Skin cancer clinics in Australia: workload profile and performance indicators from an analysis of billing data

Objective: To describe the workload profile in a network of Australian skin cancer clinics. Design and setting: Analysis of billing data for the first 6 months of 2005 in a primary-care skin cancer clinic network, consisting of seven clinics and staffed by 20 doctors, located in the Northern Territory, Queensland and New South Wales. Main outcome measures: Consultation to biopsy ratio (CBR); biopsy to treatment ratio (BTR); number of benign naevi excised per melanoma (number needed to treat [NNT]). Results: Of 69780 billed activities, 34 622 (49.6%) were consultations, 19 358 (27.7%) biopsies, 8055 (11.5%) surgical excisions, 2804 (4.0%) additional surgical repairs, 1613 (2.3%) non-surgical treatments of cancers and 3328 (4.8%) treatments of premalignant or non-malignant lesions. A total of 6438 cancers were treated (116 melanomas by excision, 4709 non-melanoma skin cancers [NMSCs] by excision, and 1613 NMSCs non-surgically); 5251 (65.2%) surgical wounds were repaired by direct suture, 2651 (32.9%) by a flap (of which 44.8% were simple flaps), 42 (0.5%) by wedge excision and 111 (1.4%) by grafts. The CBR was 1.79, the BTR was 3.1 and the NNT was 28.6. Conclusions: In this network of Australian skin cancer clinics, one in three biopsies identified a skin cancer (BTR, 3.1), and about 29 benign lesions were excised per melanoma (NNT, 28.6). The estimated NNT was similar to that reported previously in general practice. More data are needed on health outcomes, including effectiveness of treatment and surgical repair.

Selection of power market structure using the analytic hierarchy process

Selection of a power market structure from the available alternatives is an important activity within an overall power sector reform programme. The evaluation criteria for selection are both subjective as well as objective in nature and the selection of alternatives is characterised by their conflicting nature. This study demonstrates a methodology for power market structure selection using the analytic hierarchy process (AHP), a multiple attribute decision-making technique, to model the selection methodology with the active participation of relevant stakeholders in a workshop environment. The methodology is applied to a hypothetical case of a State Electricity Board reform in India.

Impacto do Programa Saúde da Família sobre indicadores de saúde da criança em municípios de grande porte da região Nordeste do Brasil

The present study carried out in the context of the Baseline Studies of the PROESF was aimed at evaluating the impact of the Family Health Program (PSF) on indicators for child health in cities with more than 100,000 inhabitants in the Brazilian Northeast. Four cities were investigated. In each one, twenty censual sectors were selected randomly from areas covered by the PSF and compared with twenty sectors selected from areas not covered by the PSF on the basis of socioeconomic criteria. In most cases, no significant differences were found between the areas covered and not covered by the PSF. The only difference found was a significantly lower rate of hospital admissions due to diarrhea but this was on account of the Program of Community Health Agents. The PSF exerted no additional effect on the reduction of this indicator. It was also observed that the way by which the program is implemented in each city interferes directly in the results. Thus, there is no basis for considering the PSF per se ineffective or not differing from other programs with regard to its health care patterns. An evaluation of the PSF would necessarily have to include an analysis of the way the program is implemented and conducted in each case, besides considering its general socioeconomical and political characteristics.

Jogos eletrônicos de movimento e educação física: uma revisão sistemática

v. 19, n. 2, abr./jun. 2016.

Bioexploration of wild Alaskan berries: From field screening to functional food

Wild berries are fundamental components of traditional diet and medicine for Native American and Alaska Native tribes and contain a diverse array of phytochemicals, including anthocyanins and proanthocyanidins, with known efficacy against metabolic disorders. Bioexploration represents a new paradigm under which bioactive preparations are screened in coordination with indigenous communities, to prepare for subsequent in-depth chemical and biological analysis. The inclusive, participatory philosophical approach utilized in bioexploration has additional benefits that could be realized in seemingly disparate areas, such as education and economics. Five species of wild Alaskan berries (Vaccinium uliginosum, V. ovalifolium, Empetrum nigrum, Rubus chamaemorus, and R. spectabilis) were tested using “Screens-to-Nature” (STN), a community-participatory approach to screen for potential bioactivity, in partnership with tribal members from three geographically distinct Alaskan villages: Akutan, Seldovia, and Point Hope. Berries were subsequently evaluated via HPLC and LC-MS2, yielding significant species and location-based variation in anthocyanins (0.9-438.6 mg eq /100g fw) and proanthocyanins (73.7-625.2 mg eq /100g fw). A-type proanthocyanidin dimers through tetramers were identified in all species tested. Berries were analyzed for in vitro and in vivo activity related to diabetes and obesity. R. spectabilis samples increased preadipocyte-factor-1 levels by 82% over control, and proanthocyanidin-rich fractions from multiple species reduced lipid accumulation in 3T3-L1 adipocytes. Furthermore, extracts of V. uliginosum and E. nigrum (Point Hope) reduced serum glucose levels in C57bl/6j mice up to 45%. The same precepts of bioexploration, especially the inclusion of indigenous community perspectives and knowledge, have relevance in other areas of study, such as education and economics. Studies have established the apathetic, low-motivational environment characteristic of many introductory science laboratory classes is detrimental to student interest, learning, and continuation in scientific education. A primary means of arresting this decline and stimulating the students’ attention and excitement is via engagement in hands-on experimentation and research. Using field workshops, the STN system is investigated as to its potential as a novel participatory educational tool, using assays centered around bioexploration and bioactive plant compounds that hold the potential to offset human health conditions. This evaluation of the STN system provided ample evidence as to its ability to augment and improve science education. Furthermore, Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was employed as a theoretical framework to review the potential benefits and hurdles associated with developing a wild Alaskan berry commodity. Synthesizing various sources of information – including logistics and harvest costs, sources of initial capital, opportunities in the current superfruit industry, and socioeconomic factors – the development of a berry commodity proves to be a complex amalgam of competing factors which would require a delicate balance before proceeding.

Systematic reviews as a tool for planning and interpreting trials

Background Systematic reviews followed by ameta-analysis are carried out in medical research to combine the results of two or more related studies. Stroke trials have struggled to show beneficial effects and meta-analysis should be used more widely throughout the research process to either speed up the development of useful interventions, or halt more quickly research with hazardous or ineffective interventions. Summary of review. This review summarises the clinical research process and illustrates how and when systematic reviews may be used throughout the development programme. Meta-analyses should be performed after observational studies, preclinical studies in experimental stroke, and after phase I, II, and III clinical trials and phase IV clinical surveillance studies. Although meta-analyses most commonly work with summary data, they may be performed to assess relationships between variables (meta-regression) and, ideally, should utilise individual patient data. Meta-analysis techniques may alsoworkwith ordered categorical outcome data (ordinal meta-analysis) and be used to perform indirect comparisons where original trial data do not exist. Conclusion Systematic review/meta-analyses are powerful tools in medical research and should be used throughout the development of all stroke and other interventions

Management interventions in dairy herds: exploring within herd uncertainty using an integrated Bayesian model

Knowledge of the efficacy of an intervention for disease control on an individual farm is essential to make good decisions on preventive healthcare, but the uncertainty in outcome associated with undertaking a specific control strategy has rarely been considered in veterinary medicine. The purpose of this research was to explore the uncertainty in change in disease incidence and financial benefit that could occur on different farms, when two effective farm management interventions are undertaken. Bovine mastitis was used as an example disease and the research was conducted using data from an intervention study as prior information within an integrated Bayesian simulation model. Predictions were made of the reduction in clinical mastitis within 30 days of calving on 52 farms, attributable to the application of two herd interventions previously reported as effective; rotation of dry cow pasture and differential dry cow therapy. Results indicated that there were important degrees of uncertainty in the predicted reduction in clinical mastitis for individual farms when either intervention was undertaken; the magnitude of the 95% credible intervals for reduced clinical mastitis incidence were substantial and of clinical relevance. The large uncertainty associated with the predicted reduction in clinical mastitis attributable to the interventions resulted in important variability in possible financial outcomes for each farm. The uncertainty in outcome associated with farm control measures illustrates the difficulty facing a veterinary clinician when making an on-farm decision and highlights the importance of iterative herd health procedures (continual evaluation, reassessment and adjusted interventions) to optimise health in an individual herd.

Importância da avaliação da aptidão física : avaliação da aptidão cardiorrespiratória no Virgin Active Oeiras

O presente relatório diz respeito às atividades realizadas no âmbito de um estágio no Health Club Virgin Active Oeiras (VAO), com incidência sobre a importância da avaliação da aptidão física aos utentes. Este estágio decorreu ao longo do 2º ano de Mestrado em Exercício e Saúde da Faculdade de Motricidade Humana. Para além de uma descrição e reflexão sobre os métodos e procedimentos adotados no decorrer do estágio, este relatório tem como objetivo principal explorar questões relacionadas com a metodologia de avaliação física aos utentes neste clube de saúde, com vista à sua otimização. Perante isto, foram estudados os meios disponíveis para a operacionalização de um protocolo de avaliação que englobasse todas as componentes da aptidão física segundo as recomendações atuais, incluindo a vertente cardiorrespiratória que não era usualmente avaliada no clube. De forma a atingir os objetivos pretendidos, o processo de sensibilização da direção do Clube foi realizado através da avaliação da aptidão cardiorrespiratória a 100 utentes iniciantes. Esta abordagem mostrou que 47% dos utentes iniciantes possuía uma aptidão cardiorrespiratória abaixo do razoável. Uma vez que esta análise era limitada, tendo em conta a elevada população que frequenta o clube, foram ainda abordados 150 utentes não iniciantes, através de uma campanha denominada “coração saudável”, na qual constou incluiu um “vale” para a realização de uma avaliação da aptidão cardiorrespiratória e um questionário. Este questionário refletiu que aproximadamente 70% dos utentes nunca tinha sido sujeito a uma prova de esforço já tendo frequentado outros clubes de saúde. Outras abordagens aos utentes foram realizadas durante este processo, nomeadamente, a promoção de atividades de cariz cardiorrespiratório e a disponibilização e instrução quanto ao uso do cardio-frequêncimetro. Este relatório refletiu a necessidade de um clube de saúde diferenciar-se não só pelas infraestruturas e atividades oferecidas, mas também pela informação e educação dos utentes relativamente à aptidão física relacionada com a saúde e ao impacto do exercício físico na qualidade de vida de quem o pratica.

Economic evaluations of clinical pharmacy services in Ireland, 2007-2015

Introduction The concept of this thesis was driven by stagnation within the Irish healthcare system. Multiple reports from pharmacy organisations had outlined possible future directions for the profession but progress was minimal, especially in comparison with other countries. The author’s directive was to evaluate the economic impact of a series of clinical pharmacy services (CPS) in hospital and community settings. Methods A systematic review of economic evaluations of clinical pharmacy services in hospital patients was undertaken to gain insight into recent research in the field. Eligible studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), to establish the quality, consistency and transparency of relevant research. A retrospective analysis of an internal hospital pharmacy interventions database was conducted. A method first described by Nesbit et al. was implemented to estimate the level of cost avoidance achieved. A cost-effectiveness analysis based on data from a randomised controlled trial of a pharmacist-supervised patient self-testing (PST) of warfarin therapy is presented. Outcome measure was the incremental cost associated with six months of intervention management. A similar cost-effectiveness analysis based on previously published RCT data was used to evaluate a novel structured pharmacist review of medication in older hospitalised patients. Cost-effectiveness analysis was presented in the form of an incremental cost-effectiveness ratio (ICER). An ICER is an additional cost per unit effect, in the case of this study, the cost of preventing an additional non-trivial ADR in hospital. A method described by Preaud et al. was adapted to estimate the clinical and economic benefit gained from vaccination of patients by a community pharmacist in Ireland in 2013/14. Sample demographic data was obtained from a national chain of community pharmacies and applied to overall national vaccination data. Results Systematic review identified twenty studies which were eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15%) were deemed to be “good-quality” studies. No ‘novel’ clinical pharmacist intervention was identified during the course of this review. Analysis of internal hospital database identified 4,257 interventions documented on 2,147 individual patients over a 12 month period. Substantial cost avoidance of €710,000 was generated over a 1 year period from the perspective of the health care provider. Mean cost avoidance of €166 per intervention was generated. The cost of providing these interventions was €82,000. Substantial net cost-benefits of €626,279 and a cost-benefit ratio of 8.64 : 1 were generated based on this evaluation of pharmacist interventions. Results from an evaluation of a novel pharmacist-led form of warfarin management indicated indicated that on a per patient basis, PST was slightly more expensive than established anticoagulant management. On a per patient basis over a six month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Overall cost of managing a patient through pharmacist-supervised PST for a six month period is €226.45. However, for this increase in cost a clinically significant improvement in care was provided. Patients achieved a significantly higher time in therapeutic range during the PST arm in comparison with routine care, (72 ± 19.7% vs 59 ± 13.5%). Difference in overall cost was minimal and PST was the dominant strategy in some scenarios examined during sensitivity analysis. Structured pharmacist review of medication was determined to be dominant in comparison to usual pharmaceutical care. Even if the healthcare payer was unwilling to pay any money for the prevention of an ADR, the intervention strategy is still likely to be cost-effective (probability of being determined cost-effective = 0.707). Implementation of pharmacist-led influenza vaccination has resulted in substantial clinical and economic benefits to the healthcare system. The majority of patients (64.9%) who availed of this service had identifiable influenza-related risk factors. Of patients with influenza-related risk factors, age ≥65 year was the most commonly cited risk factor. Pharmacist vaccination services averted a total of 848 influenza cases across all age groups during the 2013/2014 influenza season. Due to receipt of vaccination in a pharmacy setting, 444 influenza-related GP visits were prevented. In terms of more serious influenza-associated events, 11 hospitalisations and five influenza-related deaths were averted. Costs averted were approximately €305,000. These were principally wider societal-related costs associated with lost productivity. Conclusion Overall, clinical pharmacy services are adding value to the Irish healthcare system in both hospital and community settings, but provision of additional funding for new services would enable them to offer a great deal more.

Acoso laboral y sus efectos en la salud del trabajador : revisión de la literatura

Introducción: Desde los años 80 se viene haciendo énfasis en el acoso laboral, conocido en otros países como Mobbing, describiéndose como una forma de abuso y violencia psicológica en el lugar de trabajo, realizado ya sea por una sola persona o por un grupo de personas y que por sus implicaciones se estima de alto impacto para los trabajadores, y las organizaciones. Considerando la importancia y prevalencia del mobbing en la sociedad actual, se convierte en un tema relevante para el área de salud ocupacional. Objetivo: El objetivo de este estudio fue identificar los efectos del acoso laboral generados en la salud del trabajador. Metodología: Se realizó una revisión sistemática utilizando el método PRISMA, de las publicaciones vigentes entre los años 2006 a 2016 sobre los efectos del acoso laboral en la salud del trabajador. En la búsqueda se obtuvieron 778 artículos de los cuales 27 cumplían con los criterios de inclusión. Resultados: se encontró que la prevalencia del acoso laboral puede ser diferente de acuerdo a la definición utilizada, instrumento de medida y población estudiada, la cual fluctúa entre el 7% al 88% según el estudio analizado. Además se evidenció que la prevalencia también difiere dependiendo de quién sea el perpetrador del acoso, si el líder o jefe es el acosador es mayor (60,3%) que cuando es causado por colegas o por clientes (41,5%). El impacto del acoso laboral, según la mayoría de los estudios, es que provoca efectos negativos en la salud emocional del trabajador siendo la depresión una de las principales consecuencias con una relación estadísticamente significativa (p<0,001). Las enfermedades del aparato respiratorio y del sistema musculo esquelético y del tejido conectivo fueron las que se presentaron con mayor frecuencia en los trabajadores que sufren de acoso con un 43,5% y un 37.8% respectivamente. Conclusiones: éstos resultados demuestran que el acoso laboral no solamente es un problema desde el punto de vista organizacional, sino que conlleva consecuencias en la salud mental y física de los trabajadores que lo sufren. Palabras clave: Mobbing, workplace, acoso laboral, acoso psicológico, bullying, harassment, salud ocupacional, occupational health.

NLG-Metricverse: An End-to-End Library for Evaluating Natural Language Generation

Driven by recent deep learning breakthroughs, natural language generation (NLG) models have been at the center of steady progress in the last few years. However, since our ability to generate human-indistinguishable artificial text lags behind our capacity to assess it, it is paramount to develop and apply even better automatic evaluation metrics. To facilitate researchers to judge the effectiveness of their models broadly, we suggest NLG-Metricverse—an end-to-end open-source library for NLG evaluation based on Python. This framework provides a living collection of NLG metrics in a unified and easy- to-use environment, supplying tools to efficiently apply, analyze, compare, and visualize them. This includes (i) the extensive support of heterogeneous automatic metrics with n-arity management, (ii) the meta-evaluation upon individual performance, metric-metric and metric-human correlations, (iii) graphical interpretations for helping humans better gain score intuitions, (iv) formal categorization and convenient documentation to accelerate metrics understanding. NLG-Metricverse aims to increase the comparability and replicability of NLG research, hopefully stimulating new contributions in the area.