Qualitative study exploring the phenomenon of multiple electronic prescribing systems within single hospital organisations

BACKGROUND: A previous census of electronic prescribing (EP) systems in England showed that more than half of hospitals with EP reported more than one EP system within the same hospital. Our objectives were to describe the rationale for having multiple EP systems within a single hospital, and to explore perceptions of stakeholders about the advantages and disadvantages of multiple systems including any impact on patient safety. METHODS: Hospitals were selected from previous census respondents. A decision matrix was developed to achieve a maximum variation sample, and snowball sampling used to recruit stakeholders of different professional backgrounds. We then used an a priori framework to guide and analyse semi-structured interviews. RESULTS: Ten participants, comprising pharmacists and doctors and a nurse, were interviewed from four hospitals. The findings suggest that use of multiple EP systems was not strategically planned. Three co-existing models of EP systems adoption in hospitals were identified: organisation-led, clinician-led and clinical network-led, which may have contributed to multiple systems use. Although there were some perceived benefits of multiple EP systems, particularly in niche specialities, many disadvantages were described. These included issues related to access, staff training, workflow, work duplication, and system interfacing. Fragmentation of documentation of the patient's journey was a major safety concern. DISCUSSION: The complexity of EP systems' adoption and deficiencies in IT strategic planning may have contributed to multiple EP systems use in the NHS. In the near to mid-term, multiple EP systems may remain in place in many English hospitals, which may create challenges to quality and patient safety.Peer reviewe

Aerial Surveys of Cliff-Nesting Raptors

In summer 1999, an extensive aerial survey of cliff-nesting raptors was conducted in the National Petroleum Reserve–Alaska (NPR–A) on Alaska’s North Slope. No similarly extensive survey had been conducted since 1977. In the interim, the regional population of the Arctic peregrine falcon (Falco peregrinus tundrius) had increased, as shown by monitoring along the Colville River. The 1999 survey assessed the present abundance and distribution of the peregrine falcon, as well as the gyrfalcon (Falco rusticolus), golden eagle (Aquila chrysaetos), and rough-legged hawk (Buteo lagopus) in most of the NPR–A. Specifically excluded from the 1999 survey were the Kogosukruk and Kikiakrorak Rivers and the Colville River below its junction with the Etivluk River. These areas had been included in other recent surveys. Peregrine falcons were found occupying 67 sites in 1999, 61 of which were in the area surveyed in 1977 and in which only four occupied sites were found. Gyrfalcons nest earlier than other raptor species in the NPR–A, and the 1999 survey was conducted too late in the season to determine occupancy of many sites. Gyrfalcons were located at only 19 sites in 1999, down from 29 in 1977, but 41 sites showing evidence of gyrfalcon use were identified, whereas only 29 such sites were identified in 1977. Eleven pairs of golden eagles were found in 1999, which is similar to the 10 pairs found in 1977. Rough-legged hawks were the most abundant and widespread cliff-nesting raptors in the NPR–A in both years. Their relative distribution was similar in the 2 years, but twice as many pairs were found in 1999 (109) as in 1977 (55). The difficulties of comparing the results of the two surveys are discussed

American history : The modern era since 1865

xxxviii,918 p .; 29 cm

Performance of Lactating Dairy Cows Fed Dried Sardines

To utilize locally available feed resources with livestock production in hot climates, dried sardines were incorporated into diets for lactating dairy cows. Fourteen Holstein and 13 Australian Milk Zebu multiparous cows were used in a 70-day continuous feeding experiment. lsonitrogenous and isoenergetic diets containing either soybean meal or dried sardines (supplied 40% of dietary crude protein) were fed ad - libitum. Comparisons between diets were made during the 7-week experimental period. The experiment was conducted as a 2 x 2 factorial arrangement of treatment, with diet and breed as main factors. Ruminal pH, ammonia N, total and individual volatile fatty acids concentrations were not altered by the feeding of dried sardines. Intakes of dry matter, energy, crude protein, and acid detergent fiber were lower (P0.05) in Holstein cows fed dried sardines than those fed the control diet (16.2 vs 15.1 kg/d). Feeding of dried sardines did not affect milk composition and compositional yields. Milk production was higher (P<0.01) in Holstein than Australian Milk Zebu cows. Effect of diet and breed interaction on milk production was significant (P<0.01 ). Potential of feeding marine proteins may be higher for higher milk producers (Holstein) than lower producers (Australian Milk Zebu). Reproduction parameters, body condition scores, and heat-stress associated parameters were not affected by the feeding of dried sardines. This study suggests that dried sardines could be incorporated into diets of lactating dairy cows without affecting milk production