Implementation of an audit with feedback knowledge translation intervention to promote medication error reporting in health care: a protocol.

BACKGROUND: Health professionals strive to deliver high-quality care in an inherently complex and error-prone environment. Underreporting of medical errors challenges attempts to understand causative factors and impedes efforts to implement preventive strategies. Audit with feedback is a knowledge translation strategy that has potential to modify health professionals' medical error reporting behaviour. However, evidence regarding which aspects of this complex, multi-dimensional intervention work best is lacking. The aims of the Safe Medication Audit Reporting Translation (SMART) study are to: 1. Implement and refine a reporting mechanism to feed audit data on medication errors back to nurses 2. Test the feedback reporting mechanism to determine its utility and effect 3. Identify characteristics of organisational context associated with error reporting in response to feedback METHODS/DESIGN: A quasi-experimental design, incorporating two pairs of matched wards at an acute care hospital, is used. Randomisation occurs at the ward level; one ward from each pair is randomised to receive the intervention. A key stakeholder reference group informs the design and delivery of the feedback intervention. Nurses on the intervention wards receive the feedback intervention (feedback of analysed audit data) on a quarterly basis for 12 months. Data for the feedback intervention come from medication documentation point-prevalence audits and weekly reports on routinely collected medication error data. Weekly reports on these data are obtained for the control wards. A controlled interrupted time series analysis is used to evaluate the effect of the feedback intervention. Self-report data are also collected from nurses on all four wards at baseline and at completion of the intervention to elicit their perceptions of the work context. Additionally, following each feedback cycle, nurses on the intervention wards are invited to complete a survey to evaluate the feedback and to establish their intentions to change their reporting behaviour. To assess sustainability of the intervention, at 6 months following completion of the intervention a point-prevalence chart audit is undertaken and a report of routinely collected medication errors for the previous 6 months is obtained. This intervention will have wider application for delivery of feedback to promote behaviour change for other areas of preventable error and adverse events.

Understanding context in knowledge translation: a concept analysis study protocol.

AIM: To conduct a concept analysis of clinical practice contexts (work environments) that facilitate or militate against the uptake of research evidence by healthcare professionals in clinical practice. This will involve developing a clear definition of context by describing its features, domains and defining characteristics. BACKGROUND: The context where clinical care is delivered influences that care. While research shows that context is important to knowledge translation (implementation), we lack conceptual clarity on what is context, which contextual factors probably modify the effect of knowledge translation interventions (and hence should be considered when designing interventions) and which contextual factors themselves could be targeted as part of a knowledge translation intervention (context modification). DESIGN: Concept analysis. METHODS: The Walker and Avant concept analysis method, comprised of eight systematic steps, will be used: (1) concept selection; (2) determination of aims; (3) identification of uses of context; (4) determination of defining attributes of context; (5) identification/construction of a model case of context; (6) identification/construction of additional cases of context; (7) identification/construction of antecedents and consequences of context; and (8) definition of empirical referents of context. This study is funded by the Canadian Institutes of Health Research (January 2014). DISCUSSION: This study will result in a much needed framework of context for knowledge translation, which identifies specific elements that, if assessed and used to tailor knowledge translation activities, will result in increased research use by nurses and other healthcare professionals in clinical practice, ultimately leading to better patient care.

Intradialytic Laughter Yoga therapy for haemodialysis patients: a pre-post intervention feasibility study.

BACKGROUND: Laughter Yoga consists of physical exercise, relaxation techniques and simulated vigorous laughter. It has been associated with physical and psychological benefits for people in diverse clinical and non-clinical settings, but has not yet been tested in a haemodialysis setting. The study had three aims: 1) to examine the feasibility of conducting Laughter Yoga for patients with end stage kidney disease in a dialysis setting; 2) to explore the psychological and physiological impact of Laughter Yoga for these patients; and 3) to estimate the sample size required for future research. METHODS: Pre/post intervention feasibility study. Eighteen participants were recruited into the study and Laughter Yoga therapists provided a four week intradialytic program (30-min intervention three times per week). Primary outcomes were psychological items measured at the first and last Laughter Yoga session, including: quality of life; subjective wellbeing; mood; optimism; control; self-esteem; depression, anxiety and stress. Secondary outcomes were: blood pressure, intradialytic hypotensive episodes and lung function (forced expiratory volume). Dialysis nurses exposed to the intervention completed a Laughter Yoga attitudes and perceptions survey (n = 11). Data were analysed using IBM SPSS Statistics v22, including descriptive and inferential statistics, and sample size estimates were calculated using G*Power. RESULTS: One participant withdrew from the study for medical reasons that were unrelated to the study during the first week (94 % retention rate). There were non-significant increases in happiness, mood, and optimism and a decrease in stress. Episodes of intradialytic hypotension decreased from 19 pre and 19 during Laughter Yoga to 4 post Laughter Yoga. There was no change in lung function or blood pressure. All nurses agreed or strongly agreed that Laughter Yoga had a positive impact on patients' mood, it was a feasible intervention and they would recommend Laughter Yoga to their patients. Sample size calculations for future research indicated that a minimum of 207 participants would be required to provide sufficient power to detect change in key psychological variables. CONCLUSIONS: This study provides evidence that Laughter Yoga is a safe, low-intensity form of intradialytic physical activity that can be successfully implemented for patients in dialysis settings. Larger studies are required, however, to determine the effect of Laughter Yoga on key psychological variables. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry - ACTRN12614001130651 . Registered 23 October 2014.

Reliability and validity of the Alberta context tool (ACT) with professional nurses: Findings from a multi-study analysis

Although organizational context is central to evidence-based practice, underdeveloped measurement hindersitsassessment. The Alberta Context Tool, comprised of 59 items that tap10 modifiable contextual concepts, was developed to address this gap. The purpose of this study to examine the reliability and validity of scores obtained when the Alberta Context Tool is completed by professional nurses across different healthcare settings. Five separate studies (N = 2361 nurses across different care settings) comprised the study sample. Reliability and validity were assessed. Cronbach's alpha exceeded 0.70 for9/10 Alberta Context Tool concepts. Item-total correlations exceeded acceptable standards for 56/59items. Confirmatory Factor Analysescoordinated acceptably with the Alberta Context Tool's proposed latent structure. The mean values for each Alberta Context Tool concept increased from low to high levels of research utilization(as hypothesized) further supporting its validity. This study provides robust evidence forreliability and validity of scores obtained with the Alberta Context Tool when administered to professional nurses.

Decision-making on birth choices following a caesarean delivery in Taiwan

 A qualitative research aimed to explore decision-making on birth choices following a caesarean delivery in Taiwan. Safety and risk management were the major influences for both Taiwanese women’s and obstetricians’ decisions. Biased information provision regarding birth options and over-medicalisation of the birth environment contributed to women seeking repeat caesarean delivery.

Heat affected zone microstructures and their influence on toughness in two microalloyed HSLA steels

Microstructures and Charpy impact properties have been examined in two microalloyed steels following heat treatments to simulate weld heat affected zone (HAZ) structures over a range of heat input conditions, characterised by the cooling time from 800 to 500°C (Δt8/5). The base materials were low carbon structural steel plates microalloyed with vanadium and nitrogen (V-N) and niobium (Nb), respectively. The toughnesses of the HAZs displayed remarkably different behaviours as shown by their impact transition temperatures. For the V-N steel, the toughness improved with increasingly rapid cooling (low heat input conditions) whereas the Nb steel showed an opposite trend. Some of this behaviour could be explained by the presence of coarse ferrite grains in the slowly cooled V-N steel. However, other conditions where all the structures were bainitic and rather similar in optical micrographs gave widely different toughness values. The recently developed method of five dimensional boundary analysis based on electron backscattering diffraction has been applied to these cases for the first time. This showed that the lath boundaries in the bainite were predominantly on {1 1 0} planes of the ferrite and that the average spacing of these boundaries varied depending on steel composition and cooling rate. Since {1 1 0} is also the slip plane in ferrite, it is considered that close spacing between the lath boundaries inhibits general plasticity at stress concentrations and favours initiation of fracture. The differences between the two steels are believed to be due to their transformation behaviours on cooling where precipitation of vanadium nitride in austenite accelerates ferrite formation and raises the temperature of the phase transformation in V-N steels.

Exploring the influence of workplace supports and relationships on safe medication practice: a pilot study of Australian graduate nurses

BACKGROUND: Despite the growing awareness of the benefits of positive workplace climates, unsupportive and disruptive workplace behaviours are widespread in health care organisations. Recent graduate nurses, who are often new to a workplace, are particularly vulnerable in unsupportive climates, and are also recognised to be at higher risk for medication errors. OBJECTIVES: Investigate the association between workplace supports and relationships and safe medication practice among graduate nurses. DESIGN AND PARTICIPANTS: Exploratory study using quantitative survey with a convenience sample of 58 nursing graduates in two Australian States. METHODS: Online survey focused on graduates' self-reported medication errors, safe medication practice and the nature of workplace supports and relationships. RESULTS: Spearman's correlations identified that unsupportive workplace relationships were inversely related to graduate nurse medication errors and erosion of safe medication practices, while supportive Nurse Unit Manager and supportive work team relationships positively influenced safe medication practice among graduates. CONCLUSIONS: Workplace supports and relationships are potentially both the cause and solution to graduate nurse medication errors and safe medication practices. The findings develop further understanding about the impact of unsupportive and disruptive behaviours on patient safety and draw attention to the importance of undergraduate and continuing education strategies that promote positive workplace behaviours and graduate resilience.

The competition between metastable and equilibrium S (Al2CuMg) phase during the decomposition of AlCuMg alloys

Abstract The decomposition sequence of the supersaturated solid solution leading to the formation of the equilibrium S (Al2CuMg) phase in AlCuMg alloys has long been the subject of ambiguity and debate. Recent high-resolution synchrotron powder diffraction experiments have shown that the decomposition sequence does involve a metastable variant of the S phase (denoted S1), which has lattice parameters that are distinctly different to those of the equilibrium S phase (denoted S2). In this paper, the difference between these two phases is resolved using high-resolution synchrotron and neutron powder diffraction and atom probe tomography, and the transformation from S1 to S2 is characterised in detail by in situ synchrotron powder diffraction. The results of these experiments confirm that there are no significant differences between the crystal structures of S1 and S2, however, the powder diffraction and atom probe measurements both indicate that the S1 phase forms with a slight deficiency in Cu. The in situ isothermal aging experiments show that S1 forms rapidly, reaching its maximum concentration in only a few minutes at high temperatures, while complete conversion to the S2 phase can take thousands of hours at low temperature. The kinetics of S phase precipitation have been quantitatively analysed for the first time and it is shown that S1 phase forms with an average activation energy of 75 kJ/mol, which is much lower than the activation energy for Cu and Mg diffusion in an Al matrix (136 kJ/mol and 131 kJ/mol, respectively). The mechanism of the replacement of S1 with the equilibrium S2 phase is discussed.

A longitudinal evaluation of the resilient families randomized trial to prevent early adolescent depressive symptoms

This study aimed to evaluate whether an intervention prevented the development of depressive symptoms through the early years of secondary school (Grades 7 to 9 - mean ages 12.3 to 14.5 years) in Victoria, Australia. Twelve schools were randomized to a universal preventative intervention (including a student social relationship/emotional health curriculum, and parent/caregiver parenting education); 12 were randomized as control schools. Multivariate regression analyses used student self-report to predict depressive symptoms at 26-month follow-up (13-months after intervention completion) from baseline measures and intervention status (N = 2027). There was no overall intervention effect on depressive symptoms. However, intervention students with moderate symptoms whose parents attended parent education events had a significantly reduced risk of depressive symptoms at follow-up. Future evaluations of interventions of this type should investigate: therapeutic processes; methods to increase recruitment into effective parent education events; and the potential to target assistance to students with high depressive symptoms.

Warm deformation and annealing behaviour of iron-silicon-(carbon) steel sheets

Single pass warm rolling and compression experiments were carried out from ambient to 800°C for ultra-low carbon (ULC) steel with ∼100 ppm carbon and interstitial free (IF) steels, both with two levels of silicon. Subsequently, annealing was done in order to recrystallize the deformed specimens. The main purpose of this study was to understand the effects of rolling temperature and silicon on stress responses and textures. This study comprises two main themes: flow stress and strain rate sensitivity during compression and shear banding and textures in warm rolled specimens. The effects of deformation temperature on in-grain shear bands were different between ULC-Si and IF-Si steels. As in previous work with more conventional steels, in-grain shear bands in the IF grade had low sensitivity to rolling temperature, while those in the ULC grade depended significantly on the deformation temperature. However, the temperature profile of shear banding in the ULC grade was approximately 150°C higher than in previous work. Deformation and recrystallisation textures for both IF and ULC grades depended on their rolling temperatures. The variation of both grain size and texture after annealing can be explained by the rise and fall of in-grain shear banding activity which is related to the strain rate sensitivity.

Yielding behaviour of martensite in steel

Although martensite is recognised as a very strong phase in carbon steels, its initial yielding commences at low stresses and the tensile stress-strain curve shows a smooth, rounded form. Evidence is presented from x-ray diffraction to show that this behaviour is due to the presence of intra-granular stresses that are residues after the shear transformation from austenite to martensite. These internal stresses are reduced in magnitude by plastic deformation and also by tempering. Reduction of internal stress due to plasticity is shown by a decrease in XRD line broadening after deformation. A simple model is presented in which the stress-strain behaviour is controlled by relaxation of the internal stresses almost up to the point of the ultimate tensile strength. It demonstrates that only a very small fraction of the material remaining in a purely elastic state provides a large stabilising effect resisting necking. A corollary of this is that the uniform elongation of martensitic steel actually increases with increase in the strength level. Effects of heat treatment are also reproduced in the model, including the increase in conventional yield stress (Rp0.2) that occurs after low temperature tempering.

Cyber attacks against supply chain management systems: A short note

Supply chain management (SCM) is increasingly dependent on electronic systems. At the same time, the vulnerability of these systems to attack from malicious individuals or groups is growing. This paper examines some of the forms such attacks can take, and their relevance to the supply function. Provides examples of attacks. Concludes that companies should consider the security aspects of electronic commerce before developing their systems. © MCB University Press.

Effect of strain ageing on the mechanical properties of partially damaged structural mild steel

ABSTRACT
This paper addresses the strain ageing effects on the mechanical properties of the partially damaged structural mild steel. Since repairing partly damaged structures may not occur immediately, the strain ageing effect can significantly influence the structural behaviour. The changes due to this effect have not so far been considered in the civil engineering design guidelines. In order to investigate strain ageing effects, two-stage experimental tests are carried out on the mild-steel specimens. In the first stage, partial damage is made using quasi-static loading. During the second stage, the strength and ductility of the specimens are examined after 2 and 7 days ‘ageing’ at room temperature and the results are compared with the corresponding no-age samples. The microstructure of the specimens is examined using scanning electron microscopy (SEM). To illustrate the effect of strain ageing on the global behaviour of steel structures, a numerical example is provided in which strain ageing impacts on loading capacity and deflection of a steel beam. Finally, the stress–strain relation of partially damaged mild-steel material incorporating strain ageing effects is expressed by calibrating the parameters of Ramberg–Osgood model.