Clin Med
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Comparative Study
Comparative studies and healthcare policy: learning and mislearning across borders.
This article addresses the vocabulary of cross-national analysis and commentary about health care, health policy and health politics. We conclude there is a large gap between promise and performance in comparative policy commentary and point to major sources of confusion, such as the lack of generally agreed vocabulary, vague language and the use of faddish and misleading terms and aspirational labels (illustrated by a selection of widely used expressions in comparative reports). We next examine the basic purposes of international policy comparison, distinguish three useful and two misleading approaches and frame defensible ground rules for comparative work.
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Care of patients with diabetes and chronic kidney disease (CKD) in the UK is divided between primary care, diabetologists and nephrology. In a retrospective analysis, we examined the distribution of care provision for patients with diabetes and CKD. Nephrology services see a minority of diabetic patients with CKD, but they see the majority of those with an estimated glomerular filtration rate (eGFR) of <30 ml/min. ⋯ Half of the patients with diabetes and CKD seen in either the primary care and diabetology cohorts, with no nephrology input, had a rate of fall of eGFR of >5 ml/min/yr. This suggests that older age might deter referral to nephrology, which is based predominantly on CKD stage. This results in a significant proportion of patients with stable renal function being seen by nephrology, and in the under-referral of a large cohort of patients with progressive CKD.
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The landscape and opportunities for clinical research have changed significantly following the creation of the National Institute for Health Research (NIHR) in 2006. This article describes the scale and impact of the NIHR network infrastructure for clinical research and identifies areas for future development in partnership with the National Health Service (NHS), clinicians and research funders.
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This paper describes the unsatisfactory situation that currently affects the provision of neurological services in parts of England, as identified in three recent reports, and contains a number of suggested ways in which the situation might be improved, while highlighting the good work being done by specialist nurses and therapists and by the Neurological Alliance on behalf of patients and their families.