Managing Activity-Based Funding Using Costing Data and Activity-Based Budgets

2019 ◽  
pp. 128-143
Author(s):  
Stephen A. Cole
Keyword(s):  
Evidence Base ◽  
Activity Based Costing ◽  
Hospital Budget ◽  
The Individual ◽  
Support Activity ◽  
Activity Forecast ◽  
Target Activity

This chapter will show how detailed information from an activity-based costing (ABC) system can be used to support activity-based funding (ABF) by providing management with a detailed perspective of the activity and how it can be used to internally model the allocation of target activity to build an activity-based budget (ABB). By building a set of internal cost weights based on ABC data, this chapter will show how activity forecast in a funding agreement can be broken up and applied to the individual cost centers that contributed to the activity in the current year. Building an ABB provides an evidence base for the overarching hospital budget and encourages the adoption of a focus on efficiency by hospital departments.

THE ROLE OF PHAGE THERAPY IN THE FORMATION OF THE INTESTINAL MICROECOSYSTEM

2020 ◽  
pp. 183-191
Author(s):  
Gladkov S.F. ◽  
Perevoshchikova N.K. ◽  
Chernykh N.S. ◽  
Pichugina Yu.S. ◽  
Surkova M.A.
Keyword(s):  
Intestinal Microbiota ◽  
Allergic Diseases ◽  
Evidence Base ◽  
Immunological Tolerance ◽  
Convincing Evidence ◽  
Selective Decontamination ◽  
Genetic Characteristics ◽  
Treatment And Prevention ◽  
Intestinal Infections ◽  
The Individual

The current adverse situation associated with the presence of a pandemic of allergic diseases is due to the lack of a scientifically based concept of treatment and prevention. The increased interest of researchers from different countries in the formation of immunological tolerance by modeling the intestinal microbiota is of high importance. Methods of influence on the microbial communities of the child's intestine should be as delicate as possible, taking into account the individual genetic characteristics of the microecosystem and the possibility of anaphylaxis. Until now, probiotic drugs have been widely used to correct dysbiosis, but data is gradually accumulating that there is no convincing evidence base for their use for the treatment and prevention of atopy. The use of bacteriophages is very relevant and one of the promising, actively studied areas of correction of intestinal biocenosis today, which are an alternative to antibiotic and probiotic medications. Selective decontamination of representatives of opportunistic flora, as the main factor in the implementation of the atopic phenotype, makes it possible to preserve and accelerate the formation of a unique and individual composition of the intestinal microbiota of the child, which can form an immunoregulatory balance. More than a century of experience in the use of bacteriophages indicates the safety of their use. Today, bacteriophages are actively used in various fields of practical medicine − obstetrics-gynecology, perinatology, urology, pediatric otorhinolaryngology, in the treatment of purulent-septic and intestinal infections. In some cases, bacteriophages are very effective against antibiotic-resistant pathogens. The active personalized use of bacteriophages in real clinical practice will make it possible to solve a number of serious, long-standing health problems in the Russian Federation and to win a world priority in this direction.

scholarly journals Sports Foods and Dietary Supplements for Optimal Function and Performance Enhancement in Track-and-Field Athletes

2019 ◽  
Vol 29 (2) ◽  
pp. 198-209 ◽  
Author(s):  
Peter Peeling ◽  
Linda M. Castell ◽  
Wim Derave ◽  
Olivier de Hon ◽  
Louise M. Burke
Keyword(s):  
Performance Enhancement ◽  
Evidence Base ◽  
Track And Field ◽  
Supplement Use ◽  
Optimal Function ◽  
Repeated Use ◽  
And Performance ◽  
The Individual ◽  
Health Function ◽  
Specific Scenario

Athletes are exposed to numerous nutritional products, attractively marketed with claims of optimizing health, function, and performance. However, there is limited evidence to support many of these claims, and the efficacy and safety of many products is questionable. The variety of nutritional aids considered for use by track-and-field athletes includes sports foods, performance supplements, and therapeutic nutritional aids. Support for sports foods and five evidence-based performance supplements (caffeine, creatine, nitrate/beetroot juice, β-alanine, and bicarbonate) varies according to the event, the specific scenario of use, and the individual athlete’s goals and responsiveness. Specific challenges include developing protocols to manage repeated use of performance supplements in multievent or heat-final competitions or the interaction between several products which are used concurrently. Potential disadvantages of supplement use include expense, false expectancy, and the risk of ingesting banned substances sometimes present as contaminants. However, a pragmatic approach to the decision-making process for supplement use is recommended. The authors conclude that it is pertinent for sports foods and nutritional supplements to be considered only where a strong evidence base supports their use as safe, legal, and effective and that such supplements are trialed thoroughly by the individual before committing to use in a competition setting.

scholarly journals Welsh Government Flying Start Programme Evaluation Using Linked Data

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Sarah Lowe ◽  
Laura McGinn ◽  
Marcos Quintela ◽  
Luke Player ◽  
Karen Tingay
Keyword(s):  
Evidence Base ◽  
Development Project ◽  
Early Years ◽  
Local Authorities ◽  
Parenting Support ◽  
Individual Level ◽  
Level Data ◽  
Part Time ◽  
The Individual ◽  
Families With Children

BackgroundFlying Start (FS) is the Welsh Government’s (WG) flagship Early Years programme for families with children aged less than 4 years of age. Running since 2006, the four entitlements are: Free part-time childcare for 2-3 year olds Enhanced Health Visiting Parenting support Speech, language, and communication support ObjectivesCurrently, while we know which areas in Wales are receiving FS support, individual-level data on which child received what entitlements is not available. Area-level outcomes can be used as proxy indicators but the individual impact of receiving FS support cannot be examined.The project aims to evaluate FS by linking the FS cohort to a range of outcomes including health, education and social care. MethodsA Dataflow Development Project (DDP) has been launched to install SAIL (Secure Anonymised Information Linkage) appliances into 6 pilot Local Authorities in Wales which will test acquiring and linking the individual level FS data from pilot Local Authorities with other datasets in SAIL. FindingsThe project will report some emerging findings from the analysis of pilot data. ImplicationsThere is a growing interest in using linked administrative data to evaluate government initiatives, and mounting enthusiasm in Local Government. If successful, this model is likely to be adopted by related WG programmes; improving the evidence base, facilitating effective evaluation, and adding to the data available for re-use in Wales.

Breathlessness and other respiratory symptoms in palliative care

2021 ◽  
pp. 589-603
Author(s):  
Miriam J. Johnson ◽  
David C. Currow
Keyword(s):  
Palliative Care ◽  
Perceptual Experience ◽  
Coping Style ◽  
Help Seeking ◽  
Evidence Base ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Help Seeking Behaviour ◽  
The Individual ◽  
Underlying Pathophysiology

Breathlessness is prevalent among palliative care patients with intensity likely to increase as death approaches for many people. There are two main patterns of breathlessness—episodic breathlessness and constant breathlessness—and three separate qualities of breathlessness—air hunger, work or effort, and tightness. Chronic breathlessness is defined as disabling breathlessness despite optimal treatment of the underlying pathophysiology. The measurement of breathlessness includes three domains: sensory-perceptual experience, affective distress, and symptom impact. The management of breathlessness includes specific disease management, non-pharmacological interventions, pharmacological therapies, and, in a very small proportion of people, palliative non-invasive ventilation. A full assessment of the widespread effects of chronic breathlessness on the individual including coping style and help-seeking behaviour is important to tailor interventions. Interventions focused on the breathlessness can be based on a ‘Breathing, Thinking, Functioning’ clinical framework. Oral, low-dose morphine in steady state remains the pharmacological treatment with the strongest evidence base.

Using medication in children’s palliative care

2021 ◽  
pp. 145-152
Author(s):  
Andy Gray ◽  
Jane Riddin ◽  
Richard Hain
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Evidence Base ◽  
Oral Route ◽  
Essential Medicines ◽  
Insufficient Evidence ◽  
Rights Of The Child ◽  
Child Friendly ◽  
The Individual ◽  
Alternative Routes

Using medication in children’s palliative care (CPC) is fraught with difficulties as a result of an insufficient evidence-base and a lack of child friendly formulations, however this cannot be a reason not to intervene and allow unnecessary suffering. A lack of access in some countries to even essential medicines such as opioids is an infringement of the rights of the child to pain relief and needs urgent redress. Often, the only reasonable option is to extrapolate from adult data and to proceed rationally on the basis of what the prescriber knows about the available drug, the individual child, and the likely effects of their disease. Alternative routes for administration of medicines in children who are no longer able to use the oral route, such as the trans- and sub-cutaneous and buccal route mean symptom control can be provided at home and until end of life.

scholarly journals The clinical assessment of acts of violence: mental mechanisms and subjectivity

2019 ◽  
Vol 26 (3) ◽  
pp. 135-144 ◽  
Author(s):  
Rajan Nathan ◽  
Peter Wilson
Keyword(s):  
Risk Assessment ◽  
Risk Management ◽  
Clinical Practice ◽  
Clinical Assessment ◽  
Clinical Utility ◽  
Individual Case ◽  
Evidence Base ◽  
Routine Clinical Practice ◽  
Factors Associated ◽  
The Individual

SUMMARYApproaches to assessing violence in clinical practice have been influenced by developments in the field of risk assessment. As a result, there has been a focus on identifying and describing factors associated with violence. However, a factor-based approach to assessing violence in individual cases has limited clinical utility. In response, the benefits of a formulation-based approach have been promoted. This approach is enhanced by an understanding of the specific mental mechanisms that increase the likelihood of violence in the individual case. Although there is an empirical evidence base for mental mechanisms associated with violence, this literature has not been distilled and synthesised in a way that informs routine clinical practice. In this article the authors present the key mechanisms that are known to be associated with violence in a way that is relevant to the clinical assessment of violence and, in turn, can inform clinical and risk management.

Common feline problem behaviors: Aggression in multi-cat households

2019 ◽  
Vol 21 (3) ◽  
pp. 221-233 ◽  
Author(s):  
Daniela Ramos
Keyword(s):  
Problem Behaviors ◽  
Behavioral Interventions ◽  
Evidence Base ◽  
Practical Relevance ◽  
Care Needs ◽  
Clinical Behavior ◽  
The People ◽  
Large Numbers ◽  
The Individual ◽  
And Behavior

Practical relevance: Being able to understand and intervene in cases of cat–cat aggression in multi-cat households is important for all veterinarians and behavior counsellors dealing with feline behavior cases. Clincal challenges: Feline conflicts are common, perhaps not helped by many owners’ assumption that this is the norm. Interventions can be complex in multi-cat households with large numbers of cats as there are more interactions to evaluate and monitor, and care needs to be taken not to negatively affect the other cats. There may be limitations due to the environment or the people involved and so behavior guidelines should always be tailored to the individual situation. Aims: This article reviews the main forms of aggression in multi-cat households and the appropriate behavioral interventions, considering both the typical scenarios and emotions/motivations most likely involved. It details essential environmental management for multi-cat homes, as well as an approach to friendly cat introductions. Audience: This article is aimed at veterinarians dealing with feline behavior cases as well as behavior counsellors, as both professionals are likely to experience cases of aggression in multi-cat households. Evidence base: The author draws on the published literature where available and, where there is a lack of research, on hypotheses derived from her own clinical behavior experience.

scholarly journals Interventions for challenging behaviour in intellectual disability

2014 ◽  
Vol 20 (3) ◽  
pp. 184-192 ◽  
Author(s):  
Afia Ali ◽  
Jessica Blickwedel ◽  
Angela Hassiotis
Keyword(s):  
Intellectual Disability ◽  
Evidence Base ◽  
Current Evidence ◽  
List Type ◽  
Challenging Behaviour ◽  
Pharmacological Treatments ◽  
Current Evidence Base ◽  
The Individual

SummaryChallenging behaviour is common in intellectual disability but it is difficult to diagnose and manage. It can adversely affect the quality of life of the individual and cause the breakdown of community placements, resulting in hospital admission. This article discusses the aetiology of challenging behaviour (including the complex relationship with mental illness), diagnostic problems, the current evidence base in relation to psychosocial and pharmacological treatments, and service delivery.LEARNING OBJECTIVES•Understand the aetiological basis of challenging behaviour.•Understand the role of functional analysis.•Appreciate the evidence base in relation to the psychological and pharmacological treatment of challenging behaviour.

scholarly journals Characterizing the Gut Microbiome of Dietary Patterns Using Pooled Samples: Assessing a Novel Methodological Approach to a Complex Web of Confounders

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1157-1157
Author(s):  
Leigh Frame ◽  
Stephanie Servetas ◽  
Scott Jackson
Keyword(s):  
Dietary Patterns ◽  
Dietary Pattern ◽  
Methodological Approach ◽  
Evidence Base ◽  
Shotgun Metagenomics ◽  
Microbiome Composition ◽  
Funding Sources ◽  
Metabolomic Data ◽  
The Individual ◽  
Pooled Samples

Abstract Objectives The response to a dietary pattern exhibits large interindividual variability—due in part to the uniqueness of the microbiome of each individual. However, specific attributes of the microbiome related to dietary intake may be directly related to the precise dietary pattern. To determine what attributes come solely from a dietary pattern, we must isolate the individual differences. To do this, we aim to establish the feasibility of assessing microbiome attributes related to disparate dietary patterns using pooled samples. Methods Samples from 4 self-identified vegans and omnivores were collected, pooled, homogenized and stored at −80°C until time of analysis. Dietary patterns were self-reported using DietID. Whole genome shotgun metagenomics was performed (Replicates: 10/diet, 4/individual). Metabolomic profiles were analyzed using NMR and MS/MS. Genomic and metabolomic data were analyzed to identify diet-specific signatures. As part of a comprehensive literature review, we developed a table predictive of the microbiomes of omnivores versus vegans. We compare our findings to this summary of emerging research to assess potential validity of pooled sample analysis. Results Key differences were detected between the vegan and omnivore samples individually and in pools including 10 genera significantly enriched in vegan and 15 in omnivore, e.g., Akkermansia, Bacteroides, Bifidobacterium, Clostridium, Faecalibacterium, Methanobrevibacter, and Ruminococcus. Fold changes were > 2 in 13 of 25 genera (4 vegan, 9 omnivore). Differences were comparable to the predictive table. Ongoing analyses include comparisons at additional taxonomic levels and diversity/richness assessments which will improve the resolution of the aforementioned relationships and the ability to detect them using pooled samples. Conclusions Even with a small cohort of pooled samples, we are able to reproduce the findings of the evidence-base to-date—the same variability and stability in microbiome composition. Funding Sources National Institute of Standards and Technology (NIST), The International Life Sciences Institute – North America (ILSI-NA).

scholarly journals Welsh Government Flying Start Programme Evaluation Using Linked Data

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Sarah Lowe ◽  
Laura McGuinn ◽  
Marcos Quintela ◽  
Luke Player
Keyword(s):  
Pilot Project ◽  
Evidence Base ◽  
Development Project ◽  
Early Years ◽  
Local Authorities ◽  
Parenting Support ◽  
Individual Level ◽  
Pilot Data ◽  
Level Data ◽  
The Individual

IntroductionFlying Start (FS) is the Welsh Government’s (WG) flagship Early Years programme for families with children aged less than 4 years of age. Running since 2006, the four entitlements are: Free part-time childcare for 2-3 year olds Enhanced Health Visiting Parenting support Speech, language, and communication support Objectives and ApproachCurrently, while we know which areas in Wales are receiving FS support, individual-level data on which child received what entitlements is not available. This means that area-level outcomes can be used as proxy indicators but the individual impact of receiving FS support cannot be examined. This project describes the issues around collecting individual-level data in deprived Welsh regions, a pilot project to facilitate this collection and will report some emerging findings from the analysis of pilot data. ResultsFollowing from previous studies funded by the ESRC and WG (e.g. Supporting People Data Linking Feasibility Study), a Dataflow Development Project (DDP) has been launched to install Secure Anonymised Information Linkage (SAIL) appliances into 6 pilot Local Authorities in Wales. The SAIL appliance technology will provide Local Authorities with the ability to link individual-level data within a Local Authority or between Local Authorities and to securely anonymise data into the SAIL Databank or ADRC-W. The DDP will test acquiring the individual level FS data from pilot Local Authorities into SAIL. The project aims to evaluate FS by linking the FS cohort to a range of outcomes including health, education and social care. We will report emerging findings from the analysis of pilot data. Conclusion/ImplicationsThere is grow interest in using linked administrative data to evaluate government initiatives, and mounting enthusiasm in Local Government. If successful, this model is likely to be adopted by related WG programmes; improving the evidence base, facilitating effective evaluation, and adding to the data available for re-use in Wales.

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