The causes of prescribing errors in English general practices: a qualitative study

Aim: To examine the causes of prescribing and monitoring errors in English general practices and provide recommendations for how they may be overcome. Design: Qualitative interview and focus group study with purposive sampling and thematic analysis informed by Reason’s accident causation model. Participants: General practice staff participated in a combination of semi-structured interviews (n=34) and six focus groups (n=46). Setting: Fifteen general practices across three primary care trusts in England. Results: We identified seven categories of high-level error-producing conditions: the prescriber, the patient, the team, the task, the working environment, the computer system, and the primary-secondary care interface. Each of these was further broken down to reveal various error-producing conditions. The prescriber’s therapeutic training, drug knowledge and experience, knowledge of the patient, perception of risk, and their physical and emotional health, were all identified as possible causes. The patient’s characteristics and the complexity of the individual clinical case were also found to have contributed to prescribing errors. The importance of feeling comfortable within the practice team was highlighted, as well as the safety of general practitioners (GPs) in signing prescriptions generated by nurses when they had not seen the patient for themselves. The working environment with its high workload, time pressures, and interruptions, and computer related issues associated with mis-selecting drugs from electronic pick-lists and overriding alerts, were all highlighted as possible causes of prescribing errors and often interconnected. Conclusion: This study has highlighted the complex underlying causes of prescribing and monitoring errors in general practices, several of which are amenable to intervention.

Teaching programming to beginners in a massive open online course

The University of Reading’s first Massive Open Online Course (MOOC) “Begin Programming: Build your first mobile game” (#FLMobiGame) was offered in Autumn 2013 on the FutureLearn platform. This course used a simple Android game framework to present basic programming concepts to complete beginners. The course attracted wide interest from all age groups. The course presented opportunities and challenges to both participants and educators. While some participants had difficulties accessing content some others had trouble grasping the concepts and applying them in a real program. Managing forums was cumbersome with the limited facilities supported by the Beta-platform. A healthy community was formed around the course with the support of social media. The case study reported here is part of an ongoing research programme exploring participants’ MOOC engagement and experience using a grounded, ethnographical approach.

Effect of breadmaking process on In Vitro gut microbiota parameters in irritable bowel syndrome

A variety of foods have been implicated in symptoms of patients with Irritable Bowel Syndrome (IBS) but wheat products are most frequently cited by patients as a trigger. Our aim was to investigate the effects of breads, which were fermented for different lengths of time, on the colonic microbiota using in vitro batch culture experiments. A set of in vitro anaerobic culture systems were run over a period of 24 h using faeces from 3 different IBS donors (Rome Criteria–mainly constipated) and 3 healthy donors. Changes in gut microbiota during a time course were identified by fluorescence in situ hybridisation (FISH), whilst the small -molecular weight metabolomic profile was determined by NMR analysis. Gas production was separately investigated in non pH-controlled, 36 h batch culture experiments. Numbers of bifidobacteria were higher in healthy subjects compared to IBS donors. In addition, the healthy donors showed a significant increase in bifidobacteria (P<0.005) after 8 h of fermentation of a bread produced using a sourdough process (type C) compared to breads produced with commercial yeasted dough (type B) and no time fermentation (Chorleywood Breadmaking process) (type A). A significant decrease of δ-Proteobacteria and most Gemmatimonadetes species was observed after 24 h fermentation of type C bread in both IBS and healthy donors. In general, IBS donors showed higher rates of gas production compared to healthy donors. Rates of gas production for type A and conventional long fermentation (type B) breads were almost identical in IBS and healthy donors. Sourdough bread produced significantly lower cumulative gas after 15 h fermentation as compared to type A and B breads in IBS donors but not in the healthy controls. In conclusion, breads fermented by the traditional long fermentation and sourdough are less likely to lead to IBS symptoms compared to bread made using the Chorleywood Breadmaking Process.

Individual differences in early language learning: a study of English learners of French

The present longitudinal study examines the interaction of learner variables (gender, motivation, self-efficacy and first language literacy) and their influence on second language learning outcomes. The study follows English learners of French from Year 5 in primary school (aged 9-10) to the first year in secondary school (Year 7 aged 11-12). Language outcomes were measured by two oral production tasks; a sentence repetition task and a photo description task both of which were administered at three time points. Longitudinal data on learner attitudes and motivation were collected via questionnaires. Teacher assessment data for general first language literacy attainment were also provided. The results show a great deal of variation in learner attitudes and outcomes and that there is a complex relationship between first language literacy, self-efficacy, gender and attainment. For example, in general, girls held more positive attitudes to boys and were more successful. However, the inclusion of first language ability, which explained 30-40% of variation, shows that gender differences in attitudes and outcomes are likely mediated by first language literacy and prior learning experience.

Reverse knowledge transfer: evidence from General Motors in the UK and Poland

This paper explores the concept of a reverse diffusion of knowledge, that is, the transfer flowing from a company’s subsidiary to its home plant. The article presents the empirical evidence gathered in General Motors UK and Poland, where the reverse diffusion of a concept of the built-in quality took place. Lastly, the implications of our findings for future research are discussed.