OTHER CONSULTANCY

Health

Review of the provision of out-of-hours emergency care arrangements for Borders Health Board

Quantics reviewed the Borders out-of-hours service (BECS) to answer the question, is it the right service, in the right place, at the right time?

This project required considerable use of the medical, as well as the statistical experience available in-house. Data provided from three overlapping datasets, one of which was on paper only. Quantics used information from telephone surveys, data sets, key staff interviews and geographical mapping to derive a number of recommendations for the Health Board.

Hip fracture care. Analysis of the Scottish Hip Fracture Audit Data for Scottish Executive

Quantics analysed  this national data set of 17,000 hip fracture records. The aim was to develop new methodology to case mix match patients and allow identification of hospitals with good or poor performance with respect to various outcome measures. Classification trees were used and the analysis showed that the variables required for case mix matching depend on the outcome being measured. Where outlying hospitals were identified, analysis of process factors compared with the average process for a case mix matched group, allowed identification of particular problems, e.g. failure to use aspirin DVT prophylaxis, and excessive non-medical delay to surgery.

This methodology has been adopted as part of the surgical governance portfolio (designed by Quantics) for all health boards in Scotland, and has also been adopted for the National Hip Fracture Audit in England and Wales.

New community pharmacy contract

Following the publication of the report considering the future of community pharmacy services in Scotland, ("The Right Medicine"), Quantics was commissioned to explore the impact of proposed changes to the remuneration structure on individual pharmacist pay and overall budget. The aim was to move away from an item-based fee towards a salary system and involved modeling dispensing activity at an individual pharmacist level, taking into account population demographics and deprivation.

Surgical governance

The SEHD (Scottish Executive Health Department) and NHSQIS (NHS Quality Improvement Scotland) wish to provide all hospitals and health boards with a comprehensive surgical governance portfolio annually. Quantics commissioned to help design the new portfolio because of the work they had undertaken with major national surgical audits. Particular emphasis was laid on the need for acceptance by clinicians. This involved sophisticated clinical case mix matching and presentation in a readily understandable way. Equally important was information that would help clinicians to identify the process factors likely to be the cause of a particular hospital's good or poor performance.

SASM

The Scottish Audit of Surgical Mortality aims to investigate every death under the care of a surgeon in Scotland and identify adverse factors in management. Quantics analysed the data from ~12,000 deaths and developed a new classification of adverse events according to their relative risk of being associated with the death. Hospitals with higher than expected numbers of "risky" adverse events can be identified, even if the number of deaths is not abnormal.

Investigator-led clinical trials

Quantics has been involved in numerous clinical trials. We have experience of the earliest stages of trial design, grant and ethical committee submissions, data monitoring committees, formal analysis of results and final report writing.
Some of the trials are large, international, and multi-centre (e.g.: The Institute of Cancer Research International Breast Group Exemestane Study, 4635 patients over 20 countries) and some are small, local studies (e.g. Edinburgh Oncology Centre Fatigue in Cancer Pain Study - 70 patients).

Quantics has particular experience in oncology trials.  

Ecotoxicology

Organisation for Economic Cooperation & Development (OECD) / Food & Agriculture Organisation (UN  FAO)

Pesticide residues: major study of global patterns for OECD / FAO Zoning Steering Group: Pesticide residues.
This project intended to map the world into geographic zones for conducting pesticide residue field trials. Within these zones pesticide residue behavior was expected to be comparable and subsequent residue trial data equivalent. 

Quantics  explored patterns in the available global residue data to support a global scheme.  JMPR field trial data were used together with regional climate data from the countries where the trials were carried out.

Analysis showed that variability in residues was not significantly greater between zones than within zones; there was a general trend in the directions expected, warmer and wetter regions producing lower residues. Analysis showed that the contribution of climate factors to the variation in residues after allowing for zero day values is very small. Between countries, there were significant variations in zero day residues for comparable trials, suggesting that local practice may be the most important factor in accounting for residues at harvest.

European Crop Protection Association (ECPA)
Single unit residue estimation: critique of proposed methodology.
The assessment of short term consumer dietary exposure requires the estimation of the residue levels likely to be seen in single units of commodities. In practice, residue levels are measured in composite samples rather than in single units (medium sized fruits, bunches of grapes etc). 'Variability factors' are applied to the residue levels seen in the composite samples to provide estimates of the likely levels in single units. Quantics reviewed  the ECPA statistical methodology developed to support the selection of these 'variability factors'. 

Technology Sciences (Europe) (TSGE)
Regulatory submissions: analysis and advice on aspects of toxicology and ecotoxicology.
Quantics provides a statistical consultancy service on the toxicology and ecotoxicology aspects of regulatory submissions for crop protection products. Projects include identifying errors in European Commission guidelines on Maximum Residue Level (MRL) estimation; synthesising teratogenic effects across reproduction studies; assessing variation in residues at harvest across regions within Europe.

Analysis of toxicology of food flavouring
An Italian firm was unsure how to analyse  the toxic effects on mice of a food flavoring additive. Quantics considered the proposed procedure of Hayashi.  Some amendments were necessary;
a) Using extra historical controls for comparisons with current data may provide more power for the statistical comparisons but has the potential for bias.

b) The use of the trend test at step 3 is inappropriate if there are no significant results in the initial comparison at step 2. This can affect the overall p values (for example if the trend test was positive but the tests in step 2 were negative.).

c) The suggested Cochran-Armitage test is for comparing trends in proportions. The experimental design must be carefully considered to ensure that this is the appropriate test. In many instances of this type of trial, this is not strictly the case as at each dose there are a number of separate, independent animals, each of which contributes a proportion. If the numbers of cells examined for toxic effects are pooled and the proportion treated as if it were binomial, the variance may be wrongly estimated by the Cochran-Armitage test because it ignores the animal-to-animal variation.