Quality of health care surveillance systems: review and implementation in the Swiss setting.

Quality of health care has been a subject of attention for many years in the USA and in Europe. Since the introduction of the new federal law on insurance in 1996 it has evolved to a progressively more important issue within the Swiss health care system. In this review, some theoretical concepts of quality of health care, variations, and surveillance systems are explored. Examples of quality of health care surveillance systems that have been developed successfully in the USA, in Canada, in Australia, and in Europe are discussed. They all demonstrate the interest in creating a large range of quality indicators in the surveillance system and in evaluating hospital performance using a benchmark approach. Currently, the measurement of quality with appropriate indicators is a subject of intense debate between the Swiss Hospitals Association (H+) and the Swiss Health Insurance Consortium (Santésuisse). Examples of existing surveillance systems in Switzerland are the Outcome Verein in Zurich and the quality of care program of the Canton of Valais. The FoQual association has also contributed to the debate by reviewing six indicators, which could be used nationally for a healthcare surveillance system. In this debate it is important to stress that ideal quality indicators intended for use as measures of quality in Swiss hospitals need to be both appropriate and valid. Only indicators that fulfil these conditions should be integrated in a Swiss health care surveillance system. Priority needs to be given to quality indicators and methods with the highest level of evidence and with a solid scientific basis

Electrostatic boundary value problems in the Schwarzschild background

The electrostatic potential of any test charge distribution in Schwarzschild space with boundary values is derived. We calculate the Green's function, generalize the second Green's identity for p-forms and find the general solution. Boundary value problems are solved. With a multipole expansion the asymptotic property for the field of any charge distribution is derived. It is shown that one produces a Reissner--Nordstrom black hole if one lowers a test charge distribution slowly toward the horizon. The symmetry of the distribution is not important. All the multipole moments fade away except the monopole. A calculation of the gravitationally induced electrostatic self-force on a pointlike test charge distribution held stationary outside the black hole is presented.Comment: 18 pages, no figures, uses iopart.st

Cosmological quantum entanglement

We review recent literature on the connection between quantum entanglement and cosmology, with an emphasis on the context of expanding universes. We discuss recent theoretical results reporting on the production of entanglement in quantum fields due to the expansion of the underlying spacetime. We explore how these results are affected by the statistics of the field (bosonic or fermionic), the type of expansion (de Sitter or asymptotically stationary), and the coupling to spacetime curvature (conformal or minimal). We then consider the extraction of entanglement from a quantum field by coupling to local detectors and how this procedure can be used to distinguish curvature from heating by their entanglement signature. We review the role played by quantum fluctuations in the early universe in nucleating the formation of galaxies and other cosmic structures through their conversion into classical density anisotropies during and after inflation. We report on current literature attempting to account for this transition in a rigorous way and discuss the importance of entanglement and decoherence in this process. We conclude with some prospects for further theoretical and experimental research in this area. These include extensions of current theoretical efforts, possible future observational pursuits, and experimental analogues that emulate these cosmic effects in a laboratory setting.Comment: 23 pages, 2 figures. v2 Added journal reference and minor changes to match the published versio

Electron Capture Strength for {60,62}Ni and {58,60,62,64}Ni(p,n){58,60,62,64}Cu reactions at 134.3 MeV

Background: The strength of electron capture for medium mass nuclei has a significant effect on the evolution of supernovae. There is insufficient knowledge of these strengths and very little data for important radioactive nuclei. Purpose: Determine whether it is feasible to obtain EC strength from studies of T_o+1 excitations in (p,n) reactions, and whether this might yield information for radioactive nuclei. Methods: Cross sections for the {58,60,62,64}Ni(p,n){58,60,62,64}Cu reactions were measured over the angular range of 0.3 deg to 11.6 deg at 134.3 MeV using the IUCF neutron time-of-flight facility. esults: The T_o+1 excitations in {60,62}Ni were identified by comparison with inelastic proton scattering spectra, their B(GT) were extracted, and the corresponding electron capture rates in supernovae were calculated. Data from the TRIUMF (n,p) experiments at 198 MeV were reanalyzed; the electron capture rates for the reanalyzed data are in moderately good agreement with the higher resolution (p,n) results, but differ in detail. The possibility of future measurements with radioactive nuclei was considered. Conclusions: It is possible to determine electron capturestrength from (p,n) experiments. This approach may make it possible to obtain electron capture strength for radioactive nuclei by studying (p,n) reactions in inverse kinematics.Comment: Submitted to Physical Review

Patient engagement with antibiotic messaging in secondary care: a qualitative feasibility study of the ‘review & revise’ experience

Background: We aimed to investigate and optimise the acceptability and usefulness of a patient leaflet about antibiotic prescribing decisions made during hospitalisation, and to explore individual patient experiences and preferences regarding the process of antibiotic prescription ‘review & revise’ which is a key strategy to minimise antibiotic overuse in hospitals. Methods: In this qualitative study, run within the feasibility study of a large, cluster-randomised stepped wedge trial of 36 hospital organisations, a series of semi-structured, think-aloud telephone interviews were conducted and data were analysed using thematic analysis. Fifteen adult patients who had experienced a recent acute medical hospital admission during which they had been prescribed antimicrobials and offered a patient leaflet about antibiotic prescribing were recruited to the study. Results: Participants reacted positively to the leaflet, reporting that it was both an accessible and important source of information which struck the appropriate balance between informing and reassuring. Participants all valued open communication with clinicians, and were keen to be involved in antibiotic prescribing decisions, with individuals reporting positive experiences regarding antibiotic prescription changes or stopping. Many participants had prior experience or knowledge of antibiotics and resistance, and generally welcomed efforts to reduce antibiotic usage. Overall, there was a feeling that healthcare professionals (HCPs) are trusted experts providing the most appropriate treatment for individual patient conditions. Conclusions: This study offers novel insights into how patients within secondary care are likely to respond to messages advocating a reduction in the use of antibiotics through the ‘review & revise’ approach. Due to the level of trust that patients place in their care provider, encouraging HCPs within secondary care to engage patients with greater communication and information provision could provide great advantages in the drive to reduce antibiotic use. It may also be beneficial for HCPs to view patient experiences as cumulative events that have the potential to impact future behaviour around antibiotic use. Finally, pre-testing messages about antibiotic prescribing and resistance is vital to dispelling any misconceptions either around effectiveness of treatment for patients, or perceptions of how messages may be received

Theorems on shear-free perfect fluids with their Newtonian analogues

In this paper we provide fully covariant proofs of some theorems on shear-free perfect fluids. In particular, we explicitly show that any shear-free perfect fluid with the acceleration proportional to the vorticity vector (including the simpler case of vanishing acceleration) must be either non-expanding or non-rotating. We also show that these results are not necessarily true in the Newtonian case, and present an explicit comparison of shear-free dust in Newtonian and relativistic theories in order to see where and why the differences appear.Comment: 23 pages, LaTeX. Submitted to GR

Intraoperative and major postoperative complications and survival of dogs undergoing surgical management of epiglottic retroversion: 50 dogs (2003-2017)

Objective: To report intraoperative and major postoperative complications in dogs treated surgically for epiglottic retroversion (ER), compare the incidence of major postoperative complications between procedures, and report survival of surgically treated dogs. Study design: Multi-institutional retrospective study. Sample population: Fifty dogs treated with 78 procedures. Methods: Medical records of dogs diagnosed and surgically treated for ER from 2003 to 2017 at 11 institutions were reviewed. Complications were divided into intraoperative and major postoperative complications. Results: Intraoperative complications occurred during 2 of 78 (2.6%) procedures. Thirty-six major postoperative complications were documented in 22 dogs after 36 of 74 (48.7%) procedures. Postoperative complications occurred after 7 of 12 (58.3%) nonincisional epiglottopexy, 23 of 43 (53.5%) incisional epiglottopexy, 2 of 4 (50%) partial epiglottectomy, 2 of 12 (16.7%) subtotal epiglottectomy, and 2 of 3 (66.7%) other surgical procedures. Epiglottopexy failure was the most common major postoperative complication. The incidence of major postoperative complications did not differ between procedures (P =.1239), although, when combined, epiglottopexy procedures (30/55) had a higher incidence of complications than epiglottectomy procedures (4/16; P =.048). Thirty (60%) dogs were alive at a median of 928 days (range, 114-2805), 8 (16%) were lost to follow-up after 411 days (range, 43-1158), and 12 (24%) were dead/euthanized after 301.5 days (range, 3-1212). Median survival time was not reached after a median of 716 days. Conclusion: Although intraoperative complications were uncommon, major postoperative complications were common, especially after epiglottopexy procedures. Clinical significance: Although surgical treatment of ER is associated with a high rate of major postoperative complications, especially epiglottopexy procedures, long-term survival can be achieved