A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis

Background: Medication errors are common in primary care and are associated with considerable risk of patient harm. We tested whether a pharmacist-led, information technology-based intervention was more effective than simple feedback in reducing the number of patients at risk of measures related to hazardous prescribing and inadequate blood-test monitoring of medicines 6 months after the intervention. Methods: In this pragmatic, cluster randomised trial general practices in the UK were stratified by research site and list size, and randomly assigned by a web-based randomisation service in block sizes of two or four to one of two groups. The practices were allocated to either computer-generated simple feedback for at-risk patients (control) or a pharmacist-led information technology intervention (PINCER), composed of feedback, educational outreach, and dedicated support. The allocation was masked to general practices, patients, pharmacists, researchers, and statisticians. Primary outcomes were the proportions of patients at 6 months after the intervention who had had any of three clinically important errors: non-selective non-steroidal anti-inflammatory drugs (NSAIDs) prescribed to those with a history of peptic ulcer without co-prescription of a proton-pump inhibitor; β blockers prescribed to those with a history of asthma; long-term prescription of angiotensin converting enzyme (ACE) inhibitor or loop diuretics to those 75 years or older without assessment of urea and electrolytes in the preceding 15 months. The cost per error avoided was estimated by incremental cost-eff ectiveness analysis. This study is registered with Controlled-Trials.com, number ISRCTN21785299. Findings: 72 general practices with a combined list size of 480 942 patients were randomised. At 6 months’ follow-up, patients in the PINCER group were significantly less likely to have been prescribed a non-selective NSAID if they had a history of peptic ulcer without gastroprotection (OR 0∙58, 95% CI 0∙38–0∙89); a β blocker if they had asthma (0∙73, 0∙58–0∙91); or an ACE inhibitor or loop diuretic without appropriate monitoring (0∙51, 0∙34–0∙78). PINCER has a 95% probability of being cost eff ective if the decision-maker’s ceiling willingness to pay reaches £75 per error avoided at 6 months. Interpretation: The PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records. Funding: Patient Safety Research Portfolio, Department of Health, England.

Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Objective: To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists’ assessment of the training, and the time implications of undertaking the training. Methods: Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists’ diaries were analysed thematically. Key findings: All six pharmacists received 22 hours of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists’ diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions: Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety.

Transforming the English NHS using information technology: the story so far

The use of information and communication technologies (ICT) for transforming the way publicservices are delivered, has been an area of investment and focus in many countries in recentyears. The UK government envisioned moving from e-Government to transformationalgovernment by 2008, and initiatives such as the National Programme for IT (NPfIT) wereunderway towards this end. NPfIT was the largest civil IT programme worldwide at an initialestimated cost of £12.4bn over a ten-year period. It was launched in 2002 by the UKgovernment as part of its policy to transform the English NHS and to implement standardised ITsolutions at a national level. However, this top down, government led approach came underincreasing scrutiny, and is now being reconfigured towards a more decentralised mode of operations. This paper looks into the implementation of NPfIT and analyses the reasons behindits failure, and what effect the new NHS reforms are likely to have on the health sector. Wedraw from past studies (Weill and Ross, 2005) to highlight the key areas of concern in ITgovernance, using the NPfIT as an illustration

Design and use of mobile technology in distance language education : Matching learning practices with technologies-in-practice

This thesis focuses on the adaptation of formal education to people’s technology- use patterns, theirtechnology-in-practice, where the ubiquitous use of mobile technologies is central. The research question is: How can language learning practices occuring in informal learning environments be effectively integrated with formal education through the use of mobile technology? The study investigates the technical, pedagogical, social and cultural challenges involved in a design science approach. The thesis consists of four studies. The first study systematises MALL (mobile-assisted language learning) research. The second investigates Swedish and Chinese students’ attitudes towards the use of mobile technology in education. The third examines students’ use of technology in an online language course, with a specific focus on their learning practices in informal learning contexts and their understanding of how this use guides their learning. Based on the findings, a specifically designed MALL application was built and used in two courses. Study four analyses the app use in terms of students’ perceived level of self-regulation and structuration. The studies show that technology itself plays a very important role in reshaping peoples’ attitudes and that new learning methods are coconstructed in a sociotechnical system. Technology’s influence on student practices is equally strong across borders. Students’ established technologies-in-practice guide the ways they approach learning. Hence, designing effective online distance education involves three interrelated elements: technology, information, and social arrangements. This thesis contributes to mobile learning research by offering empirically and theoretically grounded insights that shift the focus from technology design to design of information systems.

Carrying capacity in agriculture: Environmental significance and some related patents

Agriculture is one of the most important and possibly the oldest economic activity developed by humans. This activity was developed extensively and is becoming more and more dependent on development of technologies. The goal of this manuscript was examining some patents related to technologies developed for improving crop yields. Such patents are mainly related to more efficient formulations of agrochemicals and management techniques of plants, cattle and natural resources. A brief comment is carried out about bioprospection and related problems, relating, for example the case of Cupuaçu. The article is concluded mentioning that the development of policies and management strategies that increase agricultural yield and simultaneously preserve or conserve natural resources should also be prioritized, because certainly this is the only way we have to get the real sustainability and to improve life quality abroad the world.

Road maps towards an information society in Latin America and the Caribbean

Includes bibliography

Draft plan of action for the information society in Latin America and the Caribbean (eLAC2015)

This is the version of the draft Plan of Action eLAC2015 agreed upon at the regional preparatory conference for the third Ministerial Conference on the Information Society in Latin America and the Caribbean, held in Montevideo on 23 and 24 September 2010, incorporating editorial changes made by ECLAC.

Report of the Third Ministerial Conference on the Information Society in Latin America and the Caribbean: Lima, 21-23 November, 2010

Incluye bibliografía

Science and technology in Latin America: trends and aspirations

Information Document, No 1

Principal barriers to the adoption of ICTs in agriculture and in rural areas

Includes bibliography

Information technologies in trade facilitation and their use by msmes

This issue of the Bulletin is based on the material presented at the seminar Information Technology for Development of Small and Medium-sized Exporters in East Asia and Latin America, which was held on 23 and 24 November 2004 at the headquarters of ECLAC in Santiago, Chile. The seminar was part of the project entitled Comparative Study on East Asian and Latin American IT Industry, financed by the thematic fund for information and communication technologies (ICT) for development of the United Nations Development Programme (UNDP) and has been carried out in close collaboration with the Institute of Developing Economies (IDE), an organization that belongs to the Japanese External Trade Organization (JETRO). This article contains a discussion of the concepts, definitions and standards associated with electronic commerce, as well as the opportunities to be seized and the challenges to be met so that MSMEs can expand their electronic business.

Causes and consequences of low rates of specialisation in science and technology in CDCC member countries

The importance of science and technology (S&T) in Small Island Developing States (SIDS) is clearly articulated in Chapter XI, paragraphs 57, 58, 61 and 62 of the Mauritius Strategy for the Further Implementation of the Programme of Action for Sustainable Development of Small Island Developing States (MSI). At the regional level, the Heads of Government of the Caribbean Community (CARICOM) noted the challenge that CARICOM member States face in competing in this new international economic environment in which the impact of scientific and technological change has created a knowledge-based global economy. Given the importance of S&T to development of Caribbean SIDS, the Economic Commission for Latin America and the Caribbean (ECLAC) Subregional Headquarters for the Caribbean embarked on a study to determine the causes and consequences of low rates of specialisation in S&T with a view to making recommendations for development of strategies for addressing these challenges. Data on postgraduate (Master of Science, Master of Philosophy and Doctor of Philosophy) enrolment and graduation in agriculture, engineering and the sciences from the three campuses of the University of the West Indies (UWI) as well as from the University of Technology in Jamaica and the University of Trinidad and Tobago (UTT) were examined and analysed. Face-to-face interviews were also held with key personnel from these institutions and a questionnaire was also served to individuals in key institutions. Results of the study revealed that although the number of students enrolled in higher degree programmes has increased in absolute terms, they are decreasing in relative terms. However, enrolment in agriculture has indeed declined while enrolment rates in engineering, although increasing, were not significantly high. Market forces have proved to be a main reason for this trend while facilities for the conduct and supervision of cutting-edge research, the disconnect between science and industry and societal labelling of scientists as “misfits” are also contributing to the situation. This has resulted in a reduced desire by students at all levels of the school system and faculty to be involved in S&T; lack of innovation; a better staffed private, as compared with public, sector; and poor remuneration in science-based employment. There also appears to be a gender bias in enrolment with more males than females being enrolled in engineering while the opposite is apparent in agriculture and the sciences. Recommendations for remedying this situation range from increasing investment in S&T, creating linkages between science and industry as well as with the international community, raising awareness of the value of S&T at all levels of the education system to informing policy to stimulate the science – innovation interface so as to promote intellectual property rights.