James Raftery: NICE’s proposed new QALY modifier for appraising highly specialised technologies

After a consultation on changes to its methods for appraising health technologies, the National Institute for Health and Care Excellence (NICE) has gone public with its way forward. As discussed previously, the consultation sought views on four items: Introduce a “fast track” NICE technology appraisal process for the most promising new technologies, which fall below an incremental cost […]

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Jeffrey Aronson: When I use a word . . . Translational research—a new operational model

To recap: over the past three weeks I have used the metaphor of crossing bridges in discussing translational research in clinical medicine; derived a model of it from definitions in the Cooksey report; and, recognising its weaknesses, modified the model based on later descriptions. However, the second model still has weaknesses. For example, it retains […]

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The dual nature of hope at the end of life

Hope for cure has traditionally been the patient’s best friend and the clinician’s strongest ally. Clinicians may avoid discussing their patients’ poor prognoses with them for fear that this might destroy their hopes or cause depression. [1,2] However, patients with serious illness usually want to hear the truth from their physicians and benefit from knowing the […]

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Neel Sharma: The first rule of diagnosis—eyes first and most, hands next and least

Medical education has changed dramatically in recent years. During my training we used a standard reference text and relied heavily on seniors to provide more detail about different clinical diseases. Nowadays, this kind of teaching seems less relevant. With online resources, learners are increasingly turning to the internet to access the latest guidelines on how […]

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Alain Braillon: Should pregnant women be tested for smoking?

While rates of smoking are slightly decreasing in some high-income countries, worldwide more and more women smoke, and 10 to 25% of women smoke during pregnancy. Smoking remains the first avoidable cause of preterm births (ten cigarettes/day causes a 3-fold increase), lower birth weight, placental complications and perinatal mortality. However, smoking during pregnancy is too frequently […]

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