Psychological aspects of patient safety

Book description: Patient safety is an issue which in recent years has grown to prominence in a number of countries’ political and health service agendas. The World Health Organisation has launched the World Alliance for Patient Safety. Millions of patients, according to the Alliance, endure prolonged ill-health, disability and death caused by unreliable practices, services, and poor health care environments. At any given time 1.4 million people worldwide are suffering from an infection acquired in a health facility. Patient Safety, Law Policy and Practice explores the impact of legal systems on patient safety initiatives. It asks whether legal systems are being used in appropriate ways to support state and local managerial systems in developing patient safety procedures, and what alternative approaches can and should be utilized. The chapters in this collection explore the patient safety managerial structures that exist in countries where there is a developed patient safety infrastructure and culture. The legal structures of these countries are explored and related to major in-country patient safety issues such as consent to treatment protocols and guidelines, complaint handling, adverse incident reporting systems, and civil litigation systems, in order to draw comparisons and conclusions on patient safety

A meta-narrative review of electronic patient records

This session comprises four papers that consider how systematic review methods may be developed in order to make the best use of complex evidence in education and health. The methods and approaches reflected upon in these papers are not drawn from a single research tradition, but share a common goal of broadening the methodological scope of systematic reviews and better understanding the utilisation of knowledge produced in this way. The first paper (Henry Potts) reports an ongoing review using a meta-narrative approach to make sense of the diverse sources of knowledge regarding electronic patient records. The review method has stressed the importance of understanding knowledge from within the research tradition in which it was produced; it is argued that this has important implications for the way that evidence is utilised in the policy making process. The second paper (Geoff Wong) reflects upon the experience of using an explicit realist approach in the synthesis of the evidence in Internet based learning. This realist synthesis offers a method of making sense of the highly heterogeneous and context dependent evidence which exists in this field thus enabling greater insights into what makes such educational interventions ‘work’. The third paper (Rod Sheaff) reports a review of the predominantly qualitative research literature on organisational structures and their impacts upon policy outcomes in health systems. A scoping study found 14389 relevant papers of which 1568 were selected for review. These studies were very variable in the amount and quality of the qualitative data, hence 'evidence', which they reported. The paper describes an attempt to adapt realist methods so as to synthesise such bodies of research in ways which take account of this variation in the strength of qualitative evidence. The fourth paper (Mark Pearson) draws upon the work of Donald Campbell and colleagues in order to gain a fuller understanding of how systematic reviews are utilised in the policy making process. It is argued that interpretive approaches to understanding policy making (such as rhetorical analysis) need to be tempered with a more nuanced understanding of research validity. The case is made that interpretive approaches not only can, but should, be melded with research validity to increase understanding of the policy making process

A systematic review of electronic patient records using the meta-narrative approach: Empirical findings and methodological challenges.

Systematic reviews are central to the enterprise of evidence-based medicine (EBM). However, traditional ‘Cochrane’ reviews have major limitations, especially when dealing with heterogeneous methodologies or an applied setting. The meta-narrative review (see Soc Sci Med 2005; 61: 417-30) is one of several new methods that seek to address pragmatic policy-level questions via broad-based literature reviews. Inspired by Kuhn, meta-narrative review takes a historical and paradigmatic approach to considering different areas of research activity. As an interpretive tool, the approach seeks distinct research traditions, each with its own meta-narrative. We then use these ‘stories of how research unfolded’ as a way of making sense of a diverse literature. Incommensurability between different traditions is seen not as a problem to be lamented or resolved but as a window to higher-order explanations about the nuances of empirical data and what these nuances mean for different applied situations. Having originally developed the meta-narrative method for a study of the diffusion of innovations in healthcare, we are now applying it in a review of the electronic patient record (EPR) in an organizational context. We have collated some 600 papers and books across multiple research traditions including health informatics, information systems research, computer-supported cooperative work (CSCW) and sociology. This very contemporary topic area is raising interesting methodological questions. For example, the EPR literature does not comprise as cleanly delineable traditions for four main reasons: 1. Information and communications technology research is a particularly fast-moving field, so paradigm shifts are relatively common (e.g. the rise of CSCW out of human-computer interaction research). 2. In the electronic age, it is easy for researchers to explore beyond their own discipline and ‘borrow’ theories, ideas and methods from elsewhere. Journal editors may commission overviews from experts in another tradition; authors may explicitly address an audience in another tradition. Research traditions can begin to converge (e.g. papers bringing together CSCW, information systems research and STS). 3. Some researchers are adept ‘boundary spanners’, writing for a number of different academic audiences and adapting their theoretical pedigree to fit (e.g. Marc Berg). 4. Some traditions are characterized not by a single unified paradigm but by active dialogue between competing paradigms (e.g. ‘hard’ versus ‘soft’ perspectives on knowledge management). This work contributes to the STS literature by critically questioning the nature of rigour in secondary research. The EBM movement values ‘Cochrane’ reviews because they meet positivist criteria (e.g. they are rational, objective, replicable, data-led, and transferable across contexts). In contrast, the meta-narrative review is interpretive, reflexive, problem-oriented and work-led, and makes no claim to either replicability or transferability. Rigour is redefined in terms of plausibility, authenticity and usefulness – raising the radical suggestion that the evidence base for key policy decisions can never be set in stone. Systematic reviews are central to the enterprise of evidence-based medicine (EBM). However, traditional ‘Cochrane’ reviews have major limitations, especially when dealing with heterogeneous methodologies or an applied setting. The meta-narrative review (see Soc Sci Med 2005; 61: 417-30) is one of several new methods that seek to address pragmatic policy-level questions via broad-based literature reviews. Inspired by Kuhn, meta-narrative review takes a historical and paradigmatic approach to considering different areas of research activity. As an interpretive tool, the approach seeks distinct research traditions, each with its own meta-narrative. We then use these ‘stories of how research unfolded’ as a way of making sense of a diverse literature. Incommensurability between different traditions is seen not as a problem to be lamented or resolved but as a window to higher-order explanations about the nuances of empirical data and what these nuances mean for different applied situations. Having originally developed the meta-narrative method for a study of the diffusion of innovations in healthcare, we are now applying it in a review of the electronic patient record (EPR) in an organizational context. We have collated some 600 papers and books across multiple research traditions including health informatics, information systems research, computer-supported cooperative work (CSCW) and sociology. This very contemporary topic area is raising interesting methodological questions. For example, the EPR literature does not comprise as cleanly delineable traditions for four main reasons: 1. Information and communications technology research is a particularly fast-moving field, so paradigm shifts are relatively common (e.g. the rise of CSCW out of human-computer interaction research). 2. In the electronic age, it is easy for researchers to explore beyond their own discipline and ‘borrow’ theories, ideas and methods from elsewhere. Journal editors may commission overviews from experts in another tradition; authors may explicitly address an audience in another tradition. Research traditions can begin to converge (e.g. papers bringing together CSCW, information systems research and STS). 3. Some researchers are adept ‘boundary spanners’, writing for a number of different academic audiences and adapting their theoretical pedigree to fit (e.g. Marc Berg). 4. Some traditions are characterized not by a single unified paradigm but by active dialogue between competing paradigms (e.g. ‘hard’ versus ‘soft’ perspectives on knowledge management). This work contributes to the STS literature by critically questioning the nature of rigour in secondary research. The EBM movement values ‘Cochrane’ reviews because they meet positivist criteria (e.g. they are rational, objective, replicable, data-led, and transferable across contexts). In contrast, the meta-narrative review is interpretive, reflexive, problem-oriented and work-led, and makes no claim to either replicability or transferability. Rigour is redefined in terms of plausibility, authenticity and usefulness – raising the radical suggestion that the evidence base for key policy decisions can never be set in stone

Anomalous Transport in Sketched Nanostructures at the LaAlO3/SrTiO3 Interface

The oxide heterostructure LaAlO3/SrTiO3 supports a two-dimensional electron liquid with a variety of competing phases including magnetism, superconductivity and weak antilocalization due to Rashba spin-orbit coupling. Further confinement of this 2D electron liquid to the quasi-one-dimensional regime can provide insight into the underlying physics of this system and reveal new behavior. Here we describe magnetotransport experiments on narrow LaAlO3/SrTiO3 structures created by a conductive atomic force microscope lithography technique. Four-terminal local transport measurements on ~10-nm-wide Hall bar structures yield longitudinal resistances that are comparable to the resistance quantum h/e2 and independent of the channel length. Large nonlocal resistances (as large as 10^4 ohms) are observed in some but not all structures with separations between current and voltage that are large compared to the 2D mean-free path. The nonlocal transport is strongly suppressed by the onset of superconductivity below ~200 mK. The origin of these anomalous transport signatures is not understood, but may arise from coherent transport defined by strong spin-orbit coupling and/or magnetic interactions

Development and initial testing of a Health Confidence Score (HCS)

Introduction Patients need to feel confident about looking after their own health. This is needed to improve patient outcomes and clinical support. With few suitable tools available to measure self-care health confidence, we developed and validated a short, generic survey instrument for use in evaluation and quality improvement. Methods The Health Confidence Score (HCS) was developed through literature review, patient and expert focus groups and discussions. This paper reports an initial survey (n = 1031, study 1) which identified some issues and a further face-to-face survey (n = 378, study 2) to test the construct and concurrent validity of the final version. Scores were correlated against the My Health Confidence (MHC) rating scale, howRu (health status measure) and relevant demographics. Results The HCS is short (50 words) with good readability (reading age 8). It has four items covering health knowledge, capability to self-manage, access to help and shared decision-making; each has four response options (strongly agree, agree, neutral disagree). Items are reported independently and as a summary score. The mean summary score was 76.7 (SD 20.4) on 0–100 scale. Cronbach’s alpha = 0.82. Exploratory factor analysis suggested that the four items relate to a single dimension. Correlation of the HCS summary score with MHC was high (Spearman r = 0.76). It was also associated with health status (Spearman r = 0.49), negatively with number of medications taken (r=–0.29) and age (r=–0.22) and not with ethnicity, having children or education level. Conclusions The HCS is short, easy to use, with good psychometric properties and construct validity. Each item is meaningful independently and the summary score gives an overall picture of health confidence

Isolation of Circulating Tumour Cells in Patients With Glioblastoma Using Spiral Microfluidic Technology – A Pilot Study

Glioblastoma (GBM) is the most common and aggressive type of tumour arising from the central nervous system. GBM remains an incurable disease despite advancement in therapies, with overall survival of approximately 15 months. Recent literature has highlighted that GBM releases tumoural content which crosses the blood-brain barrier (BBB) and is detected in patients' blood, such as circulating tumour cells (CTCs). CTCs carry tumour information and have shown promise as prognostic and predictive biomarkers in different cancer types. Currently, there is limited data for the clinical utility of CTCs in GBM. Here, we report the use of spiral microfluidic technology to isolate CTCs from whole blood of newly diagnosed GBM patients before and after surgery, followed by characterization for GFAP, cell-surface vimentin protein expression and EGFR amplification. CTCs were found in 13 out of 20 patients (9/20 before surgery and 11/19 after surgery). Patients with CTC counts equal to 0 after surgery had a significantly longer recurrence-free survival (p=0.0370). This is the first investigation using the spiral microfluidics technology for the enrichment of CTCs from GBM patients and these results support the use of this technology to better understand the clinical value of CTCs in the management of GBM in future studies

A Wireless Future: performance art, interaction and the brain-computer interfaces

Although the use of Brain-Computer Interfaces (BCIs) in the arts originates in the 1960s, there is a limited number of known applications in the context of real-time audio-visual and mixed-media performances and accordingly the knowledge base of this area has not been developed sufficiently. Among the reasons are the difficulties and the unknown parameters involved in the design and implementation of the BCIs. However today, with the dissemination of the new wireless devices, the field is rapidly growing and changing. In this frame, we examine a selection of representative works and artists, in comparison to the current scientific evidence. We identify important performative and neuroscientific aspects, issues and challenges. A model of possible interactions between the performers and the audience is discussed and future trends regarding liveness and interconnectivity are suggested

Health informatics competencies in postgraduate medical education and training in the UK: a mixed methods study

OBJECTIVE: To assess health informatics (HI) training in UK postgraduate medical education, across all specialties, against international standards in the context of UK digital health initiatives (eg, Health Data Research UK, National Health Service Digital Academy and Global Digital Exemplars). DESIGN: A mixed methods study of UK postgraduate clinician training curricula (71 specialties) against international HI standards: scoping review, curricular content analysis and expert consultation. SETTING AND PARTICIPANTS: A scoping literature review (PubMed until March 2017) informed development of a contemporary framework of HI competency domains for doctors. National training curricula for 71 postgraduate medical specialties were obtained from the UK General Medical Council and were analysed. Seven UK HI experts were consulted regarding findings. OUTCOMES: The International Medical Informatics Association (IMIA) Recommendations for Biomedical and Health Informatics Education were used to develop a framework of competency domains. The number (maximum 50) of HI competency domains included in each of the 71 UK postgraduate medical specialties was investigated. After expert review, a universal HI competency framework was proposed. RESULTS: A framework of 50 HI competency domains was developed using 21 curricula from a scoping review, curricular content analysis and expert consultation. All 71 UK postgraduate medical curricula documents were mapped across 29 of 50 framework domains; that is, 21 domains were unrepresented. Curricula mapped between 0 (child and adolescent psychiatry and core surgical training) and 16 (chemical pathology and paediatric and perinatal pathology) of the 50 domains (median=7). Expert consultation found that HI competencies should be universal and integrated with existing competencies for UK clinicians and were under-represented in current curricula. Additional universal HI competencies were identified, including information governance and security and secondary use of data. CONCLUSIONS: Postgraduate medical education in the UK neglects HI competencies set out by international standards. Key HI competencies need to be urgently integrated into training curricula to prepare doctors for work in increasingly digitised healthcare environments