The prevalence and nature of prescribing and monitoring errors in English general practice – a retrospective case note review

Objective To determine the prevalence and nature of prescribing and monitoring errors in general practices in England. Design Retrospective case note review of unique medication items prescribed over a 12 month period to a 2% random sample of patients. Mixed effects logistic regression was used to analyse the data. Setting Fifteen general practices across three primary care trusts in England. Data sources Examination of 6048 unique prescription items prescribed over the previous 12 months for 1777 patients. Main outcome measures Prevalence of prescribing and monitoring errors, and severity of errors, using validated definitions. Results Prescribing and/or monitoring errors were detected in 4.9% (296/6048) of all prescription items (95% confidence interval 4.4 - 5.5%). The vast majority of errors were of mild to moderate severity, with 0.2% (11/6048) of items having a severe error. After adjusting for covariates, patient-related factors associated with an increased risk of prescribing and/or monitoring errors were: age less than 15 (Odds Ratio (OR) 1.87, 1.19 to 2.94, p=0.006) or greater than 64 years (OR 1.68, 1.04 to 2.73, p=0.035), and higher numbers of unique medication items prescribed (OR 1.16, 1.12 to 1.19, p<0.001). Conclusion Prescribing and monitoring errors are common in English general practice, although severe errors are unusual. Many factors increase the risk of error. Having identified the most common and important errors, and the factors associated with these, strategies to prevent future errors should be developed based on the study findings.

The impact of overseas training on curriculum innovation and change in English language education in Western China

This article assesses the impact of a UK-based professional development programme on curriculum innovation and change in English Language Education (ELE) in Western China. Based on interviews, focus group discussions and observation of a total of 48 English teachers who had participated in an overseas professional development programme influenced by modern approaches to education and ELE, and 9 of their colleagues who had not taken part, it assesses the uptake of new approaches on teachers’ return to China. Interviews with 10 senior managers provided supplementary data. Using Diffusion of Innovations Theory as the conceptual framework, we examine those aspects of the Chinese situation that are supportive of change and those that constrain innovation. We offer evidence of innovation in classroom practice on the part of returnees and ‘reinvention’ of the innovation to ensure a better fit with local needs. The key role of course participants as opinion leaders in the diffusion of new ideas is also explored. We conclude that the selective uptake of this innovation is under way and likely to be sustained against a background of continued curriculum reform in China.

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.

Effects of second language on cognition in English users of L2 Japanese

It is now established that certain cognitive processes such as categorisation are tightly linked to the concepts encoded in language. Recent studies have shown that bilinguals with languages that differ in their concepts may show a shift in their cognition towards the L2 pattern primarily as a function of their L2 proficiency. This research has so far focused predominantly on L2 users who started learning the L2 in childhood or early puberty. The current study asks whether similar effects can be found in adult L2 learners. English speakers of L2 Japanese were given an object classification task involving real physical objects, and an online classification task involving artificial novel objects. Results showed a shift towards the L2 pattern, indicating that some degree of cognitive plasticity exists even when a second language is acquired later in life. These results have implications for theories of L2 acquisition and bilingualism, and contribute towards our understanding of the nature of the relationship between language and cognition in the L2 user’s mind.

An investigation of working memory effects on oral grammatical accuracy and fluency in producing questions in English

This article addresses the question of how far working memory may affect second language (L2) learners' improvement in spoken language during a period of immersion. Research is presented testing the hypothesis that individual differences in working memory (WM) capacity are associated with individual variation in improvements in oral production of questions in English. Thirty-two Chinese adult speakers of English were tested, before and after a year's postgraduate study in the United Kingdom, to measure grammatical accuracy and fluency using a question elicitation task, and to measure WM using a battery of first language (L1) and L2 WM tests. Story recall in L1 (Mandarin) was significantly associated with individuals' improvement in oral grammatical measures (p < .05). However, there was no significant mean improvement across the cohort in grammatical accuracy, although there was for fluency. The findings suggest that WM may aid certain aspects of individuals' L2 oral proficiency during academic immersion through postgraduate study. They also indicate that academic immersion in itself can lead to improvements in oral proficiency, independent of WM capacity, but there is no general guarantee of significant grammatical change. Further research to clarify the opportunities for input and interaction available in academic immersion settings is called for.

A multidimensional comparison of discourse organization in English and Chinese university students' argumentative writing

Three methodological limitations in English-Chinese contrastive rhetoric research have been identified in previous research, namely: the failure to control for the quality of L1 data; an inference approach to interpreting the relationship between L1 and L2 writing; and a focus on national cultural factors in interpreting rhetorical differences. Addressing these limitations, the current study examined the presence or absence and placement of thesis statement and topic sentences in four sets of argumentative texts produced by three groups of university students. We found that Chinese students tended to favour a direct/deductive approach in their English and Chinese writing, while native English writers typically adopted an indirect/inductive approach. This study argues for a dynamic and ecological interpretation of rhetorical practices in different languages and cultures.

Framing fracking: which frames are heard in English planning and environmental policy and practice?

Fracking in England has been the subject of significant controversy and has sparked not only public protest but also an associated framing war with differing social constructions of the technology adopted by different sides. This article explores the frames and counter-frames which have been employed by both the anti-fracking movement and by government and the oil and gas industry. It then considers the way in which the English planning and regulatory permitting systems have provided space for these frames within the relevant machinery for public participation. The article thus enables one to see which frames have been allowed a voice and which have been excluded.

Processing of zero-derived words in English: an fMRI investigation

Derivational morphological processes allow us to create new words (e.g. punish (V) to noun (N) punishment) from base forms. The number of steps from the basic units to derived words often varies (e.g., nationalityin activity than simple ones ( Meinzer, Lahiri, Flaisch, Hannemann, & Eulitz, 2009). However, all studies to date have investigated derivational processes in which morphological complexity is related to a change in surface form. It is therefore unclear whether the effects reported are attributable to underlying morphological complexity or to the processing of multiple surface morphemes. Here we report the first study to investigate morphological processing where derivational steps are not overtly marked (e.g., bridge-N>bridge-V) i.e., zero-derivation ( Aronoff, 1980). We compared the processing of one-step (soakingingin an fMRI experiment. Participants were presented with derived forms of words (soaking, bridging) in a lexical decision task. Although the surface derived -ing forms can be contextually participles, gerunds, or even nouns, they are all derived from verbs since the suffix -ing can only be attached to verb roots. Crucially, the verb root is the basic form for the one-step words, whereas for the two-step words the verb root is zero derived from a basic noun. Significantly increased brain activity was observed for complex (one-step and two-step) versus simple (zero-step) forms in regions involved in morphological processing, such as the left inferior frontal gyrus (LIFG). Critically, activation was also more pronounced for two-step compared to one-step forms. Since both types of derived words have the same surface structure, our findings suggest that morphological processing is based on underlying morphological complexity, independent of overt affixation. This study is the first to provide evidence for the processing of zero derivation, and demonstrates that morphological processing cannot be reduced to surface form-based segmentation.

Production and on-line comprehension of definiteness in English and Dutch by monolingual and sequential bilingual children

The present article examines production and on-line processing of definite articles in Turkish-speaking sequential bilingual children acquiring English and Dutch as second languages (L2) in the UK and in the Netherlands, respectively. Thirty-nine 6–8-year-old L2 children and 48 monolingual (L1) age-matched children participated in two separate studies examining the production of definite articles in English and Dutch in conditions manipulating semantic context, that is, the anaphoric and the bridging contexts. Sensitivity to article omission was examined in the same groups of children using an on-line processing task involving article use in the same semantic contexts as in the production task. The results indicate that both L2 children and L1 controls are less accurate when definiteness is established by keeping track of the discourse referents (anaphoric) than when it is established via world knowledge (bridging). Moreover, despite variable production, all groups of children were sensitive to the omission of definite articles in the on-line comprehension task. This suggests that the errors of omission are not due to the lack of abstract syntactic representations, but could result from processes implicated in the spell-out of definite articles. The findings are in line with the idea that variable production in child L2 learners does not necessarily indicate lack of abstract representations (Haznedar and Schwartz, 1997).

Innovation and change in English teaching in the western provinces of China: the impact of overseas training

In this article we explore issues around the impact of continuing professional development (CPD) for secondary teachers of English offered by an overseas provider through the lens of participants from the Western provinces of China who completed courses at a UK university between 2003 and 2012. We start by offering an overview of English teaching in China. We then report two complementary studies of the same programme. The first aimed for breadth of understanding and involved the collection and analysis of interviews and focus groups discussions with former participants, their teaching colleagues and senior management, as well as classroom observation. The second aimed for depth and drew on data collected from a cohort of 38 teachers on one of the courses, using pre- and post-course surveys; focus group discussions at the end of the course with the whole cohort; and interviews with five of the participants both before they left the UK and again six months later. Evidence is presented for changes in teachers’ philosophies of education directly attributable to participation in the courses; for improved teacher competencies (linguistic, cultural and pedagogical) in the classroom; and for the ways in which returnees are undertaking new roles and responsibilities that exploit their new understandings. Finally, we discuss the implications of these findings for both providers and sponsors of CPD for English language teachers.