Multiple component patient safety intervention in English hospitals:controlled evaluation of second phase

Objective: To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design: A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients' satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting: NHS hospitals in England. Participants: Nine hospitals participating in SPI2 and nine matched control hospitals. Intervention The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. Results: One of the scores (organisational climate) showed a significant (P=0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P=0.010) and 12 hour (2.4, 1.1 to 5.0; P=0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal change was significant (7.3, 1.4 to 37.7; P=0.002), but the difference in difference was not significant (2.1, 0.4 to 11.1; P=0.236). There were no notable or significant changes in the pattern of prescribing errors, either over time or between control and SPI2 hospitals. Two items of medical history taking (exercise tolerance and occupation) showed significant improvement over time, across both control and SPI2 hospitals, but no additional SPI2 effect. The holistic review showed no significant changes in error rates either over time or between control and SPI2 hospitals. The explicit case note review of perioperative care showed that adherence rates for two of the four perioperative standards targeted by SPI2 were already good at baseline, exceeding 94% for antibiotic prophylaxis and 98% for deep vein thrombosis prophylaxis. Intraoperative monitoring of temperature improved over time in both groups, but this was not significant (1.8, 0.4 to 7.6; P=0.279), and there were no additional effects of SPI2. A dramatic rise in consumption of soap and alcohol hand rub was similar in control and SPI2 hospitals (P=0.760 and P=0.889, respectively), as was the corresponding decrease in rates of Clostridium difficile and meticillin resistant Staphylococcus aureus infection (P=0.652 and P=0.693, respectively). Mortality rates of medical patients included in the case note reviews in control hospitals increased from 17.3% (42/243) to 21.4% (24/112), while in SPI2 hospitals they fell from 10.3% (24/233) to 6.1% (7/114) (P=0.043). Fewer than 8% of deaths were classed as avoidable; changes in proportions could not explain the divergence of overall death rates between control and SPI2 hospitals. There was no significant difference in the rate of change in mortality in intensive care. Patients' satisfaction improved in both control and SPI2 hospitals on all dimensions, but again there were no significant changes between the two groups of hospitals. Conclusions: Many aspects of care are already good or improving across the NHS in England, suggesting considerable improvements in quality across the board. These improvements are probably due to contemporaneous policy activities relating to patient safety, including those with features similar to the SPI, and the emergence of professional consensus on some clinical processes. This phenomenon might have attenuated the incremental effect of the SPI, making it difficult to detect. Alternatively, the full impact of the SPI might be observable only in the longer term. The conclusion of this study could have been different if concurrent controls had not been used.

Growing better brains? Pregnancy and neuroscience discourses in English social and welfare policies

In recent years, English welfare and health policy has started to include pregnancy within the foundation stage of child development. The foetus is also increasingly designated as ‘at risk’ from pregnant women. In this article, we draw on an analysis of a purposive sample of English social and welfare policies and closely related advocacy documents to trace the emergence of neuroscientific claims-making in relation to the family. In this article, we show that a specific deterministic understanding of the developing brain that only has a loose relationship with current scientific evidence is an important component in these changes. We examine the ways in which pregnancy is situated in these debates. In these debates, maternal stress is identified as a risk to the foetus; however, the selective concern with women living in disadvantage undermines biological claims. The policy claim of neurological ‘critical windows’ also seems to be influenced by social concerns. Hence, these emerging concerns over the foetus’ developing brain seem to be situated within the gendered history of policing women’s pregnant bodies rather than acting on new insights from scientific discoveries. By situating these developments within the broader framework of risk consciousness, we can link these changes to wider understandings of the ‘at risk’ child and intensified surveillance over family life.

The effect of multimedia instruction on achievement of college history students

The purpose of this study was to investigate the effect of multimedia instruction on achievement of college students in AMR 2010 from exploration and discovery to 1865. A non-equivalent control group design was used. The dependent variable was achievement. The independent variables were learning styles, method of instruction, and visual clarifiers (notes). The study was conducted using two history sections from Palm Beach Community College, in Boca Raton, Florida, between August and December, 1998. Data were obtained by means of placement scores, posttests, the Productivity Environmental Preference Survey (PEPS), and a researcher-developed student survey. Statistical analysis of the data was done using SPSS statistical software. Demographic variables were compared using Chi square. T tests were run on the posttests to determine the equality of variances. The posttest scores of the groups were compared using the analysis of covariance (ANCOVA) at the .05 level of significance. The first hypothesis there is a significant difference in students' learning of U.S. History when students receive multimedia instruction was supported, F (1, 52) = 16.88, p < .0005, and F = (1, 53) = 8.52, p < .005 for Tests 2 and 3, respectively. The second hypothesis there is a significant difference on the effectiveness of multimedia instruction based on students' various learning preferences was not supported. The last hypotheses there is a significant difference on students' learning of U.S. History when students whose first language is other than English and students who need remediation receive visual clarifiers were not supported. Analysis of covariance (ANCOVA) indicated no difference between the groups on Test 1, Test 2, or Test 3: F (1, 45) = .01, p < .940, F (1, 52) = .77, p < .385, and F (1, 53) =.17, p < .678, respectively, for language. Analysis of covariance (ANCOVA) indicated no significant difference on Test 1, Test 2, or Test 3, between the groups on the variable remediation: F (1, 45) = .31, p < .580, F (1, 52) = 1.44, p < .236, and F (1, 53) = .21, p < .645, respectively. ^

A history of a policy-level curriculum change in California

With the publication of A Nation at Risk (1983) educational reform has had a prominent place on the agenda of virtually every one of the sovereign states. As in many other states California focused much of its reform effort on the teaching of reading. In a political battle over the reading curriculum, California went from the English/Language Arts Framework of 1987, widely viewed as giving the state's imprimatur to whole language (an approach rooted in the learner's experience), to the English/Language Arts Frameworks (a more traditional or basic approach) of 1998 that called for the inclusion of phonemic awareness as the building block of reading instruction in all elementary schools. This study examined the historical record to determine the major forces behind this curriculum change. The results of this study are helpful to those who wish to better understand the relationship between political forces and curriculum change in the current age of educational reform. ^ This study utilized qualitative research methods and is presented as humanistic historical research (Landes & Tilly, 1971). The organizational framework for the study is taken from the work of M. Frances Klein (1991) which identifies seven different levels of curriculum decision-making. In this analysis particular attention was paid to the interaction of academic, formal, and societal levels, as the problem under consideration casts curriculum decision-making in the political realm. Three sources of information were used to provide the historical record. They include articles from popular newspapers and magazines, government documents, and interviews with individuals directly involved in the political process. ^ The results of this study demonstrate the power of societal forces over formal authority in making curriculum policy decisions. ^

Pirates, exiles, and empire: English seamen, Atlantic expansion, and Jamaican settlement, 1558–1658

A life of piracy offered marginal men a profession with a degree of autonomy, despite the brand of "outlaw" and the fear of prosecution. At various times throughout history, governments and crowned heads suspended much of their piracy prosecution, licensing men to work as "privateers" for the state, supplementing naval forces. This practice has a long history, but in sixteenth-century England, Elizabeth I (1558-1603) significantly altered this tradition. Recognizing her own weakness in effectively prosecuting these men and the profit they could contribute to the government, Elizabeth began incorporating pirates into the English naval corps in peacetime—not just in war. This practice increased English naval resources, income, and presence in the emerging Atlantic World, but also increased conflict with the powerful Spanish empire. By 1605, making peace with Spain, James VI/I (1603-1625) retracted Elizabeth's privateering promotion, prompting an emigration of English seamen to the American outposts they had developed in the previous century. Now exiles, no longer beholden to the Crown, seamen reverted back to piracy. The Carolinas and Jamaica served as bases for these rover communities. In 1650, the revolutionary leader Oliver Cromwell (1649-1658) once again recognized the merits of such policies. Determined to demonstrate his authority and solidify his rule, Cromwell offered citizenship and state support to Caribbean exiles in exchange for their aiding of his navy in the taking of Spanish Jamaica. Official chartering of Port Royal, Jamaica served as reward for these men's efforts and as the culmination of a century-long cycle of piracy legislation, creating one of England's most lucrative colonies in the middle of a traditionally Spanish Caribbean empire. Through legal and diplomatic records, correspondence, and naval and demographic records from England and Spain, this dissertation explores early modern piracy/privateering policy and its impact on the development of the Atlantic World. European disputes and imperial competition converged in these piracy debates with significant consequences for the definitions of criminality and citizenship and for the development of Atlantic empire.

An examination of Bernard Connor's The History of Poland (1698) and its depiction of the political, religious, and cultural history of the Polish-Lithuanian commonwealth

Connor was an Irish-born member of seventeenth-century English medical society who made an impact on medicine through his use of anatomy. This forward-thinking scientist also worked as a court physician for the Polish king John III Sobieski (1629- 1696) and published a history of that country. This thesis will examine Bernard Connor's 1698 publication The History of Poland to show that the Commonwealth was considered a vision of a progressive European parliamentary government that could serve as a model for a struggling English parliamentary government, thus supporting Larry Wolff and Maria Todorova's vision of the later eighteenth-century creation of the idea of a backward "eastern Europe."

The effect of multimedia instruction on achievement of college history students

The purpose of this study was to investigate the effect of multimedia instruction on achievement of college students in AMH 2010 from exploration and discovery to1865. A non-equivalent control group design was used. The dependent variable was achievement. The independent variables were learning styles method of instruction, and visual clarifiers (notes). The study was conducted using two history sections from Palm Beach Community College, in Boca Raton, Florida, between August and December, 1998. Data were obtained by means of placement scores, posttests, the Productivity Environmental Preference Survey (PEPS), and a researcher-developed student survey. Statistical analysis of the data was done using SPSS statistical software. Demographic variables were compared using Chi square. T tests were run on the posttests to determine the equality of variances. The posttest scores of the groups were compared using the analysis of covariance (ANCOVA) at the .05 level of significance. The first hypothesis there is a significant difference in students' learning of U.S. History when students receive multimedia instruction was supported, F = (1, 52)= 688, p < .0005, and F = (1, 53) = 8.52, p < .005for Tests 2 and 3, respectively. The second hypothesis there is a significant difference on the effectiveness of multimedia instruction based on students' various learning preferences was not supported. The last hypotheses there is a significant difference on students' learning of U.S. History when students whose first language is other than English and students who need remediation receive visual clarifiers were not supported. Analysis of covariance (ANCOVA) indicated no difference between the groups on Test 1, Test 2, or Test 3: F (1, 4 5)= .01, p < .940, F (l, 52) = .77, p < .385, and F (1,53) =.17, p > .678, respectively, for language. Analysis of covariance (ANCOVA) indicated no significant difference on Test 1, Test 2, or Test 3, between the groups on the variable remediation: F (1, 45) = .31, p < .580, F (1, 52) = 1.44, p < .236, and F (1, 53) = .21, p < .645, respectively.

The English and Scottish Journeys of J.B. Priestley and Edwin Muir

Date of Acceptance: 25/01/2015

The English and Scottish Journeys of J.B. Priestley and Edwin Muir

Date of Acceptance: 25/01/2015

Profits and patriotism: Nicholas Weston, Old English merchants, and Ireland’s Nine Years’ War, 1594–1603

Ireland’s Old English merchants, and especially those of the Pale, provided the English crown with vital material supplies, finance and intelligence throughout the Nine Years’ War (1594–1603). Yet, surviving official correspondence criticised the mercantile community for providing weak support and accused its members of favouring the queen’s Irish enemies. The reality was that they did both, but their reasons for doing so were complicated. Too often described as a homogenous group, Old English merchants did not all share the same economic ambitions, political views or faith. Examining the specific actions of certain individuals alongside those of the wider community provides a fresh angle on the conflict and sheds new light on the role of Old English merchants.

Studying French-Origin Middle English Lexis Using the Bilingual Thesaurus of Medieval England: A Comparison of the Vocabulary of Two Occupational Domains

This paper investigates how far it is possible to assess the degree of penetration of French-origin lexis into Middle English by means of the structures and data of the Bilingual Thesaurus of Medieval England. It begins with an outline of the aim and scope of the project, describing some of the methodological decisions behind the creation of the Bilingual Thesaurus, such as the use of the Middle English Dictionary and the Anglo Norman Dictionary as sources. Some provisional findings relating to Middle English words of French-origin in the semantic domains of Manufacture, in particular the sub-domains of Metal-working and Woodworking, and Travel by Water are then presented.

Market reforms and privatisation in the English National Health Service

The article examines developments in the marketisation and privatisation of the English National Health Service, primarily since 1997. It explores the use of competition and contracting out in ancillary services and the levering into public services of private finance for capital developments through the Private Finance Initiative. A substantial part of the article examines the repeated restructuring of the health service as a market in clinical services, initially as an internal market but subsequently as a market increasing opened up to private sector involvement. Some of the implications of market processes for NHS staff and for increased privatisation are discussed. The article examines one episode of popular resistance to these developments, namely the movement of opposition to the 2011 health and social care legislative proposals. The article concludes with a discussion of the implications of these system reforms for the founding principles of the NHS and the sustainability of the service.

The Dynamics of Quadropoly: League Position in English Football between 1888 and 2010

The paper explores competitive balance in top tier English league football from its inception in 1888. It examines the extent to which finishing in the top four positions in successive seasons is the preserve of a small number of clubs. Using a range of statistical measures, the analysis shows that the current high levels of competitive imbalance are not new phenomena. The overall pattern approximates a ‘U curve’: current patterns parallel those in the 1890s. In the early years of English league football, differences in resources between clubs soon became apparent. Clubs from the larger conurbations generated consistently larger revenues than their counterparts in the smaller industrial towns. This was primarily the result of the larger crowds that they could attract to their home games. This enabled them to entice the best players to their clubs away from their smaller rivals. The introduction of the maximum wage in 1901 and the transfer system helped to stem these increasing inequalities between clubs. This coincided with a massive wave of new stadia construction which enabled all the clubs to compete on an increasingly level playing field. These conjunctural changes to English football before 1915 produced the era of relatively competitive football during the inter-war years. This continued until the abolition of the maximum wage in 1961. Since that time, competitive balance has reversed and become increasingly restricted. English top-tier football has re-entered an era of extreme competitive imbalance.