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At least 523 records · Page 29Linked to original sources
PubMed2006

Factor analysis improves the selection of prescribing indicators.

OBJECTIVE: To test a method for improving the selection of indicators of general practitioners' prescribing. METHODS: We conducted a prescription database study including all 180 general practices in the County of Funen, Denmark, approximately 472,000 inhabitants. Principal factor analysis was used to model correlation between 19 register-based indicators for the quality of non-steroidal anti-inflammatory drug (NSAID) prescribing. RESULTS: The correlation between indicators ranged widely from 0 to 0.93. Factor analysis revealed three dimensions of quality: (1) "Coxib preference", comprising indicators directly quantifying choice of coxibs, indicators measuring expenditure per Defined Daily Dose, and indicators taking risk aspects into account, (2) "Frequent NSAID prescribing", comprising indicators quantifying prevalence or amount of NSAID prescribing, and (3) "Diverse NSAID choice", comprising indicators focusing on the width of GPs' formularies. The number of indicators for measuring the important aspects of quality in prescribing of NSAIDs could be reduced substantially by selecting the indicator in each dimension with the highest factor loading. A high preference for coxibs indicated both appropriate and inappropriate prescribing, as revealed by the correlation of the indicators in the first factor. CONCLUSION: Correlation and factor analysis is a feasible method that assists the selection of indicators and gives better insight into prescribing patterns.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

Monitoring marine recreational water quality using multiple microbial indicators in an urban tropical environment.

The microbial water quality at two beaches, Hobie Beach and Crandon Beach, in Miami-Dade County, Florida, USA was measured using multiple microbial indicators for the purpose of evaluating correlations between microbes and for identifying possible sources of contamination. The indicator microbes chosen for this study (enterococci, Escherichia coli, fecal coliform, total coliform and C. perfringens) were evaluated through three different sampling efforts. These efforts included daily measurements at four locations during a wet season month and a dry season month, spatially intensive water sampling during low- and high-tide periods, and a sand sampling effort. Results indicated that concentrations did not vary in a consistent fashion between one indicator microbe and another. Daily water quality frequently exceeded guideline levels at Hobie Beach for all indicator microbes except for fecal coliform, which never exceeded the guideline. Except for total coliform, the concentrations of microbes did not change significantly between seasons in spite of the fact that the physical-chemical parameters (rainfall, temperature, pH, and salinity) changed significantly between the two monitoring periods. Spatially intense water sampling showed that the concentrations of microbes were significantly different with distance from the shoreline. The highest concentrations were observed at shoreline points and decreased at offshore points. Furthermore, the highest concentrations of indicator microbe concentrations were observed at high tide, when the wash zone area of the beach was submerged. Beach sands within the wash zone tested positive for all indicator microbes, thereby suggesting that this zone may serve as the source of indicator microbes. Ultimate sources of indicator microbes to this zone may include humans, animals, and possibly the survival and regrowth of indicator microbes due to the unique environmental conditions found within this zone. Overall, the results of this study indicated that the concentrations of indicator microbes do not necessarily correlate with one another. Exceedence of water quality guidelines, and thus the frequency of beach advisories, depends upon which indicator microbe is chosen.

Cities↗
PubMed2005

Using a set of strategic indicator systems as a decision-making support implement for establishing a recycling-oriented society. A Taiwanese case study.

UNLABELLED: BACKGROUND, SCOPE AND AIMS: To realize the vision of sustainable development (SD) originating from the 'only one earth' philosophy, and to integrate the conceptions of ecology and sustainability into the planning and decision-making criteria of urban growth management, the establishment of a recycling-oriented society (ROS) is essential. However, before the above intention can be achieved, it is indispensable to develop a system of strategic indicators for supporting a radical reformation of the urban development plan. Therefore, this study, based on the conception of the new urban development pattern ROS, attempted to carefully choose a sample city in Taiwan for launching a preliminary case study, and furthermore designed and proposed a concise and strategy-oriented assessment indicator system termed ROSAIS. ROSAIS, on the one hand, can act as a compass for understanding resource using efficiency and recycling status during city development and, on the other hand, can serve as an implement supporting decision-making for ROS construction. METHODS: According to the definition and spirit of ROS, the structure of ROSAIS should clearly represent the relationship between resources and environment in human activities. The eco-efficiency indicator system (EEIS) and environmental symbiosis indicator system (ESIS) can be considered two key subindicator systems, and are the necessary components of ROSAIS. EEIS chooses the dominant production sectors in urban economic activities to calculate their eco-efficiency (EE). Separately, for obtaining a consensus regarding the framework of ESIS, the questionnaire approaches and expert consultation, together with the research experience and foundation of current relevant studies and indicator systems, are applied when crucial resource and environmental issues and respective indicators are selected. RESULTS AND DISCUSSION: The calculation results of EEIS in this case study indicated that among the three dominant production activities (agricultural, fishery, and animal husbandry sector) the fishery sector has the highest EE, which indicates that the fishery activities and resources significantly influence the sustainability of the economic-environmental system of the sample city. Furthermore, according to a consensus achieved in ESIS, local green spaces, resource recovery, energy consumption pattern change, freshwater conservation and greenhouse effect abatement were considered as the five crucial issues influencing how the case study city can develop into an ES-city. The rate of local green spaces, resource recycling, freshwater conservation and the rate of reduction of nonrenewable energy use as well as carbon dioxide (CO2) emissions were used to evaluate the above five issues. CONCLUSION: This case study is unparalleled in Taiwan. Even in Japan, where ROS legislation has been implemented, this kind of study remains in the preliminary stages. Furthermore, when communicating the indicator results, it is essential to provide the context and countermeasures of the crucial issues that are faced. The two sub-indicator systems proposed in this case study could comply completely with the above-mentioned requirements. For example, the EEIS provides information for achieving a balance between environmental burden and economic benefits among dominant production sectors; the ESIS provides information for setting strategies for overcoming the crucial issues faced. RECOMMENDATION AND OUTLOOK: This study recommends that urban planers should consider the construction of the corresponding strategic indicator system to be indispensable, and makes further use of the indicator results related to the environmental education of residents for identifying and promoting participation with ROS, and turning them into implements for supporting urban SD decision-making. Furthermore, a successful indicator system depends on data availability and quality. This study recommends that urban planers should pay considerable attention to constructing relevant data collection channels, databases and the data quality.

Cities↗
PubMed1998

[Cesarean section frequency and its indications at the State University Hospital Maternity Home over a 12-year period].

The aim of this retrospective study is to analyse the tendency of change of the rate of CS and the indications for them. The data are taken from the hospital medical documentation. For each year is determine the rate of CS and the indications. Only the first two leading indications are taken because next are most often consequence or subgroup of them. The incidence of each indications is calculate on the sum of this indications from different cases to the sum of indications from all CS. From 1986 to 1997 year there were 49,855 deliveries and 9384 CS. CS rate at 1986 was 13.9 and increased to 24.0 at 1997 year. The mean CS rate for the period is 18.75. The leading indications are: dystocia (39.2%), previous CS (20.9%), fetal distress (16.9%), breech presentation (14.6%). In more than half of CS in the leading indication there are relative indications. For the period there is significant tendency of decrease of the indications: previous CS, hearth diseases, myoma, elderly patients. We found increase in the indications like: unfavorable pelvic score, atypical or pathological cephalic presentations, ophthalmic diseases, prolonged period of ruptured membranes. The increase of CS rate is mainly due to the relative indication and to the indications based on the subjective assessment of the fetal well-being and of the obstetric status.

Analysis of Variance↗
PubMed1992

Appropriateness of hysterectomies performed for multiple preoperative indications.

OBJECTIVE: To correlate the listing of multiple preoperative indications for hysterectomy with the risk of non-confirmation of the preoperative diagnosis. METHODS: Records of 171 women undergoing consecutive hysterectomies for all indications at a large teaching hospital were reviewed for preoperative indication(s), compliance with published preoperative validation criteria for cases in which tissue pathology was not expected, and histologic verification of the preoperative diagnosis for cases in which tissue pathology was expected. Rates of confirmation (histologic verification plus successful compliance with validation criteria) of the preoperative diagnosis were compared between subgroups of cases in which single indications were listed (N = 124) or multiple indications were listed (N = 47) preoperatively. RESULTS: The rate of confirmation of single indications (115 of 124 cases, 93%) was significantly higher than the rate of confirmation of even one indication in cases in which multiple indications were listed (28 of 47 cases, 60%, P < .0001; relative risk for non-confirmation of multiple indications = 1.55). Multiple indications were more likely to be listed when tissue pathology was not expected, representing 49% of validatable indications as compared with only 18% of histologically verifiable indications (P < .0001). Overall, the rate of compliance with validation criteria (70%) was significantly lower than the rate of histologic verification (90%) (P < .01). CONCLUSION: These data suggest that listing of multiple preoperative indications for hysterectomy is associated with both decreased appropriateness, as reflected in decreased compliance with generally accepted preoperative validation criteria, and decreased diagnostic accuracy, as reflected in lower rates of histologic verification.

Female↗
PubMed1996

Bone marrow transplant indications for childhood leukemias: achieving a consensus. The EBMT Pediatric Diseases Working Party.

During the "2nd International Course on Bone Marrow Transplantation in Children" a multiple choice questionnaire on bone marrow transplant indications for children with acute leukemias was distributed with the aim of achieving a consensus. The answers obtained from the twenty representatives of fourteen European countries during the meeting were analyzed and assigned to one of the following groups: I. definitive indication: when more than 75% participants were in favour; II. acceptable indication: when 50% to 74% participants were in favour; III. requires further investigation: when 25% to 49% participants were in favour; IV. no indication: when less than 24% participants were in favour. In acute lymphoblastic leukemia the following circumstances were considered a definitive indication for allogeneic bone marrow transplant (BMT) from a matched sibling donor (MSD): infancy, "high risk" (HR) patients in 1st complete remission (CR1); CR2 patients after an early bone marrow relapse (defined as a relapse occurring up to six months after stopping therapy). Patients experiencing an early meningeal relapse and CR2 patients after a late relapse (defined as a relapse occurring later than six months after stopping therapy) were considered an acceptable indication. Further investigation was required in order to better define the role of BMT for patients experiencing an early isolated testicular relapse. If a MSD is not available, HR patients in CR1 and CR2 patients, after an early bone marrow relapse, were considered a definite indication for a matched unrelated donor (MUD). This latter group was considered an acceptable indication for a haploidentical BMT if a MUD was not available. Further investigation was required to better define the role of autologous bone marrow transplant (ABMT) for patients experiencing an early extramedullary relapse and for HR patients in CR1 all of whom lacked MSD's. In acute myeloblastic leukemia (AML), CR2 patients were considered a definitive indication and CR1 patients were considered an acceptable indication for BMT from a MSD. CR2 patients were considered a definitive indication for ABMT and CR1 patients an acceptable indication in cases lacking a MSD. AML was not considered an indication for MUD BMT.

Bone Marrow Transplantation↗
PubMed2005

The identification and development of Canadian coronary artery bypass graft surgery quality indicators.

OBJECTIVE: The study objective was to develop quality indicators for coronary artery bypass graft surgery that relate to quality of care, associate with preventable death, and could be reported on performance reports. METHODS: A comprehensive list of quality indicators was collected from quality improvement organizations including the Society For Thoracic Surgery, Northern New England Cardiovascular Disease Study Group, and Veteran's Affairs System. Indicators were collated from practice guidelines from the American College of Cardiology and the American Heart Association. A MEDLINE search using the keywords "quality indicators" and "coronary bypass" was completed. A 17-member multidisciplinary international expert panel was assembled, who voted using a 2-step Delphi process regarding association with quality of care, risk adjustment, association with preventable death, and inclusion on performance reports. RESULTS: A total of 149 quality indicators were examined. This list was distilled to 33 indicators related to quality of care, 10 indicators that could be adequately risk adjusted, 34 indicators related to preventable death, and 18 indicators to be included on performance reports. These selected indicators consisted of 19 outcome variables, 23 process of care variables, and 4 structure variables. The quality indicators believed to be useful on a Canadian institutional coronary artery bypass graft surgery report card included the following: 30-day mortality, in-hospital mortality, electrocardiographic myocardial infarction, red cell transfusion, allogeneic blood product transfusion, deep sternal wound infection, postoperative stroke, postoperative dialysis, intensive care unit readmission, intensive care unit length of stay, ventilation time, repeat cardiac operation, repeat surgery with cardiopulmonary bypass, repeat revascularization, waiting time to surgery, completion of surgery within a recommended waiting time, use of left internal thoracic artery graft, and institutional volume. CONCLUSIONS: This set of consensus quality indicators can be used as a standard list to be monitored by providers of coronary artery bypass graft surgery in an effort to continuously evaluate and improve their performance.

Canada↗
PubMed2003

Use of quality indicators to evaluate the care of patients with localized prostate carcinoma.

BACKGROUND: The goal of quality assurance in health care is to preserve and improve patient care. Recently, RAND developed a set of evidence-based candidate indicators for evaluating the quality of care for patients with localized prostate carcinoma; however, the feasibility and sensitivity of these indicators have not been tested in a clinical setting. The objectives of this study were to evaluate the feasibility of measuring these quality indicators and to determine their sensitivity to change in practice patterns over time. METHODS: One hundred sixty-eight men who presented in either 1995 or in 2000 and were treated for localized prostate carcinoma were selected randomly from the University of Michigan tumor registry. A combination of electronic data base review and explicit chart review was used to assess the feasibility of measuring compliance for each indicator. For each indicator in which assessment was feasible, compliance with the RAND indicators was determined for patients in both years. Multivariate regression analysis was used to adjust for potential confounding effects of disease stage, tumor grade, prostate specific antigen (PSA) level, patient age, and therapy. RESULTS: Based on review of available clinical data, measurement of compliance was feasible for 19 of 22 RAND candidate quality indicators (86%). For five indicators, significant differences in documentation (compliance) were detected between 1995 and 2000 (P < 0.05). Treatment received and higher PSA levels were associated independently with documentation of compliance for several indicators (P < 0.05). CONCLUSIONS: Measurement of the majority of the RAND quality indicators for the treatment of patients with localized prostate carcinoma was feasible, and improvements in several indicators were observed between 1995 and 2000. Demonstration of such variation, even within a single institution, suggests that the indicators are sufficiently sensitive to detect differences in practice patterns.

Aged↗
PubMed1997

Validating quality indicators for hospital care.

BACKGROUND: Many of the indicators used to monitor the quality of hospital care are resource intensive and ineffective. Furthermore, current efforts to develop new indicators for report cards are generally directed at the evaluation of health plans and are not constructed to help providers (physician groups, hospitals, and health plans that contract to provide care to patients) find and fix problems with the quality of care at their organizations. FOUR QUESTIONS: Before using an indicator, four questions should be posed: (1) When cases identified by the indicator are examined, can one find a set of definable and preventable processes of care known to lead to a bad outcome? (2) Can a review instrument be created that will allow providers to identify which process problems are present? (3) Are there substantially more process problems in those cases identified by the indicator than in those cases not identified by the indicator, and can the sensitivity and specificity of the indicator be defined? and (4) Is the indicator primarily useful for quality improvement efforts by a provider, or is it also useful as an external measure of quality across providers? A FOUR-STEP FRAMEWORK: Four corresponding steps comprise an efficient validation method to produce indicators that detect deficiencies in an important process-outcome continuum, help produce the tools to find the deficiencies, document the efficiency of using the indicator to search for process problems, and define the appropriate use of the indicator. Use of such validated indicators, and the information about their utility, would allow providers to optimize the impact of money spent on quality improvement efforts.

Hospital Administration↗
PubMed2000

Clinical governance in primary care groups: the feasibility of deriving evidence-based performance indicators.

OBJECTIVES: To test the feasibility of deriving comparative indicators in all the practices within a primary care group. DESIGN: A retrospective audit using practice computer systems and random note review. SETTING: A primary care group in southern England. SUBJECTS: All 18 general practices in a primary care group. MAIN OUTCOME MEASURES: Twenty six evidence-based process indicators including aspirin therapy in high risk patients, detection and control of hypertension, smoking cessation advice, treatment of heart failure, raised cholesterol levels in those with established cardiovascular disease, and the treatment of atrial fibrillation. Feasibility was tested by examining whether it was possible to derive these indicators in all the practices; the problems and constraints incurred when collecting data; the variations in indicator values between practices in both their identification of diseases and in the uptake of various interventions; the possible reasons for these variations; and the cost of generating such indicators. RESULTS: It was possible to derive eight indicators in all practices and in three practices all 26 indicators. The median number of indicators derived was 12 with two practices able to generate eight. There was considerable variation in the use of computers between practices and in the ability and ease of various practice computer systems to generate indicators. Practices varied greatly in the identification of diseases and in the uptake of effective interventions. Variation in identification of ischaemic heart disease could not be explained by a higher prevalence in practices with a more deprived population. The cost of generating these indicators was 5300 Pounds. CONCLUSION: Comparative evidence-based indicators, used as part of clinical governance in primary care groups, could have the potential to turn evidence into everyday practice, to improve the quality of patient care, and to have an impact on the population's health. However, to derive such indicators and to be able to make meaningful comparisons primary care groups need greater conformity and compatibility of computer systems, improved computer skills for practice staff, and appropriate funding.

Benchmarking↗
PubMed2001

Comparison of indicators assessing the quality of drug prescribing for asthma.

OBJECTIVE: To compare different indicators for assessing the quality of drug prescribing and establish their agreement in identifying doctors who may not adhere to treatment guidelines. DATA SOURCES/STUDY SETTING: Data from 181 general practitioners (GPs) from The Netherlands. The case of asthma is used as an example because, in this area, different quality indicators exist whose validity is questioned. The study is part of the European Drug Education Project. STUDY DESIGN: Spearman rank correlations were assessed among the GPs' scores on self-report instruments, aggregated prescribing indicators, and individualized prescribing indicators. Kappa values were calculated as agreement measures for identifying low adherence to the guidelines. DATA COLLECTION: Prescribing data from GPs were collected through pharmacies, public health insurance companies, or computerized GP databases. Two self-report instruments were mailed to the GPs. The GPs first received a questionnaire assessing their competence regarding the treatment of asthma patients. Three months later they received a series of 16 written asthma cases asking for their intended treatment for each case. PRINCIPAL FINDINGS: Correlations between scores based on self-report instruments and indicators based on actual prescribing data were mostly nonsignificant and varied between 0 and 0.21. GPs identified as not adhering to the guidelines by the prescribing indicators often had high scores on the self-report instruments. Correlations between 0.20 and 0.55 were observed among indicators based on aggregated prescribing data and those based on individualized data. The agreement for identifying low adherence was small, with kappa values ranging from 0.19 to 0.30. CONCLUSIONS: Indicators based on self-report instruments seem to overestimate guideline adherence. Indicators assessing prescribing quality at an aggregated level give clearly different results, as compared to indicators evaluating prescribing data on an individual patient level. Caution is needed when using such prescribing indicators to identify low adherence to guidelines. Further validation studies using a gold standard comparison are needed to define the best possible indicator.

Administration, Inhalation↗
PubMed2002

Towards sets of hazardous waste indicators. Essential tools for modern industrial management.

Decision-makers require useful tools, such as indicators, to help them make environmentally sound decisions leading to effective management of hazardous wastes. Four hazardous waste indicators are being tested for such a purpose by several countries within the Sustainable Development Indicator Programme of the United Nations Commission for Sustainable Development. However, these indicators only address the 'down-stream' end-of-pipe industrial situation. More creative thinking is clearly needed to develop a wider range of indicators that not only reflects all aspects of industrial production that generates hazardous waste but considers socio-economic implications of the waste as well. Sets of useful and innovative indicators are proposed that could be applied to the emerging paradigm shift away from conventional end-of-pipe management actions and towards preventive strategies that are being increasingly adopted by industry often in association with local and national governments. A methodological and conceptual framework for the development of a core-set of hazardous waste indicators has been developed. Some of the indicator sets outlined quantify preventive waste management strategies (including indicators for cleaner production, hazardous waste reduction/minimization and life cycle analysis), whilst other sets address proactive strategies (including changes in production and consumption patterns, eco-efficiency, eco-intensity and resource productivity). Indicators for quantifying transport of hazardous wastes are also described. It was concluded that a number of the indicators proposed could now be usefully implemented as management tools using existing industrial and economic data. As cleaner production technologies and waste minimization approaches are more widely deployed, and industry integrates environmental concerns at all levels of decision-making, it is expected that the necessary data for construction of the remaining indicators will soon become available.

Decision Making↗
PubMed1998

Indications for cone biopsy: pathologic correlation.

OBJECTIVE: Our purpose was to determine the ability of different indications for cone biopsy to predict the presence of disease in the cone specimen and the utility of conization for low-grade disease. STUDY DESIGN: The records were reviewed of all patients who had an excisional cone biopsy at Queens Hospital Center between 1984 and 1995. Data were gathered regarding cytologic studies, visualization of the transformation zone, colposcopically directed biopsy, and endocervical curettage. The indications for the cone procedure were grouped as being for treatment (biopsy-proved disease) (indication A), discrepancy between cytologic and histologic diagnoses (indication B), positive endocervical curettage results (indication C), and transformation zone not fully visualized (indication D), and combinations of the above. RESULTS: Two thousand nine hundred sixty-nine records were reviewed. Of these, 604 had cone biopsies. Three hundred twenty-three of 355 (91%) cone biopsies done for indication A alone had disease on the cone specimen (defined as any grade of dysplasia or condyloma). Forty of 47 (85.1%) cone biopsies done for indication B alone had disease of the cone specimen. Forty-three of 46 (93.5%) cone biopsies done for indication C alone had disease on the cone specimen. Ninety-one cone procedures were done for a combination of indications A and D, with 87 (95.6%) showing disease on the cone specimen. Thirty-one procedures were done for a combination of indications B and D, with 25 (80.6%) showing disease on the cone specimen. Cone procedures were done on 32 women for a combination of indications C and D, and 30 (93.8%) had disease on the cone specimen. Two cone procedures were done because of the colposcopic appearance alone; one had high-grade disease on the cone specimen. Age did not help to predict the likelihood that disease would be found on the cone specimen. The data were then reanalyzed to determine the likelihood of finding high-grade disease (cervical intraepithelial neoplasia grades 2 or 3 or invasive cancer) on the cone specimen. Overall, those with preoperative high-grade cytologic or histologic characteristics (cervical intraepithelial neoplasia grades 2 or 3) were much more likely to have high-grade disease (277/371 [74.7%]) than were those with preoperative low-grade cytologic or histologic characteristics (condyloma or cervical intraepithelial neoplasia grade 1) (49/233 [21.0%]) (p < 0.001). CONCLUSION: Neither age nor the preoperative grade of disease are good discriminators of the likelihood that disease will be found on a conization specimen. However, patients who have high-grade disease on the preoperative evaluation are much more likely than those with only low-grade disease to have high-grade dysplasia or cancer on a subsequent conization.

Adolescent↗
PubMed1996

Symptom indices in bladder outlet obstruction.

BPH, the most common benign tumour that affects men, is a disease that mostly causes morbidity through its associated LUTS. Symptom indices are instruments that allow the objective measurement of these symptoms. Analysis of the data they provide allows symptom severity to be measured and the changes that occur in symptoms with time to be monitored. Measurement of symptom severity and assessment of disease progression are important parameters when treatment decisions are being made. After treatment, measurement of LUTS using symptom indices allows efficacy to be judged as well as providing an ongoing assessment of patients. Data from symptom indices allow patients to be compared with each other and may provide useful epidemiological information when groups of patients are assessed. However, it should be stressed that symptom indices are not reliable for screening populations for disease and should not be used for case-finding. Many new treatments for BPH/BPO are being developed and assessed in clinical trials. The measurement of symptoms using symptom indices has had a central role in these trials and will continue to do so. A considerable volume of published work presenting data from these trials is now accumulating. Comparing new treatments with the 'gold standard' of TURP is facilitated by symptom indices, as is the comparison with other novel modes of treatment. The AUA-7 index remains the best scientifically validated index used in patients with symptomatic BPO, although other indices, e.g. the Boyarsky, Madsen-Iversen and MMAP, when compared with the AUA-7 have been found to perform similarly. However, it would be preferable if the validation process of current indices included validation against pathophysiological processes such as proven BOO and detrusor instability. The current use of symptom indices will add to data supporting their reliability and validity. It is to be anticipated that symptom indices will be used increasingly both in clinical practice and clinical trials and that trust will be placed in the data they provide. It is essential that the limitations of these indices are borne in mind, and that the indices are applied correctly so that the information they produce remains valid and reliable.

Decision Support Techniques↗
PubMed1990

Quality assurance indicators and short-term outcome of hysterectomy.

Fifteen gynecologic quality assurance indicators recently published by The American College of Obstetricians and Gynecologists were applied to a previously reported hysterectomy data base. Chart reviews were performed for the most recent 257 cases in the data base, representing an 18-month interval. The indicators were divided into two groups: those intended to identify morbidity and mortality and those intended to screen for appropriateness of care. Rates of actual morbidity and cases that failed to meet published criteria sets for hysterectomy were determined by chart review regardless of the presence of a quality assurance indicator. A total of 135 indicators were identified in 114 (44%) of the 257 cases, including 64 patients (25%) with morbidity indicators and 50 (19%) with appropriateness indicators. Actual morbidity was correctly identified in all 64 cases in which morbidity indicators were present. Three cases with significant morbidity were identified by chart review but not identified by the indicators, yielding positive and negative predictive values of 100 and 98%, respectively, and an overall accuracy of 99% for morbidity indicators. By contrast, 14 of the 50 cases in which appropriateness indicators were present actually failed to meet published criteria sets. An additional seven cases failing to meet criteria sets were identified by chart review and not identified by the indicators, yielding a positive predictive value of 28%, a negative predictive value of 97%, and an overall accuracy of 83% for appropriateness indicators.

California↗
PubMed2000

Complementarity as a biodiversity indicator strategy.

Richness, rarity, endemism and complementarity of indicator taxon species are often used to select conservation areas, which are then assumed to represent most regional biodiversity. Assessments of the degree to which these indicator conservation areas coincide across different taxa have been conducted on a variety of vertebrate, invertebrate and plant groups at a national scale in Britain, Canada, USA and South Africa and at a regional scale in Cameroon, Uganda and the USA. A low degree of spatial overlap among and within these selected indicator conservation areas has been demonstrated. These results tend to suggest that indicator conservation areas display little congruence across different taxa. However, some of these studies demonstrate that many conservation areas for indicator taxa capture a high proportion of non-target species. Thus it appears that indicator conservation areas might sample overall biodiversity efficiently. These indicator conservation areas may, however, exclude species essential for effective conservation, e.g. rare, endemic or endangered species. The present study investigated the value of indicator taxa as biodiversity surrogates using spatial congruence and representativeness of different indicator priority conservation areas. The conservation status of species excluded by the indicator approaches is also assessed. Indicator priority conservation areas demonstrate high land area requirements in order to fully represent non-target species. These results suggest that efficient priority area selection techniques must reach a compromise between maximizing non-target species gains and minimizing land-use requirements. Reserve selection procedures using indicator-based complementarity appear to be approaches which best satisfy this trade-off.

Animals↗
PubMed2006

Role of follow-on drugs and indications on the WHO Essential Drug List.

INTRODUCTION: The World Health Organization's Essential Drug List (EDL) contains first-in-class drugs and subsequent class entrants (follow-on drugs) deemed necessary to combat diseases prevalent throughout the world, with a special emphasis on developing nations. The EDL also includes originally approved and follow-on indications. There are opposing views regarding the value of follow-on drugs and indications. Critics suggest many follow-on drugs and indications offer little or no benefit to patients. Advocates counter that follow-on drugs offer advantages in terms of improved effectiveness, compliance and patient satisfaction. OBJECTIVE: In order to inform this debate on the value of follow-on drugs and indications we examined the numbers of follow-on drugs on the EDL and the extent to which follow-on indications are recommended. METHODS: We identified all 312 drugs on the 14th edition of the EDL, omitting 72 non-pharmaceutical entities. For the 240 pharmaceutical entities we ascertained whether the Food and Drug Administration (FDA) had approved them, and, if so, when each was approved. We chose a validated therapeutic classification system - the United States Pharmacopeia's Model Guidelines for Medicare formulary management - in order to distinguish first-in-class and follow-on drugs on the EDL. Specifically, we selected the formulary key drug type as our benchmark therapeutic class. We assigned each EDL drug to a formulary key drug type. We defined first-in-class drugs as the first in each formulary key drug type, and follow-on drugs as all other drugs in each formulary key drug type. We identified follow-on indications by comparing WHO-listed indications with the original approved indication(s) by the FDA. Finally, we examined the therapeutic rating (priority vs. standard) given by the FDA to follow-on drugs on the EDL. RESULTS: Sixty-three per cent of the EDL drugs were follow-ons; 15% of the indications were follow-on indications. Fourteen drugs were listed in multiple WHO (sub) groupings; and 49% of follow-on drugs were given a priority rating by the FDA. CONCLUSIONS: In light of the fact that the EDL only includes drugs and indications deemed essential, the large number of follow-on drugs, follow-on indications, and priority-rated follow-on drugs on the EDL suggest their importance. From a public policy perspective, it may prove counterproductive to erect hurdles that impede follow-on research and development.

Developing Countries↗
PubMed2006

Developing valid indicators of injury incidence for "all injury".

BACKGROUND/AIMS: This paper focuses on the methods used to develop indicators for "all injury" incidence for the New Zealand Injury Prevention Strategy (NZIPS), launched in June 2003. Existing and previously proposed New Zealand national non-fatal injury indicators exhibited threats to validity. Population/ SETTING: The total population of New Zealand. METHODS: The authors proposed fatal and new non-fatal injury indicators for "all injury" based on national mortality and hospitalizations data. All of the candidate indicators were subjected to a systematic assessment of validity, using the International Collaborative Effort on Injury Statistics (ICE) criteria. Based on the results of that validation, the authors identified four proposed NZIPS indicators. RESULTS: The proposed "all injury" indicators were as follows: age standardized injury mortality rate per 100 000 person-years at risk; number of injury deaths; age standardized serious non-fatal injury rate per 100 000 person-years at risk; and number of cases of serious non-fatal injury. The authors identified no threat-to-validity when assessed against the ICE criteria. The estimated numbers and rates of serious non-fatal injury increased over the period, in contrast to the numbers and rates of fatal injury. CONCLUSION: The authors have proposed serious non-fatal injury indicators that they judge suffer substantially less bias than traditional non-fatal injury indicators. This approach to indicator development is consistent with the view that before newly proposed indicators are promulgated, they should be subjected to formal validation. The authors are encouraged that the New Zealand Government has accepted these arguments and proposed indicators, and are starting to act on some of their recommendations, including the development of complementary indicators.

Bias↗