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4. Governing the constructs of life : what constitutes ‘good’ governance?

Author

Morgan Jones, Molly

Subjects
610.28, QH0426 Genetics, R856 Biomedical engineering. Electronics. Instrumentation
Abstract

This thesis explores contrasting perspectives on what constitutes 'good governance' for human embryonic stem cell (hESC) research. It asks whether there are systematic differences between perspectives of UK and US policy actors and what kinds of patterns are discernible. Biomedical technologies like hESCs generate complex interactions between public values, institutional interests, societal expectations and technological uncertainties. These pose serious governance challenges. Under such conditions, diverse aspects and implications of risk, ambiguity and uncertainty come into focus. We need appraisal processes that address these issues by combining quantitative and qualitative dimensions to 'open up' divergent governance framings. The research framework employed here uses and further develops one such elicitation and analysis process called Multicriteria Mapping (MCM). MCM combines qualitative sensitivity with quantitative precision, while also aiding transparency and reflexivity in documenting and understanding diverse stakeholder perspectives. We therefore address 'good' governance both as an analytical subject and as a rationale for testing a novel form of appraisal. The analysis discerns systematic patterns in perspectives on good governance across national contexts and between stakeholders, identifying several points of convergence and divergence. We examine underlying rationales behind individual perspectives, obtaining empirical support for recent theoretical arguments concerning technology appraisal and democratic deliberation. We find national policy literatures make greater use of moral and ethical language to frame governance challenges, by comparison with stakeholders' emphasis on institutional and socio-political factors. This suggests a more critical and cautious stance is needed towards the legitimatory language of 'bioethics' in policy making. Finally, we explore some of the normative implications for governance of culturally sensitive and scientifically uncertain issues. By providing reflexive explanations of factors influencing perspectives of policy actors, this thesis makes a number of interlinked theoretical, methodological, empirical and normative contributions to understanding of how good governance of biomedical technologies is and should be conducted.

Published
2011

18. Clinical and cost effectiveness of issuing longer versus shorter duration (3 month vs. 28 day) prescriptions in patients with chronic conditions: systematic review and economic modelling

Author

Martin, Adam, Exley, Josephine, Doble, Brett, Wilson, Ed, Payne, Rupert, Avery, Anthony, Meads, Catherine, Kirtley, Anne, Morgan Jones, Molly, and King, Sarah

Abstract

Background: To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain.Objective: To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care.Design/data sources: The design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with

Published
2017

21. Comparative Performance of Adult Social Care Research, 1996-2011: A Bibliometric Assessment.

Author

Campbell, David, Côté, Grégoire, Grant, Jonathan, Knapp, Martin, Mehta, Anji, and Morgan Jones, Molly

Subjects
BIBLIOMETRICS, COMPARATIVE studies, RESEARCH evaluation, SERIAL publications, SOCIAL work research, BIBLIOGRAPHIC databases
Abstract

Decision makers in adult social care are increasingly interested in using evidence from research to support or shape their decisions. The scope and nature of the current landscape of adult social care research (ASCR) need to be better understood. This paper provides a bibliometric assessment of ASCR outputs from 1996 to 2011. ASCR papers were retrieved using three strategies: from key journals; using keywords and noun phrases; and from additional papers preferentially citing or being cited by other ASCR papers. Overall, 195,829 ASCR papers were identified in the bibliographic database Scopus, of which 16 per cent involved at least one author from the UK. The UK output increased 2.45-fold between 1996 and 2011. Among selected countries, those with greater research intensity in ASCR generally had higher citation impact, such as the USA, UK, Canada and the Netherlands. The top five UK institutions in terms of volume of papers in the UK accounted for 26 per cent of total output. We conclude by noting the limitations to bibliometric analysis of ASCR and examine how such analysis can support the strategic development of the field. [ABSTRACT FROM AUTHOR]

Published
2016
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22. Clinical and cost effectiveness of issuing longer versus shorter duration (3 month vs. 28 day) prescriptions in patients with chronic conditions: systematic review and economic modelling

Author

Miani, Céline, Martin, Adam, Exley, Josephine, Doble, Brett, Wilson, Ed, Payne, Rupert, Avery, Anthony, Meads, Catherine, Kirtley, Anne, Morgan Jones, Molly, King, Sarah, Miani, Céline, Martin, Adam, Exley, Josephine, Doble, Brett, Wilson, Ed, Payne, Rupert, Avery, Anthony, Meads, Catherine, Kirtley, Anne, Morgan Jones, Molly, and King, Sarah

Abstract

Background: To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. Objective: To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care. Design/data sources: The design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with < 60-day and ≥ 60-day prescriptions for five patient cohorts over an 11-year period from the Clinical Practice Research Datalink. Third, a decision model adapting three existing models to predict costs and effects of differing adherence levels associated with 28-day versus 3-month prescriptions in three clinical scenarios. Review methods: In the systematic review, from 15,257 unique citations, 54 full-text papers were reviewed and 16 studies were included, five of which were abstracts and one of which was an extended conference abstract. None was a randomised controlled trial: 11 were retrospective cohort studies, three were cross-sectional surveys and two were cost studies. No information on health outcomes was available. Results: An exploratory meta-analysis based on six retrospective cohort studies suggested that lower adherence was associated with 28-day prescriptions (standardised mean differen

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23. Clinical and cost effectiveness of issuing longer versus shorter duration (3 month vs. 28 day) prescriptions in patients with chronic conditions: systematic review and economic modelling

Author

Miani, Céline, Martin, Adam, Exley, Josephine, Doble, Brett, Wilson, Ed, Payne, Rupert, Avery, Anthony, Meads, Catherine, Kirtley, Anne, Morgan Jones, Molly, King, Sarah, Miani, Céline, Martin, Adam, Exley, Josephine, Doble, Brett, Wilson, Ed, Payne, Rupert, Avery, Anthony, Meads, Catherine, Kirtley, Anne, Morgan Jones, Molly, and King, Sarah

Abstract

Background: To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. Objective: To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care. Design/data sources: The design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with < 60-day and ≥ 60-day prescriptions for five patient cohorts over an 11-year period from the Clinical Practice Research Datalink. Third, a decision model adapting three existing models to predict costs and effects of differing adherence levels associated with 28-day versus 3-month prescriptions in three clinical scenarios. Review methods: In the systematic review, from 15,257 unique citations, 54 full-text papers were reviewed and 16 studies were included, five of which were abstracts and one of which was an extended conference abstract. None was a randomised controlled trial: 11 were retrospective cohort studies, three were cross-sectional surveys and two were cost studies. No information on health outcomes was available. Results: An exploratory meta-analysis based on six retrospective cohort studies suggested that lower adherence was associated with 28-day prescriptions (standardised mean differen

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24. Clinical and cost effectiveness of issuing longer versus shorter duration (3 month vs. 28 day) prescriptions in patients with chronic conditions: systematic review and economic modelling

Author

Miani, Céline, Martin, Adam, Exley, Josephine, Doble, Brett, Wilson, Ed, Payne, Rupert, Avery, Anthony, Meads, Catherine, Kirtley, Anne, Morgan Jones, Molly, King, Sarah, Miani, Céline, Martin, Adam, Exley, Josephine, Doble, Brett, Wilson, Ed, Payne, Rupert, Avery, Anthony, Meads, Catherine, Kirtley, Anne, Morgan Jones, Molly, and King, Sarah

Abstract

Background: To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. Objective: To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care. Design/data sources: The design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with < 60-day and ≥ 60-day prescriptions for five patient cohorts over an 11-year period from the Clinical Practice Research Datalink. Third, a decision model adapting three existing models to predict costs and effects of differing adherence levels associated with 28-day versus 3-month prescriptions in three clinical scenarios. Review methods: In the systematic review, from 15,257 unique citations, 54 full-text papers were reviewed and 16 studies were included, five of which were abstracts and one of which was an extended conference abstract. None was a randomised controlled trial: 11 were retrospective cohort studies, three were cross-sectional surveys and two were cost studies. No information on health outcomes was available. Results: An exploratory meta-analysis based on six retrospective cohort studies suggested that lower adherence was associated with 28-day prescriptions (standardised mean differen

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25. Clinical and cost effectiveness of issuing longer versus shorter duration (3 month vs. 28 day) prescriptions in patients with chronic conditions: systematic review and economic modelling

Author

Miani, Céline, Martin, Adam, Exley, Josephine, Doble, Brett, Wilson, Ed, Payne, Rupert, Avery, Anthony, Meads, Catherine, Kirtley, Anne, Morgan Jones, Molly, King, Sarah, Miani, Céline, Martin, Adam, Exley, Josephine, Doble, Brett, Wilson, Ed, Payne, Rupert, Avery, Anthony, Meads, Catherine, Kirtley, Anne, Morgan Jones, Molly, and King, Sarah

Abstract

Background: To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. Objective: To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care. Design/data sources: The design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with < 60-day and ≥ 60-day prescriptions for five patient cohorts over an 11-year period from the Clinical Practice Research Datalink. Third, a decision model adapting three existing models to predict costs and effects of differing adherence levels associated with 28-day versus 3-month prescriptions in three clinical scenarios. Review methods: In the systematic review, from 15,257 unique citations, 54 full-text papers were reviewed and 16 studies were included, five of which were abstracts and one of which was an extended conference abstract. None was a randomised controlled trial: 11 were retrospective cohort studies, three were cross-sectional surveys and two were cost studies. No information on health outcomes was available. Results: An exploratory meta-analysis based on six retrospective cohort studies suggested that lower adherence was associated with 28-day prescriptions (standardised mean differen

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26. Clinical and cost effectiveness of issuing longer versus shorter duration (3 month vs. 28 day) prescriptions in patients with chronic conditions: systematic review and economic modelling

Author

Miani, Céline, Martin, Adam, Exley, Josephine, Doble, Brett, Wilson, Ed, Payne, Rupert, Avery, Anthony, Meads, Catherine, Kirtley, Anne, Morgan Jones, Molly, King, Sarah, Miani, Céline, Martin, Adam, Exley, Josephine, Doble, Brett, Wilson, Ed, Payne, Rupert, Avery, Anthony, Meads, Catherine, Kirtley, Anne, Morgan Jones, Molly, and King, Sarah

Abstract

Background: To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. Objective: To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care. Design/data sources: The design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with < 60-day and ≥ 60-day prescriptions for five patient cohorts over an 11-year period from the Clinical Practice Research Datalink. Third, a decision model adapting three existing models to predict costs and effects of differing adherence levels associated with 28-day versus 3-month prescriptions in three clinical scenarios. Review methods: In the systematic review, from 15,257 unique citations, 54 full-text papers were reviewed and 16 studies were included, five of which were abstracts and one of which was an extended conference abstract. None was a randomised controlled trial: 11 were retrospective cohort studies, three were cross-sectional surveys and two were cost studies. No information on health outcomes was available. Results: An exploratory meta-analysis based on six retrospective cohort studies suggested that lower adherence was associated with 28-day prescriptions (standardised mean differen

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