Children's views on unlicensed/off-label paediatric prescribing and paediatric clinical trials

Objectives - To explore the views and perspectives of children on the unlicensed/off-label use of medicines in children and on the participation of children in clinical trials. Methods - Focus-group discussions, involving school children, were carried out in a range of primary and secondary schools in Northern Ireland. A purposeful sample was chosen to facilitate representation of various socioeconomic groupings. Results - A total of 123 pupils, aged from 10 to 16 years, from six schools, participated in 16 focus groups. In general, pupils viewed the unlicensed/off-label use of medicines in children as unsafe and unethical and felt it is necessary to test medicines in children to improve the availability of licensed products. The majority felt that older children should be told, and that parents should be told, about the unlicensed/off-label use of medicines in children, yet they recognised some implications of this, such as potential medication non-adherence. Conclusions - This is the first study to explore the views of healthy children on unlicensed medicine use in children. Children were able to recognise potential risks associated with the unlicensed use of medicines and felt it is necessary to test and license more medicines in children. Practice implications - Health care professionals should consider the views of children in decisions that affect their health.

Practices and views on fetal heart monitoring:A structured observation and interview study

Objective: To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design: Qualitative study. Setting: Large teaching hospital in the UK. Sample: Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods: Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures: Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results: All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion: Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. © RCOG 2006.

Patients' and health professionals' views on primary care for people with serious mental illness:focus group study

Objective: To explore the experience of providing and receiving primary care from the perspectives of primary care health professionals and patients with serious mental illness respectively. Design: Qualitative study consisting of six patient groups, six health professional groups, and six combined focus groups. Setting: Six primary care trusts in the West Midlands. Participants: Forty five patients with serious mental illness, 39 general practitioners (GPs), and eight practice nurses. Results: Most health professionals felt that the care of people with serious mental illness was too specialised for primary care. However, most patients viewed primary care as the cornerstone of their health care and preferred to consult their own GP, who listened and was willing to learn, rather than be referred to a different GP with specific mental health knowledge. Swift access was important to patients, with barriers created by the effects of the illness and the noisy or crowded waiting area. Some patients described how they exaggerated symptoms ("acted up") to negotiate an urgent appointment, a strategy that was also employed by some GPs to facilitate admission to secondary care. Most participants felt that structured reviews of care had value. However, whereas health professionals perceived serious mental illness as a lifelong condition, patients emphasised the importance of optimism in treatment and hope for recovery. Conclusions: Primary care is of central importance to people with serious mental illness. The challenge for health professionals and patients is to create a system in which patients can see a health professional when they want to without needing to exaggerate their symptoms. The importance that patients attach to optimism in treatment, continuity of care, and listening skills compared with specific mental health knowledge should encourage health professionals in primary care to play a greater role in the care of patients with serious mental illness.

A patient's perspective:the impact of adverse drug reactions on patients and their views on reporting

What is known and objective: Adverse drug reactions to prescribed medication are relatively common events. However, the impact such reactions have on patients and their attitude to reporting such events have only been poorly explored. Previous studies relying on self-reporting patients indicate that altruism is an important factor. In the United Kingdom, patient reporting started in 2005; though, numbers of serious reports remain low. Method: A purposive sample of fifteen patients who had been admitted to an inner city hospital with an adverse drug reaction were interviewed using a semi-structured questionnaire. Patients were asked to relate in their own words their experience of an adverse drug reaction. Patient's reactions to the information leaflet, adherence to treatment and use of other sources of information on medication were assessed. Interviews were recorded, and a thematic analysis of patients'responses was performed. Results and discussion: Analysis of the patient interviews demonstrated the reality of being admitted to hospital is often a frightening process with a significant emotional cost. Anger, isolation, resentment and blame were common factors, particularly when medicines had been prescribed for acute conditions. For patients with chronic conditions, a more phlegmatic approach was seen especially with conditions with a strong support networks. Patients felt that communication and information should have been more readily available from the health care professional who prescribed the medication, although few had read the patient information leaflet. Only a minority of patients linked the medication they had taken to the adverse event, although some had received false reassurance that the drug was not related to their illness creating additional barriers. In contrast to previous studies, many patients felt that adverse drug reporting was not their concern, particularly as they obtained little direct benefit from it. The majority of patients were unaware of the Yellow Card Scheme in the UK for patient reporting. Even when explained, the scheme was felt too cold and impersonal and not a patient's 'job'. What is new and conclusion: Patients having a severe adverse drug reaction following an acute illness felt negative emotions towards their health care provider. Those with a chronic condition rationalized the event and coped better with its impact. Neither group felt that reporting the adverse reaction was their responsibility. Encouraging patients to report remains important but expecting patients to report solely for altruistic purposes may be unrealistic. © 2011 Blackwell Publishing Ltd.

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user’s lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.

Does the subject content of the pharmacy degree course influence the community pharmacist’s views on competencies for practice?

Do community pharmacists coming from different educational backgrounds rank the importance of competences for practice differently-or is the way in which they see their profession more influenced by practice than university education? A survey was carried out on 68 competences for pharmacy practice in seven countries with different pharmacy education systems in terms of the relative importance of the subject areas chemical and medicinal sciences. Community pharmacists were asked to rank the competences in terms of relative importance for practice; competences were divided into personal and patient-care competences. The ranking was very similar in the seven countries suggesting that evaluation of competences for practice is based more on professional experience than on prior university education. There were some differences for instance in research-related competences and these may be influenced, by education.

The impact of brand owner on consumers' brand perceptions : a development of Heider's Balance Theory

Studies have shown that the brand “owner” is very influential in positioning the brand and when the brand “owner” ceases his or her active role the brand will be perceived differently by the consumers. Balance Theory (HBT), a cognitive psychological theory, studies the triadic relationships between two persons and an entity and predicts that when a person’s original perception of the relationship is disturbed, the person restructures to a new balanced perception. Consequently, this research was undertaken to: conceptualize the brand owner’s impact on consumer’s brand perception; test the applicability of both the static and dynamic predictions of the Heider’s Balance Theory in brand owner-consumer-brand relation (OCB); construct and test a model of brand owner-consumer-brand relation; and examine if personality has an influence on OCB. A discovery-oriented approach was taken to understand the selected market segment, the ready-to-wear and diffusion lines of international designer labels. Chinese Brand Personality Scale, fashion proneness and hedonic and utilitarian shopping scales were developed, and validated. 51 customers were surveyed. Both traditional and extended methods used in the Balance Theory were employed in this study. Responses to liked brand have been used to test and develop the model, while those for disliked brand were used for test and confirmation. A “what if’ experimental approach was employed to test the applicability of dynamic HBT theory in OCB Model. The hypothesized OCB Model has been tested and validated. Consumers have been found to have separate views on the brand and the brand owner; and their responses to contrasting ethical and non-ethical news of the brand owner are different. Personality has been found to have an influence and two personality adapted models have been tested and validated. The actual results go beyond the prediction of the Balance Theory. Dominant triple positive balance mode, dominant negative balance mode, and mode of extreme antipathy have been found. It has been found that not all balanced modes are good for the brand. Contrary to Heider’s findings, simply liking may not necessarily lead to unit relation in the OCB Model.

GEO Label:user and producer perspectives on a label for geospatial data

One of the aims of the Science and Technology Committee (STC) of the Group on Earth Observations (GEO) was to establish a GEO Label- a label to certify geospatial datasets and their quality. As proposed, the GEO Label will be used as a value indicator for geospatial data and datasets accessible through the Global Earth Observation System of Systems (GEOSS). It is suggested that the development of such a label will significantly improve user recognition of the quality of geospatial datasets and that its use will help promote trust in datasets that carry the established GEO Label. Furthermore, the GEO Label is seen as an incentive to data providers. At the moment GEOSS contains a large amount of data and is constantly growing. Taking this into account, a GEO Label could assist in searching by providing users with visual cues of dataset quality and possibly relevance; a GEO Label could effectively stand as a decision support mechanism for dataset selection. Currently our project - GeoViQua, - together with EGIDA and ID-03 is undertaking research to define and evaluate the concept of a GEO Label. The development and evaluation process will be carried out in three phases. In phase I we have conducted an online survey (GEO Label Questionnaire) to identify the initial user and producer views on a GEO Label or its potential role. In phase II we will conduct a further study presenting some GEO Label examples that will be based on Phase I. We will elicit feedback on these examples under controlled conditions. In phase III we will create physical prototypes which will be used in a human subject study. The most successful prototypes will then be put forward as potential GEO Label options. At the moment we are in phase I, where we developed an online questionnaire to collect the initial GEO Label requirements and to identify the role that a GEO Label should serve from the user and producer standpoint. The GEO Label Questionnaire consists of generic questions to identify whether users and producers believe a GEO Label is relevant to geospatial data; whether they want a single "one-for-all" label or separate labels that will serve a particular role; the function that would be most relevant for a GEO Label to carry; and the functionality that users and producers would like to see from common rating and review systems they use. To distribute the questionnaire, relevant user and expert groups were contacted at meetings or by email. At this stage we successfully collected over 80 valid responses from geospatial data users and producers. This communication will provide a comprehensive analysis of the survey results, indicating to what extent the users surveyed in Phase I value a GEO Label, and suggesting in what directions a GEO Label may develop. Potential GEO Label examples based on the results of the survey will be presented for use in Phase II.

Editorial

On behalf of the Operational Research Society, Palgrave Macmillan and the editorial team, I am pleased to welcome readers to this, the first issue of Knowledge Management Research & Practice (KMRP). The aim of KMRP is to provide an outlet for rigorous, high-quality, peer-reviewed articles on all aspects of managing knowledge, organisational learning, intellectual capital and knowledge economics. The Editorial Board intends that there be a particular emphasis on cross-disciplinary approaches, and on the mixing of 'hard' (e.g. technological) and 'soft' (e.g. cultural or motivational) issues. This issue features four regular papers and an editorial paper; in addition, there are two book reviews. KMRP is intended as a truly international journal. The papers in this issue feature authors based in five different countries on three continents; eight different countries and four continents if the editorial paper is included. The first of the regular papers is 'The Knowledge-Creating Theory Revisited: Knowledge Creation as Synthesizing Process', by Ikujiro Nonaka and Ryoko Toyama. There can be few readers who are unaware of the work on knowledge creation by Nonaka and his co-workers such as Takeuchi, and this paper seeks to revisit and extend some of the earlier ideas. The second paper is 'Knowledge Sharing in a Multi-Cultural Setting: A Case Study' by Dianne Ford and Yolande Chan. They present a case study that explores the extent to which knowledge sharing is dependent on national culture. The third paper is 'R&D Collaboration: The Role of bain Knowledge-creating Networks' by Malin Brännback. She also draws upon Nonaka and Takeuchi's work on knowledge creation, using the case of knowledge-creating networks in biopharmaceutical R&D involving both universities and industry as an example. The fourth regular paper is 'The Critical Role of Leadership in Nurturing a Knowledge Supporting Culture' by Vincent Ribière and Alea Saa Sitar. They examine the role of leaders in knowledge management generally, and especially in knowledge organisations, from the viewpoint of 'leading through a knowledge lens'. In addition, this issue includes an 'editorial paper', 'Knowledge Management Research & Practice: Visions and Directions' by the editorial team of John Edwards, Meliha Handzic, Sven Carlsson, and Mark Nissen. This paper presents a small survey of academics and practitioners, outlines key directions for knowledge management research and practice, and gives the editorial team's views on how KMRP can help promote scholarly inquiry in the field. We trust that you will both enjoy reading this first issue and be stimulated by it, and cordially invite you to contribute your own paper(s) to future issues of KMRP.

Knowledge management research and practice:visions and directions

This editorial paper outlines key directions for knowledge management research and practice. The editorial team presents the results from a small survey of academics and practitioners about the present and future of knowledge management, and the editors include their own informed views on how this journal can help promote scholarly inquiry in the field.

Strategic ambiguity as a rhetorical resource for enabling multiple interests

The literature on ambiguity reflects contradictory views on its value as a resource or a problem for organizational action. In this longitudinal empirical study of ambiguity about a strategic goal, we examined how strategic ambiguity is used as a discursive resource by different organizational constituents and how that is associated with collective action around the strategic goal. We found four rhetorical positions, each of which drew upon strategic ambiguity to construct the strategic goal differently according to whether the various constituents were asserting their own interests or accommodating wider organizational interests. However, we also found that the different constituents maintained these four rhetorical positions simultaneously over time, enabling them to shift between their own and other’s interests rather than converging upon a common interest. These findings are used to develop a conceptual framework that explains how strategic ambiguity might serve as a resource for different organizational constituents to assert their own interests whilst also enabling collective organizational action, at least of a temporary nature.

Ethical issues about shared medical records

Focal points: Patient views on pharmacists' access to medical records was studied using a self-completion questionnaire in medical practice and two community pharmacies There was some support for pharmacist access to records with a third of the sample being unsure There was a majority support when the purpose was clearly pharmacy related A clear majority was confident of confidentiality in the pharmacy

The training experience of primary care pharmacists

Objectives — To map the tasks, activities and training provision for primary care pharmacists (PCPs) and to identify perceived future training needs. Methods — Survey undertaken in 1998/1999 using a pre-piloted, postal, self-completion questionnaire to two samples of PCPs. Setting — PCPs in (a) the West Midlands and (b) England (outside West Midlands). Key findings — The response rate was 66 per cent. A majority (68 per cent) had worked in the role for less than two years. Eighty per cent had some form of continuing education or training for the role although only 50 per cent had a formal qualification. Over two-thirds had contributed to the funding of their training, with one-third providing all funding. Seventy-four per cent of PCPs agreed that pharmacists should go through a procedure to ensure competence (accreditation) before being allowed to work for a general medical practice or primary care group. Views on the need for formal education/training prior to work differed: 82 per cent of those with formal qualifications, but only 46 per cent of those without, considered that this should be a requirement. There was general agreement that training/education had met training needs. Views on future training closely reflected previous training experiences, with a focus upon pharmaceutical roles rather than upon generic skill development and the acquisition of management skills. Conclusions — The study provides a snapshot in time of the experience of pioneer PCPs and the training available to them. PCPs will need further training or updating if they are to provide the wider roles required by the developing needs of the National Health Service. Consideration should be given to formal recognition of the training of PCPs in order to assure competence. The expectation that pharmacists should fund their own training is likely to be a barrier to uptake of training and uncertainties over funding will militate against consistency of training.

Creativity and learning through electronic group causal mapping

This paper proposes, and begins to evaluate, a format of brainstorming-type activity which aims to release the creativity of participants and encourage them to learn about a wider range of issues in more detail. The format does this through providing a two-stage brainstorming session. After the first brainstorm, participants have an opportunity to both piggy-back off other peoples ideas (i.e. create new ideas by synthesising other peoples' ideas into their own perspectives), and share causal links to build a causal map with the brainstormed ideas. Five causal mapping sessions with organisations have been analysed. Findings suggest that ideas shared when piggy-backing are often highly creative and unique for the participant who shared them. Also piggy-backing and causal linking seem to provide effective opportunities for individual learning as participants have time to reflect upon other peoples' perspectives and share their own views on those.

Designing a methodology for an office communication and information system:for executives in the Malaysian public sector : the Prime Minister's office

Modern managers are under tremendous pressure in attempting to fulfil a profoundly complex managerial task, that of handling information resources. Information management, an intricate process requiring a high measure of human cognition and discernment, involves matching a manager's lack of information processing capacity against his information needs, with voluminous information at his disposal. The nature of the task will undoubtedly become more complex in the case of a large organisation. Management of large-scale organisations is therefore an exceedingly challenging prospect for any manager to be faced with. A system that supports executive information needs will help reduce managerial and informational mismatches. In the context of the Malaysian public sector, the task of overall management lies with the Prime Minister and the Cabinet. The Prime Minister's Office is presently supporting the Prime Minister's information and managerial needs, although not without various shortcomings. The rigid formalised structure predominant of the Malaysian public sector, so opposed to dynamic treatment of problematic issues as faced by that sector, further escalates the managerial and organisational problem of coping with a state of complexity. The principal features of the research are twofold: the development of a methodology for diagnosing the problem organisation' and the design of an office system. The methodological development is done in the context of the Malaysian public sector, and aims at understanding the complexity of its communication and control situation. The outcome is a viable model of the public sector. `Design', on the other hand, is developing a syntax or language for office systems which provides an alternative to current views on office systems. The design is done with reference to, rather than for, the Prime Minister's Office. The desirable outcome will be an office model called Office Communication and Information System (OCIS).