Building the office team: what's the payoff?

Bogged down in the everyday mire of a busy medical practice with multiple locations, a management team was faced with issues of cohesiveness, employee morale, and communication. Enter an outside facilitator who, with the executive director and president of the organization, developed a plan for a management retreat and subsequent monthly management meetings. The results were nothing short of astonishing, with a shared vision and goals communicated throughout the organization, communication being consciously expanded to all locations, and palpable physician support of employees.     

Upper gastrointestinal bleeding: what's the score?

Upper gastrointestinal haemorrhage (UGIH) is a common medical emergency. Recent publications have emphasised the need for early risk assessment of patients with this condition to help direct management. Several risk scores have been developed for UGIH and are variably used in clinical practice. In this article, we discuss the various risk scoring systems for this condition and summarise the available evidence for their use.     

Knowledge into practice: what's the problem?

It is now widely accepted that there is a problem in putting research findings into routine clinical practice. Approaches the topic by identifying the conditions which would have to be met for the "perfect" implementation of such findings, and by outlining some of the research findings concerning each of these. Concludes that research to date has concentrated on certain of these conditions at the expense of others.     

Health-related on-line forums: what's the big attraction?

This study investigates what motivates people to make use of health-related online forums, and how people feel that using these forums helps them in coping with their situation. Results are based on an online questionnaire (N = 189) among users of a variety of health forums. Findings show an overall positive effect of using forums on the degree to which people are better able to cope with the situation they are facing, both socially and with their condition. This especially holds for people who find forums a convenient tool for inclusion or gathering information. A negative effect on coping, however, is found for people who primarily use forums for discussion. The study also shows that features that often are mentioned in literature on computer-mediated communication (i.e., the anonymity it affords, its text-based character, and the possibility it offers for network expansion) are recognized but appreciated differently by users. Users who feel stigmatized especially appreciate the anonymity of online forums, while people who are restricted in their mobility appreciate the possibilities for network expansion.     

Welfare agencies and risk: the missing link?

This paper is based on research into risk and social welfare being conducted at the University of Hull, funded by the Economic and Social Research Council (1.10.94–30.9.96) as part of the Risk and Human Behaviour Programme. The research project focuses on the issues of risk affecting the social welfare of adults with learning disabilities and vulnerable children. The role of agencies has been relatively neglected in discussions of risk assessment and risk management concerning vulnerable clients in the community. This paper examines how and why risk influences the nature and operations of welfare agencies. Using data collected from a sample of welfare agencies providing care and support for either vulnerable children or adults with a learning disability, we examine how agencies respond to and manage risk. Although the documents provided by the majority of welfare agencies indicated recognition of risk, in only a minority of agencies was this recognition translated into explicit risk policy and practice.     

Reporting and dealing with missing quality of life data in RCTs: has the picture changed in the last decade?

Purpose

Missing data are a major problem in the analysis of data from randomised trials affecting power and potentially producing biased treatment effects. Specifically focussing on quality of life outcomes, we aimed to report the amount of missing data, whether imputation was used and what methods and was the missing mechanism discussed from four leading medical journals and compare the picture to our previous review nearly a decade ago.

Methods

A random selection (50 %) of all RCTS published during 2013–2014 in BMJ, JAMA, Lancet and NEJM was obtained. RCTs reported in research letters, cluster RCTs, non-randomised designs, review articles and meta-analysis were excluded.

Results

We included 87 RCTs in the review of which 35 % the amount of missing primary QoL data was unclear, 31 (36 %) used imputation. Only 23 % discussed the missing data mechanism. Nearly half used complete case analysis. Reporting was more unclear for secondary QoL outcomes. Compared to the previous review, multiple imputation was used more prominently but mainly in sensitivity analysis.

Conclusions

Inadequate reporting and handling of missing QoL data in RCTs are still an issue. There is a large gap between statistical methods research relating to missing data and the use of the methods in applications. A sensitivity analysis should be undertaken to explore the sensitivity of the main results to different missing data assumptions. Medical journals can help to improve the situation by requiring higher standards of reporting and analytical methods to deal with missing data, and by issuing guidance to authors on expected standard.

     

Association health plans: what's all the fuss about?

Policymakers have tried to address the problem of the uninsured and to help small businesses with rising premiums by encouraging associations to offer coverage. Although supporters and opponents have made claims about the potential impact of this strategy, the association market has not been studied in depth. Examining current standards might explain why proponents seek changes. This paper discusses states' approaches to regulating health insurance offered by associations, including "self-insurance," as well as existing state exemptions from state insurance laws that otherwise would apply to coverage sold to small businesses, self-employed people, and individual purchasers. We also examine market problems such as insolvency and fraud.