Search PubMed⌕ Search

Biomedical subjects

Michael D Rawlins

Publications and source records attributed to Michael D Rawlins.

13 recordsLinked to original sources
PubMed2005

Quality, innovation, and value for money: NICE and the British National Health Service.

The National Institute for Health and Clinical Excellence (NICE) was established as a part of the British National Health Service in 1999 to set standards for the adoption of new health care technologies and the management of specific conditions. In doing so it was required explicitly to take into account both clinical effectiveness and cost-effectiveness. This article describes how NICE has responded to the challenge and considers whether its experience of balancing quality, innovation, and value for money holds policy lessons for the United States.

Academies and Institutes↗
PubMed2002

Dose-response relationships between individual nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDs) and serious upper gastrointestinal bleeding: a meta-analysis based on individual patient data.

AIMS: To define by amalgamation of data obtained in contemporaneous case-control studies, the risks associated with individual nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDs) according to doses used. METHODS: Meta-analysis of individual patient data from three retrospective case-control studies using similar data collection protocols was carried out in hospitals in Catalonia, England, Scotland and Sweden. 2472 cases of upper gastrointestinal bleeding and 5877 controls were studied. Main outcome measures were risks associated with individual NANSAIDs according to dose used and the period of time for which they were given. RESULTS: Ibuprofen showed the lowest odds ratio (OR = 1.7; 95% confidence interval 1.1, 2.5), followed by diclofenac (4.9; 3.3, 7.1), indomethacin (6.0; 3.6, 10.0), naproxen (9.1; 6.0-13.7), piroxicam (13.1; 7.9-21.8) and ketoprofen (34.9; 12.7, 96.5). Striking dose-response relationships were seen with four to eight-fold increases in risk within conventionally used dose ranges for all except ketoprofen, where numbers were too few to allow dose analysis. Across the class, risk was highest during the first week of use (11.7; 6.5, 21.0), decreased thereafter with continuing use (5.6; 4.6, 7.0), and fell to 3.2 (2.1, 5.1) 1 week after discontinuing use. Concurrent use of more than one NANSAID substantially increased risk. CONCLUSIONS: The risk of upper gastrointestinal bleeding with NANSAIDs varies twenty-fold depending on the drug, and by three to seven-fold depending on the dose chosen. Risk is maximal during the first week and decreases thereafter. Paracetamol (acetaminophen) is not associated with upper gastrointestinal bleeding at any dose and should be the first-line analgesic wherever possible.

Aged↗
PubMedDate not supplied

5 NICE years.

Explore the source record for details and available documents.

Advisory Committees↗
PubMedDate not supplied

Pharmacopolitics and deliberative democracy.

Setting priorities in healthcare has become a highly politicised activity. Traditionally it has been undertaken by government and the health professions but there is an increasing imperative to involve the public. The National Institute for Health and Clinical Excellence (NICE) has established a Citizens' Council as an attempt to capture the informed views of the public in shaping the Institute's social value judgements. Although, in the future, better ways of involving the public may emerge, NICE's approach represents one way in which ordinary citizens can engage in the process of prioritising healthcare.

Community Participation↗