Investigating the prevalence and causes of prescribing errors in general practice: the PRACtICe Study

Aim: To determine the prevalence and nature of prescribing errors in general practice; to explore the causes, and to identify defences against error. Methods: 1) Systematic reviews; 2) Retrospective review of unique medication items prescribed over a 12 month period to a 2% sample of patients from 15 general practices in England; 3) Interviews with 34 prescribers regarding 70 potential errors; 15 root cause analyses, and six focus groups involving 46 primary health care team members Results: The study involved examination of 6,048 unique prescription items for 1,777 patients. Prescribing or monitoring errors were detected for one in eight patients, involving around one in 20 of all prescription items. The vast majority of the errors were of mild to moderate severity, with one in 550 items being associated with a severe error. The following factors were associated with increased risk of prescribing or monitoring errors: male gender, age less than 15 years or greater than 64 years, number of unique medication items prescribed, and being prescribed preparations in the following therapeutic areas: cardiovascular, infections, malignant disease and immunosuppression, musculoskeletal, eye, ENT and skin. Prescribing or monitoring errors were not associated with the grade of GP or whether prescriptions were issued as acute or repeat items. A wide range of underlying causes of error were identified relating to the prescriber, patient, the team, the working environment, the task, the computer system and the primary/secondary care interface. Many defences against error were also identified, including strategies employed by individual prescribers and primary care teams, and making best use of health information technology. Conclusion: Prescribing errors in general practices are common, although severe errors are unusual. Many factors increase the risk of error. Strategies for reducing the prevalence of error should focus on GP training, continuing professional development for GPs, clinical governance, effective use of clinical computer systems, and improving safety systems within general practices and at the interface with secondary care.

The causes of prescribing errors in English general practices: a qualitative study

Aim: To examine the causes of prescribing and monitoring errors in English general practices and provide recommendations for how they may be overcome. Design: Qualitative interview and focus group study with purposive sampling and thematic analysis informed by Reason’s accident causation model. Participants: General practice staff participated in a combination of semi-structured interviews (n=34) and six focus groups (n=46). Setting: Fifteen general practices across three primary care trusts in England. Results: We identified seven categories of high-level error-producing conditions: the prescriber, the patient, the team, the task, the working environment, the computer system, and the primary-secondary care interface. Each of these was further broken down to reveal various error-producing conditions. The prescriber’s therapeutic training, drug knowledge and experience, knowledge of the patient, perception of risk, and their physical and emotional health, were all identified as possible causes. The patient’s characteristics and the complexity of the individual clinical case were also found to have contributed to prescribing errors. The importance of feeling comfortable within the practice team was highlighted, as well as the safety of general practitioners (GPs) in signing prescriptions generated by nurses when they had not seen the patient for themselves. The working environment with its high workload, time pressures, and interruptions, and computer related issues associated with mis-selecting drugs from electronic pick-lists and overriding alerts, were all highlighted as possible causes of prescribing errors and often interconnected. Conclusion: This study has highlighted the complex underlying causes of prescribing and monitoring errors in general practices, several of which are amenable to intervention.

Massive Science with VO and Grids

There is a growing need for massive computational resources for the analysis of new astronomical datasets. To tackle this problem, we present here our first steps towards marrying two new and emerging technologies; the Virtual Observatory (e.g, AstroGrid) and the computa- tional grid (e.g. TeraGrid, COSMOS etc.). We discuss the construction of VOTechBroker, which is a modular software tool designed to abstract the tasks of submission and management of a large number of compu- tational jobs to a distributed computer system. The broker will also interact with the AstroGrid workflow and MySpace environments. We discuss our planned usages of the VOTechBroker in computing a huge number of n–point correlation functions from the SDSS data and mas- sive model-fitting of millions of CMBfast models to WMAP data. We also discuss other applications including the determination of the XMM Cluster Survey selection function and the construction of new WMAP maps.

Statistical computations with AstroGrid and the Grid

We outline our first steps towards marrying two new and emerging technologies; the Virtual Observatory (e.g, Astro- Grid) and the computational grid. We discuss the construction of VOTechBroker, which is a modular software tool designed to abstract the tasks of submission and management of a large number of computational jobs to a distributed computer system. The broker will also interact with the AstroGrid workflow and MySpace environments. We present our planned usage of the VOTechBroker in computing a huge number of n–point correlation functions from the SDSS, as well as fitting over a million CMBfast models to the WMAP data.

Agents and the Grid: Service Discovery

The Grid is a large-scale computer system that is capable of coordinating resources that are not subject to centralised control, whilst using standard, open, general-purpose protocols and interfaces, and delivering non-trivial qualities of service. In this chapter, we argue that Grid applications very strongly suggest the use of agent-based computing, and we review key uses of agent technologies in Grids: user agents, able to customize and personalise data; agent communication languages offering a generic and portable communication medium; and negotiation allowing multiple distributed entities to reach service level agreements. In the second part of the chapter, we focus on Grid service discovery, which we have identified as a prime candidate for use of agent technologies: we show that Grid-services need to be located via personalised, semantic-rich discovery processes, which must rely on the storage of arbitrary metadata about services that originates from both service providers and service users. We present UDDI-MT, an extension to the standard UDDI service directory approach that supports the storage of such metadata via a tunnelling technique that ties the metadata store to the original UDDI directory. The outcome is a flexible service registry which is compatible with existing standards and also provides metadata-enhanced service discovery.

Machine learning and small robot navigation

Developing successful navigation and mapping strategies is an essential part of autonomous robot research. However, hardware limitations often make for inaccurate systems. This project serves to investigate efficient alternatives to mapping an environment, by first creating a mobile robot, and then applying machine learning to the robot and controlling systems to increase the robustness of the robot system. My mapping system consists of a semi-autonomous robot drone in communication with a stationary Linux computer system. There are learning systems running on both the robot and the more powerful Linux system. The first stage of this project was devoted to designing and building an inexpensive robot. Utilizing my prior experience from independent studies in robotics, I designed a small mobile robot that was well suited for simple navigation and mapping research. When the major components of the robot base were designed, I began to implement my design. This involved physically constructing the base of the robot, as well as researching and acquiring components such as sensors. Implementing the more complex sensors became a time-consuming task, involving much research and assistance from a variety of sources. A concurrent stage of the project involved researching and experimenting with different types of machine learning systems. I finally settled on using neural networks as the machine learning system to incorporate into my project. Neural nets can be thought of as a structure of interconnected nodes, through which information filters. The type of neural net that I chose to use is a type that requires a known set of data that serves to train the net to produce the desired output. Neural nets are particularly well suited for use with robotic systems as they can handle cases that lie at the extreme edges of the training set, such as may be produced by "noisy" sensor data. Through experimenting with available neural net code, I became familiar with the code and its function, and modified it to be more generic and reusable for multiple applications of neural nets.

Informatização da operação e da gestão de uma unidade de saúde de alta complexidade do sistema único de saúde (SUS): estudo de caso do instituto de medicina integral Prof. Fernando Figueira (Imip) sob o enfoque do isomorfismo institucional

O trabalho buscou identificar e avaliar a escolha do Imip à luz da teoria neoinstitucional, mediante os mecanismos isomórficos que caracterizam o campo das organizações de saúde. Trata-se de um estudo de caso, tendo o Imip como objeto de análise, voltado especificamente para dois modelos de informatização da operação e da gestão, a fim de verificar qual o mais adequado para as especificidades da instituição, incluindo o aspecto financeiro, custo/benefício. O primeiro modelo se refere a um sistema próprio de informatização; o segundo a um modelo de sistema de gestão já existente, comercializado por empresa especializada nesta tecnologia. A metodologia abrangeu pesquisas bibliográficas, documentais e de campo. O referencial teórico foi a teoria neoinstitucional e o trabalho de campo constou de uma pesquisa incluindo observação simples, visando compor variáveis dos dois modelos avaliados, e coleta de dados realizada por meio da aplicação de dois questionários: um questionário aberto, com os dirigentes do Imip, e um questionário misto, com cem colaboradores, utilizadores do sistema, escolhidos aleatoriamente, por sorteio. Entre os achados se identificou claras referências ao isomorfismo, principalmente o mimético, nas percepções dos indivíduos respondentes. Ao final da pesquisa, foi possível concluir que a contratação de um sistema de gestão hospitalar, já existente no mercado, concebido e comercializado por empresa de tecnologia especializada no segmento da saúde, justificou-se como a melhor escolha para a organização, pois, as semelhanças existentes entre os processos do Instituto e aqueles contidos no sistema eram muito mais relevantes que suas particularidades. Outro fator relevante levou em consideração os elevados custos para uma única instituição desenvolver e manter sozinha um sistema atualizado segundo as exigências normativas e técnicas necessárias às organizações de saúde e os padrões de qualidade da informação estabelecidos pelo SUS.

Sistema auxiliar na análise de mamogramas digitais

This work proposes the development of a Computer System for Analysis of Mammograms SCAM, that aids the doctor specialist in the identification and analysis of existent lesions in digital mammograms. The computer system for digital mammograms processing will make use of a group of techniques of Digital Image Processing (DIP), with the purpose of aiding the medical professional to extract the information contained in the mammogram. This system possesses an interface of easy use for the user, allowing, starting from the supplied mammogram, a group of processing operations, such as, the enrich of the images through filtering techniques, the segmentation of areas of the mammogram, the calculation the area of the lesions, thresholding the lesion, and other important tools for the medical professional's diagnosis. The Wavelet Transform will used and integrated into the computer system, with the objective of allowing a multiresolution analysis, thus supplying a method for identifying and analyzing microcalcifications

Superando os riscos da segurança baseada em perímetro - Uma abordagem com identificação federada através de certificados digitais A3/ICP-Brasil e SAML

The traditional perimeter-based approach for computer network security (the castle and the moat model) hinders the progress of enterprise systems and promotes, both in administrators and users, the delusion that systems are protected. To deal with the new range of threats, a new data-safety oriented paradigm, called de-perimeterisation , began to be studied in the last decade. One of the requirements for the implementation of the de-perimeterised model of security is the definition of a safe and effective mechanism for federated identity. This work seeks to fill this gap by presenting the specification, modelling and implementation of a mechanism for federated identity, based on the combination of SAML and X.509 digital certificates stored in smart-cards, following the A3 standard of ICP-Brasil (Brazilian official certificate authority and PKI)

Uma arquitetura de referência para o desenvolvimento de sistemas interativos multiplataformas

It is increasingly common use of a single computer system using different devices - personal computers, telephones cellular and others - and software platforms - systems graphical user interfaces, Web and other systems. Depending on the technologies involved, different software architectures may be employed. For example, in Web systems, it utilizes architecture client-server - usually extended in three layers. In systems with graphical interfaces, it is common architecture with the style MVC. The use of architectures with different styles hinders the interoperability of systems with multiple platforms. Another aggravating is that often the user interface in each of the devices have structure, appearance and behaviour different on each device, which leads to a low usability. Finally, the user interfaces specific to each of the devices involved, with distinct features and technologies is a job that needs to be done individually and not allow scalability. This study sought to address some of these problems by presenting a reference architecture platform-independent and that allows the user interface can be built from an abstract specification described in the language in the specification of the user interface, the MML. This solution is designed to offer greater interoperability between different platforms, greater consistency between the user interfaces and greater flexibility and scalability for the incorporation of new devices

Desenvolvimento de um sistema computacional para geração automática de mapas de vulnerabilidade como ferramenta de auxílio às ações de prevenção ao derramamento de óleo em áreas costeiras

The northern portion of the Rio Grande do Norte State is characterized by intense coastal dynamics affecting areas with ecosystems of moderate to high environmental sensitivity. In this region are installed the main socioeconomic activities of RN State: salt industry, shrimp farm, fruit industry and oil industry. The oil industry suffers the effects of coastal dynamic action promoting problems such as erosion and exposure of wells and pipelines along the shore. Thus came the improvement of such modifications, in search of understanding of the changes which causes environmental impacts with the purpose of detecting and assessing areas with greater vulnerability to variations. Coastal areas under influence oil industry are highly vulnerable and sensitive in case of accidents involving oil spill in the vicinity. Therefore, it was established the geoenvironmental monitoring of the region with the aim of evaluating the entire coastal area evolution and check the sensitivity of the site on the presence of oil. The goal of this work was the implementation of a computer system that combines the needs of insertion and visualization of thematic maps for the generation of Environmental Vulnerability maps, using techniques of Business Intelligence (BI), from vector information previously stored in the database. The fundamental design interest was to implement a more scalable system that meets the diverse fields of study and make the appropriate system for generating online vulnerability maps, automating the methodology so as to facilitate data manipulation and fast results in cases of real time operational decision-making. In database development a geographic area was established the conceptual model of the selected data and Web system was done using the template database PostgreSQL, PostGis spatial extension, Glassfish Web server and the viewer maps Web environment, the GeoServer. To develop a geographic database it was necessary to generate the conceptual model of the selected data and the Web system development was done using the PostgreSQL database system, its spatial extension PostGIS, the web server Glassfish and GeoServer to display maps in Web

Electromyographic validation of the double pulley equipment during movements of the lower limbs

The double pulley equipment was tested on ten male volunteers during contraction of the semitendinosus and biceps femoris (caput longum) muscles in the following movements of the lower limbs: 1) hip extension with extended knee and erect trunk, 2) hip extension with flexed knee and erect trunk, 3) hip extension with flexed knee and erect trunk, 3) hip extension with extended knee and inclined trunk, 5) hip abduction along the midline, 7) hip abduction with extension beyond the midline, 8) adduction with hip flexion beyond the midline, 8) adduction with hip flexion beyond the midline, and 9) adduction with hip extension beyond the midline. The myoelectric signals were taken up by Lec Tec surface electrodes connected to a 6-channel Lynx electromyographic signal amplifier coupled with a computer equipped with a model CAD 10/26 analogue digital conversion board and with a specific software for signal recording and analysis. The semitendinosus and biceps femoris muscles presented the highest potentials in movements 1; 2; 7, 8 and 9, whereas the potentials in the remaining movements were negligible. The pattern of activity of the semitendinosus and the biceps femoris was similar in exercises 1, 2, 3, 4 and 8. The potentials of the semitendinosus prevailed in movements 5, 6 and 7, and the strongest potentials observed in movement 9 were those of the biceps femoris.

Sistema inteligente para la selección de brocas de perforación de pozos

The present work begins with a review of the literature on bit selection methods for oil well drilling. A proposal for the structure and organization of a drilling database and a knowledge base, is described. Previous studies formed the principal elements in the process of selection of drills for proposed drilling. The procedure was implemented as a computer system for the selection of tricone bits. A drilling bit database for three different Brazilian sedimentary basins was obtained for several wells drilled, and knowledge was collected from drilling engineers from different fields both electronically and also by means of interviews. It can be concluded that the selection process showed good results based on tests, which were carried out.