Medication reconciliation and discharge communication from hospital to general practice: A quantitative analysis

Background: The aim of this study was to assess the quality of effective discharge communication to primary practice from a hospital that uses ieMR (integrated electronic Medical Record), a complete electronic prescribing/medical record platform. Methods: A retrospective quantitative analysis of 232 discharge encounters from a major tertiary hospital assessed the discharge summary quality; timeliness, completeness and medication information. Results: Median time to discharge summary was 1 day. 22.0% of discharge summaries were incomplete at 30 days post discharge and 44.5% of discharge summaries were incomplete at 30 days post discharge if discharged on a weekend compared to weekday (P-value = 0.001). Rates of medication reconciliation were completed at approximately 35% at each point of the patient stay and 56.9% of patients had a GP discharge summary listing discharge medications. However, if certain progressive steps were completed (i.e. Home Medications recorded in ieMR, Discharge Reconciliation in ieMR, and Patient Discharge Medication Record in eLMs (Enterprise-wide Liaison Medication System)), then, the 'Medications on Discharge' was significantly more likely to be present in the discharge summary, at rates of 70.1%, 85.9%, and 98.6% respectively (P-value = 0.007, <0.001, <0.001). Conversely not doing these steps dropped rates of having medications listed in the discharge summary to 50.0%, 40.3% and 34.1% respectively. Conclusions: This study assessed current discharge summary quality since the introduction of electronic medical records. It demonstrated the significant value of correct use of electronic programs, including performing all crucial steps of reconciliation. Targeted interventions in future studies that rectify the shortfalls in discharge communication are warranted

WMTrace : a lightweight memory allocation tracker and analysis framework

The diverging gap between processor and memory performance has been a well discussed aspect of computer architecture literature for some years. The use of multi-core processor designs has, however, brought new problems to the design of memory architectures - increased core density without matched improvement in memory capacity is reduc- ing the available memory per parallel process. Multiple cores accessing memory simultaneously degrades performance as a result of resource con- tention for memory channels and physical DIMMs. These issues combine to ensure that memory remains an on-going challenge in the design of parallel algorithms which scale. In this paper we present WMTrace, a lightweight tool to trace and analyse memory allocation events in parallel applications. This tool is able to dynamically link to pre-existing application binaries requiring no source code modification or recompilation. A post-execution analysis stage enables in-depth analysis of traces to be performed allowing memory allocations to be analysed by time, size or function. The second half of this paper features a case study in which we apply WMTrace to five parallel scientific applications and benchmarks, demonstrating its effectiveness at recording high-water mark memory consumption as well as memory use per-function over time. An in-depth analysis is provided for an unstructured mesh benchmark which reveals significant memory allocation imbalance across its participating processes

Australian general practitioners' views on qualities that make effective discharge communication: a scoping review

Transitions of patient care between hospital discharge and primary care are known to be an area of high-risk where communication is imperative for patient safety. Discharge summaries are known to often be incomplete, delayed and unhelpful for community healthcare providers. The aim of this review was to identify and map the literature which discusses Australian general practitioners' (GPs) views on the qualities that make up effective discharge communication. Medline, Scopus and the Cochrane register of controlled drug trails and systematic reviews were searched for publications until October 2021 that discussed Australian GPs' views on discharge communication from hospital to general practice. Of 1696 articles identified, 18 met inclusion and critical appraisal criteria. Five studies identified that GPs view timeliness of discharge summary receipt to be a problem. Communication of medication information in the discharge summary was discussed in six studies, with two reporting that GPs view reasons for medication changes to be essential. Five studies noted GPs would prefer to receive clinical discipline or diagnosis specific information. Four studies identified that GPs viewed the format and readability of discharge summaries to be problematic, with difficulties finding salient information. The findings of this scoping review indicate that GPs view timeliness, completeness, readability, medication related information and diagnosis/clinical discipline specific information to be qualities that make up effective discharge communication from hospital to the community. There are opportunities for further research in perspectives of effective discharge communication, and future studies on interventions to improve discharge communication, patient safety and policy in transfers of care

Pharmacist-Led Education for Final Year Medical Students: A Pilot Study

Background: Prescribing is a core skillset for medical officers. Prescribing errors or deficiencies can lead to patient harm and increased healthcare costs. There is an undefined role for pharmacist-led education to final year medical students to improve prescribing skills. Aim: Assess if pharmacist-led education on prescription writing improves the quality and safety of final year medical students' prescribing skills. Method: Participants and Intervention: Final year medical students were randomised into tutorial (TG) or non-tutorial groups (NTG) and assessed pre- and post- intervention. TG received education by a clinical pharmacist and pharmacy educator using case-based learning. NTG received no additional training as per usual practice. Following the pre-test, all students completed a 3-week tertiary hospital medical ward placement. Students completed the post-test following placement and after the TG participated in the intervention. Student Assessment: Assessment included writing Schedule 4 (S4, prescription only), Schedule 8 (S8, controlled drug), S4 streamline (S4SL), and Mixed case (S4 and S8) prescriptions. Results: At baseline, there were no significant differences between TG and NTG for overall scores or proportion of passes. Post intervention scores significantly improved in TG (p = 0.012) whereas scores significantly decreased in the NTG (p = 0.004). The overall proportion of passes was significantly higher in the TG than NTG (p < 0.001). Conclusion: Education by a clinical pharmacist improved short-term prescribing skills of final year medical students in this study. Students learning primarily experientially from peers and rotational supervisors showed decreased prescribing skills. We propose pharmacist-led education on prescription writing should be further evaluated in larger studies across more student cohorts and for longer periods of follow up time to clarify whether such an educational model could be included in future medical school curricula

Impact of the electron density and temperature gradient on drift-wave turbulence in the Large Plasma Device

In this paper we present an experimental study of edge turbulence in the Large Plasma Device at UCLA. We utilize a scan of discharge power and prefill pressure (neutral density) to show experimentally that turbulent density fluctuations decrease with decreasing density gradient, as predicted for resistive drift-wave turbulence (RDWT). As expected for RDWT, we observe that the cross-phase between the density and potential fluctuations is close to 0. Moreover, the addition of an electron temperature gradient leads to a reduction in the amplitude of the density fluctuations, as expected for RDWT. However, counter to theoretical expectations, we find that the potential fluctuations do not follow the same trends as the density fluctuations for changes either in density gradients or the addition of a temperature gradient. The disconnect between the density and potential fluctuations is connected to changes in the parallel flows as a result of differences in the prefill pressure, i.e. neutral density. Further analysis of the density and potential fluctuation spectra show that the electron temperature gradient reduces the low frequency fluctuations up to 10kHz role= presentation style= box-sizing: border-box; margin: 0px; padding: 0px; border: 0px; font-family: inherit; font-variant-caps: inherit; font-stretch: inherit; line-height: normal; vertical-align: baseline; display: inline; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; position: relative; \u3e10kHz10kHzand the introduction of a temperature gradient leads to an unexpected ∼π role= presentation style= box-sizing: border-box; margin: 0px; padding: 0px; border: 0px; font-family: inherit; font-variant-caps: inherit; font-stretch: inherit; line-height: normal; vertical-align: baseline; display: inline; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; position: relative; \u3e∼∼πshift of the density–potential cross-phase at ∼10kHz role= presentation style= box-sizing: border-box; margin: 0px; padding: 0px; border: 0px; font-family: inherit; font-variant-caps: inherit; font-stretch: inherit; line-height: normal; vertical-align: baseline; display: inline; word-spacing: normal; word-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; position: relative; \u3e∼10kHz∼10kHz, while maintaining the typical resistive drift-wave cross-phase at lower frequencies. These experiments partly confirm existing knowledge on resistive drift-wave turbulence, but also introduce new observations that indicate a need for dedicated nonlinear three-dimensional turbulence simulations that include neutrals

Not seeing the carbon for the trees? Why area-based targets for establishing new woodlands can limit or underplay their climate change mitigation benefits

Acknowledgements: The James Hutton Institute is supported by the Scottish Government’s Rural and Environment Science and Analytical Services Division (RESAS). This research was funded through both ClimatexChange and two strategic Research Programs (2011-16 and 2016-21). The authors acknowledge the assistance provided by other staff – Marie Castellazzi, Nikki Baggaley, Allan Lilly (The James Hutton Institute); Jo Smith (University of Aberdeen); Philip Taylor, Duncan Ray (Forest Research).Peer reviewedPublisher PD

Investigating the impact of a clinical pharmacist on the health outcomes of a paediatric pharmacists

Background: Recent fiscal scrutiny and changes in health care financing have necessitated that health care providers justify a clinical and economical basis for their involvement in patient care. Although clinical pharmacists have been shown to enhance patient health outcomes and reduce costs among adult patients, the impact of a pharmacist in paediatric patient care has not been extensively documented. Method: A team of pharmacists was established to conduct a systematic review of the literature. A title scan of papers in 5 databases was performed by 14 pharmacists using the MeSH terms Pharmacists, Medical Intervention, Paediatrics and Cost-Benefit Analysis. The underpinning research question was: "How do the professional activities of a clinical pharmacist impact the health outcomes of paediatric in-patients?" The abstracts of suitable titles were scanned and articles were read to assess relevance. Relevant articles were then evaluated independently by at least two members of the team, using critical appraisal tools suitable for quantitative, qualitative or systematic review studies. Results: The initial search identified 327 citations which after full text review and application of the scoring tool, resulted in 12 studies included in the systematic review. The average number of interventions reported varied from study to study. Dosing recommendations, pharmacokinetics and drug allergy alerts were the most commonly recorded interventions by pharmacists for a paediatric population. Evidence from this review will be used to formulate improvements to in-patient paediatric care. Conclusion: Clinical pharmacists have a positive impact on inpatient paediatric care

Recommendations for improving integration in national end-to-end flood forecasting systems: an overview of the FFIR (flooding from intense rainfall) programme

Recent surface-water and flash floods have caused millions of pounds worth of damage in the UK. These events form rapidly and are difficult to predict due to their short-lived and localised nature. The interdisciplinary Flooding From Intense Rainfall (FFIR) programme investigated the feasibility of enhancing the integration of an end-to-end forecasting system for flash and surface-water floods to help increase the lead time for warnings for these events. Here we propose developments to the integration of an operational end-to-end forecasting system based on the findings of the FFIR programme. The suggested developments include methods to improve radar-derived rainfall rates and understanding of the uncertainty in the position of intense rainfall in weather forecasts; the addition of hydraulic modelling components; and novel education techniques to help lead to effective dissemination of flood warnings. We make recommendations for future advances such as research into the propagation of uncertainty throughout the forecast chain. We further propose the creation of closer bonds to the end users to allow for an improved, integrated, end-to-end forecasting system that is easily accessible for users and end users alike, and will ultimately help mitigate the impacts of flooding from intense rainfall by informed and timely action

Regulation of early cartilage destruction in inflammatory arthritis by death receptor 3

Objective: To investigate the role of death receptor 3 (DR-3) and its ligand tumor necrosis factor–like molecule 1A (TL1A) in the early stages of inflammatory arthritis. Methods: Antigen-induced arthritis (AIA) was generated in C57BL/6 mice deficient in the DR-3 gene (DR3−/−) and their DR3+/+ (wild-type) littermates by priming and intraarticular injection of methylated bovine serum albumin. The joints were sectioned and analyzed histochemically for damage to cartilage and expression of DR3, TL1A, Ly-6G (a marker for neutrophils), the gelatinase matrix metalloproteinase 9 (MMP-9), the aggrecanase ADAMTS-5, and the neutrophil chemoattractant CXCL1. In vitro production of MMP-9 was measured in cultures from fibroblasts, macrophages, and neutrophils following the addition of TL1A and other proinflammatory stimuli. Results: DR3 expression was up-regulated in the joints of wild-type mice following generation of AIA. DR3−/− mice were protected against cartilage damage compared with wild-type mice, even at early time points prior to the main accumulation of Teff cells in the joint. Early protection against AIA in vivo correlated with reduced levels of MMP-9. In vitro, neutrophils were major producers of MMP-9, while neutrophil numbers were reduced in the joints of DR3−/− mice. However, TL1A neither induced MMP-9 release nor affected the survival of neutrophils. Instead, reduced levels of CXCL1 were observed in the joints of DR3−/− mice. Conclusion: DR-3 drives early cartilage destruction in the AIA model of inflammatory arthritis through the release of CXCL1, maximizing neutrophil recruitment to the joint and leading to enhanced local production of cartilage-destroying enzymes