Innovating from the inside: teacher influence and the 'promisingness' of digital learning environments

In line with global trends, Australian educational policy emphatically recognises the need for contemporary learners to be digitally literate, with provision of 'one-to-one' devices to individual learners in schools a major implementation strategy. However, without teacher commitment, the benefits of such investment in one-to-one programs are undermined and the devices themselves are under-utilised. Too often, the focus on hardware is not accompanied by insight into the organisational learning and change required in pedagogical practices. In the knowledge that curriculum and pedagogical renewal rests squarely with teachers and leaders rather than with technological hardware and software per se, this article draws on outcomes/findings from a school/university ethnographic collaboration which closely explored the introduction of a school-funded, one-to-one netbook program in a school excluded from a state-wide initiative. It seeks to make visible the often overlooked work of teachers as members of learning organisations through a narrative of change. The narrative focuses on teacher agency and capacity to mobilise a school community to commit to a vision of; no-blame risk taking; collective professional learning; the power of purpose and passion; leadership in the face of government practice which disempowered teachers and disadvantaged students; and the development of an innovation 'from the inside'.

Benzodiazepine use and aggressive behaviour: a systematic review

The relationship between benzodiazepine consumption and subsequent increases in aggressive behaviour in humans is not well understood.

Effects of patient-, environment- and medication-related factors on high-alert medication incidents.

To measure the rate of medication incidents associated with the prescription and administration of high-alert medications and to identify patient-, environment- and medication-related factors associated with these incidents.

Nanomedicine based nanoparticles for neurological disorders

Human health is severely hampered by a majority of the neurological disorders such as the brain tumors, degenerative Alzheimer's disease, Parkinson's disease and those involving inflammatory component. Owing to the stringent protection offered by the blood brain barrier, conventional therapeutics gain limited access and therefore, are therapeutically suboptimal. Hence, research has now focused to develop the novel drug delivery systems with a prime motto of maintaining therapeutic drug levels inside the brain, avoiding non-specific tissue distribution. The introduction of nanotechnology has addressed few of these objectives and opened up new avenues for even more improvization. To some extent, nanodelivery systems were successful in crossing the blood brain barrier and accessing the remote areas of the brain. They also have shown tremendous potential in delivering the therapeutic and diagnostic aids following systemic administration. What revolutionised the nano applications is the development of "smart" nanosystems, whose surface is tailor made for the effective theranostic delivery. However, a detailed understanding of the long term nanoformulation toxicities, along with the neuropathology, is the critical future question to be addressed. In this review, a brief introduction of the prominent neurological disorders and detailed applications of nanotechnology are discussed.

The characteristics and outcome of infective endocarditis involving implantable cardiac devices

Infection of implantable cardiac electronic devices in particular lead endocarditis (cardiac device infective endocarditis (CDIE)) is an emerging problem with significant morbidity, mortality and health care costs. The epidemiology is characterised with advanced age and health care association in cases presenting within 6 months of implantation. Risk factors include those of the patient, the procedure and the device. Staphylococcal species predominate as the causative organisms. Diagnosis is reliably made by blood cultures and transesophageal echocardiography. Complications include pulmonary and systemic emboli, persistent bacteremia and concomitant valvular involvement. Management includes complete device removal and prolonged antimicrobial therapy. With long-term follow-up to 1 year, the mortality of CDIE is as high as 23 %. It is associated with patient co-morbidities and concomitant valvular involvement and may be prevented by device removal during index admission.

Social media conflict: platforms for racial vilification, or acts of provocation and citizenship?

Although racism remains an issue for social media sites such as YouTube, this focus often overshadows the site’s productive capacity to generate ‘agonistic publics’ from which expressions of cultural citizenship and solidarity might emerge. This paper examines these issues through two case studies: the recent proliferation of mobile phone video recordings of racist rants on public transport, and racist interactions surrounding the performance of a Maori ‘flash mob’ haka in New Zealand that was recorded and uploaded to YouTube. We contrast these incidents as they are played out primarily through social media, with the case of Australian Football League player Adam Goodes and the broadcast media reaction to a racial slur aimed against him by a crowd member during the AFL’s Indigenous Round. We discuss the prevalence of vitriolic exchange and racial bigotry, but also, and more importantly, the productive and equally aggressive defence of more inclusive and tolerant forms of cultural identification that play out across these different media forms. Drawing on theories of cultural citizenship along with the political theory of Chantal Mouffe, we point to the capacities of YouTube as ‘platform’, and to social media practices, in facilitating ground-up antiracism and generating dynamic, contested and confronting micropublics.

A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer: study protocol.

AIM: To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance. BACKGROUND: Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy. DESIGN: A critical ethnographic design will be used, incorporating non-participant observations, individual semi-structured and focus-group interviews as several collecting methods. METHODS: Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012). DISCUSSION: Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy.

Contributory factors to patient safety incidents in primary care: protocol for a systematic review

BACKGROUND: Organisations need to systematically identify contributory factors (or causes) which impact on patient safety in order to effectively learn from error. Investigations of error have tended to focus on taking a reactive approach to learning from error, mainly relying on incident-reporting systems. Existing frameworks which aim to identify latent causes of error rely almost exclusively on evidence from non-healthcare settings. In view of this, the Yorkshire Contributory Factors Framework (YCFF) was developed in the hospital setting. Eighty-five percent of healthcare contacts occur in primary care. As a result, this review will build on the work that produced the YCFF, by examining the empirical evidence that relates to the contributory factors of error within a primary care setting. METHODS/DESIGN: Four electronic bibliographic databases will be searched: MEDLINE, Embase, PsycInfo and CINAHL. The database search will be supplemented by additional search methodologies including citation searching and snowballing strategies which include reviewing reference lists and reviewing relevant journal table of contents, that is, BMJ Quality and Safety. Our search strategy will include search combinations of three key blocks of terms. Studies will not be excluded based on design. Included studies will be empirical studies conducted in a primary care setting. They will include some description of the factors that contribute to patient safety. One reviewer (SG) will screen all the titles and abstracts, whilst a second reviewer will screen 50% of the abstracts. Two reviewers (SG and AH) will perform study selection, quality assessment and data extraction using standard forms. Disagreements will be resolved through discussion or third party adjudication. Data to be collected include study characteristics (year, objective, research method, setting, country), participant characteristics (number, age, gender, diagnoses), patient safety incident type and characteristics, practice characteristics and study outcomes. DISCUSSION: The review will summarise the literature relating to contributory factors to patient safety incidents in primary care. The findings from this review will provide an evidence-based contributory factors framework for use in the primary care setting. It will increase understanding of factors that contribute to patient safety incidents and ultimately improve quality of health care.

Inside Plato's cave (after Irigaray)

Coventry University exhibition curated by Rosemary Cisernos

Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study

BACKGROUND: Patients can have an important role in reducing harm in primary-care settings. Learning from patient experience and feedback could improve patient safety. Evidence that captures patients' views of the various contributory factors to creating safe primary care is largely absent. The aim of this study was to address this evidence gap. METHODS: Four focus groups and eight semistructured interviews were conducted with 34 patients and carers from south-east Australia. Participants were asked to describe their experiences of primary care. Audio recordings were transcribed verbatim and specific factors that contribute to safety incidents were identified in the analysis using the Yorkshire Contributory Factors Framework (YCFF). Other factors emerging from the data were also ascertained and added to the analytical framework. RESULTS: Thirteen factors that contribute to safety incidents in primary care were ascertained. Five unique factors for the primary-care setting were discovered in conjunction with eight factors present in the YCFF from hospital settings. The five unique primary care contributing factors to safety incidents represented a range of levels within the primary-care system from local working conditions to the upstream organisational level and the external policy context. The 13 factors included communication, access, patient factors, external policy context, dignity and respect, primary-secondary interface, continuity of care, task performance, task characteristics, time in the consultation, safety culture, team factors and the physical environment. DISCUSSION: Patient and carer feedback of this type could help primary-care professionals better understand and identify potential safety concerns and make appropriate service improvements. The comprehensive range of factors identified provides the groundwork for developing tools that systematically capture the multiple contributory factors to patient safety.

Involving people with diabetes and the wider community in diabetes research: a realist review protocol

BACKGROUND: Patient and public involvement in diabetes research is now actively encouraged in different countries because it is believed that involving people with experience of the condition will improve the quality and relevance of the research. However, reviews of patient involvement have noted that inadequate resources, patients' and communities' lack of research knowledge, and researchers' lack of skills to involve patients and communities in research may present significant contextual barriers. Little is known about the extent of patient/community involvement in designing or delivering interventions for people with diabetes. A realist review of involvement will contribute to assessing when, how and why involvement works, or does not work, to produce better diabetes interventions.

METHODS/DESIGN: This protocol outlines the process for conducting a realist review to map how patients and the public have been involved in diabetes research to date. The review questions ask the following: How have people with diabetes and the wider community been involved in diabetes research? What are the characteristics of the process that appear to explain the relative success or failure of involvement? How has involvement (or lack of involvement) in diabetes research influenced the development and conduct of diabetes research? The degree of support in the surrounding context will be assessed alongside the ways in which people interact in different settings to identify patterns of interaction between context, mechanisms and outcomes in different research projects. The level and extent of the involvement will be described for each stage of the research project. The descriptions will be critically reviewed by the people with diabetes on our review team. In addition, researchers and patients in diabetes research will be asked to comment. Information from researcher-patient experiences and documents will be compared to theories of involvement across a range of disciplines to create a mid-range theory describing how involvement (or lack of involvement) in diabetes research influences the development and conduct of diabetes research.