Evaluation of the implementation of the alert issued by the UK National Patient Safety Agency on the storage and handling of potassium chloride concentrate solution

Objectives: To assess the effectiveness of the response of NHS hospital trusts to an alert issued by the National Patient Safety Agency designed to limit the availability of concentrated potassium chloride in hospitals in England and Wales, and to determine the nature of any unintended consequences. Design: Multi-method study involving interviews and a physical inspection of clinical areas. Setting: 207 clinical areas in 20 randomly selected acute NHS trusts in England and Wales between 31 October 2002 and 31 January 2003. Participants: Senior managers and ward based medical and nursing staff. Main outcome measures: Degree of staff awareness of and compliance with the requirements of the national alert, withdrawal of concentrated potassium chloride solutions from non-critical areas, provision of pre-diluted alternatives, storage and recording in accordance with controlled drug legislation. Results: All trusts required that potassium chloride concentrate be stored in a separate locked cupboard from common injectable diluents (100% compliance). Unauthorised stocks of potassium chloride were found in five clinical areas not authorised by the trust (98% compliance). All trusts required documentation control of potassium chloride concentrate in clinical areas, but errors were recorded in 20 of the 207 clinical areas visited (90% compliance). Of those interviewed, 78% of nurses and 30% of junior doctors were aware of the alert. Conclusions: The NPSA alert was effective and resulted in rapid development and implementation of local policies to reduce the availability of concentrated potassium chloride solutions. The success is likely to be partly due to the nature of the proposed changes and it cannot be assumed that future alerts will be equally effective. Continued vigilance will be necessary to help sustain the changes

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews

OBJECTIVES: To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE). DESIGN: Interrupted time series analysis, review of case notes, survey, and interviews. SETTING: Acute and primary care trusts in England and Wales. PARTICIPANTS: All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts. MAIN OUTCOME MEASURES: Rates of prescribing and use of procedures and medical devices relative to evidence based guidance. RESULTS: 6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P <0.002) and orlistat for obesity (P <0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer’s disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued. CONCLUSIONS: Implementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context

Performance of AAOmega: the AAT multi-purpose fibre-fed spectrograph

AAOmega is the new spectrograph for the 2dF fibre-positioning system on the Anglo-Australian Telescope. It is a bench-mounted, double-beamed design, using volume phase holographic (VPH) gratings and articulating cameras. It is fed by 392 fibres from either of the two 2dF field plates, or by the 512 fibre SPIRAL integral field unit (IFU) at Cassegrain focus. Wavelength coverage is 370 to 950nm and spectral resolution 1,000-8,000 in multi-Object mode, or 1,500-10,000 in IFU mode. Multi-object mode was commissioned in January 2006 and the IFU system will be commissioned in June 2006. The spectrograph is located off the telescope in a thermally isolated room and the 2dF fibres have been replaced by new 38m broadband fibres. Despite the increased fibre length, we have achieved a large increase in throughput by use of VPH gratings, more efficient coatings and new detectors - amounting to a factor of at least 2 in the red. The number of spectral resolution elements and the maximum resolution are both more than doubled, and the stability is an order of magnitude better. The spectrograph comprises: an f/3.15 Schmidt collimator, incorporating a dichroic beam-splitter; interchangeable VPH gratings; and articulating red and blue f/1.3 Schmidt cameras. Pupil size is 190mm, determined by the competing demands of cost, obstruction losses, and maximum resolution. A full suite of VPH gratings has been provided to cover resolutions 1,000 to 7,500, and up to 10,000 at particular wavelengths.Comment: 13 pages, 4 figures; presented at SPIE, Astronomical Telescopes and Instrumentation, 24 - 31 May 2006, Orlando, Florida US

3D virtual worlds as environments for literacy learning

Background: Although much has been written about the ways in which new technology might transform educational practice, particularly in the area of literacy learning, there is relatively little empirical work that explores the possibilities and problems - or even what such a transformation might look like in the classroom. 3D virtual worlds offer a range of opportunities for children to use digital literacies in school, and suggest one way in which we might explore changing literacy practices in a playful, yet meaningful context. Purpose: This paper identifies some of the key issues that emerged in designing and implementing virtual world work in a small number of primary schools in the UK. It examines the tensions between different discourses about literacy and literacy learning and shows how these were played out by teachers and pupils in classroom settings.Sources of evidence: Case study data are used as a basis for exploring and illustrating key aspects of design and implementation. The case study material includes views from a number of perspectives including classroom observations, chatlogs, in-world avatar interviews with teachers and also pupils, as well as the author’s field notes of the planning process with accompanying minutes and meeting documents.Main argument: From a Foucauldian perspective, the article suggests that social control of pedagogical practice through the regulation of curriculum time, the normalisation of teaching routines and the regimes of individual assessment restricts teachers’ and pupils’ conceptions of what constitutes literacy. The counternarrative, found in recent work in new litearcies (Lankshear & Knobel, 2006) provides an attractive alternative, but a movement in this direction requires a fundamental shift of emphasis and a re-conceptualisation of what counts as learning.Conclusions: This work on 3D virtual worlds questions the notion of how transformative practice can be achieved with the use of new technologies. It suggests that changes in teacher preparation, continuing professional development as well as wider educational reform may be needed

On the poverty of a priorism: technology, surveillance in the workplace and employee responses

Many debates about surveillance at work are framed by a set of a priori assumptions about the nature of the employment relationship that inhibits efforts to understand the complexity of employee responses to the spread of new technology at work. In particular, the debate about the prevalence of resistance is hamstrung from the outset by the assumption that all apparently non-compliant acts, whether intentional or not, are to be counted as acts of resistance. Against this background this paper seeks to redress the balance by reviewing results from an ethnographic study of surveillance-capable technologies in a number of British workplaces. It argues for greater attention to be paid to the empirical character of the social relations at work in and through which technologies are deployed and in the context of which employee responses are played out

Investigating children’s interactions around digital texts in classrooms : how are these framed and what counts?

This article argues that, in informing our understanding of the possibilities and challenges associated with new technologies in educational contexts, we need to explore what counts to children when using digital texts in classrooms, and what children think counts for their teachers. It suggests that such insights can be gained by investigating children's interactions around these texts and, drawing on Goffman's work, considering how these are framed. This is illustrated using examples from a study of classroom digital literacy events. The article suggests that it is important to consider how frames disrupt, intersect with and over-layer each other

"Evil cats" and "jelly floods": young children’s collective constructions of digital art-making in the early years classroom

Digital technologies have the potential to offer new opportunities for children’s expressive arts practices. While adult expectations surround and shape children’s visual art-making on paper in the early years classroom, such expectations are not so established in relation to digital art-making. So how do children make sense of digital art-making when it is newly introduced into the classroom and adult input is minimal? Drawing on a social semiotic ethnographic perspective, this paper explores this question by examining instances of 4-5 year olds’ spoken dialogue around the computer during a week in which digital art-making was first introduced into the classroom. Analysis focused on interactions where children proposed, reinforced or challenged conceptions of digital art-making. These interactions demonstrated that children’s digital art-making was negotiated and constructed through particular processes. Three such processes are presented here: the use of collective motifs and metaphors; attributing ‘expert’ status; and polarizing conflicts. Understanding these processes offers a starting point for thinking about how a new activity like digital art-making can be integrated into the early years classroom and supported by practitioners

Collaborative care for depression in UK primary care: a randomized controlled trial

Reproduced with permission of the publisher. © 2008 Cambridge University Press.Background. Collaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial. Method. We undertook a Phase II patient-level randomized controlled trial in primary care, nested within a clusterrandomized trial. Depressed participants were randomized to ‘collaborative care’ – case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication – or a usual care control. The primary outcome was symptoms of depression (PHQ-9). Results. We recruited 114 participants, 41 to the intervention group, 38 to the patient-randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18–1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (-2.99, 95% CI -7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (-4.64, 95% CI -7.93 to -1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00–0.32). Conclusions. Collaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings