The challenges of implementing packaged hospital electronic prescribing and medicine administration systems in UK hospitals: premature purchase of immature solutions?

The UK National Health Service is making major efforts to implement Hospital Electronic Prescribing and Medicine Administration (HEPMA) to improve patient safety and quality of care. Substantial public investments have attracted a wide range of UK and overseas suppliers offering Commercial-Off –The-Shelf (COTS) solutions. A lack of (UK) implementation experience and weak supplier-user relationships are reflected in systems with limited configurability, poorly matched to the needs and practices of English hospitals. This situation echoes the history of comparable corporate information infrastructures - Enterprise Resource Planning systems - in the 1980s/1990s. UK government intervention prompted a similar swarming of immature, often unfinished, products into the market. This resulted, in both cases, in protracted and difficult implementation processes as vendors and adopters struggled to get the systems to work and match the circumstances of the adopting organisations. An analysis of the influence of the Installed Base on Information Infrastructures should explore how the evolution of COTS solutions is conditioned by the structure of adopter and vendor ‘communities’

Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis

Background: Activity-based funding (ABF) of hospitals is a policy intervention intended to re-shape incentives across health systems through the use of diagnosis-related groups. Many countries are adopting or actively promoting ABF. We assessed the effect of ABF on key measures potentially affecting patients and health care systems: mortality (acute and post-acute care); readmission rates; discharge rate to post-acute care following hospitalization; severity of illness; volume of care.     Methods: We undertook a systematic review and meta-analysis of the worldwide evidence produced since 1980. We included all studies reporting original quantitative data comparing the impact of ABF versus alternative funding systems in acute care settings, regardless of language. We searched 9 electronic databases (OVID MEDLINE, EMBASE, OVID Healthstar, CINAHL, Cochrane CENTRAL, Health Technology Assessment, NHS Economic Evaluation Database, Cochrane Database of Systematic Reviews, and Business Source), hand-searched reference lists, and consulted with experts. Paired reviewers independently screened for eligibility, abstracted data, and assessed study credibility according to a pre-defined scoring system, resolving conflicts by discussion or adjudication.     Results: Of 16,565 unique citations, 50 US studies and 15 studies from 9 other countries proved eligible (i.e. Australia, Austria, England, Germany, Israel, Italy, Scotland, Sweden, Switzerland). We found consistent and robust differences between ABF and no-ABF in discharge to post-acute care, showing a 24% increase with ABF (pooled relative risk = 1.24, 95% CI 1.18–1.31). Results also suggested a possible increase in readmission with ABF, and an apparent increase in severity of illness, perhaps reflecting differences in diagnostic coding. Although we found no consistent, systematic differences in mortality rates and volume of care, results varied widely across studies, some suggesting appreciable benefits from ABF, and others suggesting deleterious consequences.     Conclusions: Transitioning to ABF is associated with important policy- and clinically-relevant changes. Evidence suggests substantial increases in admissions to post-acute care following hospitalization, with implications for system capacity and equitable access to care. High variability in results of other outcomes leaves the impact in particular settings uncertain, and may not allow a jurisdiction to predict if ABF would be harmless. Decision-makers considering ABF should plan for likely increases in post-acute care admissions, and be aware of the large uncertainty around impacts on other critical outcomes

Is the multicolored Asian ladybeetle, Harmonia axyridis, the most abundant natural enemy to aphids in agroecosystems?

The multicolored Asian ladybeetle, Harmonia axyridis Pallas (Coleoptera: Coccinellidae), was introduced into Western Europe in the late 1990s. Since the late 2000s, this species has been commonly considered one of the most abundant aphid predators in most Western European coun- tries. In spite of the large amount of research on H. axyridis, information concerning its relative abundance in agroecosystems is lacking. This study aims to evaluate the abundance of H. axyridis within the aphidophage community in four crops situated in southern Belgium: wheat, Triticum aestivum L. (Poales: Poaceae), corn, Zea mays, potato, Solanum tuberosum (Solanales: Solanaceae), and broad bean Vicia faba (Fabales: Fabaceae). In order to assess the species diver- sity, the collected data were analyzed by considering (1) the species richness and (2) the evenness according to the Shannon diversity index. Eleven aphidophages were observed in every invento- ried agroecosystem, including five abundant species: three coccinellids, the seven-spotted ladybug, Coccinella septempunctata L. (Coleoptera: Coccinellidae), the 14-spotted Ladybird, Propylea quatuordecimpunctata, and H. axyridis; one hoverfly, the marmalade hoverfly, Episyr- phus balteatus De Geer (Diptera: Syrphidae); and one lacewing, the common green lacewing, Chrysoperla carnea Stephens sensu lato (= s.l.) (Neuroptera: Chrysopidae). Harmonia axyridis has been observed to thrive, breed, and reproduce on the four studied crops. Harmonia axyridis is the most abundant predator of aphids in corn followed by C. septempunctata, which is the main aphid predator observed in the three other inventoried crops. In wheat and potato fields, H. axyridis occurs in low numbers compared to other aphidophage. These observations suggest that H. axyridis could be considered an invasive species of agrosystems, and that potato and wheat may intermittently act as refuges for other aphidophages vulnerable to intraguild predation by this invader. Harmonia axyridis is not the most abundant aphid predator in the main Belgian crops.Impact de la coccinelles asiatique sur l'agriculture wallonn

Intraguild predation involving Harmonia axyridis: a review of current knowledge and future perspectives.

As an effective generalist predator of aphids and other hemipteran pests H. axyridis has been a successful biological control agent. However, the very functional traits that have contributed to its success in this regard also implicate it as an intraguild predator that poses a significant risk not only to the diversity of other natural enemies of Hemiptera (and their associated ecosystem services), but to biodiversity more widely. In this paper we will specifically review the existing data on intraguild predation involving H. axyridis, and consider the strength and symmetry of such interactions both within its native guild and within exotic guilds where it has established as an invasive alien. We will use these studies to interpret the observed population declines in predator diversity in the field, predict species at risk in regions not yet invaded and consider implications for resulting ecosystem services. We will also indicate gaps in our knowledge that require further study in order to identify opportunities for mitigation