The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study

Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

Detection of transgenic DNA and protein, in rumen fluid, duodenal digesta, milk, blood and faeces of lactating dairy cows

The objective was to determine the presence or absence of transgenic and endogenous plant DNA in ruminal fluid, duodenal digesta, milk, blood, and feces, and if found, to determine fragment size. Six multiparous lactating Holstein cows fitted with ruminal and duodenal cannulas received a total mixed ration. There were two treatments (T). In T1, the concentrate contained genetically modified (GM) soybean meal (cp4epsps gene) and GM corn grain (cry1a[b] gene), whereas T2 contained the near isogenic non-GM counterparts. Polymerase chain reaction analysis was used to determine the presence or absence of DNA sequences. Primers were selected to amplify small fragments from single-copy genes (soy lectin and corn high-mobility protein and cp4epsps and cry1a[b] genes from the GM crops) and multicopy genes (bovine mitochondrial cytochrome b and rubisco). Single-copy genes were only detected in the solid phase of rumen and duodenal digesta. In contrast, fragments of the rubisco gene were detected in the majority of samples analyzed in both the liquid and solid phases of ruminal and duodenal digesta, milk, and feces, but rarely in blood. The size of the rubisco gene fragments detected decreased from 1176 bp in ruminal and duodenal digesta to 351 bp in fecal samples.

Detection of transgenic and endogenous plant DNA in rumen fluid, duodenal digesta, milk, blood, and feces of lactating dairy cows

The objective was to determine the presence or absence of transgenic and endogenous plant DNA in ruminal fluid, duodenal digesta, milk, blood, and feces, and if found, to determine fragment size. Six multiparous lactating Holstein cows fitted with ruminal and duodenal cannulas received a total mixed ration. There were two treatments (T). In T1, the concentrate contained genetically modified (GM) soybean meal (cp4epsps gene) and GM corn grain (cry1a[b] gene), whereas T2 contained the near isogenic non-GM counterparts. Polymerase chain reaction analysis was used to determine the presence or absence of DNA sequences. Primers were selected to amplify small fragments from single-copy genes (soy lectin and corn high-mobility protein and cp4epsps and cry1a[b] genes from the GM crops) and multicopy genes (bovine mitochondrial cytochrome b and rubisco). Single-copy genes were only detected in the solid phase of rumen and duodenal digesta. In contrast, fragments of the rubisco gene were detected in the majority of samples analyzed in both the liquid and solid phases of ruminal and duodenal digesta, milk, and feces, but rarely in blood. The size of the rubisco gene fragments detected decreased from 1176 bp in ruminal and duodenal digesta to 351 bp in fecal samples.

A flexible monitoring and notification system for distributed resources

Resource monitoring in distributed systems is required to understand the 'health' of the overall system and to help identify particular problems, such as dysfunctional hardware, a faulty, system or application software. Desirable characteristics for monitoring systems are the ability to connect to any number of different types of monitoring agents and to provide different views of the system, based on a client's particular preferences. This paper outlines and discusses the ongoing activities within the GridRM wide-area resource-monitoring project.

Using a RESTful messaging and registry system to support a range a distributed applications

Tycho was conceived in 2003 in response to a need by the GridRM [1] resource-monitoring project for a ldquolight-weightrdquo, scalable and easy to use wide-area distributed registry and messaging system. Since Tycho's first release in 2006 a number of modifications have been made to the system to make it easier to use and more flexible. Since its inception, Tycho has been utilised across a number of application domains including widearea resource monitoring, distributed queries across archival databases, providing services for the nodes of a Cray supercomputer, and as a system for transferring multi-terabyte scientific datasets across the Internet. This paper provides an overview of the initial Tycho system, describes a number of applications that utilise Tycho, discusses a number of new utilities, and how the Tycho infrastructure has evolved in response to experience of building applications with it.

A camera based digit location and recognition system for garment tracking

Garment information tracking is required for clean room garment management. In this paper, we present a camera-based robust system with implementation of Optical Character Reconition (OCR) techniques to fulfill garment label recognition. In the system, a camera is used for image capturing; an adaptive thresholding algorithm is employed to generate binary images; Connected Component Labelling (CCL) is then adopted for object detection in the binary image as a part of finding the ROI (Region of Interest); Artificial Neural Networks (ANNs) with the BP (Back Propagation) learning algorithm are used for digit recognition; and finally the system is verified by a system database. The system has been tested. The results show that it is capable of coping with variance of lighting, digit twisting, background complexity, and font orientations. The system performance with association to the digit recognition rate has met the design requirement. It has achieved real-time and error-free garment information tracking during the testing.

Slogger: a profiling and analysis system based on semantic web technologies

Increasingly, distributed systems are being used to host all manner of applications. While these platforms provide a relatively cheap and effective means of executing applications, so far there has been little work in developing tools and utilities that can help application developers understand problems with the supporting software, or the executing applications. To fully understand why an application executing on a distributed system is not behaving as would be expected it is important that not only the application, but also the underlying middleware, and the operating system are analysed too, otherwise issues could be missed and certainly overall performance profiling and fault diagnoses would be harder to understand. We believe that one approach to profiling and the analysis of distributed systems and the associated applications is via the plethora of log files generated at runtime. In this paper we report on a system (Slogger), that utilises various emerging Semantic Web technologies to gather the heterogeneous log files generated by the various layers in a distributed system and unify them in common data store. Once unified, the log data can be queried and visualised in order to highlight potential problems or issues that may be occurring in the supporting software or the application itself.

Blood and memory

Book review of 'The ethics of memory' by A. Margalit.

PEGylated amyloid peptide nanocontainer delivery and release system

A micellar nanocontainer delivery and release system is designed on the basis of a peptide-polymer conjugate. The hybrid molecules self-assemble into micelles comprising a modified amyloid peptide core surrounded by a PEG corona. The modified amyloid peptide previously studied in our group forms helical ribbons based on a beta-sheet motif and contains beta-amino acids that are excluded from the beta-sheet structure, thus being potentially useful as fibrillization inhibitors. In the model peptide-PEG hybrid system studied, enzymatic degradation using alpha-chymotrypsin leads to selective cleavage close to the PEG-peptide linkage, break up of the micelles, and release of peptides in unassociated form. The release of monomeric peptide is useful because aggregation of the released peptide into beta-sheet amyloid fibrils is not observed. This concept has considerable potential in the targeted delivery of peptides for therapeutic applications.

Biogas innovation processes and innovation system: lessons from Davao del Sur, Philippines

This paper examines biogas innovation system and processes in two farming communities in Davao del Sur, Philippines. Innovation histories were traced through workshops, semi-structured interviews, observations and document analysis. The paper shows that there were diverse innovation actors both from public and private sectors. Restrictive attitudes and practices resulted in weak and limited interactions among actors. Multi-actor interaction was weak, signifying a lack of innovation actors that focus on creating, developing and strengthening linkages, networks and partnerships. The lack of support in the socio-organisational institutions that constitute the enabling environment within which innovation actors operate may lead to systemic failure.