Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework

Contains fulltext : 96936.pdf (publisher's version ) (Open Access)BACKGROUND: Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP) using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF). METHODS: The indicator testing protocol involved a multi-step and methodological process: 1) The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2) data extraction from patients' medical records, to test technical feasibility and reliability, 3) diaries, to test workload, 4) cost-effectiveness modelling, and 5) semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. RESULTS: Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010) involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. CONCLUSIONS: This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health care settings and may be of use to policy-makers and researchers worldwide to test the likely effect of implementing indicators prior to roll out. It builds on and codifies existing literature and other testing protocols to create a field testing methodology that can be used to produce country specific quality indicators for pay-for-performance or quality improvement schemes

Compiling symbolic attacks to protocol implementation tests

Recently efficient model-checking tools have been developed to find flaws in security protocols specifications. These flaws can be interpreted as potential attacks scenarios but the feasability of these scenarios need to be confirmed at the implementation level. However, bridging the gap between an abstract attack scenario derived from a specification and a penetration test on real implementations of a protocol is still an open issue. This work investigates an architecture for automatically generating abstract attacks and converting them to concrete tests on protocol implementations. In particular we aim to improve previously proposed blackbox testing methods in order to discover automatically new attacks and vulnerabilities. As a proof of concept we have experimented our proposed architecture to detect a renegotiation vulnerability on some implementations of SSL/TLS, a protocol widely used for securing electronic transactions.Comment: In Proceedings SCSS 2012, arXiv:1307.802

Symbolic NS-3 for Efficient Exhaustive Testing

Exhaustive testing is an important type of simulation, where a user exhaustively simulates a protocol for all possible cases with respect to some uncertain factors, such as all possible packet delays or packet headers. It is useful for completely evaluating the protocol performance, finding the worst-case performance, and detecting possible design or implementation bugs of a protocol. It is, however, time consuming to use the brute force method with current NS-3, a widely used network simulator, for exhaustive testing. In this paper, we present our work on Sym-NS-3 for more efficient exhaustive testing, which leverages a powerful program analysis technique called symbolic execution. Intuitively, Sym-NS-3 groups all the cases leading to the same simulator execution path together as an equivalence class, and simulates a protocol only once for each equivalence class. We present our design choices and implementation details on how we extend current NS-3 to support symbolic execution, and also present several exhaustive testing results to demonstrate the significantly improved testing speeds of Sym-NS-3 over current NS-3. Adviser: Lisong X

Task Queues: A General Model for the Implementation of Communications Protocols

When any computer communications network is built, its communications protocol must always be implemented. The protocol is implementetd on the switching nodes of the network. The node software must respond in real time to events generated external to the switching node. Thus, the software running on a switching node constitutes a concurrent program; this complicates the design, implementation and testing of the switching node software. The task queue model presented in this paper defines a structure for this software that facilitates the design, implementation and testing of communications protocols

Mars Sample Handling Protocol Workshop Series: Workshop 4

In preparation for missions to Mars that will involve the return of samples to Earth, it will be necessary to prepare for the receiving, handling, testing, distributing, and archiving of martian materials here on Earth. Previous groups and committees have studied selected aspects of sample return activities, but specific detailed protocols for the handling and testing of returned samples must still be developed. To further refine the requirements for sample hazard testing and to develop the criteria for subsequent release of sample materials from quarantine, the NASA Planetary Protection Officer convened a series of workshops in 2000-2001. The overall objective of the Workshop Series was to produce a Draft Protocol by which returned martian sample materials can be assessed for biological hazards and examined for evidence of life (extant or extinct) while safeguarding the purity of the samples from possible terrestrial contamination. This report also provides a record of the proceedings of Workshop 4, the final Workshop of the Series, which was held in Arlington, Virginia, June 5-7, 2001. During Workshop 4, the sub-groups were provided with a draft of the protocol compiled in May 2001 from the work done at prior Workshops in the Series. Then eight sub-groups were formed to discuss the following assigned topics: Review and Assess the Draft Protocol for Physical/Chemical Testing Review and Assess the Draft Protocol for Life Detection Testing Review and Assess the Draft Protocol for Biohazard Testing Environmental and Health/Monitoring and Safety Issues Requirements of the Draft Protocol for Facilities and Equipment Contingency Planning for Different Outcomes of the Draft Protocol Personnel Management Considerations in Implementation of the Draft Protocol Draft Protocol Implementation Process and Update Concepts This report provides the first complete presentation of the Draft Protocol for Mars Sample Handling to meet planetary protection needs. This Draft Protocol, which was compiled from deliberations and recommendations from earlier Workshops in the Series, represents a consensus that emerged from the discussions of all the sub-groups assembled over the course of the five Workshops of the Series. These discussions converged on a conceptual approach to sample handling, as well as on specific analytical requirements. Discussions also identified important issues requiring attention, as well as research and development needed for protocol implementation

A user space implementation of the AODVv2 routing protocol

Ad hoc On Demand Distance Vector Routing (AODV) protocol is a reactive MANET routing protocol frequently used as reference for either developing new ad hoc routing protocols or performance assessment purposes. Although it is present in several general-purpose network simulators (e.g. ns2, omnetpp, etc.), there are few implementations that can be used under real conditions for on-field research or performance evaluation. This paper presents a user space implementation of the last version of this protocol, the AODVv2, that can be deployed in any device able to run the Linux O.S. The goal is developing a fresh, open source and easy-to-maintain implementation of the AODVv2 protocol that can be used by the research community for testing purposes. The paper provides a description of the main design and encoding decisions taken in order to implement the protocol, and explains the main testing actions carried out to prove its correctness.Postprint (published version

Evidenced-Based Practice Improvement Project: Anesthesia Preoperative Testing Protocol

In the United States, the number of patients seeking surgical interventions in the outpatient setting continues to rise. With more than 22.5 million annual procedures performed in outpatient surgery centers, total healthcare costs across the United States increases as the population ages and requires surgical interventions. An opportunity for a practice improvement lies within outpatient surgery centers, for the anesthesia care team, by efficiently managing preoperative testing decisions prior to surgery. Decisions regarding patient preoperative testing require careful consideration, centered around the patient’s medical history, comorbidities, or disease processes to decrease the amount of unnecessary healthcare costs. Evidence-based guidelines and recommendations have shown utilizing a standardized anesthesia preoperative testing protocol will lower unnecessary healthcare costs. This project was initiated to validate an existing anesthesia preoperative testing protocol at an outpatient surgical facility. To facilitate our scholarly project, staff members were provided with a pre-survey to determine baseline preoperative testing protocol knowledge and confidence in the existing protocol. Next, implementation of an educational PowerPoint session was presented to the staff members. Then a post-survey was administered to staff members to evaluate post education knowledge, retention, and confidence when ordering preoperative tests. Last, the staff members graded the PowerPoint presentation utilizing the PEMAT-P screening tool. Keywords: anesthesia preoperative testing protocol, unnecessary lab testing, preoperative testing guidelines, outpatient surgery preoperative testing, unnecessary diagnostic testing, low-risk surgery procedure

Impact of rapid mecA polymerase chain reaction rapid diagnostic testing for Staphylococcus aureus in a pediatric setting

Rapid molecular technology can detect the mecA resistance gene in Staphylococcus aureus (SA), predicting methicillin susceptibility in under one hour. In combination with antimicrobial stewardship program interventions in adults with SA bacteremia, rapid mecA testing decreases time to targeted therapy. This intervention has not yet been shown effective in pediatric patients or in the absence of real-time stewardship interventions. The objective of this study was to determine if time to optimal therapy decreased following implementation of GeneXpert rapid diagnostic testing (RDT) in a pediatric institution without a formal antimicrobial stewardship protocol for response. The primary outcome was time to optimal therapy, determined by the number of hours from collection of the blood sample to the initiation of an optimal regimen. Optimal regimens were defined as vancomycin therapy alone for MRSA and nafcillin, oxacillin, or cefazolin alone for MSSA