A synthesis of mobile learning literature in education, business, and medicine

M-learning, or using a mobile device as a tool for learning, is a relatively new phenomenon. This project examined m-learning within education, business, and medicine. Specifically, three types of mobile devices were examined within the three sub-categories of m-learning: the mobile phone or smartphone, the iPold, and the PDA. A mixed-method design was used to review 40 m-learning articles and to synthesize the literature to explore m-learning projects around the world. The literature revealed that m-learning was used in many parts of the world, and mostly in North America, within all three fields. There were also numerous projects in Europe, Asia, the United Kingdom, and in Oceania. Mobile phones, smartphones, iPods, and PDAs were used in all three fields. --P. ii.The original print copy of this thesis may be available here: http://wizard.unbc.ca/record=b166632

An exploration of healthcare professionals' attitudes and perceptions towards a local hospital drug formulary and their impact on prescribing practice

Background: Hospital drug formularies are developed in order to support safe, effective and cost-effective prescribing. Their utilisation is based on the assumption that prescribers and other users will follow guidance outlined within them. The role of formulary users’ attitudes has been largely overlooked in the research literature. The nature and impact of attitudes to formularies on influencing prescribing practice have not been fully investigated. This study seeks to address this issue through a local practice based research project. Objectives: To determine the attitudes and experiences of users and key stakeholders with the utilisation of a new formulary at a local hospital trust. Methodology: Semi-structured interviews were conducted exploring the views of doctors, pharmacists and non-medical prescribers. An online self-completion questionnaire was sent to all key stakeholders. In addition prescribing data was also extracted from the Pharmacy computer system to assess impact of the new formulary. Data collection was thus split into two phases with modifications made to the formulary based on preliminary findings and emerging themes. Results: The local formulary symbolises a ‘critical split’ in the approach to resource management and patient care. Pharmacists are ‘closely bound’ to the formulary, relying on it for retrospective decision-support and ultimately seen to improve pharmacists’ autonomy while prescribers consider it to be over-rationalisation eroding their professional autonomy. Although the quantitative data in this study demonstrates a statistically significant improvement in doctors’ perceptions of using the formulary, the distinct divide between doctors’ and pharmacists’ attitudes towards the formulary remained. Prescribing data extracted showed no significant impact of the formulary on prescribing practice. Conclusion: The study confirms the existence of deeper sociological constructs, particularly concerning autonomy and professionalism. Doctors claim an ability to manage uncertainty during patient consultations while pharmacists claim to be drug ‘experts’. The monopoly on drug knowledge is therefore contested ground. This study concludes that both the formulary and the pharmacy profession need to be more influential, and embrace a more ‘humanised-bureaucracy.’ It is recommended that pharmacists build on a new philosophical union with the formulary and focus on asserting their claim and dominance on the monopoly of drug knowledge.East and North Herts NHS Trus

IMPACT OF INDUSTRY TRANSFORMATION ON THE LIFECYCLE OF PHARMACEUTICAL PRODUCTS: A Science and Risk Based Perspective

The aim of this thesis is to explore the ongoing transformation in the pharmaceutical industry and its impact on pharmaceutical quality from the perspective of risk identification. This research was built upon three key pillars: Theoretical Evidence, Operational Evidence, and Opinion-based Evidence.The regulatory environment is one of the most important external factors that affect a company’s organization, processes and technological strategy. A quantitative analysis of regulatory events since 1813 revealed that the focus of regulators from 1813 to 1970s was centred on crisis management and public health protection. Since the 1980s a gradual move towards a greater focus on public health promotion, international harmonization, innovation, and agency modernization occurred.The evolution of the pharmaceutical transformation was assessed through systematic review of the literature. Fourteen factors were identified that impact the pharmaceutical industry in future years. These factors, termed “transformation triggers”, were considered as the theoretical evidence for the ongoing transformation. The relative importance ranking of the triggers was computed based on their prevalence within the articles studied. The four main triggers with the strongest theoretical evidence were: fully integrated pharma network, personalised medicine, translational research, and pervasive computing.Operational evidence to verify existence of the transformation triggers was compiled through systematic collection of operational data. Trends in the operational evidence and the associated theoretical evidence were compared. Strong correlation between theoretical and operational evidence was found for the four transformation triggers listed above. Key areas of contrast included; healthcare management focus, adaptive trials and regulatory enforcement where the operational evidence was stronger than the theoretical evidence.Expert opinion, obtained from a questionnaire-based survey on participants with recognised expertise in pharmaceutical regulation, product lifecycle or technology, validated the theoretical and operational evidence and supported the same four main pharmaceutical transformation triggers.A quality risk model derived from the survey indicated a firm relationship between the pharmaceutical quality risks and regulatory compliance outcomes during the marketing approval and post-marketing phases of the product lifecycle and a weaker relationship during the pre-market evaluation phase

Telehealth in the developing world

Co-published with the Royal Society of Medicine Pres

Evaluation of Glibenclamide Quality and Stakeholders’ Perception of Medicine Quality in the Clinical Settings of the Ministry of Interior in Saudi Arabia

Aim: To explore medicine quality and perception among the stakeholders in the Ministry of Interior Medical Services (MOI-MSD) clinical settings in Saudi Arabia using glibenclamide as an indicator. Method: A mixed method approach was used in two phases. Phase one involved chemical analysis for identity and quantity of the active pharmaceutical ingredient (API), visual analysis and authentication of source of a popular diabetes medicine (glibenclamide) collected from MOI-MSD general warehouse in Riyadh, Saudi Arabia. Phase two contained a focus group discussion, self-completed survey questionnaires and semi-structured interviews to explore the perceptions of various stakeholders including commissioners, physicians, pharmacists and patients in the MOI-MSD settings in Saudi Arabia about medicine quality and related problems. Data analysis: Phase one collected quantitative data of API quantity from the chemical analysis of glibenclamide samples using a high performance liquid chromatography apparatus (HPLC) based on United States Pharmacopoeia (USP 36) method. The visual inspection of glibenclamide samples was performed using tool kit developed by The World Health Professions Alliance (WHPA) and The International Pharmaceutical Federation (FIP). The authentication of glibenclamide source was performed by on-site comparison of available samples in the general MOI-MSD warehouse with the available official reception documents. Phase two collected quantitative and qualitative data regarding perceptions about medicine quality and related problems and subsequently analysed them using SPSS for descriptive statistics and NVivo version 10 for thematic analysis following data coding and the development of themes and sub-themes. Subsequently, stakeholders’ data were triangulated to establish common and specific themes and sub-themes among MOI-MSD stakeholders. Findings: Phase one of the study found that all glibenclamide samples were within acceptable USP limits in terms of identity and quantity between 90-110%. It was also found that all available glibenclamide batch numbers were present in the official reception documents and the visual analysis of samples revealed no visible errors on the medicine samples or its packaging. Phase two of the study found that most stakeholders, particularly commissioners and physicians, believed that medicine quality was good or excellent in Saudi Arabia. However, the commissioners, physicians and pharmacists believed that the quality of medicines in the MOI-MSD was less than what is available in Saudi Arabia but patients mostly disagreed with these views. Most patients believed that the quality of medicines was high in both the Saudi Arabian market and in the MOI-MSD settings. Limited knowledge about good quality medicines and counterfeit medicines was found among most stakeholders where the quality of medicines was commonly associated with the effect rather than technical attributes of medicines including content, appearance and source. The stakeholders in this study reported a wide range of behaviour when in doubt about medicine quality such as reporting these doubts to authorities, finding alternative medicines, stopping the medicine use and taking no further action regarding these doubts. Furthermore, all stakeholders have identified medicine procurement focusing on price rather than quality, difficulty in reporting medicine quality problems and medicine storage conditions as challenges to medicine quality in the MOI-MSD. Patients, particularly chronic patients from Jeddah city, have complained about medicine non-availability in their local MOI-MSD primary clinic and expensive medicine prices. Conclusions: Glibenclamide quality in the MOI-MSD settings was found to be acceptable in terms of API identity and quantity, source and visual appearance. The perception about medicine quality in these settings seems to be low particularly from commissioners and pharmacists but not the patients. There is an urgent need to implement quality assurance steps to increase the commissioners and pharmacists trust in the quality of their medicines at the medicine selection, procurement, storage and transportation stages in addition to improving the accessibility to report medicine quality problems to all stakeholders. Subsequently, future research is needed to measure and evaluate the impact of these quality assurance steps on the confidence of commissioners and pharmacists trust in the quality of the MOI-MSD medicines. Furthermore, patients’ issues about medicine non-availability need to be addressed rapidly as it could result in patients’ acquiring medicines from unknown sources and/or cause additional financial burdens

Examining the post-adoptive infusion of mobile technology in a healthcare domain: determinants and outcomes

The healthcare industry is beginning to appreciate the benefits which can be obtained from using Mobile Health Systems (MHS) at the point-of-care. As a result, healthcare organisations are investing heavily in mobile health initiatives with the expectation that users will employ the system to enhance performance. Despite widespread endorsement and support for the implementation of MHS, empirical evidence surrounding the benefits of MHS remains to be fully established. For MHS to be truly valuable, it is argued that the technological tool be infused within healthcare practitioners work practices and used to its full potential in post-adoptive scenarios. Yet, there is a paucity of research focusing on the infusion of MHS by healthcare practitioners. In order to address this gap in the literature, the objective of this study is to explore the determinants and outcomes of MHS infusion by healthcare practitioners. This research study adopts a post-positivist theory building approach to MHS infusion. Existing literature is utilised to develop a conceptual model by which the research objective is explored. Employing a mixed-method approach, this conceptual model is first advanced through a case study in the UK whereby propositions established from the literature are refined into testable hypotheses. The final phase of this research study involves the collection of empirical data from a Canadian hospital which supports the refined model and its associated hypotheses. The results from both phases of data collection are employed to develop a model of MHS infusion. The study contributes to IS theory and practice by: (1) developing a model with six determinants (Availability, MHS Self-Efficacy, Time-Criticality, Habit, Technology Trust, and Task Behaviour) and individual performance-related outcomes of MHS infusion (Effectiveness, Efficiency, and Learning), (2) examining undocumented determinants and relationships, (3) identifying prerequisite conditions that both healthcare practitioners and organisations can employ to assist with MHS infusion, (4) developing a taxonomy that provides conceptual refinement of IT infusion, and (5) informing healthcare organisations and vendors as to the performance of MHS in post-adoptive scenarios

DNA barcoding and phytochemical analysis in quality control of herbal medicine : a case study of Devil’s Claw (Harpagophytum spp) AND Buchu (Agathosma spp)

Abstract: The formulation of any herbal product starts with the raw plant material supply chain where it is crucial to have an in-depth understanding of the molecular and chemical composition and discrepancies in the plant material to ensure a standardized, effective, and reliable consumer product. The issue of plant substitution is noteworthy in the two genera under investigation: Harpagophytum spp (Devil’s claw) and Agathosma spp (Buchu). Currently, the preferred species for Devil’s claw herbal products is H. procumbens, which is often substituted with H. zeyheri. Similarly, the preferred species in Buchu herbal products is A. betulina, which is commonly substituted with A. crenulata. In both instances, species share some taxonomic similarities but are not chemically equivalent. The practice of species substitution may reduce the quality of the therapeutic effect and pose risks to the consumer. Considering the popularity of both Harpagophytum spp and Agathosma spp as indigenous herbal drugs, the study aimed to establish whether molecular techniques (DNA barcoding) could be used to authenticate these herbal products. Quality assessment concerns associated with Devil’s claw and Buchu were addressed in a two-pronged approach. Firstly, separate Reference DNA Barcode Library (RDBL) were generated for Harpagophytum spp and Agathosma spp using a variety of plastid regions (matK, trnL-F, and ycf1) and expertly identified material of known provenance. Respective commercial herbal products allegedly containing H. procumbens or A. betulina were then purchased online from various health outlets, which were then analysed for their authenticity. Secondly, phytochemical analysis was used to identify the biological markers, present in the respective genera...Ph.D. (Botany