The healthcare quality measurement industry: time to slow the juggernaut?

It is time to pause and reflect on the degree to which performance measurement is acting optimally and in the interests of society and health

Factors influencing the publication of health research

Objectives: Assess the degree to which research project findings were published and explore factors that influenced publication. Methods: Questionnaire to project leaders. Classification of publications and findings. Chi-squared; univariate and multivariate Cox regression analyses. Results: Forty percent of projects published in peer-reviewed journal; highly statistically significant relationships between publication in peer-reviewed journals and (1) projects in Responsive/Fellowships streams (p = .045); and (2) projects awarded >pound22,713 (p = .02); influence of study findings not statistically significant. Conclusions: Funders should consider the significant number of studies that did not result in publication and the higher rate of publication in peer-reviewed journals from some programs

The plasmoelectric effect: optically induced electrochemical potentials in resonant metallic structures

We describe a strategy for conversion of optical power into DC electrical power using resonant absorption in plasmonic nanostructures. A thermodynamic analysis of the underlying mechanism motivates our description of the phenomenon, which we term the plasmoelectric effect. Power conversion results from the dependence of optically generated heat on shifts of the plasmon resonance frequency that occur with changes of electron density. We model an all-metal device constructed from 10 nm radius silver spheres and predict a characteristic conversion efficiency of 14.3% under 1 kW m-2 intensity, single-frequency radiation. We discuss strategies for enhanced efficiency, broadband power conversion, and further applications of this new class of optoelectronic device.Comment: 24 pages with supplemental include

Getting research findings into practice : when to act on the evidence.

There is increasing interest in providing evidence based health care—that is, care in which healthcare professionals, provider managers, those who commission health care, the public, and policymakers consistently consider research evidence when making decisions. Purchasers, for example, should be able to influence the organisation and delivery of care (such as for cancer and stroke services) and the type and content of services (such as using chiropractic for back pain or dilatation and curettage and drug treatment for menorrhagia). Policymakers should ensure that policies on treatment reflect and are consistent with research evidence, and that the incentive structure within the health system promotes cost effective practice. They must also ensure that there is an adequate infrastructure for monitoring changes in practice and for producing, gathering, summarising, and disseminating evidence. Clinicians determine the day to day care patients receive in healthcare systems, and user groups (for example, patients, their families, and their representatives) are also beginning to play an important role in influencing healthcare decisions

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

Global electric field determination in the Earth's outer magnetosphere using charged particles

Although many properties of the Earth's magnetosphere have been measured and quantified in the past 30 years since it was discovered, one fundamental (for a zeroeth order magnetohydrodynamic (MHD) equilibrium) measurement was made infrequently and with poor spatial coverage: the global electric field. This oversight is in part due to the difficulty of measuring a plasma electric field, and in part due to the difficulty of measuring a plasma electric field, and in part due to the neglect of theorists. However, there is renewed interest in the convection electric field, since it has been realized that it is vital for understanding many aspects of the magnetosphere: the global MHD equilibrium, reconnection rates, Region 2 Birkeland currents, magnetosphere-ionosphere coupling, ring current and radiation belt transport, substorm injections, acceleration mechanisms, etc. Unfortunately the standard experimental methods have not been able to synthesize a global field (excepting the pioneering work of McIlwain's geostationary models), and we are left with an overly simplistic theoretical field, the Volland-Stern electric field mode. Again, single point measurements of the plasma pause were used to infer the appropriate amplitudes of the model, parameterized by Kp (Maynard & Chen, JGR 1975). Although this result was never intended to be the definitive electric field model, it has gone nearly unchanged for 15 years. However, the data sets being taken today require a great deal more accuracy than can be provided by the Volland-Stern model. Nor has the variability of the electric field shielding been properly addressed, although effects of penetrating magnetospheric electric fields has been seen in mid- and low-latitude ionospheric data sets. The growing interests in substorm dynamics also requires a much better assessment of the electric fields responsible for particle injections. Thus, we proposed and developed algorithms for extracting electric fields from particle data taken in the earth's magnetosphere. As a test of the effectiveness of these techniques, we analyzed data taken by the AMPTE/CCE spacecraft in equatorial orbit between 1984-1988. Some analytic tools had to be developed before construction of computer algorithms, and they are discussed

Mentoring to reduce antisocial behaviour in childhood

The effects of social interventions need to be examined in real life situations as well as studie

Acute care nurses' perceptions of barriers to using research information in clinical decision-making

Aim. To examine the barriers that nurses feel prevent them from using research in the decisions they make. Background. A sizeable research literature focusing on research utilization in nursing has developed over the past 20 years. However, this literature is characterized by a number of weaknesses: self-reported utilization behaviour; poor response rates and small, nonrandom sampling strategies. Design. Cross-case analysis involving anonymised qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 h, and 122 nurses were involved in the Q modelling exercise (response rate of 64%). Results. Four perspectives were isolated that encompassed the characteristics associated with barriers to research use. These related to the individual, organization, nature of research information itself and environment. Nurses clustered around four main perspectives on the barriers to research use: (1) Problems in interpreting and using research products, which were seen as too complex, 'academic' and overly statistical; (2) Nurses who felt confident with research-based information perceived a lack of organizational support as a significant block; (3) Many nurses felt that researchers and research products lack clinical credibility and that they fail to offer the desired level of clinical direction; (4) Some nurses lacked the skills and, to a lesser degree, the motivation to use research themselves. These individuals liked research messages passed on to them by a third party and sought to foster others' involvement in research-based practice, rather than becoming directly involved themselves. Conclusions. Rejection of research knowledge is not a barrier to its application. Rather, the presentation and management of research knowledge in the workplace represent significant challenges for clinicians, policy-makers and the research community