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.

A method to weight three categories of adaptive thermal comfort

The adaptive thermal comfort theory considers people as active rather than passive recipients in response to ambient physical thermal stimuli, in contrast with conventional, heat-balance-based, thermal comfort theory. Occupants actively interact with the environments they occupy by means of utilizing adaptations in terms of physiological, behavioural and psychological dimensions to achieve ‘real world’ thermal comfort. This paper introduces a method of quantifying the physiological, behavioural and psychological portions of the adaptation process by using the analytic hierarchy process (AHP) based on the case studies conducted in the UK and China. Apart from three categories of adaptations which are viewed as criteria, six possible alternatives are considered: physiological indices/health status, the indoor environment, the outdoor environment, personal physical factors, environmental control and thermal expectation. With the AHP technique, all the above-mentioned criteria, factors and corresponding elements are arranged in a hierarchy tree and quantified by using a series of pair-wise judgements. A sensitivity analysis is carried out to improve the quality of these results. The proposed quantitative weighting method provides researchers with opportunities to better understand the adaptive mechanisms and reveal the significance of each category for the achievement of adaptive thermal comfort.

Auditing technology uses within a global voluntary organisation

WAGGGS, the World Association of Girl Guides and Girl Scouts, is the umbrella organization for Member Organizations from 145 countries around the world. As such one of its remits is to provide programmes that promote leadership development and opportunities for girls and young women to advocate on issues they care about. One of the ways WAGGGS is exploring to do this more widely and efficiently is through the use of digital technologies. This paper presents the results of an audit undertaken of the technologies already used by potential participants in online communities and courses and investigates the challenges faced in using technology to facilitate learning, within this context.

The type and quantity of dietary fat and carbohydrate alter faecal microbiome and short-chain fatty acid excretion in a metabolic syndrome ‘at-risk’ population syndrome.

An obese-type human microbiota with an increased Firmicutes:Bacteroidetes ratio has been described that may link the gut microbiome with obesity and metabolic syndrome (MetS) development. Dietary fat and carbohydrate are modifiable risk factors that may impact on MetS by altering the human microbiome composition. We determined the effect of the amount and type of dietary fat and carbohydrate on faecal bacteria and short chain fatty acid (SCFA) concentrations in people ‘at risk’ of MetS.

Synthesis and phase behaviour of a homologous series of polymethacrylate-based side-chain liquid crystal polymers

The homologous series of side chain liquid crystal polymers, the poly[x-(4-methoxyazobenzene- 40-oxy)alkyl methacrylate]s, has been prepared in which the length of the flexible alkyl spacer has been varied from 3 to 11 methylene units. All the polymers exhibit liquid crystalline behaviour. The propyl and butyl members show exclusively nematic behaviour. The pentyl, hexyl, octyl and decyl members show a nematic and a smectic A phase while the heptyl, nonyl and undecyl homologues exhibit only a smectic A phase. The smectic A phase has been studied using X-ray diffraction and assigned as a smectic A1 phase in which the side chains are fully overlapped and the backbones are confined to lie between the smectic layers. For the nonyl member an incommensurate smectic phase is observed. The dependence of the transition temperatures on the length of the flexible spacer is understood in terms of the average shapes of the side chains.

The spatial impact of visual distractors on saccade latency

Remote transient changes in the environment, such as the onset of visual distractors, impact on the exe- cution of target directed saccadic eye movements. Studies that have examined the latency of the saccade response have shown conflicting results. When there was an element of target selection, saccade latency increased as the distance between distractor and target increased. In contrast, when target selection is minimized by restricting the target to appear on one axis position, latency has been found to be slowest when the distractor is shown at fixation and reduces as it moves away from this position, rather than from the target. Here we report four experiments examining saccade latency as target and distractor posi- tions are varied. We find support for both a dependence of saccade latency on distractor distance from target and from fixation: saccade latency was longer when distractor is shown close to fixation and even longer still when shown in an opposite location (180°) to the target. We suggest that this is due to inhib- itory interactions between the distractor, fixation and the target interfering with fixation disengagement and target selection.

What GPs need to know about palliative-care drugs: ketamine

This is the first in a short series of articles that focus on what GPs should consider when monitoring and prescribing specialist-initiated palliative-care drugs. This first article summarises the key issues for patients receiving ketamine.

The Aqua-Planet Experiment (APE): CONTROL SST Simulation

Climate simulations by 16 atmospheric general circulation models (AGCMs) are compared on an aqua-planet, a water-covered Earth with prescribed sea surface temperature varying only in latitude. The idealised configuration is designed to expose differences in the circulation simulated by different models. Basic features of the aqua-planet climate are characterised by comparison with Earth. The models display a wide range of behaviour. The balanced component of the tropospheric mean flow, and mid-latitude eddy covariances subject to budget constraints, vary relatively little among the models. In contrast, differences in damping in the dynamical core strongly influence transient eddy amplitudes. Historical uncertainty in modelled lower stratospheric temperatures persists in APE. Aspects of the circulation generated more directly by interactions between the resolved fluid dynamics and parameterized moist processes vary greatly. The tropical Hadley circulation forms either a single or double inter-tropical convergence zone (ITCZ) at the equator, with large variations in mean precipitation. The equatorial wave spectrum shows a wide range of precipitation intensity and propagation characteristics. Kelvin mode-like eastward propagation with remarkably constant phase speed dominates in most models. Westward propagation, less dispersive than the equatorial Rossby modes, dominates in a few models or occurs within an eastward propagating envelope in others. The mean structure of the ITCZ is related to precipitation variability, consistent with previous studies. The aqua-planet global energy balance is unknown but the models produce a surprisingly large range of top of atmosphere global net flux, dominated by differences in shortwave reflection by clouds. A number of newly developed models, not optimised for Earth climate, contribute to this. Possible reasons for differences in the optimised models are discussed. The aqua-planet configuration is intended as one component of an experimental hierarchy used to evaluate AGCMs. This comparison does suggest that the range of model behaviour could be better understood and reduced in conjunction with Earth climate simulations. Controlled experimentation is required to explore individual model behaviour and investigate convergence of the aqua-planet climate with increasing resolution.

Guiding e-learning: introducing online informal learning to a global voluntary organisation

The World Association of Girl Guides and Girl Scouts (WAGGGS) is the umbrella organisation for Member Organisations from 145 countries around the world, with a total membership of ten million. While Member Organisations offer training and development within their own countries, WAGGGS offers international opportunities. This project seeks to explore how technology can be used to offer similar opportunities to those provided by the face-to-face courses to a much wider audience, while retaining the community and interactive learning aspects of the existing programmes.