Optimising medicines administration for patients with dysphagia in hospital:Medical or nursing responsibility?

Dysphagia is common—not only associated with stroke, dementia, Parkinson’s but also in many non-neurological medical problems—and is increasingly prevalent in ageing patients, where malnutrition is common and pneumonia is frequently the main cause of death. To improve the care of people with dysphagia (PWD) and minimise risk of aspiration and choking, the textures of food and drinks are frequently modified. Whilst medicines are usually concurrently prescribed for PWD, their texture is frequently not considered and therefore any minimisation of risk with respect to food and drink may be being negated when such medicines are administered. Furthermore, evidence is starting to emerge that mixing thickeners with medicines can, in certain circumstances, significantly affect drug bioavailability and therefore amending the texture of a medicine may not be straightforward. Research across a number of hospital trusts demonstrated that PWD are three times more likely to experience medication administration errors than those without dysphagia located on the same ward. Errors more commonly seen in PWD were missed doses, wrong formulation and wrong preparation through medicines alteration. Researchers also found that the same patient with dysphagia would be given their medicines in entirely different ways depending on the person administering the medicine. The alteration of medicines prior to administration has potential for patient harm, particularly if the medicine has been designed to release medicines at a pre-defined rate or within a pre-defined location. Alteration of medicines can have significant legal implications and these are frequently overlooked. Dispersing, crushing or mixing medicines can be part of, or misconstrued as, covert administration, thus introducing a further raft of legislation. Guidance within the UK recommends that following identification of dysphagia, the ongoing need for the medicine should be considered, as should the most appropriate route and formulation, with medicines alteration used as a last resort. The patient should be at the centre of any decision making. Evidence suggests that in the UK this guidance is not being followed. This article considers the clinical and legal issues surrounding administration of medicines to PWD from a UK perspective and debates whether medicines optimisation should be the primary responsibility of the prescriber when initiating therapy on the ward or the nurse who administers the medicine

Individual effects and dynamics in count data models

In this paper we examine the panel data estimation of dynamic models for count data that include correlated fixed effects and predetermined variables.dtnamic count panel data, individual effects, predetermined regressors, Generalised Method of Moments, pre-smaple information

LawSync: navigating the ‘blue oceans’ within the ‘emerging’ legal services markets

Change, it is said, is the only constant. Whilst it cannot be avoided, the worlds of legal education and legal services have arguably enjoyed an extended period where the impact of change has been comparatively minimal. Today, these worlds face significant changes due to a combination of market and regulatory forces. True, such changes are likely to be accompanied by challenges but with these challenges come opportunities. There is no reason why Law Schools and Law students cannot help to shape these changes and benefit from them. LawSync™ is a project that seeks to enable such influence and attract such benefits at Sheffield Hallam University. See http://www.lawsync.com and http://twitter.com/lawsync for more details

Countering the Criminalization of Youth: A Denominational Strategy for Developing a Holistic Ecclesiastical Approach

The purpose of this project is to create a strategy within the North Georgia United Methodist Church Conference (NGUMC) structures to counter the criminalization of youth by engaging in opportunities that bring awareness to the NGUMC and then engage in mentoring and other activities designed to counter this criminalization of youth through holistic and intergenerational approaches at the various ecclesiastical levels within the Conference. There is a growing concern among educators and other youth service professionals in regards to what has been called “the school to prison pipeline.” While a growing number of youth are at risk of falling victim to a culture of criminalization, youth of color and lower socioeconomic status and those in foster care are at particular risk. Few churches are aware that various social agencies are engaging in processes of systemic and systematic criminalization of youth. This paper is divided into three parts. Part One explores factors contributing to the criminalization of youth in order to gain an understanding of the development and progression of this phenomenon. This portion also examines how criminalization impacts youth, families, and society. Part Two offers an overview of theology found in the Bible and the United Methodist Book of Discipline, each mandating that the Church come to the aid of those most vulnerable. Part Three suggests how the Church can be a vital part of curtailing the criminalization of young people, especially foster children who are at a greater risk of criminalization. To fulfill the goal of addressing and curtailing this, a collaborative effort with other churches and child/youth service agencies within the community is developed in order to strengthen, equip, educate, and encourage foster and adoptive families. Support also comes in the form of a monthly support group providing training and fellowship. Part Three concludes with an evaluation

Colorado’s Hazardous Waste Program: Current Activities and Issues

17 pages

Practical Analysis of Blocking Oscillators

The objective is to give a method of treatment of blocking oscillator circuits which will be of practical value for circuit design. An attempt has been made to reach a good compromise between accuracy, generality, and usefulness. The use of statistical methods to complement the mathematical analyses is stressed

Colorado’s Hazardous Waste Program: Current Activities and Issues

17 pages

The Effects of Entry on Incumbent Innovation and Productivity

How does firm entry affect innovation incentives and productivity growth in incumbent firms? Micro-data suggests that there is heterogeneity across industries--incumbents in technologically advanced industries react positively to foreign firm entry, but not in laggard industries. To explain this pattern, we introduce entry into a Schumpeterian growth model with multiple sectors which differ by their distance to the technological frontier. We show that technologically advanced entry threat spurs innovation incentives in sectors close to the technological frontier--successful innovation allows incumbents to prevent entry. In laggard sectors it discourages innovation--increased entry threat reduces incumbents' expected rents from innovating. We find that the empirical patterns hold using rich micro-level productivity growth and patent panel data for the UK, and controlling for the endogeneity of entry by exploiting the large number of policy reforms undertaken during the Thatcher era.

Competition and innovation: an inverted U relationship

This paper investigates the relationship between product market competition (PMC) and innovation. A Schumpeterian growth model is developed in which firms innovate ѳtep-by-stepҬ and where both technological leaders and their followers engage in R&D activities. In this model, competition may increase the incremental profit from innovating; on the other hand, competition may also reduce innovation incentives for laggards. This model generates four main predictions which we test empirically. First, the relationship between product market competition (PMC) and innovation is an inverted U-shape: the escape competition effect dominates for low initial levels of competition, whereas the Schumpeterian effect dominates at higher levels of competition. Second, the equilibrium degree of technological Ѯeck-and-neckness' among firms should decrease with PMC. Third, the higher the average degree of Ѯeck-and-neckness' in an industry, the steeper the inverted-U relationship between PMC and innovation in that industry. Fourth, firms may innovate more if subject to higher debt-pressure, especially at lower levels of PMC. We confront these four predictions with a new panel data set on UK firms' patenting activity at the US patenting office. The inverted U relationship, the neck and neck, and the debt pressure predictions are found to accord well with observed behavior in the data.

Competition and Innovation: An Inverted U Relationship

This paper investigates the relationship between product market competition (PMC) and innovation. A growth model is developed in which competition may increase the incremental profit from innovating; on the other hand, competition may also reduce innovation incentives for laggards. There are four key predictions. First, the relationship between product market competition (PMC) and innovation is an inverted U-shape. Second, the equilibrium degree of technological neck-and-neckness' among firms should decrease with PMC. Third, the higher the average degree of neck-and-neckness' in an industry, the steeper the inverted-U relationship. Fourth, firms may innovate more if subject to higher debt-pressure, especially at lower levels of PMC. We confront these predictions with data on UK firms' patenting activity at the US patenting office. They are found to accord well with observed behavior.