An evaluation of paediatric medicines reconciliation at hospital discharge into the community

OBJECTIVE: A UK national survey of primary care physicians has indicated that the medication information on hospital discharge summary was incomplete or inaccurate most of the time. Internationally, studies have shown that hospital pharmacist's interventions reduce these discrepancies in the adult population. There have been no published studies on the incidence and severity of the discrepancies of the medication prescribed for children specifically at discharge to date. The objectives of this study were to investigate the incidence, nature and potential clinical severity of medication discrepancies at the point of hospital discharge in a paediatric setting. METHODS: Five weeks prospective review of hospital discharge letters was carried out. Medication discrepancies between the initial doctor's discharge letter and finalised drug chart were identified, pharmacist changes were recorded and their severity was assessed. The setting of the review was at a London, UK paediatric hospital providing local secondary and specialist tertiary care. The outcome measures were: - incidence and the potential clinical severity of medication discrepancies identified by the hospital pharmacist at discharge. KEY FINDINGS: 142 patients (64 female and 78 males, age range 1 month - 18 years) were discharged on 501 medications. The majority of patients were under the care of general surgery and general paediatric teams. One in three discharge letters contained at least one medication discrepancy and required pharmacist interventions to rectify prior to completion. Of these, 1 in 10 had the potential for patient harm if undetected. CONCLUSIONS: Medicines reconciliation by pharmacist at discharge may be a good intervention in preventing medication discrepancies which have the potential to cause moderate harm in paediatric patients.

An evaluation of pharmacy education and pre-registration training

This thesis covers two major aspects of pharmacy education; undergraduate education and pre-registration training. A cohort of pharmacy graduates were surveyed over a period of four years, on issues related to undergraduate education, pre-registration training and continuing education. These graduates were the first-ever to sit the pre-registration examination. In addition, the opinions of pre-registration tutors were obtained on pre-registration training, during the year that competence-based assessment was introduced. It was concluded that although the undergraduate course provided a broad base of knowledge suitable for graduates in all branches of pharmacy, several issues were identified which would require attention in future developments of the course. These were: 1. the strong support for the expansion of clinical, social and practice-based teaching. 2. the strong support to retain the scientific content to the same extent as in the three-year course. 3. a greater use of problem-based learning methods. The graduates supported the provision of a pre-registration continuing education course to help prepare for the examination and in areas inadequately covered in the undergraduate course. There was also support for the introduction of some form of split branch training. There was no strong evidence to suggest that the training had been an application of undergraduate education. In general, competence-based training was well regarded by tutors as an appropriate and effective method of skill assessment. However, community tutors felt it was difficult to carry out effectively due to day-to-day time constraints. The assistant tutors in hospital pharmacy were found to have a very important role in provision of training, and should be adequately trained and supported. The study recommends the introduction of uniform training and a quality assurance mechanism for all tutors and assistants undertaking this role.

Time and professional work in public sector organisations: an examination of four occupational groups in education and medicine

The aim of this thesis is to examine the experience of time of four professional occupational groups working in public sector organisations and the factors affecting this experience. The literature on time and work is examined to delineate the key parameters of research in this area. A broad organisation behaviour approach to the experience of time and work is developed in which individual, occupational, organisational and socio-political factors are inter-related. The experience of secondary school teachers, further education lecturers, general medical practitioners and hosoital consultants is then examined. Multiple methods of data collection are used: open-ended interviews, a questionnaire survey and the analysis of key documents relating to the institutional settings in which the four groups work. The research aims to develop our knowledge of working time by considering the dimensions of the experience of time at work, the contexts in wlhich this experience is generated and the constraints these contexts give rIse to. By developing our understanding of time as a key feature of work experience we also extend our knowledge of organisation behaviour in general. In conclusion a model of the factors relating the experience of time to the negotiation of time at work is presented.

Education and self-management for people newly diagnosed with type 2 diabetes: a qualitative study of patients' views.

OObjectives: We explored the perceptions, views and experiences of diabetes education in people with type 2 diabetes who were participating in a UK randomized controlled trial of methods of education. The intervention arm of the trial was based on DESMOND, a structured programme of group education sessions aimed at enabling self-management of diabetes, while the standard arm was usual care from general practices. Methods: Individual semi-structured interviews were conducted with 36 adult patients, of whom 19 had attended DESMOND education sessions and 17 had been randomized to receive usual care. Data analysis was based on the constant comparative method. Results: Four principal orientations towards diabetes and its management were identified: `resisters', `identity resisters, consequence accepters', `identity accepters, consequence resisters' and `accepters'. Participants offered varying accounts of the degree of personal responsibility that needed to be assumed in response to the diagnosis. Preferences for different styles of education were also expressed, with many reporting that they enjoyed and benefited from group education, although some reported ambivalence or disappointment with their experiences of education. It was difficult to identify striking thematic differences between accounts of people on different arms of the trial, although there was some very tentative evidence that those who attended DESMOND were more accepting of a changed identity and its implications for their management of diabetes. Discussion: No one single approach to education is likely to suit all people newly diagnosed with diabetes, although structured group education may suit many. This paper identifies varying orientations and preferences of people with diabetes towards forms of both education and self-management, which should be taken into account when planning approaches to education.

Drug information in general practice pharmacy

The drug information sources currently available to general practice pharmacists have been identified. The use of and attitudes to these sources were assessed as well as the perceived information needs of practising pharmacists. The special requirements of women pharmacists and pharmacists working part-time were studied. The relationship of the medical representative as an information source for pharmacists was evaluated. Participation in continuing education programmes as a vital means of ensuring current information awareness and knowledge for the practising profession has been considered. Investigations were mainly pursued by questionnaire survey, while computer facilities were used for the processing and the analyses of data. The desirability of collated and evaluated information from one or more independent authoritative sources has been discussed. The increasing advisory role of the general practice pharmacist and the needs of the patient and potential customer have been discussed, with projections for the pharmacist's future health care contribution.

Influences on general practitioner prescribing with particular reference to community pharmacy

Influences on general practitioner prescribing of drugs continue to be of interest and importance as cost containment becomes central to Government health policy. This thesis employs a plurality of research methods including quantitative and qualitative survey techniques for example, questionnaires, interviews and prescription analyses to investigate some of the factors which may influence GP prescribing such as information sources, hospital consultants and in particular the community pharmacist. When the use and influence of drug information sources by GPs was examined, the community pharmacist was given a relatively low rating as a source but a high rating, similar to that of the consultant, for helpfulness. Influences are needed to improve prescribing and reduce the incidence of iatrogenic disease for the benefit of the patient. The education and expertise of pharmacists and their familiarity with local prescribing habits places them in a unique position to meet the needs of local GPs. As 96.5% of the public always or nearly always take their prescriptions to the same pharmacy, patient medication records, now kept by 77.5% of pharmacies, provide a valuable check on the appropriateness and safety of patients' medication. The barriers to the pharmacist's greater involvement were shown to be suspicion by GPs of pharmacists' motivation, isolation of many community pharmacists, difficulties in leaving the pharmacy for domiciliary visits, residential home care and GP practice meetings. These barriers must be lowered if the pharmacist is to have a greater influence and involvement. It was concluded that changes are necessary in pharmaceutical education, staff training, organisation and remuneration. Some changes in the targeting of remuneration to the pharmaceutical care services provided and registration of patients with pharmacies would contribute greatly to these aims.

Action research in a collective organisation:Developing an education programme in a pressure group

The aim of this project was to develop the education work of an environmental pressure group. The research devised and implemented a project to produce multi-media teaching packs on the urban environment. Whilst this involved understanding environmental education it was necessary to research beyond this to include the various structural and dynamic constraints on change in the field. This presented a number of methodological difficulties; from the resolution of which a model of the research process involved in this project has been developed. It is argued that research oriented towards practical change requires the insights of an experienced practitioner to be combined with the rigours of controlled systematic enquiry. Together these function as a model-building process encompassing intuition, induction and deduction. Model testing is carried out through repeated intervention in the field; thus an interplay between researcher and client ensues such that the project develops in a mutually acceptable direction. In practice, this development will be both unpredictable and erratic. Although the conclusions reached here are based on a single case study they address general methodological issues likely to be encountered in different field settings concerned with different practical problems.

Volunteering for success? An Analysis of Student Perceptions of the Pedagogical and Social Outcomes of Peer Mentoring in Higher Education

Previous studies into student volunteering have shown how formally organized volunteering activities have social, economic and practical benefits for student volunteers and the recipients of their volunteerism (Egerton, 2002; Vernon & Foster, 2002); moreover student volunteering provides the means by which undergraduates are able to acquire and hone transferable skills sought by employers following graduation (Eldridge & Wilson, 2003; Norris et al, 2006). Although much is known about the benefits of student volunteering, few previous studies have focused on the pedagogical value of student mentoring from the perspectives of both student mentee and mentor. Utilising grounded theory methodology this paper provides a critical analysis of an exploratory study analysing students’ perceptions of the pedagogical and social outcomes of student mentoring. It looks at students’ perceptions of mentoring, and being mentored, in terms of the learning experience and development of knowledge and skills. In doing so the paper considers how volunteering in a mentoring capacity adds ‘value’ to students’ experiences of higher education. From a public policy perspective, the economic, educational, vocational and social outcomes of student volunteering in general, and student mentoring in particular, make this an important subject meriting investigation. In terms of employability, the role of mentoring in equipping mentors and mentees with transferable, employability competencies has not been investigated. By critiquing the mentoring experiences of undergraduates within a single institution, this paper will make an important contribution to policy debates with regards to the pedagogical and employability related outcomes of student volunteering and mentoring.

Introduction: the media, animal conservation and environmental education

Natural History filmmaking has a long history but the generic boundaries between it and environmental and conservation filmmaking are blurred. Nature, environment and animal imagery has been a mainstay of television, campaigning organisations and conservation bodies from Greenpeace to the Sierra Club, with vibrant images being used effectively on posters, leaflets and postcards, and in coffee table books, media releases, short films and viral emails to educate and inform the general public. However, critics suggest that wildlife film and photography frequently convey a false image of the state of the world’s flora and fauna. The environmental educator David Orr once remarked that all education is environmental education, and it is possible to see all image-based communication in the same way. The Media, Animal Conservation and Environmental Education has contributions from filmmakers, photographers, researchers and academics from across the globe. It explores the various ways in which film, television and video are, and can be, used by conservationists and educators to encourage both a greater awareness of environmental and conservation issues, and practical action designed to help endangered species. This book is based on a special issue of the journal Environmental Education Research.

The media, animal conservation and environmental education

Natural History filmmaking has a long history but the generic boundaries between it and environmental and conservation filmmaking are blurred. Nature, environment and animal imagery has been a mainstay of television, campaigning organisations and conservation bodies from Greenpeace to the Sierra Club, with vibrant images being used effectively on posters, leaflets and postcards, and in coffee table books, media releases, short films and viral emails to educate and inform the general public. However, critics suggest that wildlife film and photography frequently convey a false image of the state of the world’s flora and fauna. The environmental educator David Orr once remarked that all education is environmental education, and it is possible to see all image-based communication in the same way. The Media, Animal Conservation and Environmental Education has contributions from filmmakers, photographers, researchers and academics from across the globe. It explores the various ways in which film, television and video are, and can be, used by conservationists and educators to encourage both a greater awareness of environmental and conservation issues, and practical action designed to help endangered species. This book is based on a special issue of the journal Environmental Education Research.

Using an experiential business game to stimulate sustainable thinking in marketing education

Recent years have seen a significant increase in the importance of environmental protection and sustainability to consumers, policy makers, and society in general. Reflecting this, most organizations are at least aware of this new agenda and wish to be seen as taking steps to improve behaviors in this regard. However, there appears to be a gap between this evolving agenda and the comparatively low level of knowledge that marketing managers actually have of the environmental impact of their own functional decisions. We suggest that this low knowledge level may be due, in part, to the marketplace focus of foundational marketing educational programs, and we attempt to show how broadening the horizons of marketing courses can help students (i.e., future managers) more deeply understand the environmental consequences of their actions. We demonstrate the use of a novel business game, based on the Life Cycle Assessment method, as the foundational cornerstone for the development of a broad understanding of the environmental impact of marketing decisions and actions for the entire life cycle of a product—from raw material extraction to ultimate disposal. The results of an empirical study show that this approach increases students’ appreciation for, and understanding of, these fundamental environmental sustainability concepts.

Advanced education and training in bioenergy in Europe

The paper explains how bioenergy education and training is growing in Europe. Employment estimates are included for renewable energy in general, and bioenergy in particular, to highlight the need for a broadly based education and training programme that is essential to build a knowledgeable workforce that can drive Europe's growing bioenergy sector. The paper reviews current provisions in bioenergy at Masters and PhD levels across the 27 members of the EU (EU27) plus Norway and Switzerland. This identifies a very active and expanding bioenergy education provision. 65 English-language Masters Courses in bioenergy (either focussing completely on bioenergy or with significant bioenergy content or specialisation) were identified. 231 providers of PhD studies in bioenergy were found.Masters Course offerings have grown rapidly across Europe during the last five years, but where data is available, enrolment has been quite low suggesting that there is an oversupply of courses and that course organisers are being optimistic in their projections. Existing provisions in Europe at Masters and PhD levels are clearly more than sufficient for short term needs, but further work is needed to evaluate the take-up rate and the content and focus of the provisions. To ensure talented graduates are attracted to these programmes, better promotion, stronger links with the research community and industry, and increased collaboration among course providers are needed. Short Courses of two to five days are an excellent way of meeting post-experience training needs but require further growth and development to serve the needs of the bioenergy community. © 2011 Elsevier Ltd.

Activity and affect:repeated within-participant assessment in people after joint replacement surgery

Objective: Between-participant research has shown that high negative affectivity predicts greater activity limitations and vice versa. This study examined both between- and within-participant associations of negative and positive affectivity with activity levels using ecological momentary assessment. Method: Participants were 25 people who had undergone joint replacement surgery 12 months previously. Participants made multiple reports of their activity and positive and negative affectivity over a single day using, a computerized diary. Activity was also objectively recorded using an activity monitor. The following day, participants made a self-report of their activity over the measurement day and general positive and negative affectivity levels were recorded. Results: Higher self-reported walking time over the whole measurement day was associated with higher general positive affectivity but not negative affectivity. However, using ecological momentary assessment, higher diary reports of negative affectivity predicted increased activity levels while positive affectivity neither predicted nor was predicted by activity. Conclusion: These findings demonstrate the importance of within-participant methodology in detecting subtle and immediate effects of individuals' mood on behavior that may differ from findings investigating between-participant effects over longer time periods.

Was it good for them? Reflections on the use of MENTOR and changes in course design using general performance measures

This paper considers the use of general performance measures in evaluating specific planning and design decisions in higher education and reflects on the students' learning process. Specifically, it concerns the use of the MENTOR multimedia computer aided learning package for helping students learn about OR as part of a general business degree. It includes the transfer of responsibility for a learning module to a new staff member and a change from a single tutor to a system involving multiple tutors. Student satisfaction measures, learning outcome measures and MENTOR usage patterns are examined in monitoring the effects of the changes in course delivery. The results raise some questions about the effectiveness of general performance measures in supporting specific decisions relating to course design and planning.