The Application of Soft Systems Methodology for Improving the Agrotechnology Transfer Process Responding to Tree Crop Farming Concerns in Kona, Hawaii

This dissertation applied soft systems methodology for improving the agrotechnology transfer process responding to tree crop farming concerns in Kona, Hawaii. The ten-month study undertook on-site research activities involving randomly selected Kona farmers, leaders of commodity organizations and university staff. The analyst engaged participants in the methodology's seven-stage process. They 1) described non-commodity specific and coffee, macadamia nut and avocado concerns, 2) envisioned improvements, 3) developed models of improved situations, 4) compared these models with the actual situation, 5) debated feasible and desirable changes and 6) implemented agreed-upon changes. Major conclusions of the study were that: 1) soft systems methodology caused change in agrotechnology transfer because it accounted for multiple worldviews affecting the process, 2) the current agrotechnology transfer structure, the Industry Analysis Program, had shortcomings, 3) participants requested soft systems methodology for improving the agrotechnology transfer process and on-farm research activities in Kona for assisting small-scale farmers, and 4) the analyst was a catalyst that assisted community members in bringing changes to the agrotechnology transfer process

Experiences and Perceptions of Rural Junior High Teachers Participating in a Professional Learning Community

In this qualitative descriptive case study, the researcher investigated how junior high school teachers’ perceptions of the role of how professional learning communities (PLCs) shaped their instructional practices in a rural Title I school in Texas. Exploring and understanding the experiences and perceptions of the teachers and administrators that participated in an English, language arts, and reading PLC provided valuable data that helped the administration determine professional development opportunities that could improve the instructional strategies of the teachers. By collaborating, analyzing student data, and sharing teaching strategies, the teachers were empowered to take ownership and improve their instructional practices. Examining the teachers’ perceptions and experiences revealed the strengths and weaknesses of the local program and provided an opportunity to personalize professional development to increase teacher learning as well as student achievement. Furthermore, the researcher identified and analyzed barriers to develop a plan of action to increase stronger team bonding. Keywords: professional learning communities; collaboration; shared mission, vision, and values; collective inquiry; continuous improvement; results orientatio

Inclusion: A Sense of Belonging

The purpose of this professional development module is to improve knowledge and skills in order to facilitate individual, school-wide, and district-wide improvements for the purpose of increasing academic and social achievement of students with disabilities in the inclusive setting. View professional learning module.https://digitalcommons.gardner-webb.edu/improve/1021/thumbnail.jp

Hospital electronic prescribing system implementation impact on discharge information communication and prescribing errors: a before and after study.

The study aimed to test the hypothesis that hospital electronic prescribing and medicine administration (HEPMA) system implementation impacted patient discharge letter quality, and the nature and frequency of prescribing errors. A quasi experimental before and after retrospective case note review was conducted in one United Kingdom district general hospital. The total sample size was 318 (random samples of 159 before and after implementation), calculated to achieve a 10% error reduction with a power of 80% and p < 0.05. Adult patients discharged after ≥24 hour inpatient stay were assessed for discharge information documentation quality using a modified validated discharge document template. Prescribing errors were classified as medicine omissions, commissions, incorrect dose/frequency/ duration, drug interactions, therapeutic duplications or missing/inaccurate allergy information. Post-implementation assessments were undertaken four months after HEPMA implementation. Error severity was determined by a multidisciplinary panel consensus using the Medications at Transitions and Clinical Handoffs (MATCH) study validated scoring system. There were no statistically significant differences in patient demographics between the pre and post-implementation groups. Discharge information documentation quality improved; allergy documentation increased from 11 to 159/159 (p < 0.0001). The number of patients with prescribing errors reduced significantly from 158 to 37/159 (p < 0.001).Prescribing error category incidence identified in preimplementation patients was reduced (e.g. omission incidence from 66 to 18/159 (p < 0.001)), although a new error type (sociotechnical [errors caused by the system]) was identified post-implementation (n=8 patients). Post-implementation prescribing errors severity rating identified 8/37 as likely to cause potential patient harm. In conclusion, HEPMA implementation was associated with improved discharge documentation quality, statistically significant prescribing error reduction and prescribing error type alteration. There remains a need to be alert for potential prescribing errors

Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation.

Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation produced perceptions of patient safety improvement. TDF use enabled behaviour change analysis due to implementation, for example, staff adoption of behaviours to ensure general practitioners receive good quality discharge information

Hospital discharge information communication and prescribing errors: a narrative literature overview.

Objectives - To provide a narrative overview of the literature on discharge information communication and medicines discharge prescribing error rate in the UK and other similar healthcare systems. Methods - A narrative review of the peer reviewed literature (2000-2014) on communication of discharge information from hospitals to general practitioners. Databases included were MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index and Abstracts, and International Pharmacy Abstracts database. Results - The search yielded 673 results with 15 papers satisfying all inclusion criteria. Direct comparison of studies was not feasible due to differences in study populations and outcome measures. No studies reported post Hospital Electronic Prescribing and Medicine Administration (HEPMA) implementation. Studies (n=6) investigating handwritten discharge communication systems demonstrated medicine information inaccuracy ranging from 0.81 errors per patient to 17.5% medicines with errors and 67% letters missing medicines change information; with 77% assessed as legible. Studies (n=4) comparing interim electronic solutions with traditional showed variable results: improved, unchanged or decreased medicine information accuracy. Studies researching solely interim electronic solutions (n=5) with one including prescribing error rate assessment at 8.4% of prescribed items and identification of a new electronic system-related error type. Conclusion - Implementation of interim electronic discharge solutions resulted in complete legibility but did not eradicate information and prescribing errors. A paucity of information is available about HEPMA implementation impact on discharge information communication and prescribing error rates. There is urgent need for formal evaluation in this area

Hospital electronic prescribing and medicines administration system implementation into a district general hospital: a mixed method evaluation of discharge communication.

Hospital electronic prescribing and medicines administration (HEPMA) system implementation is advocated by national e-health strategies to produce patient safety benefits. No previous study has evaluated the impact of HEPMA implementation on either discharge information communication or occurence of discharge prescribing errors. The aims of this thesis were to assess the impact of HEPMA system implementation on medicines-related discharge communication and prescribing errors, and to understand the perspective of hospital staff involved in the communication process. Following a narrative literature review, a convergent parallel mixed methods approach was selected, consisting of interpretative phenomenology, and experimental before-and-after study design. Face-to-face semi-structured interviews were undertaken with a purposive sample of hospital staff involved in discharge information communication, using the Theoretical Domains Framework (TDF) as a theoretical lens. In addition, a quasi-experimental retrospective case notes review was completed both before and after implementation. Pre-implementation, staff described patient safety concerns with traditional discharge communication processes. They cited frequent prescribing errors, and associated adverse events and hospital readmissions. HEPMA implementation was anticipated to improve patient safety and create more efficient discharge communication. Post-implementation staff articulated improved information quality highlighting fewer omitted medicines and improved patient safety. TDF findings of behaviour change highlighted behavioural alteration including adoption of processes to improve discharge quality. Quantitative data collection (n = 159 before and after) confirmed qualitative findings, showing increased compliance with discharge documentation. For example: staff grade recorded increased from 40% to 100% (p < 0.001); prescribing error quantity and severity were reduced, with errors reduced from 99% to 23% of patients (p < 0.001) and only 22% of identified errors likely to cause harm; and omitted medicines decreased from 42% to 11% of patients (p < 0.001). The findings contribute original knowledge concerning the impact of HEPMA implementation on discharge information communication and prescribing errors. The study demonstrated reduced prescribing errors and improved patient safety, which potentially impacted health and wellbeing. Qualitative findings and quantitative results are transferable, and applicable to other NHS organisations or similar healthcare settings

Childhood emotional maltreatment and disordered eating in a general adolescent population. Does emotion regulation play a mediating role?

Objectives: To determine if emotion regulation mediates the link between emotional maltreatment and disordered eating behaviour in a community sample of adolescents. Design and method: Participants were 222 secondary school pupils (aged 14-18 years) from a state high school in a rural area in Scotland. Standardised questionnaire measures were used to gather data on history of emotional abuse and neglect using the Childhood Trauma Questionnaire (CTQ), emotion regulation strategies using the Regulation of Emotions Questionnaire (REQ) and subclinical disordered eating behaviour using the Eating Attitudes Test (EAT-26) and the Dutch Eating Behaviour Questionnaire (DEBQ). Pearson correlation and multiple mediation analyses were conducted to determine significant relationships and to identify whether dysfunctional emotion regulation was a mediator of the relationship between emotional maltreatment and disordered eating behaviour. Results: Multiple mediation analyses found both emotional abuse and emotional neglect to have a significant direct relationship with EAT-26 total score and DEBQ restraint scores - mediated by internal dysfunctional emotion regulation (with external dysfunctional emotion regulation also being a significant mediator in the analysis with emotional neglect and EAT-26 total). The direct relationship between emotional abuse/neglect and DEBQ emotional eating scores was non-significant, although a specific indirect effect through internal dysfunctional emotion regulation was observed. Conclusions: To the best of the author‟s knowledge, this is the first study which has looked at history of emotional maltreatment and disordered eating behaviour focussing on the influence of emotion regulation in particular. Results were indicative of significant indirect effects between emotional abuse and neglect and all measures of disordered eating through internal dysfunctional emotion regulation. Findings suggest the role of emotion regulation warrants further study in the research on childhood maltreatment and disordered eating behaviour

The Diagnostic Pathfinder: Ten years of using technology to teach diagnostic problem solving

The Diagnostic Pathfinder has been used for nearly ten years at multiple colleges of veterinary medicine to teach diagnostic problem solving. A number of prior studies show this tool to be effective. Research in medical diagnostic problem solving provides hints, but no unambiguous answers regarding how such a tool should be designed. This in-depth review of the interface discusses each interaction in terms of how that interaction relates to the tool’s success. Nine faculty members who have taught using the Pathfinder during the last decade responded to interview questions regarding the tool. Their responses supported what had already been learned – that there is benefit when learner and instructor use the same process for solving a diagnostic problem, and then compare results, and when students learn in the context of realistic problems. Additionally, instructor responses suggest that the Pathfinder has been effective because it has 1.) enabled precise communication among experts and learners in a field where there is no generally agreed upon format for precisely communicating understandings of interrelationships between mechanisms of disease and clinical laboratory data, and 2.) provided a framework for manipulating data that respects the limitations of human memory and invites a thorough, explicit, and “artistic” rendering of the rationale