A rapid, Web-based method for obtaining patient views on effects and side-effects of antidepressants.

OBJECTIVE: This project was undertaken to develop a rapid method for obtaining a widespread sample of patient views on the efficacy and side-effects of antidepressants. METHOD: A Web-based method is described for rapidly and objectively obtaining patient views on the effects and side-effects of treatment with antidepressants. The method entails a systematized search of many URLs (Uniform Resource Locators, or Web page addresses), using keywords and phrases to extract the named drug and symptom that are reliably relevant to the medication being taken by the individual reporting the experience online. Unwanted medical conditions (e.g., cancer) are excluded. RESULTS: Three successive searches of thousands of Web pages revealed a cumulative total of 835 "mentions" of patient experience on duloxetine, 756 for venlafaxine, 637 for citalopram, 636 for sertraline, 559 for paroxetine, 457 for fluoxetine, 318 for desvenlafaxine, 289 for fluvoxamine, and 210 for mirtazapine, in association with various symptoms. A comparison of the associated symptoms for each of the antidepressants found that the prevalence of the combined factor of fatigue, drowsiness, tiredness or lethargy ranged from 6.4±0.8% down to 2.9±0.15% of the mentions, where the S.E. was derived from three repeats of the Web-based analysis. The prevalence of dizziness or vertigo ranged from 7.6±0.8% down to 1.9±0.3% of the mentions. CONCLUSIONS: Given the increasing number of patient narratives about drug experiences on open-access Web forums, this rapid novel method will have increasing utility in post-marketing surveillance and in comparing the effects of psychiatric medications.

Crossing the strategic synapse: aligning hospital strategy with shared system priorities in ontario, Canada.

The dominant system-level strategic priorities facing Ontario hospitals were elicited and validated. Researchers employed a multi-stage survey and focus group process to solicit the opinions of senior hospital managers and other healthcare stakeholders. Four shared, system-level priorities emerged: (i) improved clinical and staff recruitment; (ii) stronger inter-hospital partnership and vertical integration along the continuum of care; (iii) improved patient safety; and (iv) the implementation of decision support systems. A subsequent CEO validation survey showed strong endorsement of these system priorities. The authors conclude that a survey, focus group, and validation process can reveal shared system priorities and can highlight emergent organizational strategies designed to resolve them. This process, in which a hospital learns of the priorities facing other hospitals in a system, is a potentially useful managerial tool to promote "strategic synapse"-whereby management can adjust internal organizational strategy and local scorecards to align with shared system priorities.

Acute care hospital strategic priorities: perceptions of challenges, control, competition and collaboration in Ontario's evolving healthcare system.

To explore the current and pending strategic agenda of Ontario hospitals (the largest consumers of the provincial healthcare budget), a survey of Ontario acute care hospital CEOs was conducted in January 2004. The survey, with an 82% response rate, identifies 29 strategic priorities under seven key strategic themes consistent across different hospital types. These themes include (1) human resources cultivation, (2) service integration and partnerships, (3) consumer engagement, (4) corporate governance and management, (5) organizational efficiency and redesign, (6) improved information use for decision-making, (7) patient care management. The extent to which an individual hospital's control over strategic resolutions is perceived may affect multilevel strategic priority-setting and action-planning. In addition to supporting ongoing development of meaningful performance measures and information critical to strategic decision-making, this study's findings may facilitate a better understanding of hospitals' key resource commitments, the extent of competition and collaboration for key resources, the perceived degree of individual control over strategic issue resolution and where systemic resolutions may be required.