Nosokinetics
December 2006 Issue (no 3.6)
(c)Authors for content; Peter Millard, Roy Johnston for e-version
(comments to rjtechne at iol dot ie)
Qincheng Wang memorial Issue
On November 10, 2003, Qincheng Wang, a PhD student at the University of Westminster, died. We dedicate this issue to his memory in recognition of the completion by Thierry Chaussalet and Haifeng Xie of his research objective:
A Closed Queueing Network Approach to the Analysis of Patient Flow in Health Care Systems. (Methods Inf Med 2006, 45: 492-7).
Qincheng was a brilliant young mathematician - one of the best students in the University of Bejing - with a Masters degree in mathematics and statistics. His long term goal was to be a Professor of Mathematics in China. Sadly, that was not to be, but thanks to Thierry and Haifeng his work lives on.
Qincheng Wang, Born Beijing 24/12/76, Died London 10/11/2003
Qincheng joined us in September 2002. During 2003, he had developed a mathematical solution which forecast the impact of change in departments of geriatric medicine with a constrained bed stock, using a phase type renewal model and closed queuing networks.
Each hospital day begins with most (sometimes all) of the beds occupied. So the application of queuing theory to medical services is not as simple as it sounds. Moreover, change takes time, not only because change is difficult and takes time, but also because outside factors impact on the outcome of inpatient care.
I remember, as if it was yesterday, asking him 'How long does it take for the changes to take place?' 'Immediately' he replied, quick as a flash, turning to his computer keyboard to show me.
Bearing in mind the Chinese saying, 'Tell someone and they may forget. Teach them and they may remember. Involve them and they never forget.' I lay on the floor beside him until he realised that we are dealing with people's lives.
'Oh. I can do that' he said, but sadly he died before he could do it. A summary of the paper appears elsewhere in this issue (p5 of printed version).
Qincheng's father, a master of ancient Chinese writing, gave us this when he came to England. Now it graces our home, as a daily reminder of the contribution of mathematics to medicine.
Elsewhere in this issue (pp2-3) we consider the potential benefit of On Line Analytical Programming in analysing hospital data. Also (p4) we report the contribution mathematics is making to medicine in Melbourne.
Valedictory Reading
Death takes us by surprise,And stays our hurrying feet;
The great design unfinished lies,
Our lives are incomplete.
But in the dark unknown,
Perfect their circles seem,
Even as a bridge's arch of stone
Is rounded in a stream.
Alike are life and death
When life in death survives,
And the interrupted breath
Inspires a thousand lives.
Were a star quenched on high,
For ages would its light,
Still travelling downward from the sky,
Shine on our mortal sight.
Henry Wadsworth Longfellow 1874
Good news: Thanks to Mark Mackay, and the contributors, seven papers from the 2006 Nosokinetics meeting in Adelaide are in the February 2007 issue of the Australian Health Review.
Research in Action (Maths is good for your health):
Prof Terry Mills, La Trobe University & Bendigo Health, Melbourne.
Hospitals need the skills of doctors, nurses, psychologists, physiotherapists, dieticians and technicians to ensure the health of patients. However, they cannot maximise patient health outcomes unless they also make use of the skills of mathematicians.
On-Line Analytical Processing (OLAP) in the provision of health care: building capacity for exploratory data analysis and facilitating decision making:
Christos Vasilakis PhD , Senior Lecturer, Harrow School of Computer Science, University of Westminster, C.M.Vasilakis@westminster.ac.uk.
On-Line Analytical Processing (OLAP) is the software technology that enables analysts and managers to gain fast access to large amounts of summarized data stored in data warehouse. Both storage and presentation of the data reflect the dimensionality of the organisation as understood by the user.
A Closed Queueing Network Approach to the Analysis of Patient Flow in Health Care Systems. Chaussalet et al, Methods of Information in Medicine 2006, 45:492-7.
When planning bed allocation to hospital specialties, there is a clear distinction between services with constrained and unconstrained bed allocations. General medicine is a front-line, medical emergency service. 'Bed borrowing' by admitting physicians shows that their bed allocation is unconstrained.
Abstracts:
Cordoba, J. R. (2006): Using Foucault to analyse ethics in the practice of problem structuring methods, Journal of the Operational Research Society 57: 1027 - 1034.What responsibility do we have for the implementation of the models we construct? Based on problem structuring methods, Cordoba argues that ethics needs to be understood as a continuous development by individuals in relation to existing frameworks and codes. Using Foucalt's ideas, to enhance critical reflection about ethics, two main areas of inquiry are suggested, namely, individualisation of ethics and possibilities and constraints of ethics in power relations. There are no simple answers, but, if you are interested in the ethical values of modellers, this paper is worthy of consideration.
Xie, H., T. Chaussalet, et al. (2006): A software tool to aid long-term care budget planning at local authority level, International Journal of Medical Informatics 75(9): 664-70.
Research with the Social Services Department of the London Borough of Merton into survival time in residential and nursing care has developed a prototype software tool, with a user friendly graphical interface, that combines unit costs of care with an estimated underlying survival model to determine publicly funded residents. The underlying model forecasts the cost of known commitments in long-term care, i.e. how much of next years budget allocation must be set aside to pay for current residents. Feedback from care planners shows the tool helps of understanding of survival time and facilitates budget planning.
O'Connor, R. J. and V. C. Neumann (2006): Payment by results or payment by outcome? The history of measuring medicine, Journal of the Royal Society of Medicine 99(5): 226-31.
Commenting on the payment by results component of the new NHS plan, the authors argue that outcome, not activity, should be the ultimate validation of the effectiveness and quality of care. Taking the analogy of a train journey, you would expect to arrive on time and safely in return for your fare. They conclude by asking 'Why then, when clinicians strive to deliver evidence based medicine, is the Department of Health introducing evidence-free policies?'
Raj, K., K. Baker, et al. (2006) National Emergency Department Overcrowding Study tool is not useful in an Australian emergency department, Emergency Medicine Australasia 18: 282-288.
Study in an urban emergency department in Ipswich hospital, Queensland, suggests that the National Emergency Department Overcrowding Study (NEDOCS) tool does not reflect the subjective assessment of senior staff. Developed in America, NEDOCS may not be useful in Australia. However, limitations are a single study, short term (three weeks) and no serious overcrowding during that time period.
Akcali, E., M. J. Cote, et al. (2006): A network flow approach to optimizing hospital bed capacity decisions, Health Care Management Science 9: 391-404.
The model is generic and treats both demand (patient arrivals) and services (beds) as being homogenous. It is not computationally intensive and gives insight into the problem of matching increasing demand with reducing resources. However, there are limitations as to its use, as the polynomial bounded network structure is based on normal distributions.
King, D. L., D. I. Ben-Tovim, et al. (2006): Redesigning emergency department patient flows: Application of Lean Thinking to health care Emergency Medicine Australasia 18(391-397).
Process mapping into value streams are a key component of 'Lean thinking'. Flinders hospital emergency department had been under pressure for several years. Many established methods had been tried. Three sessions with staff revealed two value streams - patients needing admission (40%) and those that could go home after treatment. Introducing two teams working to these goals minimized queues, decreased the service time and reduced the number of people leaving.
Health expenditure Australia 2004-05
Health expenditure Australia 2004-05 examines expenditure on health goods and services in Australia for 1994-95 to 2004-05. Australia spent over $87 billion on health in 2004-05, an estimated rise of $8 billion since 2003 - 04. Expenditure estimates by area of health expenditure, as a proportion of gross domestic product (GDP), on a per person basis, by state and territory, by comparison with selected OECD and Asia-Pacific countries, and by source of funding (Australian Government, other governments and the non-government sector) are presented. This report will be helpful to anyone interested in studying, analysing and comparing estimates of health expenditure in Australia.
http://www.aihw.gov.au/publications/index.cfm/title/10350
Forthcoming conferences
5th IMA QUANTITATIVE MODELLING IN THE MANAGEMENT OF HEALTH CARE, Goodenough College, Central London on 2nd - 4th April 2007Conference website or the IMA website
The deadline for abstracts, 300 to 500 words has been extended to 20th January 2007. Authors who submitted to previous deadline will be notified in January. Abstracts to be mailed to Lucy.Nye@ima.org.uk.
Selected papers presented (oral or poster) will be published in the Springer journal Health Care Management Science or in IMA Journal of Mathematics.
Contact: Dr. T.J. Chaussalet, Reader, Department of Information Systems, University of Westminster, 115 New Cavendish Street, London W1W 6UW. Email: chausst@wmin.ac.uk
Young OR 15, University of Bath, Bath, UK 28th-30th March 2007
Health Stream: Adele Marshall and Barry Shaw , Queen's University of Belfast
The Health Stream welcomes recent applications of Operational Research to healthcare decision support and health policy. Such topics include, but are not limited to, areas such as disease modelling and cost-effectiveness, medical decision-making, planning health services and logistics to include the modelling of health care interventions and patient care, resource allocation and workforce planning, performance measurement and evaluation, and clinical monitoring.
Three years ago we launched Nosokinetics News onto an unsuspecting world. Thanks to your support, from modest beginnings, we now mail to 437 people worldwide. Nosokinetics now has 299 Google hits on the web and 1,917 on my computer. But success has brought its problems and we need to change the way the newsletter is constructed and mailed.
This is the last newsletter that will be sent with personalised letters. Future newsletters will be sent using jisc mail, the UK academic mailing list. The benefit being simplicity, and ease to subscribe and unsubscribe. Everyone who is now on the mailing list will be automatically included in the new system.
Instructions about how others can register, and how to subscribe and unsubscribe will be sent in the new year. We intend to bring news about the research of different groups, to include a PhD research section in addition to short articles.
Feedback, contributions and leads to papers will always be welcome. These should be sent to nosokinetics@tiscali.co.uk. At this stage, looking forward to the 3rd birthday celebration - candles and cake - we are growing slowly but surely in our mission to bring a scientific approach to the planning and monitoring of health and social care. For the benefit of all.
Peter Millard : editor Nosokinetics News
Copyright (c)Roy Johnston, Ray Millard, 2005, for e-version; content is author's copyright,
12th International Conference on Applied Stochastic Models and Data Analysis May 29 - June 1, 2007
20th IEEE International Symposium on COMPUTER-BASED MEDICAL SYSTEMS 20-22. June 2007 Maribor, Slovenia. Probable health stream - Contact Adele Marshall.
Web-site: http://cbms2007.uni-mb.si/
Nosokinetics News: Three years old and growing strong
Professor J. Z. Young, professor of anatomy at University College Hospital, London taught us that "We grow oldest, when we are youngest". If you don't see an infant for a few months you notice the difference. Teenagers change but slowly and adults only really change in months or years if they are sick.
We are indebted to IMS MAXIMS plc's sponsorship for enabling the website version to be developed. IMS is a significant supplier to NHS and has an ongoing interest in enhancing the scope of IT support in the NHS, especially in the areas of clinical knowledge and decision support. Developers of systems looking for market opportunities are invited to contact IMS at their UK office, or by e-mail to Paul Cooper (pcooper at imsmaxims dot com). Accessing their web-site
http://www.imsmaxims.com will give a feel for the scope of their work.
Some navigational notes:
A highlighted number may bring up a footnote or a reference. A highlighted word hotlinks to another document (chapter, appendix, table of contents, whatever). In general, if you click on the 'Back' button it will bring to to the point of departure in the document from which you came.