Closing the UK care home data gap - methodological challenges and solutions

UK care home residents are invisible in national datasets. The COVID-19 pandemic has exposed data failings that have hindered service development and research for years. Fundamental gaps, in terms of population and service demographics coupled with difficulties identifying the population in routine data are a significant limitation. These challenges are a key factor underpinning the failure to provide timely and responsive policy decisions to support care homes. In this commentary we propose changes that could address this data gap, priorities include: (1) Reliable identification of care home residents and their tenure; (2) Common identifiers to facilitate linkage between data sources from different sectors; (3) Individual-level, anonymised data inclusive of mortality irrespective of where death occurs; (4) Investment in capacity for large-scale, anonymised linked data analysis within social care working in partnership with academics; (5) Recognition of the need for collaborative working to use novel data sources, working to understand their meaning and ensure correct interpretation; (6) Better integration of information governance, enabling safe access for legitimate analyses from all relevant sectors; (7) A core national dataset for care homes developed in collaboration with key stakeholders to support integrated care delivery, service planning, commissioning, policy and research. Our suggestions are immediately actionable with political will and investment. We should seize this opportunity to capitalise on the spotlight the pandemic has thrown on the vulnerable populations living in care homes to invest in data-informed approaches to support care, evidence-based policy making and research

Human Resource Flexibility as a Mediating Variable Between High Performance Work Systems and Performance

Much of the human resource management literature has demonstrated the impact of high performance work systems (HPWS) on organizational performance. A new generation of studies is emerging in this literature that recommends the inclusion of mediating variables between HPWS and organizational performance. The increasing rate of dynamism in competitive environments suggests that measures of employee adaptability should be included as a mechanism that may explain the relevance of HPWS to firm competitiveness. On a sample of 226 Spanish firms, the study’s results confirm that HPWS influences performance through its impact on the firm’s human resource (HR) flexibility

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

An investigation of the dental pulp hemogram as a diagnostic aid for vital pulp therapy

Indiana University-Purdue University Indianapolis (IUPUI

Length changes in FTR prototypic cladding irradiated in EBR-II to 1 x 10/sup 22/ N/CM/sup 2/, E > 0. 1 MeV (PIN B-65)(RM-24)

Swelling in prototypic FTR cladding and duct specimens is being determined from a series of three irradiations designed to cover a range of temperatures approximately 800 to 1500/sup 0/F and peak fluences of approximately 1 x 10/sup 22/, 6 x 10/sup 22/, and 1 x 10/sup 23/ n/cm/sup 2/. The length change measurements for the low fluence irradiation have been completed and are summarized in this report. No swelling, only shrinkage, was found in the 20 percent cold worked Type 316 stainless steel cladding specimens. This shrinkage is of the same magnitude and has the same temperature dependency as unirradiated, control samples. Annealed specimens did swell slightly. Details of the experiment and analysis are given

Making sense of psychoanalysis in criminological theory and probation practice.

Recent developments in criminology have included a revival of interest in offenders' biographies and inner emotional experiences, and a stress on the importance of self-understanding for an understanding of crime. These approaches recall discussions of probation practice from the 1950s to the early 1970s, in which writers sought to make sense of the psychoanalytic emphasis of social work training. The article discusses the most striking of these efforts, by Clare Winnicott and William Jordan, and explores their relevance to current thinking and research on probation, in which the importance of the relationship between offender and supervising officer is once again receiving close attention