A pilot study to evaluate the self-medication system for liver transplant patients at the Queen Elizabeth Hospital in Birmingham

Background and Objective: Medication non-compliance is a considerable obstacle in achievinga therapeutic goal, whichcan result in poorerhealthcare outcomes, increased expenditure, wastage and potential for medication resistance. The UK Government’s Audit Commission’s publication ‘A Spoonful of Sugar’1 addresses these issues and promotes self-medication systems as a possible solution. The self-medication system within the Liver Transplant Unit (LTU) was implemented to induct patients onto new post- transplantation medication regimes ready for discharge. The system involves initial consultations with both the Liver Transplant Pharmacist and Trans- plant Co-ordinator, supported with additional advice as and when necessary. Design: Following ethical approval, evaluation of the self-medication sys- tem for liver transplant patients was conducted between January and March 2004 via two methods: audit and structured post-transplantation interview. The audit enabled any discrepancies between current Hospital guidelines and Liver Transplant Unit (LTU) practices to be highlighted. Patient interviews generated a retrospective insight into patient acceptance of the self-medication system. Setting: LTU, Queen Elizabeth Hospital, Birmingham, England. Main Outcome Measures: LTU compliance with Hospital self-medication guidelines and patient insight into self-medication system. Results: A total of seven patients were audited. Findings illustrated that self- medication by transplant patients is a complex process which was not fully addressed by current Hospital self-medication guidelines. Twenty-three patients were interviewed, showing an overwhelming positive attitude to- wards participating in their own care and a high level of understanding towards their individual medication regimes. Following a drugs counselling session, 100% of patients understood why they were taking their medica- tion, and their doses, 95% understood how to take their medication and 85% were aware of potential side effects. Conclusions: From this pilot evaluation it can be stated that the LTU self-medication system is appreciated by patients and assists them in fully understanding their medication regimes. There appear to be no major defects in the system. However areas such as communication barriers and on-going internet education were illustrated as areas for possible future investigation. References: 1. Audit Commission. A spoonful of sugar – medicines management in NHS hospitals. London: Audit Commission; 2001.

Developing Collective Teaching Computer Software for the Course “Decision Theory”

Improvement of training students using modern information technologies, like collective developing teaching computer software, is discussed. Organizational, technical, technological advices are given. Experience of using information technologies in educational course “Decision Theory” is described.

Research of Influence of Medication Preparations on the Process of Renewal of the Broken Equilibrium of Man Organism on the Doctor of Phytotherapy Workstation

In the given work by authors new approach to the exposure of degree of influencing of medications of vegetable origin in a time of renewal of broken equilibrium of man organism is offered. During realization of the given approach it is suggested to use the mathematical vehicle of.

It's good to be different:diversity, heterogeneity, and dynamics in collective systems

We identify two different forms of diversity present in engineered collective systems, namely heterogeneity (genotypic/phenotypic diversity) and dynamics (temporal diversity). Three qualitatively different case studies are analysed, and it is shown that both forms of diversity can be beneficial in very different problem and application domains. Behavioural diversity is shown to be motivated by input diversity and this observation is used to present recommendations for designers of collective systems.

CP-036 evaluation of outpatient clinic letters for medication errors

Background - It is well recognised that errors are more likely to occur during transitions of care, especially medicines errors. Clinic letters are used as a communication tool during a transition from hospital (outpatient clinics) to primary care (general practitioners). Little is known about medicines errors in clinic letters, as previous studies in this area have focused on medicines errors in inpatient or outpatient prescriptions. Published studies concerning clinic letters largely focus on perceptions of patients or general practitioners in respect to overall quality. Purpose - To investigate medicines errors contained in outpatient clinic letters generated by prescribers within the Neurology Department of a specialist paediatric hospital in the UK.Materials and methods - Single site, retrospective, cross-sectional review of 100 clinic letters generated during March–July 2013 in response to an outpatient consultation. Clinic letters were conveniently selected from the most recent visit of each patient. An evaluation tool with a 10-point scale, where 10 was no error and 0 was significant error, was developed and refined throughout the study to facilitate identification and characterisation of medicines errors. The tool was tested for a relationship between scores and number of medicines errors using a regression analysis.Results - Of 315 items related to neurology mentioned within the letters, 212 items were associated with 602 errors. Common missing information was allergy (97%, n = 97), formulation (60.3%, n = 190), strength/concentration (59%, n = 186) and weight (53%, n = 53). Ninety-nine letters were associated with at least one error. Scores were in range of 4–10 with 42% of letters scored as 7. Statistically significant relationships were observed between scores and number of medicines errors (R2 = 0.4168, p < 0.05) as well as between number of medicines and number of drug-related errors (R2 = 0.9719, p < 0.05). Conclusions - Nearly all clinic letters were associated with medicines errors. The 10-point evaluation tool may be a useful device to categorise clinic letter errors.

Medication discrepancies at transitions in pediatrics:a review of the literature

Medication reconciliation is an important process in reducing medication errors in many countries. Canada, the USA, and UK have incorporated medication reconciliation as a priority area for national patient safety initiatives and goals. The UK national guidance excludes the pediatric population. The aim of this review was to explore the occurrence of medication discrepancies in the pediatric population. The primary objective was to identify studies reporting the rate and clinical significance of the discrepancies and the secondary objective was to ascertain whether any specific interventions have been used for medication reconciliation in pediatric settings. The following electronic bibliographic databases were used to identify studies: PubMed, OVID EMBASE (1980 to 2012 week 1), ISI Web of Science, ISI Biosis, Cumulative Index to Nursing and Allied Health Literature, and OVID International Pharmaceutical Abstracts (1970 to January 2012). Primary studies were identified that observed medication discrepancies in children under 18 years of age upon hospital admission, transfer and discharge, or had reported medication reconciliation interventions. Two independent reviewers screened titles and abstracts for relevant articles and extracted data using pre-defined data fields, including risk of bias assessment. Ten studies were identified with variances in reportage of stage and rate of discrepancies. Studies were heterogeneous in definitions, methods, and patient populations. Most studies related to admissions and reported consistently high rates of discrepancies ranging from 22 to 72.3 % of patients (sample size ranging from 23 to 272). Seven of the studies were low-quality observational studies and three studies were 'grey literature' non-peer reviewed conference abstracts. Studies involving small numbers of patients have shown that medication discrepancies occur at all transitions of care in children. Further research is required to investigate and demonstrate how implementing medication reconciliation can reduce discrepancies and potential patient harm. © 2013 Springer International Publishing Switzerland.

Union experience of social dialogue and collective participation in India

The labor regulatory framework in India provides a conducive environment for social dialogue and collective participation in the organizational decision-making process (Venkata Ratnam, 2009). Using data from a survey of workplace union representatives in the federal state of Maharashtra, India, this paper examines union experiences of social dialogue and collective participation in public services, private manufacturing, and private services sector. Findings indicate that collective worker participation and voice is at best modest in the public services but weak in the private manufacturing and private services. There is evidence of growing employer hostility to unions and employer refusal to engage in a meaningful social dialogue with unions. These findings are discussed within the political economy framework of employment relations in India examining the role of the state and judiciary in employment relations and, the links between political parties and trade unions in India.

Clinical significance of medication reconciliation in children admitted to a UK pediatric hospital:observational study of neurosurgical patients

Background: In December 2007, the National Institute for Health and Clinical Excellence and the National Patient Safety Agency in the UK (NICE-NPSA) published guidance that recommends all adults admitted to hospital receive medication reconciliation, usually by pharmacy staff. A costing and report tool was provided indicating a resource requirement of d12.9 million for England per year. Pediatric patients are excluded from this guidance. Objective: To determine the clinical significance of medication reconciliation in children on admission to hospital. Methods: A prospective observational study included pediatric patients admitted to a neurosurgical ward at Birmingham Childrens Hospital, Birmingham, England, between September 2006 and March 2007. Medication reconciliation was conducted by a pharmacist after the admission of each of 100 consecutive eligible patients aged 4 months to 16 years. The clinical significance of prescribing disparities between pre-admission medications and initial admission medication orders was determined by an expert multidisciplinary panel and quantified using an analog scale. The main outcome measure was the clinical signficance of unintentional variations between hospital admission medication orders and physician-prescribed pre-admission medication for repeat (continuing) medications. Results: Initial admission medication orders for children differed from prescribed pre-admission medication in 39%of cases. Half of all resulting prescribing variations in this setting had the potential to cause moderate or severe discomfort or clinical deterioration. These results mirror findings for adults. Conclusions: The introduction of medication reconciliation in children on admission to hospital has the potential to reduce discomfort or clinical deterioration by reducing unintentional changes to repeat prescribed medication. Consequently, there is no justification for the omission of children from the NICENPSA guidance concerning medication reconciliation in hospitals, and costing tools should include pediatric patients. © 2010 Adis Data Information BV. All rights reserved.

Az információterjedés szerepe az innováció-elfogadásban. Az okostelefonok és az on-line kollektív intelligencia (Role of informationspread in the innovation acceptance: the smart phones and the online collective intelligence)

A tanulmány célja az innováció-terjedés marketingvonzatú irodalmának bemutatása, valamint betekintés az exploratív tartalomelemzés módszerével az informális, kollektív intelligenciát generáló on-line felületek, nevesül a blogok és fórumok kutathatóságába. Az okostelefonok innováció-elfogadásának példáján keresztül a szerzők megpróbálják felderíteni az információterjedés elméletének megvalósulását az elemzett felületeken. Bemutatnak három, a mintára jellemző információterjedési és felvett szerep mintát, melyek alapul szolgálhatnak a további célirányú kutatások számára. / === / Adaptive smart phones that give space for user-added functions create active online discussions. Committed users are ready to share information, advise others, while less expert users seek this information. In their paper the authors show that related user-generated content i.e. blogs and bulletin boards provide a rich data source for analysis, which gives them the opportunity to further elaborate on the diffusion of information in the case of smart phone usage among online Hungarian users. Online collective intelligence may well contribute to the diffusion of innovations through diffusing information. Following a thorough review on the literature on the diffusion of innovations, in their exploratory content analysis, they found two categories of users on the analyzed boards: a first group we dubbed "experts" (corresponding to innovators in Bass's typology) that made a special effort trying to solve particular problems thus contributing to collective intelligence, thus reducing (among others) the perceived complexity of these phones and adding to their trialability, both factors influencing users' innovation acceptance, and a second group, "simple users" (or imitators in Bass's typology), uninterested in product innovation, still asking questions and searching for solutions concerning extant technology. Manufacturers do not seem yet to regard these boards as a source of valuable data, even though these clearly serve as an important pool of information and a growing factor of decision for their potential customers.

Inter-subjective and transnational racial effects: The role of the United States in the formation and evolution of the collective perception and racial relations in Cuba, 1898–1902

Since the arrival of the first African slaves to Cuba in 1524, the issue of race has had a long-lived presence in the Cuban national discourse. However, despite Cuba’s colonial history, it has often been maintained by some historians that race relations in Cuba were congenial with racism and racial discrimination never existing as deep or widespread in Cuba as in the United States (Cannon, 1983, p. 113). In fact, it has been argued that institutionalized racism was introduced into Cuban society with the first U.S. occupation, during 1898–1902 (Cannon, 1983, p. 113). This study of Cuba investigates the influence of the United States on the development of race relations and racial perceptions in post-independent Cuba, specifically from 1898-1902. These years comprise the time period immediately following the final fight for Cuban Independence, culminating with the Cuban-Spanish-American War and the first U.S. occupation of Cuba. By this time, the Cuban population comprised Africans as well as descendants of Africans, White Spanish people, indigenous Cubans, and offspring of the intermixing of the groups. This research studies whether the United States’ own race relations and racial perceptions influenced the initial conflicting race relations and racial perceptions in early and post-U.S. occupation Cuba. This study uses a collective interpretative framework that incorporates a national level of analysis with a race relations and racial perceptions focus. This framework reaches beyond the traditionally utilized perspectives when interpreting the impact of the United States during and following its intervention in Cuba. Attention is given to the role of the existing social, political climate within the United States as a driving influence of the United States’ involvement with Cuba. This study reveals that emphasis on the role of the United States as critical to the development of Cuba’s race relations and racial perceptions is credible given the extensive involvement of the U.S. in the building of the early Cuban Republic and U.S. structures serving as models for reconstruction. U.S. government formation in Cuba aligned with a governing system reflecting the existing governing codes of the U.S. during that time period.

The relationship between spirituality, knowledge and tuberculosis (TB) medication adherence among African Americans and Haitians

Tuberculosis (TB) is an infectious disease and nonadherence to medication can lead to new cases, multi-drug resistant TB, or potential death. Additionally, healthcare professionals and individuals with TB’s knowledge of the disease and medication adherence are crucial for successful completion of medication therapy. Patient education is one of the most important aspects of care provided in healthcare settings (CDC, 1994). TB tends to disproportionately affect minority and economically disadvantaged patient populations. The purpose of this mixed method study was to explore the relationship between spirituality, knowledge, and TB medication adherence among African Americans and Haitians. The primary research question was: What is the relationship between spirituality, knowledge and TB medication adherence among African Americans and Haitians? Quantitative data were gathered from 33 questionnaires and analyzed by two ANOVAs and four chi square analyses. The null hypothesis was not rejected; there was not a statistically significant relationship between spirituality and TB medication adherence (p =.208) among the study’s African Americans and Haitians. Qualitative data concerning participants’ knowledge of TB, gathered from 16 individual interviews further informed this analysis. Secondary research questions examined the role of spirituality, knowledge of TB and medication adherence among African Americans and Haitians. Four common themes emerged across both groups to answer the secondary research questions. Interviews revealed the themes: (a) God is in control, (b) stigmatization of TB, (c) lack of knowledge, and (d) fear of death. The theme lack of knowledge about TB was found to contribute to stigmatization of TB patients. However, in this study stigma and lack of knowledge were related to initial denial of symptoms and delayed diagnosis, but not found to be related to TB medication adherence. This study could help adult educators and health educators enhance their educational interventions, develop a better understanding of adult learning, resulting in early diagnosis and treatment ultimately decreasing transmission of TB, drug resistance, and potential death. Educators should be aware that TB patients’ spirituality may be an important part of how they cope with having TB. A larger scale study, conducted at multiple locations should be conducted to extend the findings of this small scale exploratory study. Further studies should be done to better determine what patient, healthcare provider and health care system factors might mediate relationships that may exist between lack of knowledge of TB, stigma and TB medication adherence.

Collective bargaining and faculty unionization: An administrative perspective

The purpose of this qualitative case study was to gain insight into the perspectives of experienced higher education administrators regarding faculty unionization, the collective bargaining process, and the interpersonal relationships between higher education faculty members and administrators. ^ The primary method of data collection was semi-structured face to face interviews with nine administrators from two community colleges and two universities in the south Florida area. All of the study participants worked with unionized faculty members and had direct experience participating in bargaining negotiations. ^ Upon the completion of each interview, the researcher listened to the taped audio recording of the interview several times and then transcribed all of the information from the audiotape into a Word file. Data collection and analysis for each participant were performed concurrently. Using a modified concept mapping approach, the research questions were written on large yellow sticky notes and placed in the middle of a wall in the researcher’s home with nine descriptive categorical themes written on smaller sticky notes placed around the study questions. The highlighted quotes and key phrases were cut from each transcript and placed under each of the descriptive categories. Over the course of a few months repeatedly reviewing the research questions that guided this study, the theory of symbolic interactionism, and relevant literature the categorical descriptive themes were refined and condensed into five descriptive themes. ^ Study findings indicated that the administrators: (a) must have a clear understanding of what it is that the faculty does to be an effective representative at the bargaining table, (b) experienced role ambiguity and role strain related to a lack of understanding as to their role at the bargaining table and a lack of organizational support, (c) were not offered any type of training in preparation for bargaining, (d) perceived a definite “us versus them” mentality between faculty and administration, and (e) saw faculty collective bargaining at public institutions of higher education in Florida as ineffectual. ^