Non medical prescribing leads views on their role and the implementation of non medical prescribing from a multi-organisational perspective

BACKGROUND: In the United Kingdom, non-medical prescribing (NMP) has been identified as one way to improve healthcare quality and efficiency. Healthcare organisations are charged with overseeing the clinical governance of NMP and guidance recommends the identification of a lead director to be responsible for its implementation. While over twelve million items are prescribed each year by the 50,000 qualified NMPs its uptake is inconsistent. Several studies have explored the barriers to NMP at a practice level, however little is known about the role the NMP lead and the implementation of NMP from an organisational perspective. The aim of this research was to explore the role of the organisational NMP lead across a range of practice settings within one Strategic Health Authority (SHA) and consider the development of NMP from a multi-organisational perspective. METHODS: Semi-structured telephone interviews with 28 NMP leads across one SHA were undertaken by a trained qualitative researcher. Interviews addressed the purpose of the role and difficulties encountered; audiotapes were transcribed, coded and themes were identified. RESULTS: The NMP lead role comprised of four main functions; communication, coordinating, clinical governance and support. Factors hampering progress in overseeing the safe development of NMP included lack of clarity about the NMP lead role and responsibilities, strategic support and a lack of protected time. The extent to which clinical governance systems were in place across organisations was inconsistent. Where a strategic approach to its development was adopted, fewer barriers were encountered and NMP was more likely to become embedded within organisations. CONCLUSIONS: The significant contribution that NMP leads play in embedding NMP within organisations should be acknowledged by clearer national guidance for this role and its responsibilities. Greater standardisation and consistency is required of clinical governance systems if quality and safety is to be ensured given the expanding development of NMP. The extent to which NMP is in place worldwide differs. However, our findings will be of interest to policymakers in other countries involved in the development and implementation of this role

VA Accountability Act of 2015 (H.R. 1994), as Reported to the House

[Excerpt] This report describes the VA Accountability Act of 2015 (H.R. 1994) as reported to the House by the Committee on Veterans Affairs on July 23 2015 and compares it to current law where appropriate. A press account has reported that Chairman Jeff Miller may meet with all committee members to seek views of the minority before floor action. As a result of this meeting, it is possible that the final bill that will go to the House floor may have some provisions that differ from those that the Committee reported. This report provides a section-by-section description of the act

Co-design and prototype development of the 'Ayzot App' : a mobile phone based remote monitoring system for palliative care

Background: Palliative care, a recognised component of care by the World Health Organization is poorly developed in low- and middle-income countries. Mobile phone technology, an effective way to increase access and sustainability of healthcare systems globally, has demonstrated benefits within palliative care service delivery, but is yet to be utilised in Ethiopia. Aim: To co-design, develop and evaluate a mobile phone based remote monitoring system for use by palliative care patients in Ethiopia Design: Two-phase co-design approach comprising multiple methods that is stakeholder interviews, focus groups, user-co-creation activities and healthcare worker prioritisation discussions 2019–2020. Phase-1 interviews ( n = 40), Phase-2 focus groups ( n = 3) and interviews ( n = 10). Setting/Participants: Hospice Ethiopia and Yekatit 12 Medical College Hospital: healthcare workers, palliative care patients, family carers & software-developers. Results: Co-design activities lead to development of the prototype ‘Ayzot’ application, which was well received and reported to be easy to use. Patients, and family caregivers saw provision of self-care information and symptom management as a key function of the App and expressed very positive attitudes towards such information being included. Healthcare workers found the App offered service benefits, in terms of time and cost-savings. Conclusion: This paper provides a detailed example of the development and design of a prototype remote monitoring system using mobile phone technology for palliative care use in Ethiopia. Further development and real-world testing are required, to not only understand how it acts within usual care to deliver anticipated benefits but also to explore its effectiveness and provide cost estimates for wider implementation

A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists

Background Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists.Aim: to compare outcomes of physiotherapist and podiatrist Independent Prescriber (PP- IP) patients with those of physiotherapist and podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications.Design: a mixed method comparative case study Methods: Using mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016). Results: 489 patients were recruited: n=243 IP sites, and n=246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p>0.05) and patient satisfaction (p≤0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than PP-NP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 minutes). ConclusionThis study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce

Point-to-point overlay of a 100Gb/s DP-QPSK channel in LR-PONs for urban and rural areas

The continuing growth in information demand from fixed and mobile end-users, coupled with the need to deliver this content in an economically viable manner, is driving new innovations in access networks. In particular, it is becoming increasingly important to find new ways to enable the coexistence of heterogeneous services types which may require different signal modulation formats over the same fiber infrastructure. For example, the same physical layer can potentially be used to deliver shared 10Gb/s services to residential customers, dedicated point-to-point (P2P) 100Gb/s services to business customers, and wireless fronthaul, in a highly cost-effective manner. In this converged scenario, the performance of phase modulated signals can be heavily affected by nonlinear crosstalk from co-propagating on-off-keying (OOK) channels. In this paper, the overlay of a 100G P2P dual-polarization quadrature phase-shift keying (DP-QPSK) channel in a long-reach passive optical network (LR-PON) in the presence of co-propagating 10Gb/s OOK neighboring channels is studied for two different PON topologies. The first LR-PON topology is particularly suited for densely populated areas while the second is aimed at rural, sparsely populated areas. The experimental results indicate that with an emulated load of 40 channels the urban architecture can support up to 100km span and 512 users, while the rural architecture can support up to 120km span and 1024 users. Finally, a system model is developed to predict the system performance and system margins for configurations different from the experimental setups and to carry out design optimization that could in principle lead to even more efficient and robust schemes

Hyracks: A flexible and extensible foundation for data-intensive computing

Abstract—Hyracks is a new partitioned-parallel software plat-form designed to run data-intensive computations on large shared-nothing clusters of computers. Hyracks allows users to express a computation as a DAG of data operators and connec-tors. Operators operate on partitions of input data and produce partitions of output data, while connectors repartition operators’ outputs to make the newly produced partitions available at the consuming operators. We describe the Hyracks end user model, for authors of dataflow jobs, and the extension model for users who wish to augment Hyracks ’ built-in library with new operator and/or connector types. We also describe our initial Hyracks implementation. Since Hyracks is in roughly the same space as the open source Hadoop platform, we compare Hyracks with Hadoop experimentally for several different kinds of use cases. The initial results demonstrate that Hyracks has significant promise as a next-generation platform for data-intensive applications. I

AsterixDB: A Scalable, Open Source BDMS

AsterixDB is a new, full-function BDMS (Big Data Management System) with a feature set that distinguishes it from other platforms in today's open source Big Data ecosystem. Its features make it well-suited to applications like web data warehousing, social data storage and analysis, and other use cases related to Big Data. AsterixDB has a flexible NoSQL style data model; a query language that supports a wide range of queries; a scalable runtime; partitioned, LSM-based data storage and indexing (including B+-tree, R-tree, and text indexes); support for external as well as natively stored data; a rich set of built-in types; support for fuzzy, spatial, and temporal types and queries; a built-in notion of data feeds for ingestion of data; and transaction support akin to that of a NoSQL store. Development of AsterixDB began in 2009 and led to a mid-2013 initial open source release. This paper is the first complete description of the resulting open source AsterixDB system. Covered herein are the system's data model, its query language, and its software architecture. Also included are a summary of the current status of the project and a first glimpse into how AsterixDB performs when compared to alternative technologies, including a parallel relational DBMS, a popular NoSQL store, and a popular Hadoop-based SQL data analytics platform, for things that both technologies can do. Also included is a brief description of some initial trials that the system has undergone and the lessons learned (and plans laid) based on those early "customer" engagements

Ultra-broadband 2D electronic spectroscopy of carotenoid-bacteriochlorophyll interactions in the LH1 complex of a purple bacterium

International audienc

Burst-mode FEC performance for PON upstream channels with EDFA optical transients

The performance of forward error correction (FEC) based on Reed-Solomon coding is analyzed experimentally for a burst-mode upstream channel within a passive optical network (PON) testbed. During this analysis, the upstream FEC performance is impaired by inducing correlated and localized errors within the burst through the injection of optical transients. These transients emulate the optical signal variation associated with the add-and-drop events of wavelength channels within a long-reach optical link based on a chain of erbium doped fiber amplifiers (EDFAs). The robustness of the FEC has been analyzed by measuring the post-FEC bit error rate (BER) as a function of the amplitude of the emulated transients and their delay with respect to the transmitted bursts. A margin of approximately 4dB is demonstrated for the transient amplitude before the FEC degradation. Furthermore, while the post-FEC BER is strongly degraded by the emulated transients, the preFEC BER stays below the FEC threshold, demonstrating the importance of measuring the post-FEC BER in order to correctly characterize the FEC performance in PON upstream channels affected by optical transients

Medicines management activity with physiotherapy and podiatry: a systematic mixed studies review

Objective: Making best use of existing skills to increase service capacity is a global challenge. The aim was to systematically review physiotherapy and podiatrist prescribing and medicines management activity, including evidence of impact on patient care, levels of knowledge and attitudes towards extended medicines role. Methods: A search of MEDLINE, CINAHL, and Cochrane databases, using terms to identify prescribing and medicines management across a range of roles, was conducted from January 1985 to May 2016 for physiotherapy, and January 1968 to May 2016 for podiatry. Hand searching of citations and databases from professional organisations was undertaken. Data were extracted and analysed descriptively, and quality appraised by 2 reviewers using the mixed methods appraisal tool. Results:1316 papers were identified, and 21 included in the review. No studies were identified that reported prescribing and no studies specific to podiatry met the inclusion criteria. Physiotherapists were highly involved in administering medicines, providing medicines advice, and recommending new medicines. Patient satisfaction, cost and outcomes were equivalent when comparing physiotherapist-led injection therapy to traditional care. Pharmacology knowledge was variable and unmet training needs identified. Conclusion:Medicines management practices were identified in physiotherapy and positive outcomes of extended scope physiotherapy. There was a lack of evidence regarding podiatric practice. Review of educational preparation for medicines management is recommended along with evaluation of medicines management practice