A descriptive exploratory study of how admissions caused by medication-related harm are documented within inpatients' medical records.

BACKGROUND: Adverse drug reactions, poor patient adherence and errors, here collectively referred to as medication-related harm (MRH), cause around 2.7-8.0% of UK hospital admissions. Communication gaps between successive healthcare providers exist, but little is known about how MRH is recorded in inpatients' medical records. We describe the presence and quality of MRH documentation for patients admitted to a London teaching hospital due to MRH. Additionally, the international classification of disease 10th revision (ICD-10) codes attributed to confirmed MRH-related admissions were studied to explore appropriateness of their use to identify these patients. METHODS: Clinical pharmacists working on an admissions ward in a UK hospital identified patients admitted due to suspected MRH. Six different data sources in each patient's medical record, including the discharge summary, were subsequently examined for MRH-related information. Each data source was examined for statements describing the MRH: symptom and diagnosis, identification of the causative agent, and a statement of the action taken or considered. Statements were categorised as 'explicit' if unambiguous or 'implicit' if open to interpretation. ICD-10 codes attributed to confirmed MRH cases were recorded. RESULTS: Eighty-four patients were identified over 141 data collection days; 75 met our inclusion criteria. MRH documentation was generally present (855 of 1307 statements were identified; 65%), and usually explicit (705 of 855; 82%). The causative agent had the lowest proportion of explicit statements (139 of 201 statements were explicit; 69%). For two (3%) discharged patients, the causal agent was documented in their paper medical record but not on the discharge summary. Of 64 patients with a confirmed MRH diagnosis at discharge, only six (9%) had a MRH-related ICD-10 code. CONCLUSIONS: Availability of information in the paper medical record needs improving and communication of MRH-related information could be enhanced by using explicit statements and documenting reasons for changing medications. ICD-10 codes underestimate the true occurrence of MRH

Human resources requirements for highly active antiretroviral therapy scale-up in Malawi

<p>Abstract</p> <p>Background</p> <p>Twelve percent of the adult population in Malawi is estimated to be HIV infected. About 15% to 20% of these are in need of life saving antiretroviral therapy. The country has a public sector-led antiretroviral treatment program both in the private and public health sectors. Estimation of the clinical human resources needs is required to inform the planning and distribution of health professionals.</p> <p>Methods</p> <p>We obtained data on the total number of patients on highly active antiretroviral treatment program from the Malawi National AIDS Commission and Ministry of Health, HIV Unit, and the number of registered health professionals from the relevant regulatory bodies. We also estimated number of health professionals required to deliver highly active antiretroviral therapy (HAART) using estimates of human resources from the literature. We also obtained data from the Ministry of Health on the actual number of nurses, clinical officers and medical doctors providing services in HAART clinics. We then made comparisons between the human resources situation on the ground and the theoretical estimates based on explicit assumptions.</p> <p>Results</p> <p>There were 610 clinicians (396 clinical officers and 214 physicians), 44 pharmacists and 98 pharmacy technicians and 7264 nurses registered in Malawi. At the end of March 2007 there were 85 clinical officer and physician full-time equivalents (FTEs) and 91 nurse FTEs providing HAART to 95,674 patients. The human resources used for the delivery of HAART comprised 13.9% of all clinical officers and physicians and 1.1% of all nurses. Using the estimated numbers of health professionals from the literature required 15.7–31.4% of all physicians and clinical officers, 66.5–199.3% of all pharmacists and pharmacy technicians and 2.6 to 9.2% of all the available nurses. To provide HAART to all the 170,000 HIV infected persons estimated as clinically eligible would require 4.7% to 16.4% of the total number of nurses, 118.1% to 354.2% of all the available pharmacists and pharmacy technicians and 27.9% to 55.7% of all clinical officers and physicians. The actual number of health professionals working in the delivery of HAART in the clinics represented 44% to 88.8% (for clinical officers and medical doctors) and 13.6% and 47.6% (for nurses), of what would have been needed based on the literature estimation.</p> <p>Conclusion</p> <p>HAART provision is a labour intensive exercise. Although these data are insufficient to determine whether HAART scale-up has resulted in the weakening or strengthening of the health systems in Malawi, the human resources requirements for HAART scale-up are significant. Malawi is using far less human resources than would be estimated based on the literature from other settings. The impact of HAART scale-up on the overall delivery of health services should be assessed.</p

The structure of research expenditure

SIGLEAvailable from British Library Document Supply Centre- DSC:8242.2723(SEPSU-PS--4) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

The rise of sustainability services for the built environment in Malaysia

In the past two decades, the growth of the global sustainability agenda has led to the conception of a new business market, most commonly referred to as 'sustainability services for the built environment'. For developing countries, the emergence of this market represents an opportunity to meet sustainability goals by improving access to skills necessary for improved performance in the design, construction and operation of buildings. Set against global trends in policy and market growth, this paper examines the rise of sustainability services in Malaysia - a developing country with a relatively young, undeveloped market with potential to benefit from market growth. Drawing on first hand experiences of consultants offering sustainability services in Malaysia, the current status of the market and the key barriers are discussed. The paper explores the business opportunities this emerging market has to offer to the Malaysian built environment sector and concludes with the potential it presents to contribute to the country's aspirations for sustainable development

Developing policy analytics for public health strategy and decisions-the Sheffield alcohol policy model framework

This paper sets out the development of a methodological framework for detailed evaluation of public health strategies for alcohol harm reduction to meet UK policy-makers needs. Alcohol is known to cause substantial harms, and controlling its affordability and availability are effective policy options. Analysis and synthesis of a variety of public and commercial data sources is needed to evaluate impact on consumers, health services, crime, employers and industry, so a sound evaluation of impact is important. We discuss the iterative process to engage with stakeholders, identify evidence/data and develop analytic approaches and produce a final model structure. We set out a series of steps in modelling impact including: classification and definition of population subgroups of interest, identification and definition of harms and outcomes for inclusion, classification of modifiable components of risk and their baseline values, specification of the baseline position on policy variables especially prices, estimating effects of changing policy variables on risk factors including price elasticities, quantifying risk functions relating risk factors to harms including 47 health conditions, crimes, absenteeism and unemployment, and monetary valuation. The most difficult model structuring decisions are described, as well as the final results framework used to provide decision support to national level policymakers in the UK. In the discussion we explore issues around the relationship between modelling and policy debates, valuation and scope, limitations of evidence/data, how the framework can be adapted to other countries and decisions. We reflect on the approach taken and outline ongoing plans for further development