Rodger Edwards

Will changes in primary care improve health outcomes? Modelling the impact of financial incentives introduced to improve quality of care in the UK

Objectives: To estimate the total health gain from improving the quality of care among patients with cardiovascular disease in line with the quality indicator targets in the new contract for general practitioners (GPs) in the UK. Design: Statistical modelling, applying population impact measures to estimate cardiovascular health gains from achieving treatment targets in the GP contract, taking into account current levels of treatment and control. Main outcome measures: Number of events prevented in the population over 5 years applied to a notional general practice population of 10 000. Results: The greatest health gain in those aged 45–84 years would come from reaching cholesterol reduction targets. This could prevent 15 events in people with coronary heart disease, seven events in those with a history of stroke, and seven events in those with diabetes. Achieving blood pressure control targets in hypertensive patients without the above conditions could prevent 15 cardiovascular events, with further benefits from reducing blood pressure in patients with high blood pressure and coronary heart disease, stroke, or diabetes. Achieving other targets would have smaller impacts because high levels of care are already being achieved or because of the low prevalence of conditions or associated event risk. Conclusion: It is possible to quantify the health gain to a practice population of achieving quality targets such as those set in the new GP contract. The amount of health gain is sensitive to current quality of care, prevalence of conditions, and risk factors, and to the size of change anticipated. Nevertheless, it appears that significant health gains could result from achieving the proposed quality targets.

Comparison of processes and intermediate outcomes between South Asian and European patients with diabetes in Blackburn, north-west England.

Background  Diabetes and its complications are more prevalent among South Asians than people of European origin and there is some evidence that patients of South Asian origin with diabetes receive poorer quality care.

Evaluation of overall equipment effectiveness based on market

Purpose – Continuous manufacturing systems used within the steel industry involve different machines and processes that are arranged in a sequence of operations in order to manufacture the products. The steel industry is generally a capital‐intensive industry and, because of high capital investment, the utilisation of equipment as effectively as possible is of high priority. This paper seeks to illustrate a new method, overall equipment effectiveness market‐based (OEE‐MB) for the precise calculation of equipment effectiveness for full process cycle in order to respond to the steel market.Design/methodology/approach – A refinement of the existing concept of OEE is developed based on a new scheme for loss analysis within market time. The paper illustrates the concept with a case study based on compact strip manufacturing processes within the steel industry.Findings – While the results for OEE by ignoring a considerable amount of possible hidden losses might be satisfying, the OEE‐MB report shows potential r...

Building fabric thermal storage: Use of computational fluid dynamics for modelling

The paper describes work towards the construction and validation of an accurate and detailed computer model of a commercially available thermal storage system. The model is constructed with the aid of a computational fluid dynamics package, using a minimum of fitted data. The paper also includes a discussion of the reasons for current interest in fabric energy storage (FES), the mechanisms by which it may operate and summaries of operational experience with FES buildings and current research in this field. Some preliminary results from the computer model are presented and the plans for future work are outlined.

Environmental Tobacco Smoke

UK workplace regulations leave hospitality trade workforce unprotected Bans on smoking in public places and workplaces, including bars and restaurants, have recently been introduced in California and New York City and have been announced in Ireland. In addition, the UK Chief Medical Officer1 and the EU Health Commissioner have recently called for a ban on smoking in public places. Despite clear evidence that environmental tobacco smoke (ETS) adversely affects health and is an important occupational health hazard, the current UK policy response and regulatory framework for occupational ETS exposure remains inadequate with no discernable scientific rationale. ETS is a complex mixture of over 3800 gaseous and particulate components, including more than 50 known or suspected human carcinogens and 100 toxic chemicals. Exposure to ETS through passive smoking has been associated with many diseases including lung cancer, and cardiovascular and respiratory diseases.2,3 The impact on cardiovascular disease is particularly important from an occupational and public health perspective. Steenland et al recently estimated that in the USA there are 2000–3000 deaths annually among non-smokers from cardiovascular related disease due to occupational exposure to ETS.4 Occupational exposure to ETS is widespread, with an estimated 7.5 million workers in the EU and 1.3 million workers in the UK exposed to ETS for at least 75% of their working time.5 Many are employed in the hospitality industry on a casual basis in bars, pubs, restaurants, hotels, and nightclubs. Studies have shown high ETS marker concentrations levels in a range of hospitality settings.6,7 “Control measures should be implemented to reduce occupational exposure” The UK has no specific regulatory framework for occupational ETS exposure. The Health …

Population impact of stricter adherence to recommendations for pharmacological and lifestyle interventions over one year in patients with coronary heart disease

Study objective: To assess the potential number of lives saved associated with the full implementation of aspects of the National Service Framework (NSF) for coronary heart disease (CHD) in England using recently developed population impact measures. Design: Modelling study. Setting: Primary care. Data sources: Published data on prevalence of acute myocardial infarction and heart failure, baseline risk of mortality, the relative risk reduction associated with different interventions and the proportion treated, eligible for treatment and adhering to each intervention. Main results: Adopting the NSF recommendations for pharmacological interventions would prevent an extra 1027 (95% CI 418 to 1994) deaths in post-acute myocardial infarction (AMI) patients and an extra 37 899 (95% CI 25 690 to 52 503) deaths in heart failure patients in the first year after diagnosis. Lifestyle based interventions would prevent an extra 848 (95% CI 71 to 1 614) deaths in post-AMI patients and an extra 7249 (95% CI 995 to 16 696) deaths in heart failure patients. Conclusions: Moving from current to “best” practice as recommended in the NSF will have a much greater impact on one year mortality rates among heart failure patients compared with post-AMI patients. Meeting pharmacological based recommendations for heart failure patients will prevent more deaths than meeting lifestyle based recommendations. Population impact numbers can help communicate the impact on a population of the implementation of guidelines and, when created using local data, could help policy makers assess the local impact of implementing a range of health care targets.

Performance measurement based on a total quality approach

Purpose – The steel industry is a capital‐intensive industry and equipment utilisation as effectively as possible is of high priority. One of the key difficulties in the steel industry is the need to synchronise several processes to create a flow through every machine and plant. This paper aims to introduce the concept of integrated equipment effectiveness (IEE), which is a new approach for overall equipment effectiveness (OEE) measurement in three elements, consisting of “OEE loading‐based”, “OEE capital‐based”, and “OEE market‐based” so as to meet these essential requirements.Design/methodology/approach – Based on a comprehensive scheme for loss analysis, the concept of integrated equipment effectiveness is developed. The case study is conducted in the factory of one large Asian steel‐making company in order to examine the proposed model.Findings – The case study reveals the importance of the new scheme for loss analysis in a steel‐making plant. IEE gives managers of steel plants a whole perspective on ...

Comparison of CO2, Nd:YAG and high power diode lasers for the ablation of tile grout

Abstract Process feasibility of a laser-based grout removal process and the effects thereof on the processing parameters have been successfully examined using three different lasers: CO 2 , Nd:YAG and HPDL (high power diode laser). The grout removal rate was found to increase linearly with laser power level. In contrast, it was affected very little by laser traverse speed. The optimum removal rate was obtained with the CO 2 laser and this occurrence was believed to be due to the CO 2 laser’s wavelength. Surface morphological and material characterisation on the laser-removed grout was carried out. Depending on the laser used, colour ranged from white to dark grey. Significant differences between the untreated and laser-treated samples, as well as between the samples treated by the different lasers, were observed. The CO 2 laser produced relatively larger sized particles, with the Nd:YAG and HPDL generating finer particles exhibiting a similar appearance. An energy depressive X-ray (EDX) and an X-ray diffraction analysis (XRD) of the epoxy grout chemical composition before and after the laser treatment revealed that CaCO 3 (limestone) was decomposed to give CaO and CO 2 during laser interaction. The existence of SiO 2 , Ti and dolomite was also found in the original grout material. thermogravimetric and differential thermal analysis (TG–DTA) identified a sequence of three stages in the thermal history of the epoxy grout.

Advanced fabric energy storage IV: Experimental monitoring

The paper is the last in a series of four which describe a three-year research project into advanced fabric-energy-storage (FES) systems. It presents experimental monitoring of the first uk building to put the FES-slab into practice, showing the buildings thermal performance and energy consumption during 1995. The results are discussed and recommendations made to improve the buildings operation during 1996.

Porosity/bubble formation mechanism in laser surface enamelling

The grouts between commercial tiles applied to walls and floors can be contaminated over time and normally have to be removed by manual or mechanical processes. To overcome the contamination problem, a specially developed tile grout was used to fill the voids between the tiles. The base filler was overlaid with an enamel surface that glazes after laser irradiation. One problem discovered in this work is that bubbles and porosities were formed after laser treatment. The use of water glass (sodium silicate) as a binder has been undertaken in this study. This paper investigates the mechanism of bubble formation and its effects on the enamel surface. It has been found that the CO2 gas released during the reaction causes bubble formation. The results and the technique for the removal of bubbles/porosities are presented in the paper.