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Clinical Evidence Health Care Public Health Value

Avastin in Opthalmology, after the draft AMD guideline

Christmas is here The AMD guideline is out https://www.nice.org.uk/guidance/indevelopment/gid-cgwave0658/documents p150 odd onwards of the full guideline is the business end https://www.nice.org.uk/guidance/gid-cgwave0658/documents/draft-guideline#page155 it is largely as expected very clear (& exceptionally detailed) appraisal of the evidence base around the management of AMD. For me (and many) we were all waiting for this CG to see the […]

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Ageing Clinical Health Care Public Health Healthcare Reform Prevention

Ageing population lazy thinking for when you cant be bothered to understand the real issues

By me and Steve Laitner I’ve (GF)  blogged a lot on the myth that is the “demographic timebomb”, and set out a set of data and arguments to make up case argument wise. See references at the bottom.    Here are our collected summary thoughts on why getting the narrative wrong on this is harmful […]

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Ageing Clinical Health Care Public Health Prevention

Notes on the epidemiology of multi morbidity, and why it matters

Multi morbidity the new black.Well, it’s not really. But it’s one of the defining features of modern healthcare. And if you stick multimorbidity in a social context – with all its social complexity, it’s one of the defining features of contemporary health and social care.Given that, we know remarkably little about the epidemiology of it.Arguably […]

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Clinical Health and Social Care Health Care Public Health

how to cut the incident AF stroke rate by 15% in 18 months. Turning science in to change.

        This is a very old story. Its also a very long one. It is one I have wanted to tell for a time. It is the story of how we increased performance by 33% on a “difficult indicator” that was known to be problematic to change. It is also the story […]

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Clinical Health and Social Care Healthcare Reform Inequality Primary Care Value

The GP 5 Year Forward View, the importance of inequality and the Deep End

So we are all doing responses to the GP 5 Year Forward view Who knows whether there’s any REAL investment fund. Meanwhile the world keeps revolving. General Practice, you know the bit that everyone says is the jewel in the NHS crown, gets ever more fragile. The point re General Practice in the most disadvantaged […]

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Clinical Health Care Public Health Screening Shared decisions Value

A prostate cancer bumper edition

ICYMI here’s a suite of studies – principally the ProtecT and linked study. I’m told this is the most expensive trial ever. Which concluded that no difference in prostate specific cancer survival between three arms – active surveillance, radiotherapy, surgery. (Remember we know that robotic surgery is no better than standard surgery – study earlier […]

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Clinical Health Care Public Health Screening

What would it take to get guideline bodies eg NSC to change their view on screening for AF 

Bottom line for the short of attention span / don’t like detail folk The proposition to screen for AF doesn’t pass the NSC criteria It nearly does, but didn’t at last review. 2014? Fails on a number ofcriteria:- Non optimised population. Why find new people to treat when you suboptimally manage the risk in those […]

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Clinical Health Care Public Health Healthcare Reform

The centralisation of hyper acute stroke care will save lives and money, won’t it?

how many lives will be saved by the centralisation of hyper acute stroke units. How much money will this save. Warning – this is long and pretty tricky. The short answer is not many & not much. There may be higher value things to do. I’m often asked thisWe are centralising hyper acute stroke care. […]

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Clinical Health and Social Care Health Care Public Health Prevention STP Value

Up scaling prevention and the STP, some questions for CCGs to ponder

Up scaling prevention and the STP, the role of CCGs   Some thoughts on a session for CCG Board on “up scaling prevention” – a la the 5YFV The full version of this has some pretty graphics that haven’t transferred to the blog. Email me if you want them?             […]

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Clinical Health Care Public Health Healthcare Reform Prevention

Value in pathways versus value in populations – Don’t forget population health in your efforts to improve “efficiency”. Its important but remarkably easy to forget

Value in pathways versus value in populations – Don’t forget population health in your efforts to improve “efficiency”. Its important but remarkably easy to forget   A 2014 UCL study published in the BMJ[i] provided some fascinating evidence on the potential impact of stroke centralisation. This was essentially an n=2 study using data from two […]