Background: Oxidative stress is critically involved in the pathogenesis of cardiovascular disease by promoting endothelial dysfunction and reducing arterial compliance. However, a direct link between oxidative stress and vascular stiffness has not yet been demonstrated in humans. Methods: We examined 73 patients age: 60711 years ; . Of these, 49 patients had severe coronary artery disease CAD ; and underwent coronary artery bypass grafting, and 24 patients underwent surgery for removal of varicose veins but were otherwise healthy. Vascular superoxide SO ; production was examined by lucigenin-enhanced chemiluminescence in saphenous vein. Reduced to oxidised glutathione ratio GSH GSSG; whole blood ; was measured as circulating marker of oxidative stress in a subset of patients n 58 ; . Compliance of the ascending aorta was measured in 39 patients 22 CAD and 17 control patients ; by magnetic resonance.
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By providing authoritative guidance it was hoped that NICE would be able to cut through this noise and ensure professionals quickly start using new treatments. Effective use of resources NICE weighs up the cost effectiveness as well as the clinical effectiveness of treatments. New treatments may not be recommended for use because the benefit they provide is considered to be at too great a cost. Existing treatments may face cuts because NICE views them as being a poor use of finite NHS resources. Equity of access - Access to healthcare in the UK is unequal. Some patients do not receive the care they need. This fact has been obscured from view because the decisions within the NHS on which treatments to fund are made largely away from public view, and because politicians continue to insist that all patients will receive the treatment that they need.13 In fact neither currently, nor even after Gordon Brown's billions have arrived by 2007-08, will we be able to afford to pay for every suitable treatment for every single patient. Ignoring this unpalatable reality does not make the decisions disappear. It simply passes them on to the healthcare professionals within the NHS who are forced to choose which patients will receive the treatment that they need, and which patients will not. All 302 Primary Care Trusts, and 17414 NHS Acute Trusts must make decisions about which treatments to fund. Different trusts make different decisions. This means that whether or not you receive the treatment that you need is determined by where you live. Recognising this, the Government determined that it could not continue with what is supposedly a national health service that allows such inequalities to persist. By providing national guidance NICE is designed to eliminate such inequities, and to do so beyond the influence of politicians and vermox.
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