Terminology of facial morphology in the vertical dimension

Consideration of facial type plays an important role in the formulation of an orthodontic treatment plan and prognosis of treatment. Of particular importance is the vertical relationship, that is, whether an individual is long-faced (dolichofacial), or short-faced (brachyfacial). The vertical facial type provides a clue regarding the growth direction of the facial complex, and should be used with an anteroposterior classification to describe a patient's face. The potential for confusion in communicating vertical facial types exists due to the nature of the terminology in use. For example, the term dolichoprosopic as used in the Bimler analysis has an opposite meaning to the term dolichofacial. It would seem prudent that if such terminology is to be employed there should be some attempt at standardization, and at least an appreciation of the derivations of the terms, and their differences.     

Supporting public involvement in research design and grant development: a case study of a public involvement award scheme managed by a National Institute for Health Research (NIHR) Research Design Service (RDS)

Background

It is good practice for the public to be involved in developing health research. Resources should be available for researchers to fund the involvement of the public in the development of their grants.

Objective

To describe a funding award scheme to support public involvement in grant development, managed by an NIHR Research Design Service (RDS). Case examples of how the award contributed to successful grant applications and findings from a recent evaluation of the scheme are presented.

Design

A case study of resource provision to support public involvement activities in one region of England.

Participants

University and NHS‐based researchers, and members of the public.

Findings

Between 2009 and 2012, the RDS approved 45 public involvement funding awards (totalling nearly £19 000). These awards contributed to 27 submitted applications at the time of writing, of which 11 were successful (totalling over £7.5 million). The evaluation revealed difficulties encountered by some researchers when involving the public in grant development, which led to suggestions about how the scheme could be improved.

Conclusion

This award scheme represents an efficient method of providing researchers with resources to involve the public in grant development and would appear to represent good value for money.     

What is a new drug worth? An innovative model for performance‐based pricing

This article focuses on a novel method to derive prices for new pharmaceuticals by making price a function of drug performance. We briefly review current models for determining price for a new product and discuss alternatives that have historically been favoured by various funding bodies. The progressive approach to drug pricing, proposed herein, may better address the views and concerns of multiple stakeholders in a developed healthcare system by acknowledging and incorporating input from disparate parties via comprehensive and successive negotiation stages. In proposing a valid construct for performance‐based pricing, the following model seeks to achieve several crucial objectives: earlier and wider access to new treatments; improved transparency in drug pricing; multi‐stakeholder involvement through phased pricing negotiations; recognition of innovative product performance and latent changes in value; an earlier and more predictable return for developers without sacrificing total return on investment (ROI); more involved and informed risk sharing by the end‐user.     

Scoliosis repair in a teenager with Duchenne’s muscular dystrophy: who calls the shots?

In this exchange, a clinician (the first author) presents a case scenario for comment by an ethicist (the second author). The case concerns a 15-year-old boy with Duchenne's muscular dystrophy requested palliative surgical correction of a 60 degree thoraco-lumbar scoliosis. The surgical team were initially reluctant to offer surgery given their assessment of the perioperative and postoperative risks (anesthetic review suggested an 80% chance of surviving the surgery and 50% likelihood of returning home), but the operation proceeded. The case raises issues of the rights of patients to insist on nonfutile but high risk surgery, risk perception, resource allocation, autonomy, and the integrity of clinicians.     

Waiting for placement: Discharge from hospital to long-term care in Ontario

Great pressures are placed on hospitals to promptly discharge patients. This is especially true of patients deemed “alternate level of care,” often referred to pejoratively as “bed blockers.” To alleviate these pressures, hospitals enact policies, both formal and informal, to discharge alternate level of care patients who are awaiting placement into long-term care homes. In addition to being dangerous for some of the patients discharged, these discharge policies also leave the hospital, its employees, physicians, and Community Care Access Centres open to legal liability. In 2013, the Advocacy Centre for the Elderly received more than 300 individual requests for legal service in 2013 on behalf of patients, relating to conflict with hospital policies and the placement process. This article analyzes the legal requirements relating to discharge from hospital and admission to long-term care.