Unmet health needs in patients with coronary heart disease: implications and potential for improvement in caring services

BACKGROUND: Improving the quality of health care services requires tailoring facilities to fulfil patients' needs. Satisfying patients' healthcare needs, listening to patients' opinions and building a closer provider-user partnership are central to the NHS. Few published studies have discussed cardiovascular patients' health needs, but they are not comprehensive and fail to explore the contribution of outcome to needs assessment. METHOD: A comprehensive self-administered health needs assessment (HNA) questionnaire was developed for concomitant use with generic (Short Form-12 and EuroQOL) and specific (Seattle Angina Questionnaire) health-related quality of life (HRQL) instruments on 242 patients admitted to the Acute Cardiac Unit, Nottingham. RESULTS: 38% reported difficulty accessing health facilities, 56% due to transport and 32% required a travelling companion. Mean HRQOL scores were lower in those living alone (P < 0.05) or who reported unsatisfactory accommodation. Dissatisfaction with transport affected patients' ease of access to healthcare facilities (P < 0.001). Younger patients (<65 y) were more likely to be socially isolated (P = 0.01). Women and patients with chronic disease were more likely to be concerned about housework (P < 0.05). Over 65 s (p < 0.05) of higher social classes (p < 0.01) and greater physical needs (p < 0.001) had more social needs, correlating moderately (0.32 < r < 0.63) with all HRQL domains except SAQ-AS. Several HRQL components were highly correlated with the HNA physical score (p < 0.001). CONCLUSIONS: Patients wanted more social (suitable accommodation, companionship, social visits) and physical (help aids, access to healthcare services, house work) support. The construct validity and intra-class reliability of the HNA tool were confirmed. Our results indicate a gap between patients' health needs and available services, highlighting potential areas for improvement in the quality of services

Self-archiving publications

This chapter discusses the historical development, current practice and future prospects of the self-archiving of research papers in open-access repositories (so-called 'e-print archives'). It describes how the development of interoperable e-print repositories in a number of subject communities has shown that self-archiving can benefit academic researchers (and potentially others) by enabling quick and easy access to the research literature and therefore maximising the impact potential of papers. Realising that the possible benefits are high and the technical entry barriers low, many organisations such as universities have recently tried to encourage widespread self-archiving by setting up institutional repositories. However, major barriers to self-archiving remain - most of them cultural and managerial. There are concerns about quality control, intellectual property rights, disturbing the publishing status quo, and workload. Ways in which these issues are currently being addressed are discussed in this chapter. A number of self-archiving initiatives in different countries have been set up to address the concerns and to kick-start e-print repository use. However, issues remain which require further investigation; those discussed in this chapter include discipline differences, definitions of 'publication', versioning problems, digital preservation, costing and funding models, and metadata standards. The ways in which these issues are resolved will be important in determining the future of self-archiving. Possible futures are discussed with particular reference to journal publishing and quality control. If widely adopted, self-archiving might come to assume a central place in the scholarly communication process, but a great deal of restructuring of the process needs to take place before this potential can be realised.

Artificial Immune Tissue using Self-Organizing Networks

As introduced by Bentley et al. (2005), artificial immune systems (AIS) are lacking tissue, which is present in one form or another in all living multi-cellular organisms. Some have argued that this concept in the context of AIS brings little novelty to the already saturated field of the immune inspired computational research. This article aims to show that such a component of an AIS has the potential to bring an advantage to a data processing algorithm in terms of data pre-processing, clustering and extraction of features desired by the immune inspired system. The proposed tissue algorithm is based on self-organizing networks, such as self-organizing maps (SOM) developed by Kohonen (1996) and an analogy of the so called Toll-Like Receptors (TLR) affecting the activation function of the clusters developed by the SOM.

Artificial Immune Tissue using Self-Organizing Networks

As introduced by Bentley et al. (2005), artificial immune systems (AIS) are lacking tissue, which is present in one form or another in all living multi-cellular organisms. Some have argued that this concept in the context of AIS brings little novelty to the already saturated field of the immune inspired computational research. This article aims to show that such a component of an AIS has the potential to bring an advantage to a data processing algorithm in terms of data pre-processing, clustering and extraction of features desired by the immune inspired system. The proposed tissue algorithm is based on self-organizing networks, such as self-organizing maps (SOM) developed by Kohonen (1996) and an analogy of the so called Toll-Like Receptors (TLR) affecting the activation function of the clusters developed by the SOM.