Effect of a pharmacist-led multicomponent intervention focussing on the medication monitoring phase to prevent potential adverse drug events in nursing homes

OBJECTIVES: To determine the extent to which the use of a clinical informatics tool that implements prospective monitoring plans reduces the incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality.

DESIGN: Randomized cluster trial.

SETTING: Twenty-five nursing homes serviced by two long-term care pharmacies.

PARTICIPANTS: Residents living in nursing homes during 2003 (1,711 in 12 intervention; 1,491 in 13 usual care) and 2004 (1,769 in 12 intervention; 1,552 in 13 usual care).

INTERVENTION: The pharmacy automatically generated Geriatric Risk Assessment MedGuide (GRAM) reports and automated monitoring plans for falls and delirium within 24 hours of admission or as part of the normal time frame of federally mandated drug regimen review.

MEASUREMENTS: Incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality.

RESULTS: GRAM triggered monitoring plans for 491 residents. Newly admitted residents in the intervention homes experienced a lower rate of potential delirium onset than those in usual care homes (adjusted hazard ratio (HR)=0.42, 95% confidence interval (CI)=0.35–0.52), overall hospitalization (adjusted HR=0.89, 95% CI=0.72–1.09), and mortality (adjusted HR=0.88, 95% CI=0.66–1.16). In longer stay residents, the effects of the intervention were attenuated, and all estimates included unity.

CONCLUSION: Using health information technology in long-term care pharmacies to identify residents who might benefit from the implementation of prospective medication monitoring care plans when complex medication regimens carry potential risks for falls and delirium may reduce adverse effects associated with appropriate medication use.

Policing the Globe: State Sovereignty and the International in the Post-9/11 Crime Novel

Two recent studies of 9/11 literature are dismissive of the contributions that crime and espionage novels have made to ongoing efforts to map the significance of 9/11 and its aftermath. My essay contests the assumption that only literary fiction – which pays sufficient attention to trauma – can “bear witness” to the events of 9/11 and argues that such fiction is, in fact, singularly ill-equipped to illuminate the complex geo-political circumstances that 9/11 entrenched and transformed. By contrast, genre novels by John Le Carré and Don Winslow have responded in imaginative and critical ways to post-9/11 and avowedly trans-national securitization initiatives and hence to efforts to trouble traditional accounts of state sovereignty.

An exploration of the importanceof emotional intelligence in midwifery

Background, Recognition of the importance of Emotional intelligence dates back as far as Aristotle (350BC). More recently the notion of emotional intelligence features in social psychology literature; it has also been embraced within personnel management and is now beginning to appear in nursing, medical and midwifery journals. Emotional intelligence involves possessing the capacity for motivation, creativity, the ability to operate at peak performance and the ability to persist in the face of setbacks and failures. Emotional intelligence refers to the ability to recognise our own feelings and those of others and it enables us to manage emotions effectively in ourselves and in our relationships. Midwives are constantly responding to change and challenges within maternity services. This paper examines how emotional intelligence can assist midwives in dealing with pressures which involve delivering the Government reforms, providing choice to women and facing current issues within the midwifery workforce. Midwives need emotional intelligence in order to express their feelings and recognize the feelings of others. Enhancing our relationships with colleagues and clients will ultimately impact on the quality of care delivered to women. Overall the aims of the paper are to create an awareness of the importance of emotional intelligence in practice and define emotional intelligence.

Gender differences in the role of emotional intelligence during the primary-secondary school transition

The relationship between components of emotional intelligence (EI) (interpersonal
ability, intrapersonal ability, adaptability and stress management) and academic
performance in English, maths and science was examined in a sample of 86 children
(49 males and 37 females) aged 11–12 years during the primary–secondary school
transition period. Results indicated that for both males and females, intrapersonal
ability had little relationship with academic achievement, while adaptability had the
strongest relationship with achievement in all subjects. Gender differences were particularly
pronounced for science, for which stronger relationships were observed with all
EI components for males. In addition, apparent only for males was a negative
relationship between stress management and science. These findings offer support for
the current inclusion of a personal and emotional element in the primary school curriculum,
and indicate that such training is likely to help males more than females to make
a successful transition from primary to secondary school.

Emotional intelligence, personality and decoding non-verbal expressions of emotion

Previous research has highlighted theoretical and empirical links between measures of both personality and trait emotional intelligence (EI), and the ability to decode facial expressions of emotion. Research has also found that the posed, static characteristics of the photographic stimuli used to explore these links affects the decoding process and differentiates them from the natural expressions they represent. This undermines the ecological validity of established trait-emotion decoding relationships. This study addresses these methodological shortcomings by testing relationships between the reliability of participant ratings of dynamic, spontaneously elicited expressions of emotion with personality and trait EI. Fifty participants completed personality and self-report EI questionnaires, and used a computer-logging program to continuously rate change in emotional intensity expressed in video clips. Each clip was rated twice to obtain an intra-rater reliability score. The results provide limited support for links between both trait EI and personality variables and how reliably we decode natural expressions of emotion. Limitations and future directions are discussed.

Globalization, Police Reform and Development; Doing it the Western Way?

Under what conditions does successful police reform take place? Can democratic forms of policing exist within undemocratic state structures? What are the motives of donor and recipient nations, and can the norms of global civil society be cultivated in order to promote human rights, democratic governance, and fair and accountable policing? These questions are addressed in this volume, which presents a unique examination of Western-led police reform efforts by theoretically linking neoliberal globalization, police reform and development. The authors present seven country case studies based on this theoretical approach (Afghanistan, Brazil, Iraq, Northern Ireland, South Africa, Trinidad and Tobago, and Turkey) and assess the prospects for successful police reform in a global context.