Designing care bundle documentation to support the recognition and treatment of acute kidney injury: a route to quality improvement

The chapter describes development of care bundle documentation, through an iterative, user-centred design process, to support the recognition and treatment of acute kidney injury (AKI). The chapter details stages of user and stakeholder consultation, employed to develop a design response that was sensitive to user experience and need, culminating in simulation testing of a near final prototype. The development of supplementary awareness-raising materials, relating to the main care bundle tool is also discussed. This information design response to a complex clinical decision-making process is contrasted to other approaches to promoting AKI care. The need for different but related approaches to the working tool itself and the tool’s communication are discussed. More general recommendations are made for the development of communication tools to support complex clinical processes.

The political economy of bovine tuberculosis in Great Britain

A brief history of bovine tuberculosis (bTB) and its control in Great Britain is presented. Numerous diverse policies to control the disease in man, cattle and wildlife have been pursued over the last 100 years and many millions of pounds have been spent. After notable success in reducing the incidence and prevalence of bTB in cattle in GB from the 1950s to the mid-1980s, the number of cattle slaughtered has increased with increased geographical spread continually since that time with a high point of bTB incidence in 2008. This increase appeared to coincide with changing policy regarding the control of the disease in badgers with a more humane approach adopted and with strengthened protection for badgers through legislation. Indeed, much controversy has been involved in the debate on the role of badgers in disease transmission to cattle and the need for their control as vectors of the disease with various commissioned research projects, trials, public consultations and media attention. The findings of two social science investigations presented as examples showed that citizens generally believed that bTB in cattle is an important issue that needs to be tackled but objected to badgers being killed, whilst cattle farmers were willing to pay around £17/animal/year for a bTB cattle vaccine. It is noted that successes regarding the control of bTB in other countries have combined both cattle and wildlife controls and had strong involvement from industry working with government.