Clinical indicators for common paediatric conditions: processes, provenance and products of the CareTrack Kids study

BACKGROUND:In order to determine the extent to which care delivered to children is appropriate (in line with evidence-based care and/or clinical practice guidelines (CPGs)) in Australia, we developed a set of clinical indicators for 21 common paediatric medical conditions for use across a range of primary, secondary and tertiary healthcare practice facilities. METHODS:Clinical indicators were extracted from recommendations found through systematic searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts reviewed the indicators using a multi-round modified Delphi process and collaborative online wiki to develop consensus on what constituted appropriate care. RESULTS:From 121 clinical practice guidelines, 1098 recommendations were used to draft 451 proposed appropriateness indicators. In total, 61 experts (n = 24 internal reviewers, n = 37 external reviewers) reviewed these indicators over 40 weeks. A final set of 234 indicators resulted, from which 597 indicator items were derived suitable for medical record audit. Most indicator items were geared towards capturing information about under-use in healthcare (n = 551, 92%) across emergency department (n = 457, 77%), hospital (n = 450, 75%) and general practice (n = 434, 73%) healthcare facilities, and based on consensus level recommendations (n = 451, 76%). The main reason for rejecting indicators was 'feasibility' (likely to be able to be used for determining compliance with 'appropriate care' from medical record audit). CONCLUSION:A set of indicators was developed for the appropriateness of care for 21 paediatric conditions. We describe the processes (methods), provenance (origins and evolution of indicators) and products (indicator characteristics) of creating clinical indicators within the context of Australian healthcare settings. Developing consensus on clinical appropriateness indicators using a Delphi approach and collaborative online wiki has methodological utility. The final indicator set can be used by clinicians and organisations to measure and reflect on their own practice.Louise K. Wiles, Tamara D. Hooper, Peter D. Hibbert, Charlotte Molloy, Les White ... Helena Williams ... et al

Assessing the appropriateness of the management of otitis media in Australia: a population-based sample survey

AIM:Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) of AOM and otitis media with effusion (OME) management in Australian children. METHODS:We searched for national and international CPGs relating to AOM and OME in children and created 37 indicators for assessment. We reviewed medical records for adherence to these indicators in 120 locations, across one inpatient and three ambulatory health-care settings. Our review sample was obtained from three Australian states that contain 60% of the nation's children. RESULTS:We reviewed the records of 1063 children with one or more assessments of CPG adherence for otitis media. Of 22 indicators with sufficient data, estimated adherence ranged from 7.4 to 99.1%. Overuse of treatment, particularly overprescribing of antibiotics, was more common than underuse. A frequent lack of adherence with recommended care was observed for children aged between 1 and 2 years with AOM. Adherence varied by health-care setting, with emergency departments and inpatient settings more adherent to CPGs than general practices. CONCLUSIONS:Our assessment of a number of indicators in the common settings in which otitis media is treated found that guideline adherence varied widely between individual indicators. Internationally agreed standards for diagnosis and treatment, coupled with clinician education on the existence and content of CPGs and clinical decision support, are needed to improve the management of children presenting with AOM and OME.Robyn Clay‐Williams, Jacqueline H Stephens, Helena Williams, Andrew Hallahan, Chris Dalton, Peter Hibbert ... et al. on behalf of the CareTrack Kids Investigative Tea

From Topology to Phenotype in Protein–Protein Interaction Networks

We have recently witnessed an explosion in biological network data along with the development of computational approaches for their analyses. This new interdisciplinary research area is an integral part of systems biology, promising to provide new insights into organizational principles of life, as well as into evolution and disease. However, there is a danger that the area might become hindered by several emerging issues. In particular, there is typically a weak link between biological and computational scientists, resulting in the use of simple computational techniques of limited potential to explain these complex biological data. Hence, there is a danger that the community might view the topological features of network data as mere statistics, ignoring the value of the information contained in these data. This might result in the imposition of scientific doctrines, such as scale-free-centric (on the modelling side) and genome-centric (on the biological side) opinions onto this nascent research area. In this chapter, we take a network science perspective and present a brief, high-level overview of the area, commenting on possible challenges ahead. We focus on protein-protein interaction networks (PINs) in which nodes correspond to proteins in a cell and edges to physical bindings between the proteins. © 2010 Springer-Verlag London Limited