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Tools for priority setting: lessons from South Australia.

BACKGROUND: This paper provides an overview of the process and tools used to develop and implement a priority setting framework for the Clinical Senate of South Australia. Established as a clinical advisory group to the Minister and Department of Health, the Clinical Senate recognised the need for an open priority setting process to fairly assign planning resources to the large number of clinical issues that needed to be addressed. DISCUSSION: Using a workbook, developed from the literature and evidence related to priority setting, agreement was reached on the use, components and structure of the priority setting process. The final products included a Gap Finder Tool and a Priority Setting Framework. SUMMARY: This paper describes the process used to develop the priority setting tools. Decision makers in other organisations can use similar processes and tools to develop or enhance their priority Setting processes.

Health Priorities↗

[Development of a tool for assessment of local government health policy].

OBJECTIVE: A tool was developed for assessment of health status in communities to help formulate health policy of local governments and allow estimates of magnitude of changes in mortality with modification of selected risk variables. MATERIALS AND METHODS: A total of 25,201 men and 51,776 women aged 40-69 years who underwent health checkups in Ibaraki-ken, Japan, in 1993 were followed through 2002. Risk ratios for all cause, cardiovascular disease, cerebrovascular disease, ischemic heart disease, all cancer, and lung cancer deaths were calculated according to smoking, heavy alcohol consumption, obesity, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol, and diabetes using a Cox proportional hazards model. Regression coefficients for body mass index, systolic blood pressure, serum total cholesterol, serum high-density lipoprotein cholesterol, and plasma glucose were also calculated by the model with quadratic terms. On the basis of the results, we developed a tool using Microsoft EXCEL, allowing estimation of the magnitude of changes in death rates according to variation in mean and standard deviation values for risk factors by impact fraction. RESULTS: The developed tool facilitates estimation of magnitude of changes in death rates with alteration in exposure rates and means/standard deviations of risk variables with intervention. The best magnitude of decline for all cause mortality with a 50% reduction of exposure to smoking was 10% in men. The magnitudes of decline in cardiovascular disease mortality with a 50% reduction in hypertension were 12% in men and 11% in women. Furthermore, the magnitude of decline in cardiovascular disease mortality if a 10% lowering of mean systolic blood pressure were achieved would be 22% in men and 18% in women. CONCLUSIONS: Our developed tool may be useful to assess health status in communities with cooperation between municipal and prefectural governments.

Adult↗

Current bioinformatics tools in genomic biomedical research (Review).

On the advent of a completely assembled human genome, modern biology and molecular medicine stepped into an era of increasingly rich sequence database information and high-throughput genomic analysis. However, as sequence entries in the major genomic databases currently rise exponentially, the gap between available, deposited sequence data and analysis by means of conventional molecular biology is rapidly widening, making new approaches of high-throughput genomic analysis necessary. At present, the only effective way to keep abreast of the dramatic increase in sequence and related information is to apply biocomputational approaches. Thus, over recent years, the field of bioinformatics has rapidly developed into an essential aid for genomic data analysis and powerful bioinformatics tools have been developed, many of them publicly available through the World Wide Web. In this review, we summarize and describe the basic bioinformatics tools for genomic research such as: genomic databases, genome browsers, tools for sequence alignment, single nucleotide polymorphism (SNP) databases, tools for ab initio gene prediction, expression databases, and algorithms for promoter prediction.

Computational Biology↗

Gene Class expression: analysis tool of Gene Ontology terms with gene expression data.

Serial analysis of gene expression (SAGE) technology produces large sets of interesting genes that are difficult to analyze directly. Bioinformatics tools are needed to interpret the functional information in these gene sets. We present an interactive web-based tool, called Gene Class, which allows functional annotation of SAGE data using the Gene Ontology (GO) database. This tool performs searches in the GO database for each SAGE tag, making associations in the selected GO category for a level selected in the hierarchy. This system provides user-friendly data navigation and visualization for mapping SAGE data onto the gene ontology structure. This tool also provides graphical visualization of the percentage of SAGE tags in each GO category, along with confidence intervals and hypothesis testing.

Animals↗

Screening for controlled substance abuse in interventional pain management settings: evaluation of an assessment tool.

There is a need for an assessment tool to identify drug abuse behaviors in patients in pain treatment practices. Many assessment tools are complex, lengthy, lack external validation, and/or are difficult to administer. This prospective evaluation was undertaken to provide external validation for an assessment tool with 12 sections and 27 items. The test was applied in a prospective fashion to 500 consecutive patients: 100 patients in a drug abuse group and 400 patients in a non-abuse group. Drug abuse was defined as the misuse of controlled substances in a clinical setting, including obtaining controlled substances from other physicians or other identifiable sources, dose escalation with inappropriate use, and/or violation of controlled substance agreements. This study was performed in an interventional pain management setting with patients who were in stable therapy and were followed for at least one year. Results identified 8 of 12 parameters to be useful in identifying patients with drug abuse. Three factors were particularly useful, allowing correct identification of patients with abuse behavior in 90% of cases (odds ratios greater than 100 and P values of 0.001 or less). Important factors identified included excessive opiate needs, deception or lying to obtain controlled substances, and current or prior intentional doctor shopping. Together, these factors appear to identify 90% of patients with drug abuse. This tool provides a simple, reliable, and cost effective means of screening for drug abuse during the clinical evaluation of patients in interventional pain management settings.

Journal Article↗

Three assessment tools for family therapy.

In this paper the authors attempt to utilize existing knowledge of the family and family therapy in order to develop a universal tool for family analysis. The assessment tools represent a conceptualization of the three phases of family analysis. Using a simplistic guide, such as these assessment tools, should aid the therapist in organizing the overwhelming volume of information that is obtained in a short amount of interviewing time. Again the assessment tools are only as applicable as the family therapist is imaginative and creative.

Communication↗

The evolution of a public health nursing performance evaluation tool.

A tool was developed to evaluate the performance of nurses in a large public health department. Nursing staff were involved in the development process and received inservice education in some aspects of performance that would be measured by the tool. The evaluation tool is used to assess performance in four areas: clinical practice, supervision and management, professional growth and research. The authors wish to express their appreciation to the following individuals in the Chicago Department of Health who worked so diligently in the development of the Performance Evaluation Tool and the inservice education program described in this paper: Elizabeth Velten, Lee Gross, JoAnn Macon, Mitchi Oki, Carol Corcoran, Hazel Barclay, Carrie Manley, Evelyn Ribic, Etherlene Palmer, Zettie Richardson. The authors also acknowledge the guidance of Ms. Claudie Leckeisik during the preparation of this manuscript.

Chicago↗

[A new cause of accidents resulting from the use of air-powered tools].

Air-powered tools are employed increasingly frequently in industry and involve new possibilities for occupational accidents. A new mechanism of trauma is described where the cause is failure of the snap connection between the tool and the air pipeline. The pipeline and the connection are hurled away from the tool with great force and can hit persons in the vicinity. During the period 1.1.1984 to 31.12.1986, 33 accidents of this type were registered with the workers' supervision authorities. 63% of these consisted to trauma to the neck, head and eyes. As prophylaxis, the present authors suggest a safety chain between the tool and the pipeline and a valve which interrupts the air supply when the pressure in the system falls.

Accidents, Occupational↗

Laboratory computers: tools for increased productivity.

Revolutionary changes in the computer industry brought about in part by the introduction of personal computers are now reaching into clinical laboratories everywhere. Although the true justification for any computer tool may be an intangible one such as improvement in service, such tools can typically be cost justified by increases in productivity alone. A broad spectrum of applications software useful in the medical laboratory is now available in any scale required to meet the needs of any size of laboratory. Perhaps one of the most dramatic changes in this field in the last several years has been the introduction of small-scale integrated laboratory systems that are true small-scale laboratory information systems. As a result, smaller laboratories can now acquire laboratory information systems appropriately scaled to their workload for a fraction of the cost of the large systems. These small laboratory information systems are typically more easily cost justified than larger ones. Achieving productivity gains using computer tools in the laboratory is a management-intensive process requiring careful analysis and thorough planning. Laboratory managers who eschew computer tools are now an anachronism; extinction of this species is imminent.

Computers↗

A tool and an instrument modification to facilitate aortic flow probe placement.

A tool was designed and fabricated to simplify the procedure of placing a flow probe around the aortic root in acute animal experiments. The tool was made from a section of silicone rubber tubing which was flattened and tapered at one end. The flow probe was inserted into the open end of the tool, and the tapered end was drawn under the aorta, thus pulling the probe into position. Grooves were also ground into the probe body to ease the installation of the slot cover. During the 2 years that the tool and modified probes were used, they saved time and eliminated rupture of vessels as complications of aortic root flow probe placement.

Animals↗

Revision total hip arthroplasty using ultrasonically driven tools. A clinical evaluation.

A three-center clinical evaluation of the use of ultrasonic instrumentation for cement removal during 90 revision total hip arthroplasties was undertaken. In conjunction with hand tools, cement removal was facilitated with ultrasonic tools. Superficial bone burns were seen in eight cases (9%). Bone perforations were created with ultrasonic tools in three cases (4%)--two followed perforations already created by hand tools in the proximal metaphyseal area. Only one perforation (1%) was made in the shaft of the femur. Ultrasonic instrumentation is a valuable adjunct for cement removal in revision total hip arthroplasty.

Acetabulum↗

A decision support tool for antibiotic therapy.

We developed a decision support tool to assist physicians anticipating the need for antibiotic therapy. The initial screen alerts physicians of pertinent patient information, provides direct access to other essential medical information, and stimulates clinical judgment by suggesting an antibiotic regimen. The decision support tool also suggests the dose and interval for any ordered antibiotics selected by the physicians. During a 7-month pilot study, all antibiotics for patients admitted to the Shock/Trauma/Respiratory Intensive Care Unit (STRICU) were ordered using the decision support tool. Clinical data from the study period and a 12-month control period (the previous year) were collected and compared. The decision support tool was used to order antibiotics 588 times during the study period and the suggested antibiotics were used 218 (37%) times. The computer suggested dosages were used over 90% of the time. The mean cost of antibiotics was $87.00 (p < 0.04) less per patient during the study period as compared to the control period. Prospective assessment revealed only 3 antibiotic adverse drug events (ADEs) (0.9%) among 336 study patients as compared to 15 ADEs (2.4%) among 626 control patients (p = 0.164).

Anti-Bacterial Agents↗

MARIAN: an analysis tool for the assessment of left ventricular function measured by velocity encoding MRI.

Velocity encoding MRI is a new non-invasive technique for measuring cardiac blood flow velocities. Flow in the three directions of space can be measured during the entire heart cycle. However, the analysis of large amount of data obtained from this technique requires specialized computational software packages to provide physicians with efficient analysis tools. A data visualization software package named Magnetic Resonance Imaging Analyzer (MARIAN) was developed. This software package uses visualization, animation, analysis, and computational tools adapted to time series of cardiac MRI data files, all accessible through a sophisticated graphics user interface. MARIAN was used as a tool for the analysis of the left heart blood flow patterns in two groups of human subjects: ten volunteers and eight patients. The patients were diagnosed with incapacitating angina pectoris and previous left ventricular myocardial infarction. Vector plot animations of the left atrial flow were realized for all volunteer examinations. The temporal flow velocity profiles were sampled at the tips of the mitral leaflets and in the lumen of the right upper pulmonary vein, when possible. The isovolumic relaxation time (IVRT) was estimated. The following flow parameters were obtained from the velocity profiles: at the mitral valve, the early diastolic E-wave, the late diastolic A-wave, the time of occurrence of the E- and A- waves; at the right upper pulmonary vein, the systolic S-wave, the early diastolic D-wave and the reverse late diastolic R-wave. The results obtained were consistent with previous studies using similar MRI techniques. Compared to the control group, the patient group exhibited higher isovolumic relaxation time, a lower peak E-wave, and a lower D-wave. MARIAN thus provided a fast, efficient and accurate data visualization tool for the analysis of human data.

Adult↗

Computational tools for the modern andrologist.

With such a wide array of computational tools to solve inference problems, andrologists and their mathematical or statistical collaborators face perhaps bewildering choices. It is tempting to criticize a method with which one is unfamiliar for its apparent complexity. Yet, many methods are quite elegant; neural computation uses nature's own best biological classifier, for example, and genetic algorithms apply rules of natural selection. Computer scientists will likely find no one single best inference engine to solve all classification problems. Rather, the modeler should choose the most appropriate computational tool based on the specific nature of a problem. If the problem can be separated into obvious components, a Markov chain may be useful. If the andrologist would like to encode a well-known clinical algorithm into the computer, the programmer may use an expert system. Once a modeler builds an inference engine, that engine is not truly useful until other andrologists use it to make inferences with their own data. Because a wide variety of computer hardware and software exists, it is a significant endeavor to translate, or "port," software designed and built on one machine to many other different computers. Fortunately, the World Wide Web offers a means by which computational tools may be made directly available to multiple users on many different systems, or "platforms." The World Wide Web refers to a standardization of information traffic on the global computer network, the Internet. The Internet is simply the linkage of many computers worldwide by computer operators who have chosen to allow other users access to their systems. Because many different types of computers exist, until recently only communication in very rudimentary form, such as text, or between select compatible machines, was available. Within the last half-decade, computer scientists and operators began to use standard means of communication between computers. Interpreters of these standard languages, such as Mosaic and Netscape, are now widely available, and they allow the casual user to access the most sophisticated multimedia aspects of computer information on a variety of different systems. Andrologists may thus use the World Wide Web to make inference engines that they have programmed available to other clinicians and researchers. For example, we programmed a World Wide Web interface to the neural networks that we trained in order to solve a number of andrology classification problems. Interested users connect to our address (at this writing http:@godot.urol.uic.edu), and they may fill out electronic forms with their own patient data, press a "predict" button, and nearly immediately view the results of our neural networks' prediction on their own computers. With the explosion in computer hardware technology, mathematics and computer science that once seemed esoteric can now be investigated on computers available to nearly all andrologists. Rapid advances in computer network technology now render a tool developed by one andrologist immediately available to many. Clearly, andrologists may expect that computational investigations in their field will be a productive ground in the near and far future.

Algorithms↗

The development and testing of a cardiac rehabilitation audit tool.

Cardiac rehabilitation is a multidisciplinary activity and as such necessitates the development of audit systems that cut across professional boundaries. The objective of this paper is to describe the development and testing of an audit tool for cardiac rehabilitation. The tool, based on published guidelines, comprised three proformas: one for each patient entering a cardiac rehabilitation programme, one for a summary of a series of patients and one for the facilities available. The proformas were tested in three centres that were assessed as either 'high', 'moderate' or 'low' providers of cardiac rehabilitation. The cardiac rehabilitation programme coordinator of each centre examined a consecutive series of 30 patients' case notes and completed the proformas. The proformas were found to be clear and easy to use. Information was obtained that informed users of current practice and provided pointers to improvements in the provision of care. In conclusion, the cardiac rehabilitation audit tool proved to be effective in determining the documented evidence of practice, was better for determining the level of provision than a purely subjective judgement and provided information indicating an individual programme's strengths and weaknesses. This is the first attempt at producing an audit tool for cardiac rehabilitation. However, further work may be required in its refinement.

Heart Diseases↗

Structured care methodologies: tools for standardization and outcomes measurement.

In today's healthcare environment, institutions are striving to streamline processes, reduce costs of healthcare, and establish best practice patterns while maintaining and improving the quality of care provided. Various healthcare delivery models are in use including case management and outcomes management. Various tools or structured-care methodologies (SCMs) are incorporated into these different models to support cost reduction and streamline processes while enhancing quality of care. This article discusses the tools frequently used, such as critical pathways, algorithms, and guidelines, as well as how these tools can be used in combination to support each other. This article also addresses the benefits of SCMs, how these tools are developed, and how the data obtained can be used in quality enhancement programs.

Algorithms↗

A cultural values assessment tool.

Faculty members at a small liberal arts college teaching in a course entitled "Contemporary Cultures: China, Guatemala and Nigeria" found that using a cultural values assessment tool strengthened the course. This assessment tool was developed by a faculty member teaching in the course when no standardized tool of this type could be found. Students and faculty involved with this senior core course found the cultural values assessment tool to be effective in introducing the course, in stimulating some critical thinking throughout the course and in concluding the course.

Cultural Characteristics↗

Creating an environment for linking knowledge-based systems to a clinical database: a suite of tools.

A difficulty in using knowledge-based systems has been linking them to clinical databases. The challenge is in making a correct mapping from the data in the knowledge base to the data in the database. At Columbia-Presbyterian Medical Center, we have built a suite of tools developed to create queries that address this challenge. The tools were designed to allow users to easily retrieve data from the database without requiring the users have extensive database and vocabulary knowledge. The tools help users write correct queries (Query Builder), find correct terms in the clinical database (MED Browser), aggregate the resulting data into a useful form (Clinical Database Browser), and allow the user to test the query within the environment of the knowledge-based system (Event Playback). The tools have been in use for one year.

Artificial Intelligence↗