Are the economically active more deserving?

OBJECTIVE--To investigate the possibility of an association between the duration of medical treatment before coronary angiography and demographic and non-clinical factors. DESIGN--A systematic review of a random sample of 500 patients undergoing their first angiographic assessment. SUBJECTS--500 cases were selected randomly from patients investigated in 1991 at the two catheterisation centres in Northern Ireland. MAIN OUTCOME MEASURES--The duration of medical management before angiography. RESULTS--346 had elective and 154 urgent catheterisation. The duration of medical management was adjusted for both case mix (age at onset, body mass index, angina grade, history of myocardial infarction, history of hypertension, diabetes or hyperlipidaemia, treatment intensity) and other demographic variables (sex, smoking status, an indicator of "deprivation", and distance of the patient's area of residence from the hospital). After this adjustment the mean duration of medical management before angiography was twice as long for economically inactive patients as for those who were economically active. In a multiple regression, the relevant beta coefficient was 0.44 (95% confidence interval 0.33 to 0.58, P < 0.0001). CONCLUSIONS--These results suggest that, in making discretionary decisions about when to refer patients with angina for revascularisation assessment, doctors may be influenced by non-clinical factors unrelated to disease severity

Communication of Medical Information Using Agents

Agents are self-contained software entities which act faithfully and autonomously on behalf of a body of knowledge. They can operate in a standalone capacity, or as part of a social group collaborating and coordinating activities with other software agents. To access their knowledge, agents are interfaced with using message passing communication. The principle behind medical communications is to provide a means for exchanging information and knowledge from one computerised location to another, whilst preserving its true meaning and understanding between the listener and sender. Agent communication is similar to medical communications, but must provide an additional framework element to allow agents to interact at a social and operational level. Social aspects relate to agents collaborating on shared objectives, and operational aspects relate to coordination of tasks between the loosely coupled agents working as part of a group. Medical communications focus on data exchanges specific to the medical domain, while agent communication was designed for a much broader audience. Therefore, it is essential to verify if agent communications can support standard medical data exchanges. This paper investigates current forms of agent based communications and demonstrates they can support medical communication, yet retain their social and interaction information exchange functionality

Patient-Centred Laboratory Validation Using Software Agents

Guidelines are self-contained documents which healthcare professionals reference to obtain knowledge about a specific condition or process. They interface with these documents and apply known facts about specific patients to gain useful supportive information to aid in developing a diagnosis or manage a condition. To automate this process a series of Standard Operating Procedures (SOP) and workflow processes are constructed using the contents of these documents in order to manage the validation flow of a patient sample. These processes decompose the guidelines into workflow plans, which are then called using condition triggers controlled by a centralised management engine. The software BDI agent offers an alternative dynamic which more closely matches the modus operandi of narrative based medical guidelines. An agent’s beliefs capture information attributes, plans capture the deliberative and action attributes, and desire captures the motivational attributes of the guideline in a self-contained autonomous software module. Agents acting on behalf of guidelines which overlap and interweave in similar domains can collaborate and coordinate in a loosely coupled fashion without the need for an all encompassing centralised plan

Expanding access to coronary artery bypass surgery: who stands to gain

OBJECTIVE--To determine the perceptions of general practitioners (GPs) about the benefits of coronary artery bypass surgery, in terms of gains in life expectancy, for different groups of patients. DESIGN--A questionnaire survey of all GPs in Northern Ireland. SETTING--A survey conducted collaboratively by the departments of public health medicine in each of the four health boards in the province, serving a total population of 1.5 million. MAIN OUTCOME MEASURES--The median and mean gain in life expectancy perceived by groups of doctors for smoking and non-smoking male and female 55 year old patients. The percentage of 50 year old and 70 year old non-smoking patients considered likely to have their lives extended with bypass surgery. Differences were assessed using the Mann-Whitney U test for unpaired samples and the Wilcoxon signed rank tests for paired. RESULTS--541 GPs replied (response rate 56%). The median (and mean) perceived gain in life expectancy after cardiac surgery for non-smoking 55 year old subjects was 120 (104) months for men and 120 (112) months for women (z = 6.42; P < 0.0001; Wilcoxon signed rank test). For male and female smokers of the same age, the perceived gains were 48 (47) and 60 (52) months respectively (z = 6.72; P < 0.0001; Wilcoxon signed ranks test), both figures being significantly different than for non-smokers. The median (and mean) percentage of patients that the doctors considered would have their lives extended by bypass surgery was 70 (64) of every 100 "young" patients and 40 (42) of every 100 "old" patients, (z = 16.2; P < 0.0001). CONCLUSIONS--These results point to a significant overestimation of the benefits of coronary artery bypass surgery by GPs in Northern Ireland and to a need to develop guidelines for referral

The benefits of deciding now and not later: The influence of the timing between acquiring knowledge and deciding on decision confidence, omission neglect bias, and choice deferral

Consumers often spend time searching before making a purchasing decision to acquire knowledge about products. If the purchasing decision is delayed, recall of acquired knowledge is likely to be impaired. Because products in the marketplace are rarely described completely, consumers who take too long to decide may fail to notice the absence of information relevant to a purchasing decision and fall prey to a phenomenon called ‘omission neglect’, an inability to detect missing information and form extreme and confidently held judgments. Omission neglect may be corrected by acquiring knowledge about the target product before making the choice. In the present research, we examine consumer decisions in the context of choice sets described incompletely and presented either immediately or a week after the acquisition of relevant information about a target product. Specifically, we investigate how the timing between product knowledge acquisition and decision-making affects the detection of missing information, decision confidence, and choice deferral. Across three experiments, we find that, after acquiring knowledge, when consumers have their decision delayed, they are less able to detect missing information, feel more confident, and defer choices less

2017 American Brachytherapy Society’s Annual Meeting Report

The American Brachytherapy Society (ABS) and its membership seeks to benefit patients by promoting the highest possible standard for brachytherapy practice, support health care professionals through the encouragement of state of the art technology and education, promote clinical and laboratory research, and advocate for the socioeconomic aspects of brachytherapy. The 2017 ABS Annual Meeting took place is Boston, Massachusetts, United States from April 20–22, 2017. The theme “The Value of Brachytherapy in Multidisciplinary Cancer Care” drew a multitude of national and international speakers to present data and debate clinical indications, advancements in practice and the value of brachytherapy. With a focus on the advancement of brachytherapy for prostate cancer and the socioeconomic benefits of brachytherapy, the globally focused program hosted 93 speakers, 506 attendees, and exhibitors from 15 countries and featured 251 abstracts for presentation and display. The ABS Annual Meeting left attendees with initial data on timely and relevant topics such as outcomes following brachytherapy for recurrent prostate cancer following external beam radiotherapy, findings of prototype algorithms capable of rapidly generating prostate brachytherapy pre-operative treatment plans and results on the socioeconomic disparities impacting the utilization of brachytherapy for common malignancies. These novel findings, among many other thoughtful and thought-provoking presentations, gave meeting attendees knowledge of the current state of brachytherapy and future directions of the specialty

Principles of Stakes Fairness in Sport

Fairness in sport is not just about assigning the top prizes to the worthiest competitors. It is also about the way the prize structure itself is organised. For many sporting competitions, although it may be acceptable for winners to receive more than losers, it can seem unfair for winners to take everything and for losers to get nothing. Yet this insight leaves unanswered some difficult questions about what stakes fairness requires and which principles of stakes fairness are appropriate for particular competitions. In this article I specify a range of different principles of stakes fairness (ten in total) that could regulate sporting competitions. I also put forward a theoretical method for pairing up appropriate principles of stakes fairness with given sporting competitions. Specifically, I argue that the underlying rationales for holding sporting competitions can provide useful guides for identifying appropriate principles of stakes fairness. I then seek to clarify and work through some of the implications of this method for a sample of real world controversies over sporting prize structures. I also attempt to refine the method in response to two possible objections from indeterminacy and relativism. Finally, I compare and contrast my conclusions with more general philosophical debates about justice

Effect of venepuncture process design on efficiency and failure rates: a simulation model study for secondary care

Background: Healthcare aims to deliver good patient outcomes. For many clinical procedures there are multiple alternative task sequences that can be performed. These deviations can influence procedure reliability, efficiency of usage of hospital resources and risk to staff and patient safety. Venepuncture is one of the most common invasive procedures in healthcare. Literature of clinical practice shows evidence of wide variability in the procedure order and the duration of each step, which can depend on attributes, such as patient health, sampling method and staff skills. Objective: To use a computer simulation model based on Petri nets to evaluate the impact on outcomes of commonly practiced deviations from the venepuncture procedure guideline and variations in key dependent variables. The outcomes considered include the probability of successfully obtaining a blood sample and the procedure completion time. Design: A computer simulation model was constructed using the Petri net technique which mimics the different variations of the venepuncture procedure. Qualitative and quantitative data for the model was collected from the literature and through interviews and questionnaire responses from doctors and phlebotomists. Statistics on the reliability and duration for different variations were then calculated from the model output. Setting: A digital laboratory to model venepuncture in secondary care. Results: The model showed that the common practice of applying the tourniquet prior to vein identification and releasing it after sample tubes are filled may result in a ten-fold increase in sample haemolysis, compared to the recommended guideline procedure. Equipment layout on wards and patient vein prominence were identified as the two most important factors influencing time efficiency of blood sample collection. Conclusions: Petri net computer models were shown to be an effective method for evaluating the success rate and completion time of the venepuncture procedure under alternative task sequences and variations in key dependent variables. The results obtained from the model showed a significant increase in the rate of sample laboratory rejection due to haemolysis when commonly practiced deviations from the guideline procedure were performed. The rate of failure to collect a sample and the mean time for performing the procedure increased significantly for patients with less prominent veins and when the procedure was performed on unfamiliar wards. These results highlight the need for healthcare providers to ensure guidelines are followed when performing venepuncture, equipment layouts are standardised across locations and that the vein prominence of different patient groups is considered when allocating resources for blood sample collection

Defining a sustainable development target space for 2030 and 2050

With the establishment of the sustainable development goals (SDGs), countries worldwide agreed to a prosperous, socially inclusive, and environmentally sustainable future for all. This ambition, however, exposes a critical gap in science-based insights, namely on how to achieve the 17 SDGs simultaneously. Quantitative goal-seeking scenario studies could help explore the needed systems' transformations. This requires a clear definition of the "target space." The 169 targets and 232 indicators used for monitoring SDG implementation cannot be used for this; they are too many, too broad, unstructured, and sometimes not formulated quantitatively. Here, we propose a streamlined set of science-based indicators and associated target values that are quantifiable and actionable to make scenario analysis meaningful, relevant, and simple enough to be transparent and communicable. The 36 targets are based on the SDGs, existing multilateral agreements, literature, and expert assessment. They include 2050 as a longer-term reference point. This target space can guide researchers in developing new sustainable development pathways