What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews

OBJECTIVES: To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE). DESIGN: Interrupted time series analysis, review of case notes, survey, and interviews. SETTING: Acute and primary care trusts in England and Wales. PARTICIPANTS: All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts. MAIN OUTCOME MEASURES: Rates of prescribing and use of procedures and medical devices relative to evidence based guidance. RESULTS: 6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P <0.002) and orlistat for obesity (P <0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer’s disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued. CONCLUSIONS: Implementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context

Characterisation of baseline microbiological and host factors in an inception cohort of people with surgical wounds healing by secondary intention reveals circulating IL-6 levels as a potential predictive biomarker of healing [version 1; peer review: awaiting peer review]

Background: More than 2 million people per year are treated for surgical wounds in the UK. Over a quarter of these wounds are estimated to heal by secondary intention (from the “bottom up”) resulting in further complications and requiring increased healthcare resources. Identification of microbiological or host biomarkers that can predict healing outcomes may help to optimize the management of surgical wounds healing by secondary intention. However, the microbial and host factor heterogeneity amongst this diverse population is completely unexplored. Methods: We demonstrate feasibility of determining presence and levels of wound microbes and systemic host factors in an inception cohort of 54 people presenting with surgical wounds healing by secondary intention, who were subsequently followed-up for a period of 12-21 months. We present descriptive statistics for plasma levels of inflammatory, angiogenic cytokines and microRNAs, and we identify a range of wound colonizing microbes. We tentatively explore association with healing aiming to generate hypotheses for future research. Results: We report a potential correlation between poor healing outcomes and elevated interleukin (IL)-6 plasma levels at presentation (ρ=0.13) which requires confirmation. Conclusions: This study demonstrates the degree of biological heterogeneity amongst people with surgical wounds healing by secondary intention and proves the feasibility of embedding a biomarker discovery study in a cohort study in surgical wounds. Our results are essential for designing large biomarker discovery studies to further investigate the potential validity of circulating IL-6 or other factors as novel predictive biomarkers of healing for surgical wounds healing by secondary intention

Signatures of electron correlations in the transport properties of quantum dots

The transition matrix elements between the correlated $N$ and $N\!+\!1$ electron states of a quantum dot are calculated by numerical diagonalization. They are the central ingredient for the linear and non--linear transport properties which we compute using a rate equation. The experimentally observed variations in the heights of the linear conductance peaks can be explained. The knowledge of the matrix elements as well as the stationary populations of the states allows to assign the features observed in the non--linear transport spectroscopy to certain transition and contains valuable information about the correlated electron states.Comment: 4 pages (revtex,27kB) + 3 figures in one file ziped and uuencoded (postscript,33kB), to appear in Phys.Rev.B as Rapid Communicatio

Energy-level statistics at the metal-insulator transition in anisotropic systems

We study the three-dimensional Anderson model of localization with anisotropic hopping, i.e. weakly coupled chains and weakly coupled planes. In our extensive numerical study we identify and characterize the metal-insulator transition using energy-level statistics. The values of the critical disorder $W_c$ are consistent with results of previous studies, including the transfer-matrix method and multifractal analysis of the wave functions. $W_c$ decreases from its isotropic value with a power law as a function of anisotropy. Using high accuracy data for large system sizes we estimate the critical exponent $\nu=1.45\pm0.2$. This is in agreement with its value in the isotropic case and in other models of the orthogonal universality class. The critical level statistics which is independent of the system size at the transition changes from its isotropic form towards the Poisson statistics with increasing anisotropy.Comment: 22 pages, including 8 figures, revtex few typos corrected, added journal referenc

An accurate description of quantum size effects in InP nanocrystallites over a wide range of sizes

We obtain an effective parametrization of the bulk electronic structure of InP within the Tight Binding scheme. Using these parameters, we calculate the electronic structure of InP clusters with the size ranging upto 7.5 nm. The calculated variations in the electronic structure as a function of the cluster size is found to be in excellent agreement with experimental results over the entire range of sizes, establishing the effectiveness and transferability of the obtained parameter strengths.Comment: 9 pages, 3 figures, pdf file available at http://sscu.iisc.ernet.in/~sampan/publications.htm

Metal-insulator transitions in anisotropic 2d systems

Several phenomena related to the critical behaviour of non-interacting electrons in a disordered 2d tight-binding system with a magnetic field are studied. Localization lengths, critical exponents and density of states are computed using transfer matrix techniques. Scaling functions of isotropic systems are recovered once the dimension of the system in each direction is chosen proportional to the localization length. It is also found that the critical point is independent of the propagation direction, and that the critical exponents for the localization length for both propagating directions are equal to that of the isotropic system (approximately 7/3). We also calculate the critical value of the scaling function for both the isotropic and the anisotropic system. It is found that the isotropic value equals the geometric mean of the two anisotropic values. Detailed numerical studies of the density of states for the isotropic system reveals that for an appreciable amount of disorder the critical energy is off the band center.Comment: 6 pages RevTeX, 6 figures included, submitted to Physical Review

Critical spectral statistics in two-dimensional interacting disordered systems

The effect of Coulomb and short-range interactions on the spectral properties of two-dimensional disordered systems with two spinless fermions is investigated by numerical scaling techniques. The size independent universality of the critical nearest level-spacing distribution $P(s)$ allows one to find a delocalization transition at a critical disorder $W_{\rm c}$ for any non-zero value of the interaction strength. At the critical point the spacings distribution has a small-$s$ behavior $P_c(s)\propto s$, and a Poisson-like decay at large spacings.Comment: 4 two-column pages, 3 eps figures, RevTeX, new results adde

Non-Hermitian Rayleigh-Schroedinger Perturbation Theory

We devise a non-Hermitian Rayleigh-Schroedinger perturbation theory for the single- and the multireference case to tackle both the many-body problem and the decay problem encountered, for example, in the study of electronic resonances in molecules. A complex absorbing potential (CAP) is employed to facilitate a treatment of resonance states that is similar to the well-established bound-state techniques. For the perturbative approach, the full CAP-Schroedinger Hamiltonian, in suitable representation, is partitioned according to the Epstein-Nesbet scheme. The equations we derive in the framework of the single-reference perturbation theory turn out to be identical to those obtained by a time-dependent treatment in Wigner-Weisskopf theory. The multireference perturbation theory is studied for a model problem and is shown to be an efficient and accurate method. Algorithmic aspects of the integration of the perturbation theories into existing ab initio programs are discussed, and the simplicity of their implementation is elucidated.Comment: 10 pages, 1 figure, RevTeX4, submitted to Physical Review

Smoothed universal correlations in the two-dimensional Anderson model

We report on calculations of smoothed spectral correlations in the two-dimensional Anderson model for weak disorder. As pointed out in (M. Wilkinson, J. Phys. A: Math. Gen. 21, 1173 (1988)), an analysis of the smoothing dependence of the correlation functions provides a sensitive means of establishing consistency with random matrix theory. We use a semiclassical approach to describe these fluctuations and offer a detailed comparison between numerical and analytical calculations for an exhaustive set of two-point correlation functions. We consider parametric correlation functions with an external Aharonov-Bohm flux as a parameter and discuss two cases, namely broken time-reversal invariance and partial breaking of time-reversal invariance. Three types of correlation functions are considered: density-of-states, velocity and matrix element correlation functions. For the values of smoothing parameter close to the mean level spacing the semiclassical expressions and the numerical results agree quite well in the whole range of the magnetic flux.Comment: 12 pages, 14 figures submitted to Phys. Rev.

Strongly Correlated Electrons on a Silicon Surface: Theory of a Mott Insulator

We demonstrate theoretically that the electronic ground state of the potassium-covered Si(111)-B surface is a Mott insulator, explicitly contradicting band theory but in good agreement with recent experiments. We determine the physical structure by standard density-functional methods, and obtain the electronic ground state by exact diagonalization of a many-body Hamiltonian. The many-body conductivity reveals a Brinkman-Rice metal-insulator transition at a critical interaction strength; the calculated interaction strength is well above this critical value.Comment: 4 pages; 4 figures included in text; Revte