Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome: a systematic review

Background. Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments has been advocated as part of clinical care to aid the recognition of psychosocial problems, to inform clinical decision making, to monitor therapeutic response and to facilitate patient-doctor communication. However, their adoption is not without cost and the benefit of their use is unclear. Method. A systematic review was conducted. We sought experimental studies that examined the addition of routinely administered measures of HRQoL to care in both psychiatric and non-psychiatric settings. We searched the following databases: MEDLINE, EMBASE, CINAHL, PsycLIT and Cochrane Controlled Trials Register (to 2000). Data were extracted independently and a narrative synthesis of results was presented. Results. Nine randomized and quasi-randomized studies conducted in non-psychiatric settings were found. All the instruments used included an assessment of mental well-being, with specific questions relating to depression and anxiety. The routine feedback of these instruments had little impact on the recognition of mental disorders or on longer term psychosocial functioning. While clinicians welcomed the information these instruments imparted, their results were rarely incorporated into routine clinical decision making. No studies were found that examined the value of routine assessment and feedback of HRQoL or patient needs in specialist psychiatric care settings. Conclusions. Routine HRQoL measurement is a costly exercise and there is no robust evidence to suggest that it is of benefit in improving psychosocial outcomes of patients managed in non-psychiatric settings. Major policy initiatives to increase the routine collection and use of outcome measures in psychiatric settings are unevaluated

Routinely administered questionnaires for depression and anxiety : systematic review

Objectives To examine the effect of routinely administered psychiatric questionnaires on the recognition, management, and outcome of psychiatric disorders in non-psychiatric settings. Data sources Embase, Medline, PsycLIT, Cinahl, Cochrane Controlled Trials Register,and hand searches of key journals. Methods A systematic review of randomised controlled trials of the administration and routine feedback of psychiatric screening and outcome questionnaires to clinicians in non-psychiatric settings. narrative overview of key design features and end points, together with a random effects quantitative synthesis of comparable studies. Main outcome measures Recognition of psychiatric disorders after feedback of questionnaire results; interventions for psychiatric disorders and outcome of psychiatric disorders. Results Nine randomised studies were identified that examined the use of common psychiatric instruments in primary care and general hospital settings. Studies compared the effect of the administration of these instruments followed by the feedback of the results to clinicians, with administration with no feedback. Meta-analytic pooling was possible for four of these studies (2457 participants), which measured the effect of feedback on the recognition of depressive disorders. Routine administration and feedback of scores for all patients (irrespective of score) did not increase the overall rate of recognition of mental disorders such as anxiety and depression (relative risk of detection of depression by clinician after feedback 0.95, 95% confidence interval 0.83 to 1.09). Two studies showed that routine administration followed by selective feedback for only high scores increased the rate of recognition of depression (relative risk of detection of depression after feedback 2.64, 1.62 to 4.31). This increased recognition, however, did not translate into an increased rate of intervention. Overall, studies of routine administration of psychiatric measures did not show an effect on patient outcome. Conclusions The routine measurement of outcome is a costly exercise. Little evidence shows that it is of benefit in improving psychosocial outcomes of those with psychiatric disorder managed in non-psychiatric settings

Variations in the hospital management of self harm in adults in England: observational study

More than 140 000 people present to hospital after an episode of self harm each year in England and Wales. Improving the general hospital management of these people is a key area in preventing suicide. Although professional consensus has been reached on how self harm services should be organised and delivered, wide variations in care delivery have been reported in two regions in England. Using a nationally representative sample, we investigated the variation in services and delivery of care for self harm patients in hospitals in England

Lawyers\u27 Obligations to the Courts

This paper will concern itself largely with the duty of lawyers to the courts. It is written from the viewpoint of a country lawyer suddenly catapulted from almost thirty years of practice to his state\u27s court of last resort via eight months on the trial bench. These vantage points have afforded an opportunity to observe the lawyer\u27s duty to the courts in various perspectives. With due respect to the learned scholars who have written on the subject, this small contribution is launched

Tests of an N.A.C.A. 23012 Airfoil with a slotted deflector flap

Section aerodynamic characteristics of a large-chord N.A.C.A. 23012 airfoil with a slotted deflector flap were obtained in the N.A.C.A. 7- by 10-foot wind tunnel. The characteristics of an N.A.C.A. slotted flap and of a simple split flap are included for comparison. The slotted deflector flap was found to have a somewhat lower maximum lift coefficient and somewhat higher drag at high lift coefficients than the N.A.C.A. slotted flap. The high drag of the open slot with the deflector flap neutral indicates that the slot should be closed for this condition

The effects of partial-span plain flaps on the aerodynamic characteristics of a rectangular and a tapered Clark Y wing

An investigation was made to determine the aerodynamic characteristics of tapered and rectangular wings with partial-span plain flaps. Two Clark Y airfoils equipped with center section and with tip-section flaps were tested. The results showed that the aerodynamic characteristics of partial-span plain flaps were, in general, similar to those of split flaps of the same span, but that the lift and the drag were less for the wing with plain flaps than for the wing with split flaps of comparable size. For the rectangular wing with center-section plain flaps, the maximum lift and the lift-drag ratio at maximum lift were greater and the drag at maximum lift was less than for the wing with tip-section plain flaps of the same size. The maximum lift of the tapered wing varied in the same manner as that of the rectangular wing but the drag and the lift-drag-ratio relationship were opposite

The effects of partial-span slotted flaps on the aerodynamic characteristics of a rectangular and a tapered N.A.C.A. 23012 wing

An investigation was made in the N.A.C.A. 7- by 10-foot wind tunnel to determine the aerodynamic characteristics of tapered and rectangular wings with partial-span slotted flaps. Two N.A.C.A. 23012 airfoils equipped with center-section and tip-section flaps were tested. The results showed that the changes in lift and drag due to changes in flap span for both rectangular and tapered wings having partial-span slotted flaps were similar to those for corresponding wings having partial-span split or plain flaps. For the two wings tested, higher values of maximum lift were obtained with center-section slotted flaps than with tip-section slotted flaps of the same size. The highest values of lift-drag ratio at maximum lift for the rectangular wing were obtained with center-section flaps and, for the tapered wing, with tip-section flaps. Center-section flaps on the tapered wing gave higher values of drag at maximum lift than tip-section flaps; no great difference in drag at maximum lift was apparent for either center-section or tip-section slotted flaps on the rectangular wing

The Aerodynamic Drag of Five Models of Side Floats N.A.C.A. Models 51-E, 51-F, 51-G, 51-H, 51-J

The drag of five models of side floats was measured in the N.A.C.A. 7- by 10-foot wind tunnel. The most promising method of reducing the drag of floats indicated by these tests is lowering the angle at which the floats are rigged. The addition of a step to a float does not always increase the drag in the flying range, floats with steps sometimes having lower drag than similar floats without steps. Making the bow chine no higher than necessary might result in a reduction in air drag because of the lower angle of pitch of the chines. Since side floats are used formally to obtain lateral stability when the seaplane is operating on the water at slow speeds or at rest, greater consideration can be given to factors affecting aerodynamic drag than is possible for other types of floats and hulls

Insights from unifying modern approximations to infections on networks

Networks are increasingly central to modern science owing to their ability to conceptualize multiple interacting components of a complex system. As a specific example of this, understanding the implications of contact network structure for the transmission of infectious diseases remains a key issue in epidemiology. Three broad approaches to this problem exist: explicit simulation; derivation of exact results for special networks; and dynamical approximations. This paper focuses on the last of these approaches, and makes two main contributions. Firstly, formal mathematical links are demonstrated between several prima facie unrelated dynamical approximations. And secondly, these links are used to derive two novel dynamical models for network epidemiology, which are compared against explicit stochastic simulation. The success of these new models provides improved understanding about the interaction of network structure and transmission dynamics

Trust in the US-EU fruit and vegetable chain: Do US exporters understand EU importers?

Research on organizational and inter organizational trust has become an important field in management and marketing literature, as it is perceived as a pivotal aspect of business transactions. However, clarifications are still needed on the issue of whom we trust; is the person whom we are trading with trusted, or the organization, or just the product‐quality? Not only has this question not been answered within this field of research, neither have cultural differences have been described to any great extent. Additionally, if the perceived factors important to establish trusting relationships may or may not be the same on the buyers and the sellers side in international business transaction in food chains. The primary objective of this research study therefore is to identify how well US exporters understand the elements of trust that establish strong relationships with EU importers. The Analytical Hierarchy Process was used to evaluate the importance of different trust elements in interviews conducted with US exporters and EU importers of fruits and vegetables. Results are compared, providing both a picture of the important facets of trust, as well as whether the partners understand the perspectives of the other partner