Improving the management of people with a family history of breast cancer in primary care: before and after study of audit-based education

Background: In England, guidance from National Institute for Clinical Excellence (NICE) states women with a family history of breast cancer presenting to primary care should be reassured or referred. We reviewed the evidence for interventions that might be applied in primary care and conducted an audit of whether low risk women are correctly advised and flagged. Methods: We conducted a literature review to identify modifiable risk factors. We extracted routinely collected data from the computerised medical record systems of 6 general practices (population approximately 30,000); of the variables identified in the guidance. We implemented a quality improvement (QI) intervention called audit-based education (ABE) comparing participant practices with guidelines and each other before and after; we report odds ratios (OR) of any change in data recording. Results: The review revealed evidence for advising on: diet, weight control, physical exercise, and alcohol. The proportion of patients with recordings of family history of: disease, neoplasms, and breast cancer were: 39.3%, 5.1% and 1.3% respectively. There was no significant change in the recording of family history of disease or cancer; OR 1.02 (95% CI 0.98-1.06); and 1.08 (95% CI 0.99-1.17) respectively. Recording of alcohol consumption and smoking both increased significantly; OR 1.36 (95% CI 1.30-1.43); and 1.42 (95% CI 1.27-1.60) respectively. Recording lifestyle advice fell; OR 0.84 (95% CI 0.81-0.88). Conclusions: The study informs about current data recording and willingness to engage in ABE. Recording of risk factors improved after the intervention. Further QI is needed to achieve adherence to current guidance

Defining dimensions of research readiness: a conceptual model for primary care research networks

Background: Recruitment to research studies in primary care is challenging despite widespread implementation of electronic patient record (EPR) systems which potentially make it easier to identify eligible cases. Methods: Literature review and applying the learning from a European research readiness assessment tool, the TRANSFoRm International Research Readiness instrument (TIRRE), to the context of the English NHS in order to develop a model to assess a practice’s research readiness. Results: Seven dimensions of research readiness were identified: (1) Data readiness: Is there good data quality in EPR systems; (2) Record readiness: Are EPR data able to identify eligible cases and other study data; (3) Organisational readiness: Are the health system and socio-cultural environment supportive; (4) Governance readiness: Does the study meet legal and local health system regulatory compliance; (5) Study-specific readiness; (6) Business process readiness: Are business processes tilted in favour of participation: including capacity and capability to take on extra work, financial incentives as well as intangibles such as social and intellectual capital; (7) Patient readiness: Are systems in place to recruit patients and obtain informed consent? Conclusions: The model might enable the development of interventions to increase participation in primary care-based research and become a tool to measure the progress of practice networks towards the most advanced state of readiness

Defining dimensions of research readiness: a conceptual model for primary care research networks

Background: Recruitment to research studies in primary care is challenging despite widespread implementation of electronic patient record (EPR) systems which potentially make it easier to identify eligible cases. Methods: Literature review and applying the learning from a European research readiness assessment tool, the TRANSFoRm International Research Readiness instrument (TIRRE), to the context of the English NHS in order to develop a model to assess a practice’s research readiness. Results: Seven dimensions of research readiness were identified: (1) Data readiness: Is there good data quality in EPR systems; (2) Record readiness: Are EPR data able to identify eligible cases and other study data; (3) Organisational readiness: Are the health system and socio-cultural environment supportive; (4) Governance readiness: Does the study meet legal and local health system regulatory compliance; (5) Study-specific readiness; (6) Business process readiness: Are business processes tilted in favour of participation: including capacity and capability to take on extra work, financial incentives as well as intangibles such as social and intellectual capital; (7) Patient readiness: Are systems in place to recruit patients and obtain informed consent? Conclusions: The model might enable the development of interventions to increase participation in primary care-based research and become a tool to measure the progress of practice networks towards the most advanced state of readiness

Smart Card-based Access Control System using Isolated Many-to-Many Authentication Scheme for Electric Vehicle Charging Stations

In recent years, the Internet of Things (IoT) trend has been adopted very quickly. The rapid growth of IoT has increased the need for physical access control systems (ACS) for IoT devices, especially for IoT devices containing confidential data or other potential security risks. This research focused on many-to-many ACS, a type of ACS in which many resource-owners and resource-users are involved in the same system. This type of system is advantageous in that the user can conveniently access resources from different resource-owners using the same system. However, such a system may create a situation where parties involved in the system have their data leaked because of the large number of parties involved in the system. Therefore, ‘isolation’ of the parties involved is needed. This research simulated the use of smart cards to access electric vehicle (EV) charging stations that implement an isolated many-to-many authentication scheme. Two ESP8266 MCUs, one RC522 RFID reader, and an LED represented an EV charging station. Each institute used a Raspberry Pi Zero W as the web and database server. This research also used VPN and HTTPS protocols to isolate each institute’s assets. Every component of the system was successfully implemented and tested functionally

Randomized controlled trial of standard versus double dose cotrimoxazole for childhood pneumonia in Pakistan

Objective: Increasing concern over bacterial resistance to cotrimoxazole, which is recommended by WHO as a first-line drug for treating non-severe pneumonia, led to the suggestion that this might not be optimal therapy. However, changing to alternative antimicrobial agents, such as amoxicillin, is costly. We compared the clinical efficacy of twice-daily cotrimoxazole in standard versus double dosage for treating non-severe pneumonia in children.Methods: A randomized controlled multicentre trial was implemented in seven hospital outpatient departments and two community health programmes. A total of 1143 children aged 2-59 months with non-severe pneumonia were randomly allocated to receive 4 mg trimethoprim plus 20 mg sulfamethoxazole/kg of body weight or 8 mg trimethoprim plus 40 mg sulfamethoxazole/kg of body weight orally twice-daily for 5 days Treatment failure occurred when a child required a change of therapy, died or was lost to follow-up. Children required a change of therapy if their condition worsened (they developed chest indrawing or danger signs) or if at 48 hours after enrollment, their clinical condition was the same (defined as having a respiratory rate that was 5 breaths/minute higher or lower than at the time of enrollment).Findings: The results of 1134 children were analysed: 578 were assigned to the standard dose of cotrimoxazole and 556 to the double dose. Treatment failed in 112 children (19.4%) in the standard group and 118 (21.2%) in the double-dose group (relative risk 1.10; 95% confidence interval = 0.87-1.37). Using multivariate analysis we found that treatment was more likely to fail in children who were not given the medicine correctly (P = 0.001), in those younger than 12 months (P = 0.004), those who had used antibiotics previously (P = 0.002), those whose respiratory rate was \u3e or =20 breaths/minute above the age-specific cut-off point (P = 0.006), and those from urban areas (P = 0.042).Conclusion: Both standard and double strength cotrimoxazole were equally effective in treating non-severe pneumonia. Close follow-up of patients is essential to prevent worsening of disease. Definitions of clinical failure need to be more specific. Surveillance in both rural and urban areas is essential in the development of treatment policies that are based on clinical outcomes

Smart Card-based Access Control System using Isolated Many-to-Many Authentication Scheme for Electric Vehicle Charging Stations

In recent years, the Internet of Things (IoT) trend has been adopted very quickly. The rapid growth of IoT has increased the need for physical access control systems (ACS) for IoT devices, especially for IoT devices containing confidential data or other potential security risks. This research focused on many-to-many ACS, a type of ACS in which many resource-owners and resource-users are involved in the same system. This type of system is advantageous in that the user can conveniently access resources from different resource-owners using the same system. However, such a system may create a situation where parties involved in the system have their data leaked because of the large number of parties involved in the system. Therefore, ‘isolation’ of the parties involved is needed. This research simulated the use of smart cards to access electric vehicle (EV) charging stations that implement an isolated many-to-many authentication scheme. Two ESP8266 MCUs, one RC522 RFID reader, and an LED represented an EV charging station. Each institute used a Raspberry Pi Zero W as the web and database server. This research also used VPN and HTTPS protocols to isolate each institute’s assets. Every component of the system was successfully implemented and tested functionally

Impact of IoT on Manufacturing Industry 4.0: A New Triangular Systematic Review

The Internet of Things (IoT) has realised the fourth industrial revolution concept; however, its applications in the manufacturing industry are relatively sparse and primarily investigated without contextual peculiarities. Our research undertakes an intricate critical review to investigate significant aspects of IoT applications in the manufacturing Industry 4.0 perspective to address this gap. We adopt a systematic literature review approach by Denyer and Tranfield (2009) to carry out critical analyses that help develop future research domains based on empirical studies. We describe key knowledge gaps in the existing literature and empirical studies by exploring the main contribution categories and finding six critical differences between traditional and manufacturing Industry 4.0 and 10 enablers and 11 challenges of IoT applications. Finally, an agenda for future research is proposed with 11 research domains to focus on the recognised gaps

A simple clinical coding strategy to improve recording of child maltreatment concerns: an audit study

Background Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE) but there is evidence of substantial under-recording.Aim To determine whether a simple coding strategy improved recording of maltreatment-related concerns in electronic primary care records.Design and Setting Clinical audit of rates of maltreatment-related coding before January 2010–December 2011 and after January–December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code ‘Child is cause for concern’. A total of 25,106 children aged 0–18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording.Method Outcomes were recording of 1) any maltreatment-related codes, 2) child protection proceedings and 3) child was a cause for concern.Results We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1–1.6), child protection procedures (RR 1.4; 95% CI 1.1–1.6) and cause for concern (RR 2.5; 95% CI 1.8–3.4) after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation.Conclusion This simple coding strategy improved clinician’s recording of maltreatment-related concerns in a small sample of practices with some ‘buy-in’. Further research should investigate how recording can best support the doctor–patient relationshipHow this fits in Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE), but there is evidence of substantial underrecording. We describe a simple clinical coding strategy that helped general practitioners to improve recording of maltreatment-related concerns. These improvements could improve case finding of children at risk and information sharing