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Episode 192: ADHD Treatment.  Jordan Redden (MSIV) explains the treatment of ADHD. Dr. Bustamante adds input about pharmacologic and non-pharmacologic treatments. Dr. Arreaza shares the how stimulants were discovered as the treatment for ADHD. Written by Jordan Redden, MSIV, Ross University School of Medicine. Comments and edits by Isabelo Bustamante, MD, and Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction.ADHD is a chronic neurodevelopmental condition characterized by inattention, impulsivity, and/or hyperactivity. While it's often diagnosed in childhood, symptoms can persist well in adulthood. The treatment for ADHD is multifaceted. It often includes medication, behavioral therapy, environmental modifications, and sometimes educational interventions which are especially effective in younger patients. Ongoing evaluation is needed during treatment. Treatment needs adjustments over time.Starting with medications: Stimulants are the most well-studied and effective pharmacologic treatment for ADHD. These include methylphenidate-based medications such as Ritalin, Concerta, and Focalin, and amphetamine-based options, like Adderall, Vyvanse, and Dexedrine. Discovery of stimulants for ADHD> Dr. Charles Bradley discovered stimulants as the treatment for ADHD around 1937. ADHD did not have a name at that time, but it was known that some children had behavioral problems related to poor attention and inability to control their impulses, but they were still intelligent. Dr. Bradley was a psychiatrist who was working in the Bradley Hospital (Rhode Island), he was studying these children and, as part of his experiments, they developed severe headaches. He gave “Benzedrine” (a decongestant) to his pediatric patients to treat severe headaches, and he discovered that Benzedrine improved academic performance and interest in school and improved disruptive behavior in some children.How do stimulants work.Stimulants work primarily by increasing dopamine and norepinephrine levels in the brain, which helps improve focus, attention span, and impulse control. They typically show a rapid onset of action and can lead to noticeable improvements within the first few days of use. Dosing is individualized and should start low with gradual titration. Side effects can include reduced appetite, insomnia, headaches, increased heart rate, and emotional lability.Types of stimulants. Stimulants come as short acting and long acting. They can come as a tablet, liquid, patch, or orally disintegrating tablet. After the discovery of Benzedrine as a possible treatment for ADHD, more research was done over the years, and Ritalin became the first FDA-approved medication for ADHD (1955). The list of medications may seem overwhelming, but there are only two types of stimulants used to treat ADHD: methylphenidate and amphetamine. Long-acting stimulant medications are often preferred for their consistent symptom control and lower potential for misuse. Vyvanse (lis-dexa-mfetamine) is a widely used long-acting amphetamine-based option. As a prodrug, it remains inactive until metabolized in the body, which results in a smoother onset and offset of action and may reduce the risk of abuse. This extended duration of effect can help patients maintain focus and regulate impulses throughout the day without the peaks and crashes sometimes seen with shorter-acting formulations. Of note, Vyvanse is also approved for Binge Eating Disorder. Many of these medications are Schedule II controlled substances, so to prescribe them you need a DEA license. Other long-acting options include Concerta, an extended-release methylphenidate, as well as extended-release versions of Adderall and Focalin. These are especially helpful for school-aged children who benefit from once-daily dosing, and for adults who need sustained attention during work or academic activities. The choice between short- and long-acting stimulants depends on individual response, side effect tolerance, and daily routine.For patients who cannot tolerate stimulants, or for those with contraindications such as a history of substance misuse or certain cardiac conditions, non-stimulant medications are an alternative. One of the most used is atomoxetine, which inhibits the presynaptic norepinephrine transporter (NET). This leads to increased levels of norepinephrine (and to a lesser extent dopamine). Guanfacine or clonidine are alpha-2A adrenergic receptor agonists that lead to reduced sympathetic outflow and enhanced prefrontal cortical function, improving attention and impulse control. These alpha agonists are particularly useful in younger children with significant hyperactivity or sleep disturbances.Non-pharmacologic treatments.Behavioral therapy before age 6 is the first choice, after that, medications are more effective than BH only, and as adults again you use CBT.Medication is often just one part of a broader treatment plan. Behavioral therapy, especially in children, plays a critical role. Parent-training programs, positive reinforcement systems, and structured routines can significantly improve functioning. And for adolescents and adults, cognitive-behavioral therapy (CBT) is particularly helpful. CBT can address issues like procrastination, time management, emotional regulation, and self-esteem which are areas that medication doesn't always touch.Using medications for ADHD can be faced with resistance by parents, and even children. There is stigma and misconceptions about mental health, there may be concerns about side effects, fear of addiction, negative past experiences, and some parents prefer to treat ADHD the “natural” way without medications or only with supplements. All those concerns are valid. Starting a medication for ADHD is the first line of treatment in children who are 6 years and older, but it requires a shared decision with parents and patients. Cardiac side effects are possible with stimulants. EKG may be needed before starting stimulants, but it is not required. Get a personal and family cardiac history, including a solid ROS. Benefits include control of current condition and treating comorbid conditions.The presentation of ADHD changes as the person goes through different stages of life. For example, you may have severe hyperactivity in your school years, but that hyperactivity improves during adolescence and impulsivity worsens. It varies among sexes too. Women tend to present as inattentive, and men tend to be more hyperactive. ADHD is often underdiagnosed in adults, yet it can significantly impact job performance, relationships, and mental health. In adults, we often use long-acting stimulants to minimize the potential for misuse. And psychotherapy, particularly CBT or executive functioning coaching, can be life-changing when combined with pharmacologic treatment. There are several populations where treatment must be tailored carefully such as pregnant patients, individuals with co-occurring anxiety or depression, and those with a history of substance use. For example, atomoxetine may be preferred in patients with a history of substance misuse. And in children with coexisting oppositional defiant disorder, combined behavioral and pharmacologic therapy is usually more effective than either approach alone.Comorbid conditions.Depression and anxiety can be comorbid, and they can also mimic ADHD. Consult your DSM-5 to clarify what you are treating, ADHD vs depression/anxiety.Treatment goes beyond the clinic. For school-aged children, we often work closely with schools to implement 504 plans or Individualized Education Programs (IEPs) that provide classroom accommodations. Adults may also benefit from workplace strategies like structured schedules, noise-reducing headphones, or even coaching support. Ongoing monitoring is absolutely essential. We assess side effects of medication, adherence, and symptom control. ***In children, we also monitor growth and sleep patterns. We often use validated rating scales, like the Vanderbilt questionnaire for children 6–12 (collect answers from two settings) or Conners questionnaires (collect from clinician, parents and teachers), to track progress. And shared decision-making with patients and families is key throughout the treatment process.To summarize, ADHD is a chronic but manageable condition. Effective treatment usually involves a combination of medication and behavioral interventions, tailored to the individual's needs. And early diagnosis and treatment can significantly improve quality of life academically, socially, and emotionally.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text rev. (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022. CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder). Understanding ADHD. Accessed May 2025. https://chadd.org National Institute for Health and Care Excellence (NICE). Attention Deficit Hyperactivity Disorder: Diagnosis and Management. NICE guideline [NG87]. Updated March 2018. Accessed May 2025. https://www.nice.org.uk/guidance/ng87 Pliszka SR; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(7):894–921. doi:10.1097/chi.0b013e318054e724 Subcommittee on Children and Adolescents with Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019;144(4):e20192528. doi:10.1542/peds.2019-2528 Texas Children's Hospital. ADHD Provider Toolkit. Baylor College of Medicine. Accessed May 2025. https://www.bcm.edu Wolraich ML, Hagan JF Jr, Allan C, et al. Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis. UpToDate. Published 2024. Accessed May 2025.https://www.uptodate.comThe History of ADHD and Its Treatments, https://www.additudemag.com/history-of-adhd/Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

With the help of the FSU, a former Royal Marine who served in Iraq has been cleared of publishing threatening material with intent to stir up racial hatred – in reality, a 12-minute Facebook video urging people to stage peaceful protests about illegal immigration. Jamie Michael, an FSU member, was unanimously acquitted by a jury at Merthyr Tydfil Crown Court in just 17 minutes. The story was reported this week in The Telegraph. We paid his legal fees and arranged for him to be represented by solicitor Luke Gittos and barrister Adam King. Prosecutors claimed his language was “unrelentingly negative” towards immigrants, but his defence made clear that it was directed only at those who are “illegal, unchecked or radicalised”. The jury reached its verdict in 17 minutes, less time than it took to hear the prosecution's opening arguments. FSU General Secretary Toby Young has written to the Chief Constable of Greater Manchester Police (GMP) on behalf of the FSU protesting its decision to release the name and street address of the man who was arrested on Monday for publicly burning the Koran. In the letter, Toby tells the Chief Constable: “As you must know, demonstrations involving damage to or the destruction of a Koran have been responded to with violence of the most serious kind. Just last week, an Iraqi man named Salwab Momika was murdered in Sweden after he burnt a Koran”. Meanwhile, Angela Rayner, in her role as communities secretary, is planning a new council on ‘Islamophobia' and lining up ex-Tory attorney-general Dominic Grieve to chair it, according to The Telegraph. The 16-strong body will draw up an official government definition of Islamophobia. In 2018 Mr Grieve wrote a foreword to the report by the All-Party Parliamentary Group (APPG) on British Muslims which set out the controversial definition of Islamophobia later adopted by the Labour Party when it was in opposition. This definition has been widely criticised – including in a Free Speech Union briefing – for being far too broad and labelling perfectly legitimate criticisms of Islam ‘Islamophobic'. We end with a report that NHS staff have been told not to call people “obese” in an inclusive language guide produced by the medicines watchdog, the National Institute for Health and Care Excellence (NICE). The guide, reported in The Telegraph, instructs medical workers to describe the badly overweight as “people with obesity”. It also warns against using “diabetic”, and “alcoholic” rather than “people with diabetes” and “people who are dependent on alcohol”. ‘That's Debatable!'  is edited by Jason Clift.

The first drugs to slow Alzheimer's progression have been making headlines around the world. For researchers in the field, the arrival of these two therapies called Lecanemab and Donanemab is testament to decades of advancements in the field of Alzheimer's research because for the first time they go further than modifying the symptoms and have been shown in trials to slow down cognitive decline. For patients and families these treatments offer hope that the amount of quality time they'll have together could be lengthened. Around the world regulatory bodies are weighing up their effectiveness, safety and cost. In the UK by the Medicines and Healthcare products Regulatory Agency (MHRA) has approved Lecanemab and Donanemab for use but the National Institute for Health and Care Excellence (NICE) rejected them for use in the NHS on the basis the benefit to patients did not outweight the cost, although they could still be available privately.Presenter James Gallagher examines the decision with Professor of Public Health Carol Brayne from the University of Cambridge and neuroscientist Professor Tara Spires-Jones from the University of Edinburgh. Then, looking forward, he meets scientists searching for future treatments including Dr Emma Mead, chief scientist at the Alzheimer's UK Drug Discovery Institute at the University of Oxford, Dr Ashvini Keshavan, co-lead of University College London's ADAPT blood biomarker trial, Selina Wray, Professor of Molecular Neuroscience and Alzheimer's Research UK Senior Research Fellow at University College London, and UK Dementia Research Institute Emerging Leader Dr Claire Durrant.This programme was produced in partnership with The Open University.Presenter: James Gallagher Producer: Tom Bonnett Editor: Holly Squire

According to the UK's National Institute for Health and Care Excellence (NICE; 2024), women who are S/P scheduled CS and recovering well, who are afebrile, and do not have complications, should be discharged early (after 24 h) and followed at home because this is not related to the readmission of the baby or mother. However, the first 24 hours after a C-section can be challenging, with many of the same challenges as a vaginal delivery PLUS the usual post-surgical issues: The mother will be adjusting to new parenthood, attempting breastfeeding, and fielding visitors; the incision will be sore, and pain may increase as anesthesia wears off. Is this postop plan coming to the USA? A soon to be published systematic review and meta-analysis (Dec 2024) in the AJOG MFM seems to favor that. Is this the new progression of the postop ERAS protocol? Listen in for details.

The lads talked to each other about the exciting news that the National Institute for Health and Care Excellence (Nice) announced it had approved a new drug, Abaloparatide, for use by the health service. It will be available for use on the NHS in England within three months.

In this episode of AI For Pharma Growth, Dr Andree Bates is joined by haemato-oncologist Niamh Boyle, who works in the Health Economic Evaluation of Precision Medicine in Cancer research project, University of South Wales.   Andree and Niamh discuss the use of AI in research methodologies and processes related to precision oncology. They also talk about how Health Technology Appraisal (HTA) bodies, such as the National Institute for Health and Care Excellence (NICE) implement and analyse AI in current medical practices.   Niamh delves into how AI has been used most recently in cancer research, targeted therapies and where these essential technologies will evolve from here. How HTA has ultimately been affected and improved from various aspects of modern AI systems is also explored, as well as its underlying implications.   In this episode you will learn: Niamh's background and connections to oncology and haematology How AI has affected and is shaping these medical fields The views of HTA bodies, such as NICE, have towards this increasingly common and vital use of AI International guidelines for machine learning and deep learning in pharma contexts Modelling health systems through methods such as digital twinning Health economic evaluations by organisations such as HTA bodies investigating the ethics and implications of AI in precision oncology   Niamh can be reached at: https://www.linkedin.com/in/niamh-boyle-268201209/   Click to connect with Dr. Andree Bates for more information in this episode: https://eularis.com/   AI For Pharma Growth is the podcast from pioneering Pharma Artificial Intelligence entrepreneur Dr. Andree Bates created to help organisations understand how the use of AI based technologies can easily save them time and grow their brands and business.  This show blends deep experience in the sector with demystifying AI for all pharma people, from start up biotech right through to Big Pharma. In this podcast Dr Andree will teach you the tried and true secrets to building a pharma company using AI that anyone can use, at any budget. As the author of many peer-reviewed journals and having addressed over 500 industry conferences across the globe, Dr Andree Bates uses  her obsession with all things AI and futuretech to help you to navigate through the, sometimes confusing but, magical world of AI powered tools to grow pharma businesses.  This podcast features many experts who have developed powerful AI powered tools that are the secret behind some time saving and supercharged revenue generating business results. Those who share their stories and expertise show how AI can be applied to sales, marketing, production, social media, psychology, customer insights and so much more.   Resources:  Dr. Andree Bates LinkedIn | Facebook | Twitter

FIRST JAK INHIBITOR SPECIFICALLY FOR ALOPECIA AREATA APPROVED IN THE UK!!Tommy and Frank discuss the breaking news that the National Institute for Health and Care Excellence (NICE) has made the decision to recommend the JAK inhibitor medicine ritlecitinib (Litfulo) for routine commissioning from the NHS.  This recommendation is for treatment of severe alopecia areata in patients aged 12 and over.Tommy shares his personal experience with the NHS, and how tremendous this news is for those in the UK with alopecia.  Congratulations to Sue Schilling and Alopecia UK for all their advocacy work regarding this decision!Connection is everything!Remember to rate, review, subscribe and share!Alopecia Connection Linktree Alopecia Connection Website*Discussions on Alopecia Connection are from the personal perspectives and experiences of its host and guests, and should be considered that. Any personal medical decisions should only be made after consultation with one's health care provider.

Episode 67 - Innovating Community Fitness: Building Bridges from Research to Post-Stroke Rehab.New National Institute for Health and Care Excellence (NICE) guidelines in the UK recommend stroke patients receive at least three hours of rehabilitation a day, five days a week. This is a dramatic increase from previous guidance of 45 minutes a day. Currently there are big gaps in service when it comes to supporting people with stroke after they're discharged from care not only in the UK but worldwide. Often, survivors have nowhere to go to exercise and accessing a conventional gym for most is challenging and for some it's impossible.With our continued theme of exercise as the best medicine for stroke recovery, in this episode we are diving deeper into this topic to find solutions for expanding the reach of rehab into the community and highlighting champions innovating for more solutions to make these new rehab guidelines a reality.Meet Our Guest: Dr Rachel Young PhD MSc, BSc  Rachel is a senior research fellow at the Advanced Wellbeing Research Centre in Sheffield Hallam University. She is a chartered physiotherapist with expertise in neurological rehabilitation and exercise prescription. Rachel's research interests include the development and evaluation of rehabilitation technologies and accessible exercise solutions.  In our discussion Dr. Young reminded us that the NICE guidelines of three hours are not the first to recommend extensive rehabilitation. The National Clinical Guidance for Stroke launched in March 2023 actually advised six hours of activity a day, which may include activities of daily living, communication and exercise.We dove into why these guidelines sent a ripple through the stroke community, including how providers don't have the workforce to meet these new recommendations. We also discussed her research and how she believes technology, in the form of accessible exercise equipment, apps and wearables has to be part of the solution if we're to have any hope of meeting the guidelines. Connect with our guest:  Linkedin |  Twitter/X  @physioyoungShow Mentions:Everyone's Talking About: Stroke Rehab-Health Care Management Magazine ArticleThe Real Problem with Stroke: Co-Host David Dansereau's Blog Post on Know-Stroke.orgSupport Us: Become a Show SponsorFor more information about joining our show orNew show supporter CTA for 2024-Mike Garrow For more information about joining our show or advertising with us visit: https://enable4us.comSupport the showBe sure to give the show a like and share, & follow plus connect with us on social or contact us to support us as a show sponsor or become a guest on the Know Stroke Podcast. Visit website to to learn more: https://www.knowstrokepod.com/Show credits:Music intro credit to Jake Dansereau. Our intro welcome is the voice of Caroline Goggin, a stroke survivor and our first podcast guest! Please listen to her inspiring story on Episode 2 of the podcastConnect with Us and Share our Show on Social: Website | Linkedin | Twitter | YouTube | Facebook

For a full transcript of this episode, click here. Here's something Randy Vogenberg, PhD, wrote the other day; and I made some light edits: Research has documented the unintended impacts of poor pharmacy benefit strategy. Examples include increasing costs of care, bankruptcies, and member satisfaction declines. And, yeah … agreed. Also, probably health problems if we're talking about a member unable to access a drug they really need. I heard the other day about how so many patients who have had organ transplants have a hard time getting their transplant rejection meds. What?! I just can't even with that one. On the other hand, you could have a plan that pays for all manner of drugs, cost-effective or not, appropriate or not. And now we have premiums that no one can afford, and everybody loses for the exact opposite reason. These are the downsides that happen when pharmacy purchasing gets itself into a suboptimal place. And this can happen for many reasons, but one of them is when there is not a concerted effort to buy pharmaceuticals in a value-based way. Now, here's some reasons why employers may have a rough time paying for value (ie, paying a fair price for drugs that work). Here's one reason: Most employers do not have the power to influence the price of a medication. So, any given employer could decide, based on some cost-effectiveness analysis, that the price of a drug is too high. But it's not like they can march into Pharma HQ and haggle. It's more of a take-it-or-leave-it kind of thing. Here's a number two reason why value-based pharmacy purchasing can be tough: Pharmacy spend is siloed a lot of times from medical spend. So, the pharmacy vendor is only concerned about cost and denies access to even drugs that are proven to reduce medical spend. Why wouldn't they do that? The PBM (pharmacy benefit manager) was hired to reduce pharmacy spend. The end. Who cares how many ER visits or disease exacerbations transpired? That's the medical director's problem, not theirs. Here's the number three reason why value-based purchasing is rough: The time horizon an employee is with an employer, which is not one day—and it's not a lifetime. Why did I say one day? I have heard more than once that the actuarial time horizon that some pharmacy plans use to determine if a drug is cost-effective is one day. If the drug doesn't accrue any benefits in one day, well then, it's a cost. It's not effective. On the other hand (and also problematic in the real world), sometimes cost-effectiveness analyses are done with a timeframe of the patient's lifetime. And, yeah … there aren't many employers who have employees for a lifetime—like, they're 85 years old and still on the employer's dime—so the time horizon can't be too short. But if it's a really expensive med that will, at most, prevent something that's not gonna happen anytime soon (heart failure, kidney failure, a stroke), these are things that an employer may pay for but likely is never gonna see the cost benefit of because that benefit will happen 30 years from now when the patient is on Medicare. And here's a fourth reason why value-based purchasing is tough: The FDA is approving drugs based on evidence from one study (ie, not a ton of evidence). And these drugs are also really expensive. So, some of the above issues are solvable; some are less solvable. With this in mind, let's tick through some advice that my guest today, Nina Lathia, suggests if you want to offer members a value-based formulary. 1. Have a stated goal. And maybe that stated goal is to meaningfully improve health of plan members while maintaining access, satisfaction, and affordability for said plan members and the plan. 2. Think holistically about healthcare spend, not just pharmacy spend. 3. Know what the value-based price of a drug has been calculated to be. I talked about this at length in the show with Anna Kaltenboeck (EP303). Also, Bryce Platt, PharmD, has written about this a lot. 4. Look into risk-based deals with Pharma and/or installment payments and/or some of these other interesting payment models that are emerging. Luke Prettol linked to one of them the other day. 5. Set good decision-making precedents that include shared decision-making with members/patients. This means communicating with employees and plan members about what you are doing to make good drug purchasing decisions and evaluate the clinical pros and cons of expensive drugs for any given patient. There are genetic tests now that can be done to determine if a drug is ever going to work for a patient, were these tests even done. I mean, from a patient standpoint, some of these drugs have horrible side effects; and they might be being prescribed by a doc who's not an expert in that condition. If I'm a patient and there's a genetic test I could take before I pay a ton of my own money and subject myself to what might be some pretty nasty side effects (you know, all the things that you hear about at the ends of those pharma ads on TV, right?), this could be, in the right hands, a patient benefit. This feels very different from prior auths administered by a vendor doing all kinds of stuff, where it's hard to make any connections to clinical value or patient upside, even if you squint at it sideways and use your imagination. And, yeah … this is easy to say and really hard to do. One definition I want to chuck in here for you: If we're talking about a cost-effectiveness analysis, cost-effectiveness analyses calculate how effective is the drug, minus side effects at diminishing the so-called burden of illness—burden of illness meaning the financial and health costs of the disease itself or its exacerbations. Nina Lathia, my guest today, is a pharmacist by training who has worked in hospital pharmacies. She earned a PhD in health economics. Currently she's doing consulting work, helping purchasers make value-based decisions about pharmacy spend and managing formularies. Specialty Pharmacy Playlist: https://lnns.co/uNZ3moCaQMb Hit the subscribe button to add it to your podcast player. Also mentioned in this episode are Randy Vogenberg, PhD; Anna Kaltenboeck; Bryce Platt, PharmD; Luke Prettol; Olivia Webb; Pramod John, PhD; Scott Haas; Aaron Mitchell, MD, MPH; Keith Hartman, RPh; Erik Davis; Autumn Yongchu; and Berkley Accident and Health.   You can learn more by emailing Nina at nina.lathia@healthcaredecisionmaking.com. You can also connect with her on LinkedIn.   Nina Lathia, RPh, MSc, PhD, has spent over 15 years helping healthcare payers achieve value on their drug spend. As the chief executive officer of Healthcare Decision Making, Nina works with public and private healthcare payers, helping them to make evidence-based decisions about their pharmaceutical benefits that lead to improved health outcomes and long-term financial sustainability of their health plans. Her focus is on providing independent, actionable advice for healthcare payers on reimbursement decisions related to expensive new drug therapies. Nina is a frequent public speaker and commentator on employer-sponsored pharmacy benefits design, value-based healthcare decision-making, and evidence-based medicine. Nina honed her skills in value-based assessment of drug therapies when she was a senior technical advisor at the National Institute for Health and Care Excellence (NICE) in the United Kingdom from 2014 to 2017. She has also worked as a clinical lecturer at the University of Toronto. Her work has been published in a number of high-impact peer-reviewed journals. Nina holds a master's degree and doctorate in health economics from the University of Toronto.   06:34 What does cost containment mean? 07:43 Why is it important to consider health outcomes? 10:00 What does value-based purchasing mean in Pharma? 11:09 What are the principles of cost-effectiveness analysis? 12:50 Pharmacy plan time horizons versus employer time horizons. 14:42 Why is it increasingly important for payers to take a more global look at health and cost outcomes? 16:14 Why is the first step establishing a value-based price for drugs? 16:43 Why is the second step thinking about risk-sharing agreements with manufacturers? 18:57 LinkedIn article by Bryce Platt, PharmD. 19:20 What should an employer do if there's only one drug option and the price is too high? 21:20 What's a specialty carve-out solution? 21:26 EP352 and EP353 with Pramod John, PhD, of VIVIO. 22:10 Why should employers get more comfortable with saying “no” to certain drugs? 25:36 Why is patient engagement key? 28:23 What does “good” look like for employers implementing drug-spend changes? 29:51 EP337 with Olivia Webb.   You can learn more by emailing Nina at nina.lathia@healthcaredecisionmaking.com. You can also connect with her on LinkedIn.   Nina Lathia discusses #costcontainment and #valuebasedpurchasing in #pharma on our #healthcarepodcast. #healthcare #podcast #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Marshall Allen, Stacey Richter (INBW39), Peter Hayes, Joey Dizenhouse, Benjamin Jolley, Emily Kagan Trenchard (Encore! EP392), Cora Opsahl (Encore! EP372), Jodilyn Owen, Ge Bai, Andreas Mang  

Welcome to Have A Crack, where I explore the evolving landscape of healthcare and delve into alternative approaches to pain management. In today's episode, join us as we unravel the growing trend of chiropractic care and its appeal, featuring real-life stories and evidence-based insights. In this episode, I delve into the appeal of chiropractic care, exploring why it has become a growing trend in healthcare. With approximately 35 million Americans seeking chiropractic care annually, according to the American Chiropractic Association, and a steady rise reported by the British Chiropractic Association in the United Kingdom, we explore the non-invasive nature of chiropractic care, providing a drug-free and surgery-free option for those grappling with back pain. A cornerstone of chiropractic care's popularity lies in its evidence-based foundation. Unlike some alternative therapies, chiropractic care is rooted in scientific studies supporting its efficacy in managing musculoskeletal conditions. I unpack a 2018 study published in the Spine Journal, revealing that chiropractic care led to greater improvements in pain and function compared to standard medical care. Further adding to chiropractic care's credibility, the National Institute for Health and Care Excellence (NICE) in the UK recommends manual therapy, including chiropractic care, for non-specific lower back pain. This endorsement from a reputable health organization reinforces chiropractic care as a viable option for relief without resorting to surgery or painkillers. As concerns about opioid addiction and the side effects of pain medication dominate the current healthcare landscape, we explore how chiropractic care offers a drug-free approach. The Centers for Disease Control and Prevention reported nearly 50,000 opioid-related deaths in 2019, prompting a shift in public perception towards non-pharmacological options. Chiropractic care, with its emphasis on manual adjustments and rehabilitation exercises, emerges as a beacon of hope for those looking to avoid the pitfalls of opioid medications. Surgery is often viewed as a last resort for chronic back pain, with its invasive procedures and lengthy recovery periods. We examine a 2019 study published in the Journal of Manipulative and Physiological Therapeutics, demonstrating that chiropractic care can be a safe and effective alternative, reducing the need for surgery in many cases. However, as chiropractic care gains popularity, we emphasize the importance of informed decision-making. The Advertising Standards Agency in the UK has strict guidelines to prevent misleading claims in health-related advertising. We guide listeners on how to verify a chiropractor's adherence to evidence-based practices and professionalism through registration with the General Chiropractic Council and affiliations with reputable chiropractic associations. Are we witnessing a move towards more natural and preventive measures in healthcare? As we navigate this landscape, it is vital to stay informed, consult with healthcare professionals, and make decisions aligning with individual needs and preferences. Remember, the information provided in this podcast is for informational purposes only and should not be considered as medical advice. Consult with a qualified healthcare professional for personalized advice and treatment. --- Send in a voice message: https://podcasters.spotify.com/pod/show/trishulvadi/message

Welcome to the first episode of season three of Conversations in Fetal Medicine, where we talk to Professor Asma Khalil. See below for her bio.We have not included any patient identifiable information, and this podcast is intended for professional education rather than patient information (although welcome anyone interested in the field to listen). Please get in touch with feedback or suggestions for future guests or topics: conversationsinfetalmed@gmail.com, or via Twitter (X) or Instagram via @fetalmedcast. Music by Crowander ('Acoustic romance') used under creative commons licence. Podcast created, hosted and edited by Dr Jane Currie.  Biography of Prof. Khalil:Prof. Asma Khalil, MD,MBBCh, MRCOG, MSc(Epi), DFSRH, Dip(GUM)Professor of Fetal Medicine, St George's Hospital, University of LondonDirector of Fetal Medicine Unit, Liverpool Women's HospitalVice-President of Royal College of Obstetricians and GynaecologistsAsma Khalil is a Professor of Fetal Medicine. She is the Obstetric Lead at the National Maternity and Perinatal Audit (NMPA). She gained her MD at the University of London in 2008. She was elected as the Vice-President of the Royal College of Obstetricians and Gynaecologists.She set up the Laser service for fetal interventions at Liverpool Women's Hospital in 2011.Prof. Asma Khalil has published more than 400 peer-reviewed papers, and many published review articles and chapters. She was awarded many research prizes, both at national and international meetings. She was awarded the 2021 FIGO Women's Awards: Recognising Female Obstetricians and Gynaecologists. Her research interests include twin pregnancy, congenital infections, fetal growth restriction and hypertensive disorders in pregnancy.She had a fellowship with the National Institute of Health and Care Excellence (NICE).  committed to the implementation of clinical guidelines in practice. She is the Lead author of the ISUOG guideline on the role of ultrasound in twins and congenital infections. She also led the guideline team developing the FIGO guideline on twin pregnancies. She was a member of the NICE Guideline Committee updating the Twin and Multiple Pregnancy guidance. 

Quem assina o Medcof pelo link do TdC ganha meses gratuitos do Guia TdC! Extensivo Elite: Ganhe 12 meses de Guia TdC Extensivo Regular: Ganhe 6 meses de Guia TdC Extensivo para R+ de Clínica Médica: https://extensivo.grupomedcof.com.br/extensivo-2024-r-clinica-medica-tdc Extensivo para R1: https://extensivo.grupomedcof.com.br/extensivo-r1-tdc Parceria TdC + Medcof! Comece a estudar antes dos seus concorrentes e seja aprovado na residência médica que você quiser! Na Medcof, você estuda para residência médica com - inteligencia artificial generativa (o único que tem isso): permite gerar questões de qualquer tema ou encontrar sua dúvida pesquisada no minuto e segundo exato da aula que o professor está falando a respeito, economizando tempo de busca. - time de especialistas e preceptores dos grandes serviços - USP, unifesp, einstein, unicamp - Aulas curtas mas completas, que abordam do básico ao avançado tudo o que pode cair na prova, com boa didática. Dividimos as aulas em verde, amarelo e vermelho, de acordo com o nível de prioridade. - Questões transformadoras (com comentários feitos pelos especialistas de cada especialidade, que revisam o tema da questão e não apenas explicam as alternativas); - Flashcards digitais com revisão espaçada, cofcards físicos (3000 flashcards físicos); - Fichas resumo físicas (e digitais) que resumem cada aula. - simulados mensais comentados por especialistas e com ranking, para analisar como você está perante os outros alunos. - Tarefas mínimas semanais (mesmo naquela semana que está uma correria, separamos o mínimo de questões obrigatórias de serem feitas naquela semana). - Raio-x da banca das principais provas do Brasil (uma revisão de véspera do que caiu nos anos anteriores, dado pelo especialista). Nesse episódio, Rapha e Letícia conversam sobre como é a primeira consulta de uma paciente diagnosticada com hipertensão arterial! Referências: 1- Mancia, Giuseppe et al. “2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA).” Journal of hypertension vol. 41,12 (2023): 1874-2071. doi:10.1097/HJH.0000000000003480 2- Whelton, Paul K et al. “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Hypertension (Dallas, Tex. : 1979) vol. 71,6 (2018): e13-e115. doi:10.1161/HYP.0000000000000065 3- Hypertension in adults: diagnosis and management. National Institute for Health and Care Excellence (NICE), 18 March 2022. 4- Barroso, Weimar Kunz Sebba et al. “Brazilian Guidelines of Hypertension - 2020.” “Diretrizes Brasileiras de Hipertensão Arterial – 2020.” Arquivos brasileiros de cardiologia vol. 116,3 (2021): 516-658. doi:10.36660/abc.20201238 5- Tschanz, Cdr Mark P et al. “Synopsis of the 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: The Diagnosis and Management of Hypertension in the Primary Care Setting.” Annals of internal medicine vol. 173,11 (2020): 904-913. doi:10.7326/M20-3798

Indah G & Joshua Kenji sit down with psychologists Astrid Ramadhani and Yolanda Pasaribu (M.Psi) to ask them all of the uncomfortable, awkward and certainly taboo questions that behind closed doors, everyone secretly wonders regarding mental health. Has mental illness become somewhat trendy amongst Gen-Z's and Gen-Alphas these days? Are certain clients claiming to have some form of mental illness when they actually don't? What constitutes s*icidality? Does it also include wishing you were never born, in which case then, isn't everyone s*icidal to some extent? Astrid, Indah, Joshua & Yolanda also get very deep and personal into their faiths (or lack thereof for some), and philosophies of hope, gratitude, perseverance, and life purpose. Timestamps: 00:00 — Intro 00:28 — Self-proclaimed experts, self-diagnosing, ill for attention, dealing with loved ones that are depressed/s*icidal 09:46 — Is mental illness now trendy? Seeking for attention or reaching out? 19:25 — How to handle s*icidal family/peers? 22:39 — Sharing personal issues on social media vs personal message 27:22 — S*icide rate in Indonesia and data statistics regarding mental health issues, differences between male and female in therapy 33:55 — Toxic friend groups and trauma-bonding, to leave or not to leave? Lack of support system and fear of being left out 44:26 — Family's perspective and religious views on mental health issues 49:28 — Aspects in having a religion that contributes in preventing or developing mental health issues 55:24 — Mental illness diagnosis between the east and west, self-diagnosing due to limited resources, therapy options to deal with each problems 1:03:48 — Trauma coping mechanism/outlets 1:07:41 — Triangle of Needs; do you really need to seek therapy? How mental health professionals do assessments before diagnosis 1:16:35 — Fomo of having mental illness 1:20:24 — Are you abusing your mental health professionals? 1:22:41 — Differences between therapy and counselling, different attitudes while going into therapy, seeking validation from therapists? 1:33:36 — Is everyone depressed? Indah's s*icidal tendencies and existential issues 1:50:29 — Active vs passive s*icidality 1:53:11 — When is medically assisted s*icide okay? 2:02:07 — Fan message on s*icide, having purpose in life For those interested in seeking counseling/therapy services from mental health services in Jakarta: IndoPsyCare is an evidence-based, scientifically-backed, international-standard psychology clinic based in Jakarta, Indonesia. Their clinician-scientists adhere to international standards outlined within the Cochrane Library and the Clinical Guidelines set forth by the UK-based National Institute for Health and Care Excellence (NICE) coupled with the Indonesian IPK Clinical Guidelines (Panduan Nasional Praktik Psikologi Klinis, PNPPK). They welcome both English-speaking clients, as well as local Bahasa Indonesia speaking clients. Visit indopsycare.com to learn more, as well as book your first consultation.

It's In the News, a look at the top stories and headlines from the diabetes community happening now. Top stories this week: Novo Nordisk will discontinue Levemir by the end of 2024, Tandem begins limited launch of software updates that will include Dexcom's G7, Beta Bionics iLet pump will be covered until some pharmacy plans, and lots more! Links and transcript below Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Take Control with Afrezza  Omnipod - Simplify Life Learn about Dexcom  Edgepark Medical Supplies Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com   Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. XX In the news is brought to you by Edgepark simplify your diabetes journey with Edgepark XX This week was World Diabetes Day so there is a LOT going on.. Our top story is XX Novo Nordisk said on Wednesday it would discontinue its long-acting insulin Levemir in the United States, citing manufacturing constraints, reduced patient access and available alternatives. The Danish drugmaker said supply disruptions would start in mid-January, followed by discontinuation of the Levemir injection pen in April and of Levemir vials by the end of 2024. Novo has another long-acting insulin, Tresiba, on the market and says quote - "global manufacturing constraints, significant formulary losses impacting patient access effective in January 2024, and the availability of alternative options in the U.S. market" are key factors in the decision. The announcement comes eight months after Novo said it would cut U.S. list prices for several of its insulin products next year, including a 65% reduction in the list price of Levemir. Novo, which overtook LVMH (LVMH.PA) as Europe's most valuable listed company this year, posted record operating profit for the third quarter, with sales of its obesity drug Wegovy reaching $1.36 billion, up 28% from the previous quarter. https://www.reuters.com/business/healthcare-pharmaceuticals/novo-nordisk-discontinue-levemir-insulin-us-market-2023-11-08/ XX Big news from Tandem Diabetes this week – first, their Control IQ algorithm gets FDA approval for children as young as two years old. the technology's original 2019 clearance limited its use to those aged 6 and older. And.. they are officially rolling out the software update that will allow users to connect to either the Dexcom G6 or G7 CGM. If you're in the limited launch you got an email this week telling you the next steps – wider release is expected gradually in the first part of 2024. Integration with Abbot's FreeStyle Libre is expected very soon as well – which would mean Tandem's tslim x2 and Mobi pumps would be compatible with three CGMs. Full disclosure: there wasn't a media release that I received on this, but my son is in the limited launch group so we got the email.   https://www.fiercebiotech.com/medtech/tandem-diabetes-care-cruises-fda-ok-toddler-use-automated-insulin-delivery-algorithm XX Beta Bionics iLet pump and its supplies are now covered as part of some pharmacy benefits - Express Scripts added it to its national formulary list. Historically, insulin pumps fall under the durable medical equipment (DME) insurance benefit. Usually pharmacy benefits are more flexible with fewer up front costs. The system uses an adaptive, closed-loop algorithm that initializes with the user's body weight and requires no additional insulin dosing parameters. The algorithm removes the need to manually adjust insulin pump therapy settings and variables. iLet simplifies mealtime use by replacing conventional carb counting with its meal announcement feature. This enables users to estimate the amount of carbs in their meal, categorized as “small,” “medium” or “large.” Over time, the algorithm learns to respond to users' individual insulin needs. https://www.drugdeliverybusiness.com/beta-bionics-pharmacy-benefit-bionic-pancreas/ XX The UK has launched a pioneering study to explore the development of type 1 diabetes in adults which aims to screen 20,000 individuals. Research will enable earlier and safer diagnosis of type 1 diabetes through blood tests. This makes the UK the first country to implement general population screening for type 1 diabetes in both children and adults. The Type 1 Diabetes Risk in Adults (T1DRA) study, launched on World Diabetes Day, seeks to enroll 20,000 adults aged 18 to 70. Supported by The Leona M. and Harry B. Helmsley Charitable Trust and building on the Diabetes UK-funded Bart's Oxford Family study (BOX), T1DRA aims to unravel the mysteries of adult-onset type 1 diabetes. https://www.diabetes.co.uk/news/2023/nov/groundbreaking-study-to-screen-20000-adults-for-type-1-diabetes.html XX The National Institute for Health and Care Excellence (NICE), England's cost-effectiveness watchdog, has finalized a draft guidance regarding hybrid closed-loop systems, concluding that the technology should be made broadly affordable and accessible to help people with Type 1 diabetes better manage the condition. In this month's final draft guidance (PDF), NICE recommended that hybrid closed-loop technology be offered to all people with Type 1 diabetes who are having trouble controlling the condition using their existing devices.   NICE said that it has already devised a five-year rollout plan with the NHS to bring the technology to people with Type 1 diabetes. Hybrid closed-loop systems will be offered first to children, young people, existing insulin pump users and women who are pregnant or planning to become pregnant, after which they'll be issued to adults who have an average HbA1c reading of at least 7.5%. https://www.fiercebiotech.com/medtech/nice-recommends-hybrid-closed-loop-systems-type-1-diabetes-prompting-praise-medtronic XX     Commercial XX Kyle Banks was diagnosed with type 1 diabetes on November 1, 2015 while performing with the traveling production of Disney's The Lion King.  Performing nightly for sold out audiences across the country was a dream come true, but after experiencing symptoms of the onset of type 1 diabetes, the dream temporarily turned into a nightmare. The symptoms he experienced were  typical for the onset of this chronic illness. but with limited knowledge of type 1 diabetes, he had no idea what was occurring or the drastic life change that would soon follow.  In 2020, he founded Kyler Cares in partnership with Children's Hospital New Orleans and has since connected with families from across the country that are living with this disease.  Kyler Cares seeks to improve health outcomes for people of color living with diabetes and ensuring families can access the resources and technology available for better management is the route the organization is taking to achieve that goal. At Kyler Cares we're working to improve health outcomes for people of color living with diabetes by improving access to diabetes technology, creating connections to education and resources, and fostering community as an added system of support on our journeys. Kyler Bear & Friends' T1 Diaries is an eight-part animated series for kids, dedicated to storytelling about life with Type 1 Diabetes. Our series is more than just an educational tool; it's a reflection of real-life stories and an avenue to strengthen community ties. It's a vehicle for us to inspire young people to begin laying a foundation of knowledge and self-confidence with management of T1D that will resonate throughout their lives until a cure for the disease is discovered.   By supporting this series with a donation, you will be contributing to a project that not only educates and informs but also offers comfort and a sense of belonging to kids navigating life with T1D. ‘Kyler Bear's T1 Diaries' isn't just a series; it's a beacon of hope, a source of information, and a testament to the strength found in our amazing T1D community. Join us in bringing these stories to life XX Married At First Sight UK ends this week, but one bride says viewers haven't seen her whole story.   Fans will find out if Tasha Jay, 25, decides to stay with partner Paul Liba on the Channel 4 show.   But Tasha, who has type 1 diabetes, has spoken out about how footage about her condition didn't make the final cut.   While she's "really sad" that it was left out, Tasha's pleased that people are now realising why she behaved in a certain way on the show at times.     Married at First Sight - or MAFS - is a social experiment where experts match complete strangers who try to live as a couple.   Tasha says her wedding day with Paul on the show was a "really beautiful moment" that included her telling Paul about her diabetes and his reaction.   "I got filmed taking my insulin and checking my blood sugar," she tells BBC Newsbeat.. Tasha was diagnosed at aged two and half and says people have asked why that part of her was hidden in the show.   "And I'm like I didn't hide it," she says.   "For whatever reason they haven't shown it, which really upsets me because diabetes is a part of my story."   Tasha believes that, if people had known about her diabetes, it would have changed their perception of certain moments in the show. https://www.bbc.com/news/newsbeat-67368445

Featuring leading cardiology experts, this podcast episode navigates atherosclerotic cardiovascular disease (ASCVD), including plaque morphology, residual risk, secondary treatment options, and guidelines from the National Institute for Health and Care Excellence (NICE). They also detail how these different treatment options work, and conclude the episode by sharing relevant patient case studies that reflect the themes discussed.   Lale Tokgözoğlu, Professor of Cardiology, Hacettepe University, Ankara, Turkey; and Pierre Sabouret, Heart Institute, ACTION Study Group-CHU Pitié-Salpêtrière University Hospital, Paris, France, join EMJ to share their expert insights on this pertinent topic.   Following the recording of this podcast the European Society of Cardiology (ESC) 2023 Guidelines have been updated. Please refer to your local guidelines and relevant prescribing information for the most up-to-date information.   Disclaimer: This podcast is sponsored by an educational grant by Amarin. The speakers opinion is entirely their own and did not receive an honorarium for their part.

The National Institute for Health and Care Excellence(NICE), in the United Kingdom, released the following guidelines in regards to diagnosing and managing M.E./CFS: “The draft guideline recognises that ME/CFS, which is estimated to affect over 250,000 people in England and Wales, is a complex, multi-system, chronic medical condition where there is no ‘one size fits all' approach to managing symptoms. It stresses the need for a tailored, individualised approach to care that allows joint decision making and informed choice. Because of the harms reported by people with ME/CFS, as well as the committee's own experience of the effects when people exceed their energy limits, the draft guideline says that any programme based on fixed incremental increases in physical activity or exercise, for example, graded exercise therapy (GET) should not be offered for the treatment of ME/CFS. Instead, it highlights the importance of ensuring that people remain in their ‘energy envelope' when undertaking activity of any kind and recommends that a physical activity programme, in particular, should only be considered for people with ME/CFS in specific circumstances.” If you want to know the true reason why G.E.T doesn't work and what to do instead. Listen to this episode! Click here for the transcript Here are 4 ways we can help. 1. Join our free community to meet others, be inspired, and get more recovery info - https://www.facebook.com/groups/cfshealthrecoveryhub 2. Watch the newly released past members "Guest Panel" Workshop where they share their top 5 recovery secrets - https://www.cfshealth.com/guestpanelreplay 3. Get our free most popular recovery trainings:- Find your baseline - Stop pushing and crashing - https://www.cfshealth.com/baseline - The 3 stages of recovery and what to do in each one - https://www.cfshealth.com/the3stages - The "9 do's and don'ts" PDF - to decrease symptoms and improve energy - https://www.Cfshealth.com/pdf 4. Want to help professionally with a step-by-step recovery plan specific to you? Fill out the application form and the team will send you the details - https://www.cfshealth.com/form

Helen Knight, Director of Medicines and Evaluation at the National Institute of Health and Care Excellence (NICE), talks to Lymphoma Action's Policy and Public Affairs Advisor, Tara Steeds. In the podcast they discuss Health Technology Assessments and their role in making new treatments available through the NHS. They also discuss the role and impact of people with lived experience of lymphoma in the process, as well as that of organisations like Lymphoma Action. Lymphoma Voices is a series of podcasts for people living with lymphoma, and their family and friends. In each podcast, we are in conversation with an expert in their field, or someone who has been personally affected by lymphoma, who shares their thoughts and experiences.   Lymphoma Action is the only charity in the UK dedicated to supporting people affected by lymphoma. We are here to make sure that everyone affected by the condition receives the best possible information, support, treatment and care. Our services include a Freephone helpline, support group network, Buddy Service, medical information, conferences for those affected by lymphoma, and education and training for healthcare professionals. We would like to thank all of our incredible supporters whose generous donations enable us to offer all our essential support services free of charge. As an organisation we do not receive any government or NHS funding and so every penny received is truly valued. From everyone at Lymphoma Action and on behalf of those affected by lymphoma, thank you. For further information visit: www.lymphoma-action.org.uk 

Emma is joined by a very special guest Professor Sir David Haslam to discuss his book Side Effects: How Our Healthcare Lost Its Way and How We Fix It.Along with being a GP for over 35 years Sir David has held a number of senior posts including being both chair and president of the Royal College of GPs, president of the BMA and chair of the National Institute for Health and Care Excellence (NICE), a post he held from 2013 to 2019.His book, which was published last year, explores what good healthcare should achieve and how we can create a system that is affordable, fair and provides good quality care.This interview, which was recorded in October 2022, looks at some of the really important themes raised in the book, including why the cost of healthcare will always continue to rise, why we need to better value primary care and public health, tackling health inequalities, over-medicalisation and whether we have our priorities right when it comes to end-of-life care.Produced by Czarina DeenUseful links● NHS at 75: Primary care-focused 'reboot' can save NHS● Side Effects: How Our Healthcare Lost Its Way and How We Fix It on Amazon Hosted on Acast. See acast.com/privacy for more information.

Dos guías importantes sobre el manejo de pacientes con trauma a la cabeza fueron actualizadas en el 2023. Las "Guías de cuidado prehospitalario de la lesión traumática cerebral" del Brain Trauma Foundation y la guía "Trauma a la cabeza: Evaluación y manejo inicial" del National Institute for Health and Care Excellence (NICE). En su mayoría, la nueva guía del Brain Trauma Foundation consistió en una re-evaluación de la evidencia actual sobre el tema en cuestión. De igual forma, el sitio web de NICE tiene la sumatoria de todas las recomendaciones vigentes, incluyendo las más recientes. Es importante señalar que este artículo no discute todos los componentes de las guías nuevas, sino los cambios más relevantes y/o significativos. Para más información, consulte ambos documentos de referencia. Lesión cerebral traumática Las guías NICE definen el traumatismo cerebral o lesión cerebral traumática se define como una alteración en la función cerebral, u otra evidencia de patología cerebral, causado por una fuerza externa. Cuando hablamos de trauma a la cabeza, nos estamos refiriendo comúnmente a lesiones que causan un aumento en la presión intracranial. La causa más común del aumento en la presión intracranial es el sangrado, pero puede ser también edema (especialmente en la lesión axonal difusa). El aumento en la presión intracranial causa una disminución en la perfusión cerebral. Entonces, cuando hablamos de trauma a la cabeza, lo que estamos hablando realmente es de un aumento en la presión intracranial que disminuye la perfusión cerebral. En este otro episodio del ECCpodcast explico el tema de manejo del paciente con trauma a la cabeza y la fórmula: Presión de perfusión cerebral = Presión arterial media - Presión intracranial Si no ha tenido la oportunidad de oír ese otro episodio, por favor escúchelo primero antes de estudiar este ya que en este simplemente voy a reiterar los puntos más importantes de las guías nuevas. Resucitación inicial Existen lesiones catastróficas al sistema nervioso central, que no son compatibles con la vida, que provocan herniación cerebral y/o muerte cerebral inmediatamente (antes de que lleguen los primeros respondieres),  que exceden la posibilidad de alguna esperanza para el paciente... y por eso no hay nada que podamos discutir aquí que sea de utilidad en su manejo. La clave del manejo del paciente que tiene una lesión cerebral aparenta estar en el reconocimiento temprano de que la lesión está ocurriendo, para tratar de detener el aumento, y reducir la presión intracranial, antes de que ocurra el síndrome de herniación y la muerte cerebral. Por lo tanto, el punto de "Discapacidad" en el XABCDE del PHTLS (Prehospital Trauma Life Support), o la H de Head Trauma en el acrónimo MARCH, lo que busca es reconocer signos de trauma a la cabeza para que se puedan instituir manejos que eviten el aumento en la presión intracranial (lo que llamamos lesión secundaria). Debido a la fisiopatología del trauma a la cabeza (descrita en el podcast anterior), el paciente que tiene un aumento en la presión intracranial tratable, va a morir primero por problemas de su vía aérea, respiración y circulación posiblemente antes de que muera de la lesión a la cabeza. En adición, el mal manejo de la vía aérea, respiración y circulación redunda en un aumento en la presión intracranial y/o menor presión de perfusión cerebral debido a la hiposa, hipercarbia e hipotensión. Por estas razones, el mejor manejo del paciente con trauma a la cabeza consiste en el abordaje que presenta el PHTLS, con énfasis particular en los primeros cuatro componentes: X - Corregir sangrados exanguinantes A - Abrir la vía aérea B - Ventilación adecuada C - Mantener la circulación D - Reconocer la discapacidad E - Exposición para identificar otras lesiones y proteger del medioambiente (environment) También puede considerarse el otro acrónimo MARCH: M - Masiva hemorragia (massive bleeding) A - Abrir la vía aérea B - Ventilación adecuada C - Mantener la circulación H - Prevención de hipotermia y trauma a la cabeza (head) Se enseña en secuencia pero se realiza simultáneo. Si un estudiante me pregunta "qué hago primero", probablemente le diría que siga la secuencia XABCDE (o MARCH). Tiene mucho sentido el detener el sangrado masivo primero porque hay una gran oportunidad de hacer lo mejor por el paciente si detenemos un sangrado masivo de provocar un estado de shock hipovolémico. Es mejor detener el sangrado antes de que el paciente haya perdido suficiente cantidad de sangre para tener pobre perfusión cerebral por la hipovolemia. Pero luego de esto existen otras circunstancias que pueden complicar el manejo si se sigue un único orden siempre. Por ejemplo, el manejo definitivo de la vía aérea puede provocar episodios de hipotensión debido al uso de medicamentos para la inducción, estimulación vagal por la laringoscopía, y reducción en el retorno venoso por el aumento en la presión intratoráxica al llevar a cabo ventilaciones con presión positiva con un dispositivo de ventilación manual. No sería inapropiado brincar la vía aérea para manejar la pobre perfusión primero antes de intubar al paciente que lo necesita. Un equipo de trabajo que puede asignar a una o dos personas a atender la circulación mientras una o dos personas atienden la vía aérea y ventilación pudiera demostrar el mejor manejo posible de este tipo de paciente, aún teniendo en cuenta que el manejo apropiado de cada una de estas dos condiciones puede tomar algo de tiempo (corregir la pobre perfusión y/o mantener una ventilación efectiva). Cada uno de estos ejemplos, por separado, pudiera ser una buena razón para realizar las mínimas intervenciones necesarias en la escena y comenzar el transporte. Cuando se junta la necesidad de realizar todas, a la misma vez, en un paciente que lo necesita justo ahora (piense en una obstrucción a la vía aérea por sangrado y lesiones faciales y/o de cuello, en combinación con un sangrado sistémico y trauma a la cabeza), estamos discutiendo un tipo de paciente severamente lesionado. Nota a los instructores: cuando están dando un caso a un alumno, y quieren forzar que se siga un orden específico, no quieran traer complicaciones que puedan abrir la posibilidad de tener que realizar múltiples tareas simultáneamente. Ahora bien, cuando quieran evaluar el paciente verdaderamente politraumatizado, estén preparados para ver diferentes abordajes (buenos y malos) y luego discutir por qué uno, o más de uno, pudiera ser efectivo o perjudicial. Un abordaje por etapas En un paciente que eventualmente necesita ser intubado, una primera etapa puede consistir en mantener la vía abierta manualmente mientras se realizan otras intervenciones de circulación. No significa que no se manejó apropiadamente la vía aérea. Significa que se realizaron las intervenciones (una o muchas) necesarias para poder continuar con el abordaje de las amenazas a la vida, para entonces volver a retomar el tema de la vía aérea y pre-oxigenar al paciente mientras se preparan otros aspectos del transporte, y finalmente llevar a cabo la intubación tan pronto el paciente está lo mejor preparado desde el punto de vista de preoxigenación y perfusión. Cuando un grupo de proveedores se dividen la tareas, pueden ser más eficientes y adelantar estas etapas concomitantemente. El líder debe estar pendiente que un grupo no se adelante antes de tiempo (valga la redundancia y el ejemplo repetido: intubar al paciente antes de que el resto del equipo esté listo). Esto es un verdadero trabajo en equipo. Aunque es posible que el personal del servicio de emergencias médicas tenga pocos recursos en la escena, no siempre es así. En muchas ocasiones es posible contar con más rescatistas y paramédicos en la escena. No estoy abogando por retrasar el transporte, sino en evitar causar daño cuando el paciente necesita acción inmediata o si no va a morir ahora, en la escena y antes del transporte. CPP = MAP - ICP El insulto primario es la lesión que inicialmente provocó el aumento en la presión intracranial. Si bien no podemos hacer más nada por el insulto primario luego de que este ocurre, sí podemos prevenir lo que llamamos la lesión secundaria. La lesión secundaria es todo lo que agrava el insulto primario. El aumento en la presión intracranial tiene el efecto de reducir la perfusión cerebral. Todo lo que reduzca aún más la lesión intracranial produce una lesión secundaria. La fórmula CPP = MAP - ICP provee el marco de referencia para entender el problema de la lesión primaria y de la lesión secundaria. Todo lo que reduzca el MAP o aumente el ICP va a producir menos presión de perfusión cerebral. Presión arterial Por lo antes expresado, sabemos que el paciente con trauma a la cabeza necesita mantener la presión arterial porque esto es lo que está protegiendo la perfusión cerebral. Cuando hay una lesión al sistema central nervioso, un solo episodio de hipotensión puede ser detrimental. Es importante poder determinar de forma temprana el deterioro gradual de la presión arterial porque puede ser un indicador de otros sangrados concomitantes en el resto del cuerpo. Cuando se puede llevar a cabo un monitoreo invasivo de la presión intracranial, es posible determinar la presión arterial necesaria para mantener perfusión cerebral... y esta puede ser más alta que lo que las guías recomiendan como presión arterial mínima. Esto no quiere decir que todos los pacientes necesita valores más altos, y tampoco estos valores significan que esta es la presión ideal... sino la mínima. Las guías del Brain Trauma Foundation hacen referencia a valores específicos de presión según la edad: 28 días o menos >70 mmHg 1–12 meses >  84 mmHg 1–5 años > 90 mmHg 6 años o más > 100 mmHg Adultos 110 mmHg en adelante Sin embargo, el documento hace referencia a que no existe data específica acerca de cuáles son los valores óptimos, por lo que el valor ideal pudiera ser superior. Lo que sí especifica es que valores inferiores están asociados a peores resultados. En el contexto de trauma, hay dos escenarios que pueden resultar en hipotensión: sangrado concomitante en otras partes del cuerpo y procedimientos como la intubación endotraqueal. Equipo pediátrico Los equipos de respuesta a emergencia tienen que tener equipo de monitoreo de signos vitales pediátricos, incluyendo el mango para tomar la presión y sensores de oxímetría de pulso. Sin embargo, las guías sugieren la alternativa, en escenarios de bajos recursos, de documentar el estado mental, la calidad de los pulsos periféricos y el llenado capilar como marcadores sustitutos a la presión arterial. Resucitación con fluidos Es importante tratar la hipotensión rápidamente, ya sea con sangre, solución salina e inclusive vasopresores en casos extremos. La solución de salina hipertónica puede ser útil para reducir la presión intracranial. Aunque su uso como expansor intravascular es controversial, la alta concentración de soluto produce un gradiente osmolar que ayuda a reducir el edema. Sin embargo, no está recomendado de forma profiláctica. Ventilación La alteración en el aumento en la presión intracranial produce disminución en el nivel de consciencia y depresión respiratoria, lo que puede provocar la obstrucción de la vía aérea e hipoventilación. La hipoventilación produce hipercarbia, o aumento en el nivel de CO2 en la sangre, y esto a su vez, produce vasodilatación cerebral... que a su vez puede aumentar el sangrado. Por lo tanto, los problemas con la ventilación agravan la lesión cerebral traumática. Todo paciente que tenga alteración en el estado de consciencia necesita monitoreo de la ventilación. El método de monitorear la ventilación no es la oximetría de pulso sino el CO2 exhalado. El EtCO2 debe estar entre 35-40 mmHg. Escala de Coma de Glasgow No todos los traumas a la cabeza son clínicamente significativos. La frase "clínicamente significativo" quiere decir que tiene un efecto en el paciente. Por ejemplo, un jugador de baloncesto puede chocar con otro jugador y caer al piso, golpeando la cancha con la cabeza. El jugador rápidamente se pone de pie y continúa corriendo para recuperar el balón.  Aunque tuvo una leve abrasión en el frente de la cabeza, nunca tuvo ningún otro signo o síntoma adicional asociado. Esta historia hipotética puede ser un ejemplo de una lesión que no es clínicamente significativa. No significa que no haya tenido un golpe, sino que no hay nada que preocuparse. Todo trauma a la cabeza que sea clínicamente significativo produce una alteración en el estado de consciencia y/o un déficit neurológico focal. Por lo tanto, es sumamente importante evaluar correctamente el nivel de consciencia. Evalúe y trate la circulación, vía aérea y ventilación antes de evaluar la Escala de Coma de Glasgow porque la pobre perfusión y la hipoxia pueden producir una alteración en el nivel de consciencia que podemos mejorar si mejoramos la perfusión y oxigenación y no necesariamente estar asociado a una lesión cerebral traumática. La evaluación periódica de la Escala de Coma de Glasgow permite detectar tempranamente una lesión a la cabeza que sea clínicamente significativa y permite determinar signos de que continúa aumentando la presión intracranial si el nivel de consciencia sigue progresivamente disminuyendo. Se debe documentar la Escala de Coma de Glasgow cada 30 minutos, y cuando haya un cambio en el estado mental (ya sea mejoría o deterioro). También se debe documentar la Escala de Coma de Glasgow en el camino al hospital, o transferencia interhospitalaria. La Escala de Coma de Glasgow tiene tres componentes: respuesta visual, verbal y motora. De las tres, la más importante es la motora. Por lo tanto, es importante describir los tres componentes por separado. No es lo mismo que un paciente pierda 2 puntos en la respuesta visual a que pierda dos puntos en la respuesta motora. Si es posible, es útil documentar la Escala de Coma de Glasgow antes de administrar un medicamento que afecte el nivel de consciencia (sedación o parálisis, por ejemplo). Documente la presencia de cualquier medicamento que pueda alterar el nivel de consciencia cuando esté documentando la Escala de Coma de Glasgow porque puede ayudar a entender por qué hubo una disminución en el nivel de consciencia. Finalmente, la Escala de Coma de Glasgow es tan útil como se sepa medir correctamente. En ocasiones pudiera ser más útil medir solamente el componente motor como método alterno. También es importante medir a los pediátricos usando la versión pediátrica. [caption id="attachment_1891" align="aligncenter" width="532"] Imagen cortesía de Wikipedia Commons.[/caption] Déficit neurológico focal Lo que los ojos no ven y la mente no conoce, no existe.“ - David Herbert Lawrence. Cuando buscamos la presencia o ausencia de un déficit neurológico focal, buscamos lo siguiente: Debilidad Disminución en la sensación Pérdida de balance Problemas para caminar Dificultad en entender, hablar, leer o escribir Cambios visuales Nistagmo Reflejos anormales Amnesia desde la lesión Ácido tranexámico La guía NICE recomienda la administración de 2 gramos de ácido tranexámico IV a pacientes de 16 años o más, con un trauma a la cabeza de menos de 2 horas, que tengan un GCS igual a, o menor de, 12. Para pacientes de menos de 16 años, la dosis es 15 mg/kg a 30 mg/kg (hasta un máximo de 2 g). Sin embargo, la guía del Brain Trauma Foundation no recomienda el uso de forma rutinaria, sin embargo deja abierta la decisión al sistema de salud, citando que hace falta más evidencia para recomendar su uso generalizado en el paciente con trauma a la cabeza. El único estudio que demostró beneficio fue CRASH-3 pero fue solamente en pacientes con trauma craneocefálico leve a moderado. No hubo diferencia significativa en el paciente con trauma severo. En otros estudios, no hubo diferencia. Pacientes intoxicados Aunque NO es una recomendación nueva, es importante recordar que los pacientes que tienen intoxicaciones pueden tener lesiones concomitantes a la cabeza, y los pacientes con lesiones a la cabeza pueden tener lesiones que alteran su nivel de consciencia y parecen como si estuvieran intoxicados. Nunca asumir que la alteración en el estado mental se debe al alcohol si hubo un mecanismo de trauma a la cabeza. Tomografía computarizada (CT) de la cabeza Las Guías NICE detallan los criterios para realizar una tomografía axial computadorizada. Para pacientes de 16 años o más, se debe hacer un CT de la cabeza dentro de la primera hora de haber identificado cualquiera de estos criterios: Escala de Coma de Glasgow de 12 o menos en la evaluación inicial en el departamento de emergencias Escala de Coma de Glasgow de menos de 15 luego de 2 horas de la lesión al ser evaluado en el departamento de emergencias Sospecha de fractura abierta o deprimida Cualquier signo de fractura de base de cráneo (hemotímpano), ojos de mapache o de panda (equimosis periorbital), salida de líquido cerebroespinal del oído o nariz, signos de Battle) Convulsión pos-traumática Déficit neurológico focal Más de 1 episodio de vómito Las guías NICE establecen que para pacientes menores de 16 años, se debe hacer una tomografía computarizad para trauma a la cabeza dentro de la primera hora de haber identificado cualquiera de los siguientes criterios: Escala de Coma de Glasgow menor de 14 al llegar al departamento de emergencias, o menos de 15 en bebés de menos de 1 año. Escala de Coma de Glasgow menor de 15 luego de 2 horas de la lesión Sospecha de fractura de cráneo abierta o deprimida, o tensión en las fontanelas Cualquier signo de fractura de base de cráneo (hemotímpano), ojos de mapache o de panda (equimosis periorbital), salida de líquido cerebroespinal del oído o nariz, signos de Battle) Convulsión pos-traumática Déficit neurológico focal Sospecha de lesión no-accidental En bebés de menos de 1 año, una abrasión, edema o laceración de más de 5 cm en la cabeza Las guías NICE tienen unas recomendación especial para los pacientes que usan anticoagulantes (antagonistas de vitamina K, anticoagulantes orales de acción directa, heparina y heparina de bajo peso molecular), o terapia antiplaquetaria (excepto monoterapia con aspirina). En estos pacientes, se recomienda una tomografía de cráneo: Dentro de las primeras 8 horas de la lesión ó Dentro de la primera hora si llevan más de 8 horas luego de la lesión. Desde el 2007, las guías NICE aclaran que no se debe usar la radiografía simple de cráneo para diagnosticar una lesión cerebral traumática importante. No obstante, hacen el señalamiento que los pacientes pediátricos pudieran necesitar radiografías simples en búsqueda de otras lesiones por abuso. Transporte al hospital apropiado La principal diferencia entre el manejo intrahospitalario y el manejo prehospitalario del manejo de trauma a la cabeza es que el paciente va a recibir el cuidado definitivo dentro del hospital. Pero, esto es cierto solamente si el paciente se encuentra en un hospital que tenga la capacidad de neurocirugía para llevar a cabo el manejo definitivo. Si el paciente no se encuentra en la facilidad apropiada, para todos los efectos, el manejo sigue siendo el mismo como si estuviera fuera del hospital. Las guías recomiendan que los pacientes con trauma a la cabeza moderado a severo sean transportados directamente a un centro de trauma que tenga capacidad de neuroimágenes, cuidado de neurocirugía y la habilidad de monitorear y tratar la presión intracranial. Pero hace una sugerencia que debe tomarse con mucho cuidado: "Aunque el transporte directo a un centro de trauma es preferible para la mayoría de los pacientes, en el evento de que este transporte no sea posible, se puede realizar la estabilización en un centro no-traumatológico dentro de un sistema de trauma establecido, con transferencia subsiguiente a un centro de trauma." Es muy fácil malinterpretar a conveniencia este tipo de recomendación si no se entiende claramente a qué se refiere. "Estabilizar" - El primer y mejor ejemplo que me viene a la mente es la vía aérea. En el dado caso que el manejo del paciente requiera una vía aérea avanzada que no haya podido ser lograda en la escena, pudiera ser necesario detenerse en una facilidad con capacidad de cuidado inferior con el fin de patentizar la vía aérea, si esa facilidad tiene expertos en el manejo de vías aéreas avanzadas (y potencialmente difíciles). Esto tampoco quiere decir que los pacientes con trauma a la cabeza deben ser transportados primero a un hospital local para ser intubados. "Sistema de trauma establecido" - Un sistema de cuidado implica que ambas facilidades están coordinadas y comparten criterios y recursos para el manejo en la periferia de pacientes potencialmente gravemente lesionados. Si no existe esa estrecha colaboración, cómo sabemos que en su determinado sistema, eso funciona bien. El hecho de que funcione en un sistema no significa que va a funcionar en todos. Por lo tanto, debemos aceptar que en los lugares donde se ha demostrado que se puede lograr dicha coordinación, es posible llevarlo a cabo de esta manera. Pero, no necesariamente esto aplica a todos los lugares. El escenario más común donde se pierde la oportunidad de ayudar al paciente es cuando el sistema de emergencias médicas transporta el paciente a alguna (o cualquier) facilidad local, a veces por criterio de cercanía física y/o de ubicación geográfica y usan como excusa el hecho de que no pueden gastar recursos desviando una unidad largas distancias. O inclusive otros han sugerido que los hospitales son los que deben coordinar y costear la transferencia por lo tanto ellos solamente transportan al hospital local. Actitudes, mentalidades, opiniones y directrices operacionales como esas son las que hacen que los pacientes esperen horas antes de llegar a la facilidad adecuada. Los servicios de emergencias médicas deben tener protocolos claramente establecidos de a dónde es permitido transportar este tipo de paciente. Se debe intubar a los pacientes con trauma a la cabeza con una Escala de Coma de Glasgow de 8 o menos que requieran transferencia interhospitalaria. Igualmente, otros pacientes que pueden necesitar intubación endotraqueal previo al transporte pueden ser aquellos que tengan: Deterioro significativo de la consciencia (aunque no hayan llegado todavía a 8) Fractura inestable de huesos de la cara Sangrados excesivo en la boca Convulsiones La estimulación sensorial puede aumentar la presión intracranial. Por lo tanto, los pacientes que están intubados deben estar adecuadamente sedados y paralizados. Diferencia en mortalidad La mortalidad del paciente de trauma a la cabeza es 22% más alto en las zonas rurales que en las zonas urbanas debido a tiempos de transporte más prolongados y menos acceso a cuidado prehospitalario. Referencias https://www.tandfonline.com/doi/full/10.1080/10903127.2023.2187905?af=R https://www.nice.org.uk/guidance/ng232  https://pubmed.ncbi.nlm.nih.gov/31623894/  

Top 5 Most Read RNS's on Vox Markets for Friday 19th May 2023 1. Premier African Minerals #PREM - Funding and Appointment of Joint Broker Premier African Minerals announces a further placing to raise £610,000 at 0.925p for the ongoing Zulu Lithium and Tantalum Project Pilot Plant optimisation. George Roach, Chief Executive Officer, has agreed to participate in the placing at the Placing Price by way of a subscription of £110,000. 2. Genedrive #GDR - NICE recommends CYP2C19 genotyping genedrive announces that the UK's National Institute for Health and Care Excellence ("NICE") has recommended in draft guidance that CYP2C19 genotyping should be used before clopidogrel administration in the management of ischemic stroke ("IS") patients. Although the Genedrive® CYP2C19 ID test is in development, the NICE Committee included its predicted performance and pricing in its clinical and economic models. 3. Tharisa #THS - H1 FY2023 Results and dividend timetable REVENUE US$335.3m up 0.4%, PROFIT BEFORE TAX US$72.4 m down 41.8% (HY2022: US$124.3 m), INTERIM DIVIDEND US 3 cents. 4. Europa Metals #EUZ - Drilling Results Europa Metals announce the first assay results from its ongoing infill diamond drilling programme at the Company's 100% owned Toral Pb, Zn & Ag project. Significant intersection from drillhole TOD-043 of 8.70m @ 11.03% ZnEq(PbAg)*, including: o 3.10m @ 20.35% ZnEq(PbAg)* 5. Conroy Gold & Natural Resources #CGNR - Debt capitalisation of amounts owed by KDR Conroy Gold and Natural Resources has acquired an equity interest in AIM-quoted Karelian Diamond Resources through entering into a debt capitalisation arrangement, including the issue of convertible loan notes, with Karelian Diamonds. Capitalisation of debt amounting to £125,000 into new ordinary shares in Karelian Diamond Resources plc at a price of 2.5p per share Exchange of debt amounting to £112,500 into a convertible loan of £112,500 in Karelian Diamond Resources plc.

In this episode I chat with 3 amazing women, Dianne Benson, Yogi adventurer from season 2 episode 4, Nurse Practitioner Gilly Spence from Season 1 episode 23 and Bee Macpherson Associate Professor Clinical Education, Associate Director Student Support, at the School of Medicine, University of Leeds.  Each share with us their menopause journey, from symptoms to emotions, what helped them and how they got though it.Bee has set up 'Menopause for thought' cafes for peer support and is a pioneer in raising awareness through talks, workshops and programmes.Gilly has set up Our Menopause Ripon facebook group and holds local monthly meetings for women to get together to share and for support.Dianne runs daily yoga classes via zoom and supports her students going through menopause in many different waysGrab a cuppa and join us!  Love  Liz xBe recommends the following for menopause guidance:• National Institute for Health and Care Excellence (NICE) guidelines. These explain how your GP willdetermine what types of treatments and interventions they can offer you.• The National Health Service provides an overview of menopause.• The Royal College of Obstetricians and Gynaecologists offer further information in a dedicated areaof their website.• Henpicked provides information on managing menopause and an insight into women's stories.• Faculty of occupational medicine provides information about menopause within the workplace.Gilly's 'Our Menopause Ripon group details Instagram: @ourmenopauseriponFacebook: @ourmenopauseriponDianne can be contacted via Instagram:  @yogadenbensonFacebook:  @YogaDenNew YouTube Channel: Adventures of a Yogi  https://www.youtube.com/channel/UCPMUj6buTE9Kc-jcsY7QjPgDianne Holds daily classes on Zoom, to sign up contact her at yogaden@yahoo.com  You can contact me at the usual details:  email:  spirituallyspeaking222@gmail.com  Instagram: spiritually_speaking_222  Facebook:  spirtuallyspeaking222  Youtube: LizzyHill222

Un nouvel épisode du Pharmascope est maintenant disponible! Dans de ce 115ème épisode, Sébastien, Nicolas et Isabelle terminent leur série d'épisodes sur l'ostéoporose. Dans cette troisième et dernière partie, on aborde la prise en charge suite à une fracture, les marqueurs du remodelage osseux, l'ostéoporose induite par les corticostéroïdes et la prise concomitante de suppléments de calcium et de vitamine D lors de l'utilisation d'un traitement pharmacologique. Les objectifs pour cet épisode sont les suivants: Discuter de la prise en charge des patients qui ont subi une fracture de fragilisation Discuter de l'utilité des marqueurs biochimiques du remodelage osseux Résumer la prise en charge de l'ostéoporose induite par les corticostéroïdes Conseiller adéquatement la prise d'un supplément de calcium et de vitamine D aux patients prenant un traitement pharmacologique contre l'ostéoporose Ressources pertinentes en lien avec l'épisode Qaseem A et coll; Clinical Guidelines Committee of the American College of Physicians. Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians. Ann Intern Med. 2023;176:224-38. National Osteoporosis Guideline Group - UK. Clinical Guideline for the Prevention and Treatment of Osteoporosis 2021. Septembre 2021. Moe S, Paige A, Allan GM. Osteoporosis in postmenopausal women. Can Fam Physician. 2021;67:346. Nayak S, Greenspan SL. Osteoporosis Treatment Efficacy for Men: A Systematic Review and Meta-Analysis. J Am Geriatr Soc. 2017;65:490-95. National Institute for Health and Care Excellence (NICE). Osteoporosis: assessing the risk of fragility fracture. London; 2017. Papaioannou A et coll. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010;182:1864-73. Management of Osteoporosis in Postmenopausal Women: The 2021 Position Statement of The North American Menopause Society'' Editorial Panel. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28:973-97. Bessette L et coll. The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int. 2008;19:79-86. Deng J et coll. Pharmacological prevention of fractures in patients undergoing glucocorticoid therapies: a systematic review and network meta-analysis. Rheumatology. 2021;60:649-57. Calculateur FRAXCentre for Metabolic Bone Diseases. FRAX: Fracture Risk Assessment Tool. University of Sheffield, UK. Outil d'aide à la décisionMayo Foundation for Medical Education and Research. Bone Health Choice Decision Aid. Mayo Clinic, USA.

Holala! Un premier épisode du Pharmascope enregistré devant public est maintenant disponible! En direct de Jonquière, Sébastien, Nicolas et Isabelle continuent leur série d'épisodes sur l'ostéoporose. Dans cette deuxième partie, on aborde le calcium, la vitamine D ainsi que les différentes options pharmacologiques dans le traitement de l'ostéoporose. Les objectifs pour cet épisode sont les suivants: Discuter des avantages et des inconvénients à la prise de calcium et de vitamine D Expliquer les avantages et les inconvénients des traitements pharmacologiques de l'ostéoporose Ressources pertinentes en lien avec l'épisode Qaseem A et coll; Clinical Guidelines Committee of the American College of Physicians. Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians. Ann Intern Med. 2023;176:224-38. Bolland MJ et coll. Calcium intake and risk of fracture: systematic review. BMJ. 2015;351:h4580. Avenell A, Mak JC, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev. 2014;2014:CD000227. Moe S, Paige A, Allan GM. Osteoporosis in postmenopausal women. Can Fam Physician. 2021;67:346. Nayak S, Greenspan SL. Osteoporosis Treatment Efficacy for Men: A Systematic Review and Meta-Analysis. J Am Geriatr Soc. 2017;65:490-95. National Institute for Health and Care Excellence (NICE). Osteoporosis: assessing the risk of fragility fracture. London; 2017. Papaioannou A et coll. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010;182:1864-73. Management of Osteoporosis in Postmenopausal Women: The 2021 Position Statement of The North American Menopause Society'' Editorial Panel. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28:973-97. Calculateur FRAXCentre for Metabolic Bone Diseases. FRAX: Fracture Risk Assessment Tool. University of Sheffield, UK. Outil d'aide à la décisionMayo Foundation for Medical Education and Research. Bone Health Choice Decision Aid. Mayo Clinic, USA.

Alex Ford, Professor and Consultant Gastroenterologist at St James's University Hospital, Leeds, UK, joins Jonathan to discuss disorders of gut–brain interaction. Ford explains his specific interest in functional gastrointestinal disorders and recent revisions of their aetiology, as well as how conditions of gut–brain interaction affect quality of life and social functioning.  Use the following timestamps to navigate the topics discussed in this episode: (00:00)-Introduction   (03:16)-Causes of disorders of gut–brain interaction   (06:00)-Impact of gut–brain interaction disorders on quality of life   (07:32)-The cost-effectiveness of eradicating H. pylori in certain conditions   (10:15)-How Ford's MD thesis impacted the National Institute for Health and Care Excellence (NICE) guidelines for the management of dyspepsia    (12:15)-Ford's experience as a Post-doctoral Fellow at McMaster University in Canada   (14:24)-The effectiveness of antidepressants in the treatment of irritable bowel disease   (16:50)-Prevalence of disorders gut–brain interaction depending on sex and ethnicity   (19:33)-Effectiveness of the low FODMAP diet on irritable bowel disease   (23:20)-Mental health disorders in patients with inflammatory bowel disease   (28:30)-Ford's three wishes for global healthcare  

Chief executive Dr Sam Roberts outlines her priorities for NICE by National Institute of Health and Care Excellence (NICE)

Un nouvel épisode du Pharmascope est maintenant disponible! Dans de ce 113ème épisode, Sébastien, Nicolas et Isabelle débutent une série d'épisodes sur l'ostéoporose. Dans ce premier épisode, on aborde le dépistage, l'évaluation et le diagnostic de l'ostéoporose, une maladie qui n'en est peut-être pas vraiment une…   Les objectifs pour cet épisode sont les suivants: Définir l'ostéoporose Identifier les patients nécessitant un dépistage de l'ostéoporose Expliquer les avantages et les limites d'une ostéodensitométrie Évaluer le risque de fracture d'un patient Ressources pertinentes en lien avec l'épisode National Institute for Health and Care Excellence (NICE). Osteoporosis: assessing the risk of fragility fracture. London; 2017. US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319:2521-31. Viswanathan M et coll. Screening to Prevent Osteoporotic Fractures: An Evidence Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018. (Evidence Synthesis, No. 162. Papaioannou A et coll. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010;182:1864-73. Korownyk C, McCormack J, Allan GM. Who should receive bone mineral density testing? Can Fam Physician. 2015;61:612. Choisir avec soin. L'ostéodensitométrie. Canada. Management of Osteoporosis in Postmenopausal Women: The 2021 Position Statement of The North American Menopause Society'' Editorial Panel. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28:973-97. Calculateur FRAXCentre for Metabolic Bone Diseases. FRAX: Fracture Risk Assessment Tool. University of Sheffield, UK.

In this episode, we talk to Kelly Lloyd, who is a research fellow within the Leeds Institute of Health Sciences at the University of Leeds.Title of paper: A factorial randomised trial investigating factors influencing general practitioners' willingness to prescribe aspirin for cancer preventive therapy in Lynch syndrome: a registered reportAvailable at: https://doi.org/10.3399/BJGP.2021.0610National Institute for Health and Care Excellence (NICE) guidance for England and Wales recommends daily aspirin for colorectal cancer prevention in people with Lynch syndrome, and it is likely that prescribing will occur in primary care. GPs may be reluctant to prescribe due to concerns about the side-effects, supporting evidence and lack of awareness of the NICE guidance. In a randomised factorial trial, providing GPs with information on these factors did not increase willingness to prescribe, or comfort discussing harms and benefits. Alternative strategies targeting multiple levels of prescribing behaviour among unwilling GPs may support prescribing.

Top 5 Most Read RNS's on Vox Markets for Thursday 9th February 2023 5. Supply @ME Capital #SYME - Holding(s) in Company OMNI PARTNERS LLP have announced they hold 3.100% of the company's shares as of 31st January 2023. 4. Horizonte Minerals #HZM - Mining Services Contract Awarded for Araguaia Five-year mining services contract signed, pre-stripping to begin in early Q2 2023. Mining operating costs are in line with overall Feasibility Study assumptions, ensuring Araguaia remains on target to be a lower quartile cost nickel operation Construction at Araguaia remains on schedule with first production to commence in Q1-2024. 3. Helium One Global #HE1 - Appointment of New CEO and Board Change Helium One Global announces David Minchin will be stepping down as CEO and from the Board of Helium One, with immediate effect, to pursue other challenges. The Board is pleased to announce the appointment of Lorna Blaisse, currently Principal Geologist at Helium One, as CEO of the Company with immediate effect. 2. Genedrive #GDR - AIHL test preliminary recommendation by NICE genedrive plc announces that the UK's National Institute for Health and Care Excellence (NICE) has preliminarily recommended that the Genedrive® MT-RNR1 ID Kit can be used by the NHS following the evidence review as part of their Early Value Assessment (EVA) Programme. the Genedrive® MT-RNR1 ID Kit can quickly and accurately identify babies with the primary genetic variant who may be at risk of hearing loss if given aminoglycoside antibiotics. 1. Argo Blockchain #ARB - Directorate Change Argo Blockchain announces that Peter Wall is stepping down from his positions as Chief Executive Officer and Interim Chairman to pursue other opportunities. Argo intends to engage an executive search firm to assist with the process of selecting a Chief Executive Officer and will update the market in due course.

According to the National Institute for Health and Care Excellence (NICE), women aged 45 and over have a less than 5% chance of getting pregnant naturally within a year of trying .What is possible, and what is realistic? This show will give you a step-by-step guide to what an IVF journey looks like for a woman post-forty. Can she use her eggs? What are donor eggs? Can women carry children post-menopause? What about adoption? What about diet and lifestyle interventions? How are celebrities having babies at 47 or 50, and is this possible for the average woman? Dr Aimee Eyvazzadeh Graduated from UCLA School Of Medicine and completed her residency in Obstetrics and Gynecology at Harvard Medical School. She specializes in reproductive endocrinology and infertility. She is a board-certified ObGyn and fellowship trained in the area of infertility. She specializes in infertility, PCOS, endometriosis and minimally invasive surgery. Dr Aimee's mission is to bring more love into the world by helping people conceive. Her patients endearingly call her their “Egg Whisperer."

Today, we talk to Dr Claire Taylor, a GP and NIHR Clinical Lecturer at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Paper: Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy studyAvailable at : https://doi.org/10.3399/BJGP.2022.0278International guidelines recommend natriuretic peptide (NP) testing to prioritise referral for heart failure (HF) diagnostic assessment in primary care. European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guidelines differ significantly in their recommended NP referral threshold. Our study found at the lower ESC threshold fewer HF diagnoses were missed but more referrals from primary care would be required. Healthcare systems need to balance the risk of a missed or delayed diagnosis for individual patients with capacity in diagnostic services. An NP level below both the ESC and NICE thresholds was reliable in ruling out HF.

This week, Jonathan is joined by Karin Butler, Project Director at York Health Economics Consortium (YHEC), UK. They discuss Butler's career in health economics and the role of health economics consultancies and the National Institute for Health and Care Excellence (NICE).

Emma is joined by a very special guest Professor Sir David Haslam to discuss his new book Side Effects: How Our Healthcare Lost Its Way and How We Fix It.Along with being a GP for over 35 years Sir David has held a number of senior posts including being both chair and president of the Royal College of GPs, president of the BMA and chair of the National Institute for Health and Care Excellence (NICE), a post he held from 2013 to 2019.His new book explores what good healthcare should achieve and how we can create a system that is affordable, fair and provides good quality care.This interview looks at some of the really important themes raised in the book, including why the cost of healthcare will always continue to rise, why we need to better value primary care and public health, tackling health inequalities, over-medicalisation and whether we have our priorities right when it comes to end-of-life care.This episode was presented by GPonline editor Emma Bower. It was produced by Czarina Deen.Useful linksSide Effects: How Our Healthcare Lost Its Way and How We Fix It on Amazon Hosted on Acast. See acast.com/privacy for more information.

Amidst a shifting diagnostic pathway, the UK's National Institute for Health and Care Excellence (NICE) reconsiders its position on vibration controlled transient elastography (VCTE) in the community. This final conversation centers around how to create and train on delivering meaningful test results to patients. Roger Green begins with his note that in recent NASH Tsunami episodes, panelists have stated that their countries could not automate FIB-4 simply because liver enzyme tests are not standard in blood panels. This prompts Will Alazawi to suggest that a campaign similar to the one for people with diabetes on learning their HbA1c levels might go a long way toward driving between enzyme collection and FIB-4 use. Ian Rowe asks which number would be used for the liver. Louise answers that FibroScan results provide multiple metrics worth considering. She adds that while FibroScan offers substantial value, acquisition is too expensive to provide at scale. However, the less expensive tests are not adequately standardized or validated as predictive at an individual level. The rest of the conversation centers on ways to consider and use tests before finishing with the closing question. Roger asks the panelists for one thing in this system worth improving. Ian calls for a clear pathway capable of efficient decision making. Louise hopes for NICE to take action on liver health to drive accessibility in primary care. Kate extends this sentiment to address inequities across communities. Will is looking for stronger signaling to answer patients' concerns: how bad is their Fatty Liver or fibrosis? Finally, Roger offers his US-centric response: if we can appropriately identify the liver's place in multi-metabolic life, the field moves closer to acknowledgement as a big ticket item. 

Amidst a shifting diagnostic pathway, the UK's National Institute for Health and Care Excellence (NICE) reconsiders its position on vibration controlled transient elastography (VCTE) in the community. In this conversation, Roger Green and Louise Campbell are joined by Dr Kathryn Jack and Professor Ian Rowe to discuss the dynamic challenges of using FibroScan and other noninvasive tests (NITs) for best practice.Louise begins by reflecting on the experience of the second public meeting around considering access to FibroScan for primary care. In describing the evaluation process, she notes a shift from analyzing costs per test to a broader focus around how these tests are positioned in the wider pathway. Ian agrees that FibroScan does not fit well within the traditional framework of NICE. Analytical challenges and out of system data obscure answers to critical questions such as what is the cost effectiveness of FibroScan in primary versus secondary care. Kate highlights the value of developing an early screening pathway. She shares her experience that when scanning patients, cirrhosis presents in those who have never been diagnosed with Fatty Liver. This is a pivotal opportunity to deliver a targeted intervention and support for the unwittingly cirrhotic population. For Kate, the decision to reimburse FibroScan community use is a “no-brainer.” Ian challenges the practicality behind the idea that every patient in primary care should receive FibroScan. “It's important to bear in mind what NICE was asked and then to try and understand how we use FibroScan as part of the wider pathways.” He suggests community non-invasive fibrosis screening, but not necessarily FibroScan.

Amidst a shifting diagnostic pathway, the UK's National Institute for Health and Care Excellence (NICE) reconsiders its position on vibration controlled transient elastography (VCTE) in the community. Professor Ian Rowe and Dr Kathryn Jack discuss navigating a scarcity of relevant data for evaluating pathway development alongside Surfers Roger Green and Louise Campbell. Roger prompts this conversation by asking the group whether there is a developed paradigm for how to adopt technology in places where the data is arriving in real time. He notes the difference between how this process is approached in open markets such as the US versus data-reliant markets similar to the UK. Ian describes a process used in oncology called “commissioning through evaluation,” where the NHS pays for medications while collecting the necessary real-world data to conduct evaluation. This point introduces political influence on decision making processes. Roger notes the resulting polarity in healthcare expenditure between the US and the UK. Roger continues to spur discussion on the political pressures and metaphorical issues that shape the differences between cancer and liver disease management. Louise analyzes the linkages between poor liver health and non-hepatic cancers, insisting on a more robust consideration of the liver-to-cancer link. Ian mentions the ever increasing challenge for hepatology of treating more aggressively and effectively with NITs while simultaneously conducting research on the best way to do so. Kate suggests utilizing the nurses and allied health professionals that are willing to become involved in research and drive the required data forward. At this point, Professor Will Alazawi joins the panel with an impressive debut. He returns to the idea that due to stigmas, liver and cancer do not occupy the same imagination in the general public. His ideas link socioeconomic strata with liver outcomes, suggesting marginalized patients are more likely to encounter complications of liver disease.

Amidst a shifting diagnostic pathway, the UK's National Institute for Health and Care Excellence (NICE) reconsiders its position on vibration controlled transient elastography (VCTE) in the community. This conversation begins with Will Alazawi concluding his comments on the link between liver outcomes and socioeconomic status. The group then explores a range of factors contributing to inequity. Roger speaks to his marketing research experience which revealed physicians' frustration with an inability to drive patients toward sustaining lifestyle management goals. Will suggests that the challenges are not strictly socioeconomic, but concedes that a number of variables remain immeasurable at this point in time. For example, he poses a few yet to be answered questions: how much space do people have in their homes? Is there access to healthy food? What financial impediments exist? Louise and Kate comment on misunderstandings about alcohol consumption and liver health. All agree that an excess of “good quality” alcohol has the same deleterious effects on liver health as does an excess of cheap drink. Discussion shifts back toward accessible pathways. Will and Louise suggest that the challenge lies in deploying hepatologist skills into the community more effectively. Kate questions who will administer the FibroScans in primary care, pointing to the shortage of nurses in the UK amongst other challenges. Ian thinks it may be impossible to implement solutions for every issue discussed in a scalable, cost effective way. He asserts that testing needs to be deliverable in a way that is meaningful to patients. Establishing a simple, communicable testing metric with accessible points of administration is key. This seems more difficult and expensive to achieve in the context of liver health than it has for identifying other successful metrics such as reading blood pressure. 

Amidst a shifting diagnostic pathway, the UK's National Institute for Health and Care Excellence (NICE) reconsiders its position on vibration controlled transient elastography (VCTE) in the community. In this episode, Roger Green and Louise Campbell are joined by Dr Kathryn Jack and Professors Ian Rowe and William Alazawi to discuss the dynamic challenges of using FibroScan and other noninvasive tests (NITs) for best practice. Louise opens the conversation by reflecting on the second public meeting around considering access to FibroScan for primary care. She notes a shift from analyzing costs per test to a broader focus around how these tests are administered and to whom. The group agrees that FibroScan does not necessarily fit well within the traditional framework of NICE. Analytical challenges and out-of-system data obscure answers to critical questions such as what is the cost effectiveness of FibroScan in primary versus secondary care. Kate highlights the value of developing an early screening pathway. She notes that when scanning patients, cirrhosis presents in those who have never been diagnosed with Fatty Liver. This is a pivotal opportunity to deliver a targeted intervention and support for the unwittingly cirrhotic population. Ian challenges the practicality behind the idea that every patient in primary care should receive FibroScan. He instead suggests non-invasive fibrosis testing in selected patients in the community. “It's important to bear in mind what NICE was asked and then to try and understand how we use FibroScan as part of the wider pathways.” Roger notes the difference between how this process is approached in the US versus the UK. He asks the group whether there is a developed paradigm for how to adopt technology in places where the data is arriving in real time. Ian describes ways the NHS can manage uncertainty and evidence for emerging technologies, citing an example from the cancer space. The conversation shifts toward how the liver can be politicized to arrive at a quicker, better decision. Midway through the episode, Will makes his debut after being locked out of the recording session due to technical difficulties. In true breakthrough fashion, he introduces spiky ideas linking socioeconomic strata with liver outcomes. His thought: the more marginalized the patient, the more likely they are to encounter complications of liver disease. The group then proposes a range of factors contributing to inequity. Kate steers discussion back to questions around administration of FibroScan and the challenges that oppose nurses and other healthcare professionals. Ian expands these questions and challenges in the context of delivering clear messaging. Settling on a simple, communicable metric may be more difficult and expensive for liver testing than other more recognized health indicators such as reading blood pressure. At the bottom of the hour, Roger asks the panelists for one thing in this system worth improving. Ian calls for a clear pathway capable of efficient decision making. Louise hopes for NICE to take action on liver health to drive accessibility in primary care. Kate extends this sentiment to address inequities across communities. Will is looking for stronger signaling to answer patients' concerns: how bad is their Fatty Liver or fibrosis? Finally, Roger offers his US-centric response: if we can appropriately identify the liver's place in multi-metabolic life, the field moves closer to acknowledgement as a big ticket item. 

A treatment for patients at high risk of having a heart attack or stroke is now available for prescribing in primary care, yet uptake among GPs has been slow.  Inclisiran was approved for use by the National Institute for Health and Care Excellence (NICE) in late 2021 and AHSNs are helping local teams to develop different models of Inclisiran delivery. Inclisiran bridges a gap in the lipid management pathway, offering an additional medication to use alongside statins and other lipid-lowering products used in primary care. Trials show that when a patient is receiving statins as part of their treatment and is prescribed Inclisiran, their low-density lipoprotein level (ldl) reduces by around 50 per cent. In this episode, Dr Phil Jennings explores the science behind Inclisiran and the evidence of its effectiveness. His guests are Professor Kausik Ray, Professor of Public Health, Honorary Consultant Cardiologist and Director of Imperial Centre for Cardiovascular Disease Prevention at Imperial College London; and to Dr Carl Deaney, a GP in Lincolnshire.  This podcast has been created to inform healthcare professionals only, to support them to roll-out the treatment.

Diabetic macular oedema is a condition that can develop when having type one or type two diabetes. It can impact sight progressively in the form of retinopathy or maculopathy. We hear about a new treatment for the condition, which The National Institute for Health and Care Excellence (NICE) has estimated to benefit around 22,000 people. Bernie Warren has the condition and she tells us about the benefits this drug could have to her life. We also get more information about the condition and the new treatment from Robin Hamilton, who is an Ophthalmic Surgeon at Moorfield's Eye Hospital. The Commonwealth Games are underway in Birmingham. They are an integrated games, with both para and able-bodied athletes competing alongside each other. Some visually impaired athletes are included in the mix and so we get a round-up of the medal winners from BBC Sports reporter, Delyth Lloyd. We speak to visually impaired Para-Triathlon gold medallist, Dave Ellis about his win and to Jonny Riall, who is the leader of Team England and also Head of Sport at the British Paralympic Association on the integration of athletes at the Commonwealth Games. Presenter: Peter White Producer: Beth Hemmings Production Coordinator: William Wolstenholme Website image description: pictured is a Team England swimmer diving into a pool at the Commonwealth Games. The image is taken using an underwater camera. The swimmer is wearing a red swimsuit and red swimming cap. Yellow and pink bunting hangs in the air over the pool.

Sir David Haslam is Chair of Young Lives vs Cancer, Senior Adviser at Kaleidoscope Health and Care, and a Non-Executive Director at Dorset HealthCare University NHS Foundation Trust.David has had a fascinating and varied career. He was a GP for 36 years, and has written a number of books on parenting, as well as presenting TV shows on the topic. He has held a number of senior posts in health and care, including Chair of the National Institute for Health and Care Excellence (NICE), and President of the British Medical Association (BMA) and the Royal College of GPs (RCGP).We explored questions like:- How can someone climb the career leader while staying true to their values?- How can people carve out a niche for their creative pursuits?- Is it better to be a generalist or a specialist in today's job market?Follow us on LinkedIn, Twitter and Instagram.

In this episode we talk to Amy Clark who is a final year medical student at Cardiff and Dr Kathryn Hughes who is a GP and senior clinical lecturer at PRIME Centre Wales at the School of Medicine at Cardiff University. Paper: Accuracy of the NICE traffic light system in children presenting to general practice: a retrospective cohort study https://doi.org/10.3399/BJGP.2021.0633 (https://doi.org/10.3399/BJGP.2021.0633) The National Institute for Health and Care Excellence (NICE) traffic light system is widely used in general practice for the assessment of unwell children; however, the majority of previous studies validating this tool have been conducted in secondary care settings. To that authors' knowledge, no studies have validated this tool within UK general practice. This study found that the traffic light system cannot accurately detect or exclude serious illness in children presenting to UK general practice with an acute illness. The conclusion reached was that it cannot be relied on by clinicians for the assessment of acutely unwell children and that it is unsuitable for use as a clinical decision tool.

It's “In the News…” Got a few minutes? Get caught up! Our top stories this week include testing a new treatment for leukemia to see if it might help with type 1, Black patients with type 1 are at higher risk of DKA, transitioning from teen care to adult care, updates on Eversense in the US and Dexcom One in the UK and front office changes at Beyond Type 1 and Vertex. Check out Stacey's book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Episode Transcription Below (or coming soon!) Please visit our Sponsors & Partners - they help make the show possible! *Click here to learn more about OMNIPOD* *Click here to learn more about DEXCOM* Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines of the past seven days. we go live on social media first and then All sources linked up at diabetes dash connections dot com when this airs as a podcast. XX The news is brought to you by The World's Worst Diabetes Mom: Real Life Stories of Parenting a Child With Type 1 Diabetes. Winner of best new non-fiction at the American Book Fest and named a Book Authority best parenting book. Available in paperback, eBook or audio book at amazon. XX Interesting look at whether a treatment for leukemia might work against type 1. Very early on here.. but AVM Biotechnology has received a grant to find out. The drug doesn't have a name yet.. it's referred to as AVM-0703 and has been shown to delay T1D in the lab. A preclinical dose-finding and mechanism of action (MOA) study in three scenarios including pre-diabetic, new-onset, and established diabetes is the first aim of the program. Those results will be used to determine the targeted dose to be used in a pivotal efficacy study for reversal of new-onset and established diabetes. It is anticipated that for patients not showing remission, AVM0703 may reinforce other immunotherapies allowing a wider range of patients to achieve insulin independence. https://www.businesswire.com/news/home/20220405005529/en/AVM-Biotechnology-Awarded-1.6-Million-Phase-II-SBIR-Grant-to-Study-AVM0703%E2%80%99s-Potential-to-Reverse-Type-1-Diabetes XX Black patients with type 1 faced a significantly higher frequency of diabetic ketoacidosis during the pandemic, and particularly during surges, researchers reported. This was a big study at several different health centers and hospitals. Researchers found there was not significant difference in the number of patients in DKA from 2019 versus 2020.. but there was a higher proportion of Black patients. The trend continued through the pandemic and again, it was significant, 48-percent versus 18 percent. Pandemic surges emphasized the disparity even more. These researchers say their work shows racial inequities in diabetes care were present before the pandemic, starkly visible during the pandemic, and will continue to persist after the pandemic -- unless we systemically root out and target racial inequities in diabetes care," https://www.medpagetoday.com/endocrinology/type1diabetes/98044 XX A new look the transition from pediatric to adult care for people with type 1 shows.. it needs improvement. This research – based on interviews with older adolescents showed many felt unprepared and dissatisfied with the transition process. Three big takeaways – the teens are aware of the changing relationship with their parents and health care teams and often want more independence than the parents are willing to give… the teens want acknowledgement that being diagnosed at different ages means they may be more or less comfortable with self-management and the third is that they think their pediatric team isn't preparing them to work with adult providers. Personally, this means a lot to me – as my son is 17 – and I'll be asking his peds endo to work with him more on this stuff in the next couple of years. https://www.healio.com/news/endocrinology/20220401/novel-programs-needed-to-improve-transition-from-pediatric-to-adult-diabetes-care XX DiabetesWise announces the launch of it's new Pro website. It's an unbranded non-biased resource created at Stanford University to help make providers more informed about diabetes devices and streamline the prescription process. We've talked about Diabetes Wise before and I'll link it up here. It's easy to feel overwhelmed by the evolving choices and providers are in the same situation. The DiabetesWise Pro website has an extensive Device Library where providers can learn about all of the FDA-approved diabetes devices on the market based on the patient's considerations. The user can compare the devices from the different manufacturers using the Compare Device tool, which displays a side-by-side analysis of the components and details of each technology, including the steps for ordering and prescribing the device. Providers can then build a comparison report of the two devices to share with their patients, colleagues, and community. Along with the Device Library, providers can receive help with ordering and prescribing the devices for their patients using the Prescription Tools feature on the website. The Prescription Tool directs the user to a guide providing accurate up-to-date information on the necessary steps for filing a prescription and ordering the device for the patient. DiabetesWise Pro has plans to update the tool to include details on the approval of devices for patients based on insurance type. DiabetesWise Pro website features for use in clinic include: 1. Device Library- Information on specific device fundamentals 2. Comparison Tool- Comprehensive tool that allows you to compare device recommendations and share with patients 3. Prescription Tool- A step-to-step guide for ordering the device and filling a prescription based on insurance type 4. Resources for providers by providers- best tips, tricks, and workarounds for diabetes technology from providers With this new resource, there have also been enhancements to the patient-facing website at DiabetesWise. Newly approved devices have been added and there are now Spanish-language versions of the Check-Up and Device Finder. https://diabeteswise.org/#/ https://providers.diabeteswise.org/#/ XX FDA approval in February, now the Eversense six-month CGM is rolling out to patients. The price is set at 99-dollars out of pocket for the first transmitter and sensor and then $100 per month for the six months of wear. The device includes a small fluorescence-based sensor, about the size of a grain of rice, which is fully embedded in the upper arm. A transmitter stuck to the skin over the sensor reads the data, transmits the information to a smartphone and provides vibration alerts for changes in blood sugar. https://www.fiercebiotech.com/medtech/ascensia-diabetes-care-launches-eversenses-6-month-cgm-system-us XX Dexcom ONE is getting a big roll out in the UK. We've talked about this a couple of times in the past.. it's the same Dexcom technology but a bit pared down and at lower cost. This news comes as the National Institute for Health and Care Excellence (NICE) announced new guidance for adults and children managing Type 1 diabetes. NICE now recommends that adults with Type 1 diabetes be offered a choice of glucose sensors. G6 is already offered there and the G7 will be as well, but this is about national health service coverage, and the Dexcom One is the only system under consideration there. https://www.businesswire.com/news/home/20220401005092/en/Dexcom-Announces-Dexcom-ONE-the-Newest-Real-Time-Continuous-Glucose-Monitoring-System-to-Its-Range-of-Scan-Free-and-Fingerprick%E2%80%A0-Free-Devices XX Some front office news around the community.. Stem cell pioneer Doug Melton is leaving Harvard to join Vertex Pharmaceuticals. Not entirely unexpected – Melton's company Semma was purchased by Vertex and they are moving ahead toward stem cell transplantation as a functional cure for type 1. This was the company that got all those headlines last fall about the cure – you remember “It worked in this one guy!” Melton is joining the company as a distinguished Vertex Fellow. Semma, by the way, was named after his two adult children who live with type 1 – Sam & Emma. https://www.statnews.com/2022/04/05/douglas-melton-noted-stem-cell-researcher-leaves-harvard-for-vertex-to-create-diabetes-treatments/ XX Beyond Type 1 names Deborah Dugan as CEO. She replaces Thom Scher who died suddenly and unexpectedly in December. Dugan was previously the CEO of RED, the not-for-profit organization founded by U-2's Bono (bah no) and Bobby Shriver to raise awareness in the fight against AIDS. Dugan, has been recognized as one of the "100 Most Powerful Women" by Forbes, "Top Woman to Help Change the World" by Elle and as a "Nelson Mandela Changemaker" https://beyondtype1.org/beyond-type-1-diabetes-deborah-dugan-ceo/ XX Congratulations to Leo and Alana Folsom who welcome a baby boy. The couple was on a recent season of the Amazing Race and after we all saw Leo's Dexcom in one of the first episodes, he came on this show to share his story. Leo lives with congenital hyperinsulinism, where the body makes too much insulin, and had almost his entire pancreas removed. He told me at the time he was amazed by the diabetes community's support. So I just wanted to say congrats to him and to Alana and help welcome baby Kitt Edwin Folsom. XX On this week's long format episode, Laurie Harper shares her story… Laurie was diagnosed as a toddler back in 1955. She's in the Joslin Medalist Study and talks about the difference this incredible group is making. Next week you'll hear from World Champion Kayaker Sage Donnely who was diagnosed with type 1 at age 3 when she'd already been kayacking for almost a year. Listen wherever you get your podcasts That's In the News for this week.. if you like it, please share it! Thanks for joining me! See you back here soon.

In this episode we talk to Dr Cassie Boness about the idea of ‘Alcohol Use Disorder' (AUD) as a widely applied concept in the identification and treatment of alcohol problems. Alcohol Use Disorder is the basis for identifying an alcohol problem in the American Psychiatric Association's DSM, but also used as a broader term for alcohol-related problems including by the UK's National Institute for Health & Care Excellence (NICE). Cassie is a  Research Assistant Professor at the University of New Mexico's Center on Alcohol, Substance Use and Addictions (CASA) and a clinical psychologist.  We discuss the basis of Alcohol Use Disorder and some of the issues around such attempts to identify the very complex nature of alcohol use and problems. This includes discussion on Cassie and others work on developing a new framework to better identify AUD - the  The Etiologic, Theory-Based, Ontogenetic Hierarchical Framework of Alcohol Use Disorder. 

Hello and welcome to the Alcohol Alert, brought to you by The Institute of Alcohol Studies.In this edition:IAS BlogsIAS Small Grants Scheme now open for applicationsWHO Europe looks to strengthen implementation of alcohol Action PlanGovernment’s “dismal record” in meeting 2012 Alcohol Strategy initiatives NICE says pregnant women should be asked how much they drinkAudit Scotland says Scottish Government’s drug and alcohol plans must be clearerLords continue to debate alcohol labelling232 million workdays missed in the US due to alcohol use disorderMounting evidence that alcohol increases CVD risk even at low amountsAlcohol Toolkit Study: updateWe hope you enjoy our roundup of stories below: please feel free to share. Thank you.IAS BlogsTo read blogs click here.IAS Small Grants Scheme now open for applicationsWe are inviting applications from researchers – especially early career researchers – to our small grants scheme.This scheme will provide funding for innovative research ideas that can help inform public policy debates on how to tackle alcohol harm. Priority will be given to proposals that align with our organisational objectives, as outlined in our Strategy 2020–2023.Please send to relevant contacts. More details and how to apply are here.WHO Europe looks to strengthen implementation of alcohol Action PlanWHO Europe consulted on the draft of a new Framework, which aims to strengthen implementation of the WHO European Action Plan to Reduce the Harmful Use of Alcohol, 2022 – 2025.The Framework includes recommendations for Member States on how to implement the Plan and Actions of the WHO Regional Office for Europe, on each of the following six focus areas:WHO Europe will now finalise the draft and submit it to the WHO Regional Committee for Europe at its 72nd session in September 2022.Government’s “dismal record” in meeting 2012 Alcohol Strategy initiatives On 23 March 2012 the UK Government launched its Alcohol Strategy, with the then Prime Minister David Cameron highlighting the harm caused by alcohol and stating that “We can't go on like this. We have to tackle the scourge of violence caused by binge drinking. And we have to do it now.”A decade on, public health actors and politicians are drawing attention to the inertia over the last 10 years, with the majority of the planned initiatives being scrapped or barely implemented.Labour MP Dan Carden says that lives lost due to alcohol could have been saved if the Conservatives hadn’t scrapped plans for minimum pricing of alcohol (MUP), one of the key parts of the Strategy’s plan to increase the cost of cheap, high-strength drinks.As well as MUP, making health a local licensing objective and banning multi-buy promotions of alcohol were also planned but scrapped by the Home Office in subsequent years.In a recent IAS blog, Head of Research Dr Sadie Boniface wrote that these failures don't "just reflect badly on the Government. Putting commercial interests ahead of health in alcohol policies – such as through freezing and cutting alcohol duty in recent years – has cost lives and widened inequalities".Both Dan Carden and the Alcohol Health Alliance’s Professor Sir Ian Gilmore highlighted the need for a new Alcohol Strategy, with Mr Carden writing:“With record alcohol-specific deaths, rising economic and social harms, and depleted treatment services, people are rightly asking why it has taken so long for the Government to bring forward a plan to tackle alcohol harm.“We need to remove barriers to effective action, including the undue influence of corporate lobbyists on policy decisions. Government must finally put public health first. Lives depend on it.”In agreement, Prof Sir Ian Gilmore said:“The situation has never looked bleaker. We need a strategy with measures to stop the incessant promotion of alcohol, give consumers information on harms, and to properly fund alcohol treatment.”NICE says pregnant women should be asked how much they drinkEarlier this month, the National Institute for Health and Care Excellence (NICE) published a quality standard that focuses on assessing and diagnosing foetal alcohol spectrum disorder (FASD) in children and young people.Among other statements, the new standard states that women who are pregnant should be advised by healthcare professionals not to drink alcohol throughout pregnancy, and that they should be asked about their alcohol use and this should be recorded.NICE dropped an earlier draft which suggested adding a pregnant woman’s alcohol consumption data to their child’s medical notes, with fears that women that may need help might hide their drinking.FASD prevalence is unknown and there is no reliable evidence on incidence of FASD, according to NICE. Estimates for global prevalence are 7.7 per 1,000 population and for UK prevalence are 32.4 per 1,000 population, over four times the global rate. That equates to 2.18 million people in the UK, more than the population of people living with autism, highlighting the need for improved diagnosis and support.Lia Brigante of the Royal College of Midwives said:"As there is no known safe level of alcohol consumption during pregnancy, the RCM believes it is appropriate and important to advise women that the safest approach is to avoid drinking alcohol during pregnancy and advocates for this.”Others have raised concerns about the guidance, with Claire Murphy of the British Pregnancy Advisory Service stating that:“We remain concerned about the routine questioning of women throughout pregnancy on this issue."Our research shows women find antenatal discussions about alcohol - even when they don't drink at all - can supersede other issues important to them, like their own mental health and wellbeing.”Ian Hamilton of the University of York argued that considering the short amount of time in appointments, midwives and GPs risk missing other connected issues:“For example, higher consumption of alcohol is often related to mental problems like depression and anxiety. It could be more effective to make that the focus of scarce appointment time – rather than going through tick-box-driven conversations about alcohol.”Audit Scotland says Scottish Government’s drug and alcohol plans must be clearerThe independent public body Audit Scotland, which looks to ensure public money is spent “properly, efficiently and effectively”, has said that the Scottish Government must have a clearer spending plan for its “complex” drug and alcohol services.Scotland saw a marked increase in the number of alcohol and drug deaths in 2020 and the Government has announced £250 million over this parliamentary term to tackle drug deaths.Audit Scotland’s report states that there needs to be more information from the Government about where the money was being spent and that this should be available in one place."This includes more clarity on the different funding streams, which organisations are receiving funding, the purpose of funding and how decisions are made on prioritisation and distribution of funding.”Auditor General Stephen Boyle said:"We've recently seen more drive and leadership around drug and alcohol misuse from the Scottish government."But it's still hard to see what impact policy is having on people living in the most deprived areas, where long-standing inequalities remain."A Scottish Government spokesperson said they welcome the report and acknowledge the concerns. Regarding alcohol, they said, "We are working with Public Health Scotland (PHS) to improve alcohol treatment data, including the development of PHS's surveillance system."In other Scottish news, a recent study by the University of Stirling has identified the major obstacles faced by local public health actors in seeking to influence the alcohol premises licensing system. These challenges included:The researchers wrote that having a public health objective for alcohol licensing – a policy measure frequently called for by public health groups – may not “remove the need for effective local advocacy in a multi-centric system” and that successful advocacy may “involve diverse strategies and relationship building over time”.Another Scottish study to come out in March was by Glasgow Caledonian University, which identified barriers people from the LGBTQ+ community face in accessing alcohol services. These included:Professor Carol Emslie, who led the SHAAP-funded study, said:“Our report recommends that all staff working in alcohol services should receive LGBTQ+ diversity training and services should check they are reaching the LGBTQ+ community, and tailoring their services appropriately.”Lords continue to debate alcohol labellingThe Health and Care Bill is in its final stages, having had its third reading in the House of Lords. It will now pass to the Commons for consideration of Lords amendments. One amendment that was withdrawn during debate was tabled by Baroness Finlay of Llandaff, in order to give the opportunity to discuss alcohol labelling requirements.Baroness Finlay stated that voluntary labelling has failed and highlighted public support for improved labelling.Many of the peers present gave their support, including Lord Bethell of Romford, who was Minister of the Department of Health from March 2020 until September 2021. He made clear that he thinks it is a moral obligation to give people more information so that they can make informed choices.Lord Bethell also mentioned his time as Health Minister and the promises he made that the labelling consultation would be issued by the end of 2021. He therefore asked the current Minister to make “the very specific time commitment the amendment seeks”: no later than 1 year from the Act passing.Earl Howe responded that “The consultation will be launched in due course” but that he couldn’t give definitive timings. In response Baroness Finlay withdrew the amendment, saying:“I note the tone with which “in due course” was uttered, which is really disappointing. I hope the Government will take the message back to the Secretary of State to empower him to grasp the nettle, provide leadership in public health and, for the first time, proceed to make sure that people know what they are drinking and what the harms are…we will hold the Government’s feet to the fire over what “in due course” means; I hope it is a very short course.”232 million workdays missed in the US due to alcohol use disorderA study in the United States looked at data from the US National Survey on Drug Use and Health, to examine the association of alcohol use disorder (AUD) and workplace absenteeism each year.It found that increasing severity of alcohol use disorder (AUD) was associated with an increased number of days of work missed due to sickness:In total, workers with alcohol use disorder missed more than 232 million workdays annually. People with AUD represented 9.3% of the full-time workforce yet contributed to 14.1% of total reported workplace absences.The study researchers concluded that:“These results provide economic incentive for increased investment in AUD prevention and treatment, both for employers and policy makers.”In the UK estimates for working days lost each year due to alcohol-related sickness stand at 17 million, at a cost of £1.7billion to employers.This US research came at the same time that a study reported a 26% increase in deaths involving alcohol in the US, between 2019 and 2020. The researchers wrote that:“Deaths involving alcohol reflect hidden tolls of the pandemic. Increased drinking to cope with pandemic-related stressors, shifting alcohol policies, and disrupted treatment access are all possible contributing factors.”Mounting evidence that alcohol increases CVD risk even at low amountsA Massachusetts’ study of UK Biobank data looked at the association between alcohol consumption and cardiovascular disease (CVD) risk. Observational studies have previously suggested lower CVD risk among light to moderate drinkers compared to those abstaining or drinking heavily.This new research initially found the same, however the study found that those light to moderate drinkers had healthier lifestyles than abstainers. For instance they tended to engage in more physical activity, have lower BMI, and smoke less. Adjusting for these lifestyle factors, and using newer Mendelian randomization techniques, the researchers concluded that the relationship between alcohol consumption and CVD risk looks like this:As one of the researchers wrote on Twitter:Dr Aragam went on to say:“These findings imply that alcohol intake should not be recommended to improve CV health and that reducing intake reduces CVD risk in all individuals.”Alcohol Toolkit Study: updateThe monthly data collected is from English households and began in March 2014. Each month involves a new representative sample of approximately 1,700 adults aged 16 and over.See more data on the project website here.Prevalence of increasing and higher risk drinking (AUDIT)Increasing and higher risk drinking defined as those scoring >7 AUDIT. A-C1: Professional to clerical occupation C2-E: Manual occupationCurrently trying to restrict consumptionA-C1: Professional to clerical occupation C2-E: Manual occupation; Question: Are you currently trying to restrict your alcohol consumption e.g. by drinking less, choosing lower strength alcohol or using smaller glasses? Are you currently trying to restrict your alcohol consumption e.g. by drinking less, choosing lower strength alcohol or using smaller glasses?All past-year attempts to cut down or stopQuestion: How many attempts to restrict your alcohol consumption have you made in the last 12 months (e.g. by drinking less, choosing lower strength alcohol or using smaller glasses)? Please include all attempts you have made in the last 12 months, whether or not they were successful, AND any attempt that you are currently making.The UK Alcohol Alert (incorporating Alliance News) is designed and produced by The Institute of Alcohol Studies. Please click the image below to visit our website and find out more about us and what we do, or the ‘Contact us’ button. Thank you. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit instalcstud.substack.com

Time stamp interview notes continued on my website: https://treesmendus.com My new book Optimize Your Heart Rate: Balance Your Mind and Body  With Green Space1:19 Professor Andy Jones is a public health academic who holds the position of professorial fellow in Norwich Medical School at the University of East Anglia in the UK. He has wide ranging interests including the pragmatic evaluation of public health interventions, the role of the environment as a determinant of health and related behaviours, and the impact of access to services on health outcomes. He has a strong focus on policy and delivery in his work and collaborates with several key organisations working in this field, including the National Institute for Health Research (NIHR), the National Institute for Health and Care Excellence (NICE) and Cancer Research UK.2;20  childhood, mother took him outside along the Suffolk coastline. Studied environmental science and always interested in health. Nature and health relationship - advocate for both.4:36  definition and history  of green space, UK companies like Cadbury recognized that if  you wanted productive workers, you needed healthy workers  --  so developed new settlements that integrated green space - 6:47 everyone had a garden7:31 green space in UK has been an urban centric movement eg massive Hyde Park09:37  “The health benefits of the great outdoors: a systematic review and meta-analysis of green space exposure and health outcomes.” Published in the Journal Environmental Research, 2018. What did you want to know? The  process?   Individual studies may not offer a strong case for causality but when you combine individual  studies in a way that allows for more broad conclusions. According  to 290 million people  in 140 studies (96% of studies from last 10 years – illustrating the rapid growth in green space and health). Living close to green space and spending time outside has significant and wide ranging benefits. Time in green space reduces risk of diabetes, cardiovascular disease, premature death, stress, high blood pressure. 10:02 Review of the literature, systematic, so that somebody else can some along and do the same thing - and would get the same thing. 10:53 Why  did do review? Take stock, let's try and cut through all the noise and get the signal. Find out what is common. 11:57  looked at everything except mental health 12:34 Health outcomes that we can measure - heart rate, heart rate variability HRV, mortality, cortisol levels13: 26 143 studies - signal, explosion of interest 14:41 Populations in green space had better health outcome, particularly stress outcomes 1)  heart rate and 2) heart rate variability HRV 3) cardiac mortality15:56 Results: 20% reduction in bad things, if we had a pill that would do that we would take it. 17:07  The most surprising thing was the consistency of the findings and size of differences in populations with more green space and those with the least access to green space. 18:08 Threw out some studies and only kept the highest quality  studies and got the same result. Still consistent. 19:36 Interesting unanswered questions on quality  of green space. Do we have to use it or is it enough to just look at it? 

Dr Tom Freeman talks to us before his plenary talk at the Society of Mental Health Research conference in Hobart on "The role of cannabinoids in the development and treatment of addiction and mental health disorders". Dr Tom Freeman is Senior Lecturer and Director of the Addiction and Mental Health Group in the Department of Psychology at the University of Bath, United Kingdom. He is a member of Council for the British Association for Psychopharmacology and was supported by the Society for the Study of Addiction as a Senior Academic Fellow. He has contributed clinical guideline development for the National Institute of Health and Care Excellence (NICE) and international projects for the European Union drugs agency. In his talk “The role of cannabinoids in the development and treatment of addiction and mental health disorders” he will firstly outline the effects of THC and CBD, which are distinct cannabinoids found in the cannabis plant. Next, he will present data on how levels of cannabinoids have changed in cannabis over time, and the health impact of these changes. Finally, he will present new trial data investigating cannabinoids as treatments for addiction and mental health disorders.

The UK's National Institute for Health and Care Excellence (NICE) issues health economics-based decisions on whether therapies and diagnostics should be reimbursed by the British government. In a recent draft guidance titled FibroScan for assessing liver fibrosis and cirrhosis outside secondary and specialist care, NICE has stated that "there is not enough certainty for [using FibroScan to assess liver fibrosis or cirrhosis for adults in primary or community care] to recommend it as a clinically effective and cost saving option for routine use." This episode centers around understanding the draft guidance and what it means for out of hospital screening.In addition to Louise, Jörn Schattenberg, Ian Rowe and Roger, this panel includes a first-time: lead modeler and epidemiologist Chris Estes of the Center for Disease Analysis Foundation. Chris has been lead modeler on some of the 2015-2030 projects previously discussed on the podcast.The question driving this episode is: what about the NICE decision makes sense and what might not. Ian started by providing context about NICE: its mission is to "allow 'rational' in inverted commas decisions to be made about health care spend, mostly from a cost effectiveness and clinical effectiveness perspective." He noted that this decision revolves around a fairly narrow target: FibroScan in a community or primary setting, as compared to its delivery or secondary care. Ian goes on to note that two sets of data that would help drive a decision are scarce: how well the test works and, separately, how well learning test results causes patients to improve their health. Against that backdrop, he noted that a decision not to fund might be "regrettable" and not in the interest of patients, but a logical outcome of the presenting question, organizational mission and lack of existing data.Louise Campbell followed Ian and question some specifics of how the analysis was conducted and the source and nature of cost data NICE used. On the "nature of data" issue, she noted that the NICE review team presented FibroScan costs as a single, fixed variable, whereas in the "real world," the ways and amounts that different institutions charge vary widely.Roger Green then broadened the question to ask what the outcome might be with a broader question or approach the economics of the situation. Chris Estes discussed the direct and indirect costs that would go into a complete calculation and then to note that if you could prevent disease before it began (by addressing obesity or early NAFLD, this would be the most cost effective strategy. Ian noted it was also one on which the manufacturer seemed unable to provide data.The rest of the episode focused on issues such as how this question would be treated differently in Germany, what data sources or facts might drive a different decision and how to research or acquire this data. Louise noted several examples of areas where she felt the costing analysis might not have reflected the realities of the market and patient care cases. The conversation jumps from one topic to another. Toward the end, Jörn notes that while our primary focus should be to support wellness, the easier economics to evaluate are those of treating illness and it becomes clear that this tension between illness that provides hard data and wellness that is a softer measure but clearly of greater benefit to society is a significant source of friction that tends to undercut long-term thinking.

Pharmacist, Jonathan Underhill is a consultant clinical advisor for the Medicines Optimisations team at the National Institute for Health and Care Excellence (NICE). His work is focussed on evidence-based medicine but, as he explains, this is more than simply telling people what to do. One of the particular focuses of Jonathan's work is the process known as ‘shared decision making' between the clinician and the patient and he's interested in how you involve a person in choices and decisions about their own healthcare. Jonathan outlines some of the reasons NICE was originally set up – to reduce uncertainty and variation in prescribing – and with Louise, he evaluates whether this has been the outcome 6 years down the line, after the release of the NICE guidelines on menopause diagnosis and management. Jonathan's tips for shared decision making as a patient: It's OK to ask questions. If you need it, take someone with you that you trust who can listen and advocate for you And for healthcare professionals: David Haslam's (former Chair of NICE) consultation skills advice for doctors were basically ‘shut up and listen, show empathy, and know something'. If you can do these 4 things well it will make a big difference Practice your conversation skills as a clinician. You can learn to communicate better with your patients. The NICE guidelines on menopause can be read in full here and more about shared decision making can be found here. If you are a healthcare professional, the following link offers 4 hours of free online learning in shared decision making from NICE and Keele University: https://www.nice.org.uk/guidance/ng197/resources/shared-decision-making-learning-package-9142488109

Today we talk to Aswin Chari, an academic neurosurgical trainee; Ph.D. student at Great Ormond Street Hospital and UCL. When Aswin grows up, he wants to be an academic neurosurgeon (!); where he balances looking after patients and doing research into improving outcomes for children with epilepsy. Aswin is also the Clinical Fellow on the National Institute for Health and Care Excellence (NICE) guideline on the diagnosis and management of epilepsy, an Associate Editor for the British Journal of Neurosurgery, and the research lead for the neurosurgical charity Brainbook. **CONNECT WITH ASWIN**• Twitter: https://twitter.com/aswinchari **READ ABOUT ASWIN'S WORK**UCL: https://iris.ucl.ac.uk/iris/browse/profile?upi=ACHAB77ResearchGate: https://www.researchgate.net/profile/Aswin-ChariBrainbook: https://brainbookcharity.org/meet-the-team **CHECK OUT THE PODCAST WITH ASWIN**Available on Spotify, Apple, Google, Stitcher, Amazon Music, and Deezer - Type in “Epilepsy Sparks Insights”**CONNECT WITH TORIE**• Website: https://www.torierobinson.com• Twitter: https://twitter.com/torierobinson10• LinkedIn: https://www.linkedin.com/torierobinson• Facebook:https://www.facebook.com/TorieRobinsonSpeaker **CHECK OUT TORIE'S YOUTUBE & BLOG**• YouTube: https://www.youtube.com/c/TorieRobinson• Blog: https://www.torierobinson.com/blog**HIRE TORIE AS A SPEAKER ON EPILEPSY, MENTAL HEALTH, DISABILITY, & DIVERSITY**https://www.torierobinson.com/contact

Dr Rosie Benneyworth is the Chief Inspector of Primary Medical Services and Integrated Care at the Care Quality Commission (CQC). Prior to this Rosie held a series of senior leadership roles including the Vice Chair of the National Institute of Health and Care Excellence (NICE). She also led the national network of Patient Safety Collaboratives. Rosie worked as a GP for 15 years in Somerset. We ask her about the role of the CQC, common misconceptions, how GPs can get involved in driving improvement and what makes excellent General Practice. In this episode we ask her about: Her career Leadership roles Care Quality Commission Advice for medical students and doctors Driving Improvement: Case Studies from 10 GP practices: https://www.cqc.org.uk/publications/evaluation/driving-improvement-case-studies-10-gp-practices For comments, collaboration or feedback, contact us via email or Twitter. Email: medspirepodcast@gmail.com Twitter: @medspirepodcast

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-226   Overview: Patients with a history of transient ischemic attack (TIA) are at increased risk of stroke in the future. The ABCD2 score is the most used risk assessment tool for people with acute TIA, but it is not recommended for this purpose by the National Institute for Heath and Care Excellence (NICE). Join us for today’s episode as we describe a new validated risk assessment tool developed in Canada you can use to classify patients as low, medium, or high-risk for stroke over the 7 days following a TIA.   Episode References and Resource Links: Perry JJ et al. Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study. BMJ. 2021 Feb 4;372:n49   Guest: Alan Ehrlich MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-226   Overview: Patients with a history of transient ischemic attack (TIA) are at increased risk of stroke in the future. The ABCD2 score is the most used risk assessment tool for people with acute TIA, but it is not recommended for this purpose by the National Institute for Heath and Care Excellence (NICE). Join us for today's episode as we describe a new validated risk assessment tool developed in Canada you can use to classify patients as low, medium, or high-risk for stroke over the 7 days following a TIA.   Episode References and Resource Links: Perry JJ et al. Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study. BMJ. 2021 Feb 4;372:n49 Guest: Alan Ehrlich MD, FAAFP   Music Credit: Richard Onorato

SMA News Today’s multimedia associate, Price Wooldridge, discusses England’s National Institute for Health and Care Excellence (NICE) review of reimbursement for SMA Type 3 patients who are unable to walk. Are you interested in learning more about spinal muscular atrophy? If so, please visit https://smanewstoday.com/

IMI’s EHDEN is developing a federated data network at scale across Europe, to reduce the time to provide key answers to health research in the real world. The challenge is how can a federated data model help HTAs determine value for patients and healthcare systems? In this podcast we discuss these challenges with Jacoline Bouvy, who co-leads EHDEN’s work package 2, focused on outcome driven healthcare. It will outline many of the core challenges that HTA’s face harnessing federated datasets, and outline several issues to be discussed in a multi-stakeholder webinar to be held on October 22nd. Jacoline is the Senior Scientific Adviser for Science Policy and Research at the National Institute for Health and Care Excellence (NICE), based in London. Jacoline is a Dutch health economist specialising in the interface between marketing authorisation and health technology assessment (HTA) of drugs. She’s been involved in several pan-European IMI projects: ADAPT-SMART, ROADMAP, Neuronet and EHDEN.

Hello and welcome to the Alcohol Alert, brought to you by The Institute of Alcohol Studies. In this edition:A round-up of how alcohol drinkers, producers and retailers have fared as the prospect of a second coronavirus wave loomsThink tank finds NoLo drinks have limited impact 🎵 Podcast feature 🎵SHAAP and IAS launch the Men and Alcohol reportNumbers of alcohol-related admissions to English hospitals continue to risePoll shows almost half of Scots surveyed now back minimum pricing for alcoholBacklash over NICE plans to record pregnant womens’ consumptionWe announce the winners of our Small Grants SchemeWe hope you enjoy our roundup of stories below: please feel free to share. Thank you.Drinking in the second wave of a pandemicCoping with COVID-19: Alcohol offers little comfort to solitary drinkers One of the enduring stories of 2020 has been the question of how some people use alcohol to cope with new ways of living in the time of COVID-19. One of the many research attempts to find this out, the Global Drug Survey (GDS), found that almost half (48%) of Brits have so far upped their alcohol intake during the pandemic, ‘due to loneliness, depression and anxiety’ (Guardian, 09 Sep). Furthermore, 30% of drinkers said increased alcohol consumption had worsened their mental health and 47% disclosed that their physical health had deteriorated.Researchers found that increased use of both alcohol and cannabis due to anxiety, loneliness or depression was significantly higher among people with a pre-existing mental health or neurodevelopmental condition. That group of respondents were at least twice as likely to report worse mental health (38%) due to drinking more alcohol than those without such conditions (19%).The study also highlighted the limitations of a substance perceived as having some social purpose: when the venue for consuming alcohol is removed from people’s lives, drinking for some doesn’t simply stop, but instead manifests in other potentially unhealthy ways. The number of people drinking alone at home while on audio or video calls, such as Zoom meetings, or during ‘watch parties’, where friends view and discuss films and TV programmes together via group chat, increased from 17% to 38%.Comparing alcohol with cannabis, professor Adam Winstock, GDS chief executive, observed: ‘People’s drug use is hugely dependent upon being able to socialise and when that ability goes away, people turn to drugs that they’re already familiar with – cannabis and alcohol. But the impact of increases of those two drugs is quite distinct, and those drinking more alcohol come off worse.’Closing time for COVID? Pubs on curfewSome spending data indicated the desire on the part of some to resume pre-pandemic habits, but the results were mixed, ‘with like-for-like [August] sales down 3·6%’ against the same month last year (This is Money, 28 Sep).Signs of economic recovery were likely the focus of discussions between Hospitality Ulster and Stormont ministers about the prospect of reopening drink-only pubs (BBC News Northern Ireland, 07 Sep).But with an uptick in the number of coronavirus cases in September, attention turned to whether and how pubs – the symbol of a nation trying to return to some kind of normal – were keeping customers safe (BBC News Business, 13 Sep)?In England, hospitality businesses (including pubs) became legally mandated to take customers’ contact details so they can be traced if a potential outbreak is linked to the venue. These rules were in addition to the new ‘Rule of Six’, which limits the number of people allowed to meet each other.Some pubs experienced small outbreaks within their own workforce: the JD Wetherspoon chain reported 60 Wetherspoon staff across 50 branches had tested positive for COVID-19 (Mirror, 14 Sep).Meanwhile, rumours spread of the possibility of implementing curfews on pub opening hours if the number of new coronavirus cases did not fall over the next few weeks (Daily Star, 14 Sep). A survey of more than 4,000 UK adults found that 69% would be favour of a 9PM curfew (YouGov, 15 Sep).And so, the government made plans to shut the pubs… at 10PM (BBC News, 22 Sep). While BBC health correspondent Nick Triggle wondered whether the move would be of marginal benefit in staving off the threat of the virus, chair of the Public Accounts Committee Meg Hillier asked the prime minister how the government was able to square their proposal with extending alcohol licensing provisions for pubs to acquire pavement licences for eating and drinking on the public highway?For all the government’s desire to strike a balance, representatives of the hospitality industry still claim that a curfew will neither help curb the virus nor the commercial viability of their businesses, which are ‘still on life support’. Talking to trade outlet Morning Advertiser (22 Sep), Fuller’s chief executive Simon Emeny called pubs ‘the home of responsible socialising’ and said his company had worked hard to implement safety measures across its pubs, to be rewarded with unnecessary restrictions, while Peter Borg-Neal, chief executive at multiple operator Oakman Inns, said he saw little public health benefit but ‘lots of economic damage’ instead.Can addiction treatment services survive a second wave?Whatever happens in the coming weeks, it is clear that our addiction services can ill afford to combat the swelling number of high risk drinkers seeking treatment alongside a second wave of COVID-19 cases. Royal College of Psychiatrists analysis of Public Health England’s latest data on the indirect effects of COVID-19 found that over 8·4 million people are now drinking at higher risk, up from just 4·8 million in February. But the multi-million-pound cuts made to addiction services since 2013/14 mean they could miss out on life-saving treatment (14 Sep).Professor Julia Sinclair, chair of the college’s addictions faculty, said: ‘COVID-19 has shown just how stretched, under-resourced and ill-equipped addiction services are to treat the growing numbers of vulnerable people living with this complex illness.Drug-related deaths and alcohol-related hospital admissions were already at all-time highs before COVID-19. I fear that unless the government acts quickly we will see these numbers rise exponentially.’Think tank: NoLo drinks have limited impact🎵 Podcast feature 🎵A report on no and low alcohol beverages (‘NoLo’) from the Social Market Foundation finds limited evidence for their impact on health outcomes (08 Sep). Sponsored by Alcohol Change UK (ACUK), the publication finds that whilst NoLo products may help individuals reduce their consumption, they are unlikely to produce the aggregate level reductions in alcohol-related harms public health experts would desire.The key findings were:The market for NoLo drinks – whilst brands continue to release new products into the NoLo drinks category – worth around £110 million in 2018/19 – it is thought NoLo products comprised just 0·2% of the total market for alcoholic drinks in that year. The report estimates that annual sales growth of NoLo drinks would have to exceed over 40% per annum for market share to stand above 10% by 2030Consumers in the NoLo market – survey results commissioned specially for this study found that one in five people (21%) have consumed an alcohol-free beer, cider, wine or spirit in the last year. Including low-strength drinks (up to 1·2% alcohol content), this rises to 27%. Young people and those in higher income socioeconomic groups were more likely to have tried a NoLo productThe regulation of the NoLo market – Guidance and ABV descriptors issued by the Department of Health and Social Care contains elements of ambiguity and are often out of step with other European countriesThe presentation of NoLo products – press coverage of NoLo drinks typically centres on the ‘new sensibility’ of younger people and NoLo as a ‘community’ or ‘movement’. Some producers have tapped into this by promoting their NoLo products as substitutes for stronger products. Others prefer to market them as additional to existing drinks on the marketThe impact on alcohol-related harms – survey results for this report indicate that among those that have consumed NoLo drinks over the past 12 months, about four in ten have cut back on their alcohol consumption. However, a similar number reported no change. A significant proportion of consumers of NoLo also indicated that they do so on top of, rather than instead of, stronger products. This raises concerns about how NoLo products can tackle alcohol-related harms at the population levelConsiderations for policy – whilst the Government has indicated that NoLo products will be key to reducing alcohol-related harm, this report cautions that NoLo drinks must form part of a much wider harm prevention strategy. Government should also consider reforming ABV descriptors for NoLo and legislate to protect against alibi marketing.Commenting on the findings, ACUK director of research and policy Lucy Holmes said (you can listen to our interview on NoLo drinks in our podcast):MPs and peers call on government to urgently address Britain’s alcohol harm crisisAbridged from the Alcohol Health Alliance UK press releaseAs the leading risk-factor for ill health, death and disability among those aged 15 to 49 in England, alcohol is inflicting long-lasting harm across all areas of society and family life, yet not enough is being done to tackle the problem, say a group of cross-party parliamentarians, who are calling on the government to develop an alcohol strategy to get to the heart of the nation’s drink problem.Under the independent Commission on Alcohol Harm was set up by alcohol health experts and parliamentarians to examine the full extent of alcohol harm across the UK. Evidence submitted to the Commission highlights the serious impact alcohol harm has on family life, with children living with an alcohol dependent parent five times more likely to develop eating disorders, twice as likely to develop alcohol dependence or addiction, and three times as likely to consider suicide. The accompanying online launch also saw moving testimony from those whose lives have been harmed by alcohol.The Commission concluded that a new UK-wide alcohol strategy is required urgently. Recommendations from the final report include (summary):The new alcohol strategy must include targeted measures to support families and protect children from harm, including alcohol-fuelled violenceThe new alcohol strategy must be science-led and adopt the World Health Organization’s evidence-based recommendations for reducing the harmful use of alcohol. This includes measures on affordability – such as the introduction of minimum unit pricing in England – and restrictions on alcohol advertising and marketing – such as ending sports sponsorship, better information for consumers, advice and treatment for people drinking at hazardous and harmful levels, and action to reduce drink-drivingReducing the £3·5bn cost of alcohol to the NHS would help to relieve pressure on the service and free up capacity to respond to the consequences of COVID-19Changing the conversation and challenging alcohol’s position in our culture. This means addressing the stigma around alcohol use disorders, encouraging conversations about drinking to take place more easily and creating space for people to be open about the effects of alcohol on their health and those around them.Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance said (you can also hear his thoughts on the report in the podcast): ‘When people think about alcohol harm, they often think about liver damage – but its impact goes much further than this. This report highlights the very real ways that alcohol can devastate not just the life of the drinker but those around them. If we wish to emerge from the coronavirus pandemic as a healthier society, we must address the ongoing health crisis of alcohol harm.’If you want to help the Alcohol Health Alliance reach decision makers so they take action to reduce alcohol harm, you can – follow the link below to share the report with your local MP.Launch of Men and Alcohol reportScottish Health Action on Alcohol Problems (SHAAP) and the Institute of Alcohol Studies (IAS) have launched a new report presenting key findings and recommendations for policy and practice from their 2019/2020 Men and Alcohol seminar series (09 Sep), along with a webinar discussion of key themes raised.The report highlights how alcohol consumption is closely connected to male identity, and that alcohol-related harms, both mental and physical, remain a significant issue for men in the UK, with men less likely to seek help for mental health problems.Key recommendations for policy include: calls to strengthen restrictions on alcohol availability; to enforce bans on alcohol advertising, sponsorship and promotion; to make alcohol less affordable via taxation and pricing policies, and to invest in youth services and ‘alcohol-free’ spaces to help prevent alcohol-related harm.The report’s recommendations for practice address the need for all services to be joined-up, trauma-informed and exercising professional optimism, and emphasise that services should be guided by the expertise of individuals with lived experience in order to reduce the stigma of seeking help.Alcohol-related admissions to hospitals risingNHS Digital’s latest release on patient care activity in English NHS hospitals (17 Sep) has found that there were nearly 670,000 admissions by diagnosis for the three most common alcohol-related case types (Mental and behavioural disorders due to use of alcohol, Alcoholic liver disease, and Toxic effects of alcohol) in 2019/20.The number of admissions marks a 4% increase on the previous year: there were approximately 644,000 admissions in 2018/19. As the main diagnosis, the three main case types totalled just over 120,000 admissions, 2% up on the previous period, when there were almost 118,000.When split by case type, the majority (69%) of the three major alcohol-related admissions were for Mental and behavioural disorders due to use of alcohol (459,468), of which it was the main diagnoses for 68,128 admissions. A quarter were for Alcoholic liver disease (170,031), of which it was the main reason for 50,561 admissions. 6% were for the Toxic effects of alcohol (40,337), of which it was the main reason for 1,329 admissions.The majority of cases were male (67%), and when split by age, those in their fifties were most frequently admitted to English hospitals in 2019/20. There were across-the-board increases in admissions for patients aged 50 years and above compared with 2018/19. In other researchAlmost half of Scots surveyed now back minimum pricing for alcohol: 49·8% of 1,022 people surveyed by Public Health Scotland supported the measure (22 Sep).The survey comes as research published in Health Economics finds that minimum unit pricing (MUP) has had a successful initial impact on increasing alcohol prices (thus reducing affordability) and reducing alcohol sales (and consumption by proxy). The paper found that the impact of MUP on alcohol prices and sales is most pronounced on off‐premise venues (15 Sep).And in Wales, polling commissioned by Alcohol Change UK Cymru found that three quarters of 1,000 respondents knew about MUP compared with just half of drinkers in Wales when asked a year ago, and that of those who were aware of its implementation six months ago, 10% were drinking less alcohol because of it (Bro Radio, 28 Sep).Using publicly available national data (including Hospital Episode Statistics), a study conducted by the University of Hull reported that a decrease in admissions to specialist alcohol inpatient services subsequently marked an increase in admissions to acute hospital services (Alcohol and Alcoholism, 04 Sep). This decrease in admissions to specialist treatment centres has been associated with significant reductions in public health funding to such services since the introduction of the Health and Social Care Act 2012. However, these reductions have resulted in a shift of service use, particularly placing increasing pressures on emergency departments due to a larger number of patients with chronic alcohol disorders accessing care.A new paper conducted by the London School of Hygiene and Tropical Medicine, Dark Nudges and Sludge in Big Alcohol: Behavioral Economics, Cognitive Biases, and Alcohol Industry Corporate Social Responsibility, evaluates the roles of dark nudges and sludges in the alcohol industry (Milbank Quarterly, 15 Sep; video summary here). It shows how alcohol industry bodies such as Drinkaware use dark nudges and sludges to influence consumers’ views, often against their best interests. In particular, messages promoting the ‘social norms’ of drinking are frequently distributed, for example the technique of ‘omission biases’ in the infographic ‘Alcohol and the body’ from Drinkaware Ireland, which, by omitting women, consequently fails to highlight that breast cancer is also a major hazard of alcohol consumption.A multicohort study conducted by University College London has shown that those who have reported losing consciousness due to alcohol consumption (regardless of their weekly intake) have double the risk of developing dementia, compared with moderate drinkers who never lost consciousness (JAMA Network, 09 Sep). Overall, those who were moderate-to-heavy drinkers had a 1·2-fold greater risk of developing dementia in the long-term. Alcohol misuse was seen to cause brain atrophy and neuronal loss in several areas of the brain, such as the frontal cortex. Other side-effects of heavy drinking, such as hypertension, can also be attributed to dementia. Plans to record pregnant womens’ consumption not so NICEPregnancy rights’ advocates have criticised a proposal from National Institute for Health and Care Excellence (NICE) of a Quality Standard to record pregnant women’s alcohol consumption on their child’s medical records in England (Guardian, 16 Sep).NICE’s proposal was drawn up as part of a consultation to cement guidelines for doctors to diagnose and prevent foetal alcohol spectrum disorder (FASD). Proponents argue that the risk of FASD – a range of physical and mental conditions caused by drinking in pregnancy – to an unborn child should be the reason for prioritising their needs.However, pregnancy charities including the British Pregnancy Advisory Service (BASP) and Birthrights suggested that the guideline on recording alcohol consumption could be a breach of the expectant mother’s confidentiality, and therefore fall foul of data protection regulations.A quarter of adopted UK children may have symptoms of FASDThe results of an Adoption UK survey of nearly 5,000 adopters underscore FASD campaigners’ concern about drinking habits during pregnancy: one in four adopted children are either diagnosed with or suspected to have a range of conditions caused by drinking in pregnancy (Guardian, 29 Sep).8% of children had a diagnosis, and a further 17% were suspected by their parents to have foetal alcohol spectrum disorder (FASD),The survey also showed 55% of families polled had waited two years or longer for an FASD diagnosis, and 78% felt healthcare professionals lacked basic knowledge about the condition.Maria Catterick, director of the FASD Network UK, said the statistics were unsurprising given that ‘alcohol, drugs and domestic abuse are major reasons why children are placed into the care system’.Small Grants Scheme awards announced!We are delighted to announce that we will be funding three projects led by early career researchers in the alcohol field through the new IAS Small Grants Scheme.Proposals were considered in a two-stage process and reviewed externally. This was a highly competitive round and the standard of applications overall was extremely high. Feedback was provided to all applicants. We will be funding the following projects in the coming months:Dr Elena Dimova, Glasgow Caledonian University: Exploring men’s alcohol consumption in the context of becoming a father: A scoping reviewJessica Muirhead, Wrexham Glyndŵr University: Effective online age gating using MCC codesDr Emily Nicholls, University of Portsmouth: Rewriting the rules or playing the game? An investigation into the ways in which social norms around gender & drinking are challenged &/or reinforced through the promotion, marketing & consumption of Alcohol-Free drinksThe UK Alcohol Alert (incorporating Alliance News) is designed and produced by The Institute of Alcohol Studies. Please click the image below to visit our website and find out more about us and what we do, or the ‘Contact us’ button. Thank you. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit instalcstud.substack.com

SMA News Today’s multimedia associate, Price Wooldridge, discusses England’s National Institute for Health and Care Excellence (NICE) widening its Zolgensma appraisal due to the European marketing authorization. DeAnn Runge shares what it was like to demo a JACO Robotic Arm. Are you interested in learning more about spinal muscular atrophy? If so, please visit https://smanewstoday.com/

Host Heather Wicklein talks with Nick Pateras, Managing Director for Europe at Materia Ventures and CKO of New Frontier Data, John Kagia. They discuss recent challenges to the NHS's interpretation of medical Cannabis' efficacy. They explore how the National Institute for Health and Care Excellence (NICE)  failure to recommend Cannabis as a viable treatment has led to nearly no prescriptions being offered by the UK's doctors. The also discuss the recent push for adult-use legalization amid budgeting shortfalls in the UK's government. Contact: Cannaweek@newfrontierdata.com InstagramTwitterwww.newfrontierdata.com

At the first sight of the word “mindfulness” in the book title, some of you might feel some apprehension. You might be thinking: “I’m not a spiritual person who needs to be seated through a meditation exercise or practice mindfulness.” Or, “I’m an atheist who believes in science. Why would I need to do such things?” In fact, Mindfulness: An Eight-week Plan for Finding Peace in a Frantic World, is not written for spiritual persons only, but for each and every of us. Living within modern society, we may often have experienced certain negative emotions, such as anxiety and depression. In fact, the Gallup 2019 Global Emotions Report shows that sadness, anger, and worry were three negative emotional indicators of respondents which continued to increase over the years and hit an all-time record high in 2019. The world has become sadder, more worried, and angrier than ever before. In this regard, Mindfulness: An Eight-week Plan for Finding Peace in a Frantic World by Mark Williams and Denny Penman, may offer you a new way of thinking, as well as a solution to our current emotional state.  The book, Mindfulness: An Eight-week Plan for Finding Peace in a Frantic World, shares an eight-week mindfulness program and offers a series of simple and practical forms of meditation exercises. It aims to help us catch and withhold our negative thought patterns. Through practicing non-judgmental observations of the present moment, we will be able to get away from our negative emotions such as anxiety, depression, and annoyance, and find our inner peace. The methods in the book are recommended by the National Institute for Health and Care Excellence (NICE) as a priority treatment solution, and have proved effective in treating both depression and psychological trauma.

The palliative care needs of infants, children and young people differ to those of adults. The broad spectrum of paediatric life-limiting or life-threatening conditions mean that symptoms are varied and complex to manage. The UK National Institute for Health and Care Excellence (NICE) has emphasised pain management in paediatric palliative care as a research priority. This is the first systematic review and meta-analysis to investigate and report on the barriers and facilitators experienced by carers and healthcare professionals when managing paediatric symptoms at end of life. Healthcare professionals’ attitudes, treatment and its side effects, place of care and families’ own symptom management strategies all impact on family caregivers’ ability to manage symptoms. Barriers and facilitators to symptom management for healthcare professionals include medicine access, treatment efficacy and side effects, specialist support, training and education, health services delivery and home care.

The UK’s National Institute for Health and Care Excellence (NICE) recently issued guidelines for how to manage heavy menstrual bleeding. Guidelines only provide guidance and they must be interpreted for an individual patient's clinical context. Andrew Kauntiz, MD, professor and associate chair in the department of obstetrics and gynecology, University of Florida College of Medicine in Jacksonville, an expert in this topic, discusses these new NICE guidelines and how clinicians should use them. Read the article: Assessment and Management of Heavy Menstrual Bleeding

This piece focuses upon a new report from the World Health Organisation (WHO) looking at Arts and Health. The first of its kind, the report demonstrates the relationship between the arts, health and wellbeing. Are there ways you could incorporate the arts into your practice? Can it help with issues such as brain health, addiction and pain relief? A link to the report, "What is the evidence on the role of the arts in improving health and well-being? A scoping review (2019)" is here: http://www.euro.who.int/en/media-centre/sections/press-releases/2019/can-you-dance-your-way-to-better-health-and-well-being-for-the-first-time,-who-studies-the-link-between-arts-and-health The Social Prescribing Network is here: https://www.socialprescribingnetwork.com/ The National Institute for Health and Care Excellence (NICE) guidance is here: https://www.nice.org.uk/guidance The Culture Health and Wellbeing Alliance website is here: https://www.culturehealthandwellbeing.org.uk/ Katherine Taylor's twitter is here: https://twitter.com/communikatt And her blog is here: https://artthouwell.com/ Presented by Nick Margerrison with his guest Katherine Taylor, Clinical psychologist, Arts & Mental Health Innovation Programme Manager at GMiTHRIVE.

The National Institute for Health and Care Excellence (NICE) approved the use of a new gene therapy treatment that could slow down sight loss.   The exciting development could see NHS England patients living with a rare inherited eye disorder access the service as soon as early next year.   Charity Retina UK had been actively involved throughout the NICE decision-making process and we spoke with its CEO, Tina Houlihan to find out how the treatment could change lives.  Ms Houlihan spoke with RNIB Connect Radio’s Simon Pauley.   For more information visit: www.retinauk.org.uk 

Sam Feltham is the Director of the Public Health Collaboration in the UK, a nonprofit organization dedicated to improving the quality of public health education. The PHC coordinates campaigns and produces evidence-based reports for improving pressing health issues, such as obesity and diabetes, which are on the rise in the UK and worldwide. I met up with Sam at the Real Food Rocks Festival in July, a family event coordinated by the PHC to bring people together with music, fun, and of course, real food. In this podcast, Sam and I discuss the current initiatives being pursued by the Public Health Collaboration, including training and deploying a nationwide team of volunteer ambassadors to inform and implement healthier decisions at a local level. We discuss some of the obstacles encountered in educating the public, and Sam shares some of his long-term goals for a healthier future. Here’s the outline of this interview with Sam Feltham: [00:00:09] Real Food Rocks Festival. [00:02:25] The Public Health Collaboration (PHC). [00:03:24] PHC Advisory Board members: Dr. David Unwin and Dr. Jen Unwin, Dr. Trudi Deakin. [00:07:24] PHC Ambassadors Programme; currently 150 ambassadors across the country. [00:08:58] Andy Bishop; reversed type-2 diabetes and now runs patient groups [00:10:11] Current obstacles: perceived cost and the existing government guidelines. [00:11:28] Sugar infographics, endorsed by National Institute for Health and Care Excellence (NICE).  [00:12:48] The value of educating in small groups instead of individual sessions. [00:16:35] Ivor Cummins; Podcasts: How Not to Die of Cardiovascular Disease and Coronary Artery Calcium (CAC): A Direct Measure of Cardiovascular Disease Risk. [00:18:08] People under significant financial stress are 13 times more likely to have a heart attack. Study: Rosengren, Annika, et al. "Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study." The Lancet 364.9438 (2004): 953-962. [00:20:17] Denmark’s saturated fat tax.  It didn’t last long. [00:20:37] Influencing food policy; Real Food Lifestyle dietary guidelines. [00:21:49] Tom Watson, deputy of the Labour Party.  [00:23:55] Type 2 diabetes is currently 10% of the NHS budget. [00:26:29] War on Plastic show on BBC One. [00:27:32] The grocery store sugar-laden rat run. [00:30:50] Patric Holden, founding director of the Sustainable Food Trust. [00:32:00] Distributed food network. [00:34:01] Getting people into the system before they have health problems. [00:35:14] Changing the standards for hypertension in 2017. [00:37:19] Dr. Michael Mosley; Documentary: Michael Mosley vs. The Superbugs. [00:41:26] How to become an ambassador; phcuk.org/ambassadors.

Half a century worth of research exists on neuropathic pain but what are the latest developments? With the previous edition of Airing Pain focussing on the ‘psycho’ and ‘social’ of the bio-psycho-social model, this programme tackles the ‘bio’ component. In this second instalment in a mini-series on neuropathic pain, Paul Evans delves into the latest scientific developments on the condition and the ways in which the gap between research and treatments could be bridged.  Following on from Airing Pain 115, which concentrated on targeted Pain Management Programmes, this edition discusses the ‘bio’ element on dealing with neuropathic pain. Speaking to Professor Srinivasa Raja, Paul discusses what exactly is going on in the brain with neuropathic pain. Professor Raja provides a valuable explanation of the science behind the condition. Patrick M. Dougherty, Professor at the Department of Pain Medicine at The University of Texas MD Anderson Cancer Centre then shares with Paul the latest advances in neuropathic pain research. He examines the link between cancer treatments and the condition as well as the potential for treatments such as immunotherapy to combat neuropathic pain in the future.  Contributors: Patrick M. Dougherty, Professor at the Department of Pain Medicine, Division of Anaesthesiology and Critical Care, The University of Texas MD Anderson Cancer Centre, Houston Professor Srinivasa Raja (John Hopkins School of Medicine, USA). More information: Neuropathic pain fact sheets and support, IASP https://www.iasp-pain.org/GlobalYear/NeuropathicPain News, information and support at RELIEF, IASP Pain Research Forum https://relief.news/ The University of Texas MD Anderson Cancer Centre https://www.mdanderson.org/?_ga=2.205594646.486343381.1563359882-181156349.1563359882 Neuropathic Pain information, National Institute for Health and Care Excellence (NICE), https://www.nice.org.uk/search?q=Neuropathic+pain.

How do drugs taken to manage pain fit within the legal framework of controlled substances? This edition of Airing Pain is funded by Foundation Scotland. On 1 April 2019 pregabalin and gabapentin, drugs recommended by the National Institute for Health and Care Excellence (NICE) for the management of neuropathic pain, were re-classified as class-C controlled substances. This change means it is illegal to possess pregabalin and gabapentin without a prescription, and illegal to supply or sell them to others, as well as restricting the ease with which doctors and pharmacists can prescribe and dispense them. Also in this edition of Airing Pain, medicinal cannabis: Is it safe? Does it work for pain? Is it legal? Where do people who use these drugs to manage their chronic pain, now stand within UK law?  Contributors: Blair Smith, Consultant in Pain Medicine at NHS Tayside, and National Lead Clinician for Chronic Pain in Scotland. Steve Alexander, Associate Professor in Molecular Pharmacology at Nottingham University Cameron Rashide, who lives with neuropathic pain.

Professor Mike Kelly, Primary Care Unit, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, gives a talk for the Evidence Based Healthcare seminar series. Professor Mike Kelly is Senior Visiting Fellow in the Department of Public Health and Primary Care at the Institute of Public Health and a member of St John's College at the University of Cambridge. Between 2005 and 2014, when he retired, he was the Director of the Centre for Public Health at the National Institute of Health and Care Excellence (NICE). From 2005 to 2007, he directed the methodology work stream for the World Health Organisation's (WHO) Commission on the Social Determinants of Health. His research interests include the prevention of non-communicable disease, living with chronic illness, health inequalities, health related behaviour change, end of life care, dental public health, the relationship between evidence and policy and the methods and philosophy of evidence based medicine. This talk will describe the approach to development of public health guidelines adopted by NICE (the National institute for Health and Care Excellence) between 2005 and 2014 when Mike Kelly was leading the public health team there. It will consider the influences that realist theories and methods had on the process which NICE engineered as it applied the conventional model of evidence based medicine to public health matters. Some of the academic opposition to this endeavour will be noted and the broader political environment described. Using the development of the guideline on the prevention of alcohol misuse as a case study, the paper will examine the political consequences of taking a realist approach to the evidence. The controversy, which ensued after NICE, published the guideline, which among other things recommended minimum unit pricing, will be analysed. Some of the lessons of working at the policy/practice/politics/academy interface will be discussed.

Professor Mike Kelly, Primary Care Unit, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, gives a talk for the Evidence Based Healthcare seminar series. Professor Mike Kelly is Senior Visiting Fellow in the Department of Public Health and Primary Care at the Institute of Public Health and a member of St John's College at the University of Cambridge. Between 2005 and 2014, when he retired, he was the Director of the Centre for Public Health at the National Institute of Health and Care Excellence (NICE). From 2005 to 2007, he directed the methodology work stream for the World Health Organisation's (WHO) Commission on the Social Determinants of Health. His research interests include the prevention of non-communicable disease, living with chronic illness, health inequalities, health related behaviour change, end of life care, dental public health, the relationship between evidence and policy and the methods and philosophy of evidence based medicine. This talk will describe the approach to development of public health guidelines adopted by NICE (the National institute for Health and Care Excellence) between 2005 and 2014 when Mike Kelly was leading the public health team there. It will consider the influences that realist theories and methods had on the process which NICE engineered as it applied the conventional model of evidence based medicine to public health matters. Some of the academic opposition to this endeavour will be noted and the broader political environment described. Using the development of the guideline on the prevention of alcohol misuse as a case study, the paper will examine the political consequences of taking a realist approach to the evidence. The controversy, which ensued after NICE, published the guideline, which among other things recommended minimum unit pricing, will be analysed. Some of the lessons of working at the policy/practice/politics/academy interface will be discussed.

In this episode, Prof Gillian Leng, Deputy Chief Executive & Director of Health and Social Care at the National Institute for Health and Care Excellence (NICE) & Andy Thompson, Founder and Chief Executive of Proteus, discuss the role of Digital Medicines in tomorrow's NHS. Visit [https://www.rsm.ac.uk/resources/podcasts/](https://www.rsm.ac.uk/resources/podcasts/) [](https://videos.rsm.ac.uk/)for more content.

Well good morning, good afternoon and good evening, wherever you are in the world, hello and welcome to the Saturday 22nd September edition of EV News Daily. It’s Martyn Lee here with the news you need to know about electric cars and the move towards sustainable transport.   Thank you to MYEV.com for helping make this show, they’ve built the first marketplace specifically for Electric Vehicles. It’s a totally free marketplace that simplifies the buying and selling process, and help you learn about EVs along the way too.   FCC RELEASES PICTURE OF MODEL 3 KEY FOB From not being in America, all i can say is the FCC seems to be a really good place for leaks. When I used to follow mobile phones much more closely, there always seemed to be stories because the FCC published something. So thank you FCC. Fred at Electrek says; "Some owners have been complaining of occasional issues of using the app, which relies on their phone’s Bluetooth connection. When Tesla applied for a new key fob using a BLE frequency with the FCC, we speculated that Tesla was introducing the device for Model 3. The documents were confidential until today and now we can confirm that the key fob is for Model 3" It's very similar to the Model S and X fobs, so kinda chunky, and with buttons for doors, frunk and trunk. I'm not clear on whether it will ship as standard or be a paid extra, for many owners the mobile method has worked just fine.   https://electrek.co/2018/09/20/tesla-model-3-key-fob-images/                         LARGE DELIVERY OF MODEL 3’S From InsideEvs.com: "A trusted source that works at Tesla and requested to remain anonymous contacted InsideEVs with some inside information. Makes sense right? Anyhow, they shared that Tesla Service Center techs are being pulled from their usual duties over the next week or so to help with deliveries. Apparently, Tesla has readied some 7,000 Model 3 vehicles to be delivered just in the San Francisco Bay Area over the course of seven days. We hear that the specific goal is for the automaker to deliver 1,000 Model 3s each day for the last week of the month in the Bay Area alone."   POLESTAR UNVEILS FIRST PRODUCTION EV WITH AIM TO OVERTAKE TESLA "Polestar debuted its first production EV and previewed its electric car line in New York with the CEO squarely taking aim at Tesla." reports Jake Bright for TechCrunch. The Polestar 1 isn't cheap at $155,000 but you do get both batteries and a fossil for performance. There are three motors powered by twin 34kWh battery packs and that's before you stick gas in. With a range of 100 miles you won’t NEED the fossil unless you want it to gun the car all day. I can't think of a hybrid which has a range of more than 100 miles, that better than most first gen BEVs. “Polestar 2 will be a direct competitor to the Tesla Model 3…” CEO Thomas Ingenlath said on the launch stage. He told TechCrunch the company will focus more on creating converts to EVs than pulling away Tesla’s existing market share. "There are many people out there who still think a car has to have a combustion engine. Polestar 1 is an extremely good vehicle to get people across that line and once they drive it…understand what an amazing experience an electric car is." "While Polestar’s HQ is in Gothenburg, Sweden, it will manufacture cars at a plant in Chengdu China."   https://techcrunch.com/2018/09/21/polestar-unveils-first-production-ev-with-aim-to-overtake-tesla/   TESLARATI HAS NEW SEMI VIDEO "The Semi has since been sighted in multiple states across the US, and during the company’s Q2 2018 earnings call, Jerome Guillen, the former head of Tesla’s truck programs who is now serving as the company’s President of Automotive, pointed out that the vehicle had already been improved since it was initially unveiled. The exact nature of these improvements remains to be seen, but if a video of the Semi captured earlier this month is any indication, it appears that the electric long-hauler has gotten even more daunting and impressive when it performs a full-speed acceleration run." [audio] Simon at Teslarati says: "The Semi’s performance, handling, and power were specifically pointed out by professional driver Emile Bouret, a close friend of Tesla chief designer Franz von Holzhausen, in an Instagram post earlier this month."   https://www.teslarati.com/tesla-semi-trailer-acceleration-spaceship-new-sighting/   https://www.youtube.com/watch?v=CtwP-aDUtWk   RENAULT UNVEILS SMART ISLAND ON BELLE-ÎLE-EN-MER Renault say they're delighted to unveil a brand new joint project known as FlexMob’île. The aim of this smart electric ecosystem is to facilitate the energy transition on the French island of Belle-Île-en-Mer which lies off the coast of southern Brittany. This initiative follows in the footsteps of the innovative Smart Fossil Free Island programme which has been operational since last February on the Portuguese island of Porto Santo in the Madeira archipelago. For the next 24 months, Groupe Renault and its public and private partners will be developing a smart electric ecosystem that has been conceived to reduce the island’s carbon footprint and increase its energy independence. From 2019, Belle-Île-en-Mer residents and visitors to the island will have access to a fleet of electric cars by means of a self-service hire programme featuring Renault ZOE and Kangoo Z.E. These vehicles will be powered thanks to a network of charging stations located close to the island’s main attractions. This new carsharing service will take advantage of surplus energy produced by solar panels installed on the roofs of the island’s main public buildings. For instance, solar panels on the school’s rooftop provide heat and lighting for classrooms during the week, while the energy produced at weekends or during school holidays will be used to charge the cars. Groupe Renault plans to provide second-life electric car batteries for the island’s largest holiday residences facility. These batteries will be used to store energy produced during the day by solar panels for use in the evening, chiefly to heat the bungalows. This should allow the centre to extend its season which until now has been restricted by central heating costs.   http://www.press.renault.co.uk   A TRIP TO HOSPITAL IN AN EV? "The EV revolution may be starting to gain ground on the retail market, but emergency service vehicles such as ambulances should switch to electric or hybrid propulsion, according to the UK’s leading public health body." reports AutoExpress.co.uk: "The National Institute for Health and Care Excellence (NICE) has published draft guidance recommending public-sector organisations “should make low vehicle emissions one of the key criteria when making routine procurement decisions. This could include selecting low-emission vehicles, including electric vehicles.” "   https://www.autoexpress.co.uk/car-news/104719/emergency-vehicles-could-go-electric-and-autonomous   TESLA SIGNS THREE YEAR DEAL WITH GANFENG FOR LITHIUM "China’s top producer of lithium, a metal used in electric-vehicle batteries, said it’s agreed a deal with Tesla Inc. to supply a fifth of its production to the vehicle maker, highlighting the push for supply pacts." according to Bloomberg: "Tesla will designate its battery suppliers to buy lithium-hydroxide products from Ganfeng Lithium Co. and its unit, the Jiangxi-based company said in a filing to the Shenzhen exchange on Friday. The agreement runs from 2018 to 2020 and could be extended by three years, Ganfeng said." "Earlier this week, Ganfeng announced an agreement to supply LG Chem between 2019-2025 under a supplementary contract, according to a separate filing. Tesla may need as much as 28,000 tons of lithium hydroxide a year from late next year based on battery output at its Nevada facility reaching the equivalent of 35 gigawatt hours, according to Benchmark Mineral’s forecasts."   https://www.bloomberg.com/news/articles/2018-09-21/chinese-lithium-giant-agrees-three-year-pact-to-supply-tesla       COMMUNITY And thanks to MYEV.com they’ve set us another Question Of The Week. Keep your comments coming in on email and YouTube…   How was your EV buying experience? Dealer? Price? Lease? Used or new? What are your successes and fails? Tell me your EV buying experience.   I want to say a heartfelt thank you to the 83 patrons of this podcast whose generosity means I get to keep making this show, which aims to entertain and inform thousands of listeners every day about a brighter future. By no means do you have to check out Patreon but if it’s something you’ve been thinking about, by all means look at patreon.com/evnewsdaily     PHIL ROBERTS / FUTURE ELECTRIC CESAR TRUJILLO DAVID ALLEN SASCHA PALLENBERG DAMIEN LOUIS HOPKIN ASHLEY HILL BÃ¥RD FJUKSTAD CHRIS BENSON CHRIS HOPKINS DAVID PARTINGTON DAVID PRESCOTT JOHN BAILEY JOHN H MEYER III JON TIMMIS MARCEL LOHMANN MARCEL WARD MARTIN CROFT MATTHEW ELLIS MATTHEW GROOBY NEIL E ROBERTS PAUL SEAGER-SMITH PHILIPPE CALVE ROD JAMES SCOTT CALLAHAN THE LIMOUSINE LINE SYDNEY   You can listen to all 242 previous episodes of this this for free, where you get your podcasts from, plus the blog https://www.evnewsdaily.com/ – remember to subscribe, which means you don’t have to think about downloading the show each day, plus you get it first and free and automatically. It would mean a lot if you could take 2mins to leave a quick review on whichever platform you download the podcast. 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In this episode, Prof Gillian Leng, Deputy Chief Executive & Director of Health and Social Care at the National Institute for Health and Care Excellence (NICE) and visiting professor at King's College London, discusses the role of NICE, recent controversies and the challenges for NICE in the future. Visit [https://www.rsm.ac.uk/resources/podcasts/](https://www.rsm.ac.uk/resources/podcasts/) for more content.

Going through adolescence can be a difficult process for anyone, but for young adults with chronic pain the difficulties of these formative years can become multifaceted. With 8% of young people in the 13-18 age range affected by chronic pain (15,000 living with arthritis alone), the transition to adulthood, and the medical support that accompanies it, is an important process. This edition was funded by a grant by the Agnes Hunter Trust In this edition of Airing Pain we explore the challenges and successes that patients, parents and healthcare professionals encounter when entering this crucial period. Pain management consultant Dr Mary Rose and nurse Mandy Sim of the Royal Hospital for Sick Children in Edinburgh speak to Paul Evans about the methods they use to make the transition into adulthood as supportive as possible, as well as the importance of educating patients, parents and schools on the biopsychosocial aspects of pain and its management. Dr Alison Bliss, paediatric anaesthesia and chronic pain consultant at Leeds Children’s Hospital, emphasises the importance of finding a balance between cultivating independence in young-adults with pain and helping them find the support in their transitional period. Paul also speaks to Dr. Line Caes, psychology lecturer at Stirling University, touches on the nuances in dealing with how young people see themselves in comparison to their peers and making the classroom a more accepting space. Contributors: •    Dr Mary Rose, consultant at the pain management clinic at Edinburgh’s Sick Children’s Hospital •    Mandy Sim, pain nurse specialist at Edinburgh’s Sick Children’s Hospital pain management clinic •    Dr Alison Bliss, consultant in paediatric anaesthesia and chronic pain at Leeds Children’s Hospital •    Dr Line Caes, psychology lecturer at University of Stirling’s School of Natural Science, researcher in paediatric psychology and psychological aspects of children’s pain More information: •    Royal Hospital for Sick Children Edinburgh Charity: https://echcharity.org/ •    Scottish Transitions Forum’s “Principles of Good Transition”: https://scottishtransitions.org.uk/summary-download/ •    National Institute for Health and Care Excellence (NICE) guidance on transition services: https://www.nice.org.uk/guidance/ng43

In this podcast, we talk to Professor Carl Roobottom, Associate Editor for BJR and Consultant Radiologist at Plymouth Hospitals NHS Trust, about the recent National Institute for Health and Care Excellence (NICE) guidelines for chest pain.

This talk will illustrate the highs and lows of using evidence in the healthcare setting, drawing on experience from the National Institue for Health and Care Excellence (NICE) relevant to veterinary medicine...  GL - Using Evidence: Pitfalls, Practicalities and Positive Benefits Veterinary Evidence TodayEdinburgh, 1-3 November 2016  

Professor Kelly is Senior Visiting Fellow in the Department of Public Health and Primary Care at the Institute of Public Health at the University of Cambridge and a member of St John’s College, Cambridge. Between 2005 and 2014 he was the Director of the Centre for Public Health at the National Institute of Health and Care Excellence (NICE) where he led the teams producing public health guidelines. Professor Kelly’s research interests include the methods and philosophy of evidence based medicine, prevention of CVD, health inequalities, health related behaviour change, the causes of non-communicable disease, end of life care, dental public health and the sociology of chronic illness. Professor Simon Szreter is a Fellow of St John's College and Professor of History and Public Policy at the Faculty of History. Professor Szreter is an historian of population, public health and reproduction. His most recent books have all presented historical studies with diverse contemporary public policy implications: Registration and Recognition. Documenting the Person in World History (2012), The Big Society Debate. A New Agenda for Social Welfare? (2011), History, Historians and Development Policy (2011) and Sex Before the Sexual Revolution (2010). Simon Szreter is a Steering Committee member of the Public Policy SRI.

Economic evaluation of healthcare interventions follows the guideline produced by the National Institute for Health and Care Excellence (NICE). NICE recommends a Cost Utility Analysis (CUA) approach where outcomes are health effects on patients (and carers where relevant) expressed in terms of Quality Adjusted Life Years (QALYs), and costs are restricted to only those falling on the budgets of the NHS and Social Services. An individual-level simulation is developed to estimate all costs and consequences of several healthcare interventions for dementia. Then, two different decision making approaches are applied to determine which option has the best value for money. These approaches account for a broad range of costs and consequences for both the NHS, people with dementia, and informal caregivers. The research will contribute to the development of a new decision making framework at national level to approve health care interventions for people with dementia.