Ferhana Hashem

Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems.

This article presents an ethnographic study of regulatory decision-making regarding the cost-effectiveness of expensive medicines at the National Institute for Health and Care Excellence (NICE) in England. We explored trust as one important mechanism by which problems of complexity and uncertainty were resolved. Existing studies note the salience of trust for regulatory decisions, by which the appraisal of people becomes a proxy for appraising technologies themselves. Although such (dis)trust in manufacturers was one important influence, we describe a more intricate web of (dis)trust relations also involving various expert advisors, fellow committee members and committee Chairs. Within these complex chains of relations, we found examples of both more blind-acquiescent and more critical-investigative forms of trust as well as, at times, pronounced distrust. Difficulties in overcoming uncertainty through other means obliged trust in some contexts, although not in others. (Dis)trust was constructed through inferences involving abstract systems alongside actors’ oral and written presentations-of-self. Systemic features and ‘forced options’ to trust indicate potential insidious processes of regulatory capture.

Responding to minority ethnic groups' language support needs in Britain

– The purpose of this paper is to answer the question: in the British states relationship with its diverse minority ethnic communities, how have politics framed administrative allocation of language support services? The dynamics of policy development are investigated, a tangible effect of the shift from unofficial pragmatic multiculturalism towards community cohesion/“Britishness” having been a government focus on English for speakers of other languages (ESOL) rather than translation/interpreting. This change has revealed a tension between the demands of identity and equality for minority ethnic people: respect for cultural identity requires provision of translation/interpreting while creating (political) equality between majority and minority communities entails the latter having access to the political language so placing an emphasis on ESOL., – An evidence synthesis is undertaken of policy documents relating to the British states provision of language support services and data on the skill levels in English from government surveys., – The relative contribution of financial constraints and new policy/ideological positions to changes in the direction of policy and provision is assessed. With respect to the “new approach to ESOL”, this process of discretionary allocation that privileges policies of integration and community cohesion rather than language need itself is viewed against the inadequacies of the data currently available on levels of English language proficiency in providing the basis for making policy decisions and allocating resources., – The level of English language skills amongst Britains minority ethnic groups and of government policy to address skill deficits has been substantially neglected. The paper provides a policy focus ahead of the release of the 2011 Census findings on language questions.

Decision making in NICE single technological appraisals: How does NICE incorporate patient perspectives?

The National Institute for Health and Care Excellence (NICE) has an explicit mandate to include patient and public involvement in the appraisal of medicines to be available for funding on the NHS. NICE involves an appraisal committee who are required to take on board experiential evidence from patient experts alongside population‐based evidence on clinical and cost‐effectiveness when making a decision whether to fund a drug.

Still Elegantly Muddling Through? NICE and Uncertainty in Decision Making About the Rationing of Expensive Medicines in England:

This article examines the “technological appraisals” carried out by the National Institute for Health and Care Excellence as it regulates the provision of expensive new drugs within the English National Health Service on cost-effectiveness grounds. Ostensibly this is a highly rational process by which the regulatory mechanisms absorb uncertainty, but in practice, decision making remains highly complex and uncertain. This article draws on ethnographic data—interviews with a range of stakeholders and decision makers (n = 41), observations of public and closed appraisal meetings, and documentary analysis—regarding the decision-making processes involving three pharmaceutical products. The study explores the various ways in which different forms of uncertainty are perceived and tackled within these Single Technology Appraisals. Difficulties of dealing with the various levels of uncertainty were manifest and often rendered straightforward decision making problematic. Uncertainties associated with epistemology, procedures, interpersonal relations, and technicality were particularly evident. The need to exercise discretion within a more formal institutional framework shaped a pragmatic combining of strategies tactics—explicit and informal, collective and individual—to navigate through the layers of complexity and uncertainty in making decisions.

Elite conceptions of Muslim identity from the partition of Bengal to the creation of Bangladesh, 1947–1971

The historic partition of Bengal in 1947 caused a shift in the composition of the Muslim and Hindu political elite who were now geographically bounded into two separate newly formed provincial states of East Pakistan and West Bengal. The aim of this article is to explore the transformation in elite conceptions of identity in East Pakistan from the post-1947 era until the creation of Bangladesh in 1971. The prevalence of two new competing elites created a great dichotomy in the way identity was conceived. The change of these elite groups fundamentally altered the view of identity that was articulated during this period.

Supporting patients self-managing respiratory health: a qualitative study on the impact of the Breathe Easy voluntary group network

Self-management strategies are designed to improve lung and respiratory health through structured self-management plans with regular practitioner reviews. Strategies have not, however, focused upon how patient support groups and advocacy networks can help with the management of these conditions; therefore, it is unknown what impact they may have on patient self-management. A qualitative study was designed to help understand what impact the British Lung Foundations Breathe Easy (BE) groups have on patients managing their lung and respiratory conditions. A semistructured telephone interview schedule was developed to study the network. Topics covered included: perceptions about the BE groups; current referrals systems and integration pathways; benefits of attending the BE groups; and integration of the BE groups into the respiratory pathway. Key themes explored included: shared patient experience and peer support; patient self-management and self-education; attendance of healthcare professionals; and the impact of integrating BE groups into the respiratory pathway. BE networks were shown to support self-care initiatives for people attending the groups, and members expressed a social and educational benefit. BE networks were working with the local National Health Service to become an integral part of the respiratory pathway, yet there was evidence of resistance from the health service in incorporating the networks. Lung and respiratory conditions affect ∼12.7 million people in the UK with asthma, COPD or other longstanding respiratory illnesses; half are dependent on prescribed medicines. Voluntary patient support groups can provide peer support for self-management. http://ow.ly/7Xz330hbeth

Effects of preoperative and postoperative resistance exercise interventions on recovery of physical function in patients undergoing abdominal surgery for cancer: a systematic review of randomised controlled trials

Objective To systematically review the effects of preoperative and postoperative resistance exercise training on the recovery of physical function in patients undergoing abdominal surgery for cancer. Data sources A systematic review of English articles using Medline, Physiotherapy Evidence Database, CINAHL and the Cochrane Library electronic databases was undertaken. Eligibility criteria for selecting studies Studies were included if they used a randomised, quasi-randomised or controlled trial study design and compared the effects of a muscle-strengthening exercise intervention (±other therapy) with a comparative non-exercise group; involved adult participants (≥18 years) who had elected to undergo abdominal surgery for cancer; and used muscle strength, physical function, self-reported functional ability, range of motion and/or a performance-based test as an outcome measure. Results Following screening of titles and abstracts of the 588 publications retrieved from the initial search, 24 studies met the inclusion criteria and were accessed for review of the full-text version of the article, and 2 eligible studies met the inclusion criteria and were included in the review. One exercise programme was undertaken preoperatively and the other postoperatively, until discharge from hospital. The exercise interventions of the included studies were performed for five and eight sessions, respectively. There were no differences between groups in either study. Conclusion The only two studies designed to determine whether preoperative or postoperative resistance muscle-strengthening exercise programmes improved or negatively affected physical function outcomes in patients undergoing abdominal surgery for cancer provide inconclusive results.

Are our data on teenage pregnancy across ethnic groups in England fit for the purpose of policy formulation, implementation, and monitoring?

The Teenage Pregnancy Strategy for England has a Public Service Agreement target to substantially reduce the level of teenage pregnancies by 2010. It argues that all the main risk factors need to be incorporated into risk assessments undertaken by agencies and professionals. These include deprivation, poor educational attainment and disengagement from school, and ethnicity, the lasts association with high teenage pregnancy rates being independent of deprivation. The strategy adds, too, that local areas should target delivery of their local strategy more intensively on these groups most at risk. An attempt is made to systematically review the evidence on the availability and quality of ethnicity data on maternities and abortions, based on extensive structured searches of a wide range of abstracted and full-text literature and statistical sources published 1997–2008. This reveals that, in practice, local teenage pregnancy strategies have little, if any, ethnically coded data to draw upon and it is not surprising that they have had difficulties in targeting these groups. The experience of other countries demonstrates that data of quality can be collected on teenage pregnancy if this is prioritised. The Race Relations (Amendment) Act 2000 should be used to catalyse statutory agencies to set up the necessary systems to ensure that collection of teenage pregnancy data by ethnic group is routine and robust.