Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature

Background: The UK, USA and the World Health Organization have identified improved patient safety in healthcare as a priority. Medication error has been identified as one of the most frequent forms of medical error and is associated with significant medical harm. Errors are the result of the systems that produce them. In industrial settings, a range of systematic techniques have been designed to reduce error and waste. The first stage of these processes is to map out the whole system and its reliability at each stage. However, to date, studies of medication error and solutions have concentrated on individual parts of the whole system. In this paper we wished to conduct a systematic review of the literature, in order to map out the medication system with its associated errors and failures in quality, to assess the strength of the evidence and to use approaches from quality management to identify ways in which the system could be made safer. Methods: We mapped out the medicines management system in primary care in the UK. We conducted a systematic literature review in order to refine our map of the system and to establish the quality of the research and reliability of the system. Results: The map demonstrated that the proportion of errors in the management system for medicines in primary care is very high. Several stages of the process had error rates of 50% or more: repeat prescribing reviews, interface prescribing and communication and patient adherence. When including the efficacy of the medicine in the system, the available evidence suggested that only between 4% and 21% of patients achieved the optimum benefit from their medication. Whilst there were some limitations in the evidence base, including the error rate measurement and the sampling strategies employed, there was sufficient information to indicate the ways in which the system could be improved, using management approaches. The first step to improving the overall quality would be routine monitoring of adherence, clinical effectiveness and hospital admissions. Conclusion: By adopting the whole system approach from a management perspective we have found where failures in quality occur in medication use in primary care in the UK, and where weaknesses occur in the associated evidence base. Quality management approaches have allowed us to develop a coherent change and research agenda in order to tackle these, so far, fairly intractable problems

Review of artificial intelligence development, its impact and its challenges

The field of Artificial Intelligence, which started roughly half a century ago, has a turbulent history. In the 1980s there has been a major paradigm shift towards embodiment. While embodied artificial intelligence is still highly diverse, changing, and far from “theoretically stable”, a certain consensus about the important issues and methods has been achieved or is rapidly emerging. In this paper we briefly characterize the field, summarize its achievements, and identify important issues for future research. With the popularization of the Internet, permeation of sensor networks, emergence of big data, increase in size of the information community, and interlinking and fusion of data and information throughout human society, physical space, and cyberspace, the information environment related to the current development of artificial intelligence (AI) has profoundly changed. AI faces important adjustments, and scientific foundations are confronted with new breakthroughs, as AI enters a new stage: AI 2.0. This paper briefly reviews the 60-year developmental history of AI, analyzes the external environment promoting the formation of AI 2.0 along with changes in goals, and describes both the beginning of the technology and the core idea behind AI 2.0 development. The goals of this research article are to review and synthesize the literature about service quality delivery through Artificial intelligence, describe what is known about the topic, and develop an agenda for needed research

Methods to Facilitate the Capture, Use, and Reuse of Structured and Unstructured Clinical Data.

Electronic health records (EHRs) have great potential to improve quality of care and to support clinical and translational research. While EHRs are being increasingly implemented in U.S. hospitals and clinics, their anticipated benefits have been largely unachieved or underachieved. Among many factors, tedious documentation requirements and the lack of effective information retrieval tools to access and reuse data are two key reasons accounting for this deficiency. In this dissertation, I describe my research on developing novel methods to facilitate the capture, use, and reuse of both structured and unstructured clinical data. Specifically, I develop a framework to investigate potential issues in this research topic, with a focus on three significant challenges. The first challenge is structured data entry (SDE), which can be facilitated by four effective strategies based on my systematic review. I further propose a multi-strategy model to guide the development of future SDE applications. In the follow-up study, I focus on workflow integration and evaluate the feasibility of using EHR audit trail logs for clinical workflow analysis. The second challenge is the use of clinical narratives, which can be supported by my innovative information retrieval (IR) technique called “semantically-based query recommendation (SBQR)”. My user experiment shows that SBQR can help improve the perceived performance of a medical IR system, and may work better on search tasks with average difficulty. The third challenge involves reusing EHR data as a reference standard to benchmark the quality of other health-related information. My study assesses the readability of trial descriptions on ClinicalTrials.gov and found that trial descriptions are very hard to read, even harder than clinical notes. My dissertation has several contributions. First, it conducts pioneer studies with innovative methods to improve the capture, use, and reuse of clinical data. Second, my dissertation provides successful examples for investigators who would like to conduct interdisciplinary research in the field of health informatics. Third, the framework of my research can be a great tool to generate future research agenda in clinical documentation and EHRs. I will continue exploring innovative and effective methods to maximize the value of EHRs.PHDInformationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/135845/1/tzuyu_1.pd

Developing an early design stage embodied carbon prediction model: a case study.

The focus of carbon management has shifted from operational carbon towards Embodied Carbon (EC) as a result of zero carbon agenda. Even though effort is made to quantify EC in detail design stage and choose the best solution for design there is no such approaches in managing EC during early stages of the design. The reason for this is lack of sufficient design information to quantify EC at early design stages. Hence, this research intends to fill that gap by using a unique approach of predicting EC by capturing the relationship between design and morphological parameters (such as plan shape, storey height, no. of storeys, finishes quality, services quality, etc.) and EC. Some building elements can be considered as 'carbon hotspots'; (carbon intensive). Since carbon and cost are known to be the currencies of sustainable construction projects, the aim of the study is to develop a decision support system to optimise design in terms of carbon and cost during early stages of design. The aim is to be achieved by developing a database of elemental (NRM compliant) EC and cost (using Hutchins UK Building Blackbook and other data sources) of sample office buildings in the UK and identifying the correlations of EC and cost with design parameters. Consequently, regression models will be derived as the key component for the DSS development. This paper presents a detailed literature review of EC and EC estimating tools, a detailed discussion of the proposed research method and exemplar case study of an office building and EC and capital cost analysis of the building. The paper concludes with the identification of the carbon hotspots for the building (mainly, substructure, frame, upper floor and external walls) and compares it with published case studies while exploring the implications of the case study for the DSS to be developed

The construction of a model of qualitative evaluation to support the development of the policy and practice of measuring student satisfaction in a higher education institution

The dissertation is an analysis of the methods used for the measurement of student satisfaction in Higher Education (HE) in the United Kingdom and draws on evidence from Europe, Australia and the USA. The prevalent measurement system is quantitative via the application of surveys. This predominance has been influenced by developments as indicated in marketing literature and adopted widely by manufacturing and service businesses. It is considered appropriate, according to this model, to consider students as customers of the service - HE. There is increasing formalisation of the survey system because of its adoption as part of audit procedures set up by the QAA. This formalisation is raising the status of student satisfaction on the quality agenda of HE managers. The research study was designed to establish whether it is practicable to develop a qualitative based evaluation model. The model was developed using a grounded theory methodology. The application of grounded theory is problematic because of its complexity and the variety of interpretations as indicated by academic literature. The issues concerned in adapting the methodology are considered as part of the methodological literature review. The process of adaptation was both iterative and evolutionary in nature. Field research involving the application of the model was undertaken in two separate HE institutions - Colleges A and B. The research in College A was completed over a two-year period. Grounded theory techniques were trialled but were judged incomplete. The research in College B was undertaken in a much shorter time of two months and involved the application of a fully developed grounded theory technique. In both colleges, reports were produced for the consideration of senior managers in each college. The grounded theory analysis revealed two separate but related core categories. In College A, the core was Communication Problems and in College B, Issues relating to Empathy with Students. The cores were derived from an analysis that made use of a constant comparative method of examining themes and categories to produce an integrative category that explained the main determinant(s) of student satisfaction. The methodology, through adaptation provides information that allows HE managers to understand how students experience service quality. In this respect, it has the potential to explain the statistics generated by satisfaction surveys. The study culminated in the production of The Student Satisfaction Evaluation Tool (SSET). This tool was developed from an adaptation of grounded theory techniques

Everyday life information literacy: a review of literature.

Information literacy (IL) within an everyday life context is connected to searching for, critically evaluating and using information effectively. Everyday life IL is about being able to address a range of information needs (e.g., financial, health, or legal) that relate to everyday practices as well as making informed decisions that are of significant value to individuals and communities. IL is regarded as an important condition for civic participation and engagement, informed citizenship, health, well-being and, generally, people's quality of life (Leung, 2010). However, compared to the vast amount of IL research within educational and workplace settings, there has been relatively little research conducted so far on examining the effective use of information and its impact in relation to people's everyday life situations. For example, although IL has been researched within quite diverse contexts and with a variety of foci, such as age (e.g., older adults/fourth age/retired people, young people/men, early years/preschool, nursery, aging women), different roles (e.g., parents, retired, citizens) and situations (e.g. pregnant women, immigrants, unemployed, job seekers, carers, health issues), the literature lacks a holistic view to this body of research. In addition, so far, IL in everyday life context has received less attention in terms of empirical research when compared to other conceptual lenses that have been adopted within the wider spectrum of user-focused information research, such as that of information seeking behaviour, that do not address the critical positioning and value of IL. Thus, this paper presents a critical review of relevant literature on everyday life IL. It seeks to offer a snapshot of existing research within this area and aims to develop a research agenda for further exploration of the growing everyday life IL domain. We based the review on literature published between 2000-2016 and sourced from a range of different databases (Science Direct, Library and Information Science and Technology Abstracts, ERIC, Emerald, ABI/Inform, Library and Information Science Abstracts, Library Literature and Information Science, and Google Scholar). We conducted the search using two terms, 'information literacy' and 'everyday life' in all search fields of the individual databases. Additional related terms, such as 'community', were found to be closely connected to other contexts, for example, that of education and the workplace, which were beyond the scope of this research. We also excluded from the retrieved results articles that focused directly on students' education and the workplace. Our paper emphasises the importance of examining IL within different everyday life settings and highlights existing gaps that need further development in terms of empirical research. A comprehensive review of everyday life IL research is particularly of importance since it will help us understand the diversity and the dynamic nature of IL needs and activities. It will also help us highlight the implications of the lack of IL and identify the key players in the advocacy of IL within different everyday life settings. The review suggests that the outcome of everyday life IL research has the potential to inform the design and delivery of evidence-based information services offered by decision makers and practitioners in different sectors and communities (Yates and Partridge, 2014). It also demonstrates that this area of research is still in its infancy and more varied contexts need to be explored to nurture a robust understanding of the use and impact of information in people's everyday lives

Implementation Action Plan for organic food and farming research

The Implementation Action Plan completes TP Organics’ trilogy of key documents of the Research Vision to 2025 (Niggli et al 2008) and the Strategic Research Agenda (Schmid et al 2009). The Implementation Action Plan addresses important areas for a successful implementation of the Strategic Research Agenda. It explores the strength of Europe’s organic sector on the world stage with about one quarter of the world’s organic agricultural land in 2008 and accounting for more than half of the global organic market. The aims and objectives of organic farming reflect a broad range of societal demands on the multiple roles of agriculture and food production of not only producing commodities but also ecosystem services. These are important for Europe’s economic success, the resilience of its farms and prosperity in its rural areas. The organic sector is a leading market for quality and authenticity: values at the heart of European food culture. Innovation is important across the EU economy, and no less so within the organic sector. The Implementation Action Plan devotes its third chapter to considering how innovation can be stimulated through organic food and farming research and, crucially, translated into changes in business and agricultural practice. TP Organics argues for a broad understanding of innovation that includes technology, know-how and social/organisational innovations. Accordingly, innovation can involve different actors throughout the food sector. Many examples illustrate innovations in the organic sector includign and beyond technology. The various restrictions imposed by organic standards have driven change and turned organic farms and food businesses into creative living laboratories for smart and green innovations and the sector will continue to generate new examples. The research topics proposed by TP Organics in the Strategic Research Agenda can drive innovation in areas as wide ranging as production practices for crops, technologies for livestock, food processing, quality management, on-farm renewable energy or insights into the effects of consumption of organic products on disease and wellbeing and life style of citizens. Importantly, many approaches developed within the sector are relevant and useful beyond the specific sector. The fourth chapter addresses knowledge management in organic agriculture, focusing on the further development of participatory research methods. Participatory (or trans-disciplinary) models recognise the worth and importance of different forms of knowledge and reduced boundaries between the generators and the users of knowledge, while respecting and benefitting from transparent division of tasks. The emphasis on joint creation and exchange of knowledge makes them valuable as part of a knowledge management toolkit as they have the capacity to enhance the translation of research outcomes into practical changes and lead to real-world progress. The Implementation Action Plan argues for the wider application of participatory methods in publicly-funded research and also proposes some criteria for evaluating participatory research, such as the involvement and satisfaction of stakeholders as well as real improvements in sustainability and delivery of public goods/services. European agriculture faces specific challenges but at the same time Europe has a unique potential for the development of agro-ecology based solutions that must be supported through well focused research. TP Organics believes that the most effective approaches in agriculture and food research will be systems-based, multi- and trans-disciplinary, and that in the development of research priorities, the interconnections between biodiversity, dietary diversity, functional diversity and health must be taken into account. Chapter five of the action plan identifies six themes which could be used to organise research and innovation activities in agriculture under Europe’s 8th Framework Programme on Research Cooperation: • Eco-functional intensification – A new area of agricultural research which aims to harness beneficial activities of the ecosystem to increase productivity in agriculture. • The economics of high output / low input farming Developing reliable economic and environmental assessments of new recycling, renewable-based and efficiency-boosting technologies for agriculture. • Health care schemes for livestock Shifting from therapeutics to livestock health care schemes based on good husbandry and disease prevention. • Resilience and “sustainagility” Dealing with a more rapidly changing environment by focusing on ‘adaptive capacity’ to help build resilience of farmers, farms and production methods. • From farm diversity to food diversity and health and wellbeing of citizens Building on existing initiatives to reconnect consumers and producers, use a ‘whole food chain’ approach to improve availability of natural and authentic foods. • Creating centres of innovation in farming communities A network of centres in Europe applying and developing trans-disciplinary and participatory scientific approaches to support innovation among farmers and SMEs and improving research capacities across Europe

Research report 22: liveability in NDC areas: findings from six case studies

New Deal for Communities (NDC) is a key programme in the Government's strategy to tackle multiple deprivation by giving some of the poorest communities in the UK the resources to tackle their problems in an intensive and co-ordinated way. The programme, which began in 1998, has encouraged the development of partnerships between local people, community and voluntary organisations, public agencies, local authorities and business. These partnerships are working to tackle the problems of social exclusion and make a lasting improvement to their neighbourhood, with the active involvement of the local community. While different areas face different problems, the five main issues to be tackled by NDC partnerships are: worklessness; improving health; tackling crime; raising educational achievement; and housing and the physical environment. Sustainable Cities Research Institute is part of a national consortium carrying out the evaluation of NDC. The evaluation is led by Sheffield Hallam University and involves 14 UK research centres, universities, and private consultancy firms. Sustainable Cities staff involved with this work are Keith Shaw, who is the North East Region Co-ordinator (with responsibility for Hartlepool, Middlesbrough, Newcastle and Sunderland partnerships), and Gill Davidson, who is carrying out evaluation tasks in Middlesbrough. Also involved in this work at a regional level are staff members from the University's School of Politics, and from the University of Newcastle. The evaluation began with a scoping phase in October 2001. The evaluation is expected to continue in its current format until at least 2005, with annual evaluation reports being produced in 2003, 2004, and 2005. Sustainable Cities is also undertaking research for a series of case studies focusing on West Middlesbrough NDC; so far these have covered subjects including mainstreaming, involving hard-to-reach young people in regeneration, and liveability