Development of a prescribing indicator for objective quantification of antibiotic usage in secondary care

Objectives: To compare the recognized defined daily dose per 100 bed-days (DDD/100 bed-days) measure with the defined daily dose per finished consultant episode (DDD/FCE) in a group of hospitals with a variety of medicines management strategies. To compare antibiotic usage using the above indicators in hospitals with and without electronic prescribing systems. Methods: Twelve hospitals were used in the study. Nine hospitals were selected and split into three cohorts (three high-scoring, three medium-scoring and three low-scoring) by their 2001 medicines management self-assessment scores (MMAS). An additional cohort of three electronic prescribing hospitals was included for comparison. MMAS were compared to antibiotic management scores (AMS) developed from a questionnaire relating specifically to control of antibiotics. FCEs and occupied bed-days were obtained from published statistics and statistical analyses of the DDD/100 bed-days and DDD/FCE were carried out using SPSS. Results: The DDD/100 bed-days varied from 81.33 to 189.37 whilst the DDD/FCE varied from 2.88 to 7.43. The two indicators showed a high degree of correlation with r = 0.74. MMAS were from 9 to 22 (possible range 0-23) and the AMS from 2 to 13 (possible range 0-22). The two scores showed a high degree of correlation with r = 0.74. No correlation was established between either indicator and either score. Conclusions: The WHO indicator for medicines utilization, DDD/100 bed-days, exhibited the same level of conformity as that exhibited from the use of the DDD/FCE indicating that the DDD/FCE is a useful additional indicator for identifying hospitals which require further study. The MMAS can be assumed to be an accurate guide to antibiotic medicines management controls. No relationship has been found between a high degree of medicines management control and the quantity of antibiotic prescribed. © The British Society for Antimicrobial Chemotherapy; 2004 all rights reserved.

Adverse drug reaction teaching in UK undergraduate medical and pharmacy programmes

Objectives: To assess the extent of teaching about the Committee on Safety of Medicine's Yellow Card scheme and adverse drug reactions within UK Schools of Medicine and Pharmacy. Methods: A self-completed questionnaire sent to all heads of undergraduate schools of medicine and pharmacy within the UK. Results: The majority of undergraduate syllabuses feature the Yellow Card Scheme. Knowledge of the Yellow Card Scheme was assessed in 79% of pharmacy programmes and 57% of medical schools. Specialist speakers on the Yellow Card Scheme were infrequently used. Fewer than half of respondents provided students with a guide to reporting ADRs (43% pharmacy and 43% medical). There is some disagreement about the value of supplying students with printed material about the Yellow Card Scheme. Half of medical Schools did not think that supplying 'Current Problems In Pharmacovigilance' would be useful. Conclusions: It was found that in both medicine and pharmacy, courses differed substantially in teaching about the Yellow Card Scheme and adverse drug reactions (ADRs). There is scope for increased involvement of the Medicines and Healthcare products Regulatory Agency in undergraduate education, in line with recommendations from the National Audit Office.

Development and validaton of an indicator to compare antibiotic usage in secondary care in England

The use of antibiotics was investigated in twelve acute hospitals in England. Data was collected electronically and by questionnaire for the financial years 2001/2, 2002/3 and 2003/4. Hospitals were selected on the basis of their Medicines Management Self-Assessment Scores (MMAS) and included a cohort of three hospitals with integrated electronic prescribing systems. The total sample size was 6.65% of English NHS activity for 2001/2 based on Finished Consultant Episode (FCE) numbers. Data collected included all antibiotics dispensed (ATC category J01), hospital activity FCE's and beddays, Medicines Management Self-assessment scores, Antibiotic Medicines Management scores (AMS), Primary Care Trust (PCT) of origin of referral populations, PCT antibiotic prescribing rates, Index of Multiple Deprivation for each PCT. The DDD/FCE (Defined Daily Dose/FCE) was found to correlate with the DDD 100beddays (r = 0.74 pindicating this is a useful additional indicator for identifying hospitals that require further study. Antibiotic use increased from a mean 4.16 DDD/FCE in 2001/2 to 4.35 DDD/FCE in 2003/4. Antibiotic use in the electronic prescribing cohort was found to be lower, than the sample mean at 3.48 DDD/FCE in 2001/2 and 3.34 DDD/FCE in 2003/4. The MMAS and AMS were found to correlate (r = 0.74 ping the use of the MMAS as an indication of control of antibiotic use. No correlation was found between the MMAS and a range of qualitative indicators of antibiotic use. A number of indicators are proposed as triggers for further investigation including a proportion of 0.24 for the ratio of third generation to first/second generation cephalosporin use, and five percent as the limit for parenteral quinolone DOD of total quinolone DOD usage. It was possible to demonstrate a correlation between the IMD 2000 and primary care antibiotic prescribing rates but not between primary and secondary care antibiotic prescribing rates for the same referral population or between the weighted mean IMD 2000 for each hospital's referral population and the hospital antibiotic prescribing rate.

Survey of teacher stress in secondary schools in the local authority

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A comparison of antibiotic prescribing indicators and medicines management scoring in secondary care

Poster: - Robust prescribing indicators analogous to those used in primary care are not available currently in NHS hospital trusts - The Department of Health has recently implemented a scheme for self-assessment scoring medicines management processes (maximum 23) in NHS hospitals - There is no clear relationship between average values for two antibiotic prescribing indicators obtained in ten NHS hospital trusts in the West Midlands - There is no clear relationship between either indicator value and the corresponding self-assessment medicines management score - This study highlights the difficulties involved in assessing the medicines management processes in NHS hospitals; better medicines management evaluation systems are needed

French linguistics research and teaching in UK and Irish HE institutions

Introduction: The research and teaching of French linguistics in UK higher education (HE) institutions have a venerable history; a number of universities have traditionally offered philology or history of the language courses, which complement literary study. A deeper understanding of the way that the phonology, syntax and semantics of the French language have evolved gives students linguistic insights that dovetail with their study of the Roman de Renart, Rabelais, Racine or the nouveau roman. There was, in the past, some coverage of contemporary French phonetics but little on sociolinguistic issues. More recently, new areas of research and teaching have been developed, with a particular focus on contemporary spoken French and on sociolinguistics. Well supported by funding councils, UK researchers are also making an important contribution in other areas: phonetics and phonology, syntax, pragmatics and second-language acquisition. A fair proportion of French linguistics research occurs outside French sections in psychology or applied linguistics departments. In addition, the UK plays a particular role in bringing together European and North American intellectual traditions and methodologies and in promoting the internationalisation of French linguistics research through the strength of its subject associations, and that of the Journal of French Language Studies. The following sections treat each of these areas in turn. History of the French Language There is a long and distinguished tradition in Britain of teaching and research on the history of the French language, particularly, but by no means exclusively, at the universities of Cambridge, Manchester and Oxford.

Mapping teaching, learning and assessment in the MPharm in UK schools of pharmacy

Aim To undertake a national study of teaching, learning and assessment in UK schools of pharmacy. Design Triangulation of course documentation, 24 semi-structured interviews undertaken with 29 representatives from the schools and a survey of all final year students (n=1,847) in the 15 schools within the UK during 2003–04. Subjects and setting All established UK pharmacy schools and final year MPharm students. Outcome measures Data were combined and analysed under the topics of curriculum, teaching and learning, assessment, multi-professional teaching and learning, placement education and research projects. Results Professional accreditation was the main driver for curriculum design but links to preregistration training were poor. Curricula were consistent but offered little student choice. On average half the curriculum was science-based. Staff supported the science content but students less so. Courses were didactic but schools were experimenting with new methods of learning. Examinations were the principal form of assessment but the contribution of practice to the final degree ranged considerably (21–63%). Most students considered the assessment load to be about right but with too much emphasis upon knowledge. Assessment of professional competence was focused upon dispensing and pharmacy law. All schools undertook placement teaching in hospitals but there was little in community/primary care. There was little inter-professional education. Resources and logistics were the major limiters. Conclusions There is a need for an integrated review of the accreditation process for the MPharm and preregistration training and redefinition of professional competence at an undergraduate level.

Maintenance of communication in primary classrooms : some evidence for the role of elicitation and code-switching in English medium schools in Kenya, with implications for teaching

This is a study of specific aspects of classroom interaction primary school level in Kenya. The study entailed the identification of the sources of particular communication problems during the change-over period from Kiswahili to English medium teaching in two primary schools. There was subsequently an examination of the language resources which were employed by teachers to maintain pupil participation in communication in the light of the occurrence of possibility of occurrence of specific communication problems. The language resources which were found to be significant in this regard concerned firstly the use of different elicitation types by teachers to stimulate pupils into giving responses and secondly teachers' recourse to code-switching from English to Kiswahili and vice-versa. It was also found in this study that although the use of English as the medium of instruction in the classrooms which were observed resulted in certain communication problems, some of these problems need not have arisen if teachers had been more careful in their use of language. The consideration of this finding, after taking into account the role of different elicitation types and code-switching as interpretable from data samples had certain implications which are specified in the study for teaching in Kenyan primary schools. The corpus for the study consisted of audio-recordings of English, Science and Number-Work lessons which were later transcribed. Relevant data samples were subsequently extracted from transcripts for analysis. Many of the samples have examples of cases of communication breakdowns, but they also illustrate how teachers maintained interaction with pupils who had yet to acquire an operational mastery of English. This study thus differs from most studies on classroom interaction because of its basic concern with the examination of the resources available to teachers for overcoming the problem areas of classroom communication.

Medicines reconciliation in comparison with NICE guidelines across secondary care mental health organisations

Background Medicines reconciliation-identifying and maintaining an accurate list of a patient's current medications-should be undertaken at all transitions of care and available to all patients. Objective A self-completion web survey was conducted for chief pharmacists (or equivalent) to evaluate medicines reconciliation levels in secondary care mental health organisations. Setting The survey was sent to secondary care mental health organisations in England, Scotland, Northern Ireland and Wales. Method The survey was launched via Bristol Online Surveys. Quantitative data was analysed using descriptive statistics and qualitative data was collected through respondents free-text answers to specific questions. Main outcomes measure Investigate how medicines reconciliation is delivered, incorporate a clear description of the role of pharmacy staff and identify areas of concern. Results Forty-two (52 % response rate) surveys were completed. Thirty-seven (88.1 %) organisations have a formal policy for medicines reconciliation with defined steps. Results show that the pharmacy team (pharmacists and pharmacy technicians) are the main professionals involved in medicines reconciliation with a high rate of doctors also involved. Training procedures frequently include an induction by pharmacy for doctors whilst the pharmacy team are generally trained by another member of pharmacy. Mental health organisations estimate that nearly 80 % of medicines reconciliation is carried out within 24 h of admission. A full medicines reconciliation is not carried out on patient transfer between mental health wards; instead quicker and less exhaustive variations are implemented. 71.4 % of organisations estimate that pharmacy staff conduct daily medicine reconciliations for acute admission wards (Monday to Friday). However, only 38 % of organisations self-report to pharmacy reconciling patients' medication for other teams that admit from primary care. Conclusion Most mental health organisations appear to be complying with NICE guidance on medicines reconciliation for their acute admission wards. However, medicines reconciliation is conducted less frequently on other units that admit from primary care and rarely completed on transfer when it significantly differs to that on admission. Formal training and competency assessments on medicines reconciliation should be considered as current training varies and adherence to best practice is questionable.

The politics of knowledge in central Asia:science between Marx and the market

Through careful historical and ethnographic research and extensive use of local scholarly works, this book provides a persuasive and careful analysis of the production of knowledge in Central Asia. The author demonstrates that classical theories of science and society are inadequate for understanding the science project in Central Asia. Instead, a critical understanding of local science is more appropriate. In the region, the professional and political ethos of Marxism-Leninism was incorporated into the logic of science on the periphery of the Soviet empire. This book reveals that science, organizes and constructed by Soviet rule, was also defined by individual efforts of local scientists. Their work to establish themselves 'between Marx and the market' is therefore creating new political economies of knowledge at the edge of the scientific world system.

Engaging tutors in using e-repositories for learning and teaching

Universities which set up online repositories for the management of learning and teaching resources commonly find that uptake is poor. Tutors are often reluctant to upload their materials to e-repositories, even though the same tutors are happy to upload resources to the virtual learning environment (e.g. Blackboard, Moodle, Sakai) and happy to upload their research papers to the university’s research publications repository. The paper reviews this phenomenon and suggests constructive ways in which tutors can be encouraged to engage with an e-repository. The authors have recently completed a major project “Developing Repositories at Worcester” which is part of a group of similar projects in the UK. The paper includes the feedback and the lessons learned from these projects, based on the publications and reports they have produced. They cover ways of embedding repository use into institutional working practice, and give examples of different types of repository designed to meet the needs of those using different kinds of learning and teaching resources. As well as this specific experience, the authors summarise some of the main findings from UK publications, in particular the December 2008 report of Joint Information Systems Committee: Good intentions: improving the evidence base in support of sharing learning materials and Online Innovation in Higher Education, Ron Cooke’s report to a UK government initiative on the future of Higher Education. The issues covered include the development of Web 2.0 style repositories rather than conventionally structured ones, the use of tags rather than metadata, the open resources initiative, the best use for conventional repositories, links to virtual learning environments, and the processes for the management and support of repositories within universities. In summary the paper presents an optimistic, constructive view of how to embed the use of e-repositories into the working practices of university tutors. Equally, the authors are aware of the considerable difficulties in making progress and are realistic about what can be achieved. The paper uses evidence and experience drawn from those working in this field to suggest a strategic vision in which the management of e-learning resources is productive, efficient and meets the needs of both tutors and their students.

An investigation into the nature and consequences of teachers' implicit philosophies of science

The aims of this study were to investigate the beliefs concerning the philosophy of science held by practising science teachers and to relate those beliefs to their pupils' understanding of the philosophy of science. Three philosophies of science, differing in the way they relate experimental work to other parts of the scientific enterprise, are described. By the use of questionnaire techniques, teachers of four extreme types were identified. These are: the H type or hypothetico-deductivist teacher, who sees experiments as potential falsifiers of hypotheses or of logical deductions from them; the I type or inductivist teacher, who regards experiments mainly as a way of increasing the range of observations available for recording before patterns are noted and inductive generalisation is carried out; the V type or verificationist teacher, who expects experiments to provide proof and to demonstrate the truth or accuracy of scientific statements; and the 0 type, who has no discernible philosophical beliefs about the nature of science or its methodology. Following interviews of selected teachers to check their responses to the questionnaire and to determine their normal teaching methods, an experiment was organised in which parallel groups were given H, I and V type teaching in the normal school situation during most of one academic year. Using pre-test and post-test scores on a specially developed test of pupil understanding of the philosophy of science, it was shown that pupils were positively affected by their teacher's implied philosophy of science. There was also some indication that V type teaching improved marks obtained in school science examinations, but appeared to discourage the more able from continuing the study of science. Effects were also noted on vocabulary used by pupils to describe scientists and their activities.

Reflection and reflexivity in reviewing and evaluating CDIO:an empirical approach to evaluation

Facilitated by an Engineer and a Social Scientist, both of whom have expertise in Engineering Education Research and Evaluation (EERE), this interactive workshop is divided into three main sections, each one focusing on a different area of evaluation. It will build on research conducted at Aston University School of Engineering and Applied Science to explore and critique the value of introducing CDIO across the first year undergraduate curriculum. Participants will be invited to consider the pedagogical and engineering related challenges of evaluating the academic and practical value of CDIO as a strategy for learning and teaching in the discipline. An empirical approach to evaluation developed by the researchers to provide empirically grounded evidence of the pedagogical and vocational value of CDIO will form the theoretical and conceptual basis of the workshop. This approach is distinctive in that it encapsulates both engineering and social science methods of evaluation. It is also contemporaneous in nature, with the researchers acting as a ‘fly on the wall’ capturing data as the programme unfolds. Through facilitated discussion and participation, the workshop will provide colleagues with the opportunity to develop a cross-disciplinary, empirically grounded research proposal specifically for the purposes of critically evaluating CDIO. It is anticipated that during the workshop, colleagues will work together in small groups. Suitable pedagogical approaches and tools will be suggested and a purposefully developed Engineering Education Research Guide, written by the workshop facilitators, will be given to all participants to inform and support the Workshop approach.

Perceptions of learning and teaching quality in Higher Education:developing a culture of co-creation of value

Perceptions about the quality of learning and teaching in Higher Education has for many years focused upon the application of market based principles. This includes the notion of students as “customers” of the Higher Education Institutions (HEI) service. We argue that the application of the customer analogy is unhelpful however, as students this approach is likely to affect student expectations about the service and their judgements about its quality. The purpose of this paper is to propose a study consisting of a series of interventions to develop a culture of value co-creation at a UK based HEI. By introducing CCV principles, it is hoped to steer students away from seeing themselves as “customers”, and passive recipients of in the learning and teaching process, to one where they take responsibility for their own learning experience, to be explored and acted upon in partnership with their lecturers and other stakeholders.