Medicines reconciliation in comparison with NICE guidelines across secondary care mental health organisations

Background Medicines reconciliation-identifying and maintaining an accurate list of a patient's current medications-should be undertaken at all transitions of care and available to all patients. Objective A self-completion web survey was conducted for chief pharmacists (or equivalent) to evaluate medicines reconciliation levels in secondary care mental health organisations. Setting The survey was sent to secondary care mental health organisations in England, Scotland, Northern Ireland and Wales. Method The survey was launched via Bristol Online Surveys. Quantitative data was analysed using descriptive statistics and qualitative data was collected through respondents free-text answers to specific questions. Main outcomes measure Investigate how medicines reconciliation is delivered, incorporate a clear description of the role of pharmacy staff and identify areas of concern. Results Forty-two (52 % response rate) surveys were completed. Thirty-seven (88.1 %) organisations have a formal policy for medicines reconciliation with defined steps. Results show that the pharmacy team (pharmacists and pharmacy technicians) are the main professionals involved in medicines reconciliation with a high rate of doctors also involved. Training procedures frequently include an induction by pharmacy for doctors whilst the pharmacy team are generally trained by another member of pharmacy. Mental health organisations estimate that nearly 80 % of medicines reconciliation is carried out within 24 h of admission. A full medicines reconciliation is not carried out on patient transfer between mental health wards; instead quicker and less exhaustive variations are implemented. 71.4 % of organisations estimate that pharmacy staff conduct daily medicine reconciliations for acute admission wards (Monday to Friday). However, only 38 % of organisations self-report to pharmacy reconciling patients' medication for other teams that admit from primary care. Conclusion Most mental health organisations appear to be complying with NICE guidance on medicines reconciliation for their acute admission wards. However, medicines reconciliation is conducted less frequently on other units that admit from primary care and rarely completed on transfer when it significantly differs to that on admission. Formal training and competency assessments on medicines reconciliation should be considered as current training varies and adherence to best practice is questionable.

Coalescence of secondary dispersions in fibrous beds

SUMMARY A study has been made of the coalescence of secondary dispersions in a fibrous bed. The literature pertaining to the formation, hydrodynamic behaviour and methods of separation of droplets less than one hundred micrometres in diameter has been reviewed with particular reference to fibrous bed coalescers. The main operating parameters were identified as inlet drop size distribution, phase ratio, superficial velocity and the thickness and voidage of the bed . A recirculatory rig with interchangeable fibrous bed pads was designed and operated with toluene-water dispersions generated by a combination of centrifugal pumps . Inlet drop sizes were analysed using a Coulter Counter and outlet drops were sized photographically. A novel technique, involving conductivity measur ements at different planes in the bed, was developed to measure hold up distribution. Single phase flow and two phase flow pressure drops were correlated by a Blake-Kozeny type equation. Exit drop size was independent of inlet drop size distribution and phase ratio but a function of superficialvelocity and packing thickness. Average bed hold up was independent of inlet drop size distribution and phase ratio, but decreased with increase in superficial velocity. Hold up was not evenly distributed in the bed, the highest value occurred at the inlet followed by a sharp -2 drop at approximately 1.2 x 10 m. Hold up remained constant throughout the rest of the bed until the exit plane, where it increased. From the results, a mechanism is postulated involving: (a) Capture of the inlet drops followed by interdrop coalescence until an equilibrium value is reached. (b) Equilibrium size droplets flowing as rivulets through the intermediate portion of the bed, and (c) Each rivulet forms droplets at the exit face, which detach by a 'drip point' mechanism.

Coalescence of secondary dispersions

A study has been made of the coalescence of secondary dispersions in beds of woven meshes. The variables investigated were superficial velocity, bed depth, mesh geometry and fibre material; the effects of presoaking the bed in the dispersed phase before operation were also considered. Equipment was design~d to generate a 0.1% phase ratio toluene in water dispersion whose mean drop size was determined using a Coulter Counter. The coalesced drops were sized by photography and a novel holographic technique was developed to evaluate the mean diameter of the effluent secondary drops. Previous models describing single phase flow in porous media are reviewed and it was found that the experimental data obtained in this study is best represented by Keller's equation which is based on a physical model similar to the internal structure of the meshes. Statistical analysis of two phase data produced a correlation, for each mesh tested, relating the pressure drop to superficial velocity and bed depth. The flow parameter evaluated from the single phase model is incorporated into a theoretical comparison of drop capture mechanisms which indicated that direct and indirect interception are predominant. The resulting equation for drop capture efficiericy is used to predict the initial, local drop capture rate in a coalescer. A mathematical description of the saturation profiles was formulated and verified by average saturation data. Based 6n the Blake-Kozeny equation, an expression is derived analytically to predict the two phase pressure drop using the parameters which characterise the saturation profiles. By specifying the local saturation at the inlet face for a given velocity, good agreement between experimental pressure drop data and the model predictions was obtained.

Coalescence of secondary dispersions in packed beds

A study has been made of the coalescence of secondary dispersions in beds of monosized glass ballotini. The variables investigated were superficial velocity, bed depth, ballotini size and dispersed phase concentration. Equipment was designed to generate a toluene ln water dispersion with phase ratios from 0.1 - 1.0 v/v % and whose mean drop size was determined using a Coulter Counter. The coalesced drops were sized by photography and the mean diameter of the effluent drops was determined using a Malvern Particle Size Analyser. Previous models describing single phase flow in porous media are reviewed and it was found that the experimental data obtained in this study is best represented by the Carman-Kozeny equations. Relative permeability correlations were used to predict the saturation profiles across the bed from measured two phase pressure drop data. Theoretical comparison of drop capture mechanisms indicated that direct and indirect interception are predominant. The total capture efficiency for the bed can also be evaluated using Spielman and Fitzpatrick's correlation.The resulting equation is used to predict the initial, local drop capture rate in a coalescer. A mathematical description of the saturation profiles is formulated and verified by the saturation profiles obtained by relative permeability. Based on the Carman-Kozeny equation, an expression is derived analytically to .predict the two phase pressure drop using the parameters which characterise the saturation profiles. By specifying the local saturation at the inlet face for a given velocity and phase ratio, good agreement between experimental pressure drop data and the model predictions was obtained. An attempt to predict the exit drop size has been made using an analogy for flow through non cylindrical channels.

Development and validaton of an indicator to compare antibiotic usage in secondary care in England

The use of antibiotics was investigated in twelve acute hospitals in England. Data was collected electronically and by questionnaire for the financial years 2001/2, 2002/3 and 2003/4. Hospitals were selected on the basis of their Medicines Management Self-Assessment Scores (MMAS) and included a cohort of three hospitals with integrated electronic prescribing systems. The total sample size was 6.65% of English NHS activity for 2001/2 based on Finished Consultant Episode (FCE) numbers. Data collected included all antibiotics dispensed (ATC category J01), hospital activity FCE's and beddays, Medicines Management Self-assessment scores, Antibiotic Medicines Management scores (AMS), Primary Care Trust (PCT) of origin of referral populations, PCT antibiotic prescribing rates, Index of Multiple Deprivation for each PCT. The DDD/FCE (Defined Daily Dose/FCE) was found to correlate with the DDD 100beddays (r = 0.74 pitional indicator for identifying hospitals that require further study. Antibiotic use increased from a mean 4.16 DDD/FCE in 2001/2 to 4.35 DDD/FCE in 2003/4. Antibiotic use in the electronic prescribing cohort was found to be lower, than the sample mean at 3.48 DDD/FCE in 2001/2 and 3.34 DDD/FCE in 2003/4. The MMAS and AMS were found to correlate (r = 0.74 pitative indicators of antibiotic use. A number of indicators are proposed as triggers for further investigation including a proportion of 0.24 for the ratio of third generation to first/second generation cephalosporin use, and five percent as the limit for parenteral quinolone DOD of total quinolone DOD usage. It was possible to demonstrate a correlation between the IMD 2000 and primary care antibiotic prescribing rates but not between primary and secondary care antibiotic prescribing rates for the same referral population or between the weighted mean IMD 2000 for each hospital's referral population and the hospital antibiotic prescribing rate.

The response to and effects of microcomputers in the education sector:the introduction of an innovation in local authority secondary schools

The study addresses the introduction of an innovation of new technology into a bureaucratic profession. The organisational setting is that of local authority secondary schools at a time at which microcomputers were being introduced in both the organisational core (for teaching) and its periphery (school administration). The research studies innovation-adopting organisations within their sectoral context; key actors influencing the innovation are identified at the levels of central government, local government and schools.A review of the literature on new technology and innovation (including educational innovation), and on schools as organisations in a changing environment leads to the development of the conceptual framework of the study using a resource dependency model within a cycle of the acquisition, allocation and utilisation of financial, physical and intangible resources. The research methodology is longitudinal and draws from both positivist and interpretive traditions. lt includes an initial census of the two hundred secondary schools in four local education authorities, a final survey of the same population, and four case studies, using both interview methods and documentation. Two modes of innovation are discerned. In respect of administrative use a rationalising, controlling mode is identified, with local education authorities developing standardised computer-assisted administrative systems for use in schools. In respect of curricular use, in contrast, teachers have been able to maintain an indeterminate occupational knowledge base, derived from an ideology of professionalism in respect of the classroom use of the technology. The mode of innovation in respect of curricular use has been one of learning and enabling. The resourcing policies of central and local government agencies affect the extent of use of the technology for teaching purposes, but the way in which it is used is determined within individual schools, where staff with relevant technical expertise significantly affect the course of the innovation.

Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularisation secondary to pathological myopia

The treatment of choroidal neovascularisation (CNV) secondary to pathological myopia has presented a number of problems to ophthalmologists over the years, but the advent of photodynamic therapy (PDT) with verteporfin has changed how we manage these patients. Until PDT became available, the use of laser photocoagulation for extra and juxtafoveal lesions had been shown to be effective in the short term in preventing loss of vision, although the risk of regrowth of CNV and undertreatment were well recognised. However, even in apparent successful cases of photocoagulation, laser scar enlargement and creepage into the fovea in the mid-to-long term often occurred with resulting loss of central vision.1 Other options for treatment were very limited with little evidence that other modalities such as transpupillary thermotherapy or submacular surgery and macular transplantation surgery would be successful in highly myopic eyes. The evidence for the role of PDT and verteporfin CNV secondary to pathological myopia comes from the verteporfin in photodynamic therapy (VIP) study that has shown how effective this treatment is in eyes with subfoveal CNV.2, 3 Now in this publication, Lam et al4 from Hong Kong have shown that PDT is also effective in juxtafoveal CNV, with high myopia. They performed a small prospective study of 11 patients of mean age 44.8 years, with 12 months of follow-up. They found that there was a mean improvement of 1.8 lines of LogMAR best-corrected visual acuity (BCVA) at 12 months, with a mean number of 2.3 PDT treatments. The most rapid improvement occurred within the first 3 months of treatment and by 12 months none of the patients had suffered a deterioration in BCVA from baseline. There were no cases of adverse effects from the infusion or laser treatment. For ophthalmologists dealing with patients with CNV secondary to causes other than AMD, this is further evidence of the effectiveness of PDT with verteporfin in maintaining vision. These patients are likely to be younger than those with AMD and are likely to be in active employment and supporting families, and clearly the preservation of best vision possible is imperative in this group. It is therefore encouraging for ophthalmologists in the United Kingdom that the verteporfin in PDT Cohort Study (VPDT Study) includes the ability to treat patients with subfoveal CNV secondary to high myopia if they fulfill National Institute of Clinical Excellence guidelines, and will allow representations to be made on an individual basis for treatment of juxtafoveal lesions.5 For those ophthalmologists used to juggling increased patient expectations with scarce NHS resources, this is promising news and will allow us to offer a better standard of care to our patients.

Why is it possible to detect doped regions of semiconductors in low voltage SEM:a review and update

There is an urgent need for fast, non-destructive and quantitative two-dimensional dopant profiling of modern and future ultra large-scale semiconductor devices. The low voltage scanning electron microscope (LVSEM) has emerged to satisfy this need, in part, whereby it is possible to detect different secondary electron yield values (brightness in the SEM signal) from the p-type to the n-type doped regions as well as different brightness levels from the same dopant type. The mechanism that gives rise to such a secondary electron (SE) contrast effect is not fully understood, however. A review of the different models that have been proposed to explain this SE contrast is given. We report on new experiments that support the proposal that this contrast is due to the establishment of metal-to-semiconductor surface contacts. Further experiments showing the effect of instrument parameters including the electron dose, the scan speeds and the electron beam energy on the SE contrast are also reported. Preliminary results on the dependence of the SE contrast on the existence of a surface structure featuring metal-oxide semiconductor (MOS) are also reported. Copyright © 2005 John Wiley & Sons, Ltd.

Investigating the current and future use of it by 3PL providers in europe and the far east

The paper investigates the role of current and future IT applications in 3PL services in Europe and the Far East. For clients' competitive advantage, 3PL providers increasingly contribute IT systems to logistics, helping 3PL providers to enhance supply chain collaboration with business partners. Through qualitative interviews, questionnaires and secondary data analysis, common attributes of both regions' IT systems are identified which enable supply chain partners to collaborate and share information. Most companies already implement IT systems for processing transactions, but recognized motivations and barriers remain, since 3PL providers incompletely understand clients' IT requirements. Long-term productivity gains require sophisticated IT systems to streamline cycles and improve supply chain visibility, thus facilitating planning and decision-making.

Modifying the hierarchical porosity of SBA-15 via mild-detemplation followed by secondary treatments

Fenton-chemistry-based detemplation combined with secondary treatments offers options to tune the hierarchical porosity of SBA-15. This approach has been studied on a series of SBA-15 mesophases and has been compared to the conventional calcination. The as-synthesized and detemplated materials were studied with regard to their template content (TGA, CHN), structure (SAXS, TEM), surface hydroxylation (Blin-Carterets approach), and texture (high-resolution argon physisorption). Fenton detemplation achieves 99% of template removal, leading to highly hydroxylated materials. The structure is better preserved when a secondary treatment is applied after the Fenton oxidation, due to the intense capillary forces during drying in water. Two successful approaches are presented: drying in a low-surface-tension solvent (such as n-BuOH) and a hydrothermal stabilization to further condense the structure and make it structurally more robust. Both approaches give rise to remarkably low structural shrinkage, lower than calcination and the direct water-dried Fenton. Interestingly, the derived textural features are remarkably different. The n-BuOH exchange route gives rise to highly hierarchical structures with enhanced interconnecting pores and the highest surface areas. The hydrothermal stabilization produces large-pore SBA-15 structures with high pore volume, intermediate interconnectivity, and minimal micropores. Therefore, the hierarchical texture can be fine-tuned in these two fashions while the template is removed under mild conditions.

Care-less spaces and identity construction:transition to secondary school for disabled children

There is a growing body of literature which marks out a feminist ethics of care and it is within this framework we understand transitions from primary to secondary school education can be challenging and care-less, especially for disabled children. By exploring the narratives of parents and professionals, we investigate transitions and self-identity, as a meaningful transition depends on the care-full spaces pupils inhabit. These education narratives are all in the context of privileging academic attainment and a culture of testing and examinations. Parents and professionals, as well as children are also surveyed. Until there are care-full education processes, marginalisation will remain, impacting on disabled children’s transition to secondary school and healthy identity construction. Moreover, if educational challenges are not addressed, their life chances are increasingly limited. Interdependent caring work enables engagement in a meaningful education and positive identity formation. In school and at home, care-full spaces are key in this process.