The impact of a closed-loop electronic prescribing and automated dispensing system on the ward pharmacist’s time and activities

Objective To assess the impact of a closed-loop electronic prescribing and automated dispensing system on the time spent providing a ward pharmacy service and the activities carried out. Setting Surgical ward, London teaching hospital. Method All data were collected two months pre- and one year post-intervention. First, the ward pharmacist recorded the time taken each day for four weeks. Second, an observational study was conducted over 10 weekdays, using two-dimensional work sampling, to identify the ward pharmacist's activities. Finally, medication orders were examined to identify pharmacists' endorsements that should have been, and were actually, made. Key findings Mean time to provide a weekday ward pharmacy service increased from 1 h 8 min to 1 h 38 min per day (P = 0.001; unpaired t-test). There were significant increases in time spent prescription monitoring, recommending changes in therapy/monitoring, giving advice or information, and non-productive time. There were decreases for supply, looking for charts and checking patients' own drugs. There was an increase in the amount of time spent with medical and pharmacy staff, and with 'self'. Seventy-eight per cent of patients' medication records could be assessed for endorsements pre- and 100% post-intervention. Endorsements were required for 390 (50%) of 787 medication orders pre-intervention and 190 (21%) of 897 afterwards (P < 0.0001; chi-square test). Endorsements were made for 214 (55%) of endorsement opportunities pre-intervention and 57 (30%) afterwards (P < 0.0001; chi-square test). Conclusion The intervention increased the overall time required to provide a ward pharmacy service and changed the types of activity undertaken. Contact time with medical and pharmacy staff increased. There was no significant change in time spent with patients. Fewer pharmacy endorsements were required post-intervention, but a lower percentage were actually made. The findings have important implications for the design, introduction and use of similar systems.

Carl von Clausewitz: On War

OUP Abridged edition, based on the Howard & Paret translation. Includes my Introduction.

Kangaroo Mother Care in a Mozambican perinatal ward : a clinical case study

Kangaroo mother care (KMC) was first introduced in Mozambique in 1984. The aim of this study was to describe Mozambican mothers’ experiences of going through admission, passing from an intensive care ward to a nursery ward with their premature baby, undergoing KMC training before early discharge. A clinical case study was conducted, involving naturalistic observations and a face-to-face interview with 41 mothers participating to complete a questionnaire. Descriptive statistics and manifest content analysis were used in this study. The results show that the mothers were of low socio-economic standing and felt that they did not have enough information on KMC. The hierarchical organization within the hospital setting as well as communalistic behaviours influenced the mothers’ support of KMC, including information, communication, relationships and actions. The conclusion is that there is an important challenge for trained neonatal nurses to improve the guidelines for KMC and to empower mothers and their families to adopt KMC.

Carl Maria von Weber’s Overture to Oberon: A History of Recorded Performance

My research examines the recorded performance history of the Overture to Weber’s Oberon in light of these aesthetic goals. I have charted changes in performance practice trends, including in timing, tempo fluctuation, rhythmic accuracy and ensemble, and the use of portamento. The twenty recordings studied that I surveyed span nearly seventy-five years, and include many of the 20th century’s most prominent conductors and orchestras, including groups from Communist Russia, both pre-World War II and post-World War II continental Europe, the British Isles, and the United States.8 Though by no means comprehensive, my selections encompass a diverse sampling of surviving recordings, ensuring a large enough sample size to reflect general trends in the performance of Weber’s masterpiece. My research and analysis confirms the conventional view of a move toward more accurate—but also more cautious, uniform, and inexpressive— performances. Surprisingly, however, this analysis also suggests that we are on the cusp of a new era in orchestra performance practice, one that shares many of the values of the earlier recorded performances. While maintaining today’s high standards of execution, modern performances now look to regain many of the past’s expressive qualities, doing so in sometimes surprising ways.

The Genome Sequence of Taurine Cattle: A Window to Ruminant Biology and Evolution

To understand the biology and evolution of ruminants, the cattle genome was sequenced to about sevenfold coverage. The cattle genome contains a minimum of 22,000 genes, with a core set of 14,345 orthologs shared among seven mammalian species of which 1217 are absent or undetected in noneutherian (marsupial or monotreme) genomes. Cattle-specific evolutionary breakpoint regions in chromosomes have a higher density of segmental duplications, enrichment of repetitive elements, and species-specific variations in genes associated with lactation and immune responsiveness. Genes involved in metabolism are generally highly conserved, although five metabolic genes are deleted or extensively diverged from their human orthologs. The cattle genome sequence thus provides a resource for understanding mammalian evolution and accelerating livestock genetic improvement for milk and meat production.

Components of Turnera diffusa Willd. var. afrodisiaca (Ward) Urb. essential oil

Turnera diffusa Willd. var. afrodisiaca (Ward) Urb. (syn. T aphrodisiaca) (Turneraceae) is a common aromatic plant growing wild in the subtropical regions of America and Africa. Its essential oil was studied by GC and GC-MS. Fifty-four components were characterized and identified, the most abundant being 1,8-cineol (11.4%), opoplenone (10.3%) cadalene (5.1%) and epi-cubenol (4.1%). Copyright (C) 2002 John Wiley Sons, Ltd.

Light-front zero-mode contribution to the Ward Identity

In a covariant gauge we implicitly assume that the Green's function propagates information from one point of the space-time to another, so that the Green's function is responsible for the dynamics of the relativistic particle. In the light front form one would naively expect, that this feature would be preserved. In this manner, the fermionic field propagator can be split into a propagating piece and a non-propagating (contact) term. Since the latter (contact) one does not propagate information; and therefore, supposedly can be discarded with no harm to the field dynamics we wanted to know what would be the impact of dropping it off. To do that, we investigated its role in the Ward identity in the light front. Here we use the terminology Ward identity to identify the limiting case of photon's zero momentum transfer in the vertex from the more general Ward-Takahashi identity with nonzero momentum transfer.