Challenges of managing medications for older people at transition points of care

In clinical practice, pharmacists play a very important role in identifying and correcting medication discrepancies as older patients move across transition points of care. With increasing complexity of health care needs of older people, these discrepancies are likely to increase. The major concern with identifying and correcting medication discrepancies is that medication reconciliation is considered a retrospective problem - that is, dealing with medication discrepancies after they have occurred. It is argued here that a more proactive stance should be taken where doctors, nurses and pharmacists collectively work together to prevent medication discrepancies from happening in the first place. Improved involvement of patients and family members will help to facilitate better management of medications across transition points of care. Efficient use of information technology aids, such as electronic medication reconciliation tools, should also assist with organizational systems problems associated with the working culture, heavy workloads, and staff and skill mix of health professionals.

Complexities of medicines safety: communicating about managing medicines at transition points of care across emergency departments and medical wards

To explore how health professionals, patients and family members communicate about managing medicines across transition points of care in two Australian public hospitals.

Rational economic models (cognitive models)

'This is essential reading for social marketing practitioners, researchers and students. the book describes a comprehensive range of behavior change theories of relevance to social marketing and is complemented with illustrative case ...

Functionalism, co-operation, good faith, and the making of the "daily-preventive justice" in contract law theory and practice. A contribution to a rational understanding of good faith and to its future reseasonable developments. Evaluations from

The thoughts and observations contained in this paper were first presented in a preliminary form at the Staff Seminar that I gave at the University of Cape Town (UCT) - Department of Private Law, on Tuesday May 8 2012. The organizers generously offered me a free choice of subject. Such an offer always poses a problem to imaginative people like myself. I finally chose as my subject the role of good faith in contract law theory and practice and then entitled the Seminar “Good Faith & Contracts - Brothers in Arms”. The aim of the talk was to briefly describe what I see behind the doctrine of good faith (and, more broadly, behind the general course of the parties’ behavior before and after the conclusion of an agreement), to then explain the need of its protection and future reasonable developments by challenging the limitations of both traditional and current legal approaches to contract law theory and practice. By adopting a comparative modus investigandi, it emerged that especially in the area of contract law a new law-finding process is emerging in the European continent and it is leading to re-conceive the meta-national legislative interventions by challenging the limits of Hobbes’s Leviathan. As asserted, we ought to not take this process for granted because although there are many forms of social organization, contract is the most pervasive and the law of contract still is the most important vehicle to support and supplement private arrangements. However, the point of departure for theorizing about private law is based on experience. Consequently, despite the growing emphasis on the convergence of national legal systems in Europe, conducting research on private law theory and practice requires that imagination and creativity be matched with prudence. Proficiency has to be aligned with what we have learned from history.

Faster than the speed of white (noise): potential pressure points in research partnerships and processes

White noise occurs in the thinking, decision making and communication of dominant Settler cultures. It inhibits clear reception of messages, somewhat like the indistinct, fuzzy static of an un-tuned radio. As much a systemic issue as an individual one, it results from assumed privilege and lack of knowledge of worldviews other than the dominant. Until white noise is acknowledged, development of partnerships between Indigenous and non-Indigenous groups is likely to be limited by having to continually start at a point of inequality where nonIndigenous gaps in knowledge and understanding remain unrecognised. This paper/workshop considers challenges encountered while researching experiences of Aboriginal education in Western Australian prisons. Each pressure point occurred where the dominant world view prevailed without question. Discussion will focus on the specific pressure points of ethics approval, project development, informed consent and application of outcomes and findings. The paper asks the questions ‘Who decides what stories are created at these pressure points? What informs those stories?’ As individuals, we might not be able to crash through the white noise barrier but we can chip away and be transparent about its existence with the goal of eventually moving faster than the speed of white (noise).

Communicating about the management of medications as patients move across transition points of care: an observation and interview study

RATIONALE, AIMS AND OBJECTIVES: As patients move across transition points, effective medication management is critical for patient safety. The aims of this study were to examine how health professionals, patients and family members communicate about managing medications as patients moved across transition points of care and to identify possible sources of communication failure.

METHOD: A descriptive approach was used involving observations and interviews. The emergency departments and medical wards of two hospitals were involved. Observations focused on how health professionals managed medications during interactions with other health professionals, patients and family members, as patients moved across clinical settings. Follow-up interviews with participants were also undertaken. Thematic analysis was completed of transcribed data, and descriptive statistics were used to analyse characteristics of communication failure.

RESULTS: Three key themes were identified: environmental challenges, interprofessional relationships, and patient and family beliefs and responsibilities. As patients moved between environments, insufficient tracking occurred about medication changes. Before hospital admission, patients participated in self-care medication activities, which did not always involve exemplary behaviours or match the medications that doctors prescribed. During observations, 432 instances of communication failure (42.8%) were detected, which related to purpose, content, audience and occasion of the communication.

CONCLUSIONS: Extensive challenges exist involving the management of medications at transition points of care. Bedside handovers and ward rounds can be utilized as patient counselling opportunities about changes in the medication regimen. Greater attention is needed on how patients in the community make medication-related decisions.

Artificial water points facilitate the spread of an invasive vertebrate in arid Australia

Summary: The spread of invasive species after their initial introduction is often facilitated by human actions. In some cases, invaders only become established in habitats where dominant native species have been displaced as a result of human actions or where humans inadvertently provide essential resources such as food, water or shelter. We investigated if dams that provide water for livestock have facilitated the cane toad's (Rhinella marina) invasion of a hot semi-arid landscape by providing toads with a resource subsidy and hence refuge from extreme heat and aridity. To determine the relationship between the presence of surface water and habitat occupancy by toads, we surveyed natural and artificial water features for cane toads during the annual dry season. We used radiotracking and acoustic tags to determine whether movement patterns and shelter use of cane toads were focussed around dams. To determine whether dams provide toads with refuge from extreme heat and aridity, we deployed plaster models with internal thermometers to estimate ambient temperatures and toad desiccation rates in shelter sites. To determine whether dams alleviate the stress experienced by toads, we measured plasma corticosterone levels of toads that sheltered in and away from dams. Toads were present in sites with standing water and absent from waterless sites. Most radiotracked toads sheltered within 1 m of water. Toad movements were focussed around water. Toads tracked with passive acoustic telemetry over a 6-month dry season were highly resident at dams. Plaster models placed in toad shelter sites away from the water lost 27% more mass and experienced higher temperatures than models placed near the water's edge. Toads that sheltered in terrestrial shelters exhibited higher plasma corticosterone levels compared to toads that sheltered near dams. Dams provide toads with refuge habitats where they are less at risk from overheating and dehydration. Synthesis and applications. Artificial water points can facilitate biological invasions in arid regions by providing a resource subsidy for water-dependent invasive species. Our study suggests that there is scope to control populations of water-dependent invasive vertebrates in arid regions by restricting their access to artificial water points.

Approximation of centroid end-points and switch points for replacing type reduction algorithms

Despite several years of research, type reduction (TR) operation in interval type-2 fuzzy logic system (IT2FLS) cannot perform as fast as a type-1 defuzzifier. In particular, widely used Karnik-Mendel (KM) TR algorithm is computationally much more demanding than alternative TR approaches. In this work, a data driven framework is proposed to quickly, yet accurately, estimate the output of the KM TR algorithm using simple regression models. Comprehensive simulation performed in this study shows that the centroid end-points of KM algorithm can be approximated with a mean absolute percentage error as low as 0.4%. Also, switch point prediction accuracy can be as high as 100%. In conjunction with the fact that simple regression model can be trained with data generated using exhaustive defuzzification method, this work shows the potential of proposed method to provide highly accurate, yet extremely fast, TR approximation method. Speed of the proposed method should theoretically outperform all available TR methods while keeping the uncertainty information intact in the process.