MAAGs: the next generation. A study of the development of medical audit advisory groups and the arrangements for supporting clinical audit in primary care

Background: MAAGs have, historically, been disparate organisations with a lack of central direction, albeit with the same goal: to develop and support the performance of audit in primary care. This goal has been (and is being) achieved in a number of ways all over the country. In the last two years, MAAGs have witnessed many changes in primary care and are adapting themselves to suit these new arrangements at a local level.

Aim: To formalise our knowledge of where MAAGs are going, how they are getting there and the support they are receiving.

Method: A postal questionnaire to the 104 MAAGs in England and Wales, addressing 6 main issues of relevance to the development of MAAGs and the support they are receiving.

Results: At least two MAAGs have dissolved, leaving a possible total of 102 still in existence. Of these, 76 (74.5%) responded to the survey. The composition of the MAAG committee has changed dramatically since the inception of MAAGs in 1990, and staffing levels appear to have risen substantially. MAAGs appear to be more adequately funded by their health authorities than has previously been reported and many are actively seeking additional sources of funding. There is still large variation in levels of MAAG funding. Furthermore, funding is unrelated to the number of GPs or practices served. Security for MAAG staff appears to have been addressed in many areas, with 84% of MAAGs having at least one member of staff on a permanent employment contract. Many MAAGs are developing rolling programmes in an attempt to eliminate the short-sighted approach to the development of clinical audit that has existed since MAAGs were first set up.

Conclusion: Many MAAGs (with the obvious exception of those that have been dissolved) appear to be thriving without central direction or initiative. It is now evident that we were a little hasty in our concerns for the future of MAAGs beyond April 1996. It would seem that many organisations have taken the situation which arose two years ago as an opportunity to grow and develop in ways that may not have been possible within the confines of the Health Circular.

Medical image retrieval with query-dependent feature fusion based on one-class SVM

Due to the huge growth of the World Wide Web, medical images are now available in large numbers in online repositories, and there exists the need to retrieval the images through automatically extracting visual information of the medical images, which is commonly known as content-based image retrieval (CBIR). Since each feature extracted from images just characterizes certain aspect of image content, multiple features are necessarily employed to improve the retrieval performance. Meanwhile, experiments demonstrate that a special feature is not equally important for different image queries. Most of existed feature fusion methods for image retrieval only utilize query independent feature fusion or rely on explicit user weighting. In this paper, we present a novel query dependent feature fusion method for medical image retrieval based on one class support vector machine. Having considered that a special feature is not equally important for different image queries, the proposed query dependent feature fusion method can learn different feature fusion models for different image queries only based on multiply image samples provided by the user, and the learned feature fusion models can reflect the different importances of a special feature for different image queries. The experimental results on the IRMA medical image collection demonstrate that the proposed method can improve the retrieval performance effectively and can outperform existed feature fusion methods for image retrieval.

QDFA : query-dependent feature aggregation for medical image retrieval

We propose a novel query-dependent feature aggregation (QDFA) method for medical image retrieval. The QDFA method can learn an optimal feature aggregation function for a multi-example query, which takes into account multiple features and multiple examples with different importance. The experiments demonstrate that the QDFA method outperforms three other feature aggregation methods.

A new query dependent feature fusion approach for medical image retrieval based on one-class SVM

With the development of the internet, medical images are now available in large numbers in online repositories, and there exists the need to retrieval the medical images in the content-based ways through automatically extracting visual information of the medical images. Since a single feature extracted from images just characterizes certain aspect of image content, multiple features are necessarily employed to improve the retrieval performance. Furthermore, a special feature is not equally important for different image queries since a special feature has different importance in reflecting the content of different images. However, most existed feature fusion methods for image retrieval only utilize query independent feature fusion or rely on explicit user weighting. In this paper, based on multiply query samples provided by the user, we present a novel query dependent feature fusion method for medical image retrieval based on one class support vector machine. The proposed query dependent feature fusion method for medical image retrieval can learn different feature fusion models for different image queries, and the learned feature fusion models can reflect the different importance of a special feature for different image queries. The experimental results on the IRMA medical image collection demonstrate that the proposed method can improve the retrieval performance effectively and can outperform existed feature fusion methods for image retrieval.

SMS-based medical diagnostic telemetry data transmission protocol for medical sensors

People with special medical monitoring needs can, these days, be sent home and remotely monitored through the use of data logging medical sensors and a transmission base-station. While this can improve quality of life by allowing the patient to spend most of their time at home, most current technologies rely on hardwired landline technology or expensive mobile data transmissions to transmit data to a medical facility. The aim of this paper is to investigate and develop an approach to increase the freedom of a monitored patient and decrease costs by utilising mobile technologies and SMS messaging to transmit data from patient to medico. To this end, we evaluated the capabilities of SMS and propose a generic communications protocol which can work within the constraints of the SMS format, but provide the necessary redundancy and robustness to be used for the transmission of non-critical medical telemetry from data logging medical sensors.

The role of the medical emergency team in end-of-life care : a multicenter, prospective, observational study

Objective: To investigate the role of medical emergency teams in end-of-life care planning.

Design: One month prospective audit of medical emergency team calls.

Setting: Seven university-affiliated hospitals in Australia, Canada, and Sweden.

Patients: Five hundred eighteen patients who received a medical emergency team call over 1 month.

Interventions: None.

Measurements and Main Results: There were 652 medical emergency team calls in 518 patients, with multiple calls in 99 (19.1%) patients. There were 161 (31.1%) patients with limitations of medical therapy during the study period. The limitation of medical therapy was instituted in 105 (20.3%) and 56 (10.8%) patients before and after the medical emergency team call, respectively. In 78 patients who died with a limitation of medical therapy in place, the last medical emergency team review was on the day of death in 29.5% of patients, and within 2 days in another 28.2%. Compared with patients who did not have a limitation of medical therapy, those with a limitation of medical therapy were older (80 vs. 66 yrs; p < .001), less likely to be male (44.1% vs. 55.7%; p .014), more likely to be medical admissions (70.8% vs. 51.3%; p < .001), and less likely to be admitted from home (74.5% vs. 92.2%, p < .001). In addition, those with a limitation of medical therapy were less likely to be discharged home (22.4% vs. 63.6%; p < .001) and more likely to die in hospital (48.4% vs. 12.3%; p < .001). There was a trend for increased likelihood of calls associated with limitations of medical therapy to occur out of hours (51.0% vs. 43.8%, p .089).

Conclusions: Issues around end-of-life care and limitations of medical therapy arose in approximately one-third of calls, suggesting a mismatch between patient needs for end-of-life care and resources at participating hospitals. These calls frequently occur in elderly medical patients and out of hours. Many such patients do not return home, and half die in hospital. There is a need for improved advanced care planning in our hospitals, and to confirm our findings in other organizations.

The politics of medical curriculum accreditation : thoughts, not facts?

The medical profession needs to adapt to the socio-political challenges of the 21st century. These have been described as the ‘Health Society’. Medical professionalism, however, is characterised by conservative values that are perpetuated by the professional attributes of autonomy, authority, and state-sanctioned altruism. The medical education enterprise is a replication and continuation of these values, sanctioned by its accreditation agencies. The Australian Medical Council through its accreditation standards only sanctions the formal curriculum. The status quo, however, is maintained by social, cultural and political parameters enmeshed in the informal and hidden curricula. By not addressing informal and hidden value constructs that maintain elitist medical arrogance the accreditation agency fails to uphold its remit. This paper explores the philosophical and empirical bases of these phenomena and illustrates them by means of a case study. Medical education and its sanctioning structure and agency are confirmed as forceful political enterprises. We conclude that explicit review of the informal and hidden curriculum is a feasible and necessary prerequisite for medical education reform and change.