Efficacy and Safety of Ticagrelor for Long-term Secondary Prevention of Atherothrombotic Events in Relation to Renal Function: Insights from the PEGASUS TIMI-54 trial

Aims: We evaluated the relationship of renal function and ischaemic and bleeding risk as well as the efficacy and safety of the P2Y12 platelet receptor inhibitor ticagrelor in stable patients with prior myocardial infarction (MI). Methods & Results: Patients with a history of MI 1-3 years prior from the Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin (PEGASUS)-TIMI 54 were stratified based on estimated glomerular filtration rate (eGFR), with<60 ml/min/1.73m2 prespecified for analysis of the effect of ticagrelor on the primary efficacy composite of cardiovascular death, MI, or stroke (MACE) and the primary safety endpoint of TIMI major bleeding. Of 20,898 patients, those with eGFR<60 (N=4,849, 23.2%) had a greater risk of MACE at 3 years relative to those without, which remained significant after multivariable adjustment (HRadj 1.54, 95% CI 1.27–1.85, p<0.001). The relative risk reduction in MACE with ticagrelor was similar in those with eGFR<60 (ticagrelor pooled vs. placebo: HR 0.81; 95% CI 0.68–0.96) vs. ≥60 (HR 0.88; 95% CI 0.77–1.00, pinteraction=0.44). However, due to the greater absolute risk in the former group, the absolute risk reduction with ticagrelor was higher: 2.7% vs. 0.63%. Bleeding tended to occur more frequently in patients with renal dysfunction. The absolute increase in TIMI major bleeding with ticagrelor was similar in those with and without eGFR<60 (1.19% vs. 1.43%), whereas the excess of minor bleeding tended to be more pronounced (1.93% vs. 0.69%). Conclusion: In patients with a history of MI, patients with renal dysfunction are at increased risk of MACE and consequently experience a particularly robust absolute risk reduction with long-term treatment with ticagrelor.

An evaluation of the epidemiology of medication discrepancies and clinical significance of medicines reconciliation in children admitted to hospital

Aims: To determine the incidence of unintended medication discrepancies in paediatric patients at the time of hospital admission; evaluate the process of medicines reconciliation; assess the benefit of medicines reconciliation in preventing clinical harm. Method: A 5 month prospective multisite study. Pharmacists at four English hospitals conducted admission medicines reconciliation in children using a standardised data collection form. A discrepancy was defined as a difference between the patient's preadmission medication (PAM), compared with the initial admission medication orders written by the hospital doctor. The discrepancies were classified into intentional and unintentional discrepancies. The unintentional discrepancies were assessed for potential clinical harm by a team of healthcare professionals, which included doctors, pharmacists and nurses. Results: Medicines reconciliation was conducted in 244 children admitted to hospital. 45% (109/244) of the children had at least one unintentional medication discrepancy between the PAM and admission medication order. The overall results indicated that 32% (78/244) of patients had at least one clinically significant unintentional medication discrepancy with potential to cause moderate 20% (50/244) or severe 11% (28/244) harm. No single source of information provided all the relevant details of a patient's medication history. Parents/carers provided the most accurate details of a patient's medication history in 81% of cases. Conclusions: This study demonstrates that in the absence of medicines reconciliation, children admitted to hospitals across England are at risk of harm from unintended medication discrepancies at the transition of care from the community to hospital. No single source of information provided a reliable medication history.

International technology transfer:perceptions and reality of quality and reliability

Impressions about product quality and reliability can depend as much on perceptions about brands and country of origin as on data regarding performance and failure. This has implications for companies in developing countries that need to compete with importers. For manufacturers in industrialised countries it has implications for the value of transferred technologies. This article considers the issue of quality and reliability when technology is transferred between countries with different levels of development. It is based on UK and Chinese company case studies and questionnaire surveys undertaken among three company groups: UK manufacturers; Chinese manufacturers; Chinese users. Results show that all three groups recognise quality and reliability as important and support the premise that foreign technology based machines made in China carry a price premium over Chinese machines based on local technology. Closer examination reveals a number of important differences concerning the perceptions and reality of quality and reliability between the groups.

Perceptions of journal quality and research paradigm:results of a web-based survey of British accounting academics

This paper reports the results of a web-based perception study of the ranking of peer reviewed accounting journals by UK academics. The design of the survey instrument allows an interactive selection of journals to be scored. The webbased format is unique in that it also includes a step in which respondents classify the journals according to methodological perspective (paradigm). This is depicted graphically in the paper in a bubble diagram that shows the "positioning" of journals according to perceptions of both paradigm and quality.

Is there a trade-off between quality and productivity? The case of diagnostic technologies in Portugal

The purpose of this paper is twofold: first, we compute quality-adjusted measures of productivity change for the three most important diagnostic technologies (i.e., the Computerised Tomography Scan, Electrocardiogram and Echocardiogram) in the major Portuguese hospitals. We use the Malmquist–Luenberger index, which allows to measure productivity growth while controlling for the quality of the production. Second, using non-parametric tests, we analyse whether the implementation of the Prospective Payment System may have had a positive impact on the movements of productivity over time. The results show that the PPS has helped hospitals to use these tools more efficiently and to improve their effectiveness.

Evaluating service quality and customer satisfaction evaluation in an emerging markets

Developing economies offer tremendous potential for future growth and organizations appreciating these consumers’ requirements stand to reap considerable returns. However, compared with more developed economies published consumer studies are few. In particular, there is a dearth of service quality research and hardly any from Africa. Furthermore, the little available research tends to apply Western methodologies, which may not be entirely appropriate. This research investigates East African consumer perceptions of retail banking using an approach that takes account of the research context. Qualitative research was undertaken to define the relevant service attributes. Performance along these was then investigated through a survey with over 2000 respondents. Principal component analysis identifies 13 core service dimensions and multinomial logistic regression reveals which are the key drivers of customer satisfaction. Comparison of the results with studies from other regions confirms that established standardized research instruments are likely to miss or under-represent service attributes important in developing countries.

The effect of lignin and inorganic species in biomass on pyrolysis oil yields, quality and stability

This paper investigates four reference fuels and three low lignin Lolium Festuca grasses which were subjected to pyrolysis to produce pyrolysis oils. The oils were analysed to determine their quality and stability, enabling the identification of feedstock traits which affect oil stability. Two washed feedstocks were also subjected to pyrolysis to investigate whether washing can enhance pyrolysis oil quality. It was found that the mineral matter had the dominate effect on pyrolysis in compared to lignin content, in terms of pyrolysis yields for organics, char and gases. However the higher molecular weight compounds present in the pyrolysis oil are due to the lignin derived compounds as determined by results of GPC and liquid-GC/MS. The light organic fraction also increased in yield, but reduced in water content as metals increased at the expense of the lignin content. It was found that the fresh oil and aged oil had different compound intensities/concentrations, which is due to a large number of reactions occurring when the oil is aged day by day. These findings agree with previous reports which suggest that a large amount of re-polymerisation occurs as levoglucosan yields increase during the aging progress, while hydroxyacetaldehyde decrease. In summary the paper reports a window for producing a more stable pyrolysis oil by the use of energy crops, and also show that washing of biomass can improve oil quality and stability for high ash feedstocks, but less so for the energy crops.

Quality risk in global supply network

Purpose - The rise of recent product recalls reveals that manufacturing firms are particularly vulnerable to product quality and safety where goods and materials have been sourced globally. The purpose of this paper is to explore the issues of quality and safety problems in global supply networks, and introduce a supply chain risk management (SCRM) framework to reduce the quality risk. Design/methodology/approach - A conceptual SCRM framework for mitigating quality risk is developed. In addition, four SCRM treatment practices are proposed by consolidating the empirical literature in the operations management and supply chain management areas. The general feasibility was discussed based on literature. Findings - The research has identified the root causes of the recent product recalls and a series of product harm scandals ranging from automobiles to unsafe toys. Supply chains are extended by outsourcing and stretched by globalization, which greatly increase the complexity of supply networks and decrease the visibility in risk and operation processes. Originality/value - The paper identifies four SCRM practices, and proposes two distinct antecedents that can prompt the effectiveness of SCRM. © 2011 Emerald Group Publishing Limited. All rights reserved.

An expert system for the development of a health and safety policy/risk assessment in the plastics industry

Health and safety policies may be regarded as the cornerstone for positive prevention of occupational accidents and diseases. The Health and Safety at Work, etc Act 1974 makes it a legal duty for employers to prepare and revise a written statement of a general policy with respect to the health and safety at work of employees as well as the organisation and arrangements for carrying out that policy. Despite their importance and the legal equipment to prepare them, health and safety policies have been found, in a large number of plastics processing companies (particularly small companies), to be poorly prepared, inadequately implemented and monitored. An important cause of these inadequacies is the lack of necessary health and safety knowledge and expertise to prepare, implement and monitor policies. One possible way of remedying this problem is to investigate the feasibility of using computers to develop expert system programs to simulate the health and safety (HS) experts' task of preparing the policies and assisting companies implement and monitor them. Such programs use artificial intelligence (AI) techniques to solve this sort of problems which are heuristic in nature and require symbolic reasoning. Expert systems have been used successfully in a variety of fields such as medicine and engineering. An important phase in the feasibility of development of such systems is the engineering of knowledge which consists of identifying the knowledge required, eliciting, structuring and representing it in an appropriate computer programming language.