Medication Reconciliation at Discharge from Hospital: A Systematic Review of the Quantitative Literature

Medicines reconciliation is a way to identify and act on discrepancies in patients’ medical histories and it is found to play a key role in patient safety. This review focuses on discrepancies and medical errors that occurred at point of discharge from hospital. Studies were identified through the following electronic databases: PubMed, Sciences Direct, EMBASE, Google Scholar, Cochrane Reviews and CINAHL. Each of the six databases was screened from inception to end of January 2014. To determine eligibility of the studies; the title, abstract and full manuscript were screened to find 15 articles that meet the inclusion criteria. The median number of discrepancies across the articles was found to be 60%. In average patient had between 1.2–5.3 discrepancies when leaving the hospital. More studies also found a relation between the numbers of drugs a patient was on and the number of discrepancies. The variation in the number of discrepancies found in the 15 studies could be due to the fact that some studies excluded patient taking more than 5 drugs at admission. Medication reconciliation would be a way to avoid the high number of discrepancies that was found in this literature review and thereby increase patient safety.

Control of wild rubber extraction in the forests of northeast India, 1850-1880

This paper uses the history of rubber extraction to explore competing attempts to control the forest environments of Assam and beyond in the second half of the nineteenth century. Forest communities faced rival efforts at environmental control from both European and Indian traders, as well as from various centres of authority within the Raj. Government attempts to regulate rubber collection were undermined by the weak authority of the Raj in these regions, leading to widespread smuggling. Partly in response to the disruptive influence of rubber traders on the frontier, the Raj began to restrict the presence of outsiders in tribal regions, which came to be understood as distinct areas outside British control. When rubber yields from the forests nearest the Brahmaputra fell in the wake of intensive exploitation, India's scientific foresters demanded and from 1870 obtained the ability to regulate the Assamese forests, blaming indigenous rubber tapping strategies for the declining yields and arguing that Indian rubber could be ‘equal [to] if not better' than Amazonian rubber if only tappers would change their practices. The knowledge of the scientific foresters was fundamentally flawed, however, and their efforts to establish a new type of tapping practice failed. By 1880, the government had largely abandoned attempts to regulate wild Indian rubber, though wild sources continued to dominate the supply of global rubber until after 1910.

To fasten words again to visible – and invisible – things

In this extended introductory essay, Catherine Gander and Sarah Garland suggest new ways of looking at the correspondences between visual and verbal practices to consider their material and conceptual connections in a specifically American set of histories, contexts and interpretive traditions. Tracing a lineage of experiential philosophy that is grounded in the overturning of a Cartesian mind/body split, the authors argue for pluralistic perspectives on intermedial innovations that situate embodied and imaginative reader-viewer response as vital to the life of the artwork. Gander and Garland chart two main strands to this approach: the pragmatist strain of American aesthetics and social politics, rooted in the essays of transcendentalist Ralph Waldo Emerson and emanating from the writings of John Dewey and William James; and the conceptualist strain of French-American Marcel Duchamp, whose ground-breaking ideas both positioned the artwork as a phenomenological construction and liberated the artist from established methods of practice and discourse. The ‘imagetext’ (after W. J. T. Mitchell) is therefore, argue Gander and Garland, a site consisting of far more than word and image – but a living assemblage of language, idea, thing, cognition, affect and shared experience.

Rent: apartment blocks and their uses

In 1974, pursuing his interest in the infra-ordinary – ‘the banal, the quotidian, the obvious, the common, the ordinary, the back-ground noise, the habitual’ – Georges Perec wrote about an idea for a novel:
‘I imagine a Parisian apartment building whose façade has been removed … so that all the rooms in the front, from the ground floor up to the attics, are instantly and simultaneously visible’.
In Life A User’s Manual (1978) the consummation of this precis, patterns of existence are measured within architectural space with an archaeological sensibility that sifts through narrative and décor, structure and history, services and emotion, the personal and the system, ascribing commensurate value to each.
Apartment comes from the Italian appartare meaning ‘to separate’. The space of the boundary between activities is reduced to a series of intimately thin lines: the depth of a floor, a party wall, a window, the convex peep-hole in a door, or the façade that Perec seeks to render invisible. The apartness of the apartment is accelerated when aligned with short-term tenancies. Here Perec’s interweaving of personal histories over time using the structure of the block, gives way to convivialities of detachment: inhabitants are temporary, their personalities anonymous, their activities unknown or overlooked.
Borrowing methods from Perec, to move somewhere between conjecture, analysis and other documentation and tracing relationships between form, structure, materiality, technology, organisation, tenure and narrative use, this paper interrogates the late twentieth-century speculative apartment block in Britain and Ireland arguing that its speculative and commodified purpose allows a series of lives that are often less than ordinary to inhabit its spaces.
Henri Lefebvre described the emergence of an ‘abstract space’ under capitalism in terms which can be applied to the apartment building: the division of space into freely alienable privatised parcels which can be exchanged. Vertical distributions of class and other new, contiguous social and spatial relationships are couched within a paradox: the building which allows such proximities is also a conductor of division. Apartment comes from the Italian appartare meaning ‘to separate’. The space of the boundary between activities is reduced to a series of intimately thin lines: the depth of a floor, a party wall, a window, the convex peep-hole in a door, or the façade that Perec seeks to render invisible. The apartness of the apartment is accelerated when aligned with short-term tenancies. Here Perec’s interweaving of personal histories over time using the structure of the block, gives way to convivialities of detachment: inhabitants are temporary, their personalities anonymous, their activities unknown or overlooked.

Validity of model devices used to assess canine temperament in behavioral tests

Temperament tests are widely accepted as instruments for profiling behavioral variability in dogs, and they are applied in numerous areas of investigation (e.g. suitability for adoption or for breeding). During testing, to elicit a dog's reaction toward novel stimuli and predict its behavior in everyday life, model devices such as a child-like doll, or a fake dog, are often employed. However, the reliability of these devices to accurately stimulate dogs' reactions to children or dogs, is unknown and perhaps overestimated. This may be a particular concern in the case of aggressive behavior toward humans, a significant public health issue. The aim of this study was to: (1) evaluate the correlation between dogs' reactions to these devices, and owners' reports of their dog's aggression history (using the C-BARQ ??); (2) compare reactions toward the devices of dogs with and without histories of aggression. Subjects were selected among those visiting for behavioral consultation at the Veterinary Hospital of the University of Pennsylvania, and previously categorized as aggressive toward unfamiliar children, conspecifics, or as non-aggressive dogs (control). The test consisted of different components: an unfamiliar female tester approaching the dog; the presentation of a child-like doll, an ambiguous object, and a fake plastic dog. All tests were videotaped and durations of behaviors were later analyzed on the basis of a specified ethogram. Dogs' reactions were compared to C-BARQ scores, and interesting correlations emerged for 'dog-directed aggression/fear' (R = 0.48, P = 0.004), and 'stranger-directed aggression' (R = 0.58, P <0.001) factors. Dogs differed in their reactions toward the devices: the child-like doll and the fake dog elicited more social behaviors than the ambiguous object used as a control stimulus. Issues concerning the reliability of these tools to assess canine temperament are discussed. ?? 2012 Elsevier B.V. All rights reserved.

Enquiring about traumatic experiences in psychosis: A comparison of case notes and self-report questionnaires

Purpose: Studies have found an association between a history of trauma and the presence of psychotic symptoms. Despite the research evidence it appears to be the case that many clinicians are not routinely asking about traumatic experiences. This study aims to ascertain the level of agreement between rates of self-reported trauma and that which is recorded in case notes.

Methods: The study population was drawn from all individuals with a confirmed diagnosis of psychosis, residing within a defined catchment area. Rates of childhood trauma, lifetime trauma and trauma related to the Troubles in Northern Ireland recorded in participants’ case notes were compared to their responses on self-report questionnaires: THQ, CTQ and TREQ.

Results: Relatively high levels of trauma were reported by participants on the self-report measures that were administered. The rates of trauma recorded in case note records were similar to that found in other studies. Also in line with other research were poor levels of agreement between self-report and case note data.

Conclusion: High levels of lifetime, childhood and trauma related to the Troubles in Northern Ireland were found when the individuals in the sample were directly assessed for the purposes of this study. In contrast much lower rates were recorded in patient notes on routine clinical assessment. The results suggest that clinicians do not routinely enquire about trauma histories with this population and as a result, case notes underestimate trauma prevalence.

Validity of a personal and family history of cataract and cataract surgery in genetic studies.

PURPOSE:

To determine the accuracy of a history of cataract and cataract surgery (self-report and for a sibling), and to determine which demographic, cognitive, and medical factors are predictive of an accurate history.

METHODS:

All participants in the Salisbury Eye Evaluation (SEE) project and their locally resident siblings were questioned about a personal and family history of cataract or cataract surgery. Lens grading at the slit lamp, using standardized photographs and a grading system, was performed for both SEE participants (probands) and their siblings. Cognitive testing and a history of systemic comorbidities were also obtained for all probands.

RESULTS:

Sensitivity of a history of cataract provided on behalf of a sibling was 32%, specificity 98%. The performance was better for a history of cataract surgery: sensitivity 90%, specificity 89%. For self-report of cataract, sensitivity was also low at 55%, with specificity at 77%. Self-report of cataract surgery gave a much better performance: sensitivity 94%, specificity 100%. Different cutoffs in the definition of cataract had little impact. Factors predicting a correct history of cataract included high school or greater education in the proband (odds ratio [OR] = 1.13, 95% confidence interval [CI]1.02-1.25) and younger sibling (but not proband) age (OR = 0.94 for each year of age, 95% CI 0.90-0.99). Gender, race and Mini-Mental Status Examination (MMSE) result were not predictive.

CONCLUSIONS:

Whereas accurate self and family histories for cataract surgery may be obtainable, it is difficult to ascertain cataract status accurately from history alone.

Reliability of reports of childhood trauma in bipolar disorder: A test–retest study over 18 months

This study aimed to explore the reliability of self-reported trauma histories in a population with a diagnosis of Bipolar Disorder using the Childhood Trauma Questionnaire. Previous studies in other populations suggest high reliability of trauma histories over time and it was postulated that a similar high reliability would be demonstrated in this population. Thirty-nine patients with a confirmed diagnosis (DSM-IV criteria) were followed-up and re-administered the Childhood Trauma Questionnaire after 18 months. Cohen's kappa scores and intraclass correlations suggest reasonable test-retest reliability over the 18-month time period of the study for all types of childhood abuse, namely emotional, physical, sexual, and physical abuse and emotional neglect. Intraclass correlations ranged from r = .50 to (sexual abuse) to r = .96 (physical abuse). Cohen's kappas ranged from .44 (sexual abuse) to .76 (physical abuse). Retrospective reports of childhood trauma can be seen as reliable and are in keeping with results found with other mental health populations.

Forced Displacement, Suffering and the Aesthetics of Loss

This article investigates how artists have addressed shocking experiences of displacement in different political contexts. Drawing on the notion of ‘the aesthetics of loss’ (Köstlin, 2010), it examines and compares the different aims, desires and strategies that have shaped the histories and social lives of paintings, memorial statues, installations and other artefacts. The analysis identifies a mode of artistic engagement with the sense of a ‘loss of homeland’ that has been commonly felt amongst Sudeten German expellees, namely the production and framing of visual images as markers of collective trauma. These aesthetics of loss are contrasted with the approach taken by the Dutch artist Sophie Ernst in her project entitled HOME. Working with displaced people from Pakistan, India, Palestine, Israel and Iraq, she created a mnemonic space to stimulate a more individualistic, exploratory engagement with the loss of home, which aimed, in part, to elicit interpersonal empathy. To simply oppose these two modes of aesthetic engagement, however, would ignore the ways in which artefacts are drawn into different discursive, affective and spatial formations. This article argues for the need to expose such dynamic processes of framing and reframing by focusing on the processual aspects of aestheticisation with attention to the perspective of loss.

Visible Difference, Stigmatising Language(s) and the Distinctive Construction of Prejudices against Others in Leeds and Warsaw

The chapter argues that language and cultural communication matter in a transnational world and that the transmission of prejudices against minorities has to be closely analysed while contextualising national histories with minorities. Looking at two spatial sites (Leeds and Warsaw) and analysing interview material that was drawn from a larger study, the authors discuss the way local people address difference particularly through the axes of gendered ethnicity (Muslim men) and gendered class (male underclass). It explores how the same categories of difference are discursively produced in Poland and the UK/ England; to what degree they differ or overlap.

Present, imagination and memory in Zakes Mda and Mia Couto

Apesar de marcadas por contextos históricos e culturais distintos, é possível observar nas obras de dois dos autores mais significativos da África do Sul e de Moçambique, Zakes Mda e Mia Couto respectivamente, perspectivas semelhantes no que diz respeito à recuperação das memórias históricoculturais e à sua contribuição para a construção e compreensão das identidades pós-coloniais. Através da ficção, Zakes Mda e Mia Couto combinam a ligação da História a factos concretos com a necessidade de revelação associada à memória, criando assim espaços importantes para a discussão de algumas das mais complexas questões colocadas às identidades pós-coloniais. Para além dos contextos políticos, culturais e históricos que caracterizam e distinguem as literaturas sul-africana e moçambicana, tanto Zakes Mda como Mia Couto assumem nas suas obras a necessidade de analisar as identidades pós-coloniais contemporâneas dos dois países através da recuperação das suas memórias históricas.

Embryonic and larval ecology and biochemistry of offshore decapods

Understanding the biology of offshore species is hardened by the difficulties of sampling in the deep-sea environment. Additionally, due to the vastness of the open ocean, knowledge of early life histories of pelagic larvae is still relatively scarce. In decapod species with bentho-pelagic lifestyle, the transition from life in the seafloor to the water column not only is associated with drastic morphological metamorphosis, but also with changes in behavior and feeding ecology. The purpose of the present thesis was to investigate physiological, biochemical and behavioral adaptation occurring during early development of such species. The Norway lobster, Nephrops norvegicus, and the crab Monodaeus couchi were used as a model as these two species are encountered off the NE Atlantic shelf at depth greater than 300 m. Chapter 1 introduces the challenges faced by both adult and larvae inhabiting such remote habitats, including the effect of food availability on development and oceanographic processes on dispersal and recruitment. The thesis follows early life histories, starting with within-brood variability in the fatty acid (FA) profile displayed by developing N. norvegicus embryos. There were no differences in the FA composition of embryos sampled from both sides of the brooding chamber in most females. However, all females exhibited significant differences in the FA profiles of embryos sampled from different pleopods. Potential causes for the variations recorded may be differential female investment during oocyte production or shifts in FA catabolism during the incubation period promoted by embryo’s location within the brooding chamber. Next, feeding rates and digestive enzymes activity of the early stage larvae was investigated in N. norvegicus. Both stages were able to maximize food intake when larvae were scarce and showed increased feeding rate following periods of starvation. Amylase activity indicated that carbohydrates are not the primary energy reserve and that feeding may be required soon after hatching to trigger amylase activity. Protease activity indicated that protein reserves are catabolized under starvation. These results indicate that larvae may maximize prey ingestion in the presence of plankton patches with higher food abundance and minimize the deleterious effects induced by previous periods of intermittent starvation or unsuitable prey densities/types. Additionally, changes in enzymatic activity may allow newly hatched N. norvegicus larvae to metabolize protein reserves to overcome short-term starvation. Vertical migration behavior and the influence of oceanographic properties were studied next. All zoeal stages of M. couchi displayed reverse diel vertical migration. Abundance of early stages was correlated with chlorophyll a levels. An ontogenic shift in vertical distribution explained the results; earlier zoeal stages remain in the food-rich upper water column while later stages migrate to the bottom for settlement. This vertical migration behavior is likely to affect horizontal distribution of larvae. Indeed, global current patterns will result in low inter-annual variations in decapod larvae recruitment, but short term variations such as upwelling events will cause deviation from the expected dispersal pattern. Throughout development, from the embryo to metamorphosis into benthic juvenile, offshore decapods face many challenges. For the developing individual survivorship will depend heavily on food availability but also on the reserves passed on by the mother. Even though vertical migration behavior can allow the larvae to take advantage of depth varying currents for transport, the effect of general circulation pattern will superimpose local current and influence feeding conditions and affect dispersal and recruitment.

Autonomy in English language learning: a case study

The main goal of this study was to analyse the development of a pedagogy for autonomy tuned to the current situation in which Higher Education finds itself, namely of implementation of the Bologna Process in Europe, and in particular at the Escola Superior Agrária of the Polytechnic School at Coimbra. For this purpose new course units were created, new descriptors written, new materials developed and new methodologies tried. A case study was undertaken to observe and analyse the changes the institution was undergoing and to assess the impact of the new methodologies, particularly regarding the development of student autonomy. The target population for this study were the first year students on the Biotechnology degree in the year 2007/2008, to whom a battery of tests were applied, namely proficiency tests, belief tests, metacognitive tests, as well as methods of ethnographic research. The study relied on the European Framework of Reference for Languages and the European Language Portfolio to establish recognised levels and competences, and employed the portfolio as its main tool for measuring student autonomy. This portfolio was simultaneously biographical and descriptive and was organised by the students in their own time. Great incentive was given to this independent work. The ethnographic component of the study was of significant importance being given to students learning histories and to the collection of students’ reflections. This component aimed in particular to allow students the opportunity to express their thoughts on the experience they underwent during 20 weeks. From the analysis of the data, a significant improvement in self-confidence and motivation for lifelong learning is observable in the development of multiple tasks. Regarding the students’ progression towards proficiency, this improvement is less clear, but the final results of educational success were generally of great relevance.

I Cling to Virtue

Kular’s work centres on design as a means of engaging with social and cultural issues. Commissioned and exhibited by the V&A Museum, this was a mixed-media collection revealing the trajectories of the Lövy-Singh clan, a fictional East London family of mixed descent. It comprised 26 sculptures and two video pieces, developing the previous explorations of the MacGuffin in narrative (Kular REF Output 2). A catalogue with 28 fictional reminiscences, a genealogy and time line positioned the family’s experiences in geographical locations and historical events. Novel use of rapid-prototyping co-opted an industry process to confuse the experience of artefact and artifice. The design explored the historical, literary and cinematic traditions of the family saga and its relationship to memory and artefact. It presented an archive of objects derived from the flawed, biased memory of the (fictional) curator. A coherent story is replaced by one that is multiple and fragmentary. Kular and Toran (RCA) ‘produced’ the family by mixing their own genealogies with those of renowned 20th-century families, both real and fictional, such as the Magnificent Ambersons and the Rothschilds, positioning family members in everyday situations or key historical moments represented by an object and a ‘memory’ triggered by the object. Concept development was undertaken jointly by Kular and Toran. Kular’s archive research emphasised commonwealth immigrant histories and British 20th-century political events. His production contribution was in 3D modelling, rapid prototyping and display, leading production of the two films and development and editing of the narrative texts. The work was accompanied by a catalogue (2011), was reviewed in ICON Magazine (2010), discussed in an article by Hayward, Jones, Toran and Kular in Design and Culture (2013), and featured in The White Review (No. 2). It was re-exhibited in the group show ‘Politique Fiction’ at la Cité du design, Saint-Étienne, France (2013).