Correlates of spontaneous reporting of adverse drug reactions within primary care: the paradox of low prescribers who are high reporters

AIM(S) To examine Primary Care Trust (PCT) demographics influencing general practitioner (GP) involvement in pharmacovigilance. METHODS PCT adverse drug reaction (ADR) reports to the Yellow Card scheme between April 2004 and March 2006 were obtained for the UK West Midlands region. Reports were analysed by all drugs, and most commonly reported drugs (‘top drugs’). PCT data, adjusted for population size, were aggregated. Prescribing statistics and other characteristics were obtained for each PCT, and associations between these characteristics and ADR reporting rates were examined. RESULTS During 2004–06, 1175 reports were received from PCTs. Two hundred and eighty (24%) of these reports were for 14 ‘top drugs’. The mean rate of reporting for PCTs was 213 reports per million population. A total of 153 million items were prescribed during 2004–06, of which 33% were ‘top drugs’. Reports for all drugs and ‘top drugs’ were inversely correlated with the number of prescriptions issued per thousand population (rs = -0.413, 95% CI -0.673, -0.062, P < 0.05, and r = -0.420, 95% CI -0.678, -0.071, P < 0.05, respectively). Reporting was significantly negatively correlated with the percentages of male GPs within a PCT, GPs over 55 years of age, single-handed GPs within a PCT, the average list size of a GP within a PCT, the overall deprivation scores and average QOF total points. ADR reports did not correlate significantly with the proportion of the population over 65 years old. CONCLUSIONS Some PCT characteristics appear to be associated with low levels of ADR reporting. The association of low prescribing areas with high ADR reporting rates replicates previous findings.

The dialectics of corporate reporting:a semiotic analysis of corporate financial and environmental reporting

The central argument to this thesis is that the nature and purpose of corporate reporting has changed over time to become a more outward looking and forward looking document designed to promote the company and its performance to a wide range of shareholders, rather than merely to report to its owners upon past performance. it is argued that the discourse of environmental accounting and reporting is one driver for this change but that this discourse has been set up as in conflicting with the discourse of traditional accounting and performance measurement. The effect of this opposition between the discourses is that the two have been interpreted to be different and incompatible dimensions of performance with good performance along one dimension only being achievable through a sacrifice of performance along the other dimension. Thus a perceived dialectic in performance is believed to exist. One of the principal purposes of this thesis is to explore this perceived dialectic and, through analysis, to show that it does not exist and that there is not incompatibility. This exploration and analysis is based upon an investigation of the inherent inconsistencies in such corporate reports and the analysis makes use of both a statistical analysis and a semiotic analysis of corporate reports and the reported performance of companies along these dimensions. Thus the development of a semiology of corporate reporting is one of the significant outcomes of this thesis. A further outcome is a consideration of the implications of the analysis for corporate performance and its measurement. The thesis concludes with a consideration of the way in which the advent of electronic reporting may affect the ability of organisations to maintain the dialectic and the implications for corporate reporting.

An examination of adverse drug reaction reporting to the yellow card scheme

Chief pharmacists in 209 hospitals were surveyed about ADR reporting schemes, the priority given to ADR reporting, and attitudes towards ADR reporting. ADR reporting had a low managerial priority. Local reporting schemes were found to be operating in 37% trusts, but there were few plans to start new schemes. Few problems were discovered by the introduction of pharmacist ADR reporting. Chief pharmacists had concerns about the competence of hospital pharmacists to detect ADRs and were in favour of increased training. Lack of time on wards, and recruitment difficulties were suggested as reasons for hospital pharmacist under-reporting. Teaching hospitals appeared to have an increased interest in ADR reporting. A retrospective analysis of reporting trends within the West Midlands region from 1994, showed increasing or stable reporting rates for most sectors of reporters, except for general practitioners (GPs). The West Midlands region maintained higher ADR reporting rates than the rest of the UK. National reporting figures showed a worrying decline in ADR reports from healthcare professionals. Variation was found in the ADR reporting rates of Acute NHS Hospital Trusts and Primary Care Trusts (PCTs) in the West Midlands region, including correlations with prescribing rates and other PCT characteristics. Qualitative research into attitudes of GPs towards the Yellow Card scheme was undertaken. A series of qualitative interviews with GPs discovered barriers and positive motivators for their involvement in the Yellow Card scheme. A grounded theory of GP involvement in the Yellow Card scheme was developed to explain GP behaviour, and which could be used to inform potential solutions to halt declining rates of reporting. Under-reporting of ADRs continues to be a major concern to those who administer spontaneous reporting schemes.

The pharmacist's contribution towards monitoring and reporting adverse drug reactions

The activities and function of the West Midlands Adverse Drug Reaction Study Group are described. The impact of the Group on the reporting of adverse drug reactions to the CSM by the yellow card system has been evaluated in several ways including a comparison with the Trent Region. The role of the pharmacist in the Group is highlighted. A nationwide survey of the hospital pharmacist's involvement in adverse drug reaction reporting and monitoring is described, the results are reported and discussed. The available sources of information on adverse drug reactions, both primary and secondary, are critically reviewed. A checklist of necessary details for case reports is developed and examples of problems in the literature are given. The contribution of the drug information pharmacist in answering enquiries and encouraging reporting is examined. A role for the ward pharmacist in identifying, reporting, documenting and following up adverse drug reactions is proposed. Studies conducted to support this role are described and the results discussed. The ward pharmacist's role in preventing adverse drug reactions is also outlined. The reporting of adverse drug reactions in Australia is contrasted with the U.K. and particular attention is drawn to the pharmacist's contribution in the former. The problems in evaluating drug safety are discussed and examples are given where serious reactions have only been recognised after many patients have been exposed. To remedy this situation a case is made for enhancing the CSM yellow card scheme by further devolution of reporting, increasing the involvement of pharmacists and improving arrangements at the CSM. It is proposed that pharmacists should undertake the responsibility for reporting reactions to the CSM in some instances.

Police interviews with women reporting rape: a critical discourse analysis

This study investigates the discursive patterns of interactions between police interviewers and women reporting rape in significant witness interviews. Data in the form of video recorded interviews were obtained from a UK police force for the purposes of this study. The data are analysed using a multi-method approach, incorporating tools from micro-sociology, Conversation Analysis and Discursive Psychology, to reveal patterns of interactional control, negotiation, and interpretation. The study adopts a critical approach, which is to say that as well as describing discursive patterns, it explains them in light of the discourse processes involved in the production and consumption of police interview talk, and comments on the relationship between these discourse processes and the social context in which they occur. A central focus of the study is how interviewers draw on particular interactional resources to shape interviewees? accounts in particular ways, and this is discussed in relation to the institutional role of the significant witness interview. The discussion is also extended to the ways in which mainstream rape ideology is both reflected in, and maintained by, the discursive choices of participants. The findings of this study indicate that there are a number of issues to be addressed in terms of the training currently offered to officers at Level 2 of the Professionalising Investigation Programme (PIP) (NPIA, 2009) who intend to conduct significant witness interviews. Furthermore, a need is identified to bring the linguistic and discursive processes of negotiation and transformation identified by the study to the attention of the justice system as a whole. This is a particularly pressing need in light of judicial reluctance to replace written witness statements, the current „end product? of significant witness interviews, with the video recorded interview in place of direct examination in cases of rape.

Internet financial reporting in Saudi Arabia: users' perceptions and disclosures

This thesis investigates corporate financial disclosure practices on Web sites and their impact. This is done, first by examining the views of various Saudi user groups (institutional investors, financial analysts and private investors) on disclosure of financial reporting on the Internet and assessing differences, if any, in perceptions of the groups. Over 303 individuals from three groups responded to a questionnaire. Views were elicited regarding: users attitude to the Internet infrastructure in Saudi Arabia, users information sources about companies in Saudi Arabia, respondents perception about the advantages and disadvantages in Internet financial reporting (IFR), respondents attitude to the quality of IFR provided by Saudi public companies and the impact of IFR on users information needs. Overall, it was found professional groups (Institutional investors, financial analysts) hold similar views in relation to many issues, while the opinions of private investors differ considerably. Second, the thesis examines the use of the Internet for the disclosure of financial and investor-related information by Saudi public companies (113 companies) and look to identify reasons for the differences in the online disclosure practices of companies by testing the association between eight firm-specific factors and the level of online disclosure. The financial disclosure index (167 items) is used to measure public company disclosure in Saudi Arabia. The descriptive part of the study reveals that 95 (84%) of the Saudi public companies in the sample had a website and 51 (45%) had a financial information section of some description. Furthermore, none of the sample companies provided 100% of the 167 index items applicable to the company. Results of multivariate analysis show that firm size and stock market listing are significant explanatory variables for the amount of information disclosed on corporate Web sites. The thesis finds a significant and negative relationship between the proportion of institutional ownership of a companys shares and the level of IFR.

Corporate responsibility reporting of biodiversity in the supply chain

Industrial development, accompanying human population growth, has had a major role in creating the situation where bio-diverse materials and services essential for sustaining business are under threat. A major contributory factor to biodiversity decline comes from the cumulative impacts of extended supply chain business operations. However, within Corporate Responsibility (CR) reporting impacts on biodiversity due to supply chain operations have not traditionally been given equal weighting with other environmental issues. This paper investigates the extent of CR reporting in managing and publicising company biodiversity supply chain issues by reviewing a cross-sector sample of publicly available CR reports. The report contents were examined for suggestions of industrial sectorial trends in the level of biodiversity consideration. The reporting of environmental management system use within company supply chain management is assessed in the samples and is considered as a mechanism for responsible supplier partnership working.

Can incident reporting improve safety? Healthcare practitioners' views of the effectiveness of incident reporting

OBJECTIVE: Recent critiques of incident reporting suggest that its role in managing safety has been over emphasized. The objective of this study was to examine the perceived effectiveness of incident reporting in improving safety in mental health and acute hospital settings by asking staff about their perceptions and experiences. DESIGN: /st>Qualitative research design using documentary analysis and semi-structured interviews. SETTING: /st>Two large teaching hospitals in London; one providing acute and the other mental healthcare. PARTICIPANTS: /st>Sixty-two healthcare practitioners with experience of reporting and analysing incidents. RESULTS: /st>Incident reporting was perceived as having a positive effect on safety, not only by leading to changes in care processes but also by changing staff attitudes and knowledge. Staff discussed examples of both instrumental and conceptual uses of the knowledge generated by incident reports. There are difficulties in using incident reports to improve safety in healthcare at all stages of the incident reporting process. Differences in the risks encountered and the organizational systems developed in the two hospitals to review reported incidents could be linked to the differences we found in attitudes to incident reporting between the two hospitals. CONCLUSION: /st>Incident reporting can be a powerful tool for developing and maintaining an awareness of risks in healthcare practice. Using incident reports to improve care is challenging and the study highlighted the complexities involved and the difficulties faced by staff in learning from incident data.

Stakeholders' perceptions of Corporate Social Reporting (CSR) in Bangladesh

The paper addresses a significant gap in the CSR literature indicated by the lack of studies that examine non-managerial stakeholders’ perceptions of the practice. Recent calls in the CSR literature have emphasised the importance of giving voice to non-managerial stakeholders groups. The research examines the perceptions of a wide group of stakeholders in the context of a developing country, Bangladesh. A series of semi-structured interviews were conducted with various stakeholder groups including employees, consumers, pressure groups, regulatory body and accounting professionals. The current practice of CSR in Bangladesh is interpreted in terms of ‘largely cosmetic responses’, ‘marketing strategy’ and ‘response to pressures from international markets’. Additionally, while some of the interviewees sharply criticised the current process of imposing social accounting codes/standards on developing countries which fail to consider the important local socio-economic context, the findings suggest that there is overwhelming support for mandatory externally verified CSR reporting based on the principles of peoples’ right to know, full disclosure/completeness, and relevance, which are anchored in the broader principles of transparency and accountability.

Stakeholders' perceptions of corporate social reporting in Bangladesh

Recent calls in the corporate social reporting (CSRep) literature have emphasized the importance of giving voice to non-managerial stakeholder groups in the social reporting process. The research, presented in this paper, employs recent work in stakeholder theory and CSRep to examine the perceptions of a diverse set of non-managerial stakeholders in the context of a developing country, Bangladesh. A series of semi-structured interviews were conducted with individuals who identify with various non-managerial stakeholder groups. Interviewees generally believed that the motivation and practice of CSRep in Bangladesh is developing in response to pressures from international markets and is producing largely cosmetic responses. Also, they expressed concerns that, given the economic, political, and social conditions in Bangladesh, premature adoption of strict CSRep standards may lead to increased corruption and other unintended consequences. Whilst some of the interviewees sharply criticized the current process of imposing social accounting codes/standards on developing countries which fail to consider the important local socio-economic context, the findings suggest that there is overwhelming support for mandatory externally verified CSRep based on the principles of peoples' right to know, full disclosure/completeness, and relevance, which are anchored in the broader principles of transparency and stakeholder accountability. © 2010 Springer Science+Business Media B.V.

The absence of corporate social responsibility reporting in Bangladesh

This paper aims to broaden the present corporate social responsibility (CSR) reporting literature by extending its focus to the absence of CSR reporting within a developing country, an area which, to date, is relatively under researched in comparison to the more widely studied presence of CSR reporting within developed Western countries. In particular this paper concentrates upon the lack of disclosure on three particular eco-justice issues: child labour, equal opportunities and poverty alleviation. We examine why this is the case and thereby illuminate underlying motives behind corporate unwillingness to address these issues. For this purpose, 23 semi-structured interviews were undertaken with senior corporate managers in Bangladesh. The findings suggest that the main reasons for non-disclosure include lack of resources, the profit imperative, lack of legal requirements, lack of knowledge/awareness, poor performance and the fear of bad publicity. Given these findings the paper raises some serious concerns as to why corporations would ever be expected to voluntarily report on eco-justice issues where performance is poor and negative publicity would be generated and profit impaired. Further research is still required to uncover current injustices and to imagine what changes can be made.

Understanding institutional conversion:the case of the National Reporting and Learning System

This article focuses on one type of institutional change: conversion. One innovative approach to institutional change, the “political-coalitional approach”, acknowledges that: institutions can have unintended effects, which may privilege certain groups over others; institutions are often created and sustained through compromise with external actors; and institutions’ external context can vary significantly over time, as different coalitions’ power waxes and wanes. This approach helps explain the conversion of one institution drawn from the UK National Health Service, the National Reporting and Learning System. However, the shift of this system from producing formative information to facilitate learning to promote safer care, towards producing summative information to support resource allocation decisions, cannot be explained merely by examining the actions of external power coalitions. An internal focus, which considers factors that are normally viewed as “organisational” (such as leadership and internal stability), is also required.