Correlates of spontaneous reporting of adverse drug reactions within primary care: the paradox of low prescribers who are high reporters

AIM(S) To examine Primary Care Trust (PCT) demographics influencing general practitioner (GP) involvement in pharmacovigilance. METHODS PCT adverse drug reaction (ADR) reports to the Yellow Card scheme between April 2004 and March 2006 were obtained for the UK West Midlands region. Reports were analysed by all drugs, and most commonly reported drugs (‘top drugs’). PCT data, adjusted for population size, were aggregated. Prescribing statistics and other characteristics were obtained for each PCT, and associations between these characteristics and ADR reporting rates were examined. RESULTS During 2004–06, 1175 reports were received from PCTs. Two hundred and eighty (24%) of these reports were for 14 ‘top drugs’. The mean rate of reporting for PCTs was 213 reports per million population. A total of 153 million items were prescribed during 2004–06, of which 33% were ‘top drugs’. Reports for all drugs and ‘top drugs’ were inversely correlated with the number of prescriptions issued per thousand population (rs = -0.413, 95% CI -0.673, -0.062, P < 0.05, and r = -0.420, 95% CI -0.678, -0.071, P < 0.05, respectively). Reporting was significantly negatively correlated with the percentages of male GPs within a PCT, GPs over 55 years of age, single-handed GPs within a PCT, the average list size of a GP within a PCT, the overall deprivation scores and average QOF total points. ADR reports did not correlate significantly with the proportion of the population over 65 years old. CONCLUSIONS Some PCT characteristics appear to be associated with low levels of ADR reporting. The association of low prescribing areas with high ADR reporting rates replicates previous findings.

The comparative impact of privatisation and regulation on productivity growth in the English and Welsh water and sewerage industry, 1985-99

After the 10 regional water authorities of England and Wales were privatized in November 1989, the successor WASCs (water and sewerage companies) faced a new regulatory regime that was designed to promote productivity growth while simultaneously improving drinking water and environmental quality. As legally mandated quality improvements necessitated a costly capital investment programme, the industry's economic regulator – the Office of Water Services – implemented a RPI + K pricing system, designed to compensate the WASCs for their capital investment programme while also encouraging faster rates of productivity growth. This paper considers the relative effects of privatization and regulation on productivity growth in the industry using both non-parametric and parametric methods to provide a crosscheck on the robustness of the results. While there is evidence that labour productivity improved after privatization, there is no evidence that privatization led to a growth in TFP (total factor productivity). However, there is some evidence of a small increase in the rate of TFP growth in the aftermath of a substantial tightening of the regulatory regime that took place in 1995. These results, therefore, are consistent with evidence from other research that privatization, in the absence of effective competition and/or regulation, is not necessarily associated with improved economic performance.

An examination of the management of Russian civil society

This thesis begins by examining the concepts of civil society and social capital. Specifically, it outlines the role of health and education third sector organisations (TSOs) in building civil society and generating social capital which is conducive to democratisation. Following this, the thesis presents literature on civil society development in the context of the Russian Federation, highlighting a void in our understanding of health and education TSOs in this context. The literature review examines cultural-historic antecedents and their impact on civil society development. These antecedents result in three constraints which limit TSOs ability to establish civil society as an autonomous space. In light of these constraints, the thesis explores the present day realities faced by Russian TSOs and proposes that the all-dominant nature of the Russian state leads to managed civil society arrangements. Consequently the thesis addresses the question of how a managed civil society manifests itself in the context of the Russian Federation. Using a qualitative research design, the thesis investigates the control mechanisms created by legislative framework, the ability of third sector organisations to substitute for the state, and the organisational characteristics of TSOs within a managed civil society space. Based on interview data from 82 TSOs across three geographical regions, the empirical chapters explore these three aspects in-depth. Firstly, the thesis demonstrates how a specific legislative framework is used as a legally mandated method to manage civil society. Secondly, the thesis explores more subtle attempts by the state to manage civil society. And thirdly, the thesis highlights ways in which the state controls TSOs and coerces them to mimic marionette organisations. Overall, the evidence presented throughout the thesis highlights the idiosyncratic nature of managed civil society arrangements in Russia in which the state is able to control and direct civil society

An examination of adverse drug reaction reporting to the yellow card scheme

Chief pharmacists in 209 hospitals were surveyed about ADR reporting schemes, the priority given to ADR reporting, and attitudes towards ADR reporting. ADR reporting had a low managerial priority. Local reporting schemes were found to be operating in 37% trusts, but there were few plans to start new schemes. Few problems were discovered by the introduction of pharmacist ADR reporting. Chief pharmacists had concerns about the competence of hospital pharmacists to detect ADRs and were in favour of increased training. Lack of time on wards, and recruitment difficulties were suggested as reasons for hospital pharmacist under-reporting. Teaching hospitals appeared to have an increased interest in ADR reporting. A retrospective analysis of reporting trends within the West Midlands region from 1994, showed increasing or stable reporting rates for most sectors of reporters, except for general practitioners (GPs). The West Midlands region maintained higher ADR reporting rates than the rest of the UK. National reporting figures showed a worrying decline in ADR reports from healthcare professionals. Variation was found in the ADR reporting rates of Acute NHS Hospital Trusts and Primary Care Trusts (PCTs) in the West Midlands region, including correlations with prescribing rates and other PCT characteristics. Qualitative research into attitudes of GPs towards the Yellow Card scheme was undertaken. A series of qualitative interviews with GPs discovered barriers and positive motivators for their involvement in the Yellow Card scheme. A grounded theory of GP involvement in the Yellow Card scheme was developed to explain GP behaviour, and which could be used to inform potential solutions to halt declining rates of reporting. Under-reporting of ADRs continues to be a major concern to those who administer spontaneous reporting schemes.

Cognitive neuroscience: the evolution of a discipline

Preface. The evolution of cognitive neuroscience has been spurred by the development of increasingly sophisticated investigative techniques to study human cognition. In Methods in Mind, experts examine the wide variety of tools available to cognitive neuroscientists, paying particular attention to the ways in which different methods can be integrated to strengthen empirical findings and how innovative uses for established techniques can be developed. The book will be a uniquely valuable resource for the researcher seeking to expand his or her repertoire of investigative techniques. Each chapter explores a different approach. These include transcranial magnetic stimulation, cognitive neuropsychiatry, lesion studies in nonhuman primates, computational modeling, psychophysiology, single neurons and primate behavior, grid computing, eye movements, fMRI, electroencephalography, imaging genetics, magnetoencephalography, neuropharmacology, and neuroendocrinology. As mandated, authors focus on convergence and innovation in their fields; chapters highlight such cross-method innovations as the use of the fMRI signal to constrain magnetoencephalography, the use of electroencephalography (EEG) to guide rapid transcranial magnetic stimulation at a specific frequency, and the successful integration of neuroimaging and genetic analysis. Computational approaches depend on increased computing power, and one chapter describes the use of distributed or grid computing to analyze massive datasets in cyberspace. Each chapter author is a leading authority in the technique discussed.

Achieving continuous improvement through self-assessment

In 2007 the UK Office of Government Commerce was mandated to carry out Procurement Capability Reviews (PCR) across the 16 top spending UK Government Departments. Since then, this programme has evolved into a self assessment based approach which is markedly different from the original approach. Will the move from a centre-led strategic review of procurement capability to a department-led model based on self assessment continue to strengthen and improve procurement capability across Central Civil Government? OGC is currently working with UK Government Departments to carry out their PCRs using a self-assessment tool which incorporates qualitative and quantitative measures. Results are generated based on a capability maturity model. The results are assured independently. OGC expectations are that tangible and measurable capability improvements will be realised when departments embed the self-assessment model and implement the findings as part of a continuous improvement regime. This paper is a case study, using some relevant literature to reflect on past and possible future development of the PCR self assessment scheme.

Unique reporter-based sensor platforms to monitor signalling in cells

Introduction - In recent years much progress has been made in the development of tools for systems biology to study the levels of mRNA and protein, and their interactions within cells. However, few multiplexed methodologies are available to study cell signalling directly at the transcription factor level. Methods - Here we describe a sensitive, plasmid-based RNA reporter methodology to study transcription factor activation in mammalian cells, and apply this technology to profiling 60 transcription factors in parallel. The methodology uses two robust and easily accessible detection platforms; quantitative real-time PCR for quantitative analysis and DNA microarrays for parallel, higher throughput analysis. Findings - We test the specificity of the detection platforms with ten inducers and independently validate the transcription factor activation. Conclusions - We report a methodology for the multiplexed study of transcription factor activation in mammalian cells that is direct and not theoretically limited by the number of available reporters.

The SEC’s retail investor 2.0: Interactive data and the rise of calculative accountability

The Securities and Exchange Commission (SEC) in the United States mandated a new digital reporting system for US companies in late 2008. The new generation of information provision has been dubbed by Chairman Cox, ‘interactive data’ (SEC, 2006a). Despite the promise of its name, we find that in the development of the project retail investors are invoked as calculative actors rather than engaged in dialogue. Similarly, the potential for the underlying technology to be applied in ways to encourage new forms of accountability appears to be forfeited in the interests of enrolling company filers. We theorise the activities of the SEC and in particular its chairman at the time, Christopher Cox, over a three year period, both prior to and following the ‘credit crisis’. We argue that individuals and institutions play a central role in advancing the socio-technical project that is constituted by interactive data. We adopt insights from ANT (Callon, 1986; Latour, 1987, 2005b) and governmentality (Miller, 2008; Miller and Rose, 2008) to show how regulators and the proponents of the technology have acted as spokespersons for the interactive data technology and the retail investor. We examine the way in which calculative accountability has been privileged in the SEC’s construction of the retail investor as concerned with atomised, quantitative data (Kamuf, 2007; Roberts, 2009; Tsoukas, 1997). We find that the possibilities for the democratising effects of digital information on the Internet has not been realised in the interactive data project and that it contains risks for the very investors the SEC claims to seek to protect.

The impact of privatisation and regulation on the water and sewerage industry in England and Wales:a translog cost function approach

After the ten Regional Water Authorities (RWAs) of England and Wales were privatized in November 1989, the successor Water and Sewerage Companies (WASCs) faced a new regulatory regime that was designed to promote economic efficiency while simultaneously improving drinking water and environmental quality. As legally mandated quality improvements necessitated a costly capital investment programme, the industry's economic regulator, the Office of Water Services (Ofwat), implemented a retail price index (RPI)+K pricing system, which was designed to compensate the WASCs for their capital investment programme while also encouraging gains in economic efficiency. In order to analyse jointly the impact of privatization, as well as the impact of increasingly stringent economic and environmental regulation on the WASCs' economic performance, this paper estimates a translog multiple output cost function model for the period 1985–1999. Given the significant costs associated with water quality improvements, the model is augmented to include the impact of drinking water quality and environmental quality on total costs. The model is then employed to determine the extent of scale and scope economies in the water and sewerage industry, as well as the impact of privatization and economic regulation on economic efficiency.

Methods in mind

The evolution of cognitive neuroscience has been spurred by the development of increasingly sophisticated investigative techniques to study human cognition. In Methods in Mind, experts examine the wide variety of tools available to cognitive neuroscientists, paying particular attention to the ways in which different methods can be integrated to strengthen empirical findings and how innovative uses for established techniques can be developed. The book will be a uniquely valuable resource for the researcher seeking to expand his or her repertoire of investigative techniques. Each chapter explores a different approach. These include transcranial magnetic stimulation, cognitive neuropsychiatry, lesion studies in nonhuman primates, computational modeling, psychophysiology, single neurons and primate behavior, grid computing, eye movements, fMRI, electroencephalography, imaging genetics, magnetoencephalography, neuropharmacology, and neuroendocrinology. As mandated, authors focus on convergence and innovation in their fields; chapters highlight such cross-method innovations as the use of the fMRI signal to constrain magnetoencephalography, the use of electroencephalography (EEG) to guide rapid transcranial magnetic stimulation at a specific frequency, and the successful integration of neuroimaging and genetic analysis. Computational approaches depend on increased computing power, and one chapter describes the use of distributed or grid computing to analyze massive datasets in cyberspace. Each chapter author is a leading authority in the technique discussed.

Warfarin toxicity: do discharge ICD-10 codes and yellow cards accurately identify serious adverse drug reactions?

Focal points: ICD-10 codings and spontaneous yellow card reports for warfarin toxicity were compared retrospectively over a one-year period Eighteen cases of ICD-10 coded warfarin toxicity were identified from a total of 55,811 coded episodes More than three times as many ADRs to warfarin were found by screening ICD-10 codes as were reported spontaneously using the yellow card scheme Valuable information is being lost to regulatory authorities and as recognised reporters to the yellow card scheme, pharmacists are well placed to report these ADRs, enhancing their role in the safe and appropriate prescribing of warfarin