Questionable care: avoiding ineffective treatment

Overview In some hospitals, far too many people get a treatment they should not get, even when the evidence is clear that it is unnecessary or doesn’t work. Australia urgently needs a system to identify these outlier hospitals and make sure they are not putting patients at risk. To show how such a system could work, this report examines five treatments that should not be used on certain patients. One is treating osteoarthritis of the knee with an arthroscope – putting a tube inside the knee to remove tissue. Another is filling a backbone (vertebrae) with cement to treat fractures. A third is putting patients in a pressurised oxygen chamber when it will not help treat their specific condition. Expert guidance labels most of these five treatments do-not-do, yet in 2010-11 nearly 6000 people – or 16 people a day – received them. These procedures can harm. Some people who had them developed infections or other complications during their hospital visit. Some could have avoided the stress, cost, inconvenience and risk of a hospital stay altogether. Do-not-do treatments happen in all states, cities and rural areas, in public and private hospitals. But the ones we measured only happen in a minority of hospitals, some of which provided do-notdo treatments at 10 or 20 times the average rate. We also examined three procedures that are sometimes appropriate, but should not be offered routinely. Again, a few hospitals have very different treatment patterns from their peers. There are important reasons why clinicians sometimes choose inappropriate treatments. Evidence about treatments can be hard for clinicians to access, evaluate and use. Second, there is little systematic monitoring of where do-not-do treatments happen, leaving clinicians and hospitals in the dark about where problems might exist. Finally, the health system does not manage this problem well. There are rarely major negative consequences for providing ineffective care. In fact, there are incentives that go the other way – hospitals and clinicians get income for giving ineffective care. To fix the problem, the Australian Commission on Safety and Quality in Health Care should publish a list of do-not-do treatments. It should then identify public and private hospitals that provide these treatments more often than usual. There could be a good reason for a do-not-do treatment, but if some hospitals provide them consistently it is a real concern. These outlier hospitals should be asked to improve. If they do not, a clinical review by the state health department should check whether the hospital is providing the right care. If it is not, and if it still fails to improve, there should be consequences for the hospital’s management and funding. The approach in this report can easily be used for many more treatments, using evidence and data that governments already have. Governments should use the approach demonstrated in this report to make sure that far fewer people get the wrong treatment

Large-Scale Analysis of the Accuracy of the Journal Classification Systems of Web of Science and Scopus

Journal classification systems play an important role in bibliometric analyses. The two most important bibliographic databases, Web of Science and Scopus, each provide a journal classification system. However, no study has systematically investigated the accuracy of these classification systems. To examine and compare the accuracy of journal classification systems, we define two criteria on the basis of direct citation relations between journals and categories. We use Criterion I to select journals that have weak connections with their assigned categories, and we use Criterion II to identify journals that are not assigned to categories with which they have strong connections. If a journal satisfies either of the two criteria, we conclude that its assignment to categories may be questionable. Accordingly, we identify all journals with questionable classifications in Web of Science and Scopus. Furthermore, we perform a more in-depth analysis for the field of Library and Information Science to assess whether our proposed criteria are appropriate and whether they yield meaningful results. It turns out that according to our citation-based criteria Web of Science performs significantly better than Scopus in terms of the accuracy of its journal classification system

On the Benefits of Non-Canonical Filtering in Publish/Subscribe Systems

Current matching approaches in pub/sub systems only allow conjunctive subscriptions. Arbitrary subscriptions have to be transformed into canonical expressions, e.g., DNFs, and need to be treated as several conjunctive subscriptions. This technique is known from database systems and allows us to apply more efficient filtering algorithms. Since pub/sub systems are the contrary to traditional database systems, it is questionable if filtering several canonical subscriptions is the most efficient and scalable way of dealing with arbitrary subscriptions. In this paper we show that our filtering approach supporting arbitrary Boolean subscriptions is more scalable and efficient than current matching algorithms requiring transformations of subscriptions into DNFs

The LONI QC System: A Semi-Automated, Web-Based and Freely-Available Environment for the Comprehensive Quality Control of Neuroimaging Data.

Quantifying, controlling, and monitoring image quality is an essential prerequisite for ensuring the validity and reproducibility of many types of neuroimaging data analyses. Implementation of quality control (QC) procedures is the key to ensuring that neuroimaging data are of high-quality and their validity in the subsequent analyses. We introduce the QC system of the Laboratory of Neuro Imaging (LONI): a web-based system featuring a workflow for the assessment of various modality and contrast brain imaging data. The design allows users to anonymously upload imaging data to the LONI-QC system. It then computes an exhaustive set of QC metrics which aids users to perform a standardized QC by generating a range of scalar and vector statistics. These procedures are performed in parallel using a large compute cluster. Finally, the system offers an automated QC procedure for structural MRI, which can flag each QC metric as being 'good' or 'bad.' Validation using various sets of data acquired from a single scanner and from multiple sites demonstrated the reproducibility of our QC metrics, and the sensitivity and specificity of the proposed Auto QC to 'bad' quality images in comparison to visual inspection. To the best of our knowledge, LONI-QC is the first online QC system that uniquely supports the variety of functionality where we compute numerous QC metrics and perform visual/automated image QC of multi-contrast and multi-modal brain imaging data. The LONI-QC system has been used to assess the quality of large neuroimaging datasets acquired as part of various multi-site studies such as the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study and the Alzheimer's Disease Neuroimaging Initiative (ADNI). LONI-QC's functionality is freely available to users worldwide and its adoption by imaging researchers is likely to contribute substantially to upholding high standards of brain image data quality and to implementing these standards across the neuroimaging community

Human resource development in construction organisations: an example of a 'chaordic' learning organisation?

Purpose/ Methodology/Approach The concept of the Learning Organisation (LO) is associated with an advanced approach to Human Resource Development (HRD) characterised by an ethos of self-responsibility and self-development. The learning climate that this engenders is supported by temporary organisational structures responsive to environmental change. This paper presents case study research of the HRD strategy, policy and practice of a large UK-based construction contractor in relation to the concept of LO. Findings The analysis suggests that the organisational project-based structure and informal culture combine to form a ‘chaordic LO’. A ‘Chaordic enterprise’ comprises a complex organisation that operates in a non-linear dynamic environment. However, it appears that this approach has evolved unintentionally rather than as a result of targeted Strategic Human Resource Management (SHRM) policies, which in turn reflects a genuine commitment to advanced HRD. Originality/value of paper The findings render previous assertions that the industry fails to invest in its employees highly questionable. They suggest a need for further research to reveal how such approaches can be captured in replicate in the future

Evaluation based on critical systems heuristics

Introduction: Critical systems heuristics (CSH) draws on the substantive work and philosophy of C. West Churchman, a systems engineer who, along with Russell Ackoff during the 1950s and 1960s, defined operations research in the United States. Churchman later pioneered developments in the 1970s of what is now known as 'soft' and 'critical' systemic thinking and practice in the domain of social or human activity systems. Churchman died in 2004. His legacy lies in signalling the importance of being alert to value-laden boundary judgements when making evaluations. Boundaries are what we socially construct in designing and evaluating any human activity system of interest (e.g., any situation of concern from a kinship group, an organisation, or a larger entity such as a national health system). The primary boundary of any human activity systems is defined by 'purpose'. Churchman's work is characterised by a continual ethical commitment to the overarching purpose of improved human well-being. In order to fulfil such purposeful activity, there is always a need to broaden inquiry from the particular system of focus so as to appreciate what Churchman calls the total relevant system. The effectiveness and efficiency of a system of interest depends on the actual boundary judgements associated with that system of interest. Churchman first identified 9 conditions or categories (including the category 'purpose�) associated with any purposeful system of interest in his book The Design of Inquiring Systems [1, 2]. He later extended these to 12 categories in a book provocatively entitled The Systems Approach and Its Enemies, significantly taking into account 3 extra factors (�enemies�) that lie outside the actual system of interest but which can be affected by, and therein have an effect on, the performance of the system [1, 2]. In the early 1980s a doctorate student of Churchman from Switzerland, Werner Ulrich, translated Churchman's 12 categories into an operational set of 12 questions which he called critical systems heuristics [3]. Ulrich returned to Switzerland and worked with CSH as a public health and social welfare policy analyst and program evaluator [4]. Section 2 introduces the basic toolbox of CSH, along with suggestions on when to use it and the benefits of its use. Section 3 will guide you through a suggested operational use of CSH questions in a process of evaluation. Section 4 provides a summary of an extensive case study in which CSH was used for evaluating the role of public participation in natural resource-use planning. Section 5 provides some advice for the practitioner in developing skills on using CSH for evaluation