A model to assess the cost effectiveness of statins in achieving the UK National Service Framework target cholesterol levels

Background: Coronary heart disease (CHD) is a public health priority in the UK. The National Service Framework (NSF) has set standards for the prevention, diagnosis and treatment of CHD, which include the use of cholesterol-lowering agents aimed at achieving targets of blood total cholesterol (TC) < 5.0 mmol/L and low density lipoprotein-cholesterol (LDL-C) < 3.0 mmol/L. In order to achieve these targets cost effectively, prescribers need to make an informed choice from the range of statins available. Aim: To estimate the average and relative cost effectiveness of atorvastatin, fluvastatin, pravastatin and simvastatin in achieving the NSF LDL-C and TC targets. Design: Model-based economic evaluation. Methods: An economic model was constructed to estimate the number of patients achieving the NSF targets for LDL-C and TC at each dose of statin, and to calculate the average drug cost and incremental drug cost per patient achieving the target levels. The population baseline LDL-C and TC, and drug efficacy and drug costs were taken from previously published data. Estimates of the distribution of patients receiving each dose of statin were derived from the UK national DIN-LINK database. Results: The estimated annual drug cost per 1000 patients treated with atorvastatin was £289 000, with simvastatin £315 000, with pravastatin £333 000 and with fluvastatin £167 000. The percentages of patients achieving target are 74.4%, 46.4%, 28.4% and 13.2% for atorvastatin, simvastatin, pravastatin and fluvastatin, respectively. Incremental drug cost per extra patient treated to LDL-C and TC targets compared with fluvastafin were £198 and £226 for atorvastatin, £443 and £567 for simvastatin and £1089 and £2298 for pravastatin, using 2002 drug costs. Conclusions: As a result of its superior efficacy, atorvastatin generates a favourable cost-effectiveness profile as measured by drug cost per patient treated to LDL-C and TC targets. For a given drug budget, more patients would achieve NSF LDL-C and TC targets with atorvastatin than with any of the other statins examined.

The unequal segmentation of public preparedness for mass evacuation:a cross-national perspective

This thesis is concerned with understanding how Emergency Management Agencies (EMAs) influence public preparedness for mass evacuation across seven countries. Due to the lack of cross-national research (Tierney et al., 2001), there is a lack of knowledge on EMAs perspectives and approaches to the governance of public preparedness. This thesis seeks to address this gap through cross-national research that explores and contributes towards understanding the governance of public preparedness. The research draws upon the risk communication (Wood et al., 2011; Tierney et al., 2001) social marketing (Marshall et al., 2007; Kotler and Lee, 2008; Ramaprasad, 2005), risk governance (Walker et al., 2010, 2013; Kuhlicke et al., 2011; IRGC, 2005, 2007; Renn et al., 2011; Klinke and Renn, 2012), risk society (Beck, 1992, 1999, 2002) and governmentality (Foucault, 1978, 2003, 2009) literature to explain this governance and how EMAs responsibilize the public for their preparedness. EMAs from seven countries (Belgium, Denmark, Germany, Iceland, Japan, Sweden, the United Kingdom) explain how they prepare their public for mass evacuation in response to different types of risk. A cross-national (Hantrais, 1999) interpretive research approach, using qualitative methods including semi-structured interviews, documents and observation, was used to collect data. The data analysis process (Miles and Huberman, 1999) identified how the concepts of risk, knowledge and responsibility are critical for theorising how EMAs influence public preparedness for mass evacuation. The key findings grounded in these concepts include: - Theoretically, risk is multi-functional in the governance of public preparedness. It regulates behaviour, enables surveillance and acts as a technique of exclusion. - EMAs knowledge and how this influenced their assessment of risk, together with how they share the responsibility for public preparedness across institutions and the public, are key to the governance of public preparedness for mass evacuation. This resulted in a form of public segmentation common to all countries, whereby the public were prepared unequally.  - EMAs use their prior knowledge and assessments of risk to target public preparedness in response to particular known hazards. However, this strategy places the non-targeted public at greater risk in relation to unknown hazards, such as a man-made disaster. - A cross-national conceptual framework of four distinctive governance practices (exclusionary, informing, involving and influencing) are utilised to influence public preparedness. - The uncertainty associated with particular types of risk limits the application of social marketing as a strategy for influencing the public to take responsibility and can potentially increase the risk to the public.

Developing a robust self evaluation framework for active learning:the first stage of an ERASMUS+ project (QAEMarketPlace4HEI)

In ensuring the quality of learning and teaching in Higher Education, self-evaluation is an important component of the process. An example would be the approach taken within the CDIO community whereby self-evaluation against the CDIO standards is part of the quality assurance process. Eight European universities (Reykjavik University, Iceland; Turku University of Applied Sciences, Finland; Aarhus University, Denmark; Helsinki Metropolia University of Applied Sciences, Finland; Ume? University, Sweden; Telecom Bretagne, France; Aston University, United Kingdom; Queens University Belfast, United Kingdom) are engaged in an EU funded Erasmus + project that is exploring the quality assurance process associated with active learning. The development of a new self-evaluation framework that feeds into a ?Marketplace? where participating institutions can be paired up and then engage in peer evaluations and sharing around each institutions approach to and implementation of active learning. All of the partner institutions are engaged in the application of CDIO within their engineering programmes and this has provided a common starting point for the partnership to form and the project to be developed. Although the initial focus will be CDIO, the longer term aim is that the approach could be of value beyond CDIO and within other disciplines. The focus of this paper is the process by which the self-evaluation framework is being developed and the form of the draft framework. In today?s Higher Education environment, the need to comply with Quality Assurance standards is an ever present feature of programme development and review. When engaging in a project that spans several countries, the wealth of applicable standards and guidelines is significant. In working towards the development of a robust Self Evaluation Framework for this project, the project team decided to take a wide view of the available resources to ensure a full consideration of different requirements and practices. The approach to developing the framework considered: a) institutional standards and processes b) national standards and processes e.g. QAA in the UK c) documents relating to regional / global accreditation schemes e.g. ABET d) requirements / guidelines relating to particular learning and teaching frameworks e.g. CDIO. The resulting draft self-evaluation framework is to be implemented within the project team to start with to support the initial ?Marketplace? pairing process. Following this initial work, changes will be considered before a final version is made available as part of the project outputs. Particular consideration has been paid to the extent of the framework, as a key objective of the project is to ensure that the approach to quality assurance has impact but is not overly demanding in terms of time or paperwork. In other words that it is focused on action and value added to staff, students and the programmes being considered.

Managing healthcare performance in analytical framework

Purpose – The purpose of the paper is to develop an integrated framework for performance management of healthcare services. Design/methodology/approach – This study develops a performance management framework for healthcare services using a combined analytic hierarchy process (AHP) and logical framework (LOGFRAME). The framework is then applied to the intensive care units of three different hospitals in developing nations. Numerous focus group discussions were undertaken, involving experts from the specific area under investigation. Findings – The study reveals that a combination of outcome, structure and process-based critical success factors and a combined AHP and LOGFRAME-based performance management framework helps manage performance of healthcare services. Practical implications – The proposed framework could be practiced in hospital-based healthcare services. Originality/value – The conventional approaches to healthcare performance management are either outcome-based or process-based, which cannot reveal improvement measures appropriately in order to assure superior performance. Additionally, they lack planning, implementing and evaluating improvement projects that are identified from performance measurement. This study presents an integrated approach to performance measurement and implementing framework of improvement projects.

Project risk management in analytic framework

Risks and uncertainties are part and parcel of any project as projects are planned with many assumptions. Therefore, managing those risks is the key to project success. Although risk is present in all most all projects, large-scale construction projects are most vulnerable. Risk is by nature subjective. However, managing risk subjectively posses the danger of non-achievement of project goals. This study introduces an analytical framework for managing risk in projects. All the risk factors are identified, their effects are analyzed, and alternative responses are derived with cost implication for mitigating the identified risks. A decision-making framework is then formulated using decision tree. The expected monetary values are derived for each alternative. The responses, which require least cost is selected. The entire methodology has been explained through a case study of an oil pipeline project in India and its effectiveness in managing projects has been demonstrated. © INTERNATIONAL JOURNAL OF INDUSTRIAL ENGINEERING.

Managing healthcare quality using logical framework analysis

Purpose - The purpose of this paper is to develop an integrated quality management model that identifies problems, suggests solutions, develops a framework for implementation and helps to evaluate dynamically healthcare service performance. Design/methodology/approach - This study used the logical framework analysis (LFA) to improve the performance of healthcare service processes. LFA has three major steps - problems identification, solution derivation, and formation of a planning matrix for implementation. LFA has been applied in a case-study environment to three acute healthcare services (Operating Room utilisation, Accident and Emergency, and Intensive Care) in order to demonstrate its effectiveness. Findings - The paper finds that LFA is an effective method of quality management of hospital-based healthcare services. Research limitations/implications - This study shows LFA application in three service processes in one hospital. This very limited population sample needs to be extended. Practical implications - The proposed model can be implemented in hospital-based healthcare services in order to improve performance. It may also be applied to other services. Originality/value - Quality improvement in healthcare services is a complex and multi-dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in healthcare delivery, they are not without flaws. There is an absence of an integrated approach, which can identify and analyse issues, provide solutions to resolve those issues, develop a project management framework to implement those solutions. This study introduces an integrated and uniform quality management tool for healthcare services. © Emerald Group Publishing Limited.

Probabilistic uncertainty in an interoperable framework

This thesis provides an interoperable language for quantifying uncertainty using probability theory. A general introduction to interoperability and uncertainty is given, with particular emphasis on the geospatial domain. Existing interoperable standards used within the geospatial sciences are reviewed, including Geography Markup Language (GML), Observations and Measurements (O&M) and the Web Processing Service (WPS) specifications. The importance of uncertainty in geospatial data is identified and probability theory is examined as a mechanism for quantifying these uncertainties. The Uncertainty Markup Language (UncertML) is presented as a solution to the lack of an interoperable standard for quantifying uncertainty. UncertML is capable of describing uncertainty using statistics, probability distributions or a series of realisations. The capabilities of UncertML are demonstrated through a series of XML examples. This thesis then provides a series of example use cases where UncertML is integrated with existing standards in a variety of applications. The Sensor Observation Service - a service for querying and retrieving sensor-observed data - is extended to provide a standardised method for quantifying the inherent uncertainties in sensor observations. The INTAMAP project demonstrates how UncertML can be used to aid uncertainty propagation using a WPS by allowing UncertML as input and output data. The flexibility of UncertML is demonstrated with an extension to the GML geometry schemas to allow positional uncertainty to be quantified. Further applications and developments of UncertML are discussed.

Community knowledge management (CKM): a framework for community action

Knowledge management (KM) is a developing field that focuses on harnessing knowledge for use by a person or community. However, most KM research focuses on improving decision making capacity in business communities, neglecting applications in wider society and non-decision making activities. This paper explores the potential of KM for rural communities, specifically for those that want to preserve their social history and collective memories (what we call heritage) to enrich the lives of others. In KM terms, this is a task of accumulating and recording knowledge to enable its retention for future use. We report a case study of Cardrona, a valley of approximately 120 people in New Zealand’s South Island. Realising that time would erode knowledge of their community a small, motivated group of residents initiated a KM programme to create a legacy for a wider community including younger generations, tourists and scholars. This paper applies KM principles to rural communities that want to harness their collective knowledge for wider societal gain, and develops a framework to accommodate them. As a result, we call for a wider conceptualization of KM to include motives for managing knowledge beyond decision making to accommodate community KM (cKM).

Implementation of a generic autonomic framework

Based on insights from the implementation of commercial products for data-centre resource management, we identified key challenges in the development of cost-effective autonomic solutions, and best practices for overcoming these challenges. In a related paper, we proposed a generic autonomic framework that complies with these best practices, and suggested ways in which existing technologies could be used to realise this framework. In this paper, we describe the actual implementation of our autonomic framework as a service-oriented architecture, and we show how the universal policy engine at its core can be configured to manage the allocation of server capacity to services of different priorities. This case study demonstrates the effectiveness of our generic approach to autonomic solution development in an area of great interest for commercial data centres, research laboratories and application service providers.

Investigating Turkey's national innovation and learning system

The national systems of innovation (NIS) approach focuses on the patterns and the determinants of innovation processes from the perspective of nation-states. This paper reports on continuing work on the application of an NIS model to the development of technological capability in Turkey. Initial assessment of the literature shows that there are a number of alternative conceptualisations of NIS. An attempt by the Government to identify a NIS for Turkey shows the main actors in the system but does not pay sufficient attention to the processes of interactions between agents within the system. An operational model should be capable of representing these processes and interactions and assessing the strengths and weaknesses of the NIS. For industrialising countries, it is also necessary to incorporate learning mechanisms into the model. Further, there are different levels of innovation and capability in different sectors which the national perspective may not reflect. This paper is arranged into three sections. The first briefly explains the basics of the national innovation and learning system. Although there is no single accepted definition of NIS, alternative definitions reviewed share some common characteristics. In the second section, an NIS model is applied to Turkey in order to identify the elements, which characterise the country’s NIS. This section explains knowledge flow and defines the relations between the actors within the system. The final section draws on the “from imitation to innovation” model apparently so successful in East Asia and assesses its applicability to Turkey. In assessing Turkey’s NIS, the focus is on the automotive and textile sectors.

Strategy and control systems:a framework for analysis

This research explores the links between the strategies adopted by companies and the mechanisms used to control the organisation. This is not seen as a one way process with the control system following from the strategy but rather as an interactive process between the control systems, the environment and the business strategy. The main proposition of the research, derived from a review of the relevant literature, is that the dimensions of Business Pro-Activity and Environmental Change provide a plausible explanation of the reasons why companies need to adopt different strategies in order to be successful in different markets. A model is proposed which links these dimensions with the business strategy, organisational structure, strategic planning system and management control systems. The model is used as a framework for analysing four companies in order to further our understanding of these interactions and the mechanisms which act to both promote and resist change. Whilst it is not suggested that the model in its present form is a perfect instrument it has, during the course of this research, proved to be an appropriate framework for analysing the various mechanisms used by four companies to formulate and implement their strategies. The research reveals that these should not be viewed independently but as a balanced system.

The impact of national cultures and interpersonal factors on managerial communication

This study was undertaken for two primary purposes. The first was to discover whether or not two of the four cultural dimensions depicted by Hof-stede (1980), namely Power Distance and Uncertainty Avoidance, could be repeated using samples from seven organizations operating in three distinct cultural settings. The second was to assess the degree to which these dimensions affect superior-subordinate communication across the culturally-different groups. Also, the impact of the three interpersonal factors: Trust in Superior, Upward Influence and Mobility Aspirations was investigated cross-culturally. Participants were 291 managers from seven organizations; four Sudanese, two white British and an organization in Britain run by a group of British citizens of Pakistani extraction. It was hypothesized that the Power Distance and Uncertainty Avoidance of the three groups would replicate Hof-stede's. Specific implications of these dimensions for organizational communication and in particular for superior-subordinate communication were also hypothesized. Multiple regression analyses were performed with items of the two cultural dimensions and the three interpersonal factors (each in turn) forming the independent variables, while the organizational communication aspects formed the dependent variables. T-tests between means were also used to compare and contrast issues such as directionality of information flow across organizations operating in these settings. Work-related values of each of the three cultural groups provided support for Hofstede's model. However, only tentative support was given to the hypothesized relationships between the cultural dimensions and organizational communication. Similarly, weak associations were found between the three interpersonal factors and superior-subordinate communication behaviour. Some practical and theoretical implications are offered. An evaluation of the study and recommendation for further research are also given.

A study of national physical planning policy

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