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Whole Team (whole + team)
Selected AbstractsPreoperative staging and evaluation of resectability in pancreatic ductal adenocarcinomaHPB, Issue 1 2004R Andersson Background Cancer of the pancreas is a common disease, but the large majority of patients have tumours that are irresectable at the time of diagnosis. Moreover, patients whose tumours are clearly beyond surgical cure are best treated non-operatively, if possible, by relief of biliary obstruction and percutaneous biopsy to confirm the diagnosis and then consideration of oncological treatment, notably chemotherapy. These facts underline the importance of a standard protocol for the preoperative determination of operability (is it worth operating?) and resectability (is there a chance that the tumour can be removed?). Recent years have seen the advent of many new techniques, both radiological and endoscopic, for the diagnosis and staging of pancreatic cancer. It would be impracticable in time and cost to submit every patient to every test. This review will evaluate the available techniques and offer a possible algorithm for use in routine clinical practice. Discussion In deciding whether to operate with a view to resecting a pancreatic cancer, the surgeon must take into account factors related to the patient, the tumour and the institution and team entrusted with the patient's care. Patient-related factors include age, general health, pain and the presence or absence of malnutrition and an acute phase inflammatory response. Tumour-related factors include tumour size and evidence of spread, whether to adjacent organs (notably major blood vessels) or further afield. Hospital-related factors chiefly concern the volume of pancreatic cancer treated and thus the experience of the whole team. Determination of resectability is heavily dependent upon detailed imaging. Nowadays conventional ultrasonography can be supplemented by endoscopic, laparoscopic and intra-operative techniques. Computed tomography (CT) remains the single most useful staging modality, but MRI continues to improve. PET scanning may demonstrate unsuspected metastases and likewise laparoscopy. Diagnostic cholangiography can be performed more easily by MR techniques than by endoscopy, but ERCP is still valuable for preoperative biliary decompression in appropriate patients. The role of angiography has declined. Percutaneous biopsy and peritoneal cytology are not usually required in patients with an apparently resectable tumour. The prognostic value of tumour marker levels and bone marrow biopsy is yet to be established. Preoperative chemotherapy or chemoradiation may have a role in down-staging an irresectable tumour sufficiently to render it resectable. Selective use of diagnostic laparoscopy staging is potentially helpful in determination of resectability. Laparotomy remains the definitive method for determining the resectability of pancreatic cancer, with or without portal vein resection, and should be undertaken in suitable patients without clear-cut evidence of irresectability. [source] Research summary: the effect of whole team training in evidence-based interventions on the knowledge, well-being and morale of inpatient mental health workersJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 9 2008MARTIN JONES sen(m) rn msc dproff [source] Investment in Human Capital in Team Members Who Are Involved in Collective Decision MakingJOURNAL OF PUBLIC ECONOMIC THEORY, Issue 3 2003Ruth Ben-Yashar This paper studies an investment policy which improves the ability of team members to decide correctly. We specify sufficient conditions on the learning function such that the best policy of investment in human capital is to invest first in the least competent person. Despite the fact that team members who are endowed with more human capital contribute more to the probability that the whole team would decide correctly, the liberal policy is still optimal under these conditions. Moreover, within the dichotomous model of collective decision-making, we show that these conditions are not so stringent. [source] Report of the Council for the session 2006,2007JOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 4 2007Council Report President's foreword., This year's annual report shows another very successful year for the Society. The range of the Society's new initiatives bears testament to our vigour and to the energy and enthusiasm of Fellows and staff. It is difficult to summarize all of these but I offer a brief overview of some of the highlights. This year we have awarded the first annual prize for ,Statistical excellence in journalism'. It is too easy to bemoan the general quality of coverage of statistical issues in the press and other media. But simply moaning does not improve the situation. As a positive step, on the instigation of Sheila Bird and Andrew Garratt, the Society decided to initiate an award for the best journalistic coverage of a statistical issue. This year first prize was awarded to Ben Goldacre of The Guardian. I hope that these annual awards will offer a positive focus on good coverage and help us to promote best practice. This year, also, we have set up the Professional Development Centre to act as a focus for statistical training both for statisticians and for others who use statistical methods as part of their work. It thus reflects our support for continuing professional development for our Fellows and at the same time provides outreach to members of the statistical user community who want to improve their statistical skills. We welcome Nicola Bright as the Director of the Centre and wish her every success. I am pleased to say that it is not just the Society centrally that has taken new activities this year. The Manchester Local Group have initiated a prize for final year undergraduates from any higher education institute in the north-west. At a time when there are concerns about the number of well-qualified graduates coming into the statistics profession this seems an excellent way to attract the attention of final year undergraduates. I wish this initiative every success. Another development to which the Society has contributed is the Higher Education Funding Council for England project ,more maths grads' which is designed to promote participation in undergraduate degrees in the mathematical sciences. A good supply of mathematically trained graduates is essential to the UK economy in general and to the health of the statistics discipline in particular. It is good that the Society is involved in practical developments that are aimed at increasing participation. The final new initiative that I shall draw attention to is the ,first-in-man' report which is concerned with the statistical design of drug trials aimed at testing novel treatment types. The working party was set up as a result of the adverse reactions suffered by healthy volunteers to a first-in-man trial of monoclonal antibodies and who were subsequently admitted to Northwick Park hospital. The report makes a series of recommendations about the design of such trials and will, I hope, contribute to the safety of future trials. I would like to thank Stephen Senn and the members of the working party for their considerable efforts. As well as these new initiatives there were, of course, many other continuing activities that are noteworthy. The annual conference in Belfast was a great success with many lively sessions and a good number of participants. In particular it was good to see a high number of young statisticians participating in the conference, reflecting the continuing impact of the Young Statisticians Forum on which I commented in the previous annual report. Another continuing activity for the Society is the statistical legislation going through Parliament as I write. The Society has long campaigned for legislation for official statistics. The issue now is to try to get good legislation which will have the required effect and will help the Government Statistical Service and other statistical producers to produce high quality, authoritative statistics in an environment that commands public confidence. As first published, the Society was disappointed with the Bill but we have worked to build support for amendments that, in our view, are essential. Time alone will tell how effective the final legislation will be in meeting our aims. I would like to draw attention to the success of the Membership Services team. We, although with other statistical Societies, have experienced a decline in membership in recent years but the team have turned this round. They are helping to recruit new Fellows and to retain the commitment of existing Fellows. This is a fine achievement and I would like to thank Nicola Emmerson, Ed Swires-Hennessy and the whole team. Finally we have, at last, reached a conclusion in our dealings with the Privy Council and will implement the second phase of constitutional changes. In future our business year, financial year and year for elected appointments will all coincide on a calendar year basis. There will be transitional arrangements but in due course all our administrative arrangements will coincide and will improve efficiency and co-ordination. This has been a long journey, steered effectively by our Director General, Ivor Goddard, and I congratulate him for a successful outcome on your behalf. As you read this report, I hope that you will share my impression of a Society that is lively and spawning many new programmes. We have a dual commitment: to the well-being of statistics as a discipline and to the promotion of statistical understanding and practice to the benefit of Society at large. In both respects I feel that the Society is in good health. This is due to the unstinting efforts of a large number of individual volunteers, including in particular our Honorary Officers and also, of course, the staff at Errol Street. On behalf of all Fellows, I wish to express my thanks to everyone involved. Tim Holt [source] Measurement Error and Incentive PayLABOUR, Issue 1 2005Eero Lauri Oskari Lehto Each agent produces an individual contribution which jointly form a total output. Agents' efforts are unobservable and the principal cannot observe individual outputs without an error. Neither the observed individual output of an agent nor the observed total output of the whole team are then sufficient statistics for the actual individual output in the sense of Blackwell. We show that the mixed contract of the pure piece-rate contract and of the pure team contract then dominates the pure contracts from the principal's point of view. [source] Improving service delivery by evaluation of the referral pattern and capacity in a clinical genetics setting,,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 3 2009Emma McCann§ Abstract Quality improvement in specialist services such as clinical genetics is challenging largely due to the complexity of the service and the difficulty in obtaining accurate, reproducible, and measurable data. The objectives were to evaluate the pattern of referrals to the All Wales Medical Genetics Service (AWMGS) North Wales Genetics team based in three separate hospitals, define the capacity of the team and implement change to improve equity, timeliness and efficiency of care delivery to patients. The methodology required collating the monthly referral rates retrospectively for each center over a 2.5-year period and plotting on statistical process control charts. Process mapping of the referral process in each center was undertaken, differences documented and a common pathway implemented. "Did not attend" and "time to first appointment" rates were also measured in one center. PDSA methodology was used to implement "patient focused booking." The results show that the range for referral rates in any given month for each center was 3,33 referrals. The range for referral rate for the whole team was 18,64 per month. Since January 2004 the average number of monthly referrals to the North Wales service has increased by 50%. The potential range in monthly referrals varies between centers and the range of the variability has also increased also in two out of the three centers. Introduction of Patient Focused Booking reduced the "Failed to Attend" rate and 100% of patients were offered a choice of appointments. In addition 100% had a first face-to-face contact within 6 weeks if they chose. The measurement of improvement involved firstly introducing a series of continuous measures to provide a baseline for the process prior to the implementation of any changes and secondly to indicate the impact of the changes following implementation. The measures implemented included process (referrals numbers, percentage of patients offered a choice of appointments), outcome (percentage of patients seen within 6 weeks and the percentage failing to attend), and balancing measures (percentage declining the service or failing to respond). It was concluded that general tools of quality improvement can be used to good effect within specialist services. Good processes and accurate, reproducible and measurable data are essential. Small changes can have a major impact both on the quality of the service offered and the ability to deliver the service. © 2009 Wiley-Liss, Inc. [source] | |||||||||||||