Prevalence and Causes of Prescribing ErrorsL The PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) Study

Objectives: Study objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing.

Method: A three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors’ self-efficacy were established.

Results: 4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p,0.001), surgical (p = ,0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p,0.001), a greater number of prescribed medicines (p,0.001) and the months December and June (p,0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen.

Conclusions: Prescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.

A pilot study of a family focused, psychosocial intervention with war-exposed youth at risk of attack and abduction in north-eastern Democratic Republic of Congo

Rural communities in the Haut-Uele Province of northern Democratic Republic of Congo live in constant danger of attack and/or abduction by units of the Lord's Resistance Army operating in the region. This pilot study sought to develop and evaluate a community-participative psychosocial intervention involving life skills and relaxation training and Mobile Cinema screenings with this war-affected population living under current threat. 159 war-affected children and young people (aged 7-18) from the villages of Kiliwa and Li-May in north-eastern DR Congo took part in this study. In total, 22% of participants had been abduction previously while 73% had a family member abducted. Symptoms of post-traumatic stress reactions, internalising problems, conduct problems and pro-social behaviour were assessed by blinded interviewers at pre- and post-intervention and at 3-month follow-up. Participants were randomised (with an accompanying caregiver) to 8 sessions of a group-based, community-participative, psychosocial intervention (n=79) carried out by supervised local, lay facilitators or a wait-list control group (n=80). Average seminar attendance rates were high: 88% for participants and 84% for caregivers. Drop-out was low: 97% of participants were assessed at post-intervention and 88% at 3 month follow-up. At post-test, participants reported significantly fewer symptoms of post-traumatic stress reactions compared to controls (Cohen's d=0.40). At 3 month follow up, large improvements in internalising symptoms and moderate improvements in pro-social scores were reported, with caregivers noting a moderate to large decline in conduct problems among the young people. Trial Registration clinicalTrials.gov, Identifier: NCT01542398.

(Re)-Introducing Themes of Religion and Spirituality to Professional Social Work Training in the Land of ‘Saints and Scholars’.

This chapter begins by alluding to Ireland’s historical reputation as the land of “Saints and Scholars” and then briefly charts its demise from this position. A parallel process in relation to religiously motivated provision of health and social care is outlined. The inclusion of themes of religion and spirituality within the current professional social work codes in the USA and Britain and the framework for social work training in Northern Ireland is noted. In this context the lack of any substantive inclusion of themes of religion and/or spirituality within the Bachelor of Social Work (BSW) degree at Queens University Belfast will be situated. A series of intersecting reasons for this lack of inclusion are proposed in terms of the experience of living through the recent troubled history of Northern Ireland and a variety of biases in academic thought.
A rationale for the re-introduction of inputs on religion and spirituality is articulated in terms of the widespread resurgence of these themes within health and social care and psychotherapy literature and the new emphasis on practicing in culturally sensitive ways in Britain. The first steps to re-introduce these themes under the higher context marker of “culturally competent practice” are described and an analysis of data from the students’ feedback presented along with illustrative quotations. The dissonance between the initial misgivings of staff and the overwhelmingly positive responses of students are highlighted. The chapter concludes with a discussion of lessons learned through the process with an emphasis on how the inclusion of these themes can result in better practice for service users, including those impacted by “the Troubles” in Northern Ireland.

Massive MIMO with Optimal Power and Training Duration Allocation

We consider the uplink of massive multicell multiple-input multiple-output systems, where the base stations (BSs), equipped with massive arrays, serve simultaneously several terminals in the same frequency band. We assume that the BS estimates the channel from uplink training, and then uses the maximum ratio combining technique to detect the signals transmitted from all terminals in its own cell. We propose an optimal resource allocation scheme which jointly selects the training duration, training signal power, and data signal power in order to maximize the sum spectral efficiency, for a given total energy budget spent in a coherence interval. Numerical results verify the benefits of the optimal resource allocation scheme. Furthermore, we show that more training signal power should be used at low signal-to-noise ratio (SNRs), and vice versa at high SNRs. Interestingly, for the entire SNR regime, the optimal training duration is equal to the number of terminals.