Variations in chemoprophylaxis for meningococcal disease: a retrospective case note review, analysis of routine prescribing data and questionnaire of general practitioners

BACKGROUND: Invasive meningococcal disease is a significant cause of mortality and morbidity in the UK. Administration of chemoprophylaxis to close contacts reduces the risk of a secondary case. However, unnecessary chemoprophylaxis may be associated with adverse reactions, increased antibiotic resistance and removal of organisms, such as Neisseria lactamica, which help to protect against meningococcal disease. Limited evidence exists to suggest that overuse of chemoprophylaxis may occur. This study aimed to evaluate prescribing of chemoprophylaxis for contacts of meningococcal disease by general practitioners and hospital staff. METHODS: Retrospective case note review of cases of meningococcal disease was conducted in one health district from 1st September 1997 to 31st August 1999. Routine hospital and general practitioner prescribing data was searched for chemoprophylactic prescriptions of rifampicin and ciprofloxacin. A questionnaire of general practitioners was undertaken to obtain more detailed information. RESULTS: Prescribing by hospital doctors was in line with recommendations by the Consultant for Communicable Disease Control. General practitioners prescribed 118% more chemoprophylaxis than was recommended. Size of practice and training status did not affect the level of additional prescribing, but there were significant differences by geographical area. The highest levels of prescribing occurred in areas with high disease rates and associated publicity. However, some true close contacts did not appear to receive prophylaxis. CONCLUSIONS: Receipt of chemoprophylaxis is affected by a series of patient, doctor and community interactions. High publicity appears to increase demand for prophylaxis. Some true contacts do not receive appropriate chemoprophylaxis and are left at an unnecessarily increased risk

Simulating customer experience and word-of-mouth in retail: a case study

Agents offer a new and exciting way of understanding the world of work. In this paper we describe the development of agent-based simulation models, designed to help to understand the relationship between people management practices and retail performance. We report on the current development of our simulation models which includes new features concerning the evolution of customers over time. To test the features we have conducted a series of experiments dealing with customer pool sizes, standard and noise reduction modes, and the spread of customers’ word of mouth. To validate and evaluate our model, we introduce new performance measure specific to retail operations. We show that by varying different parameters in our model we can simulate a range of customer experiences leading to significant differences in performance measures. Ultimately, we are interested in better understanding the impact of changes in staff behavior due to changes in store management practices. Our multi-disciplinary research team draws upon expertise from work psychologists and computer scientists. Despite the fact we are working within a relatively novel and complex domain, it is clear that intelligent agents offer potential for fostering sustainable organizational capabilities in the future.