The National Adult Inpatient Survey conducted in the English National Health Service from 2002 to 2009: how have the data been used and what do we know as a result?

<p>Abstract</p> <p>Background</p> <p>When it was initiated in 2001, England's national patient survey programme was one of the first in the world and has now been widely emulated in other healthcare systems. The aim of the survey programme was to make the National Health Service (NHS) more "patient centred" and more responsive to patient feedback. The national inpatient survey has now been running in England annually since 2002 gathering data from over 600,000 patients. The aim of this study is to investigate how the data have been used and to summarise what has been learned about patients' evaluation of care as a result.</p> <p>Methods</p> <p>Two independent researchers systematically gathered all research that included analyses of the English national adult inpatient survey data. Journals, databases and relevant websites were searched. Publications prior to 2002 were excluded. Articles were also identified following consultation with experts. All documents were then critically appraised by two co-authors both of whom have a background in statistical analysis.</p> <p>Results</p> <p>We found that the majority of the studies identified were reports produced by organisations contracted to gather the data or co-ordinate the data collection and used mainly descriptive statistics. A few articles used the survey data for evidence based reporting or linked the survey to other healthcare data. The patient's socio-demographic characteristics appeared to influence their evaluation of their care but characteristics of the workforce and the. At a national level, the results of the survey have been remarkably stable over time. Only in those areas where there have been co-ordinated government-led campaigns, targets and incentives, have improvements been shown. The main findings of the review are that while the survey data have been used for different purposes they seem to have incited little academic interest.</p> <p>Conclusions</p> <p>The national inpatient survey has been a useful resource for many authors and organisations but the full potential inherent in this large, longitudinal publicly available dataset about patients' experiences has not as yet been fully exploited.</p> <p>This review suggests that the presence of survey results alone is not enough to improve patients' experiences and further research is required to understand whether and how the survey can be best used to improve standards of care in the NHS.</p

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Processing Yttrium Barium Copper Oxide Superconductor in Near-Zero Gravity

The effects of processing YBa2Cu3Ox (Y123) superconductor in the near-zero gravity (0g) environment provided by the NASA KC-135 airplane flying on parabolic trajectories were studied. A new sheet float zone furnace, designed for this study, enabled fast temperature ramps. Up to an 18 g sample was processed with each parabola. Samples of Y123 were processed as bulk sheets and composites containing Ag and Pd. The 0g processed samples were multi-phase yet retained a localized Y123 stoichiometry where a single ground-based (1g) oxygen anneal at temperatures of 800°C recovered nearly 100 vol% superconducting Y123. The 1g processed control samples remained multi-phase after the same ground-based anneal with less than 45 vol% as superconducting Y123. The superconducting transition temperature was 91 K for both 0g and 1g processed samples. Melt texturing of bulk Y123 in 0g produced aligned grains about a factor of three larger than in analogous 1g samples. Transport-critical current densities were at or below 18 A/cm2, due to the formation of cracks caused by the rapid heating rates required by the short time at 0g

Nanorod Self-Assembly in High Jc YBa₂Cu₃O₇-x Films with Ru-Based Double Perovskites.

Many second phase additions to YBa₂Cu₃O7-x (YBCO) films, in particular those that self-assemble into aligned nanorod and nanoparticle structures, enhance performance in self and applied fields. Of particular interest for additions are Ba-containing perovskites that are compatible with YBCO. In this report, we discuss the addition of Ba₂YRuO₆ to bulk and thick-film YBCO. Sub-micron, randomly oriented particles of this phase were found to form around grain boundaries and within YBCO grains in bulk sintered pellets. Within the limits of EDS, no Ru substitution into the YBCO was observed. Thick YBCO films were grown by pulsed laser deposition from a target consisting of YBa₂Cu₃Oy with 5 and 2.5 mole percent additions of Ba₂YRuO₆ and Y₂O₃, respectively. Films with enhanced in-field performance contained aligned, self-assembled Ba₂YRuO₆ nanorods and strained Y₂O₃ nanoparticle layers. A 0.9 µm thick film was found to have a self-field critical current density (Jc) of 5.1 MA/cm² with minimum Jc(Q, H=1T) of 0.75 MA/cm². Conversely, Jc characteristics were similar to YBCO films without additions when these secondary phases formed as large, disordered phases within the film. A 2.3 µm thick film with such a distribution of secondary phases was found to have reduced self-field Jc values of 3.4 MA/cm² at 75.5 K and Jc(min, Q, 1T) of 0.4 MA/cm²

Nanorod Self-Assembly in High Jc YBa₂Cu₃O₇-x Films with Ru-Based Double Perovskites.

Many second phase additions to YBa₂Cu₃O7-x (YBCO) films, in particular those that self-assemble into aligned nanorod and nanoparticle structures, enhance performance in self and applied fields. Of particular interest for additions are Ba-containing perovskites that are compatible with YBCO. In this report, we discuss the addition of Ba₂YRuO₆ to bulk and thick-film YBCO. Sub-micron, randomly oriented particles of this phase were found to form around grain boundaries and within YBCO grains in bulk sintered pellets. Within the limits of EDS, no Ru substitution into the YBCO was observed. Thick YBCO films were grown by pulsed laser deposition from a target consisting of YBa₂Cu₃Oy with 5 and 2.5 mole percent additions of Ba₂YRuO₆ and Y₂O₃, respectively. Films with enhanced in-field performance contained aligned, self-assembled Ba₂YRuO₆ nanorods and strained Y₂O₃ nanoparticle layers. A 0.9 µm thick film was found to have a self-field critical current density (Jc) of 5.1 MA/cm² with minimum Jc(Q, H=1T) of 0.75 MA/cm². Conversely, Jc characteristics were similar to YBCO films without additions when these secondary phases formed as large, disordered phases within the film. A 2.3 µm thick film with such a distribution of secondary phases was found to have reduced self-field Jc values of 3.4 MA/cm² at 75.5 K and Jc(min, Q, 1T) of 0.4 MA/cm²

Nanorod Self-Assembly in High Jc YBa2Cu3O7−x Films with Ru-Based Double Perovskites

Many second phase additions to YBa2Cu3O7−x (YBCO) films, in particular those that self-assemble into aligned nanorod and nanoparticle structures, enhance performance in self and applied fields. Of particular interest for additions are Ba-containing perovskites that are compatible with YBCO. In this report, we discuss the addition of Ba2YRuO6 to bulk and thick-film YBCO. Sub-micron, randomly oriented particles of this phase were found to form around grain boundaries and within YBCO grains in bulk sintered pellets. Within the limits of EDS, no Ru substitution into the YBCO was observed. Thick YBCO films were grown by pulsed laser deposition from a target consisting of YBa2Cu3Oy with 5 and 2.5 mole percent additions of Ba2YRuO6 and Y2O3, respectively. Films with enhanced in-field performance contained aligned, self-assembled Ba2YRuO6 nanorods and strained Y2O3 nanoparticle layers. A 0.9 µm thick film was found to have a self-field critical current density (Jc) of 5.1 MA/cm2 with minimum Jc(Q, H=1T) of 0.75 MA/cm2. Conversely, Jc characteristics were similar to YBCO films without additions when these secondary phases formed as large, disordered phases within the film. A 2.3 µm thick film with such a distribution of secondary phases was found to have reduced self-field Jc values of 3.4 MA/cm2 at 75.5 K and Jc(min, Q, 1T) of 0.4 MA/cm2

Progress in superconducting performance of rolled multifilamentary Bi-2223 HTS composite conductors

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'Memories are made of this':explicating organisational knowledge and memory

It is a commonplace that in the `Information Age', knowledge is the most important factor in the longterm success of an organisation. Such an emphasis is increasingly important as businesses confront a series of intransigent organisational problems connected with the retention and provision of organisational histories, knowledge and skills. `Organisational memory' and its sister concept, `knowledge management', are common glosses for the analysis and treatment of these problems. We analyse some of the conceptual and empirical issues that must precede attempts to provide support for `memory' and `knowledge' in the wider organisational context