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Better Value (good + value)
Selected AbstractsA change process imbued with an Eastern ethos revitalizes an Indian businessGLOBAL BUSINESS AND ORGANIZATIONAL EXCELLENCE, Issue 3 2005Edwina Pio In the rush to outsource to developing countries, global corporations would do well to understand,and leverage,the cultural differences they are likely to encounter in their offshore alliances. In a story of East meets West, the author describes how the marriage of progressive management concepts with uniquely Eastern values and mental models enabled an Indian firm to improve its processes, quality, and productivity in a quest to assure its own long-term viability and provide better value to its global partners. © 2005 Wiley Periodicals, Inc. [source] Latest news and product developmentsPRESCRIBER, Issue 17 2007Article first published online: 6 NOV 200 Drug information stilllacking for mentally ill Half of people with mental illness still have no say in the medication they are prescribed and one-third are not informed about side-effects, according to the latest report by the Healthcare Commission and the Commission for Social Care Inspection (www.health-carecommission.org.uk). The annual national review of adult mental health services found overall improvement among local intervention teams in 2005/06 compared with the preceding year, though all could improve further and the performance of 46 per cent were rated as only fair or weak. A survey of 7446 people with schizophrenia also showed that only 46 per cent had access to psychological treatments. More incentives for shift of care in Scotland Scotland has made good progress on shifting NHS care into the community but joined-up thinking, better information and incentives are needed to overcome barriers to better management of long-term conditions in adults, says Audit Scotland (www.audit-scotland.gov.uk). Reviewing progress on the 2005 strategy document Delivering for Health, Audit Scotland found good progress on asthma and diabetes services , partly due to the effects of the GMS contract. Better information about clinical activity, costs and effectiveness is needed to help redesign services. Patients with more than one long-term condition do not receive co-ordinated care and many want greater involvement in their care, the report concluded. Acorn, QOF and Guy Rotherham awards Entries are invited for the 2007 annual Acorn, QOF and Guy Rotherham Awards. The awards are run in association with the NHS Alliance, Improvement Foundation, British Cardiac Society, British Cardiac Patients Society and Prescriber. The CHD QOF Award, sponsored by Schering-Plough, recognises the achievement of an individual practice that gains maximum points in the CHD and heart failure QOF domains, and a second award is given to the primary care organisation (PCO) that achieves the best average scores across its practices. The entry form can be found at www.escriber.com. The closing date is 12 October. Entries are also invited for the Guy Rotherham Award from PCOs that can demonstrate they have delivered a high-impact change resulting in better outcomes and services for patients. For online entry go to www.improvementfoundation.org/guy rotherhamaward. Closing date is 5 October. Award winners will receive free entry for three to the NHS Alliance conference and the conference dinner. The winner of the Guy Rotherham Award will also receive £3000. NICE scores five out of six NICE acted unreasonably in relying solely on the Mini-Mental State Examination (MMSE) to define severity of Alzheimer's disease in its updated technology appraisals, with the effect of discriminating against people with learning or language difficulties, the High Court has ruled. The five other claims by Eisai that NICE acted unreasonably and irrationally were not upheld. This was the first court action against NICE in its eight-year history. It has now promised to publish revised appraisals on its website on 7 September and is consulting with Eisai, Shire Pharmaceuticals and the Alzheimer's Society on the best approach. PPRS reform follows Office of Fair Trading report The Government is to renegotiate the Pharmaceutical Price Regulation Scheme (PPRS) following the critical report by the Office of Fair Trading (OFT). In February, the OFT recommended renegotiation of the PPRS to reward innovation and obtain better value for patients. In particular, it called for a pricing scheme based on value for patients, ie effectiveness, rather than profit controls. The DoH, acknowledging the report's complexity, says it will take four principles into account in its negotiations during the forthcoming months: value for money, promoting innovation, assisting the uptake of new cost-effective medicines and promoting market stability. MHRA launches e-bulletin The MHRA (www.mhra.gov.uk) has next issue can be downloaded. The launched an electronic bulletin to August bulletin includes items on provide health professionals with antidepressants and suicide, updates about the safe use of medi-adverse effects of dopamine ago-cines. Users need to sign up to nists and information about smokreceive an e-mail alert when the ing cessation and isotretinoin. DURG call for abstracts The Drug Utilisation Research Group is calling for abstracts for its 19th annual meeting ,Target-driven medicine , is this the end of prescribing freedom?' to be held on 7 February 2008 at the Royal Society of Medicine, London. Abstracts are requested on any aspects of drug utilisation research. A bursary of £500 will be awarded for the best abstract received. The closing date for receipt of abstracts is 26 November. Further information about abstract submission is available at www.durg.org.uk. GP prescribing up by half Prescription volume and costs in England increased by approximately half over the decade to 2006, according to data published by the Information Centre for Health and Social Care (www.ic.nhs.uk). The number of items dispensed per year increased by 55 per cent and the cost by 60 per cent in real terms. The average number of items per head of population was 10.0 in 1996 and 14.8 in 2006; older people received 21.2 items per head in 1996 but 40.8 in 2006. MR morphines similar Modified-release preparations of morphine are equivalent in the treatment of severe pain, according to a new review by Bandolier (www.jr2.ox.ac.uk). The analysis of 54 randomised trials, which reviewed the release mechanisms and clinical data for four brands, showed these preparations provide effective analgesia for malignant and nonmalignant pain; about 4 per cent of patients were unable to tolerate the adverse effects of morphine. NSAIDs compared in OA Etoricoxib (Arcoxia) and naproxen are equally effective in the long-term treatment of osteoarthritis (Ann Rheum Dis 2007;66:945,51). Extension studies for two one-year trials showed that, after a total of 138 weeks, the two drugs had almost identical effects on pain and function assessments. All treatments were generally well tolerated, but serious cardiovascular effects were more common with etoricoxib and serious GI effects more common with naproxen. CPN nystatin allowed Community practitioner nurses (CPNs) may now prescribe oral nystatin (Nystan) to treat oral thrush in neonates, following a special amendment to the regulations limiting their prescribing to licensed indications. CPNs may now prescribe oral nystatin at the dose recommended in the BNF for Children provided they are sure of the diagnosis. In doing so, they accept clinical and medicolegal responsibility for their actions. There are no other exceptions to the prohibition of off-label prescribing. Copyright © 2007 Wiley Interface Ltd [source] Evaluation of patient satisfaction with switching medicationPRESCRIBER, Issue 3 2006Angus Thompson MSc, DipPresSci, MRPharmS Switching patients' medication to provide better value for money for the NHS is common, although very little research exists on patient satisfaction with this approach. Here, the authors present the results of a survey evaluating patient response to a number of brand changes. Copyright © 2006 Wiley Interface Ltd [source] The effect of computer anxiety on price value trade-off in the on-line environmentPSYCHOLOGY & MARKETING, Issue 6 2003Rajneesh Suri This research adds to the understanding of how consumers' comfort with computers influences their evaluation of prices for goods offered over the Internet. The effect of computer anxiety, under different motivational conditions, on the evaluation of price for a product in an on-line environment was examined with the use of an experimental design. The results indicate that computer anxiety interacts with motivation to influence price perceptions, in a manner consistent with predictions derived from the process theories of attitude formation and change. Specifically, in the high-motivation condition, subjects with a greater level of computer anxiety viewed high price as indicative of higher value than those with less computer anxiety (who evaluated the low price as better value). In the low-motivation condition, both groups linked high price with higher perceived quality than the low price level. © 2003 Wiley Periodicals, Inc. [source] Cost utility analysis of physical activity counselling in general practiceAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2006Kim Dalziel Objective:To evaluate the economic performance of the ,Green Prescription' physical activity counselling program in general practice. Methods:Cost utility analysis using a Markov model was used to estimate the cost utility of the Green Prescription program over full life expectancy. Program effectiveness was based on published trial data (878 inactive patients presenting to NZ general practice). Costs were based on detailed costing information and were discounted at 5% per anum. The main outcome measure is cost per quality adjusted life year (QALY) gained. Extensive one-way sensitivity analyses were performed along with probabilistic (stochastic) analysis. Results:Incremental, modelled cost utility of the Green Prescription program compared with ,usual care' was NZ2,053 per QALY gained over full life expectancy (range NZ827 to NZ37,516 per QALY). Based on the probabilistic sensitivity analysis, 90% of ICERs fell below NZ7,500 per QALY. Conclusions:Based on a plausible and conservative set of assumptions, if decision makers are willing to pay at least NZ2,000 per QALY gained the Green Prescription program is likely to represent better value for money than ,usual care'. Implications:The Green Prescription program performs well, representing a good buy relative to other published cost effectiveness estimates. Policy makers should consider encouraging general practitioners to prescribe physical activity advice in the primary care setting, in association with support from exercise specialists. [source] Periodontal condition of the mandibular anterior dentition in patients with conventional and self-ligating bracketsORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 4 2008N Pandis Structured Abstract Authors,,, Pandis N, Vlachopoulos K, Polychronopoulou A, Madianos P, Eliades T Objectives,,, To explore whether the use of self-ligating brackets is associated with better values for periodontal indices because of the lack of elastomeric modules and concomitantly, reduced availability of retentive sites for microbial colonization and plaque accumulation. Setting and Sample Population,,, Private practice of the first author. Patients were selected using the following inclusion criteria: age range 12,17 years, fixed appliances on both arches, aligned mandibular arch, and absence of oral habits and anterior crossbites. Materials and Methods,,, Prospective cohort investigation. Participants were grouped for bracket type, thus 50 patients formed the conventional bracket cohort and 50 patients the self-ligating bracket cohort. Both cohorts were followed with the purpose to examine periodontal status. Average length of follow-up was 18 months. This time period was considered adequate for a proportion of study participants to experience the outcome of interest. Outcome variables were plaque index, gingival index, calculus index, and probing depth for the two bracket cohorts. Results,,, No difference was found in the indices recorded between the two bracket cohorts studied. Conclusion,,, Under the conditions as applied in this study, the self-ligating brackets do not have an advantage over conventional brackets with respect to the periodontal status of the mandibular anterior teeth. [source] REVIEW ARTICLE: Live prey first feeding regimes for short-snouted seahorse Hippocampus hippocampus (Linnaeus, 1758) juvenilesAQUACULTURE RESEARCH, Issue 9 2010Francisco Otero-Ferrer Abstract As with many species of seahorses, Hippocampus hippocampus wild populations are being subjected to uncontrolled exploitation in their natural environment. Thus, aquaculture could contribute to satisfy the commercial demand for animals while promoting the recovery of wild stocks. The present study was conducted to compare the effect of the substituting Artemia nauplii with rotifers for first feeding seahorse juveniles. Survival, growth and biochemical composition of prey organisms and fish were studied during the feeding trial. In addition, to help the biometric study, an anaesthetic test was also carried out using clove oil. The results showed excellent survival (average 60%) in juveniles exclusively fed with Artemia, with better values than those reported previously obtained by other authors for this species. By comparison, high mortality and poor growth were observed during first feeding with seahorses fed on rotifers. This could have been related to the lower energy intake and poorer nutritional value of the rotifers. Furthermore, clove oil concentrations of 25 ppm were found to work well as an anaesthetic for seahorse juveniles. Overall, first feeding Artemia alone was found to be an efficient and simplified method for feeding young H. hippocampus fry, building the principles for their culture for ornamental or re-stocking purposes. [source] Egg and larval quality, and egg fatty acid composition of Eurasian perch breeders (Perca fluviatilis) fed different dietary DHA/EPA/AA ratiosAQUACULTURE RESEARCH, Issue 9 2010Emilie Henrotte Abstract In Eurasian perch (Perca fluviatilis), the variability in spawning quality is a major limiting factor for successful production, especially when breeders are fed with an artificial diet. The influence of the dietary DHA/EPA/AA ratio on the egg and larval quality and on the fatty acid and lipid class composition of eggs has been investigated in perch broodstock. Two experimental diets (16% lipids) with two different DHA/EPA/AA ratios, D1 (3/2/2) and D2 (23/9/1), were compared with a natural diet consisting of cultured carp juveniles, CC (10/10/1) and with a commercial diet for salmonids, CDS (14/16/1). Percentages of fertilization and hatching were comparable between fish fed D1, D2 and CC, with the highest hatching rate observed for D1 (63.5 ± 3.8%). These diets supported better values than the CDS. Larval survival and TL50 observed after osmotic stress were higher for the D1 group, followed by larvae produced by fish fed D2 and CC. Larvae from fish fed D1, D2 and CC were significantly more robust than larvae from the CDS group. Differences were observed regarding the fatty acid (FA) profile in the eggs, which was related to the dietary FA composition. The results indicate that a ratio of 3/2/2 seemed to be effective for obtaining eggs and larvae of good quality. [source] How Effective is Farmer Early Retirement Policy?EUROCHOICES, Issue 3 2008Quelle est l'efficacité de la politique de préretraite pour les agriculteurs? Summary How Effective is Farmer Early Retirement Policy? Financial support for EU farmers seeking early retirement is a discretionary element of CAP rural development policy and some EU member states, most notably France, Ireland and Greece have chosen to implement the measure. We explore whether the introduction of such schemes is likely to represent good value for money. We use data from Northern Ireland, a region with a relatively small-scale family-farm structure, where there have been periodic calls from farmer groups to introduce support for early retirement. We estimate the benefits that might arise from the introduction of such a scheme using FADN data and a separate survey of 350 farmers aged 50 to 65. We find that farm scale is a significant determinant of profit per hectare but that operator age is not. Benefits from releasing land through an early retirement scheme are conditional on such transfers bringing about significant farm expansion and changes in land use. Even when these conditions are satisfied, however, pensions payments of only about one-third the statutory maximum could be justified in a best-case scenario. Almost a quarter of all payments would incur deadweight losses, i.e., go to farmers who would be retiring anyway. Overall, the economic case for such a scheme is considered to be weak. Le soutien financier aux agriculteurs de l'Union européenne qui veulent prendre une retraite anticipée est un élément discrétionnaire de la politique de développement rural de la PAC et certains pays membres, en tout premier lieu la France, l'Irlande et la Grèce, ont choisi de mettre en place cette mesure. Nous recherchons si l'introduction de telles mesures serait intéressante par rapport au coût financier. L'analyse porte sur des données nord-irlandaises, région d'exploitations familiales de taille relativement petite dans laquelle les représentants agricoles ont régulièrement appeléà la mise en place de soutien pour la retraite anticipée. Nous estimons les avantages que pourrait procurer l'introduction de cette mesure à l'aide de données du RICA et d'une enquête indépendante portant sur 350 agriculteurs âgés de 50 à 65 ans. Nous trouvons que la taille de l'exploitation est un déterminant significatif du profit par hectare mais que l'âge de l'exploitant n'en est pas un. Les avantages de la mise à disposition de terres grâce à un programme de préretraite dépendent de la capacité de ces transferts à entraîner un accroissement notable de la taille des exploitations et des modifications de l'utilisation des terres. Cependant, même lorsque ces conditions sont remplies, seuls des paiements représentant un tiers du niveau maximum prévu dans le programme de préretraite pourraient se justifier dans un scénario optimal. Pratiquement un quart du total des paiements serait liéà des pertes de bien-être, c'est-à-dire que les bénéficiaires seraient des agriculteurs qui aurait pris leur retraite de toute façon. Globalement, l'intérêt économique d'un tel programme est considéré comme faible. Die finanzielle Unterstützung von Landwirten in der EU, die in den Vorruhestand gehen möchten, stellt in der Politik der GAP zur Entwicklung des ländlichen Raums ein diskretionäres Element dar; in einigen Mitgliedsstaaten wie z.B. Frankreich, Irland und Griechenland wird diese Maßnahme angeboten. Wir untersuchen, ob es möglicherweise finanziell sinnvoll wäre, solche Programme einzuführen. Dazu ziehen wir Daten aus Nordirland heran, einer Region mit relativ kleinen landwirtschaftlichen Familienbetrieben, in der sich Landwirte regelmäßig dafür aussprechen, Vorruhestandprogramme einzuführen. Wir schätzen den Nutzen, der sich aus der Einführung eines solchen Programms ergeben könnte, anhand von INLB-Daten und einer gesonderten Befragung von 350 Landwirten im Alter von 50 bis 65 Jahren. Wir stellen fest, dass es sich bei der Betriebsgröße , im Gegensatz zum Alter des Betreibers , um einen entscheidenden Faktor für die Höhe des Gewinns pro Hektar handelt. Ein Nutzen aus der Landübertragung aufgrund eines Vorruhestandprogramms beruht auf solchen Transfers, die eine bedeutsame Betriebserweiterung und veränderte Flächennutzung zur Folge haben. Selbst wenn diese Bedingungen erfüllt werden, könnten günstigstenfalls nur Rentenzahlungen in Höhe von etwa einem Drittel der gesetzlich verankerten Höchstsumme gerechtfertigt werden. Beinahe ein Viertel aller Zahlungen wäre mit Mitnahmeeffekten verbunden, d.h. Landwirten zukommen, die ohnehin den Ruhestand antreten würden. Aus ökonomischer Sicht muss ein solches Programm als schwach eingestuft werden. [source] Pharmaceutical industry-sponsored meetings: good value or just a free meal?INTERNAL MEDICINE JOURNAL, Issue 8 2001S. L. Carney Abstract Although the role of the pharmaceutical industry in continuing medical education (CME) has been debated for many years, industry CME funding continues to increase. Because of concern about the educational quality of industry CME, the Hunter Postgraduate Medical Institute (HPMI), an independent Newcastle and Hunter Valley CME provider, evaluated the use and quality of industry CME as reported by rural and urban general practitioners, physicians and psychiatrists. Furthermore, clinicians were asked if they supported increased industry-funded independent CME. Sixty-two per cent of general practitioners and 71% of psychiatrists attended at least three industry-organized meetings each year, compared with 24% of physicians. Twenty-five per cent of general practitioners attended five or more such meetings. Industry meetings were judged to be of good to excellent quality by 81% of generalists, 79% of physicians and 87% of psychiatrists. All clinical groups ranked the topic and then speaker as the most important reason for attending, with CME points, venue and the sponsor ranked lowest. Eighty to 90% of doctors supported a greater role of industry-funded independent CME. Despite the absence of current data on the use and perceived benefits of industry CME, these preliminary results suggest that industry CME is playing an increasingly important role in clinician education. However, many clinicians and industry representatives support a greater role by independent postgraduate organizations in industry-sponsored CME. (Intern Med J 2001; 31: 488,491) [source] Cost and cost-effectiveness of digital mammography compared with film-screen mammography in AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2009Shuhong Wang Abstract Objective: A systematic review assessed the relative safety and effectiveness of digital mammography compared with film-screen mammography. This study utilised the evidence from the review to examine the economic value of digital compared with film-screen mammography in Australia. Methods: A cost-comparison analysis between the two technologies was conducted for the overall population for the purposes of breast cancer screening and diagnosis. In addition, a cost-effectiveness analysis was conducted for the screening subgroups where digital mammography was considered to be more accurate than film-screen mammography. Results: Digital mammography in a screening setting is $11 more per examination than film-screen mammography, and $36 or $33 more per examination in a diagnostic setting when either digital radiography or computed radiography is used. In both the screening and diagnostic settings, the throughput of the mammography system had the most significant impact on decreasing the incremental cost/examination/year of digital mammography. Conclusion: Digital mammography is more expensive than film-screen mammography. Whether digital mammography represents good value for money depends on the eventual life-years and quality-adjusted life-years gained from the early cancer diagnosis. Implications: The evidence generated from this study has informed the allocation of public resources for the screening and diagnosis of breast cancer in Australia. [source] The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: a meta-analysisINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2008Alex J. Mitchell Abstract Background Subjective memory complaints (SMC) are frequently reported by individuals with objective evidence of cognitive decline although the exact rate of complaints and their diagnostic value is uncertain. Method A meta-analysis was conducted for all studies examining SMC and either concurrent dementia or mild cognitive impairment (MCI). Results Eight studies reported the rate of SMC in dementia, seven studies reported the rate of SMC in MCI and of these four compared the rate of SMC in dementia and MCI head-to-head. SMC were present in 42.8% of those with dementia and 38.2% of those with MCI. Across all levels of cognitive impairments 39.8% of people had SMC compared with 17.4% in healthy elderly controls (Relative Risk 2.3). In head-to-head studies there was a significantly higher rate of SMC in dementia vs MCI (48.4% vs 35.1%). Examining the diagnostic value of SMC in dementia, the meta-analytic pooled sensitivity was 43.0% and specificity was 85.8%. For MCI, meta-analytic pooled sensitivity was 37.4% and specificity was 86.9%. In community studies with a low prevalence the positive and negative predictive values were 18.5% and 93.7% for dementia and 31.4% and 86.9% for MCI. The clinical utility index which calculates the value of a diagnostic method suggested ,poor' value for ruling in a diagnosis of dementia but ,good' value for ruling out a diagnosis. Conclusions When assessed by simple questions, SMC appear to be present in the minority of those with mild cognitive impairment and dementia. In cross-sectional community settings, even when people agree that they have SMC there is only a 20% or 30% chance that dementia or MCI are present, respectively. Despite this, the absence of SMC may be a reasonable method of excluding dementia and MCI and could be incorporated into short screening programs for dementia and MCI but replication is required in clinical settings. Copyright © 2008 John Wiley & Sons, Ltd. [source] | |||||||||||||