A quality improvement project using a problem based post take ward round proforma based on the SOAP acronym to improve documentation in acute surgical receiving

Objectives: Ward round documentation provides one of the most important means of communication between healthcare professionals. We aimed to establish if the use of a problem based standardised proforma can improve documentation in acute surgical receiving. Methods: Gold standards were established using the RCSE record keeping guidelines. We audited documentation for seven days using the following headings: patient name/identification number, subjective findings, objective findings, clinical impression/diagnosis, plan, diet status, discharge decision, discharge planning, signature, and grade. After the initial audit cycle, a ward round proforma was introduced using the above headings and re-audited over a seven day period. Results: The pre-intervention arm contained 50 patients and the post intervention arm contained 47. The following headings showed an improvement in documentation compliance to 100%: patient name/identification number vs 96%, subjective findings vs 84%, objective findings vs 48%, plan vs 98%, signature vs 96%, and grade vs 62%. Documentation of the clinical impression/diagnosis improved to 98% vs 30%, diet status rose to 83% vs 16%, discharge decision to 66% vs 16%, and discharge planning to 40% vs 20%. Conclusions: Standardised proformas improve the documentation of post-take ward round notes. This helps to clarify the onward management plan for all aspects of a patient's care and will help avoid adverse events and litigation. This should improve the quality and safety of Patient Care

Measuring the societal value of lifetime health

This paper considers two societal concerns in addition to health maximisation: first, concerns for the societal value of lifetime health for an individual; and second, concerns for the value of lifetime health across individuals. Health-related social welfare functions (HRSWFs) have addressed only the second concern. We propose a model that expresses the former in a metric – the adult healthy-year equivalent (AHYE) – that can be incorporated into standard HRSWFs. An empirical study based on this formulation shows that both factors matter: health losses in childhood are weighted more heavily than losses in adulthood and respondents wish to reduce inequalities in AHYEs

It’s driving her mad: gender differences in the effects of commuting on psychological well-being

In this paper, we seek to explore the effects of commuting time on the psychological well-being of men and women in the UK. We use annual data from the British Household Panel Survey in a fixed effects panel framework that includes variables known to determine well-being, as well as factors which may provide compensation for commuting such as income, job satisfaction and housing quality. Our results show that, even after all these variables are considered, commuting still has an important detrimental effect on the well-being of women, but not men, and this result is robust to numerous different specifications. We explore possible explanations for this gender difference and can find no evidence that it is due to women´s shorter working hours or weaker occupational position. Rather women´s greater sensitivity to commuting time seems to be a result of their larger responsibility for day-to-day household tasks, including childcare

Measuring the societal value of lifetime health

This paper considers two societal concerns in addition to health maximisation: first, concerns for the societal value of lifetime health for an individual; and second, concerns for the value of lifetime health across individuals. Health-related social welfare functions (HRSWFs) have addressed only the second concern. We propose a model that expresses the former in a metric – the adult healthy-year equivalent (AHYE) – that can be incorporated into standard HRSWFs. An empirical study based on this formulation shows that both factors matter: health losses in childhood are weighted more heavily than losses in adulthood and respondents wish to reduce inequalities in AHYEs

Determining the parameters in a social welfare function using stated preference data: an application to health

One way in which economists might determine how best to balance the competing objectives of efficiency and equity is to specify a social welfare function (SWF). This paper looks at how the stated preferences of a sample of the general public can be used to estimate the shape of the SWF in the domain of health benefits. The results suggest that it is possible to determine the parameters in a social welfare function from stated preference data, but show that people are sensitive to what inequalities exist and to the groups across which those inequalities exist

The Information Geometry of the One-Dimensional Potts Model

In various statistical-mechanical models the introduction of a metric onto the space of parameters (e.g. the temperature variable, $\beta$, and the external field variable, $h$, in the case of spin models) gives an alternative perspective on the phase structure. For the one-dimensional Ising model the scalar curvature, ${\cal R}$, of this metric can be calculated explicitly in the thermodynamic limit and is found to be ${\cal R} = 1 + \cosh (h) / \sqrt{\sinh^2 (h) + \exp (- 4 \beta)}$. This is positive definite and, for physical fields and temperatures, diverges only at the zero-temperature, zero-field ``critical point'' of the model. In this note we calculate ${\cal R}$ for the one-dimensional $q$-state Potts model, finding an expression of the form ${\cal R} = A(q,\beta,h) + B (q,\beta,h)/\sqrt{\eta(q,\beta,h)}$, where $\eta(q,\beta,h)$ is the Potts analogue of $\sinh^2 (h) + \exp (- 4 \beta)$. This is no longer positive definite, but once again it diverges only at the critical point in the space of real parameters. We remark, however, that a naive analytic continuation to complex field reveals a further divergence in the Ising and Potts curvatures at the Lee-Yang edge.Comment: 9 pages + 4 eps figure