The document discusses approaches for evaluating interventions aimed at reducing demand for emergency healthcare services using routine data. It summarizes challenges with traditional evaluation methods and proposes using existing data sets to continuously monitor outcomes over time for broad groups of users, developing accurate comparison groups, and exploiting linked data sets. Key approaches discussed are a randomized controlled trial of a telecare intervention and using case controls derived from routine data to account for issues like regression to the mean.
Icete content-based filtering with applications on tv viewing dataElaine Cecília Gatto
Recommendation systems provide recommendation based on information about users’ preferences. Information Filtering is used by recommendation systems so as information can be processed and suggested to users; and Content-Based Filtering is an Information Filtering approach very used in recommendation systems. Content-Based Filtering analyses the correlation of items content with the user’s profile, suggesting relevant items and putting away irrelevant items. Recommendation systems, which are very much used on the Internet, have been studied in order to be used on Digital TV context, and there already are several works in this sense. As they are used on the Internet, recommendation systems can be used in Digital TV in order to recommend TV programs, publicity and advertisement and also the electronic commerce. Thus, within Digital TV context, the items can be programs, advertisements and the products to be sold; and using Content-Based Filtering in the recommendation programs, for instance, these programs’ contents can be correlated with the user’s preferences, which in this scenario, are the type of program one wants to watch. This paper presents the studies accomplished with Content-Based Filtering with application on Digital TV data. The survey aims at observing and evaluating how some filtering techniques based on content can be used in recommendation systems in Digital TV context
Icete content-based filtering with applications on tv viewing dataElaine Cecília Gatto
Recommendation systems provide recommendation based on information about users’ preferences. Information Filtering is used by recommendation systems so as information can be processed and suggested to users; and Content-Based Filtering is an Information Filtering approach very used in recommendation systems. Content-Based Filtering analyses the correlation of items content with the user’s profile, suggesting relevant items and putting away irrelevant items. Recommendation systems, which are very much used on the Internet, have been studied in order to be used on Digital TV context, and there already are several works in this sense. As they are used on the Internet, recommendation systems can be used in Digital TV in order to recommend TV programs, publicity and advertisement and also the electronic commerce. Thus, within Digital TV context, the items can be programs, advertisements and the products to be sold; and using Content-Based Filtering in the recommendation programs, for instance, these programs’ contents can be correlated with the user’s preferences, which in this scenario, are the type of program one wants to watch. This paper presents the studies accomplished with Content-Based Filtering with application on Digital TV data. The survey aims at observing and evaluating how some filtering techniques based on content can be used in recommendation systems in Digital TV context
Roth_Society For Medical Decision Making Conference 2011-Accounting for Uncer...rothius05
This is the file for a podium presentation that I gave at the 2011 Society for Medical Decision Making Conference in Chicago, IL. The content deals with using probabilistic methods to determine the affected population in value of information analyses. This method can be used to reflect "real-world" uncertainties in incidence, diagnosis, and time-horizon, and yields a credible interval around value of information metrics like EVPI, EVPPI, EVSI, and EVSPI.
Brief view of the achievements of a regional long-term e-health strategy done in Andalusia, the southernmost region of Spain. It is a comprehensive strategy for the whole population of this spanish region: more than 8 million inhabitants. EHR, electronic prescription, appointment, lab tests, image and others. An independent economic study shows a 260 euros of benefit for each 100 euros invested after 10 years of starting the initiative
Objectives:
1.To review the need for increased efforts to implement research evidence into bedside practice.
2.To review the need for measurement to identify gaps between best practice and actual practice.
3.To demonstrate why there is a need for increased knowledge translation efforts in critical care and how aCKTION Net proposes to fill this need.
Click the link to view the video http://bit.ly/YpJWTC
Tim Straughan: The NHS Information RevolutionThe King's Fund
Tim Straughan discusses Health informatics - driving integration and efficiencies across primary, secondary and community care at The King's Fund's NHS Information Revolution conference.
Roth_Society For Medical Decision Making Conference 2011-Accounting for Uncer...rothius05
This is the file for a podium presentation that I gave at the 2011 Society for Medical Decision Making Conference in Chicago, IL. The content deals with using probabilistic methods to determine the affected population in value of information analyses. This method can be used to reflect "real-world" uncertainties in incidence, diagnosis, and time-horizon, and yields a credible interval around value of information metrics like EVPI, EVPPI, EVSI, and EVSPI.
Brief view of the achievements of a regional long-term e-health strategy done in Andalusia, the southernmost region of Spain. It is a comprehensive strategy for the whole population of this spanish region: more than 8 million inhabitants. EHR, electronic prescription, appointment, lab tests, image and others. An independent economic study shows a 260 euros of benefit for each 100 euros invested after 10 years of starting the initiative
Objectives:
1.To review the need for increased efforts to implement research evidence into bedside practice.
2.To review the need for measurement to identify gaps between best practice and actual practice.
3.To demonstrate why there is a need for increased knowledge translation efforts in critical care and how aCKTION Net proposes to fill this need.
Click the link to view the video http://bit.ly/YpJWTC
Tim Straughan: The NHS Information RevolutionThe King's Fund
Tim Straughan discusses Health informatics - driving integration and efficiencies across primary, secondary and community care at The King's Fund's NHS Information Revolution conference.
Maureen Bisognano: An international perspective: Leading for better health careThe King's Fund
Maureen Bisognano, President and CEO, Institute for Healthcare Improvement, gives an international perspective on leading for better healthcare at The King's Fund Second Annual NHS leadership and Management Summit.
Presentation that gives an overview of the impact of IT on radiology, including the growing role of biomarkers and artificial intelligence and deep learning on the (future) radiology profession. The shift to precision medicine and personalized care are explained, the reasons for a re-definition of radiology are addressed.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Effectiveness of the current dominant approach to integrated care in the NHSNuffield Trust
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Lisa Annaly, Head of Provider Analytics at the Care Quality Commission, discusses lessons learned from the CQC as they have worked to monitor care quality over time.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Monitoring quality of care: making the most of dataNuffield Trust
Chris Sherlaw-Johnson, Senior Research Analyst at the Nuffield Trust, introduced the Monitoring quality of care conference and gives an overview of some of the approaches that we've been using at the Trust to identify where care quality has been improving, especially for frail and older people.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
New Models of General Practice: Practical and policy lessonsNuffield Trust
Nuffield Trust policy researchers Rebecca Rosen and Stephanie Kumpunen present findings from our upcoming report on large scale general practice models.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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How to Give Better Lectures: Some Tips for Doctors
Martin Bardsley & Adam Steventon: Stemming demand: how best to track the impact of interventions
1. Stemming demand: how best to
track the impact of
interventions?
Martin Bardsley Adam Steventon
Nuffield Trust
Health Strategy Summit March 24th 2010
3. Approaches to managing
demand...
• self-management education, •targeting people at high risk,
• self-monitoring, •multidisciplinary teams after discharge,
• group visits to primary care, •nurse-led clinics and nurse-led follow-
• broad managed care up,
programmes, •assertive case management, home
• integrating social and health visits.
care,
• nurse-led clinics,
• multidisciplinary teams in
hospital, • telecare,
• discharge planning, • telemonitoring.
• multidisciplinary teams after
discharge, But do they work?
• care from specialist nurses, In your patch?
4. Challenges of evaluation....
• Difficult to randomise a distinctive treatment and
control group within the same organisations or service.
• Service delivery patterns may change incrementally
over time.
• The client/patient group may change over time.
• Randomised trials can be costly and sometimes out of
proportion to the investment in the change).
• Can be slow – changes need to be made embedded
and cases followed up for a long time.
• Results may only reflect experiences of a subset of
users.
6. Alternative approaches.......
• Exploits existing data sets – as much as possible. This makes it
cheaper and easier to set up though it does create its own
challenges.
• Is continuous and timely. Aiming to provide interim results and
feedback during throughout the evaluation period. This can
potentially help fine tune the service – and the measurement
process.
• Aim to capture events and experiences for as broad a group of
users and potential users as possible. So looks, to some degree at
the majority of service users.
• Develops accurate comparative tools – using the right methods to
identify pseudo control groups as the basis for judging changes
over time.
• Exploits linked data sets to construct individual patient histories.
7. Why use routine information?
Advantages Disadvantages
• Relatively inexpensive • May not include the right
• Comprehensive information
• Person and event level • Rely on prior classifications
• Accessible • Quality and completeness
• Can be linked into routine of recording
management reporting • Limited range of outcomes
processes
8. Two methodological problems
• Regression to the mean: if you select people
with high service use, their service use will
probably reduce anyway.
• Cost are highly skewed: a relatively small
change in very high costs users can have an
impact.
9. Average number of emergency bed days
Emerging risk
50
45
40
35
30
25
20
15
10
5
0
-5 -4 -3 -2 -1 Intens +1 +2 +3 +4
e year
10. Will the next card be higher or
lower?
HIGHER
LOWER
ERRRR??
= Regression to the mean in the style of Brucey
11. The distribution of future
utilisation is exponential
£4,500
Actual Average cost per patient
£4,000
£3,500
£3,000
£2,500
£2,000
£1,500
£1,000
£500
£0
0 10 20 30 40 50 60 70 80 90
Predicted Risk (centile rank)
12. Approach 1 WSD trial.
A randomised trial.
• Study started in 3 sites in 2007. Aim to recruit
6000 patients to the trial.
• Recruitment to the study ended in Autumn
2009. Last trial participant reach 12mnths in
2010.
• Final analyses early 2011.
13. Are telecare and telehealth part of the solution?
“For every pound spent on telecare, five pounds could be
saved on expensive hospital and residential care”
Counsel and Care, 2009
14. Five evaluation themes
Theme 1 Theme 2 Theme 3 Theme 4 Theme 5
(Nuffield (UCL) (LSE) (Manchester) (Imperial)
Trust)
Impact of Participant- Costs and Experiences of Organisational
service use reported cost- service users, factors and
and outcomes and effectiveness informal sustainable
associated clinical carers and adoption and
costs for the effectiveness professionals integration
NHS and
social services
Subset of
2,750 people
plus 660 of
their informal Subset of Qualitative Qualitative
All 6,000 carers 2,750 people interviews interviews
people
Universities of Oxford and Birmingham
15. Information Flows
Encrypted subset
HES/SUS Client-event based
Linked Data Subsets
Encrypted subset
GP Client-event based Client Based
Local Needs variables
(Risk Groups)
Operational Community Encrypted subset Hospital Use
Nursing Activity Client-event based
GP & Community
Use
Systems
Encrypted subset Social Care Use
Social care Client-event based
Client event data
Person level records
Demographics Batch
Service
17. Approach 2. Using case controls
derived from routine data.
1
Access routine data at person level
2
Construct control groups to
overcome regression to the mean
3
Regular monitoring and updates to
influence policy development
19. Linking participants
to HES (1) IC collates and adds (if
required) NHS
numbers using batch
Participating sites tracing
Information Centre
Sites collate patient lists
IC derives
Nuffield Trust
extra
identifiers
Patient identifiers Trial information (e.g. Non-patient identifiable keys (e.g.
(e.g. NHS number) start and end date) HES ID, pseudonymised NHS #)
23. Regression to the mean?
50
Average number of emergency
45
40
35
30
25
20
bed days
15
10
5
0
-5 -4 -3 -2 -1 Intense + 1 +2 +3 +4
year
24. Choices about multivariate
matching
• Draw controls from local area, similar areas or nationally?
• Which variables to include?
• What weight to attach to each variables (distance measure)?
• With or without replacement?
• 1-1 matching or 1-many matching?
• Caliper matching on certain variables?
25. Building models every month
Predictor variables taken from two ... To predict 12
previous years.... months ahead
27. Comparison of intervention and
control group
Intervention Control Standardised
(N=378) (N=378) difference
Proportion aged 85+ 47% 47% 0.0%
Proportion female 68% 68% 0.0%
Mean area-level deprivation score 16.6 16.2 4.8%
Mean number of emergency admissions in 1.0 0.9 3.0%
previous year
Mean number of emergency admissions in 0.3 0.3 4.0%
previous 30 days
Mean emergency length of stay in previous 8.6 8.7 0.7%
year
Mean number of chronic conditions 1.6 1.5 4.3%
Mean predictive risk score 0.25 0.25 0.2%
34. Discussion points
• What are the rate limiting steps?
– Data being available?
– The right data to measure what you want?
– Skills to analyse data locally?
– Analytical resources locally?
• What are the priority interventions for routine
tracking?
• How should feedback be organised and
delivered?
• What should only be assessed with
randomisation?