Newborn screening for inborn errors of metabolism: a systematic review. Health Technol Assessment 1997; 1(11). NHS R&D HTA Programme T he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Population Screening Panel (see inside back cover). The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health.

While there is widespread agreement among economists and management scholars that knowledge spillovers exist and have important economic consequences, researchers know substantially less about the "micro mechanisms" of spillovers-about the degree to which they are geographically localized, for example, or about the degree to which spillovers from public institutions are qualitatively different from those from privately owned firms (Jaffe, 1986; Krugman, 1991; Jaffe et al., 1993; Porter, 1990). In this paper we make use of the geographic distribution of the research activities of major global pharmaceutical firms to explore the extent to which knowledge spills over from proximate private and public institutions. Our data and empirical approach allow us to make advances on two dimensions. First, by focusing on spillovers in research productivity (as opposed to manufacturing productivity), we build closely on the theoretical literature on spillovers that suggests that knowledge externalities are likely to have the most immediate impact on the production of ideas (Romer, 1986; Aghion & Howitt, 1997). Second, our data allow us to distinguish spillovers from public research from spillovers from private, or competitively funded research, and to more deeply explore the role that institutions and geographic proximity play in driving knowledge spillovers.

As a result of the widespread use of phototherapy, the need for neonatal exchange transfusion has declined markedly over the last 25 years. However, in spite of this, we have discovered a marked disparity in the number of requests for units of blood suitable for exchange transfusion made by neonatal units of similar size. A retrospective audit was therefore performed to establish current practice. A questionnaire was sent to consultant neonatologists and an audit trail of all units of blood issued from our Transfusion Centre for exchange transfusion over an 18-month period was followed. A significant finding was the large amount of overordering of blood by neonatologists, resulting in units produced expensively to high specification being given to other patients. Only 42% of the blood issued for exchange transfusions was actually used for that purpose. Also, published guidelines are not being adhered to, particularly with respect to the specification of the blood products being used. Better communication between neonatologists, hospital haematologists and transfusion medicine specialists would help to ensure that infants requiring exchange transfusion are given the best product and that valuable resources are not wasted.