Electronic risk assessment for venous thromboembolism: investigating physicians' rationale for bypassing clinical decision support recommendations.

Objective: The underutilisation of venous thromboembolism (VTE) prophylaxis is still a problem in the UK despite the emergence of national guidelines and incentives to increase the number of patients undergoing VTE risk assessments. Our objective was to examine the reasons doctors gave for not prescribing enoxaparin when recommended by an electronic VTE risk assessment alert. Design: We used a qualitative research design to conduct a thematic analysis of free text entered into an electronic prescribing system. Setting: The study took place in a large University teaching hospital, which has a locally developed electronic prescribing system known as PICS (Prescribing, Information and Communication System). Participants: We extracted prescription data from all inpatient admissions over a 7-month period in 2012 using the audit database of PICS. Intervention: The completion of the VTE risk assessment form introduced into the hospital-wide electronic prescribing and health records system is mandatory. Where doctors do not prescribe VTE prophylaxis when recommended, they are asked to provide a reason for this decision. The free-text field was introduced in May 2012. Primary and Secondary Outcome Measures: Free-text reasons for not prescribing enoxaparin when recommended were thematically coded. Results: A total of 1136 free-text responses from 259 doctors were collected in the time period and 1206 separate reasons were analysed and coded. 389 reasons (32.3%) for not prescribing enoxaparin were coded as being due to 'clinical judgment'; in 288 (23.9%) of the responses, doctors were going to reassess the patient or prescribe enoxaparin; and in 245 responses (20.3%), the system was seen to have produced an inappropriate alert. Conclusions: In order to increase specificity of warnings and avoid users developing alert fatigue, it is essential that an evaluation of user responses and/or end user feedback as to the appropriateness and timing of alerts is obtained

Direct detection of alpha synuclein oligomers in vivo

Background: Rat models of Parkinson’s disease are widely used to elucidate the mechanisms underlying disease etiology or to investigate therapeutic approaches. Models were developed using toxins such as MPTP or 6-OHDA to specifically target dopaminergic neurons resulting in acute neuronal loss in the substantia nigra or by using viral vectors to induce the specific and gradual expression of alpha synuclein in the substantia nigra. The detection of alpha- synuclein oligomers, the presumed toxic species, in these models and others has been possible using only indirect biochemical approaches to date. Here we coinjected AAVs encoding alpha-synuclein fused to the N- or C-terminal half of VenusYFP in rat substantia nigra pars compacta and describe for the first time a novel viral vector rodent model with the unique ability to directly detect and track alpha synuclein oligomers ex vivo and in vivo. Results: Viral coinjection resulted in widespread VenusYFP signal within the nigrostriatal pathway, including cell bodies in the substantia nigra and synaptic accumulation in striatal terminals, suggestive of in vivo alpha-synuclein oligomers formation. Transduced rats showed alpha-synuclein induced dopaminergic neuron loss in the substantia nigra, the appearance of dystrophic neurites, and gliosis in the striatum. Moreover, we have applied in vivo imaging techniques in the living mouse to directly image alpha-synuclein oligomers in the cortex. Conclusion: We have developed a unique animal model that provides a tool for the Parkinson’s disease research community with which to directly detect alpha- synuclein oligomers in vivo and screen therapeutic approaches targeting alpha-synuclein oligomers

Special article : Quarterly Economic Commentary: Volume 10-18

The Fraser ofAllander Institute has, since its inception, sought to promote debate and research into the Scottish economy. One way in which we have done this is to publish, every quarter, a collection of views and results from those who conduct research in this area. In the current volume J McGilvray presents a review of the responses to the government's consultation paper on water and sewerage in Scotland. In previous volumes, a large number of articles appeared and addressed a wide variety of subjects. Articles which appeared in volumes 10 - 18 are documented on the following pages and those wishing to obtain backcopies can do so, through the Institute, by contacting the editor. Articles appear by volume & number and are labelled according to whether they were a Feature Article (FA), Briefing Paper (BP), Economic Perspective (EP) or a Special Article (SA

The Role of Emotional Disclosure in Self-Management Interventions for People with a Long-term Chronic Health Condition

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Learning spaces, agency and notions of improvement: what influences thinking and practices about teaching and learning in higher education? An interpretive meta-ethnography

This review sought to locate key themes in the literature on teaching and learning thinking and practices, by examining areas of influence and mapping ideas about the themes of practice, transfer and communities in higher education or related contexts. The findings indicate that issues of pedagogical stance, disjunction, learning spaces, agency, notions of improvement and communities of interest can help to locate overarching themes and hidden subtexts that are strong influences on areas of practice, transfer and community. Nevertheless, these are areas that are sometimes ignored, marginalised or dislocated from the central arguments about teaching and learning thinking and practices in higher education.<br/