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1.
Br J Clin Pharmacol ; 84(10): 2175-2177, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29923203

RESUMO

The UK's Life Sciences Strategy provides UK clinical pharmacologists with a unique opportunity to enhance the impact of their discipline on patients and the NHS as well as the pharmaceutical industry. The full benefits of electronic prescribing systems, supported by artificial intelligence, will require clinical pharmacological expertise. Similarly, the Strategy's support for 'healthy ageing' will only be realized if clinical pharmacologists are able to use their expertise in promoting the safe and effective use of medicines in older people. Furthermore, their needs to be an active - and continuing - collaboration between clinical pharmacologists in the NHS and the pharmaceutical industry in general as well as with the discipline of pharmaceutical medicine.


Assuntos
Disciplinas das Ciências Biológicas/organização & administração , Colaboração Intersetorial , Farmacologia Clínica/organização & administração , Medicina Estatal/organização & administração , Indústria Farmacêutica/organização & administração , Envelhecimento Saudável , Humanos , Reino Unido
2.
Eur Heart J ; 38(21): 1632-1637, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-28329235

RESUMO

Evidence generated from randomized controlled trials forms the foundation of cardiovascular therapeutics and has led to the adoption of numerous drugs and devices that prolong survival and reduce morbidity, as well as the avoidance of interventions that have been shown to be ineffective or even unsafe. Many aspects of cardiovascular research have evolved considerably since the first randomized trials in cardiology were conducted. In order to be large enough to provide reliable evidence about effects on major outcomes, cardiovascular trials may now involve thousands of patients recruited from hundreds of clinical sites in many different countries. Costly infrastructure has developed to meet the increasingly complex organizational and operational requirements of these clinical trials. Concerns have been raised that this approach is unsustainable, inhibiting the reliable evaluation of new and existing treatments, to the detriment of patient care. These issues were considered by patients, regulators, funders, and trialists at a meeting of the European Society of Cardiology Cardiovascular Roundtable in October 2015. This paper summarizes the key insights and discussions from the workshop, highlights subsequent progress, and identifies next steps to produce meaningful change in the conduct of cardiovascular clinical research.


Assuntos
Cardiologia/normas , Guias de Prática Clínica como Assunto , Saúde Pública/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Cardiologia/educação , Cardiologia/ética , Difusão de Inovações , Revelação , Humanos , Consentimento Livre e Esclarecido , Segurança do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Medição de Risco
4.
BMJ Open ; 6(2): e009070, 2016 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-26908513

RESUMO

OBJECTIVES: The prevalence of Huntington's disease (HD) recorded in the UK primary care records has increased twofold between 1990 and 2010. This investigation was undertaken to assess whether this might be due to an increased incidence. We have also undertaken a systematic review of published estimates of the incidence of HD. SETTING: Incident patients with a new diagnosis of HD were identified from the primary care records of the Clinical Practice Research Datalink (CPRD). The systematic review included all published estimates of the incidence of HD in defined populations. PARTICIPANTS: A total of 393 incident cases of HD were identified from the CPRD database between 1990 and 2010 from a total population of 9,282,126 persons. PRIMARY AND SECONDARY OUTCOME MEASURES: The incidence of HD per million person-years was estimated. From the systematic review, the extent of heterogeneity of published estimates of the incidence of HD was examined using the I(2) statistic. RESULTS: The data showed that the incidence of HD has remained constant between 1990 and 2010 with an overall rate of 7.2 (95% CI 6.5 to 7.9) per million person-years. The systematic review identified 14 independent estimates of incidence with substantial heterogeneity and consistently lower rates reported in studies from East Asia compared with those from Australia, North America and some--though not all--those from Europe. Differences in incidence estimates did not appear to be explained solely by differences in case ascertainment or diagnostic methods. CONCLUSIONS: The rise in the prevalence of diagnosed HD in the UK, between 1990 and 2010, cannot be attributed to an increase in incidence. Globally, estimates of the incidence of HD show evidence of substantial heterogeneity with consistently lower rates in East Asia and parts of Europe. Modifiers may play an important role in determining the vulnerability of different populations to expansions of the HD allele.


Assuntos
Doença de Huntington/epidemiologia , Adulto , Idade de Início , Registros Eletrônicos de Saúde , Humanos , Incidência , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde , Reino Unido/epidemiologia
5.
Neuroepidemiology ; 46(2): 144-53, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26824438

RESUMO

BACKGROUND: Reviews of the epidemiology of Huntington's disease (HD) suggest that its worldwide prevalence varies widely. This review was undertaken to confirm these observations, to assess the extent to which differences in case-ascertainment and/or diagnosis might be responsible, and to investigate whether the prevalence pattern has changed over the past 50 years. METHODS: Eighty two relevant studies were identified from Medline and Embase, previous reviews, scrutiny of references from included and excluded studies and enquiry among those interested in the field. RESULTS: The lowest rates were among the Asians and the highest among the Caucasians. The differences are not fully explained by varying approaches to case-ascertainment or diagnosis. There was evidence of an increasing prevalence of between 15 and 20% per decade in studies from Australia, North America and Western Europe. CONCLUSIONS: The prevalence of HD varies more than tenfold between different geographical regions. This variation can in part be attributed to differences in case-ascertainment and/or diagnostic criteria, but there is consistent evidence of a lower incidence in Asian populations. There is also evidence that in Australia, North America and in Western Europe (including the United Kingdom), prevalence has increased over the past 50 plus years.


Assuntos
Doença de Huntington/epidemiologia , Saúde Global , Humanos , Prevalência
6.
J R Soc Med ; 108(6): 211-9, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26085559

RESUMO

The National Institute for Clinical Excellence was established in 1999. Its original remit was to undertake technology appraisals of (mainly) new interventions and to develop clinical guidelines. In providing both forms of guidance, it was required to take into account both clinical and cost effectiveness. After a difficult first few months, it gained the confidence and trust of the professions. It subsequently gained additional responsibilities with a commensurate increase in its staffing and budget. It is, moreover, the only one of the National Health Service organisations established in the late 1990s and early 2000s to have not only survived but grown. This paper describes not only the National Institute for Clinical Excellence's early years but also, in the author's view, the features of its guidance programmes that led to its success and (in retrospect) some things it could have done differently.


Assuntos
Análise Custo-Benefício , Guias de Prática Clínica como Assunto , Avaliação da Tecnologia Biomédica , Humanos , Medicina Estatal , Reino Unido
11.
Int J Technol Assess Health Care ; 30(2): 233-8, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24774475

RESUMO

BACKGROUND: The evidence supporting the use of new, or established, interventions may be derived from either (or both) experimental or observational study designs. Although a rigorous examination of the evidence base for clinical and cost-effectiveness is essential, it is never sufficient, and those undertaking a health technology assessment (HTA) also have to exercise judgments. METHODS: The basis for this discussion is largely from the author's experience as chairman of the national Institute for Health and Clinical Excellence (NICE). RESULTS: The judgments necessary for HTA to make are twofold. Scientific judgments relate to the interpretation of the science. Social value judgments are concerned with the ethical principles, preferences, culture, and aspirations of society. CONCLUSIONS: How scientific and social value judgments might be most appropriately captured is a challenge for all HTA agencies. Although competent HTA bodies should be able to exercise scientific judgments they have no legitimacy to impose their own social values. These must ultimately be informed by the general public.


Assuntos
Tomada de Decisões , Medicina Baseada em Evidências , Avaliação da Tecnologia Biomédica/métodos , Análise Custo-Benefício , Julgamento , Estudos Observacionais como Assunto , Valores Sociais
12.
14.
Expert Rev Clin Pharmacol ; 7(2): 105-7, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24450446

RESUMO

Clinical pharmacologists have three distinct contributions to make in the economic evaluation of new and existing pharmaceutical products: they should play a significant role in promoting the principles of "opportunity costs" in healthcare; they need to have a broad understanding of the methodology of economic evaluation in healthcare; they have a critical role in bringing their specialist knowledge, skills and experience in decision-making. In fulfilling these essential roles clinical pharmacologists may find themselves outside their conventional "comfort zones". Nevertheless, clinical pharmacologists need to rise to the occasion if they are to meet their obligations to patients and to society as a whole.


Assuntos
Tomada de Decisões Gerenciais , Farmacoeconomia/organização & administração , Farmacologia Clínica/métodos , Desenho de Drogas , Humanos , Preparações Farmacêuticas/economia
15.
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