Achieving a model for improving medical devices management policy

Hospitals have always faced fundamental questions of patient safety, care, and budgetary concerns. There has been increasing recognition recently of the serious issue of medical devices management, covering the areas of procurement, training, maintenance, and governance. This issue, documented by the National Audit Office, National Patient Safety Agency, Medicines and Healthcare Products Regulatory Agency, National Health Service Litigation Authority, and World Health Organisation, impacts on healthcare costs and patient safety. It has led to new Health and Social Care Act Regulations, enforced by the Care Quality Commission. As a result of my work as a consultant in the field of medical devices management, I constructed a policy model based on my own specialist experience and knowledge. This research sought to improve that model through participatory research conducted at an NHS Hospital in London. It took the form of a case study that specifically explored the core policy areas, but this time in collaboration with participants with expertise in one or more of the four interrelated policy areas of procurement, training, maintenance, and governance. This collaboration involved researching and analysing the external demands from regulatory agencies and internal demands from the organisation, centred on procurement, budgetary, and policy issues. The action research informed changes in policy, especially around procurement, leading to improvements in practice. The challenge of keeping policy up to date, and consistent with the external regulations and internal operational demands, is discussed in the case study. The Hospital’s internal politics and culture were found to be a help when starting up the case study, but a hindrance when it came to getting agreement and approvals to change the policy content, because of multiple committees and competing interests. The overall outcome of the project was an organisationally approved best practice policy model for medical devices management within a governance framework that meets the needs of the external regulators, and the management of the organisation. More specifically it was discovered that the use, maintenance, and governance of medical equipment were all reliant on a central issue, namely procurement practice. Procurement conduct for the organisation was redefined within the Hospital policy, and is making training, maintenance, and governance easier to achieve, thereby reducing risk and cost. A major consequence is that all budget holders need to be trained in procurement itself. Moreover, it is anticipated that the model could be used at similar healthcare organisations, ultimately leading to a contribution to knowledge and practice which assists in patient safety and meeting budgets

Cross cultural verbal cues to deception: truth and lies in first and second language forensic interview contexts

Introduction: The verbal deception literature is largely based upon North American and Western European monolingual English speaker interactions. This paper extends this literature by comparing the verbal behaviors of 88 south Asian bilinguals, conversing in either first (Hindi) or second (English) languages, and 48 British monolinguals conversing in English. Methods: All participated in a live event following which they were interviewed having been incentivized to be either deceptive or truthful. Event details, complications, verifiable sources, and plausibility ratings were analyzed as a function of veracity, language and culture. Results: Main effects revealed cross cultural similarities in both first and second language interviews whereby all liar’s verbal responses were impoverished and rated as less plausible than truthtellers. However, a series of cross-cultural interactions emerged whereby bi-lingual South Asian truthtellers and liars interviewed in first and second languages exhibited varying patterns of verbal behaviors, differences that have the potential to trigger erroneous assessments in practice. Discussion: Despite limitations, including concerns centered on the reductionary nature of deception research, our results highlight that while cultural context is important, impoverished, simple verbal accounts should trigger a ‘red flag’ for further attention irrespective of culture or interview language, since the cognitive load typically associated with formulating a deceptive account apparently emerges in a broadly similar manner

Scalar entrainment in the mixing layer

New definitions of entrainment and mixing based on the passive scalar field in the plane mixing layer are proposed. The definitions distinguish clearly between three fluid states: (1) unmixed fluid, (2) fluid engulfed in the mixing layer, trapped between two scalar contours, and (3) mixed fluid. The difference betwen (2) and (3) is the amount of fluid which has been engulfed during the pairing process, but has not yet mixed. Trends are identified from direct numerical simulations and extensions to high Reynolds number mixing layers are made in terms of the Broadwell-Breidenthal mixing model. In the limit of high Peclet number (Pe = ReSc) it is speculated that engulfed fluid rises in steps associated with pairings, introducing unmixed fluid into the large scale structures, where it is eventually mixed at the Kolmogorov scale. From this viewpoint, pairing is a prerequisite for mixing in the turbulent plane mixing layer

Strong interaction of a turbulent spot with a shock-induced separation bubble

Direct numerical simulations have been conducted to study the passage of a turbulent spot through a shock-induced separation bubble. Localized blowing is used to trip the boundary layer well upstream of the shock impingement, leading to mature turbulent spots at impingement, with a length comparable to the length of the separation zone. Interactions are simulated at free stream Mach numbers of two and four, for isothermal (hot) wall boundary conditions. The core of the spot is seen to tunnel through the separation bubble, leading to a transient reattachment of the flow. Recovery times are long due to the influence of the calmed region behind the spot. The propagation speed of the trailing interface of the spot decreases during the interaction and a substantial increase in the lateral spreading of the spot was observed. A conceptual model based on the growth of the lateral shear layer near the wingtips of the spot is used to explain the change in lateral growth rat

Numerical simulations of transition due to isolated roughness elements at Mach 6

An accurate prediction of transition onset behind an isolated roughness element has not yet been established. This is particularly important in hypersonic flow, where transition is accompanied by increased surface heating. In the present contribution, a number of direct numerical simulations have been performed of a Mach 6 boundary layer over a flat plate with isolated roughness elements. The effects of roughness shape, planform, ramps, and freestream disturbance levels on instability growth and transition onset are investigated. It is found that the frontal shape has a large effect on the transition onset, which is in agreement with previous studies, whereas the roughness element planform has a marginal influence. A new result is that the roughness shape in the streamwise direction (in particular, the aft section) is also an important characteristic, since an element with a ramped-down aft section allows the detached shear layer to spread out and weaken, leading to a lower instability growth rate. Above a critical value, the instability growth rate is found to be correlated with the amplitude of the low-speed streak formed by the roughness element, suggesting that a more physically based transition criterion should take account of the local liftup effect of the particular roughness shape.<br/

A comparison of the reproducibility of manual tracing and on-screen digitization for cephalometric profile variables

The aim of this investigation was to analyse and compare the reproducibility of manual cephalometric tracings with on-screen digitization using a soft tissue analysis. A random sample of 20 lateral cephalometric radiographs, in the natural head posture, was selected. On-screen digitization using Viewbox (R) 3.1.1.9 cephalometric software and manual tracing on a 1:1 printout of the image was carried out twice in different sessions 1 week apart. Differences were analysed using a repeated measurement analysis of variance with method, session, and method-session interaction as explaining variables. The differences were expressed as an absolute percentage of the overall mean. The findings of the present study indicate that the two measurement methods differ significantly for 11 variables (P = 0.001 to P = 0.042). The area around stomion was the least reproducible. Except for s-n(s)-unt, nasal protrusion, with the manual technique, all mean differences between sessions and between methods were less than 1 degree or 1 mm and were, on-screen, smaller for 13 variables compared with those traced manually. Absolute percentage differences of the overall mean were smaller for seven variables with the digital technique and three variables in the manual technique, while four manual variables and one on-screen variable exceeded 2 per cent of the overall mean. Although small significant differences were found, the clinical relevance remains questionable

A randomised controlled trial of the Neuro Emotional Technique (NET) for childhood Attention Deficit Hyperactivity Disorder (ADHD): a protocol

<p>Abstract</p> <p>Background</p> <p>An abundance of literature is dedicated to research for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Most, is in the area of pharmacological therapies with less emphasis in psychotherapy and psychosocial interventions and even less in the area of complementary and alternative medicine (CAM).</p> <p>The use of CAM has increased over the years, especially for developmental and behavioral disorders, such as ADHD. 60–65% of parents with children with ADHD have used CAM. Medical evidence supports a multidisciplinary approach (i.e. pharmacological and psychosocial) for the best clinical outcomes. The Neuro Emotional Technique (NET), a branch of Chiropractic, was designed to address the biopsychosocial aspects of acute and chronic conditions including non-musculoskeletal conditions. Anecdotally, it has been suggested that ADHD may be managed effectively by NET.</p> <p>Design/methods</p> <p>A placebo controlled, double blind randomised clinical trial was designed to assess the effectiveness of NET on a cohort of children with medically diagnosed ADHD.</p> <p>Children aged 5–12 years who met the inclusion criteria were randomised to one of three groups. The control group continued on their existing medical regimen and the intervention and placebo groups had the addition of the NET and sham NET protocols added to their regimen respectively. These two groups attended a clinical facility twice a week for the first month and then once a month for six months.</p> <p>The Conners' Parent and Teacher Rating Scales (CRS) were used at the start of the study to establish baseline data and then in one month and in seven months time, at the conclusion of the study. The primary outcome measures chosen were the Conners' ADHD Index and Conners' Global Index. The secondary outcome measures chosen were the DSM-IV: Inattentive, the DSM-IV:Hyperactive-Impulsive, and the DSM-IV:Total subscales from the Conners' Rating Scales, monitoring changes in inattention, hyperactivity and impulsivity.</p> <p>Calculations for the sample size were set with a significance level of 0.05 and the power of 80%, yielding a sample size of 93.</p> <p>Discussion</p> <p>The present study should provide information as to whether the addition of NET to an existing medical regimen can improve outcomes for children with ADHD.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trial Registration Number: ANZCTRN 012606000332527</p