Complexity in biological signaling systems.
(49/10211)
Biological signaling pathways interact with one another to form complex networks. Complexity arises from the large number of components, many with isoforms that have partially overlapping functions; from the connections among components; and from the spatial relationship between components. The origins of the complex behavior of signaling networks and analytical approaches to deal with the emergent complexity are discussed here. (+info)
Comparative hospital databases: value for management and quality.
(50/10211)
OBJECTIVES: To establish an accurate and reliable comparative database of discharge abstracts and to appraise its value for assessments of quality of care. DESIGN: Retrospective review of case notes by trained research abstractors and comparison with matched information as routinely collected by the hospitals' own information systems. SETTING: Three district general hospitals and two major London teaching hospitals. PATIENTS: The database included 3905 medical and surgical cases and 2082 obstetric cases from 1990 and 1991. MAIN MEASURES: Accessibility of case notes; measures of reliability between reviewers and of validity of case note content; application of high level quality indicators. RESULTS: The existing hospital systems extracted insufficient detail from case notes to conduct clinical comparative analyses for medical and surgical cases. The research abstractors at least doubled the diagnostic codes extracted. Interabstractor agreement of about 70% was obtained for primary diagnosis and assignment to diagnosis related group. These data were sufficient to create a comparative database and apply high level quality indicators designed to flag topics for further study. For obstetric-specific indicators the rates were comparable for abstractors and the hospital information systems, which in each case was a departmentally based system (SMMIS) producing more detailed and accessible data. CONCLUSIONS: Current methods of extracting and coding diagnostic and procedural data from case notes in this sample of hospitals is unsatisfactory: notes were difficult to access and recording is unacceptably incomplete. IMPLICATIONS: Improvements as piloted in this project, are readily available should the NHS, hospital managers, and clinicians see the value of these data in their clinical and managerial activities. (+info)
Developing countries' health expenditure information: what exists and what is needed?
(51/10211)
In the past decade, the scarcity of financial resources for the health sector has increasingly led countries to take stock of national health resources used, review allocation patterns, assess the efficiency of existing resource use, and study health financing options. The primary difficulties in undertaking these analyses have been 1) the lack of information on health expenditures and 2) not using existing information to improve the planning and management of health sector resources. The principle sources of available health expenditure information are reported by organizations such as the World Bank, WHO, UNICEF and OECD. Special studies and non-routine information are a second major source of information. This existing data has a number of difficulties, including being sporadic, inconsistency, inclusion of only national level public expenditure, high opportunity and maintenance costs, quantitative and qualitative differences across countries, and validity and interpretability problems. Reliable health expenditure data would be useful not only for in-country, national purposes, but also for cross-national comparisons and for development agencies. Country uses of health expenditure data include policy formulation and planning and management, while international uses would facilitate examination of cross-national comparisons, reviews of existing programmes and identification of funding priorities. Collaborative efforts between countries and international development agencies, as well as between agencies, are needed to establish guidelines for health expenditure data sets. This development must ensure that the resulting information is of direct benefit to countries, as well as to agencies. Results of such collaborative efforts may include a set of standardized methodologies and tools; standardized national health accounts for developing countries; and training to enhance national capabilities to actively use the information. The opportunities for such collaboration are unique with the issuance of the World Development Report 1993, to build on this work in clearly identifying what is needed and proposing a standardized data set and the tools necessary to regularly and economically gather such data. (+info)
Patterns of anti-inflammatory therapy in the post-guidelines era: a retrospective claims analysis of managed care members.
(52/10211)
Published and widely disseminated guidelines for the care and management of asthma characterize asthma as a chronic, inflammatory disease and propose specific recommendations for therapy with inhaled anti-inflammatory medications. In a retrospective analysis of medical and pharmacy claims data of approximately 28,000 asthmatic members from five managed care settings, the dominant pattern of pharmacologic therapy that emerged was the use of bronchodilators without inhaled anti-inflammatory drug therapy. In addition, a significant proportion of asthmatic patients received no prescription drug therapy for asthma. Less than one third of asthmatic patients received any anti-inflammatory therapy and the majority of these received one or two prescriptions per year. Specialist physicians were two to three times more likely than non-specialists during a study period of 1 year to prescribe an anti-inflammatory medication, and were half as likely to have their asthmatic patients experience an emergency department or hospital event. This database analysis suggests that greater conformity with guidelines and/or access to specialist physician care for asthmatic members will lead to improved patient outcomes. (+info)
Day surgery: development of a national comparative audit service.
(53/10211)
OBJECTIVES: To develop software for hospitals to analyse their own survey data on patients' experiences of day surgery and to create and test the feasibility of a national comparative audit service. DESIGN: Software development and testing; database analysis. SETTING: Eleven general hospitals in England. PATIENTS: 1741 day surgery patients undergoing procedures during 1991-2. MAIN MEASURES: Postoperative symptoms, complications, health and functional status, general satisfaction, and satisfaction with specific aspects of care. RESULTS: Software for data entry and analysis by hospitals was successfully used at the pilot sites. The overall response rate for the 11 hospitals using the questionnaire was 60%, ranging from 33% to 90% depending on the way the survey was managed. Data from all 11 hospitals were included in the national comparative audit database. Hospitals showed little variation in measures of patients' overall satisfaction (around 85%), but significant differences were apparent for specific aspects such as receiving adequate written information before admission (range 50%-89%), provision of adequate parking facilities (14%-92%) and experiencing a significant amount of postoperative pain (8%-42%). The proportion of day case patients undergoing procedures that could have been performed in outpatient departments varied from 0 to 27% between hospitals. Further comparisons of outcome, in particular measures of effectiveness, must await the development of validated case mix adjustment methods. CONCLUSION: Establishing a comparative audit database is feasible but several methodological problems remain to be resolved. (+info)
Practice guidelines in Finland: availability and quality.
(54/10211)
OBJECTIVE: To describe the quantity, quality, and availability of practice guidelines currently used in Finland. DESIGN: Cross sectional survey. METHODS: Guidelines from 1989 to 1995 were collected through a database search, through hand searches of the two Finnish general medical journals, and through an inquiry into hospitals, health centres, and medical societies. The content and source of evidence for guidelines was assessed. RESULTS: 719 practice guidelines were found. 578 guidelines (80%) were retrieved by the inquiry, the database search identified 27 (4%) and hand searches 106 (15%). There were 150 guidelines (21%) developed nationally, 120 (17%) regionally, and 449 (62%) locally. The structure and quality of evidence supporting the guidelines was variable and only two guidelines were based on meta-analysis. The references were significantly more often (P < 0.001) documented in the national guidelines (n = 129, 86%) than in the regional or local guidelines (n = 65, 11%). CONCLUSIONS: There are many ways of disseminating guidelines and it may be difficult for end users to find the appropriate guidelines. Sources of evidence were seldom documented in the regional and local guidelines and even some national guidelines lacked all references. More attention should be paid to documenting the level of evidence, structuring the guidelines, and creating optimal strategies for development and dissemination of guidelines. (+info)
Health education and promotion spending in England: a note on the potential utility of the Health Service Indicators dataset.
(55/10211)
Health promotion and education (HPE) needs to be evaluated on a national scale. This note draws attention to the existence, possible uses and pitfalls of a little known dataset which provides information on English district health authorities' HPE expenditure for the first time. Despite its problems, cautious uses of this data has the potential to significantly increase the knowledge and understanding of local level HPE in England. (+info)
British Hyperbaric Association carbon monoxide database, 1993-96.
(56/10211)
OBJECTIVES: To study the referral pattern of patients, poisoned with carbon monoxide and subsequently transferred to British hyperbaric oxygen facilities, from April 1993 until March 1996 inclusive. METHODS: A standard dataset was used by hyperbaric facilities within the British Hyperbaric Association. The data on each patient were sent in confidence to the Hyperbaric Unit at Whipps Cross Hospital for analysis. The epidemiology of poisoning and the population studied were analysed. Times of removal from exposure, referral to a hyperbaric facility, arrival at the hyperbaric facility, and start of treatment were recorded. Data on the outcome of the episode were documented in one of the contributing facilities. RESULTS: 575 patients exposed to carbon monoxide were reported as being referred to British hyperbaric facilities in the three years, the busiest facilities being in London and Peterborough. The proportions of accidental and non-accidental exposures were 1:1.05. Of the accidental exposures, central heating faults were responsible in 71.5% of cases (n = 206). Smoke inhalation from fires was responsible for a further 13.5% (n = 39). The mean delay to arrival in a hyperbaric oxygen facility was 9 hours and 15 minutes after removal from exposure. Recovery after treatment was sometimes incomplete. CONCLUSIONS: The reported pattern of referral was regionally weighted towards the south east of England. Smoke inhalation victims were often not referred for hyperbaric oxygen treatment. The delay to treatment was multifactorial; and the mean delay was well in excess of six hours. There is room for improvement in the consistency and speed of referral. Treatment schedules require standardisation. A central advice and referral service would be helpful. (+info)