A KM perspective on implementing an electronic patient record within an NHS hospital

The Electronic Patient Record (EPR) is being developed by many hospitals in the UK and across the globe. We class an EPR system as a type of Knowledge Management System (KMS), in that it is a technological tool developed to support the process of knowledge management (KM). Healthcare organisations aim to use these systems to provide a vehicle for more informed and improved clinical decision making thereby delivering reduced errors and risks, enhanced quality and consequently offering enhanced patient safety. Finding an effective way for a healthcare organisation to practically implement these systems is essential. In this study we use the concept of the business process approach to KM as a theoretical lens to analyse and explore how a large NHS teaching hospital developed, executed and practically implemented an EPR system. This theory advocates the importance of taking into account all organizational activities - the business processes - in considering any KM initiatives. Approaching KM through business processes allows for a more holistic view of the requirements across a process: emphasis is placed on how particular activities are performed, how they are structured and what knowledge demanded and not just supplied across each process. This falls in line with the increased emphasis in healthcare on patient-centred approaches to care delivery. We have found in previous research that hospitals are happy with the delivery of patient care being referred to as their 'business'. A qualitative study was conducted over a two and half year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non- participant observation of meetings and documentary data. We believe that the inclusion of patients within the study may well be the first time this has been done in examining the implementation of a KMS. The theoretical propositions strategy was used as the overarching approach for data analysis. Here Initial theoretical research themes and propositions were used to help shape and organise the case study analysis. This paper will present preliminary findings about the hospital's business strategy and its links to the KMS strategy and process.

Recent advances in the heterogeneously catalysed aerobic selective oxidation of alcohols

The heterogeneously catalysed selective aerobic oxidation of alcohols is an important tool for the synthesis of valuable chemical intermediates and a hot topic within both academic and industrial arenas. In this mini-review, selected aspects of catalyst formulation, process operating conditions, and progress in identifying the active sites and surface reaction mechanisms notably through the application of synchrotron radiation, are highlighted. © 2010 Society of Chemical Industry.

Managing enterprise resource planning and multi-organisational enterprise governance:a new contingency framework for the enterprisation of operations

This research has been undertaken to determine how successful multi-organisational enterprise strategy is reliant on the correct type of Enterprise Resource Planning (ERP) information systems being used. However there appears to be a dearth of research as regards strategic alignment between ERP systems development and multi-organisational enterprise governance as guidelines and frameworks to assist practitioners in making decision for multi-organisational collaboration supported by different types of ERP systems are still missing from theoretical and empirical perspectives. This calls for this research which investigates ERP systems development and emerging practices in the management of multi-organisational enterprises (i.e. parts of companies working with parts of other companies to deliver complex product-service systems) and identify how different ERP systems fit into different multi-organisational enterprise structures, in order to achieve sustainable competitive success. An empirical inductive study was conducted using the Grounded Theory-based methodological approach based on successful manufacturing and service companies in the UK and China. This involved an initial pre-study literature review, data collection via 48 semi-structured interviews with 8 companies delivering complex products and services across organisational boundaries whilst adopting ERP systems to support their collaborative business strategies – 4 cases cover printing, semiconductor manufacturing, and parcel distribution industries in the UK and 4 cases cover crane manufacturing, concrete production, and banking industries in China in order to form a set of 29 tentative propositions that have been validated via a questionnaire receiving 116 responses from 16 companies. The research has resulted in the consolidation of the validated propositions into a novel concept referred to as the ‘Dynamic Enterprise Reference Grid for ERP’ (DERG-ERP) which draws from multiple theoretical perspectives. The core of the DERG-ERP concept is a contingency management framework which indicates that different multi-organisational enterprise paradigms and the supporting ERP information systems are not the result of different strategies, but are best considered part of a strategic continuum with the same overall business purpose of multi-organisational cooperation. At different times and circumstances in a partnership lifecycle firms may prefer particular multi-organisational enterprise structures and the use of different types of ERP systems to satisfy business requirements. Thus the DERG-ERP concept helps decision makers in selecting, managing and co-developing the most appropriate multi-organistional enterprise strategy and its corresponding ERP systems by drawing on core competence, expected competitiveness, and information systems strategic capabilities as the main contingency factors. Specifically, this research suggests that traditional ERP(I) systems are associated with Vertically Integrated Enterprise (VIE); whilst ERPIIsystems can be correlated to Extended Enterprise (EE) requirements and ERPIII systems can best support the operations of Virtual Enterprise (VE). The contribution of this thesis is threefold. Firstly, this work contributes to a gap in the extant literature about the best fit between ERP system types and multi-organisational enterprise structure types; and proposes a new contingency framework – the DERG-ERP, which can be used to explain how and why enterprise managers need to change and adapt their ERP information systems in response to changing business and operational requirements. Secondly, with respect to a priori theoretical models, the new DERG-ERP has furthered multi-organisational enterprise management thinking by incorporating information system strategy, rather than purely focusing on strategy, structural, and operational aspects of enterprise design and management. Simultaneously, the DERG-ERP makes theoretical contributions to the current IS Strategy Formulation Model which does not explicitly address multi-organisational enterprise governance. Thirdly, this research clarifies and emphasises the new concept and ideas of future ERP systems (referred to as ERPIII) that are inadequately covered in the extant literature. The novel DERG-ERP concept and its elements have also been applied to 8 empirical cases to serve as a practical guide for ERP vendors, information systems management, and operations managers hoping to grow and sustain their competitive advantage with respect to effective enterprise strategy, enterprise structures, and ERP systems use; referred to in this thesis as the “enterprisation of operations”.

Paediatric drug development:reformulation, in vitro, genomic and in vivo evaluation

Angiotensin converting enzyme (ACE) inhibitors lisinopril and ramipril were selected from EMA/480197/2010 and the potassium-sparing diuretic spironolactone was selected from the NHS specials list for November 2011 drug tariff with the view to produce oral liquid formulations providing dosage forms targeting paediatrics. Lisinopril, ramipril and spironolactone were chosen for their interaction with transporter proteins in the small intestine. Formulation limitations such as poor solubility or pH sensitivity needed consideration. Lisinopril was formulated without extensive development as drug and excipients were water soluble. Ramipril and spironolactone are both insoluble in water and strategies combating this were employed. Ramipril was successfully solubilised using low concentrations of acetic acid in a co-solvent system and also via complexation with hydroxypropyl-β-cyclodextrin. A ramipril suspension was produced to take formulation development in a third direction. Spironolactone dosages were too high for solubilisation techniques to be effective so suspensions were developed. A buffer controlled pH for the sensitive drug whilst a precisely balanced surfactant and suspending agent mix provided excellent physical stability. Characterisation, stability profiling and permeability assessment were performed following formulation development. The formulation process highlighted current shortcomings in techniques for taste assessment of pharmaceutical preparations resulting in early stage research into a novel in vitro cell based assay. The formulations developed in the initial phase of the research were used as model formulations investigating microarray application in an in vitro-in vivo correlation for carrier mediated drug absorption. Caco-2 cells were assessed following transport studies for changes in genetic expression of the ATP-binding cassette and solute carrier transporter superfamilies. Findings of which were compared to in vitro and in vivo permeability findings. It was not possible to ascertain a correlation between in vivo drug absorption and the expression of individual genes or even gene families, however there was a correlation (R2 = 0.9934) between the total number of genes with significantly changed expression levels and the predicted human absorption.

Shaping strategy as a structuration process

Research on top managers’ strategizing behavior has addressed how they shape either the structural context or the interpretations of organization members. I offer a structuration theory framework integrating these two partial explanations and treating strategy shaping as socially dynamic. A qualitative seven-year analysis of top managers in three universities shows a sequential pattern of shaping strategy first in the action and then in the institutional realm, and also a simultaneous pattern of shaping strategy in both realms at once. Both patterns are successful in weakly institutionalized strategy contexts, whereas the simultaneous pattern is more successful in strongly institutionalized strategy contexts.

Formulation and process engineering of freeze-dried orally disintegrating tablets

Orally disintegrating tablets (ODTs) which are also referred to as orodispersible and fast disintegrating tablets, are solid oral dosage forms which upon placing on the tongue, disperse/disintegrate rapidly before being swallowed as a suspension or solution. ODTs are therefore easier and more convenient to administer than conventional tablets and are particularly beneficial for paediatric and geriatric patients, who generally have difficulty swallowing their medication. The work presented in this thesis involved the formulation and process development of ODTs, prepared using freeze-drying. Gelatin is one of the principal excipients used in the formulation of freeze-dried ODTs. One of the studies presented in this thesis investigated the potential modification of the properties of this excipient, in order to improve the performance of the tablets. As gelatin is derived from animal sources, a number of ethical issues surround its use as an excipient in pharmaceutical preparations. This was one of the motivations, Methocel™ and Kollicoat® IR were evaluated as binders as alternative materials to gelatin. Polyox™ was also evaluated as a binder together with its potential uses as a viscosity increasing and mucoadhesive agent to increase the retention of tablets in the mouth to encourage pre-gastric absorption of active pharmaceutical ingredients (APIs). The in vitro oral retention of freeze-dried ODT formulations was one property which was assessed in a design of experiments – factorial design study, which was carried out to further understand the role that formulation excipients have on the properties of the tablets. Finally, the novel approach of incorporating polymeric nanoparticles in freeze-dried ODTs was investigated, to study if the release profile of APIs could be modified, which could improve their therapeutic effect. The results from these studies demonstrated that the properties of gelatin-based formulations can be modified by adjusting pH and ionic strength. Adjustment of formulation pH has shown to significantly reduce tablet disintegration time. Evaluating Methocel™, in particular low viscosity grades, and Kollicoat® IR as binders has shown that these polymers can form tablets of satisfactory hardness and disintegration time. Investigating Polyox™ as an excipient in freeze-dried ODT formulations revealed that low viscosity grades appear suitable as binders whilst higher viscosity grades could potentially be utilised as viscosity increasing and mucoadhesive agents. The design of experiments – factorial design study revealed the influence of individual excipients in a formulation mix on resultant tablet properties and in vitro oral retention of APIs. Novel methods have been developed, which allows the incorporation of polymeric nanoparticles in situ in freeze-dried ODT formulations, which allows the modification of the release profile of APIs.

The influence of formulation and manufacturing process parameters on the characteristics of lyophilized orally disintegrating tablets

Gelatin is a principal excipient used as a binder in the formulation of lyophilized orally disintegrating tablets. The current study focuses on exploiting the physicochemical properties of gelatin by varying formulation parameters to determine their influence on orally disintegrating tablet (ODT) characteristics. Process parameters, namely pH and ionic strength of the formulations, and ball milling were investigated to observe their effects on excipient characteristics and tablet formation. The properties and characteristics of the formulations and tablets which were investigated included: glass transition temperature, wettability, porosity, mechanical properties, disintegration time, morphology of the internal structure of the freeze-dried tablets, and drug dissolution. The results from the pH study revealed that adjusting the pH of the formulation away from the isoelectric point of gelatin, resulted in an improvement in tablet disintegration time possibly due to increase in gelatin swelling resulting in greater tablet porosity. The results from the ionic strength study revealed that the inclusion of sodium chloride influenced tablet porosity, tablet morphology and the glass transition temperature of the formulations. Data from the milling study showed that milling the excipients influenced formulation characteristics, namely wettability and powder porosity. The study concludes that alterations of simple parameters such as pH and salt concentration have a significant influence on formulation of ODT. © 2011 by the authors; licensee MDPI, Basel, Switzerland.

Investigation of formulation and process of lyophilised orally disintegrating tablet (ODT) using novel amino acid combination

Lyophilised orally disintegrating tablets (ODTs) have achieved a great success in overcoming dysphagia associated with conventional solid dosage forms. However, the extensive use of saccharides within the formulation limits their use in treatment of chronic illnesses. The current study demonstrates the feasibility of using combination of proline and serine to formulate zero sacharide ODTs and investigates the effect of freezing protocol on sublimation rate and tablets characteristics. The results showed that inclusion of proline and serine improved ODT properties when compared to individual counterparts. Additionally, annealing the ODTs facilitated the sublimation process and shortened the disintegration time. © 2010 by the authors; licensee Molecular Diversity Preservation International, Basel, Switzerland.

Problematising L2 listening pedagogy:the potential of process-based listening strategy instruction in the L2 classroom

Listening is typically the first language skill to develop in first language (L1) users and has been recognized as a basic and fundamental tool for communication. Despite the importance of listening, aural abilities are often taken for granted, and many people overlook their dependency on listening and the complexities that combine to enable this multi-faceted skill. When second language (L2) students are learning their new language, listening is crucial, as it provides access to oral input and facilitates social interaction. Yet L2 students find listening challenging, and L2 teachers often lack sufficient pedagogy to help learners develop listening abilities that they can use in and beyond the classroom. In an effort to provide a pedagogic alternative to more traditional and limited L2 listening instruction, this thesis investigated the viability of listening strategy instruction (LSI) over three semesters at a private university in Japan through a qualitative action research (AR) intervention. An LSI program was planned and implemented with six classes over the course of three AR phases. Two teachers used the LSI with 121 learners throughout the project. Following each AR phase, student and teacher perceptions of the methodology were investigated via questionnaires and interviews, which were primary data collection methods. Secondary research methods (class observations, pre/post-semester test scores, and a research journal) supplemented the primary methods. Data were analyzed and triangulated for emerging themes related to participants’ perceptions of LSI and the viability thereof. These data showed consistent positive perceptions of LSI on the parts of both learners and teachers, although some aspects of LSI required additional refinement. This project provided insights on LSI specific to the university context in Japan and also produced principles for LSI program planning and implementation that can inform the broader L2 education community.

Novel formulation strategies for the fabrication of lyophilised orally disintegrating tablets

Orally disintegrating Tablets (ODTs), also known as fast-disintegrating, fast-melt or fast-dissolving tablets, are a relatively novel dosage technology that involves the rapid disintegration or dissolution of the dosage form into a solution or suspension in the mouth without the need for water. The solution containing the active ingredients is swallowed, and the active ingredients are then absorbed through the gastrointestinal epithelium to reach the target and produce the desired effect. Formulation of ODTs was originally developed to address swallowing difficulties of conventional solid oral dosage forms (tablets and capsules) experienced by wide range of patient population, especially children and elderly. The current work investigates the formulation and development of ODTs prepared by freeze drying. Initial studies focused on formulation parameters that influence the manufacturing process and performance of lyophilised tablets based on excipients used in commercial products (gelatin and saccharides). The second phase of the work was followed up by comprehensive studies to address the essential need to create saccharide free ODTs using naturally accruing amino acids individually or in combinations. Furthermore, a factorial design study was carried out to investigate the feasibility of delivering multiparticulate systems of challenging drugs using a novel formulation that exploited the electrostatic associative interaction between gelatin and carrageenan. Finally, studies aimed to replace gelatin with ethically and morally accepted components to the end users were performed and the selected binder was used in factorial design studies to investigate and optimise ODT formulations that incorporated drugs with varies physicochemical properties. Our results show that formulation of elegant lyophilised ODTs with instant disintegration and adequate mechanical strength requires carful optimisation of gelatin concentration and bloom strength in addition to saccharide type and concentration. Successful formulation of saccharides free lyophilised ODTs requires amino acids that crystallise in the frozen state or display relatively high Tg', interact and integrate completely with the binder and, also, display short wetting time with the disintegrating medium. The use of an optimised mixture of gelatin, carrageenan and alanine was able to create viscous solutions to suspend multiparticulate systems and at the same time provide tablets with short disintegration times and adequate mechanical properties. On the other hand, gum arabic showed an outstanding potential for use as a binder in the formulation of lyophilised ODTs. Compared to gelatin formulations, the use of gum arabic simplified the formulation stages, shortened the freeze drying cycles and produced tablets with superior performance in terms of the disintegration time and mechanical strength. Furthermore, formulation of lyophilised ODTs based on gum arabic showed capability to deliver diverse range of drugs with advantages over commercial products.