User Testing to Improve Retrieval and Comprehension of Information in Guidelines to Improve Medicines Safety

Objective: The aim of the study was to investigate the effectiveness of user testing for improving healthcare professionals’ retrieval and comprehension of information in medicines guidelines. Methods: The United Kingdom’s Injectable Medicines Guide was selected as a case study. This gives guidance to nurses on preparing and administering intravenous medicines on hospital wards, in line with standard UK practice. Three rounds of user testing were completed with 10 hospital nurses per round, using the Injectable Medicines Guide for voriconazole and aminophylline. Participants used the guidelines to answer 17 questions related to the administration of these medicines. Answers were scored for “finding” and “understanding” the required information. Semistructured interviews explored participants’ opinions of guideline content, design, and wording, with responses analyzed thematically. The guidelines were revised between rounds. Results: In round 1, 8 of 17 questions were answered correctly by all participants. Participants had difficulty with dose, dilution, administration rate, and adverse effects questions. Revisions included new subsections and increased calculation support. In round 2, 14 of 17 questions were answered correctly by all participants. Difficulty persisted with dose and administration rate questions and further revisions made. In round 3, 15 of 17 questions were answered correctly by all participants. Across all rounds, participants considered appropriate subheadings and information order as important for fast location of information. Specific, detailed, and practical instructions were perceived as important to improve understandability and usefulness. Conclusions: Key information in medicines guidelines may not be found and/or understood by healthcare professionals. User testing increased information retrieval and comprehension and could have an important role in improving the safety of medicines use

User-testing guidelines to improve the safety of intravenous medicines administration: a randomised in situ simulation study

Background: User-testing and subsequent modification of clinical guidelines increases health professionals’ information retrieval and comprehension. No study has investigated whether this results in safer care. Objective: To compare the frequency of medication errors when administering an intravenous medicine using the current National Health Service Injectable Medicines Guide (IMG) versus an IMG version revised with user-testing. Method: Single-blind, randomised parallel group in situ simulation. Participants were on-duty nurses/midwives who regularly prepared intravenous medicines. Using a training manikin in their clinical area, participants administered a voriconazole infusion, a high-risk medicine requiring several steps to prepare. They were randomised to use current IMG guidelines or IMG guidelines revised with user-testing. Direct observation was used to time the simulation and identify errors. Participant confidence was measured using a validated instrument. The primary outcome was the percentage of simulations with at least one moderatesevere IMG-related error, with error severity classified by an expert panel. Results: In total, 133 participants were randomised to current guidelines and 140 to user-tested guidelines. Fewer moderate-severe IMG-related errors occurred with the user-tested guidelines (n=68, 49%) compared with current guidelines (n=79, 59%), but this difference was not statistically significant (risk ratio: 0.82; 95% CI 0.66 to 1.02). Significantly more simulations were completed without any IMG-related errors with the usertested guidelines (n=67, 48%) compared with current guidelines (n=26, 20%) (risk ratio: 2.46; 95% CI 1.68 to 3.60). Median simulation completion time was 1.6min (95% CI 0.2 to 3.0) less with the user-tested guidelines. Participants who used user-tested guidelines reported greater confidence. Conclusion: User-testing injectable medicines guidelines reduces the number of errors and the time taken to prepare and administer intravenous medicines, while increasing staff confidence. Trial registration: number researchregistry5275

User-testing guidelines to improve the safety of intravenous medicines administration: a randomised in situ simulation study

Background: User-testing and subsequent modification of clinical guidelines increases health professionals’ information retrieval and comprehension. No study has investigated whether this results in safer care. Objective: To compare the frequency of medication errors when administering an intravenous medicine using the current National Health Service Injectable Medicines Guide (IMG) versus an IMG version revised with user-testing. Method: Single-blind, randomised parallel group in situ simulation. Participants were on-duty nurses/midwives who regularly prepared intravenous medicines. Using a training manikin in their clinical area, participants administered a voriconazole infusion, a high-risk medicine requiring several steps to prepare. They were randomised to use current IMG guidelines or IMG guidelines revised with user-testing. Direct observation was used to time the simulation and identify errors. Participant confidence was measured using a validated instrument. The primary outcome was the percentage of simulations with at least one moderate-severe IMG-related error, with error severity classified by an expert panel. Results: In total, 133 participants were randomised to current guidelines and 140 to user-tested guidelines. Fewer moderate-severe IMG-related errors occurred with the user-tested guidelines (n=68, 49%) compared with current guidelines (n=79, 59%), but this difference was not statistically significant (risk ratio: 0.82; 95% CI 0.66 to 1.02). Significantly more simulations were completed without any IMG-related errors with the user-tested guidelines (n=67, 48%) compared with current guidelines (n=26, 20%) (risk ratio: 2.46; 95% CI 1.68 to 3.60). Median simulation completion time was 1.6 min (95% CI 0.2 to 3.0) less with the user-tested guidelines. Participants who used user-tested guidelines reported greater confidence. Conclusion: User-testing injectable medicines guidelines reduces the number of errors and the time taken to prepare and administer intravenous medicines, while increasing staff confidence. Trial registration number: researchregistry5275

Methodological variations and their effects on reported medication administration error rates

Medication administration errors (MAEs) are a problem, yet methodological variation between studies presents a potential barrier to understanding how best to increase safety. Using the UK as a case-study, we systematically summarised methodological variations in MAE studies, and their effects on reported MAE rates

Dramatizing an Articulation of the (P)Artistic Researcher’s Posthumanist Pathway to a ‘Slow Professorship’ Within the Corporate University Complex

Within academia, the practical arts researcher endures an unstable status owing, in part, to the diverse research methodologies gathered underneath the umbrellas of Practice-[led/based/as/for]- Research. (P)Artistic Research is difficult to define, no less validate, in a result-oriented, data-driven, ‘performance’-measuring culture. The (P)Artistic Researcher embodies dissent in such contexts, as the nature of most artistic research is process-oriented, collaborative and solution-finding. In response to Berg and Seeber’s pleas for ‘slowness’ in The Slow Professor, this chapter reflects critically on the author’s habits and history as a (P)Artistic Researcher while moving through a ‘gap’ in employment, from a dramatic resignation at one institution to an acceptance of a new post at another institution, one year later. This writing is contaminated by aspects of the author’s ‘playwrighting’ practice, becoming a posthuman ‘playper’ in which forms of writing are intertwined, and structure, layout and grammatical positioning are used innovatively to produce new knowledge which is not ‘in-prism-ed’ by the narrow perspective of the corporate university. The content of the ‘playper’ offers a malleable frame with several pedagogical points of entry, including prompts, provocations and practical exercises which intend to slowly contaminate the classroom with a conscientious commitment to a posthuman understanding of the world

Opportunistic dose amplification for proton and carbon ion therapy via capture of internally generated thermal neutrons

© 2018, The Author(s). This paper presents Neutron Capture Enhanced Particle Therapy (NCEPT), a method for enhancing the radiation dose delivered to a tumour relative to surrounding healthy tissues during proton and carbon ion therapy by capturing thermal neutrons produced inside the treatment volume during irradiation. NCEPT utilises extant and in-development boron-10 and gadolinium-157-based drugs from the related field of neutron capture therapy. Using Monte Carlo simulations, we demonstrate that a typical proton or carbon ion therapy treatment plan generates an approximately uniform thermal neutron field within the target volume, centred around the beam path. The tissue concentrations of neutron capture agents required to obtain an arbitrary 10% increase in biological effective dose are estimated for realistic treatment plans, and compared to concentrations previously reported in the literature. We conclude that the proposed method is theoretically feasible, and can provide a worthwhile improvement in the dose delivered to the tumour relative to healthy tissue with readily achievable concentrations of neutron capture enhancement drugs

Election turnout statistics in many countries: similarities, differences, and a diffusive field model for decision-making

We study in details the turnout rate statistics for 77 elections in 11 different countries. We show that the empirical results established in a previous paper for French elections appear to hold much more generally. We find in particular that the spatial correlation of turnout rates decay logarithmically with distance in all cases. This result is quantitatively reproduced by a decision model that assumes that each voter makes his mind as a result of three influence terms: one totally idiosyncratic component, one city-specific term with short-ranged fluctuations in space, and one long-ranged correlated field which propagates diffusively in space. A detailed analysis reveals several interesting features: for example, different countries have different degrees of local heterogeneities and seem to be characterized by a different propensity for individuals to conform to the cultural norm. We furthermore find clear signs of herding (i.e. strongly correlated decisions at the individual level) in some countries, but not in others.Comment: 15 pages, 9 figures, 7 table

The use and functionality of electronic prescribing systems in English acute NHS trusts: a cross-sectional survey

To describe current use of electronic prescribing (EP) in English acute NHS hospital trusts, and the use of multiple EP systems within the same hospital

Satisfaction with democracy and voter turnout

Numerous studies conclude that countries in which citizens express higher levels of satisfaction with democracy also tend to display higher levels of voter turnout in national elections. Yet it is difficult to draw causal inferences from this positive cross-sectional relationship, because democracies feature many historical, cultural, and institutional differences that are not easily controlled for in cross-sectional comparisons. We apply an alternative, temporal approach to this issue by asking the question: Are over-time declines (increases) in aggregate levels of satisfaction within democracies associated with increases (declines) in levels of voter turnout within these democracies? Our temporal analysis of this relationship in 12 democracies over the period 1976–2011 reveals a pattern that is the opposite of that suggested by previous cross-sectional studies: namely, we find that over-time increases in citizens’ satisfaction with democracy are associated with significant decreases in voter turnout in national elections in these countries. </jats:p