levels. Few studies, however, have examined the relationship between neighborhood social capital and violence over time. This study uses longitudinal data to ask whether neighborhood social capital both predicts and is influenced by firearm victimization over 3 years in Philadelphia. The results of several regression analyses suggest that trusting others and firearm victimization are inversely related over time. Implications for neighborhood policy planning and social capital as a theoretical framework are discussed.

scholarly journals Patient Global Ratings of Change Did Not Adequately Reflect Change Over Time: A Clinical Cohort Study

2014 ◽  
Vol 94 (4) ◽  
pp. 534-542 ◽  
Author(s):  
John S. Schmitt ◽  
J. Haxby Abbott
Keyword(s):  
Clinical Practice ◽  
Physical Therapy ◽  
Computerized Adaptive Testing ◽  
Recall Period ◽  
Regression Analyses ◽  
Change Over Time ◽  
Study Objective ◽  
Global Ratings ◽  
Discharge Status ◽  
Over Time

BackgroundGlobal ratings of change (GROCs) are commonly used in research and clinical practice to determine which patients respond to therapy, but their validity as a criterion for change has not been firmly established. One factor related to their validity is the length of the recall period.ObjectiveThe study objective was to examine the influence of the length of the recall period on the validity of a GROC for determining true change over time in the clinical setting.DesignThis was a longitudinal, single-cohort observational study.MethodsData from the Focus on Therapeutic Outcomes clinical database were collected for 8,955 patients reporting for physical therapy treatment of a knee disorder. Computerized adaptive testing was used to assess knee functional status (FS) at the initial and final (discharge) physical therapy visits. Each patient's GROC was obtained at discharge. Correlation and linear regression analyses of knee FS and GROC, stratified by length of time between intake and discharge, were conducted.ResultsCorrelations of GROC with knee FS change scores were modest even for the shortest period of recall (0–30 days) and were slightly lower for longer recall periods. Regression analyses using knee FS to predict GROC scores revealed similar findings. Correlations of GROC with intake and discharge scores indicated a strong bias toward discharge status, with little or no influence of baseline status. Standardized regression coefficients fitted the pattern expected for a valid measure of change but confirmed the strong bias toward discharge status.LimitationsOne version of the GROC administered serially in a cohort of patients seen in clinical practice was examined.ConclusionsThese results call into question the validity of GROCs for measuring change over time in routine clinical practice.

scholarly journals Three Evidence Based Methods to Compensate for a Lack of Subject Background when Ordering Chemistry Monographs

2008 ◽  
Vol 3 (3) ◽  
pp. 3
Author(s):  
Robert A. Wright
Keyword(s):  
Statistical Analysis ◽  
Statistical Significance ◽  
Evidence Base ◽  
Circulation Rate ◽  
Evidence Based ◽  
Practical Application ◽  
Present Evidence ◽  
Library System ◽  
Over Time ◽  
Selection Of

Objective – The aim of this article is to present evidence based methods for the selection of chemistry monographs, particularly for librarians lacking a background in chemistry. These methods will be described in detail, their practical application illustrated, and their efficacy tested by analyzing circulation data. Methods – Two hundred and ninety-five chemistry monographs were selected between 2005 and 2007 using rigorously-applied evidence based methods involving the Library's integrated library system (ILS), Google, and SciFinder Scholar. The average circulation rate of this group of monographs was compared to the average circulation rate of 254 chemistry monographs selected between 2002 and 2004 when the methods were not used or were in an incomplete state of development. Results – Circulations/month were on average 9% greater in the cohort of monographs selected with the rigorously-applied evidence based methods. Further statistical analysis, however, finds that this result can not be attributed to the different application of these methods. Conclusion – The methods discussed in this article appear to provide an evidence base for the selection of chemistry monographs, but their application does not change circulation rates in a statistically significant way. Further research is needed to determine if this lack of statistical significance is real or a product of the organic development and application of these methods over time, making definitive comparisons difficult.

scholarly journals Multimorbidity of chronic non-communicable diseases: burden, care provision and outcomes over time among patients attending chronic outpatient medical care in Bahir Dar, Ethiopia—a mixed methods study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e051107 ◽  
Author(s):  
Fantu Abebe Eyowas ◽  
Marguerite Schneider ◽  
Shitaye Alemu ◽  
Fentie Ambaw Getahun
Keyword(s):  
Quantitative Study ◽  
Qualitative Data ◽  
Premature Mortality ◽  
Evidence Base ◽  
Communicable Diseases ◽  
Bahir Dar ◽  
Multiple Sources ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Over Time

IntroductionMultimorbidity refers to the presence of two or more chronic non-communicable diseases (NCDs) in a given individual. It is associated with premature mortality, lower quality of life (QoL) and greater use of healthcare resources. The burden of multimorbidity could be huge in the low and middle-income countries (LMICs), including Ethiopia. However, there is limited evidence on the magnitude of multimorbidity, associated risk factors and its effect on QoL and functionality. In addition, the evidence base on the way health systems are organised to manage patients with multimorbidity is sparse. The knowledge gleaned from this study could have a timely and significant impact on the prevention, management and survival of patients with NCD multimorbidity in Ethiopia and in LMICs at large.Methods and analysisThis study has three phases: (1) a cross-sectional quantitative study to determine the magnitude of NCD multimorbidity and its effect on QoL and functionality, (2) a qualitative study to explore organisation of care for patients with multimorbidity, and (3) a longitudinal quantitative study to investigate disease progression and patient outcomes over time. A total of 1440 patients (≥40 years) on chronic care follow-up will be enrolled from different facilities for the quantitative studies. The quantitative data will be collected from multiple sources using the KoBo Toolbox software and analysed by STATA V.16. Multiple case study designs will be employed to collect the qualitative data. The qualitative data will be coded and analysed by Open Code software thematically.Ethics and disseminationEthical clearance has been obtained from the College of Medicine and Health Sciences, Bahir Dar University (protocol number 003/2021). Subjects who provide written consent will be recruited in the study. Confidentiality of data will be strictly maintained. Findings will be disseminated through publications in peer-reviewed journals and conference presentations.

scholarly journals Do aggression and impulsivity dominate dark triad across genders?

2020 ◽  
Author(s):  
Anupriya Singh ◽  
Aisha Naeem ◽  
Komal Chandiramani
Keyword(s):  
Gender Differences ◽  
Standard Deviation ◽  
Pearson Correlation ◽  
Correlation Method ◽  
Dark Triad ◽  
T Test ◽  
Descriptive Statistics ◽  
Regression Analyses ◽  
Future Directions ◽  
Significant Relationships

The study investigated gender differences in Overall Dark Triad (Machiavellianism, Narcissism, and Psychopathy), Aggression, Impulsivity, and impact of Dark triad on Aggression and Impulsivity. Data was collected from 214 young adults. Analyses was done using descriptive statistics (mean and standard deviation). T-test was employed to analyze gender differences. Pearson Correlation Method and Multiple regression were used to assess the relation and prediction amongst the variables, respectively. T-test suggested significant gender differences in Machiavellianism, Psychopathy, and Overall Dark Triad, with females scoring high than males. No gender difference was observed in Aggression and Impulsivity. Correlation and regression analyses revealed several significant relationships between the above constructs. The research was concluded by briefly foregrounding some of the study’s implications and future directions.

Heart and ____ or Give and ____? An Exploration of Variables That Influence Binomial Completion for Individuals With and Without Aphasia

2018 ◽  
Vol 27 (2) ◽  
pp. 819-826 ◽  
Author(s):  
Catherine Torrington Eaton ◽  
Rochelle S. Newman
Keyword(s):  
Reaction Time ◽  
Interdisciplinary Research ◽  
Evidence Base ◽  
Linguistic Variables ◽  
Regression Analyses ◽  
Communication Disorder ◽  
Grammatical Category ◽  
Response Options ◽  
Independent Variables ◽  
Level Of Difficulty

Purpose The goal of this research was to institute an evidence base behind commonly used elicitation materials known as binomials (e.g., “day and night”) that are commonly used for persons with aphasia (PWAs). The study explored a number of linguistic variables that could influence successful binomial completion in nonaphasic adults and PWAs. Method Thirty nonaphasic adults and 11 PWAs were asked to verbally complete 128 binomials; responses were scored by accuracy and reaction time. Binomials were coded according to the following independent variables: frequency of usage, phonological (e.g., alliteration, rhyme) and semantic (i.e., antonymy) relationships, grammatical category of the response, and number of plausible binomial completions. Results Regression analyses demonstrated that, for both groups, greater accuracy was predicted by presence of antonymy and absence of a phonological relationship. Though reaction time models differed between groups, items that elicited a greater number of response options led to longer latencies across participants. Conclusion Findings suggest that clinicians consider antonymy as well as the number of plausible responses for a given prompt when adapting the level of difficulty for their clients. Results also contribute to broader interdisciplinary research on how automatic language is processed in adults with and without neurogenic communication disorder. Supplemental Material https://doi.org/10.23641/asha.6030806

Abstract 14266: Management of Spontaneous Coronary Artery Dissection: Trends Over Time

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Elliot Fitzsimmons ◽  
Elizabeth Thompson ◽  
Robert L Wilensky ◽  
Clare McCarthy ◽  
Jennifer Lewey
Keyword(s):  
Coronary Artery ◽  
Beta Blockers ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Clear Trend ◽  
Event Time ◽  
Trends Over Time ◽  
Over Time

Introduction: Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of ACS that preferentially impacts young women. Increasing evidence suggests that patients with SCAD do well with a conservative approach, as intramural hematoma frequently resolves with medical management and complications from PCI are common. Our objective is to describe changes in management of SCAD over time at the University of Pennsylvania Health System (UPHS). Methods: We conducted a retrospective cohort study among patients treated within UPHS from 2005-2019. We identified all patients in the electronic health record with SCAD using ICD-9 (414.12) and ICD-10 (I25.42) codes. Charts were manually reviewed and indexed by date of SCAD event. Time categories were calculated by tertiles of patients. Since the first tertile spanned 21 years, this category was subdivided. The most recent time period represents practice after the AHA Scientific Statement on SCAD was published. Cochran-Armitage trend tests compared trends over time. Results: We identified 140 patients with SCAD. In this cohort, 43% of patients treated from 1993-2005 were managed conservatively, compared to 89% of patients treated in 2018-2019, while 57% of patients treated from 1993-2005 were managed invasively, compared to 11% of patients treated in 2018-2019, p<0.001 for trend over time (Figure). Between 1993-2005 and 2018-2019, the use of DAPT increased from 40% to 80% (p<0.001 for trend) and use of statins increased from 60% to 85% (p=0.021 for trend). Beta blocker use remained stable (80% vs. 89%, p=0.401) and ACEi/ARB use varied considerably without a clear trend over time (p=0.553). Conclusions: The proportion of patients with SCAD managed conservatively has steadily increased since 2015. This trend corresponds to the increased understanding of clinical outcomes of this patient population. Medical treatment has changed over time and most patients are treated with DAPT, statins, and beta blockers.

Sign in / Sign up

Export Citation Format

Share Document