Accounting for product impact in the pharmaceuticals industry

We apply the product impact measurement framework of the Impact-Weighted Accounts Initiative (IWAI) in two competitor companies within the pharmaceuticals industry. We design a monetization methodology that allows us to calculate monetary impact estimates of accessible product provision and efficacy, among other factors. Our results indicate substantial differences in the impact that competitors have through their products. These differences demonstrate how impact reflects corporate strategy and informs decision-making on industry-specific areas.(AU)

Accounting for product impact in the consumer finance industry

We apply the product impact measurement framework of the Impact-Weighted Accounts Initiative (IWAI) in two competitor companies within the consumer-packaged goods industry. We design a methodology that allows us to calculate monetary impact estimates on customer health, access and affordability of products and recyclability, among other factors. Our results indicate substantial differences in the impact that competitors have through their products. These differences demonstrate how impact measures reflect business strategy choices and informs decision-making on industry-specific areas, including food reformulation and product placement.(AU)

Disparities in acute in-hospital cardiovascular care for Aboriginal and non-Aboriginal South Australians.

OBJECTIVES: To assess differences in the rates of angiography and subsequent revascularisation for Aboriginal and non-Aboriginal South Australians who presented with an acute coronary syndrome (ACS); to explore the reasons for any observed differences. DESIGN: Analysis of administrative data with logistic regression modelling to assess the relationship between Aboriginal status and the decision to undertake diagnostic angiography. A detailed medical record review of Aboriginal admissions was subsequently undertaken. SETTING: Emergency ACS admissions to SA cardiac catheterisation hospitals, 2007-2012. PARTICIPANTS: 13 701 admissions of patients with an ACS, including 274 Aboriginal patients (2.1%). MAJOR OUTCOME MEASURES: Rates of coronary angiography and revascularisation; documentation of justification for non-invasive management. RESULTS: After adjustment for age, comorbidities and remoteness, Aboriginal patients presenting with an ACS were significantly less likely than non-Aboriginal patients to undergo angiography (odds ratio [OR], 0.4; 95% CI, 0.3-0.5; P < 0.001). There was no significant difference in the rates of revascularisation for Aboriginal and non-Aboriginal patients who had undergone angiography. Reasons for Aboriginal patients not undergoing angiography included symptoms being deemed non-cardiac (16%), non-invasive test performed (8%), and discharge against medical advice (11%); the reasons were unclear for 36% of Aboriginal patients. CONCLUSIONS: After controlling for age and other factors, the rate of coronary angiography was lower among Aboriginal patients with an ACS in SA. The reasons for this disparity are complex, including patient-related factors and their preferences, as well as the appropriateness of the intervention. Improved consideration of the hospital experience of Aboriginal patients must be a priority for reducing health care disparities.

Enrollment of intensive care unit patients into clinical studies: a trinational survey of researchers' experiences, beliefs, and practices.

BACKGROUND: As critical care practice increases in scope, size, and complexity, enrollment of critically ill patients into clinical studies is increasing. OBJECTIVE: To understand the experiences, beliefs, and practices of the Canadian Critical Care Trials Group and Australian and New Zealand Intensive Care Society Clinical Trials Group regarding enrollment of critically ill children and adults into clinical studies. METHODS: Survey items generated by the research team were formatted in four domains: experiences, beliefs, practices, and demographics. Five research coordinators and five physicians pretested the survey, providing feedback on clarity and completeness. Intrarater reliability (16 participants, 2 wks apart) was very good. RESULTS: The response rate was 284 of 322 (88.2%). Respondents worked in intensive care units with a mean of 20.5 (SD 10) beds, caring for adults (72.2%), pediatric (18.8%), and both groups (9%) of critically ill patients. Clinical research was considered key to the future of improved clinical care. To enhance recruitment efficiency, respondents widely endorsed the effectiveness of increasing participating centers, after-hours, and weekend enrollment (all 3 scores 7 [6-7[sqb], reflecting median [interquartile range] on 1-7 scale). Overall, the effectiveness (6 [4-7]), feasibility (5 [4-6]) and ethics (5 [4-7]) of coenrollment into more than one randomized trial was endorsed. Half of respondents have adopted coenrollment with scientific and psychosocial provisos. Alternative designs, such as factorial and cluster randomized trials, were considered when suitable. Modifications to consent approaches (deferred consent (7 [6-7]), waived consent (7 [6-7]), or consent from two physicians in the absence of a substitute decision maker (6 [5-7])) were considered effective, but beliefs about the feasibility and ethics of some of these approaches varied. CONCLUSIONS: Clinical research is highly valued by these intensive care unit communities. Strategies to increase capacity involve enhancing recruitment efficiencies, considering alternative study designs and expanding consent procedures. Thoughtfully implementing these strategies may advance the care of critically ill adults and children.

Matching nurse skill with patient acuity in the intensive care units: a risk management mandate.

AIM: This paper aims to highlight the need for the traditional concept of nursing skill mix to be reconfigured within a new concept of skill matching. BACKGROUND: Substantive literature describes staff deployment and patient-dependency models. However, limited information exists as to what informs decision making regarding nurse skill assessment and subsequent patient allocation in intensive care units. KEY ISSUES: In intensive care units, nurse numbers, available nursing skills and patient allocation decisions, impact directly on care provision and outcomes. This paper argues that staffing decisions that are based on insufficient knowledge which lack consideration of all pertinent factors result in poor 'skill matching', potential adverse events and poor outcomes. A critical inextricable link exists between staffing decisions, patient safety and risk in the intensive care unit. Use of a multifactorial skill-matching approach within a dedicated staffing decision-support system is recommended. CONCLUSION: This commentary paper adds a new perspective to nurse-staffing decision practices and their relationship to risk management in the intensive care unit and offers a new research direction.

Acquired isolated factor VII deficiency associated with severe bleeding and successful treatment with recombinant FVIIa (NovoSeven).

Acquired isolated FVII deficiency not due to vitamin K deficiency or liver disease is rare and often associated with severe bleeding. We present a case of transient acquired factor VII deficiency associated with major bleeding, successfully treated with twice daily intermittent intravenous recombinant activated factor VII (rFVIIa) (NovoSeven; Novo Nordisk). The severe transient reduction in factor VII coagulant activity (FVII:C) levels, unresponsive to fresh frozen plasma and vitamin K administration, raise the possibility of an acquired inhibitor to factor VII. However, no inhibitor to factor VII could be demonstrated using protein G sepharose adsorption, or a Bethesda assay using IgG purified from patient plasma. There are few reports of the use of rFVIIa in this setting and this case suggests that rFVIIa is effective therapy, and should be considered early when acquired factor VII deficiency is associated with severe bleeding.