Statistical process control for data without inherent order

Abstract Background The XmR chart is a powerful analytical tool in statistical process control (SPC) for detecting special causes of variation in a measure of quality. In this analysis a statistic called the average moving range is used as a measure of dispersion of the data. This approach is correct for data with natural underlying order, such as time series data. There is however conflict in the literature over the appropriateness of the XmR chart to analyse data without an inherent ordering. Methods We derive the maxima and minima for the average moving range in data without inherent ordering, and show how to calculate this for any data set. We permute a real world data set and calculate control limits based on these extrema. Results In the real world data set, permuting the order of the data affected an absolute difference of 109 percent in the width of the control limits. Discussion We prove quantitatively that XmR chart analysis is problematic for data without an inherent ordering, and using real-world data, demonstrate the problem this causes for calculating control limits. The resulting ambiguity in the analysis renders it unacceptable as an approach to making decisions based on data without inherent order. Conclusion The XmR chart should only be used for data endowed with an inherent ordering, such as a time series. To detect special causes of variation in data without an inherent ordering we suggest that one of the many well-established approaches to outlier analysis should be adopted. Furthermore we recommend that in all SPC analyses authors should consistently report the type of control chart used, including the measure of variation used in calculating control limits.</p

Living with cardiovascular disease (CVD): Exploring the biggest challenges for people affected by CVD in the UK, and their use (or not) of online resources

As death rates decrease, people affected by cardiovascular disease (CVD) continue to live with these diseases and the associated challenges, long-term. We aimed to identify the biggest challenges for people affected by CVD in the UK and explore the sources of support and information used to help manage conditions, to inform future service provision. An online questionnaire was sent and advertised to people over 16 years old in the UK self-identifying as affected by CVD (living with CVD, had risk factors, or a carer). There were 13,885 responses. The top five challenges were: feeling down, sad, or depressed; making changes to the way or amount of exercise; anxiety, fear, and uncertainty about the future; having one member of staff to speak to about all aspects of care; and being given information on the side effects of medications. Key challenges were not restricted to a particular condition, indicated by minimal variation between types of CVD. One-quarter of respondents indicated they do not use online resources or digital technologies to help manage their health. The volume and inconsistency of online sources were reported as barriers to using these. The results highlight the psychological and physical consequences of living with CVD. Fragmented care and variable access to information and support further compound these issues. Providing holistic care needs attention; the acknowledgement of psychological needs and access to support, alongside physical challenges is necessary. Stakeholders in healthcare and information technology should work together to ensure online information and support is clear, consistent, and reliable. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len

The experiences and supportive care needs of UK patients with pancreatic cancer: A cross-sectional questionnaire survey

Objectives. Patients diagnosed with pancreatic cancer have the poorest survival prognosis of any cancer. This survey aimed to describe their experiences of care and supportive care needs to inform future service provision. Design. Cross-sectional questionnaire survey of pancreatic cancer patients in the UK. Setting. Individuals at any stage along the care pathway were recruited via five NHS sites in the UK, and online, from January to June 2018. Participants. 274 individuals completed the questionnaire (78% (215) were completed online). Approximately half of participants were diagnosed within the last year (133/274). Of 212 providing gender details, 82 were male and 130 female. Ninety percent (192/213) described themselves as White British. Primary Outcome Measures. Experiences of communication and information; involvement in treatment decisions; supportive care needs. Results. Communication with, and care received from, clinical staff were generally reported positively. However, 29% (75/260) of respondents did not receive enough information at diagnosis, and 10% (25/253) felt they were not involved in decisions about their treatment, but would have liked to be. Supportive care needs were greatest in psychological and physical/daily living domains. 49% (108/221) respondents reported one or more moderate/high unmet needs within the last month, of which the most commonly reported were: dealing with uncertainty about the future; fears about the cancer spreading; not being able to do things they used to; concerns about those close to them; lack of energy; anxiety; feelings of sadness and feeling down/depressed. Experiences were poorer, and unmet supportive care needs greater, in patients with unresectable disease. Conclusions. Patients with pancreatic cancer have unmet information and support needs across the cancer trajectory. Psychological and physical support appear to be the biggest gaps in care. Needs should be assessed and supportive care interventions implemented from the point of diagnosis, and monitored regularly to help patients live as good a quality of life as possible

The Lantern Vol. 41, No. 2, Spring 1975

• Awakening • 10:27 • The Box • God\u27s Children • The Blasphemous Bean Beetle Levels Limpidland • First Flight • In April • Butterfly • In the Garden • The Emperor\u27s Pond • The Mob • Date with Destiny • While Awaiting Death • Sweet Jane • Final Thoughtshttps://digitalcommons.ursinus.edu/lantern/1106/thumbnail.jp

The Ursinus Weekly, October 2, 1975

Meetings on Perkiomen Valley growth • In memoriam • Gene Shue presents: Year of the Sixers • City planner speaks • Ursinus College appoints Assoc. Prof. of Education • Kane earns Doctorate • Editorial: A different year? • Is there more to life? • New dorms renovated • Saturday Lunch • Forum series opens: Nina Deutsch • Musical notes • Chris Hillman rated • New events at Walnut • Nancy Drew revisited • Alumnus is named to Library post • British history specialist joins Ursinus faculty • Instructor returns to Ursinus • Pa. Dutch Program is success • Instructor appointed to Biology Dept. • Lindback Award presented • Soccer season opens • Ursinus allies with area • Balloons! • Ursinus named a \u2776er • Register now! • Grads elect officers • Yes we can gang didn\u27t • NFC forecast • MAC report • F & M stings Bears 35 - 21https://digitalcommons.ursinus.edu/weekly/1041/thumbnail.jp

Finding consensus on frailty assessment in acute care through Delphi method

10.1136/bmjopen-2016-012904BMJ OPEN61

Validating a methodology to measure frailty syndromes at hospital level utilising administrative data

10.7861/clinmed.2019-0249CLINICAL MEDICINE202183-18