Implementation of automated reporting of estimated glomerular filtration rate among Veterans Affairs laboratories: a retrospective study.

BACKGROUND: Automated reporting of estimated glomerular filtration rate (eGFR) is a recent advance in laboratory information technology (IT) that generates a measure of kidney function with chemistry laboratory results to aid early detection of chronic kidney disease (CKD). Because accurate diagnosis of CKD is critical to optimal medical decision-making, several clinical practice guidelines have recommended the use of automated eGFR reporting. Since its introduction, automated eGFR reporting has not been uniformly implemented by U. S. laboratories despite the growing prevalence of CKD. CKD is highly prevalent within the Veterans Health Administration (VHA), and implementation of automated eGFR reporting within this integrated healthcare system has the potential to improve care. In July 2004, the VHA adopted automated eGFR reporting through a system-wide mandate for software implementation by individual VHA laboratories. This study examines the timing of software implementation by individual VHA laboratories and factors associated with implementation. METHODS: We performed a retrospective observational study of laboratories in VHA facilities from July 2004 to September 2009. Using laboratory data, we identified the status of implementation of automated eGFR reporting for each facility and the time to actual implementation from the date the VHA adopted its policy for automated eGFR reporting. Using survey and administrative data, we assessed facility organizational characteristics associated with implementation of automated eGFR reporting via bivariate analyses. RESULTS: Of 104 VHA laboratories, 88% implemented automated eGFR reporting in existing laboratory IT systems by the end of the study period. Time to initial implementation ranged from 0.2 to 4.0 years with a median of 1.8 years. All VHA facilities with on-site dialysis units implemented the eGFR software (52%, p<0.001). Other organizational characteristics were not statistically significant. CONCLUSIONS: The VHA did not have uniform implementation of automated eGFR reporting across its facilities. Facility-level organizational characteristics were not associated with implementation, and this suggests that decisions for implementation of this software are not related to facility-level quality improvement measures. Additional studies on implementation of laboratory IT, such as automated eGFR reporting, could identify factors that are related to more timely implementation and lead to better healthcare delivery.

Property in body parts and products of the human body

An intriguing question, which until recently had not been directly explored by the courts, is the extent to which English law recognises body parts and products of the human body as property capable of ownership. Although the common law currently recognises no general property in a dead body (and only limited possessory rights in respect of it), this apparent “no-property rule” provides no justification, it is submitted, for denying proprietary status to parts or products of a living human body. The recent decision of the Court of Appeal in Yearworth v. North Bristol NHS Trust ([2009] EWCA Civ 37) lends strong support to the view that genetic material (as the product of a living human body) is capable of ownership, at least in the context of a claim in the tort of negligence and bailment. This article examines the various issues by reference to both English and Commonwealth authority.

Meaning of "residing with" and succession rights

Reviews case law on the meaning of the phrase "residing with" as used in the Housing Act 1985 s.87 to identify one of the qualifying requirements for the right to succeed to a secure tenancy. Focuses on the Court of Appeal decision in Freeman v Islington LBC on whether a daughter intended to have her settled home with her father where, in the year preceding her father's death she lived with him full time in order to care for him whilst retaining her own flat and using it as her correspondence address for everything but her credit card. Lists conclusions that can be drawn from the case law.

Termination of tenancies for tenant default: Law Commission's draft Bill

Reviews key proposals of a draft Bill set out in Command Paper: The Law Commission: Termination of Tenancies for Tenant Default (Cm.6946), aimed at replacing the existing law on forfeiture of tenancies. Summarises the main elements of the proposed termination action by landlords, the events justifying such an action, the time limits for serving default notices, the revised range of court orders available and the considerations influencing which type of order to make. Examines the position of qualifying interest holders and the circumstances in which summary termination notices are prohibited.

Estoppel and the interests of the prospective beneficiary

Reviews case law concerning proprietary and testamentary estoppel. Examines two cases in which an elderly person made certain comments and encouraged an understanding between themselves and the claimants, that on death properties would be left to them, but where the requisite legal formalities were not undertaken. Illustrates the contrasting courts' approach, once estoppel has been established, in finding the appropriate remedy to satisfy and considers the challenges faced by the courts in differentiating between constructive trust and proprietary estoppel. [From Legal Journals Index]

The Fraud Act 2006: some early observations and comparisons with the former law

Provides a detailed analysis of the Fraud Act 2006 provisions on the offence of fraud by false representation (s.2) and the offence of obtaining services dishonestly (s.11) and assesses the extent to which they address problems arising in connection with the former deception offences under the Theft Acts 1968 and 1978. [From Legal Journals Index]

Recovery of a biodiversity action plans species in northwest England: possible role of climate change, artificial habitat and water quality amelioration. Occasional Publication of the Marine Biological Association 16

The honeycomb reef worm Sabellaria alveolata is recognised as being an important component of intertidal communities. It is a priority habitat within the UK Biodiversity Action Plan and as a biogenic reef forming species is covered by Annex 1 of the EC habitats directive. S. alveolata has a lusitanean (southern) distribution, being largely restricted to the south and west coasts of England. A broad-scale survey of S. alveolata distribution along the north-west coasts was undertaken in 2003/2004. These records were then compared with previous distribution records, mainly those collected by Cunningham in 1984. More detailed mapping was carried out at Hilbre Island at the mouth of the River Dee, due to recent reports that S. alveolata had become re-established there after a long absence.

Discovering keys to explain social policies within the social and democratic rule-of-law sate

There is a collective worldview on social policies that is expressed and understood by university professionals. However, it takes students time to construct this knowledge. Here, we provide fundamental ideas and a dynamic to facilitate learning of social policies. The preparation of a brief dictionary of significant terms is to be constructed as a group, alongside the maieutic work to be carried out by the teacher. The goal is to discover keys to understand the meaning of social policies and the underlying values that sustain a social and democratic rule-of-law state such as the one proposed in the Spanish Constitution of 1978. Attention is focused on the structure of the mixed welfare state. This is an integral proposal and comprises three dimensions. First, it considers the state and its possible welfare agents: business, market, the Church and civil society. The attitudes with which universal and inclusive social action is promoted, breaking radically with the aid-based meaning contained in other systems, are then addressed. Finally, we examine human dignity as a principle and aim of intervention, a basis for understanding other concepts such as human, social, labour and political rights. It is to be hoped that these pages prove useful for both teaching staff and students.