PINCER trial: a cluster randomised trial comparing the effectiveness and cost-effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors in general practice are an important source of potentially preventable morbidity and mortality. Building on previous descriptive, qualitative and pilot work, we sought to investigate the effectiveness, cost-effectiveness and likely generalisability of a complex pharm acist-led IT-based intervention aiming to improve prescribing safety in general practice. Objectives: We sought to: • Test the hypothesis that a pharmacist-led IT-based complex intervention using educational outreach and practical support is more effective than simple feedback in reducing the proportion of patients at risk from errors in prescribing and medicines management in general practice. • Conduct an economic evaluation of the cost per error avoided, from the perspective of the National Health Service (NHS). • Analyse data recorded by pharmacists, summarising the proportions of patients judged to be at clinical risk, the actions recommended by pharmacists, and actions completed in the practices. • Explore the views and experiences of healthcare professionals and NHS managers concerning the intervention; investigate potential explanations for the observed effects, and inform decisions on the future roll-out of the pharmacist-led intervention • Examine secular trends in the outcome measures of interest allowing for informal comparison between trial practices and practices that did not participate in the trial contributing to the QRESEARCH database. Methods Two-arm cluster randomised controlled trial of 72 English general practices with embedded economic analysis and longitudinal descriptive and qualitative analysis. Informal comparison of the trial findings with a national descriptive study investigating secular trends undertaken using data from practices contributing to the QRESEARCH database. The main outcomes of interest were prescribing errors and medication monitoring errors at six- and 12-months following the intervention. Results: Participants in the pharmacist intervention arm practices were significantly less likely to have been prescribed a non-selective NSAID without a proton pump inhibitor (PPI) if they had a history of peptic ulcer (OR 0.58, 95%CI 0.38, 0.89), to have been prescribed a beta-blocker if they had asthma (OR 0.73, 95% CI 0.58, 0.91) or (in those aged 75 years and older) to have been prescribed an ACE inhibitor or diuretic without a measurement of urea and electrolytes in the last 15 months (OR 0.51, 95% CI 0.34, 0.78). The economic analysis suggests that the PINCER pharmacist intervention has 95% probability of being cost effective if the decision-maker’s ceiling willingness to pay reaches £75 (6 months) or £85 (12 months) per error avoided. The intervention addressed an issue that was important to professionals and their teams and was delivered in a way that was acceptable to practices with minimum disruption of normal work processes. Comparison of the trial findings with changes seen in QRESEARCH practices indicated that any reductions achieved in the simple feedback arm were likely, in the main, to have been related to secular trends rather than the intervention. Conclusions Compared with simple feedback, the pharmacist-led intervention resulted in reductions in proportions of patients at risk of prescribing and monitoring errors for the primary outcome measures and the composite secondary outcome measures at six-months and (with the exception of the NSAID/peptic ulcer outcome measure) 12-months post-intervention. The intervention is acceptable to pharmacists and practices, and is likely to be seen as costeffective by decision makers.

Cloud based global positioning system as a safety monitor for dementia patients

The aim of using GPS for Alzheimer's Patients is to give carers and families of those affected by Alzheimer's Disease, as well as all the other dementia related conditions, a service that can, via SMS text message, notify them should their loved one leave their home. Through a custom website, it enables the carer to remotely manage a contour boundary that is specifically assigned to the patient as well as the telephone numbers of the carers. The technique makes liberal use of such as Google Maps.

A conceptual life event framework for government-to-citizen electronic service provision

In recent years, life event approach has been widely used by governments all over the world for designing and providing web services to citizens through their e-government portals. Despite the wide usage of this approach, there is still a challenge of how to use this approach to design e-government portals in order to automatically provide personalised services to citizens. We propose a conceptual framework for e-government service provision based on life event approach and the use of citizen profile to capture the citizen needs, since the process of finding Web services from a government-to-citizen (G2C) system involves understanding the citizens’ needs and demands, selecting the relevant services, and delivering services that matches the requirements. The proposed framework that incorporates the citizen profile is based on three components that complement each other, namely, anticipatory life events, non-anticipatory life events and recurring services.

Towards a life-event oriented G2C e-service provision: the NoBLE Framework

One of the primary features of modern government-to-citizen (G2C) service provision is the ability to offer a citizen-centric view of the e-government portal. Life-event approach is one of the most widely adopted paradigms supporting the idea of solving a complex event in a citizen’s life through a single service provision. Several studies have used this approach to design e-government portals. However, they were limited in terms of use and scalability. There were no mechanisms that show how to specify a life-event for structuring public e-services, or how to systematically match life-events with these services taking into consideration the citizen needs. We introduce the NOrm-Based Life-Event (NoBLE) framework for G2C e-service provision with a set of mechanisms as a guide for designing active life-event oriented e-government portals.

Where Does All the Knowledge Go in Small Knowledge-intensive Professional Service Firms?

Small knowledge-intensive professional service firms are becoming increasingly important agents of innovation in construction. There is thus an urgent need to better understand the nature and process of innovation in such firms. First, this paper presents a review of the relevant literature. It is concluded that this literature is often not appropriate for SKIPSFs, as it neglects the critical role of knowledge and knowledge workers in innovation within SKIPSFs. Second, a knowledge-based innovation model is presented as a holistic, system-oriented framework to better investigate how the SKIPSFs create, manage and exploit innovation. This model is to be tested with case study research.

Exploring unanticipated consequences of strategy amongst stakeholder segments: the case of a European Revenue Service

This article applies FIMIX-PLS segmentation methodology to detect and explore unanticipated reactions to organisational strategy among stakeholder segments. For many large organisations today, the tendency to apply a “one-size-fits-all” strategy to members of a stakeholder population, commonly driven by a desire for simplicity, efficiency and fairness, may actually result in unanticipated consequences amongst specific subgroups within the target population. This study argues that it is critical for organisations to understand the varying and potentially harmful effects of strategic actions across differing, and previously unidentified, segments within a stakeholder population. The case of a European revenue service that currently focuses its strategic actions on building trust and compliant behaviour amongst taxpayers is used as the context for this study. FIMIX-PLS analysis is applied to a sample of 501 individual taxpayers, while a novel PLS-based approach for assessing measurement model invariance that can be applied to both reflective and formative measures is also introduced for the purpose of multi-group comparisons. The findings suggest that individual taxpayers can be split into two equal-sized segments with highly differentiated characteristics and reactions to organisational strategy and communications. Compliant behaviour in the first segment (n = 223), labelled “relationships centred on trust,” is mainly driven through positive service experiences and judgements of competence, while judgements of benevolence lead to the unanticipated reaction of increasing distrust among this group. Conversely, compliant behaviour in the second segment (n = 278), labelled “relationships centred on distrust,” is driven by the reduction of fear and scepticism towards the revenue service, which is achieved through signalling benevolence, reduced enforcement and the lower incidence of negative stories. In this segment, the use of enforcement has the unanticipated and counterproductive effect of ultimately reducing compliant behaviour.

An insight into the public acceptance of nutrigenomic-based personalised nutrition.

It is predicted that non-communicable diseases will account for over 73 % of global mortality in 2020. Given that the majority of these deaths occur in developed countries such as the UK, and that up to 80 % of chronic disease could be prevented through improvements in diet and lifestyle, it is imperative that dietary guidelines and disease prevention strategies are reviewed in order to improve their efficacy. Since the completion of the human genome project our understanding of complex interactions between environmental factors such as diet and genes has progressed considerably, as has the potential to individualise diets using dietary, phenotypic and genotypic data. Thus, there is an ambition for dietary interventions to move away from population-based guidance towards 'personalised nutrition'. The present paper reviews current evidence for the public acceptance of genetic testing and personalised nutrition in disease prevention. Health and clear consumer benefits have been identified as key motivators in the uptake of genetic testing, with individuals reporting personal experience of disease, such as those with specific symptoms, being more willing to undergo genetic testing for the purpose of personalised nutrition. This greater perceived susceptibility to disease may also improve motivation to change behaviour which is a key barrier in the success of any nutrition intervention. Several consumer concerns have been identified in the literature which should be addressed before the introduction of a nutrigenomic-based personalised nutrition service. Future research should focus on the efficacy and implementation of nutrigenomic-based personalised nutrition.

Enforcing service level agreements using an economically enhanced resource manager

Traditional resource management has had as its main objective the optimisation of throughput, based on parameters such as CPU, memory, and network bandwidth. With the appearance of Grid Markets, new variables that determine economic expenditure, benefit and opportunity must be taken into account. The SORMA project aims to allow resource owners and consumers to exploit market mechanisms to sell and buy resources across the Grid. SORMA’s motivation is to achieve efficient resource utilisation by maximising revenue for resource providers, and minimising the cost of resource consumption within a market environment. An overriding factor in Grid markets is the need to ensure that desired Quality of Service levels meet the expectations of market participants. This paper explains the proposed use of an Economically Enhanced Resource Manager (EERM) for resource provisioning based on economic models. In particular, this paper describes techniques used by the EERM to support revenue maximisation across multiple Service Level Agreements.

Enforcing service level agreements using an economically enhanced resource manager

Traditional resource management has had as its main objective the optimisation of throughput, based on pa- rameters such as CPU, memory, and network bandwidth. With the appearance of Grid Markets, new variables that determine economic expenditure, benefit and opportunity must be taken into account. The SORMA project aims to allow resource owners and consumers to exploit market mechanisms to sell and buy resources across the Grid. SORMA’s motivation is to achieve efficient resource utilisation by maximising revenue for resource providers, and minimising the cost of resource consumption within a market environment. An overriding factor in Grid markets is the need to ensure that desired Quality of Service levels meet the expectations of market participants. This paper explains the proposed use of an Economically Enhanced Resource Manager (EERM) for resource provisioning based on economic models. In particular, this paper describes techniques used by the EERM to support revenue maximisation across multiple Service Level Agreements.

CASCADE: An Agent Based Framework For Modeling The Dynamics Of Smart Electricity Systems

The Complex Adaptive Systems, Cognitive Agents and Distributed Energy (CASCADE) project is developing a framework based on Agent Based Modelling (ABM). The CASCADE Framework can be used both to gain policy and industry relevant insights into the smart grid concept itself and as a platform to design and test distributed ICT solutions for smart grid based business entities. ABM is used to capture the behaviors of diff erent social, economic and technical actors, which may be defi ned at various levels of abstraction. It is applied to understanding their interactions and can be adapted to include learning processes and emergent patterns. CASCADE models ‘prosumer’ agents (i.e., producers and/or consumers of energy) and ‘aggregator’ agents (e.g., traders of energy in both wholesale and retail markets) at various scales, from large generators and Energy Service Companies down to individual people and devices. The CASCADE Framework is formed of three main subdivisions that link models of electricity supply and demand, the electricity market and power fl ow. It can also model the variability of renewable energy generation caused by the weather, which is an important issue for grid balancing and the profi tability of energy suppliers. The development of CASCADE has already yielded some interesting early fi ndings, demonstrating that it is possible for a mediating agent (aggregator) to achieve stable demandfl attening across groups of domestic households fi tted with smart energy control and communication devices, where direct wholesale price signals had previously been found to produce characteristic complex system instability. In another example, it has demonstrated how large changes in supply mix can be caused even by small changes in demand profi le. Ongoing and planned refi nements to the Framework will support investigation of demand response at various scales, the integration of the power sector with transport and heat sectors, novel technology adoption and diffusion work, evolution of new smart grid business models, and complex power grid engineering and market interactions.

Treating the Tenant as a Customer: can good service improve real estate performance?

Customer Relationship Management (CRM) theory suggests that good customer service results in satisfied customers, who in turn are more likely to remain loyal and recommend the service provider to others. Applied to real estate, this theory implies that landlords should see a return on any investment in the service they give to tenants, in the form of increased lease renewal rates and fewer void periods, achieved without compromising rents. This paper examines determinants of occupier satisfaction, and investigates the relationship between occupier satisfaction and property performance, using measures such as capital growth, income return, lease renewal rates and total return. The analysis is based upon a pilot study using occupier satisfaction responses from around 2500 interviewees based in multi-tenanted offices, shopping centres and retail warehouses on out-of-town retail parks in the UK. The analysis is being extended to cover a larger sample for the author’s PhD. Part 1 of the analysis examines occupier satisfaction, whilst Part 2 considers its impact on property performance.

Performance analysis and deployment of VoLTE mechanisms over 3GPP LTE-based networks

Long Term Evolution based networks lack native support for Circuit Switched (CS) services. The Evolved Packet System (EPS) which includes the Evolved UMTS Terrestrial Radio Access Network (E-UTRAN) and Evolved Packet Core (EPC) is a purely all-IP packet system. This introduces the problem of how to provide voice call support when a user is within an LTE network and how to ensure voice service continuity when the user moves out of LTE coverage area. Different technologies have been proposed for the purpose of providing a voice to LTE users and to ensure the service continues outside LTE networks. The aim of this paper is to analyze and evaluate the overall performance of these technologies along with Single Radio Voice Call Continuity (SRVCC) Inter-RAT handover to Universal Terrestrial Radio Access Networks/ GSM-EDGE radio access Networks (UTRAN/GERAN). The possible solutions for providing voice call and service continuity over LTE-based networks are Circuit Switched Fall Back (CSFB), Voice over LTE via Generic Access (VoLGA), Voice over LTE (VoLTE) based on IMS/MMTel with SRVCC and Over The Top (OTT) services like Skype. This paper focuses mainly on the 3GPP standard solutions to implement voice over LTE. The paper compares various aspects of these solutions and suggests a possible roadmap that mobile operators can adopt to provide seamless voice over LTE.

Collaborative personal profiling for web service ranking and recommendation

Web service is one of the most fundamental technologies in implementing service oriented architecture (SOA) based applications. One essential challenge related to web service is to find suitable candidates with regard to web service consumer’s requests, which is normally called web service discovery. During a web service discovery protocol, it is expected that the consumer will find it hard to distinguish which ones are more suitable in the retrieval set, thereby making selection of web services a critical task. In this paper, inspired by the idea that the service composition pattern is significant hint for service selection, a personal profiling mechanism is proposed to improve ranking and recommendation performance. Since service selection is highly dependent on the composition process, personal knowledge is accumulated from previous service composition process and shared via collaborative filtering where a set of users with similar interest will be firstly identified. Afterwards a web service re-ranking mechanism is employed for personalised recommendation. Experimental studies are conduced and analysed to demonstrate the promising potential of this research.

Any response? How demand response could be enhanced based on early UK experience

Policy makers are in broad agreement that demand response should play a major role in EU electricity systems and provide much needed future system flexibility. Yet, little demand response has been forthcoming in member states to date. This paper identifies some of the technical potential for demand response, based on empirical data from one UK demand aggregator. Half-hourly electricity readings of demand during normal operation and during response events have been analysed for different industry and service sectors. We review these findings in the context of ongoing EU policy developments with particular focus on the role appropriate arrangements to enhance the available resource. We conclude that in some sectors appropriate policy and regulation could triple the available response capacity and thereby lead to stronger commercial uptake of demand response.

Stability of dobutamine 500 mg in 50 ml syringes prepared using a Central Intravenous Additive Service

Objectives A pharmacy Central Intravenous Additives Service (CIVAS) provides ready to use injectable medicines. However, manipulation of a licensed injectable medicine may significantly alter the stability of drug(s) in the final product. The aim of this study was to develop a stability indicating assay for CIVAS produced dobutamine 500 mg in 50 ml dextrose 1% (w/v) prefilled syringes, and to allocate a suitable shelf life. Methods A stability indicating high performance liquid chromatography (HPLC) assay was established for dobutamine. The stability of dobutamine prefilled syringes was evaluated under storage conditions of 4°C (protected from light), room temperature (protected from light), room temperature (exposed to light) and 40°C (protected from light) at various time points (up to 42 days). Results An HPLC method employing a Hypersil column, mobile phase (pH=4.0) consisting of 82:12:6 (v/v/v) 0.05 M KH2PO4:acetonitrile:methanol plus 0.3% (v/v) triethylamine with UV detection at λ=280 nm was specific for dobutamine. Under different storage conditions only samples stored at 40°C showed greater than 5% degradation (5.08%) at 42 days and had the shortest T95% based on this criterion (44.6 days compared with 111.4 days for 4°C). Exposure to light also reduced dobutamine stability. Discolouration on storage was the limiting factor in shelf life allocation, even when dobutamine remained within 5% of the initial concentration. Conclusions A stability indicating HPLC assay for dobutamine was developed. The shelf life recommended for the CIVAS product was 42 days at 4°C and 35 days at room temperature when protected from light.