An empirical evaluation of Tukey's control chart for use in health care and quality management applications

Recently in this journal, F. Alemi (Qual Manage Health Care. 2004;13(4):216-221) proposed the use of Tukey's Control Chart because of the unique benefits associated with nonparametric inferential statistics including robust performance with (1) low N sizes, (2) nonnormal data, and (3) the presence of outliers, However, an assumption that applies to virtually all inferential statistical procedures (parametric and nonparametric) is that the observations in question are independent from each other. Unfortunately, there is good reason to suspect violation of this assumption when evaluating quality processes over time (as is often the case in health care settings). In this article, the power (ability to detect real changes in a data process) and type I error (probability of false positives) performance of Tukey's Control Chart technique is empirically evaluated. When observations are not independent, Tukey's Control Chart technique demonstrates unacceptable type I error performance. Additionally, regardless of whether observations are independent, the technique demonstrates low power to detect real effects unless the effects are quite large.     

Gastroenteritis outbreak in British troops, Iraq

Gastroenteritis affected many British military personnel during the war in Iraq. In the first month, 1,340 cases were seen; 73% of patients required hospital admission and 36% were hospital staff. In a survey of 500 hospital staff, 76% reported gastroenteritis, which was more likely in clinical workers. Investigations showed only caliciviruses.     

Myocarditis Outbreak among Adults, Illinois, 2003

An outbreak of myocarditis occurred among adults in Illinois in 2003. Diagnostic testing of myocardial tissues from 3 patients and comprehensive tests for enterovirus and adenovirus of other specimens from patients were inconclusive. Appropriate specimen collection from patients with idiopathic cardiomyopathy and further enhancement of diagnostic techniques are needed.     

Topacheous gout as a rare cause of spinal stenosis in the lumbar region. Case report

Despite the fact that gout is a common metabolic disorder, because its involvement of the axial skeleton is rare the diagnosis is often delayed, even in patients with long-standing gout who present with neurological deficits. The authors report the case of a woman with a history of extensive gout, emphasizing the clinical, radiological, and pathological features of a lumbar spinal stenosis.     

Biodegradable X-ray markers of controlled radio-opacity. Temporary position measurements in bone

In order to analyze X-ray markers for potential use in biodegradable implants or radiostereogrammatic analysis (RSA), we combined iopromide contrast fluid with biodegradable calcium phosphate cement. The radio-opacity of 10 x 10 mm markers containing different iodine concentrations (0, 120, 240, 360 and 720 mg per gram cement) was compared to an aluminium wedge of increasing (1-10 mm) thickness. The addition of iopromide increased the radio-opacity in a dose-dependent manner, which was comparable to 9-mm aluminium at concentrations of 240-720 mg/g. Radiographs of markers placed in explanted rabbit and in human femora were made to investigate the clinical accuracy for position determination. Markers of 1 x 1 mm (120 mg/g) were clearly discernable in all femora, and could be used to adequately measure distances of 5-45 mm (accuracy 0.10-2.19 mm). These markers might be embedded in biodegradable implants or used as temporary markers in the bone to analyze postoperative position on radiographs.     

OSMA and Oklahoma medicine: 1916-1925

Despite uncertain economic times, the Oklahoma State Association grew steadily in the decade from 1916-1925, passing the 1500 membership mark for the first time and establishing itself as the premier medical organization in the state. While the world fought its first great war and suffered an influenza pandemic, Oklahoma physicians battled diseases for which there were no immunizations or cures, and OSMA struggled to establish its identity in the arena of medical legislation.     

Building leadership capacity in medical education: developing the potential of course coordinators

The School of Medicine at the University of Southampton has undergone a process of consultation and staff development aimed at developing the leadership role of course coordinators. The paper reports on the negotiation of a generic framework of tasks and the development of a successful leadership training programme for course coordinators. The authors recommend a complex adaptive style of leadership based on whole systems theory and argue that leadership training for course coordinators is vital to the success of undergraduate medical programmes.