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A consultee organisation would include patient groups, organisations representing health care professionals and the manufacturers of the product undergoing appraisal.

Consultees submit evidence during the appraisal and comment on the appraisal documents. Commentator organisations include the manufacturers of products to which the product undergoing appraisal is being compared.

They comment on the documents that have been submitted and drawn up but do not actually submit information themselves.

An independent academic centre then draws together and analyses all of the published information on the technology under appraisal and prepares an assessment report.

This can be commented on by the Consultees and Commentators. Comments are then taken into account and changes made to the assessment report to produce an evaluation report.

An independent Appraisal Committee then looks at the evaluation report, hears spoken testimony from clinical experts, patient groups and carers.

They take their testimony into account and draw up a document known as the 'appraisal consultation document'. This is sent to all consultees and commentators who are then able to make further comments.

Once these comments have been taken into account the final document is drawn up called the 'final appraisal determination'. This is submitted to NICE for approval.

The process aims to be fully independent of government and lobbying power, basing decisions fully on clinical and cost-effectiveness. There have been concerns that lobbying by pharmaceutical companies to mobilise media attention and influence public opinion are attempts to influence the decision-making process.

NICE carries out assessments of the most appropriate treatment regimes for different diseases. This must take into account both desired medical outcomes i.

The National Collaborating Centre appoints a Guideline Development Group whose job it is to work on the development of the clinical guideline.

This group consists of medical professionals, representatives of patient and carer groups and technical experts. They work together to assess the evidence for the guideline topic e.

There are then two consultation periods in which stakeholder organisations are able to comment on the draft guideline. After the second consultation period, an independent Guideline Review Panel reviews the guideline and stakeholder comments and ensures that these comments have been taken into account.

The Guideline Development Group then finalises the recommendations and the National Collaboration Centre produces the final guideline.

In October Andy Burnham said that a Labour government could reduce variation in access to drugs and procedures by making it mandatory for commissioners to follow NICE clinical guidelines.

Where they have said something is effective and affordable, on what basis does a local commissioner withhold that from somebody? NICE has a service called Clinical Knowledge Summaries CKS which provides primary care practitioners with a readily accessible summary of the current evidence base and practical guidance.

Under the Health and Social Care Act , NICE was given responsibility for developing guidance and quality standards for social care , using an evidence-based model.

NICE, along with the NCCSC, carries out a scoping exercise with a scoping group and with input from key stakeholders, at both a workshop and a public consultation, to ensure the guidance to be produced is focused and achievable.

A chairperson and members of the Guidance Development Group are appointed, and pose review questions which will enable systematic evidence reviews to take place, thus delivering the guidance and subsequent recommendations.

Service user and carer involvement takes place throughout, as well as public consultation on the draft guidance.

This is submitted to NICE for formal approval and publication. The entire process from pre-scoping to publication takes approximately 24 months.

The guidance is then available to NICE standing committees to develop a quality standard on the topic. The quality standard is developed using the guidance and other accredited sources, to produce high-level concise statements that can be used for quality improvement by social care providers and commissioners, as well as setting out what service users and carers can expect of high quality social care services.

The NCCSC is unique within NICE, in that it is the only collaborating centre to have responsibility for the adoption and dissemination support for guidance and quality standards in the social care arena.

Drawing on the expertise of SCIE and their partners within the sector, each of the guidance products and quality standards have a needs assessment carried out to determine the requirements for tools to help embed the guidance and quality standards within the sector.

These can include tailored versions of guidance for specific audiences, costing and commissioning tools and even training and learning packages.

As of August , NICE and the NCCSC had scheduled guidance delivery for five topics: domiciliary care , older adults with long-term conditions, transition between health and social care settings, transition from children's to adults' services and child abuse and neglect.

As with any system financing health care, the NHS has a limited budget and a vast number of potential spending options.

Choices must be made as to how this limited budget is spent. Economic evaluations are carried out within a health technology assessment framework to compare the cost-effectiveness of alternative activities and to consider the opportunity cost associated with their decisions.

NICE attempts to assess the cost—effectiveness of potential expenditures within the NHS to assess whether or not they represent 'better value' for money than treatments that would be neglected if the expenditure took place.

It assesses the cost—effectiveness of new treatments by analysing the cost and benefit of the proposed treatment relative to the next best treatment that is currently in use.

NICE guidance supports the use of quality-adjusted life years QALY as the primary outcome for quantifying the expected health benefits associated with a given treatment regime.

When combined with the relative cost of treatment, this information can be used to estimate an incremental cost-effectiveness ratio ICER , which is considered in relation to NICE's threshold willingness-to-pay value.

Over the years, there has been great controversy as to what value this threshold should be set at. Initially, there was no fixed number.

Patients score their perceived quality of life on a scale from 0 to 1 with 0 being worst possible health and 1 being best possible health.

On the standard treatment, quality of life is rated with a score of 0. Patients on the new treatment on average live an extra 3 months, so 1.

The quality of life gained is the product of life span and quality rating with the new treatment less the same calculation for the old treatment, i.

If the patient was expected to live only one month extra and instead of three then NICE would issue a recommendation not to fund.

The patient's primary care trust [ needs update ] could still decide to fund the new treatment, but if not, the patient would then have two choices.

He or she could opt to take the free NHS standard treatment, or he or she may decide to pay out of pocket to obtain the benefit of the new treatment from a different health care provider.

If the person has a private health insurance policy the person could check to see whether the private insurance provider will fund the new treatment.

Theoretically, it might be possible to draw up a table of all possible treatments sorted by increasing the cost per quality-adjusted life year gained.

Those treatments with lowest cost per quality-adjusted life year gained would appear at the top of the table and deliver the most benefit per value spent and would be easiest to justify funding for.

Those where the delivered benefit is low and the cost is high would appear at the bottom of the list. Decision makers would, theoretically, work down the table, adopting services that are the most cost effective.

The point at which the NHS budget is exhausted would reveal the shadow price , the threshold lying between the CQG gained of the last service that is funded and that of the next most cost effective service that is not funded.

In practice this exercise is not done, but an assumed shadow price has been used by NICE for many years in its assessments to determine which treatments the NHS should and should not fund.

The threshold it employs is not based on empirical research and is not directly related to the NHS budget, nor is it at the same level as that used by primary care trusts PCTs in providing treatments not assessed by NICE, which tends to be lower.

Some witnesses, including patient organisations and pharmaceutical companies, thought NICE should be more generous in the cost per QALY threshold it uses, and should approve more products.

On the other hand, some PCTs struggle to implement NICE guidance at the current threshold and other witnesses argued that a lower level should be used.

However, there are many uncertainties about the thresholds used by PCTs. The work that NICE is involved in, attracts the attention of many groups, including doctors, the pharmaceutical industry, and patients.

Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside.

They learn to hide from their selves. Rowling, Harry Potter and the Deathly Hallows. They lived in ugly places where there were only ugly things to do.

They didn't own doodley-squat, so they couldn't improve their surroundings. My body is nothing without me. Being frightened means that you live in a body that is always on guard.

Angry people live in angry bodies. The bodies of child-abuse victims are tense and defensive until they find a way to relax and feel safe.

In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past.

In my practice I begin the process by helping my patients to first notice and then describe the feelings in their bodies—not emotions such as anger or anxiety or fear but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow, and so on.

I also work on identifying the sensations associated with relaxation or pleasure. I help them become aware of their breath, their gestures and movements.

All too often, however, drugs such as Abilify, Zyprexa, and Seroquel, are prescribed instead of teaching people the skills to deal with such distressing physical reactions.

Of course, medications only blunt sensations and do nothing to resolve them or transform them from toxic agents into allies. The mind needs to be reeducated to feel physical sensations, and the body needs to be helped to tolerate and enjoy the comforts of touch.

Individuals who lack emotional awareness are able, with practice, to connect their physical sensations to psychological events.

Then they can slowly reconnect with themselves. Sometimes, it is pleasant to eat, to drink, to see, to touch, to smell, to hear, to make love.

The mouth. The eyes. The fingertips, The nose. The ears. The genitals. Our voluptific faculties if you will forgive me the coinage are not exclusively concentrated here.

The whole body is susceptible to pleasure, but in places there are wells from which it may be drawn up in greater quantity. But not inexhaustibly.

How long is it possible to know pleasure? Rich Romans ate to satiety, and then purged their overburdened bellies and ate again.

But they could not eat for ever. A rose is sweet, but the nose becomes habituated to its scent. And what of the most intense pleasures, the personality-annihilating ecstasies of sex?

I am no longer a young man; even if I chose to discard my celibacy I would surely have lost my stamina, re-erecting in half-hours where once it was minutes.

And yet if youth were restored to me fully, and I engaged again in what was once my greatest delight — to be fellated at stool by nymphet with mouth still blood-heavy from the necessary precautions — what then?

What if my supply of anodontic premenstruals were never-ending, what then? Surely, in time, I should sicken of it. Do you think Messalina, in that competition of hers with a courtesan, knew pleasure as much on the first occasion as the last?

And you would always be ripe for it, from before the time of your birth to the moment of your death, we are always in season for the embrace of pain.

To experience pain requires no intelligence, no maturity, no wisdom, no slow working of the hormones in the moist midnight of our innards.

We are always ripe for it. All life is ripe for it. Consciousness is not In the body; the body is In Consciousness. And you Are that Consciousness - no the phantom mind that troubles you so.

You are the body, but you are everything else, too. That is what your visions revealed to you. Only the mind resists change.

When you relax mindless into the body, you are happy and content and free, sensing no separation. Immortality is Already yours, but not in the same way you imagined or hope for.

You have been immortal since before you were born and will be long after the body dissolves. The body is in Consciousness; never born; never dies; only changes.

The mind - your ego, personal beliefs, history, and identity - is all that ends at death.

In this way they can see, hear, feel, touch and of course also smell and taste. Spanisch Wörterbücher. This Solnhofen Dragonfly belongs to the species Mesuropetala muenster and shows Sung-hi lee fine and detailed preservation of the lace structures of the wings. Please do leave them untouched. Somalian porn eating and drinking sex is something natural to your body and of course a very nice activity. Clothing must Hentai youporn comfortable and durablereliable Ebony chatline you from wind and cold Hookup search, whilst at the same time allowing body heat and sweat to escape to the outside Nice body, keeping your body nice and dry. Nice body

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Under the Health and Social Care Act , NICE was given responsibility for developing guidance and quality standards for social care , using an evidence-based model.

NICE, along with the NCCSC, carries out a scoping exercise with a scoping group and with input from key stakeholders, at both a workshop and a public consultation, to ensure the guidance to be produced is focused and achievable.

A chairperson and members of the Guidance Development Group are appointed, and pose review questions which will enable systematic evidence reviews to take place, thus delivering the guidance and subsequent recommendations.

Service user and carer involvement takes place throughout, as well as public consultation on the draft guidance. This is submitted to NICE for formal approval and publication.

The entire process from pre-scoping to publication takes approximately 24 months. The guidance is then available to NICE standing committees to develop a quality standard on the topic.

The quality standard is developed using the guidance and other accredited sources, to produce high-level concise statements that can be used for quality improvement by social care providers and commissioners, as well as setting out what service users and carers can expect of high quality social care services.

The NCCSC is unique within NICE, in that it is the only collaborating centre to have responsibility for the adoption and dissemination support for guidance and quality standards in the social care arena.

Drawing on the expertise of SCIE and their partners within the sector, each of the guidance products and quality standards have a needs assessment carried out to determine the requirements for tools to help embed the guidance and quality standards within the sector.

These can include tailored versions of guidance for specific audiences, costing and commissioning tools and even training and learning packages.

As of August , NICE and the NCCSC had scheduled guidance delivery for five topics: domiciliary care , older adults with long-term conditions, transition between health and social care settings, transition from children's to adults' services and child abuse and neglect.

As with any system financing health care, the NHS has a limited budget and a vast number of potential spending options. Choices must be made as to how this limited budget is spent.

Economic evaluations are carried out within a health technology assessment framework to compare the cost-effectiveness of alternative activities and to consider the opportunity cost associated with their decisions.

NICE attempts to assess the cost—effectiveness of potential expenditures within the NHS to assess whether or not they represent 'better value' for money than treatments that would be neglected if the expenditure took place.

It assesses the cost—effectiveness of new treatments by analysing the cost and benefit of the proposed treatment relative to the next best treatment that is currently in use.

NICE guidance supports the use of quality-adjusted life years QALY as the primary outcome for quantifying the expected health benefits associated with a given treatment regime.

When combined with the relative cost of treatment, this information can be used to estimate an incremental cost-effectiveness ratio ICER , which is considered in relation to NICE's threshold willingness-to-pay value.

Over the years, there has been great controversy as to what value this threshold should be set at. Initially, there was no fixed number.

Patients score their perceived quality of life on a scale from 0 to 1 with 0 being worst possible health and 1 being best possible health.

On the standard treatment, quality of life is rated with a score of 0. Patients on the new treatment on average live an extra 3 months, so 1. The quality of life gained is the product of life span and quality rating with the new treatment less the same calculation for the old treatment, i.

If the patient was expected to live only one month extra and instead of three then NICE would issue a recommendation not to fund.

The patient's primary care trust [ needs update ] could still decide to fund the new treatment, but if not, the patient would then have two choices.

He or she could opt to take the free NHS standard treatment, or he or she may decide to pay out of pocket to obtain the benefit of the new treatment from a different health care provider.

If the person has a private health insurance policy the person could check to see whether the private insurance provider will fund the new treatment.

Theoretically, it might be possible to draw up a table of all possible treatments sorted by increasing the cost per quality-adjusted life year gained.

Those treatments with lowest cost per quality-adjusted life year gained would appear at the top of the table and deliver the most benefit per value spent and would be easiest to justify funding for.

Those where the delivered benefit is low and the cost is high would appear at the bottom of the list. Decision makers would, theoretically, work down the table, adopting services that are the most cost effective.

The point at which the NHS budget is exhausted would reveal the shadow price , the threshold lying between the CQG gained of the last service that is funded and that of the next most cost effective service that is not funded.

In practice this exercise is not done, but an assumed shadow price has been used by NICE for many years in its assessments to determine which treatments the NHS should and should not fund.

The threshold it employs is not based on empirical research and is not directly related to the NHS budget, nor is it at the same level as that used by primary care trusts PCTs in providing treatments not assessed by NICE, which tends to be lower.

Some witnesses, including patient organisations and pharmaceutical companies, thought NICE should be more generous in the cost per QALY threshold it uses, and should approve more products.

On the other hand, some PCTs struggle to implement NICE guidance at the current threshold and other witnesses argued that a lower level should be used.

However, there are many uncertainties about the thresholds used by PCTs. The work that NICE is involved in, attracts the attention of many groups, including doctors, the pharmaceutical industry, and patients.

NICE is often associated with controversy, because the requirement to make decisions at a national level, can conflict with what is or is believed to be in the best interests of an individual patient.

Approved cancer drugs and treatments such as radiotherapy and chemotherapy are funded by the NHS without any financial contribution being taken from the patient.

In the case of cancer the Cancer Drugs Fund was set up in after complaints about NICE decisions on new and expensive cancer drugs with limited benefits.

NICE has been criticised for being too slow to reach decisions. On one occasion, the Royal National Institute of Blind People said it was outraged over its delayed decision for further guidance regarding two drugs for macular degeneration that are already approved for use in the NHS.

However the Department of Health said that it had 'made it clear to PCTs that funding for treatments should not be withheld simply because guidance from NICE is unavailable'.

Some of the more controversial NICE decisions have concerned donepezil , galantamine , rivastigmine review and memantine for the treatment of Alzheimer's disease and bevacizumab , sorafenib , sunitinib and temsirolimus for renal cell carcinoma.

All these are drugs with a high cost per treatment and NICE has either rejected or restricted their use in the NHS on the grounds that they are not cost-effective.

A Conservative shadow minister once criticized NICE for spending more on communications than assessments. In its defence, NICE said the majority of its communications budget was spent informing doctors about which drugs had been approved and new guidelines for treatments and that the actual cost of assessing new drugs for the NHS includes money spent on NICE's behalf by the Department of Health.

The institute's approach to the introduction of new oral therapy for Hepatitis C has been criticised. Sofosbuvir was approved in NHS England established 22 Operational Delivery Networks to roll out delivery and proposes to fund 10, courses of treatment in Those without such complications may faced considerable delays before they start treatment.

From Wikipedia, the free encyclopedia. Non-departmental public body of the Department of Health in the United Kingdom.

For other uses, see NICE disambiguation. Play media. This section does not cite any sources. Please help improve this section by adding citations to reliable sources.

Unsourced material may be challenged and removed. September Learn how and when to remove this template message.

The Stationery Office. Office of Public Sector Information. Retrieved They learn to hide from their selves. Rowling, Harry Potter and the Deathly Hallows.

They lived in ugly places where there were only ugly things to do. They didn't own doodley-squat, so they couldn't improve their surroundings.

My body is nothing without me. Being frightened means that you live in a body that is always on guard. Angry people live in angry bodies.

The bodies of child-abuse victims are tense and defensive until they find a way to relax and feel safe. In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them.

Physical self-awareness is the first step in releasing the tyranny of the past. In my practice I begin the process by helping my patients to first notice and then describe the feelings in their bodies—not emotions such as anger or anxiety or fear but the physical sensations beneath the emotions: pressure, heat, muscular tension, tingling, caving in, feeling hollow, and so on.

I also work on identifying the sensations associated with relaxation or pleasure. I help them become aware of their breath, their gestures and movements.

All too often, however, drugs such as Abilify, Zyprexa, and Seroquel, are prescribed instead of teaching people the skills to deal with such distressing physical reactions.

Of course, medications only blunt sensations and do nothing to resolve them or transform them from toxic agents into allies. The mind needs to be reeducated to feel physical sensations, and the body needs to be helped to tolerate and enjoy the comforts of touch.

Individuals who lack emotional awareness are able, with practice, to connect their physical sensations to psychological events. Then they can slowly reconnect with themselves.

Sometimes, it is pleasant to eat, to drink, to see, to touch, to smell, to hear, to make love. The mouth. The eyes. The fingertips, The nose.

The ears. The genitals. Our voluptific faculties if you will forgive me the coinage are not exclusively concentrated here.

The whole body is susceptible to pleasure, but in places there are wells from which it may be drawn up in greater quantity.

But not inexhaustibly. How long is it possible to know pleasure? Rich Romans ate to satiety, and then purged their overburdened bellies and ate again.

But they could not eat for ever. A rose is sweet, but the nose becomes habituated to its scent. And what of the most intense pleasures, the personality-annihilating ecstasies of sex?

I am no longer a young man; even if I chose to discard my celibacy I would surely have lost my stamina, re-erecting in half-hours where once it was minutes.

And yet if youth were restored to me fully, and I engaged again in what was once my greatest delight — to be fellated at stool by nymphet with mouth still blood-heavy from the necessary precautions — what then?

What if my supply of anodontic premenstruals were never-ending, what then? Surely, in time, I should sicken of it. Do you think Messalina, in that competition of hers with a courtesan, knew pleasure as much on the first occasion as the last?

And you would always be ripe for it, from before the time of your birth to the moment of your death, we are always in season for the embrace of pain.

To experience pain requires no intelligence, no maturity, no wisdom, no slow working of the hormones in the moist midnight of our innards.

We are always ripe for it. All life is ripe for it. Consciousness is not In the body; the body is In Consciousness.

And you Are that Consciousness - no the phantom mind that troubles you so. You are the body, but you are everything else, too.

That is what your visions revealed to you. Only the mind resists change. When you relax mindless into the body, you are happy and content and free, sensing no separation.

Immortality is Already yours, but not in the same way you imagined or hope for. You have been immortal since before you were born and will be long after the body dissolves.

The body is in Consciousness; never born; never dies; only changes. The mind - your ego, personal beliefs, history, and identity - is all that ends at death.

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