National Institute For Clinical Excellence (nice): From 1 Different Sources
This special health authority in the National Health Service, launched in 1999, prepares formal advice for all managers and health professionals working in the service in England and Wales on the clinical- and cost-e?ectiveness of new and existing technologies. This includes diagnostic tests, medicines and surgical procedures. The institute also gives advice on best practice in the use of existing treatments.
NICE – its Scottish equivalent is the Scottish Health Technology Assessment Centre – has three main functions:
appraisal of new and existing technologies.
development of clinical guidelines.
promotion of clinical audit and con?dential inquiries. Central to its task is public concern about ‘postcode prescribing’ – that is, di?erent availability of health care according to geography.
In 2003 the World Health Organisation appraised NICE. Amongst its recomendations were that there should be greater consistency in the methods used for appraisal and the way in which results and decisions were reported. WHO was concerned about the need for transparency about the con?ict between NICE’s use of manufacturers’ commercial evidence in con?dence, and believed there should be greater de?nition of justi?cation for ‘threshold’ levels for cost-e?ectiveness in the Centre’s judgement of what represents value for money.
In all, WHO was congratulatory – but questions remain about the practical value and imlementation of NICE guidelines.
A controlled research study of the safety and effectiveness of drugs, devices or techniques that occurs in four phases, starting with the enrolment of a small number of people, to the later stages in which thousands of people are involved prior to approval by the licensing authorities (for example, the Food and Drug Administration).... clinical trial
A framework through which health organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care.... clinical governance
A MEDICAL AUDIT carried out by health professionals.... clinical audit
Clinical means literally ‘belonging to a bed’, but the word is used to denote anything associated with the practical study or observation of sick people – as in clinical medicine, clinical thermometers.... clinical
Professional specialized or therapeutic care that requires ongoing assessment, planning, intervention and evaluation by health care professionals.... clinical care
A diagnosis (e.g. myocardial infarct) or a patient state that may be associated with more than one diagnosis (such as paraplegia) or that may be as yet undiagnosed (such as low back pain).... clinical condition
Services provided to patients (history-taking, physical examination, preventive care, tests, procedures, drugs, advice) or information on clinical condition or on patient state used as a patient outcome.... clinical event
Systematically developed statements which assist clinicians and patients to decide on appropriate treatments for speci?c conditions. The guidelines are attractive to health managers and patients because they are potentially able to reduce variation in clinical practice. This helps to ensure that patients receive the right treatment of an acceptable standard. In England and Wales, the NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (NICE) is developing national guidelines with advice from health-care professionals and patients to improve clinical e?ectiveness of NHS care. Some doctors have reservations about guidelines because (1) health-care managers might use them primarily to contain costs; (2) in?exibility would discourage clinical innovations; (3) they could encourage litigation by patients. (See also HEALTH CARE COMMISSION; MEDICAL LITIGATION.)... clinical guidelines
An information system that collects, stores and transmits information that is used to support clinical applications (e.g. transmission of laboratory test results, radiology results, prescription drug orders). Electronic medical records are one method by which clinical information systems can be created.... clinical information system
Clinical information, excluding information about treatment and intervention. Clinical information that does not record an intervention is by nature a clinical observation. The observer may be the patient or related person (information about symptoms, family history, occupation or lifestyle) or a health care professional (information about physical signs, measurements, properties observed or diagnoses). While information about the nature of a planned or performed treatment is excluded by the definition, clinical observations may be recorded on the results of a treatment, on progress during the course of a treatment, or on the result of a treatment.... clinical observation
A multidisciplinary set of daily prescriptions and outcome targets for managing the overall care of a specific type of patient, e.g. from pre-admission to post-discharge for patients receiving inpatient care. Clinical pathways are often intended to maintain or improve quality of care and decrease costs for patients in particular diagnosis-related groups.... clinical pathway
An instrument that estimates the extent to which a health care provider delivers clinical services that are appropriate for each patient’s condition; provides them safely, competently and in an appropriate time-frame; and achieves desired outcomes in terms of those aspects of patient health and patient satisfaction that can be affected by clinical services.... clinical performance measure
A systematically developed statement to assist practitioner and patient decisions about appropriate health care for one or more specific clinical circumstances.... clinical practice guideline
A conclusion that an intervention has an effect that is of practical meaning to older persons and health care providers. Even though an intervention is found to have a statistically significant effect, this effect may not be clinically significant. In a trial with a large number of participants, a small difference between treatment and control groups may be statistically significant, but clinically unimportant. In a trial with few participants, an important clinical difference may be observed that does not achieve statistical significance. (A larger trial may be needed to confirm that this is a statistically significant difference).... clinical significance
The physical manifestations of an illness elicited by a doctor when examining a patient – for example, a rash, lump, swelling, fever or altered physical function such as re?exes.... clinical signs
The experiences of a patient as communicated to a doctor, for example, pain, weakness, cough. They may or may not be accompanied by con?rmatory CLINICAL SIGNS.... clinical symptoms
This body manages regional TRANSFUSION centres. Among its aims are the maintenance and promotion of blood and blood products based on a system of voluntary donors; implementing a cost-e?ective national strategy for ensuring adequate supplies of blood and its products to meet national needs; and ensuring high standards of safety and quality.... national blood authority
Initially driven by anxiety about the possibility of medical negligence cases, clinical risk management has evolved into the study of IATROGENIC DISEASE. The ?rst priority of risk managers is to ensure that all therapies in medicine are as safe as possible. Allied to this is a recognition that errors may occur even when error-prevention strategies are in place. Lastly, any accidents that occur are analysed, allowing a broader understanding of their cause. Risk management is generally centred on single adverse events. The threat of litigation is taken as an opportunity to expose unsafe conditions of practice and to put pressure on those with the authority to implement change. These might include senior clinicians, hospital management, the purchasing authorities, and even the Secretary of State for Health. Attention is focused on organisational factors rather than on the individuals involved in a speci?c case.... clinical risk management
This was set up under the CARE STANDARDS ACT 2000 as an independent regulator in respect of homes for the elderly, the disabled and children in the state and private sectors in the UK.... national care standards commission
This National Health Service initiative went online in November 2000. It aims to provide health professionals with easy and fast access to best current knowledge from medical journals, professional group guidelines, etc. Unbiased data can be accessed by both clinicians and the public.... national electronic library for health
Information, usually in the form of indicators, a country may collect on its health expenditures. Indicators may include total health expenditure, public expenditure, private expenditure, out-of-pocket expenditure, tax-funded and other public expenditure, and social security expenditure.... national health accounts
See “health policy”.... national health policy
The United Kingdom’s National Health Service was created by Act of Parliament and inaugurated on 5 July 1948. Its original aim was to provide a comprehensive system of health care to everyone, free at the point of delivery. Scotland had its own, similar legislation, as did Northern Ireland. The service is funded by National Insurance contributions and from general taxation, with a small amount from patient charges. The structure, functioning and ?nancing of the NHS have been – and still are – undergoing substantial changes.... national health service (nhs)
A National Health Service body intended to combat the increasing threat from infectious diseases and biological, chemical and radiological hazards. Covering England, the agency includes the Public Health Laboratory Service, the National Radiological Protection Board, the Centre for Applied Microbiology and Research, and the National Focus Group for Chemical Incidents.... national infection control and health protection agency
National Listening Library is a charity which produces recorded books for handicapped people who cannot read, with the exception of the blind who have their own separate organisation, the Royal National Institute for the Blind. (See also CALIBRE.)... national listening library
(See EVIDENCE-BASED MEDICINE.) Clinical trials aim to evaluate the relative effects of di?erent health-care interventions. They are based on the idea that there must a fair comparison of the alternatives in order to know which is better. Threats to a fair comparison include the play of chance and bias, both of which can cause people to draw the wrong conclusions about how e?ective a treatment or procedure is.
An appreciation of the need to account for chance and bias has led to development of methods where new treatments are compared to either a PLACEBO or to the standard treatment (or both) in a controlled, randomised clinical trial. ‘Controlled’ means that there is a comparison group of patients not receiving the test intervention, and ‘randomised’ implies that patients have been assigned to one or other treatment group entirely by chance and not because of their doctor’s preference. If possible, trials are ‘double-blind’ – that is, neither the patient nor the investigator knows who is receiving which intervention until after the trial is over. All such trials must follow proper ethical standards with the procedure fully explained to patients and their consent obtained.
The conduct, e?ectiveness and duplication of clinical trials have long been subjects of debate. Apart from occasional discoveries of deliberately fraudulent research (see RESEARCH FRAUD AND MISCONDUCT), the structure of some trials are unsatisfactory, statistical analyses are sometimes disputed and major problems have been the – usually unwitting – duplication of trials and non-publication of some trials, restricting access to their ?ndings. Duplication occurs because no formal international mechanism exists to enable research workers to discover whether a clinical trial they are planning is already underway elsewhere or has been completed but never published, perhaps because the results were negative, or no journal was willing to publish it, or the authors or funding authorities decided not to submit it for publication.
In the mid 1980s a proposal was made for an international register of clinical trials. In 1991 the NHS launched a research and development initiative and, liaising with the COCHRANE COLLABORATION, set out to collect systematically data from published randomised clinical trials. In 1994 the NHS set up a Centre for Reviews and Dissemination which, among other responsibilities, maintains a database of research reviews to provide NHS sta? with relevant information.
These e?orts are hampered by availability of information about trials in progress and unpublished completed trials. With a view to improving accessibility of relevant information, the publishers of Current Science, in 1998, launched an online metaregister of ongoing randomised controlled trials.
Subsequently, in October 1999, the editors of the British Medical Journal and the Lancet argued that the case for an international register of all clinical trials prior to their launch was unanswerable. ‘The public’, they said, ‘has the right to know what research is being funded. Researchers and research funders don’t want to waste resources repeating trials already underway.’ Given the widening recognition of the importance to patients and doctors of the practice of EVIDENCE-BASED MEDICINE, the easy availability of information on planned, ongoing and completed clinical trials is vital. The register was ?nally set up in 2005.... clinical trials
A broad intersectoral master plan for attaining national health goals through implementation of a strategy. It indicates what has to be done, who has to do it, during what time-frame, and with what resources. It is a framework leading to more detailed programming, budgeting, implementation and evaluation. It specifies, in operational terms, the steps to be taken in accordance with the strategy, keeping in mind the various objectives and targets to be attained and the programmes for attaining them.... national plan of action
Based on national health policy, a set of decisions that includes the broad lines of action required in all sectors involved to give effect to the national health policy and indicates the problems and ways of dealing with them.... national strategy
This is an executive agency of the UK government formed by an amalgamation in 1990 of the Central Statistical O?ce and the O?ce of Population Censuses and Surveys (OPCS). The ONS compiles and publishes statistics on national and local populations, including their social and economic situation and contributions to the country’s economy. It also records the demographic patterns of births, marriages and deaths, including the medical cause of death. The former OPCS organised a national ten-yearly census and ONS is carrying on this activity. The census is based on the actual presence of individuals in a house or institutions on a given night. The ?gures provide government departments and local authorities with information for planning services.... office for national statistics (ons)
Environmental medicine. Treatment of allergies by natural medicines. The science that endeavours to bridge physics and chemistry; including such disciplines as homoeopathy, acupuncture, herbalism, etc. ... clinical ecology
Est. 1864. The oldest and only body of professional medical herbalists, now known as phytotherapists, in Europe. Membership by examination after completion of course of training. A stipulated period of clinical practice must be completed before the final examination is taken.
Members are directly involved with patient-care, carrying full responsibility for their recommendations, prescribing medication suitable to the individual biological requirements of each patient. Their role includes patient-counselling, health education and research.
Official recognition of the Institute, indicating its growing importance in the field of medicine came with the historic Grant of Arms by Her Majesty’s College of Heralds. Members regard this as evidence that the Royal Charter of King Henry VIII still stands and that there is no monopoly in healing the sick. See: HENRY VIII, HERBALISTS’ CHARTER.
The Institute played a major role in winning vital concessions for the survival of the herbalist in the passage through Parliament of the Medicine’s Bill. See: MEDICINE’S ACT, 1968.
In connection with the NIMH degree courses in herbal medicine are available at a London University, and Exeter University.
The Institute provides professional indemnity cover for its members, and is engaged in a series of clinical trials to evaluate traditional remedies.
All members are required to adhere to a strict professional Code of Ethics and are entitled to carry after their names the letters of qualification: MNIMH or FNIMH.
Members have a key role in preventative medicine and health promotion in their contribution to improvement of the nation’s health.
Address: 56 Longbrook Street, Exeter EX4 6AH, from which a list of members is obtainable. ... national institute of medical herbalists
A test on human volunteers of the effectiveness and safety of a drug. A trial can also involve systematic comparison of alternative forms of medical or surgical treatment for a particular disorder. Patients involved in clinical trials have to give their consent, and the trials are approved and supervised by an ethics committee.... trial, clinical
(BNF) a reference source published by the Royal Pharmaceutical Society of Great Britain and the British Medical Journal (BMJ) Group twice a year (in March and September). It contains comprehensive information on medications from various sources, including the manufacturer as well as regulatory and professional bodies, resulting in information that is relevant to practice and takes into account national guidelines.... british national formulary
(CCGs) self-governing bodies set up by the Health and Social Care Act 2012, following the abolition of *primary care trusts and *strategic health authorities, to commission most NHS services in England. CCGs are formed of all GP practices within a given geographical area, and all GP practices must belong to a clinical commissioning group. All CCGs have their own constitution and governing body, which (in addition to GPs) must include at least one registered nurse and at least one secondary care specialist doctor. There are currently 195 CCGs in England.... clinical commissioning groups
consideration of the moral issues attendant upon, and questions arising from, clinical practice, as distinct from research. In North America, it is common for hospitals to employ a clinical ethicist or provide a formal clinical ethics consultation service. In the UK, clinical *ethics committees are increasingly common in the NHS.... clinical ethics
see community health.... clinical medical officer
the branch of medicine dealing with the study of actual patients and the diagnosis and treatment of disease at the bedside, as opposed to the study of disease by *pathology or other laboratory work.... clinical medicine
see census; Office for National Statistics.... national census
(NCAS) see Practitioner Performance Advice.... national clinical assessment service
see NICE.... national institute for health and care excellence
(CGI) rating scales commonly used by clinicians to measure symptom severity and treatment response in treatment studies of patients with psychiatric illnesses. Many researchers consider them to be a good tool to measure the clinical utility or relevance of a given treatment. The Clinical Global Impression–Severity scale (CGI-S) is used to rate the severity of the patient’s symptoms relative to the clinician’s past experience with patients who have the same diagnosis. Scores range from 1 (normal) to 7 (extremely ill). The Clinical Global Impression–Improvement scale (CGI-I) measures change in the patient’s presentation from baseline. Scores range from 1 (very much improved) to 7 (very much worse). A score of 4 indicates no change.... clinical global impression
(in Britain) a compulsory scheme of insurance under the terms of which employers and employees make joint contributions so that those who have contributed for a qualifying period may claim national insurance benefits in times of sickness, injury, maternity leave, unemployment, and retirement; self-employed persons pay all their own contributions. Those who do not qualify under the terms of this insurance scheme may also receive financial payments in times of need, but only subject to a means test.... national insurance
(NPSA) formerly, a special health authority that led and coordinated work to improve all aspects of patient safety in England. The NPSA comprised three divisions: the National Reporting and Learning Service, the National Research Ethics Service, and the National Clinical Assessment Service. It closed in 2012, with its key functions transferred to *NHS England. In 2016 the same functions were transferred from NHS England to the newly formed *NHS Improvement.... national patient safety agency
(NSFs) formerly, national standards of care published for a variety of conditions and patient groups (the first were for coronary heart disease and mental health). NSFs were ten-year programmes designed to improve, and reduce variations in, the quality of care by defining long-term strategies for delivery of the standards and by setting specific goals. The NSFs were dropped in the reform of the NHS after 2010 and subsequent establishment of *NHS England.... national service frameworks
(NS-SEC) an occupational classification of the national population that was developed to replace older systems based on social classes and socio-economic groups. The groupings are intended to stratify the population according to different forms of employment: households are classified according to the occupation of the household reference person (the person renting, owning, or otherwise responsible for accommodation). The NS-SEC is used for official surveys and statistics, including the *census. The analytic version of the classification has eight classes and is the version used for most analyses.... national statistics socio-economic classification
(OSCE) a type of examination used increasingly in the health sciences (medicine, dentistry, nursing, physiotherapy, pharmacy) to assess clinical skills in examination, communication, medical procedures, and interpretation of results. The examination usually takes the form of a circuit of stations around which each candidate moves after a specified time interval (5–10 minutes) at each station. Stations are a mixture of interactive and noninteractive tasks. Some have an examiner and a simulated patient, either an actor for assessment of communication or history-taking skills or a manikin of a specific part of the body (e.g. to demonstrate how to use an auriscope). Other stations have investigation results with a list of questions that are to be completed on computer-marked examination papers. Each station has a different examiner and the stations are standardized with specific marking criteria, thus enabling fairer comparison with peers.... objective structured clinical examination
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