Clinical trial design is still far from perfect.
CMI highlight: What’s wrong with trial design and how can we improve it?
Marc Bonten from the University Medical Center Utrecht published a comment outlining why he considers traditional randomized controlled trials (RCT) designs as suboptimal and inefficient to answer infectious disease questions. He concludes by proposing strategies to overcome the issues. To increase generalizability he suggests embedding trials in daily care practice and to immediately enrol all eligible patients. He also stresses the importance of using fully anonymized outcome data and establishing sufficient power for pre-defined subgroup analyses. Finally Professor Bonten suggests repeating analyses throughout the study and allowing for adaptive randomization to avoid statistically significant beneficial effects being hidden in a subgroup. › Read more
And we need researchers to bother asking about why ISO quality accreditation is permitted to continue with almost no trials of its worth. We need ongoing audits of audits and analysis of EQA data to investigate whether accreditation has any value.
It needs to have value in excess of it massive cost.
If it has zero value maybe it shouldn’t be done.
26 Jun 2016 Dr Robert Morley @drbobmorley
Why would you trust an inspector more than a highly-qualified professional?
Maybe just to break the NHS. Its sustainability is being examined in parliament.
12 July 2016
On Tuesday 12 July, the newly appointed Committee on the Long-term Sustainability of the NHS hears from senior officials from the Department of Health and the Department for Communities and Local Government at its first evidence session…
The session covers a broad range of topics with questions including:
- what long-term thinking is taking place within Government about the sustainability of the NHS over the next 15-20 years?
- to what extent is the current healthcare funding envelope realistic?
- what analysis has the Government done on different pricing structures and financial systems to help determine where money might be best spent?
- what is the Government’s workforce planning for the next 15-20 years?
- what are the practical changes required to provide the population with an integrated National Health and Care Service?
- to what extent is digitisation of data and services happening?
- what long-term strategy do you have for public health and prevention?
Other poor decisions about reducing NHS costs have been responded to by the ACB.
NHSI has written to all Trusts outlining the financial position and highlighting three areas where action is required:
- Elimination of pay cost growth
- Back office and pathology consolidation
- Unsustainable service consolidation.
The ACB has written a response detailing that pathology is not a back office function and that consolidation does not always lead to financial savings.
See the ACB response and the NHSI letter below:
ACB response to NHSI letter July 2016
2016-06-28 Letter re 2016-17 Financial Positions to Chairs & CEOs final