Procedures for evaluating innovatory proposals.

Leger, A. S. St; Allen, DL; Rowsell, R

doi:10.1136/bmj.299.6706.1017

Cited by 6 publications

(3 citation statements)

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“…This is particularly so at times when there is an agreed Kuhnian[ll] paradigm as to what constitute legitimate areas of interest and methods of approach. But there does not exist a paradigm for R&D (in the broad sense of research plus input to decision making) although some [5,10] have taken steps in that direction. Also, those who are likely to be asked to set the standards are those, on the basis of past motivation and performance, least likely to take an imaginative leap.…”

Section: Limitations Of Academementioning

confidence: 99%

“…Checklists are a powerful tool for aiding the appraisal of options. St Leger et al [5,10] provide a template for a checklist to be used when appraising proposals for the introduction of innovations. This encompasses traditional clinical indices of outcome, items in Peckham's extended protocol and beyond.…”

Section: Journal Ofmentioning

confidence: 99%

“…Hitherto, even if NHS structures had promoted the kind of critical and parallel [5] planning envisaged, the necessary supporting information would have been absent. Biomedical research has been very narrow in its intent.…”

Section: Introductionmentioning

confidence: 99%

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Making “Peckham” Work for Managers

Leger

1992

Journal of Management in Medicine

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The “Peckham” initiative is introducing a coherent framework for research and development (R&D) in the UK National Health Service (NHS). This entails close collaboration between the universities and the health service. However, there are inherent weaknesses in the current ethos of research and academic which suggest that there may be little understanding of the needs of NHS decision makers. There is a danger if health service managers do not take control of the agenda for R&D that it will be subverted to serve narrow academic interests. Explores means by which this can be averted. Suggests that managers should control the strategy of R&D and through the use of checklists determine broadly the content of study protocols.

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Section: Limitations Of Academementioning

confidence: 99%

Section: Journal Ofmentioning

confidence: 99%

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Making “Peckham” Work for Managers

Leger

1992

Journal of Management in Medicine

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Preventing and Managing Prematurity

Lumley

1991

Int J Technol Assess Health Care

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In the past decade the prevention and management of prematurity have begun to be addressed with more appropriate designs. A few strategies-very few-can now be recommended. A few, some widely implemented, can be abandoned. The risks and benefits of most interventions still require clarification.It is commonly agreed among clinicians, researchers, and health policy makers in industrialized countries that the crucial perinatal problem is prematurity. One response to this recognition has been an emphasis on the need for a better understanding of the pathophysiology of prematurity as the key to prevention. Eastman's (19) classic comments-"only when the factors causing prematurity are clearly understood can any intelligent attempt at prevention be made"-is still quoted by those who hold this view, and it could still be regarded as largely true.In contrast, several recent articles call for a greater sense of urgency, exhorting clinicians to stop worrying about causes and to implement preventive programs instead (32;33;36). It is tempting, in the face of stable prematurity rates and the insatiable demand for more neonatal intensive care facilities, to respond enthusiastically to the call. The only trouble with this advice is its lack of clarity about preventive programs: What is the scope of prevention and what components of which programs actually work?First, the scope for prevention is limited by the fact that more than 60% of preterm deaths occur before labor or in infants with lethal malformations (86;87). Even when the infant is alive and not malformed at the onset of labor, some preterm deliveries are elective and others are complicated by factors that contraindicate delaying the delivery (e.g., bleeding). The remaining cases of preterm birth involving spontaneous uncomplicated preterm labor or preterm premature rupture of the membranes (PPROM) with a healthy fetus offer the widest scope for prevention; in some cases, however, delivery is already inevitable at the time of hospital admission. Potential preventive efforts in the uncomplicated group include true primary prevention, early identification of preterm labor or its premonitory signs, and inhibition of preterm labor.Though it is often blurred in practice, the distinction between prevention and inhibition of preterm labor is an important one because the potential for net negative outcomes is even greater with prophylactic interventions. These interventions are used in women at risk, rather than in ones with an established problem, and are used for a greater proportion of the pregnancy.

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Evaluation of the electrodiagnostic investigation of children using the Greenwich Grading System

Fraser

Burton

Holder

et al. 2004

Eye

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Purpose To evaluate the contribution of electrodiagnostic testing (EDT) to the management of children in a paediatric ophthalmology service using the Greenwich Grading System (GGS). Methods A retrospective analysis was performed of the case notes of 105 of the 113 paediatric patients referred from the Strabismus and Paediatric Service at Moorfields Eye Hospital for electrophysiological testing over a 1-year period. The GGS was used to quantify the contribution of EDT to the diagnosis, overall investigation, and treatment of each patient. Patients were further subdivided into different diagnostic groups to allow comparison of the value of EDT in different conditions. Results EDT was found to be of value in 91% of the children tested and was considered an essential investigation in 71%. EDT made a new diagnosis in 7% of patients, changed it in 5%, and confirmed or excluded a diagnosis in 79%. EDT made a useful contribution to the overall investigation of 89% of the patients and was considered the only test that could provide the required information in 71%. The results of EDT allowed reassurance and/or explanation with regard to the diagnosis, prognosis, and treatment in 91% of children. In one patient, treatment was changed as a result of EDT. The clinical outcome was not adversely affected in any patient. Conclusions EDT was of value to the clinical management of most of the children reviewed, mainly by confirming or excluding a clinical diagnosis and allowing explanation and reassurance to children and parents. Electrodiagnostic information gave a new or changed diagnosis in 12% of the children.

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Procedures for evaluating innovatory proposals.

Abstract: The cnstant advance ofmedical technology fuels ever increasing expectatis fOf the healthi srvice by the public. During much of the history of the

Cited by 6 publications

References 0 publications

Making “Peckham” Work for Managers

Making “Peckham” Work for Managers

Preventing and Managing Prematurity

Evaluation of the electrodiagnostic investigation of children using the Greenwich Grading System

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