Using information to deliver safer care: a mixed-methods study exploring general practitioners’ information needs in North West London primary care

The National Health Service in England has given increasing priority to improving inter-professional communication, enabling better management of patients with chronic conditions and reducing medical errors through effective use of information. Despite considerable efforts to reduce patient harm through better information usage, medical errors continue to occur, posing a serious threat to patient safety.This study explores the range, quality and sophistication of existing information systems in primary care with the aim to capture what information practitioners need to provide a safe service and identify barriers to its effective use in care pathways.Data were collected through semi-structured interviews with general practitioners from surgeries in North West London and a survey evaluating their experience with information systems in care pathways.Important information is still missing, specifically discharge summaries detailing medication changes and changes in the diagnosis and management of patients, blood results ordered by hospital specialists and findings from clinical investigations. Participants identified numerous barriers, including the communication gap between primary and secondary care, the variable quality and consistency of clinical correspondence and the inadequate technological integration.Despite attempts to improve integration and information flow in care pathways, existing systems provide practitioners with only partial access to information, hindering their ability to take informed decisions. This study offers a framework for understanding what tools should be in place to enable effective use of information in primary care

A retrospective study of cognitive function in doctors and dentists with suspected performance problems: an unsuspected but significant concern.

OBJECTIVE: To examine the performance assessments and cognitive function of practitioners referred to the National Clinical Assessment Service (NCAS). DESIGN: Retrospective observational study. SETTING: Practitioners referred to NCAS for performance assessment due to suspected performance problems. PARTICIPANTS: One hundred and nine practitioners over the age of 45 years referred to NCAS between 1 September 2008 and 30 June 2012. MAIN OUTCOME MEASURES: Reasons for referral of practitioners and their characteristics; details of their assessments including screening for cognition using Addenbrooke's Cognitive Examination Revised (ACE-R); outcome of the process. RESULTS: Reasons for referral included 'clinical difficulties' and 'governance or safety issues'. Eighty-seven practitioners scored above 88 on ACE-R. Twenty-two were found to have an ACE-R score of ≤88. On further assessment, 14 of these 22 practitioners were found to have cognitive impairment. The majority of all practitioners were found to be performing below the expected level of practice for someone at their grade and specialty. Of those scoring ≤88 on the screening, only seven continued in clinical practice. CONCLUSIONS: A high proportion of practitioners scoring poorly on ACE-R were found to have cognitive impairment following detailed neuropsychological testing, the youngest aged 46 years. Many were working in isolation. Nearly all practitioners scoring poorly on ACE-R were international medical graduates; reasons for this are unclear. Performance assessment results showed persisting failings in the practitioners' record keeping and in their assessment of patients. Our findings highlight the need for increased vigilance and training of responsible officers to recognise performance problems and emphasise the importance of comprehensive assessment

Antioxidant activity, total phenolic content and antimicrobial activity of two medicinal plants from Sulaimani City, Iraqi Kurdistan Region

Malabar spinach  fruit  with dark blue skin and deep red violet flesh is a potential source of natural colorant. Nasturtium  officinal (watercress) of family  Brassica  ceae  has been long used as a home remedy or a medical plant by the people  Iraq- Sulaimaini City .The aim of this study was to investigate the antioxidant , antimicrobial activity of Malabar spinach &Nasturtium  official (water cress) extracts using various in vitro assay systems including ferric reducing antioxidant power (FRAP),1,1-dipheny-2-picrylhydrazyl (DPPH), and 2,2-azinobis -3- ethylbenzothiozoline sulphonate (ABTS ).Antibacterial activity were tested against five gram-positive ,three gram –negative bacteria and two fungi by disc  diffusion method for different extract  and determining their minimum inhibitory concentration (MIC)values . Total phenolic content was determined by folin ciocalteu reagent for the extract (mg Gallic acid  /g extract ). From the result  highest total phenol content was shown by Malabar  spinach  & Nastartium officinale in methanol extracts. Elemental analysis  have been done element by inductive couple plasma (ICP) techniques for each this two medicinal plants high amount of Na ,K Ca, Mn ,Zn ,Mg, Fe, Cu ,and se  elements have been detected in ppb. Key words:  Malabar spinach  , Nasturtium  officinal, antioxidant   , antimicrobial  ,phenolic

In Vitro Propagation and Conservation of Inula Racemosa Hook. F. an Endangered Medicinal Plant of Temperate Origin

Inula racemosa is an endangered medicinal plant. It is commonly known as Pushkarmool, Pushkar and Manu. The great sage Charaka has characterized it as Hikka magrahana (stops hiccups) and Savasahara (helpful in asthma). Also, he has cited it as the best medicament for pleurisy along with cough and asthma (http://enwikipedia.org/wiki/charaka-samhita). Due to the fragile nature of its habitat and exploitation due to its commercial medicinal properties, the species are facing the onslaught of indiscriminate over-exploitation. So far, this plant has not got the required attention from researchers, hence, except for a few efforts, not much work has been done for its cultivation and conservation. Plant tissue culture offers an attractive and quick method for its multiplication and further conservation. In the present investigation, effective procedures for micropropagation and in vitro conservation by vitrification were developed. In vitro propagation using aseptically grown seedlings and in vitro conservation via vitrification were standardized. The in vitro conserved material could be retrieved and multiplied normally on MS (Murashige and Skoog, 1962) medium fortified with 1.00 mg l-1BA (benzyl adenine) which has been recorded as the best performing medium for in vitro shoot multiplication. The conserved shoots showed normal in vitro propagation and after retrieval from vitrification, platelets were hardened and successfully established in the experimental fields under Nauni (Solan, HP) conditions at an elevation of around 1275 meters above mean sea level

Prescribing trends of gabapentin, pregabalin and oxycodone; a secondary analysis of primary care prescribing patterns in England

Background The risk of iatrogenic harm from prescription drug use, misuse and abuse of drugs such as gabapentin, pregabalin and oxycodone is substantial. In recent years, deaths associated with these drugs in England have increased. Aims To characterise general practice prescribing trends for gabapentin, pregabalin and oxycodone – termed dependence forming medicines (DFM) – in England and describe potential drivers of unwarranted variation. Design and Setting This study is a retrospective secondary analysis of open source, publicly available government data from various sources pertaining to primary care demographics and prescriptions. Methods This study used five consecutive years (April 2013 – March 2018) of aggregate data to investigate longitudinal trends of prescribing and variation in prescribing trends at practice and clinical commissioning group (CCG) level. Results Annual prescriptions of gabapentin, pregabalin and oxycodone have increased each year over the period. Variation in prescribing trends were associated with GP practice deprivation quintile, where the most deprived GP practices prescribe 313% (p<0.001) and 238% (p<0.001) greater volumes of gabapentin and pregabalin per person than practices in the least deprived quintile. The highest prescribing CCGs of each of these drugs were predominantly in northern and eastern regions of England. Conclusions Substantial increases in gabapentin, pregabalin and oxycodone prescriptions are concerning and will increase iatrogenic harm from drug-related morbidity and mortality. More research is needed to understand the large variation in prescribing between general practices; and to develop and implement interventions to reduce unwarranted variation and increase the appropriateness of prescribing of these drugs

Synthesis, Mesomorphic and Molar Conductivity Studies of some Macrocyclic Phthalocyanine Palladium (II)

Two series of Macrocyclic Phthalocyanine Palladium(II) namely 4,4,4,4-RnPcPd and 3,3,3,3-RnPcPd were prepared and characterized. The mesomorphic investigation by hot stage polarizing microscope for these series was carried out. This investigation revealed that the 4,4,4,4-RnPcPd series exhibited columner mesophases while the second series 3,3,3,3-RnPcPd did not show any liquid crystalline properties.The molar conductivity measurments carried out in dimethyl sulfoxide and N,N-dimethyl formamide solvents for all prepared compounds at room temperature indicate that these compounds behave as weak electrolytes . Keywords: Macrocyclic compounds, Macrocyclic complexes, Liquid Crystals, Conductivity

Regulatory standards and guidance for the use of health applications for self-management in Africa: scoping review protocol

Introduction: Despite health applications becoming ubiquitous and with enormous potential to facilitate self-management, regulatory challenges such as poor application quality, breach of data privacy and limited interoperability have impeded their full adoption. While many countries now have digital health-related policies/strategies, there is also a need for regulatory standards and guidance that address key regulatory challenges associated with the use of health applications. Currently, it is unclear the status of countries in Africa regarding regulatory standards and guidance that address the use of health applications. This protocol describes the process of conducting a scoping review which aims to investigate the extent to which regulatory standards and guidance address the use of health applications for self-management within the WHO African Region countries. Methods: The review will follow the methodological framework for conducting a scoping study by Arksey and O’Malley (2005), and the updated methodological guidance for conducting a Joanna Briggs Institute (JBI) scoping review. Given that regulatory standards and guidance are unlikely to be available in scientific databases, we will search Scopus, Google, OpenGrey, WHO Regional Office for Africa Library (AFROLIB), African Index Medicus (AIM), websites of WHO, ITU and Ministries of Health, repositories for digital health policies. We will also search the reference lists of included documents, and contact key stakeholders in the region. Results will be reported using descriptive qualitative content analysis based on the review objectives. The policy analysis framework by Walt and Gilson (1994) will be used to organise findings. A summary of the key findings will be presented using tables, charts and maps. Ethics and dissemination: The collection of primary data is not anticipated in this study and hence ethical approval will not be required. The review will be published in a peer-reviewed journal while key findings will be shared with relevant organisations and/or presented at conferences

Allelopathic effect of Ficus benjamina leaf extract, litter, and mulch on germination and growth of sunflower

Allelopathy is an important biological process, which has direct or indirect effects on the germination and growth potentials of plants. Awareness about the allelopathic properties of plants which prevail in agricultural systems can help growers to amend crop cultivation patterns accordingly. In this study, we evaluated the allelopathic effects of Ficus benjamina on germination and early seedling growth of four hybrids of sunflower (Oliver, Parsun-3, SFH-80 and NK- S- 278). Ethanolic and hot-water aqueous extracts from leaves, while litter and mulches of the test allelopathic plant significantly reduced germination, radicle and hypocotyle growth of sunflower. Germination percentage was drastically reduced in all the four sunflower hybrids by ethanolic, hot-water and litter extracts; however, compared to control, mulching assay significantly increased germination in hybrids Oliver (76%), Parsun-3 (42%), SFH-80 (78%) and NK-S-278 (30%) at 2, 4, 8 and 12g extract concentration, respectively. Hypocotyle and radicle length of test hybrids were significantly reduced in each assay type. Among tested assays, ethanolic extracts revealed more drastic effects on the studied parameters than hot-water, litter, and mulching. Sunflower hybrid NK-S-278 was more severely affected, while Parsun-3 exhibited resistance to the allelopathic stress. Inhibitory effects were more prominent with increasing concentration of the extracts. The order of the phytotoxic effects of tested bioassays was ethanolic extract˃ hot-water˃ litter˃ mulching. The study suggested that Ficus leaves may possess potent allelochemicals with growth inhibitory effects on sunflower seedlings. It is suggested that further study might be required to check the allelopathic effect of Ficus benjamina on germination and growth of these sunflower hybrids in field conditions

Information-theoretic criterion for the performance of single-photon avalanche photodiodes

A channel-capacity metric is introduced for assessing the performance of single-photon avalanche photodiodes (SPADs) when used as detectors in laser communication systems. This metric is employed to theoretically optimize, with respect to the device structure and operating voltage, the performance of SPADs with simple InP or In/sub 0.52/Al/sub 0.48/As-InP heterojunction multiplication regions. As the multiplication-region width increases, an increase is predicted in both the peak and the full-width at half-maximum of the channel capacity curve versus the normalized excess voltage. Calculations also show the existence of an optimal In/sub 0.52/Al/sub 0.48/As-InP heterojunction multiplication region that maximizes the peak channel capacity beyond that of InP

Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database

Background: Recent studies suggest that older patients in the United Kingdom are not benefiting as much from improvements in cancer treatments as their younger counterparts. We investigate whether this might be partly due to differential referral rates using ovarian cancer as an example. Methods: From the General Practice Research Database (GPRD), we identified all women aged 40–80 years on 1 June 2002 with a Read code for ovarian cancer between 1 June 2002 and 31 May 2007. Using these records, we compared the GPRD incidence of ovarian cancer with rates compiled from the UK cancer registries and investigated the relationship between age and coded investigations for suspected ovarian cancer. Results: The GPRD rates peaked earlier, at 70–74, and were lower than registry rates for nearly all ages particularly for patients over 59. The proportion investigated or referred by the GP decreased significantly with age and delays between first coded symptom and investigation showed a U-shaped distribution by age. Conclusions: GPs appear to be less likely to recognise and to refer patients presenting with ovarian cancer as they get older. If our findings extend to other cancers, lack of or delays in referral to secondary care may partly explain poor UK cancer mortality rates of older people