An investigation of medicines returned to general practitioners and community pharmacies

Focal points: All returned medicines were monitored in eight community pharmacies and five general medical practices over a four-week period Returns were analysed for the type, quantity, absolute cost of the medicines, original quantity and date dispensed together with the reason for return A total of 298 items was returned to pharmacists and the reason for the return was a change or stop of therapy in 56 per cent of cases; 66 per cent of these were prescribed in a quantity of one month or greater A total of 42 items was returned to GPs and the reason for the return involved a change or stop of the therapy in 54 per cent of cases; 69 per cent of these were prescribed in a quantity of one month or greater Measures to implement a procedure to limit prescribed quantities upon initiation of therapy should help to reduce medicines wastage

Families 'at risk' and the family nurse partnership:the intrusion of risk into social exclusion policy

This article considers why the family nurse partnership (FNP) has been promoted as a means of tackling social exclusion in the UK. The FNP consists in a programme of visits by nurses to low-income first-time mothers, both while the mothers are pregnant and for the first two years following birth. The FNP is focused on both teaching parenthood and encouraging mothers back into education and/or into employment. Although the FNP marks a considerable discontinuity with previous approaches to family health, it is congruent with an emerging new approach to social exclusion. This new approach maintains that the most important task of social policy is to identify quickly the most 'at-risk' households, individuals and children so that interventions can be targeted more effectively at those 'at risk', either to themselves or to others. The article illustrates this new approach by analysing a succession of reports by the Social Exclusion Unit. It indicates that there is a considerable amount of ambiguity about the relationship between specific risk-factors and being 'at risk of social exclusion'. Nonetheless, this new approach helps to explain why British policy-makers may have chosen to promote the new FNP now. © 2009 Cambridge University Press.

Greening operations management:an online sustainable procurement course for practitioners

In the Operations Management field, sustainable procurement has emerged as a way to green the purchasing and supply process. This paper explores issues in sustainable procurement training. The authors formed an interdisciplinary team to design, deliver and evaluate a training programme to promote and develop sustainable procurement in the United Kingdom health sector. Particular features of the project were its engagement with evolving and contested understandings of sustainable procurement and of the underlying concept of sustainable development and its recognition that relevant knowledge in the field is both incomplete and widely diffused through the procurement community. Eight practitioner groups worked together on themes to develop their understanding of sustainable procurement using the Blackboard virtual learning environment. Group interviews were conducted upon completion of the course and again three months later to explore qualitatively participants' experience of learning and implementing sustainable procurement. Although the course was delivered to practitioners, it might be modified for undergraduate and graduate students as it comprised the use of online activities in virtual learning environments, case studies and a broad range of literature. The course was also particularly significant in the context of contemporary policy moves in the United Kingdom and elsewhere to promote the role of higher education institutions in delivering workplace-based, high-skills education consistent with strategic policy considerations (see, for example, DIUS, 2008).

Doing action research in English language teaching:a guide for practitioners

This hands-on, practical guide for ESL/EFL teachers and teacher educators outlines, for those who are new to doing action research, what it is and how it works. Straightforward and reader friendly, it introduces the concepts and offers a step-by-step guide to going through an action research process, including illustrations drawn widely from international contexts. Specifically, the text addresses: •action research and how it differs from other forms of research •the steps involved in developing an action research project •ways of developing a research focus •methods of data collection •approaches to data analysis •making sense of action research for further classroom action. Each chapter includes a variety of pedagogical activities: •Pre-Reading questions ask readers to consider what they already know about the topic •Reflection Points invite readers to think about/discuss what they have read •action points ask readers to carry out action-research tasks based on what they have read •Classroom Voices illustrate aspects of action research from teachers internationally •Summary Points provide a synopsis of the main points in the chapter

Can incident reporting improve safety? Healthcare practitioners' views of the effectiveness of incident reporting

OBJECTIVE: Recent critiques of incident reporting suggest that its role in managing safety has been over emphasized. The objective of this study was to examine the perceived effectiveness of incident reporting in improving safety in mental health and acute hospital settings by asking staff about their perceptions and experiences. DESIGN: /st>Qualitative research design using documentary analysis and semi-structured interviews. SETTING: /st>Two large teaching hospitals in London; one providing acute and the other mental healthcare. PARTICIPANTS: /st>Sixty-two healthcare practitioners with experience of reporting and analysing incidents. RESULTS: /st>Incident reporting was perceived as having a positive effect on safety, not only by leading to changes in care processes but also by changing staff attitudes and knowledge. Staff discussed examples of both instrumental and conceptual uses of the knowledge generated by incident reports. There are difficulties in using incident reports to improve safety in healthcare at all stages of the incident reporting process. Differences in the risks encountered and the organizational systems developed in the two hospitals to review reported incidents could be linked to the differences we found in attitudes to incident reporting between the two hospitals. CONCLUSION: /st>Incident reporting can be a powerful tool for developing and maintaining an awareness of risks in healthcare practice. Using incident reports to improve care is challenging and the study highlighted the complexities involved and the difficulties faced by staff in learning from incident data.

Practitioners are from Mars; academics are from Venus? An investigation of the research-practice gap in management accounting

Purpose: The aim of this paper is to identify and gain insights into the significance of barriers contributing to the purported "gap" between academic management accounting research and practice. Design/methodology/approach: Drawing on diffusion of innovations theory, this study collects and analyses data from a questionnaire survey and follow-up interviews with 19 representatives of the four principal professional accounting bodies in Australia. Findings: Professional accounting bodies perceive the gap between academic research and practice in management accounting to be of limited concern to practitioners. The two most significant barriers to research utilisation by practitioners are identified as: difficulties in understanding academic research papers; and limited access to research findings. In acting as a conduit between the worlds of academia and practice, professional bodies have an important role to play by demonstrating the mutual value to both academics and practitioners resulting from a closer engagement between MA research and practice. Research limitations/implications: As one of the few empirically-based, theoretically informed investigations exploring the research-practice gap in management accounting, this study provides insights rather than "answers". Its findings therefore serve as a foundational basis for further empirical and theoretical enquiry. Originality/value: This study contributes to the conversation about the "research-practice gap" in management accounting by adopting a distinct theoretical vantage point to organize, analyse and interpret empirical evidence obtained from Australian professional accounting bodies about management accounting practice. © Emerald Group Publishing Limited.

Understanding data collection behaviour of mental health practitioners

Failure to detect patients at risk of attempting suicide can result in tragic consequences. Identifying risks earlier and more accurately helps prevent serious incidents occurring and is the objective of the GRiST clinical decision support system (CDSS). One of the problems it faces is high variability in the type and quantity of data submitted for patients, who are assessed in multiple contexts along the care pathway. Although GRiST identifies up to 138 patient cues to collect, only about half of them are relevant for any one patient and their roles may not be for risk evaluation but more for risk management. This paper explores the data collection behaviour of clinicians using GRiST to see whether it can elucidate which variables are important for risk evaluations and when. The GRiST CDSS is based on a cognitive model of human expertise manifested by a sophisticated hierarchical knowledge structure or tree. This structure is used by the GRiST interface to provide top-down controlled access to the patient data. Our research explores relationships between the answers given to these higher-level 'branch' questions to see whether they can help direct assessors to the most important data, depending on the patient profile and assessment context. The outcome is a model for dynamic data collection driven by the knowledge hierarchy. It has potential for improving other clinical decision support systems operating in domains with high dimensional data that are only partially collected and in a variety of combinations.

How do practitioners understand? Practitioner perceptions of an object-oriented programming.

In the computer science community, there is considerable debate about the appropriate sequence for introducing object-oriented concepts to novice programmers. Research into novice programming has struggled to identify the critical aspects that would provide a consistently successful approach to teaching introductory object-oriented programming. Starting from the premise that the conceptions of a task determine the type of output from the task, assisting novice programmers to become aware of what the required output should be, may lay a foundation for improving learning. This study adopted a phenomenographic approach. Thirty one practitioners were interviewed about the ways in which they experience object-oriented programming and categories of description and critical aspects were identified. These critical aspects were then used to examine the spaces of learning provided in twenty introductory textbooks. The study uncovered critical aspects that related to the way that practitioners expressed their understanding of an object-oriented program and the influences on their approach to designing programs. The study of the textbooks revealed a large variability in the cover of these critical aspects.

Formal professional relationships between general practitioners and specialists: possible associations with patient health and pharmacy costs

This article investigates whether the strength of formal professional relationships between general practitioners (GPs) and specialists (SPs) affects either the health status of patients or their pharmacy costs. To this end, it measures the strength of formal professional relationships between GPs and SPs through the number of shared patients and proxies the patient health status by the number of comorbidities diagnosed and treated. In strong GP–SP relationships, the patient health status is expected to be high, due to efficient care coordination, and the pharmacy costs low, due to effective use of resources. To test these hypotheses and compare the characteristics of the strongest GP–SP connections with those of the weakest, this article concentrates on diabetes—a chronic condition where patient care coordination is likely important. Diabetes generates the largest shared patient cohort in Hungary, with the highest traffic of specialist medication prescriptions. This article finds that stronger ties result in lower pharmacy costs, but not in higher patient health statuses. Key points for decision makers • The number of shared patients may be used to measure the strength of formal professional relationships between general practitioners and specialists. • A large number of shared patients indicates a strong, collaborative tie between general practitioners and specialists, whereas a low number indicates a weak, fragmented tie. • Tie strength does not affect patient health—strong, collaborative ties between general practitioners and specialists do not involve better patient health than weak, fragmented ties. • Tie strength does affect pharmacy costs—strong, collaborative ties between general practitioners and specialists involve significantly lower pharmacy costs than weak, fragmented ties. • Pharmacy costs may be reduced by lowering patient care fragmentation through channelling a general practitioner’s patients to a small number of specialists and increasing collaboration between general practitioner and specialists. • Limited patient choice is financially more beneficial than complete freedom of choice, and no more detrimental to patient health.

A gyógyszerkiadás és a betegek egészségi állapota a háziorvosi és szakorvosi kapcsolatok függvényében = Formal professional relations between general practitioners and specialists. Possible links with patient health and pharmacy cost

Arra a kérdésre keressük a választ, hogy a szoros háziorvosi-szakorvosi szakmai kapcsolatoknak van-e hatásuk a betegek gyógyszerkiadására, illetve egészségi állapotára. Az orvosok közötti szakmai kapcsolatok szorosságát a közösen gondozott betegek száma alapján határoztuk meg, míg a betegek egészségügyi állapotát a diagnosztizált és kezelt társbetegségek számával mértük. Hipotézisünk egyrészt az volt, hogy a hatékonyabb koordinációnak köszönhetően a szoros kapcsolatban kezelt betegek jobb egészségi állapotúak, másrészt kezelésük az erőforrások hatékonyabb felhasználása miatt kisebb gyógyszerköltséggel jár. E két hipotézist a cukorbetegekre teszteltük. Azért esett erre a krónikus betegségre a választásunk, mert itt a háziorvosok és a szakorvosok együttműködése elsődleges fontosságú. Magyarországon a cukorbetegek esetében a legnagyobb a közösen kezelt betegek populációja, valamint itt a legmagasabb a szakorvosi javaslatra felírt háziorvosi receptek száma. Azt az eredményt kaptuk, hogy a szoros kapcsolatban kezelt betegek nem rendelkeznek sem jobb, sem rosszabb egészségi állapottal, miközben a kapcsolódó gyógyszerkiadásuk szignifikánsan alacsonyabb. ____ The article considers whether strong formal professional relations between GPs and specialists in shared care affect either the health of patients or the pharmacy costs they incur. The strength of such relations is measured by the number of shared patients; patient health is proxied by number of co-morbidities diagnosed and treated. The first hypothesis is that patients treated amid strong GP-specialist relations have better health status than those treated amid weak ones, due to enhanced efficiency of care coordination. The second is that patients treated in such strong relations incur lower pharmacy costs high numbers of shared patients are assumed to promote appropriate, effective use of resources. The article tests these hypotheses and compares the outcomes of the strongest and weakest GP-specialist relations through the example of diabetes, a chronic condition where patient-care coordination is important. Diabetes generates the largest shared patient cohort in Hungary, with the highest number of specialist medication prescriptions. This article finds that stronger ties result in significantly lower pharmacy costs, but not a higher patient health status.

Effects of two intervention strategies on the behavior of nurses and nurse students related to advance directives

Advance directives are one mechanism for preserving the rights of individuals to exercise some control over their health care when serious illness may prevent them from direct participation. Nurses, as the health care providers with the closest and most sustained contact with critically ill and dying patients, are positioned to assist patients to plan for future health care needs. Although a majority of nurses favor the concept of advance directives for their patients and for themselves, they have not played a significant role in facilitating advance health care planning with their patients nor implemented advance health care planning for themselves.^ Research has also shown that differing forms of education and counseling increase the completion rates for advance directives in selected populations, mostly the elderly and seriously ill. Not yet developed are effective educational strategies to assist nurses and nurse students to make optimal contributions in assisting their clients' plans for future health care decision-making. This study sought to determine whether specific learning strategies (a) increased the involvement of nurses and nurse students in facilitating advance care planning with patients and (b) increased the percentage of the nurses' and nurse students' own personal advance care planning activities.^ The study compared two learning interventions and two populations, nurses and nurse students. The participants were randomly assigned to one of the two learning interventions, L1 or L2. Participants in L1 received a lecture, discussion and exploration of the forces impacting on advance directive behavior. Participants in L2 received the same intervention components with the additional component of group practice completing advance directives.^ Analysis of the data by chi-square and logistic regression did not support the hypotheses that the practice component would make a difference in the participants' facilitation of advance care planning with patients or in their own personal advance care planning activities. There were significant differences in post-intervention behavior between the nurse and nurse student groups. The nurses in the study did significantly more facilitation of advance care planning with patients and completed significantly more advance care documents than the nurse students post-intervention. However, the nurse students held more post-intervention family discussions than did the nurses. ^

The relationship between participation in unethical behaviors during the nursing student experience and participation in unethical behaviors as a registered nurse

The effect of unethical behaviors in health care settings is an important issue in the safe care of clients and has been a concern of the nursing profession for some time. The purpose of this study was to examine the relationship between use of unethical behaviors in the nursing student experience and the use of unethical behaviors in the workplace as a registered nurse. In addition, the relationship between the severity of unethical behaviors utilized in the classroom, clinical setting and those in the workplace was examined. To insure greater honesty in self-report, only a limited number of demographic variables were requested from participants.^ During the summer of 1997, a 56 item questionnaire was distributed to registered nurses enrolled in either undergraduate or graduate courses in a public or private institution. The participants were asked to self-report their own use of unethical behaviors as well as their peers use of unethical behaviors. In order to assign a severity score for each item, nursing school faculty were asked to rate severity of unethical behaviors which could be used during the nursing student experience and nursing administrators were asked to rate unethical behaviors which could be used in the workplace.^ A significant positive relationship was found between individuals' use of unethical behaviors during nursing school and those used in the workplace $r=.630.$ A significant positive relationship was found between the severity of unethical behaviors used in the nursing student experience and the severity of unethical behaviors used in the workplace $r=.637.$ No relationship was found between years of practice, type of initial nursing education and whether or not the participant was raised inside or outside the United States and the use of unethical behaviors. ^

Laypersons' awareness of the role and function of the nurse practitioner

The purpose of this descriptive study was to document the level of awareness that laypersons have regarding the role and function of the nurse practitioner (NP). An instrument developed for a similar study, conducted in 1994, comparing patients' and physicians' level of knowledge of the role and function of the NP, had a low reliability. Revision of the instrument was required before further use could be justified.^ A pilot study of 25 laypersons was conducted to ensure that the revised tool was reliable prior to conducting a study. Reliability for the pilot sample was 0.84.^ The study results indicated that the majority of the sample (83%), (n = 100) knew that a NP was a registered nurse who was qualified to diagnose and treat minor illnesses. The level of layperson awareness was limited regarding prescriptive privileges, well-woman exams, and the NPs' ability to perform physical exams, and interpret lab results and x-rays. ^

Sequence analysis of complementary DNAs encoding C3 in the nurse shark ({\it Ginglymostoma cirratum\/})

Mammalian C3 is a pivotal complement protein, encoded for by a single gene. In some vertebrate species multiple C3 isoforms are products of different C3 genes. The goal of this study was to determine whether multiple genes encode for shark C3. A protocol was developed for the isolation of mRNA from shark blood for the isolation of C3 cDNA clones. RT-PCR amplification of mRNA, using sense (GCGEQNM) and antisense (TWLTAYV) primers encoding conserved regions of human C3, yielded 21 clones. The C3-like clones isolated shared 97% similarity with each other and 40% similarity to human C3. RACE-PCR amplification of shark liver RNA, using gene specific primers, yielded products ranging from 1800bp to 3000bp. Deduced amino acid sequence, corresponding to 408bp of the 1800bp fragment, was obtained which showed 51% similarity to human C3. These results suggest that nurse shark C3 might be encoded for by more than one gene. ^