Competing risks survival modelling of childhood caries

The survival of primary molar teeth to caries was investigated using data from a cohort study of 2,654 children aged ~5 years at baseline, undertaken by Cardiff University School of Dentistry in 1999-200

Lifting export performance. Actions to drive growth in exports

This report aims to provide an independent view on options for New Zealand firms, business organisations and government to boost export growth

An audit to determine the clinical effectiveness of a pathway for managing wound infection

Prevention of wound infection is a key objective in the planning of care for patients with wounds. The potential for wound infection, particularly in chronic wounds that are heavily contaminated with bacteria, can be high (Bowler et al, 2001). Wound infection can negatively affect the patient experience, causing pain, delayed healing and poor clinical outcomes (Butcher, 2011). This article outlines the introduction of a clinical pathway for identifying and managing wound infection in a community nursing service. The article sets out the results of an audit to investigate the efficacy of the pathway, and discusses the importance of identifying and managing wound infection risk in patient care

Productivy Growth and Tenure: A Test of on-the-Job Training Theories of Wage and Productivy Growth

[Excerpt] Studies have found consistently that there is a strong positive correlation between a worker\u27s tenure with a firm and that individual\u27s wage rate. Becker\u27s (1975) on-the-job training (OJT) model is the most widely accepted explanation for this association. The OJT model posits that new employees receive training early in their tenure, which raises their productivity both in and outside the firm. Competition forces the employer to pay employees who have completed this training at least as much as they are worth outside the firm less transfer costs. Jobs that offer such training are more attractive than jobs that do not, so competition forces down the entry wage of jobs that provide training below the entry wage of jobs that offer no training. During the training period, the supervisors and other workers are spending time away from other activities, helping the new employee learn the job. The new employee may also spend time in learning activities instead of production activities. In order to offer training, the employer must be compensated for the resulting sacrifice in current output. When the training provides general skills, the only way such compensation can be provided is by a further lowering of the entry wage. Thus, there are two forces that cause wage rates of new employees to rise: the increase of the employee\u27s productivity and the decline of training expenses. When training is entirely specific, and therefore does not raise the worker\u27s productivity in other firms, the forces causing a rising wage profile are weaker. They do not disappear, however, for a rising wage profile reduces the quit rate of trained workers, and thus protects the firm\u27s investment in training

Hi ho silver lining? What firms need to think about as New Zealand ages

This report argues that the ageing New Zealand population will see fewer productive workers in proportion to the number of retirees which will drive up wages, and that firms need to prepare. Key findings: Ageing will impact on firms’ costs of doing business New Zealand’s ageing has a profound impact on the costs of producing goods and services. Ageing shrinks the future pool of labour as a fraction of society. That drives up wages as firms bid for talent. As firms respond, we show higher wages reduce output in labour - intensive sectors like manufacturing. This continues the long - run trend in that sector with firms moving away from competing on cost and moving toward competing in niche manufacturing based on specialised knowledge and expertise . Opportunities from changes in demand for firms who adapt Challenges and opportunities exist on the demand side too. Consumption effects are driven by: (i) how our needs and desires change at different points of our lives (ii) how consumption by a particular age changes over time: today’s sixty - year old is not the same as the sixty - year old of yesteryear. Some changes to demand for goods and services will be clear and industry specific: health, travel and insurance are likely to profit from an older population. But demand changes can be subtle. Firms will need a plan to make the most of shifting opportunities in their sector. Global and regional factors intensify the impact of ageing New Zealand is also ageing unevenly. Some regions show the impact of in-flows of older cohorts at the same time as opportunities in urban areas offshore are hollowing out younger cohorts. This amplifies the impact on regional labour markets and will shift regional patterns of demand. Meanwhile global competition for talent will amplify the impacts of labour in short supply further bidding up wages. If the environment for producing labour - intensive goods is challenging now, higher wages make that environment look even tougher

Exploring quality of life, physical and psychosocial morbidity for patients with non-infected wounds: a pilot study

This article reports on the results of a pilot study exploring health-related quality of life and the experience of being resilient in patients who develop acute, non-infected surgical wounds. By investigating this under-researched area of wound management, the project team intended to highlight the aspects of patient empowerment in healing post-surgery, encompassing the physical, social and psychological domains. Participants were recruited from patients who had undergone a surgical procedure resulting in an acute non-infected healing wound, and who met the inclusion criteria of the study. Patients were excluded if they had a chronic wound in addition to their acute surgical wound. Valid scores on the physical health (PCS) and mental health (MCS) domains of the SF-12 could only be obtained from six patients pre-operatively. A further six patients completed the SF12 instrument pre-operatively (five valid sets of scores obtained); these patients did not complete the HADS scale. Paired samples t-tests conducted on patients from whom both pre- and postoperative scores were obtained found no significant difference between pre-operative and postoperative PCS scores (p=0.468) or MCS scores (0.806); or between pre-operative and postoperative scores on the anxiety subscale on the HADS scale (p=0.951) or the depression subscale (p=0.951). However, as a pilot study, the study was not powered to detect significant differences. Higher levels of anxiety were revealed in this pilot study than in the wider population. No differences were observed between pre-operative and postoperative scores for physical and mental wellbeing. The findings, while from a small sample set, indicate anxiety is experienced by people living with a wound, and needs to be a consideration in care management plans to enhance adaptation

An observational study to identify factors associated with readmission and to evaluate the impact of pharmacist validation of discharge prescriptions on readmission rate

To identify demographic and pharmaceutical factors associated with readmission and to determine whether pharmacist validation of discharge prescriptions impacted on readmission rate in a district general hospital. • The average number of items prescribed at discharge and the average age were found to be significantly higher in patients who were readmitted than those who were not, and mandating pharmacist validation of discharge prescriptions was associated with a reduction of around one-fifth in the readmission rate. • The study provides evidence of the patient groups it may be most appropriate for pharmacists to focus on in order to reduce readmissions. Introduction Readmission is a growing problem for the National Health Service. In England the rate has increased by almost one-third over ten years, reaching 11.5% in 2011/12.1 In 2009 the Care Quality Commission reported that 81% of General Practitioners recorded discrepancies in discharge medication information “all” or “most of the time.”2 Whilst pharmacist validation of discharge prescriptions (TTOs) is routine in Calderdale and Huddersfield NHS Foundation Trust, it was previously prompted by the need for supply, and due to the successful implementation of one-stop dispensing theTTOvalidation rate was surprisingly low. The study aimed to identify factors associated with readmission, to quantify the effect of enforcing pharmacist validation of TTOs and to determine whether this impacted on the readmission rate. Methods Retrospective analysis of data from all adults discharged from Calderdale Royal Hospital’s Short Stay Unit between 30th September 2013 and 19th January 2014 (pharmacist validation of TTOs became mandatory during normal working hours from the mid-point). Data collected from TTOs included admission and discharge dates, demographics and pharmaceutical details (e.g. number of items prescribed, number of prescription changes, validation status). The primary outcome measure was 30-day readmission status; readmission interval was the secondary outcome measure. Ethical approval was not required. Results Two hundred eighty-three TTOs were completed during the baseline evaluation: 101 (35.7%) were validated by a pharmacist and 42 (14.8%) resulted in readmission. Two hundred ninety-six TTOs were completed during the intervention evaluation: 223 (75.3%) were validated by a pharmacist and 36 (12.2%) resulted in readmission. The average age of those readmitted (73.2) was seven and a half years older than those not readmitted (65.7) (p < 0.01, 95% CI for the difference 3.20–11.8); patients aged 65 or older were significantly more likely to be readmitted (17.6%, 63/357) than younger patients (6.8%, 15/222) (p < 0.01). The number of prescription changes on the TTO was not found to differ significantly between those who were readmitted and those who were not; however, those readmitted were prescribed an average of two more items at discharge (10.8) than those who were not (8.4) (p < 0.01, 95% CI for the difference 0.989–3.90). The readmission behaviour of patients prescribed seven or less items at discharge (n = 221)was found to differ significantly (p < 0.01) from patients prescribed eight or more (n = 264). Discussion The results indicate where pharmacists may have the most impact on reducing readmissions; specifically patients over 65 years of age and those taking eight or more medicines. Further work is needed to determine whether readmission can be reduced in these groups by application of pharmaceutical interventions and to establish the long term benefits of focusing limited resources. Mandating pharmacist validation ofTTOs in working hours was associated with a substantial increase in proportion validated and a notable reduction in readmission rate. It is acknowledged that the activity of the Trust’s Virtual Ward varied during the study, however there was not a pharmacist on the team at that time; further work will be carried out to determine the influence of this on the results observed

Valuing natural assets

Key points New Zealand producers and consumers get much value from natural assets. Much of this value is intangible. This is a fundamental reason to make special effort to measure the value of natural assets, to make sure we make the right decisions about their use and conservation.But a key barrier to using economic valuation is the cost and uncertainty of values obtained from the variety of techniques being used. This is a real issue, to the extent that doubts are being expressed in resource management cases whether economics has much to add when considering environmental effects.To remove this barrier, valuations need to be cheaper and easier to compare. A standardised technique could provide relative values for different types of natural asset or service. This would make economic value estimates from across a range of natural asset settings more consistent.Developing a practical, reliable standardised technique would involve:&nbsp;building on studies done to date , showing how much economic activity depends on natural assets in a robust and comparable waycarrying out a meta - analysis, to obtain consistent and comparable value estimates for a range of ensure economic activities from economic impact studies done to datelearning how biophysical cause - and - effect relationships translate into economic value, to identify the sensitivity of econo mic activity to changes in natural assets , such as biodiversitycommissioning a stated preference study of the value of broad categories of natural assets, as a starting point for identifying value in specific situations.&nbsp;Decision - makers need to understand how and where economic valuation can support their decisions. Providing them with explanatory materials will help.It is important to make progress. There is currently a gap in the knowledge about the full contribution of natural assets to New Zealand’s economic well-being. This creates a risk that natural assets will be undervalued. Ecosystems and the valuable services they provide may be lost or damaged.Economic valuation of environmental assets can fill the knowledge gap. To date, non-market valuations in New Zealand do not appear to have been used much to make management choices in conservation, whether those relate to responding to pest incursions or to economic development.A less ad hoc approach to weighing up the value of natural assets can make treatment of natural assets more consistent in decisions, and increase the efficiency of use of natural resources. A better approach is needed so studies inform policy and decisions about New Zealand’s natural assets. Our proposed approach could improve understanding of the value of natural assets — giving them more consistent weight in decisions, and improving the way we manage them

Investigating staff knowledge of safeguarding and pressure ulcers in care homes

Objective: To investigate whether nursing/care home staff regard pressure ulceration as a safeguarding issue; and to explore reporting mechanisms for pressure ulcers in nursing/care homes. Methods: Sixty five staff members from 50 homes within one clinical commissioning group completed a questionnaire assessing their experiences of avoidable and unavoidable pressure ulcers, grading systems, and systems in place for referral to safeguarding teams. Understanding of safeguarding was assessed in depth by interviews with 11 staff members. Results: Staff observed an average of 2.72 pressure ulcers in their workplaces over the last 12 months; judging 45.6% to be avoidable. Only a minority of respondents reported knowledge of a grading system (mostly the EPUAP/NPUAP system). Most respondents would refer pressure ulcers to the safeguarding team: the existence of a grading system, or guidance, appeared to increase that likelihood. Safeguarding was considered a priority in most homes; interviewees were familiar with the term safeguarding, but some confusion over its meaning was apparent. Quality of written documentation and verbal communication received prior to residents returning from hospital was highlighted. However, respondents expressed concern over lack of information regarding skin integrity. Most staff had received education regarding ulcer prevention or wound management during training, but none reported post-registration training or formal education programmes; with reliance placed on advice of district nurses or tissue viability specialists. Conclusion: Staff within nursing/care homes understand the fundamentals of managing skin integrity and the importance of reporting skin damage; however, national education programmes are needed to develop knowledge and skills to promote patient health-related quality of life, and to reduce the healthcare costs of pressure damage. Further research to investigate understanding, knowledge and skills of nursing/care home staff concerning pressure ulcer development and safeguarding will become increasingly necessary, as levels of the older population who may require assisted living continue to rise

Are Albumin levels a good predictor of mortality in elderly patients with neck of femur fractures?

Neck of femur fractures are associated with significant morbidity and mortality. The National Hip Fracture database in England suggest an 8.2% 30 day mortality. Suggested mortality predictors include: The Nottingham Hip Score, POSSUM score, Lactate, End Tidal CO2, Total Lymphocyte Count and Albumin. Predictors of short-term mortality may be a useful healthcare tool in these patients. Hypoalbuminaemia is determined as a level less than 35g/dl. No classification for degree of hypoalbuminaemia exists. It’s clinical significance are associated with liver/renal failure, chronic illness and poor nutritional states. We wanted to assess whether there is an association between hypoalbuminaemia and patient survival, if the severity affected outcomes and whether highlighting those patients with hypoalbuminaemia would be a useful prognostic tool