Investigating the prevalence and causes of prescribing errors in general practice: the PRACtICe Study

Aim: To determine the prevalence and nature of prescribing errors in general practice; to explore the causes, and to identify defences against error. Methods: 1) Systematic reviews; 2) Retrospective review of unique medication items prescribed over a 12 month period to a 2% sample of patients from 15 general practices in England; 3) Interviews with 34 prescribers regarding 70 potential errors; 15 root cause analyses, and six focus groups involving 46 primary health care team members Results: The study involved examination of 6,048 unique prescription items for 1,777 patients. Prescribing or monitoring errors were detected for one in eight patients, involving around one in 20 of all prescription items. The vast majority of the errors were of mild to moderate severity, with one in 550 items being associated with a severe error. The following factors were associated with increased risk of prescribing or monitoring errors: male gender, age less than 15 years or greater than 64 years, number of unique medication items prescribed, and being prescribed preparations in the following therapeutic areas: cardiovascular, infections, malignant disease and immunosuppression, musculoskeletal, eye, ENT and skin. Prescribing or monitoring errors were not associated with the grade of GP or whether prescriptions were issued as acute or repeat items. A wide range of underlying causes of error were identified relating to the prescriber, patient, the team, the working environment, the task, the computer system and the primary/secondary care interface. Many defences against error were also identified, including strategies employed by individual prescribers and primary care teams, and making best use of health information technology. Conclusion: Prescribing errors in general practices are common, although severe errors are unusual. Many factors increase the risk of error. Strategies for reducing the prevalence of error should focus on GP training, continuing professional development for GPs, clinical governance, effective use of clinical computer systems, and improving safety systems within general practices and at the interface with secondary care.

Incorporating creativity into teachers practice and self-concept of professional identity

The study explores what happens to teachers practice and ’ professional identity when they adopt a collaborative action research approach to teaching and involve external creative partners and a university mentor. The teachers aim to nurture and develop the creative potential of their learners through empowering them to make decisions for themselves about their own progress and learning directions. The teachers worked creatively and collaboratively designing creative teaching and learning methods in support of pupils with language and communication difficulties. The respondents are from an English special school, primary school and girls secondary school. A mixed methods methodology is adopted. Gains in teacher confidence and capability were identified in addition to shifts in values that impacted directly on their self-concept of what it is to be an effective teacher promoting effective learning. The development of their professional identities within a team ethos included them being able to make decisions about learning that are based on the educational potential of learners that they proved resulted in elevated standards achieved by this group of learners. They were able to justify their actions on established educational principles. Tensions however were revealed between what they perceived as their normal required professionalism imposed by external agencies and the enhanced professionalism experienced working through the project where they were able to integrate theory and practice.

Evolutionary developmental biology: impact on systematic theory and practice, and the contribution of systematics

Evolutionary developmental genetics brings together systematists, morphologists and developmental geneticists; it will therefore impact on each of these component disciplines. The goals and methods of phylogenetic analysis are reviewed here, and the contribution of evolutionary developmental genetics to morphological systematics, in terms of character conceptualisation and primary homology assessment, is discussed. Evolutionary developmental genetics, like its component disciplines phylogenetic systematics and comparative morphology, is concerned with homology concepts. Phylogenetic concepts of homology and their limitations are considered here, and the need for independent homology statements at different levels of biological organisation is evaluated. The role of systematics in evolutionary developmental genetics is outlined. Phylogenetic systematics and comparative morphology will suggest effective sampling strategies to developmental geneticists. Phylogenetic systematics provides hypotheses of character evolution (including parallel evolution and convergence), stimulating investigations into the evolutionary gains and losses of morphologies. Comparative morphology identifies those structures that are not easily amenable to typological categorisation, and that may be of particular interest in terms of developmental genetics. The concepts of latent homology and genetic recall may also prove useful in the evolutionary interpretation of developmental genetic data.

Knowledge intensive processes characteristics and improvement: a banking best practice example

This paper identifies characteristics of knowledge intensive processes and a method to improve their performance based on analysis of investment banking front office processes. The inability to improve these processes using standard process improvement techniques confirmed that much of the process was not codified and depended on tacit knowledge and skills. This led to the use of a semi-structured analysis of the characteristics of the processes via a questionnaire to identify knowledge intensive processes characteristics that adds to existing theory. Further work identified innovative process analysis and change techniques that could generate improvements based on an analysis of their properties and the issue drivers. An improvement methodology was developed to harness a number of techniques that were found to effective in resolving the issue drivers and improving these knowledge intensive processes.

iPad use in fieldwork: formal and informal use to enhance pedagogical practice in a bring your own technology world

We report on use of iPads (and other IOS devices) for student fieldwork use and as electronic field notebooks and to promote active. We have used questionnaires and interviews of tutors and students to elicit their views and technology and iPad use for fieldwork. There is some reluctance for academic staff to relinquish paper notebooks for iPad use, whether in the classroom or on fieldwork, as well as use them for observational and measurement purposes. Students too are largely unaware of the potential of iPads for enhancing fieldwork. Apps can be configured for a wide variety of specific uses that make iPads useful for educational as well as social uses. Such abilities should be used to enhance existing practice as well as make new functionality. For example, for disabled students who find it difficult to use conventional note taking. iPads can be used to develop student self-directed learning and for group contributions. The technology becomes part of the students’ personal learning environments as well as at the heart of their knowledge spaces – academic and social. This blurring of boundaries is due to iPads’ usability to cultivate field use, instruction, assessment and feedback processes. iPads can become field microscopes and entries to citizen science and we see the iPad as the main ‘computing’ device for students in the near future. As part of the Bring Your Own Technology/Device (BYOD) the iPad has much to offer although, both staff and students need to be guided in the most effective use for self-directed education via development of Personal Learning Environments. A more student-oriented pedagogy is suggested to correspond to the increasing use of tablet technologies by students

What do effective teachers of literacy do? Subject knowledge and pedagogical choices for literacy

This article explores the fine detail of practice by three teachers, recognised as effective teachers of literacy. All three were observed during nine literacy lessons, working with Year 2 (6/7 year olds) classes of successful inner-city primary schools in the South of England. Data collection took place in 2003, just as their schools were moving away from the early prescription of the National Literacy Strategy (NLS), and follow up visits were made in 2005. My initial interest had been in what these three teachers did with the NLS in order to motivate pupils and ensure high pupil attainment. Following observations, interviews and coding of teacher-pupil interaction, it became clear that The NLS Framework for Teaching (DfES, 2001) was not the driver of their success but a valuable vehicle for subtle and intuitive teacher behaviours that grew from a detailed understanding of how children develop as readers and writers. Implications for training student teachers to marry theoretical understanding with the expectations of a prescribed curriculum for literacy are discussed.

The Masters in Teaching and Learning (MTL): a retrospective, intrinsic case study of the process of policy into practice and its impact on teacher participants

The research reported here is a retrospective case study of the recent (2010) introduction of the Masters in Teaching and Learning (MTL) as a post-graduate level programme of professional development for teachers. It contributes to the debate and research over the past two decades about the impact of post-graduate professional development and appropriate ways of delivering it. The study is located within an extensive body of literature dealing with the importance of the teaching profession with regard to the success of schools and pupils and the impact of professional development on teaching quality and of teaching quality on attainment. A further relevant context is the ongoing tension between the teaching profession and academics on the one hand and government and political actors on the other, in respect of the approaches to professional development and to the control of educational processes. The research questions which inform the study deal with the perspectives of various participants – policy makers, programme directors, coaches and teachers studying for the MTL – on the extent to which the MTL is likely to have an ameliorative effect on teaching and pupil attainment, their experiences of the process of policy development and their experiences as course participants. The study adopts a case study approach which involves elite interviews with those responsible for the development and implementation of the MTL, questionnaires completed by MTL course participants and a comparison group taking a conventional MA and in depth interviews with participants and coaches. The results revealed tensions and difficulties associated with the development of the MTL including uneasy relationships between HE institutions and government agencies, ideas about ‘producer capture’, the relevance of the MBA model and concern over the role of coaches. However, while acknowledging various difficulties and some misconceived expectations they viewed its potential to meet its expressed aims positively, given time. Course participants were positive about their experience of the MTL and felt that it had contributed to many aspects of their professional development. Most saw it as a positive experience despite the variable quality of support from their schools, particularly in the form of the school-based coach the concept of which had been heralded as the bellwether of the MTL. It was striking that the responses of the MTL participants were very similar to those of teachers taking a conventional MA. A finding which would repay further investigation is that while the great majority of course participants felt that the MTL (and the MA) had contributed to their becoming more effective teachers they were much less confident that it had contributed to increased pupil attainment.

Design and use of mobile technology in distance language education : Matching learning practices with technologies-in-practice

This thesis focuses on the adaptation of formal education to people’s technology- use patterns, theirtechnology-in-practice, where the ubiquitous use of mobile technologies is central. The research question is: How can language learning practices occuring in informal learning environments be effectively integrated with formal education through the use of mobile technology? The study investigates the technical, pedagogical, social and cultural challenges involved in a design science approach. The thesis consists of four studies. The first study systematises MALL (mobile-assisted language learning) research. The second investigates Swedish and Chinese students’ attitudes towards the use of mobile technology in education. The third examines students’ use of technology in an online language course, with a specific focus on their learning practices in informal learning contexts and their understanding of how this use guides their learning. Based on the findings, a specifically designed MALL application was built and used in two courses. Study four analyses the app use in terms of students’ perceived level of self-regulation and structuration. The studies show that technology itself plays a very important role in reshaping peoples’ attitudes and that new learning methods are coconstructed in a sociotechnical system. Technology’s influence on student practices is equally strong across borders. Students’ established technologies-in-practice guide the ways they approach learning. Hence, designing effective online distance education involves three interrelated elements: technology, information, and social arrangements. This thesis contributes to mobile learning research by offering empirically and theoretically grounded insights that shift the focus from technology design to design of information systems.

Next-Generation Advising: Elevating Practice for Degree Completion and Career Success

As competition for applicants, legislative focus on graduation rates, and questions about the lifetime value of a degree intensify, many institutions are blurring boundaries between academic advising and co-curricular and career advising to promote student success and differentiate brand. This report examines how leaders break the trade-off between high-touch service and budget realities, identifying breakthrough practices, as well as the models and technologies required to deliver them in a cost-effective manner.

An effective technique to posterior resin composite restorations

AIM: The aim of this study is to present a clinical case in which an occlusal matrix device was used in a patient who needed to restore a posterior tooth. MATERIAL AND METHODS: A direct duplicate occlusal appliance was used (biteperf) in a patient who needed an occlusal restoration in two posterior teeth. RESULTS: Using the matrix helps having fast and accurate reproduction of the original anatomical details of the occlusal surface. The final result surprised with the presented restoration in terms of esthetic quality, despite the simplicity of the technique. CONCLUSION: Posterior teeth with initial lesions were confined to the occlusal surface of anatomically complex or fissured anatomy with or without signs of proximal caries wich are ideal candidates for this technique. The overlying enamel surface must be relatively intact; lesions of hidden or occult caries. CLINICAL SIGNIFICANCE: The aesthetic and time-saving benefits of the occlusal device (biteperf) are immediately clear. The matrix allows the fast and accurate reproduction of the anatomic details of the original occlusal surface of the tooth. The professionals who lack an artistic penchant and marked manual ability will be able to carry out excellent posterior resin composite restorations.

Effective Communication and Smooth Administration of Academic Libraries in the 21st Century: a New Paradigm in Nigeria

Effective communication is the soul of any institution. New opportunities are presented by Information and Communication Technology (ICTS). Library managers must adopt a more critical and communication plan that will enhance their skills and allow for further training, as well as allowing stakeholders to have input into decision-making.

EROSION LOSSES FROM RUNOFF: INTERACTION OF SOIL COVER AND EROSION CONTROL PRACTICE

The flow of sediment from cropped land is the main pollutant of water sources in rural areas. Due to this fact, it is necessary to develop and implement technologies that will reduce water and sediment discharges. Accordingly, an experiment was conducted in the Department of Biosystems Engineering - ESALQ / USP, Piracicaba - SP with the objective to evaluate the effect of different soil cover (bean, grass and bare ground) and erosion control practices (wide base terraces and infiltration furrows in slopes (no practices to control erosion)) while measuring water losses in runoff. The statistical design adopted was randomized blocks in a 3x3 factorial scheme resulting in 9 treatments with 3 replicates (blocks). The period of rainfall data collection was December 6, 2007 to April 11, 2008. A 21.1 cm diameter rain gauge was installed in the experimental area. Terraces were the most efficient practices for reducing erosion losses in the treatments with infiltration furrows being better than the control treatment. Bean was more effective than grass in reducing erosion. Bare ground was the least efficient.

Use of Demonstrably Effective Therapies in the Treatment of Acute Coronary Syndromes: Comparison between Different Brazilian Regions. Analysis of the Brazilian Registry on Acute Coronary Syndromes (BRACE)

Background: Little is known in our country about regional differences in the treatment of acute coronary disease. Objective: To analyze the behavior regarding the use of demonstrably effective regional therapies in acute coronary disease. Methods: A total of 71 hospitals were randomly selected, respecting the proportionality of the country in relation to geographic location, among other criteria. In the overall population was regionally analyzed the use of aspirin, clopidogrel, ACE inhibitors / AT1 blocker, beta-blockers and statins, separately and grouped by individual score ranging from 0 (no drug used) to 100 (all drugs used). In myocardial infarction with ST elevation (STEMI) regional differences were analyzed regarding the use of therapeutic recanalization (fibrinolytics and primary angioplasty). Results: In the overall population, within the first 24 hours of hospitalization, the mean score in the North-Northeast (70.5 +/- 22.1) was lower (p < 0.05) than in the Southeast (77.7 +/- 29.5), Midwest (82 +/- 22.1) and South (82.4 +/- 21) regions. At hospital discharge, the score of the North-Northeast region (61.4 +/- 32.9) was lower (p < 0.05) than in the Southeast (69.2 +/- 31.6), Midwest (65.3 +/- 33.6) and South (73.7 +/- 28.1) regions; additionally, the score of the Midwest was lower (p < 0.05) than the South region. In STEMI, the use of recanalization therapies was highest in the Southeast (75.4%, p = 0.001 compared to the rest of the country), and lowest in the North-Northeast (52.5%, p < 0.001 compared to the rest of the country). Conclusion: The use of demonstrably effective therapies in the treatment of acute coronary disease is much to be desired in the country, with important regional differences.

Il ruolo della Narrative in Medical Ethics, Medical Practice e Medical Education. Elementi di ricerca

La mia tesi di dottorato ha ad oggetto lo studio e l’analisi del ruolo della Narrative all’interno di tre ambiti, quali Medical Ethics, Clinical Practice e Medical Education. La tesi è strutturata in 4 capitoli: i primi tre vanno a comporre la parte teorica mentre nel quarto capitolo viene riportata una ricerca sul campo da me svolta negli Stati Uniti. Nel primo capitolo, analizzo il ruolo della narrative all’interno della Medical Ethics specificando che cosa si intenda con etica narrativa, quali sono le motivazione alla base del suo sviluppo e chi sono i suoi principali esponenti. In questo capitolo, inoltre, esamino i problemi che l’etica narrativa solleva suggerendo un nuovo modo in cui essa si integra alla riflessione bioetica. Il secondo capitolo è dedicato al contributo della narrative nella Medical Practice investigando sia le modalità attraverso le quali il paziente può avvalersi della narrazione per analizzare la sua esperienza di malattia sia la cosiddetta Medicina Narrativa. Il terzo capitolo è dedicato all'analisi delle Medical Humanities, ossia di quelle discipline che all’interno della Medical Education si stanno rivelando strumenti efficaci per una formazione più equilibrata e completa dei professionisti della salute. Il quarto capitolo, invece, è dedicato alla descrizione di una ricerca svolta presso l’University of California – Irvine . Durante questa esperienza ho frequentato i corsi del Program in Medical Humanities and Arts diretto dalla Prof.ssa J. Shapiro, (programma in vigore da 13 anni e implementato allo scopo di migliorare alcune competenze nei futuri medici quali: l'empatia, l’altruismo, la compassione e la predisposizione alla cura verso i pazienti, oltre che per affinare le comunicazione clinica e la capacità di osservazione) e intervistato gli studenti che hanno preso parte a queste lezioni.

Testing for sexually transmitted infections in general practice: cross-sectional study

Background Primary care is an important provider of sexual health care in England. We sought to explore the extent of testing for chlamydia and HIV in general practice and its relation to associated measures of sexual health in two contrasting geographical settings. Methods We analysed chlamydia and HIV testing data from 64 general practices and one genitourinary medicine (GUM) clinic in Brent (from mid-2003 to mid-2006) and 143 general practices and two GUM clinics in Avon (2004). We examined associations between practice testing status, practice characteristics and hypothesised markers of population need (area level teenage conception rates and Index of Multiple Deprivation, IMD scores). Results No HIV or chlamydia testing was done in 19% (12/64) of general practices in Brent, compared to 2.1% (3/143) in Avon. In Brent, the mean age of general practitioners (GPs) in Brent practices that tested for chlamydia or HIV was lower than in those that had not conducted testing. Practices where no HIV testing was done had slightly higher local teenage conception rates (median 23.5 vs. 17.4/1000 women aged 15-44, p = 0.07) and served more deprived areas (median IMD score 27.1 vs. 21.8, p = 0.05). Mean yearly chlamydia and HIV testing rates, in practices that did test were 33.2 and 0.6 (per 1000 patients aged 15-44 years) in Brent, and 34.1 and 10.3 in Avon, respectively. In Brent practices only 20% of chlamydia tests were conducted in patients aged under 25 years, compared with 39% in Avon. Conclusions There are substantial geographical differences in the intensity of chlamydia and HIV testing in general practice. Interventions to facilitate sexually transmitted infection and HIV testing in general practice are needed to improve access to effective sexual health care. The use of routinely-collected laboratory, practice-level and demographic data for monitoring sexual health service provision and informing service planning should be more widely evaluated.