Karyotyping human chromosomes by optical and X-ray ptychography methods

Sorting and identifying chromosomes, a process known as karyotyping, is widely used to detect changes in chromosome shapes and gene positions. In a karyotype the chromosomes are identified by their size and therefore this process can be performed by measuring macroscopic structural variables. Chromosomes contain a specific number of base pairs that linearly correlate with their size; therefore it is possible to perform a karyotype on chromosomes using their mass as an identifying factor. Here, we obtain the first images of chromosomes using the novel imaging method of ptychography. We can use the images to measure the mass of chromosomes and perform a partial karyotype from the results. We also obtain high spatial resolution using this technique with synchrotron source X-rays

Inpatient prescribing systems used in NHS Acute 65 66 Trusts across England: a managerial perspective

Objective The individualised patient prescription chart, either paper or electronic, is an integral part of communication between healthcare professionals. The aim of this study is to ascertain the extent to which different prescribing systems are used for inpatient care in acute hospitals in England and explore chief pharmacists’ opinions and experiences with respect to electronic prescribing and medicines administration (EPMA) systems. Method Audio-recorded semistructured telephone interviews with chief pharmacists or their nominated representatives of general acute hospital trusts across England. Results Forty-five per cent (65/146) of the chief pharmacists agreed to participate. Eighteen per cent (12/65) of the participants interviewed stated that their trust had EPMA systems fully or partially implemented on inpatient wards. The most common EPMA system in place was JAC (n=5) followed by MEDITECH (n=3), iSOFT (n=2), PICS (n=1) and one in-house created system. Of the 12 trusts that had EPMA in place, 4 used EPMA on all of their inpatient wards and the remaining 8 had a mixture of paper and EPMA systems in use. Fifty six (86% 56/65) of all participants had consulted the standards for the design of inpatient prescription charts. From the 12 EPMA interviews qualitatively analysed, the regulation required to provide quality patient care is perceived by some to be enforceable with an EPMA system, but that this may affect accuracy and clinical workflow, leading to undocumented, unofficial workarounds that may be harmful. Conclusions The majority of inpatient prescribing in hospital continues to use paper-based systems; there was significant diversity in prescribing systems in use. EPMA systems have been implemented but many trusts have retained supplementary paper drug charts, for a variety of medications. Mandatory fields may be appropriate for core prescribing information, but the expansion of their use needs careful consideration

Using automation to produce a ‘living map’ of the COVID-19 research literature

The COVID-19 pandemic has disrupted life worldwide and presented unique challenges in the health evidencesynthesis space. The urgent nature of the pandemic required extreme rapidity for keeping track of research, andthis presented a unique opportunity for long-proposed automation systems to be deployed and evaluated. Wecompared the use of novel automation technologies with conventional manual screening; and Microsoft AcademicGraph (MAG) with the MEDLINE and Embase databases locating the emerging research evidence. We foundthat a new workflow involving machine learning to identify relevant research in MAG achieved a much higherrecall with lower manual effort than using conventional approaches

Cost-effectiveness of Microsoft Academic Graph with machine learning for automated study identification in a living map of coronavirus disease 2019 (COVID-19) research

BACKGROUND: Conventionally, searching for eligible articles to include in systematic reviews and maps of research has relied primarily on information specialists conducting Boolean searches of multiple databases and manually processing the results, including deduplication between these multiple sources. Searching one, comprehensive source, rather than multiple databases, could save time and resources. Microsoft Academic Graph (MAG) is potentially such a source, containing a network graph structure which provides metadata that can be exploited in machine learning processes. Research is needed to establish the relative advantage of using MAG as a single source, compared with conventional searches of multiple databases. This study sought to establish whether: (a) MAG is sufficiently comprehensive to maintain our living map of coronavirus disease 2019 (COVID-19) research; and (b) eligible records can be identified with an acceptably high level of specificity. METHODS: We conducted a pragmatic, eight-arm cost-effectiveness analysis (simulation study) to assess the costs, recall and precision of our semi-automated MAG-enabled workflow versus conventional searches of MEDLINE and Embase (with and without machine learning classifiers, active learning and/or fixed screening targets) for maintaining a living map of COVID-19 research. Resource use data (time use) were collected from information specialists and other researchers involved in map production. RESULTS: MAG-enabled workflows dominated MEDLINE-Embase workflows in both the base case and sensitivity analyses. At one month (base case analysis) our MAG-enabled workflow with machine learning, active learning and fixed screening targets identified n=469 more new, eligible articles for inclusion in our living map – and cost £3,179 GBP ($5,691 AUD) less – than conventional MEDLINE-Embase searches without any automation or fixed screening targets. CONCLUSIONS: MAG-enabled continuous surveillance workflows have potential to revolutionise study identification methods for living maps, specialised registers, databases of research studies and/or collections of systematic reviews, by increasing their recall and coverage, whilst reducing production costs

Innovations in Remote Learning; Electronic Prescribing and Medications Administration (EPMA) Systems in Nurse Education

The introduction of an Electronic Prescribing and Medications Administration (EPMA) system to nurse education will be illustrated. The poster will highlight the next steps in enhancing future clinical practice education development at a large school of nursing. The innovative approach will support registered nurses to be prescriber ready (NMC, 2018). LJMU has one of the largest schools of nursing in the UK. We had been using paper prescriptions for teaching purposes. However, many NHS trusts have now adopted EPMA software, which reduce medication errors and free up staff time for other activities (NHS, 2019). It is vital that we provide credible training to ensure nurses are familiar with the systems in clinical practice in order for them to be safe practitioners, fit for purpose on qualification (NMC, 2018). Clinical partners emphasise the need for nurses to be experienced at medicines administration. Each learner is taught to both prescribe and administer medications in a virtual, real time, online demonstration. Learners can access their own simulated patients on the EPMA system. They can practise prescribing and administering medications in a virtual, safe setting, facilitating remote experiential learning (Kolb, 1984). This approach will enable skills development for students and staff redeployed, returning to practice or working remotely. It enables distance learning, ensuring that nurses continue to develop despite COVID-19 social distancing restrictions, educating the workforce in these challenging times. The software will promote inter-professional learning. We are working with our other health schools to develop integrated scenarios were students can learn together. The poster will detail next steps, incorporating the innovative EPMA system across the skills modules in the second and third year of the pre- registration nursing programme and the post registration provision, including nonmedical prescribing

QUALITY HEALTHCARE IN NHS HOSPITALS: THE IMPACT OF PRESCRIBING SYSTEMS

The National Health Service (NHS) focuses on quality of care as a priority. With the NHS planning to go paperless by 2018, more hospitals in England are making the transition from paper to electronic prescribing (ePrescribing) systems. The aim of this programme of work was to understand and explore the influence different in-patient prescribing systems can have on key NHS healthcare professionals (doctors, nurses and pharmacists) working practices in England and quality healthcare.The programme of work, a three phase sequential design, used both qualitative and quantitative approaches. The first phase involved structured telephone interviews with chief pharmacists. Chief pharmacist interviews (n=65) focused upon the type of in-patient prescribing systems in use within each Trust and gained a management perspective of the different prescribing systems. Phases two and three were carried out at three acute NHS hospitals in England, at various stages of developing and implementing their prescribing systems. Phase two data were collected through multidisciplinary team (MDT) focus group discussions. The MDT discussions explored a number of areas associated with the prescribing systems in use: these included clinical workflow, communication, collaboration, patient safety and the use of a clinical indication on the prescription chart. Phase three data were collected using documentation analysis of the prescribing system and medical records, taken from patients cared for by the MDTs involved in phase two. Information extracted included any documentation made of a newly initiated medication, as well as the design of the prescribing system. The clarity and accuracy of documentation in the prescribing system and medical notes were compared to the GMC standards Good Practice in Prescribing Guidelines.Triangulation of data indicated how a change in prescribing system can impact upon individuals working practices by changing the design and clarity of the prescription chart, enforcing of regulations, accessibility and reliability, communication between key HCPs and the patient. These influences can be considered latent conditions in the systems that need addressing to prevent quality of patient care being compromised. The use of Socio-technical systems (STS) theory considered the interaction between humans and technology when using the prescribing systems. Understanding the issues where social and technical aspects interact in the prescribing system, emphasised where healthcare quality is impacted and therefore facilitated recommendations to improve working practices.The findings will help healthcare organisations to consider the impact a change in prescribing system can have on working practices and the latent failures that need consideration within the prescribing systems. The Electronic Prescribing and Medicines Administration (EPMA) system design must take into account the visual and physical needs of the user and consider how they can be improved to facilitate clinical workflow

Issues in the incorporation of economic perspectives and evidence into Cochrane reviews

Methods for systematic reviews of the effects of health interventions have focused mainly on addressing the question of 'What works?' or 'Is this intervention effective in achieving one or more specific outcomes?' Addressing the question 'Is it worth it given the resources available?' has received less attention. This latter question can be addressed by applying an economic lens to the systematic review process.This paper reflects on the value and desire for the consideration by end users for coverage of an economic perspective in a Cochrane review and outlines two potential approaches and future directions

Economics methods in Cochrane systematic reviews of health promotion and public health related interventions.

Peer reviewedPublisher PD

Advancing the field of health systems research synthesis.

Those planning, managing and working in health systems worldwide routinely need to make decisions regarding strategies to improve health care and promote equity. Systematic reviews of different kinds can be of great help to these decision-makers, providing actionable evidence at every step in the decision-making process. Although there is growing recognition of the importance of systematic reviews to inform both policy decisions and produce guidance for health systems, a number of important methodological and evidence uptake challenges remain and better coordination of existing initiatives is needed. The Alliance for Health Policy and Systems Research, housed within the World Health Organization, convened an Advisory Group on Health Systems Research (HSR) Synthesis to bring together different stakeholders interested in HSR synthesis and its use in decision-making processes. We describe the rationale of the Advisory Group and the six areas of its work and reflects on its role in advancing the field of HSR synthesis. We argue in favour of greater cross-institutional collaborations, as well as capacity strengthening in low- and middle-income countries, to advance the science and practice of health systems research synthesis. We advocate for the integration of quasi-experimental study designs in reviews of effectiveness of health systems intervention and reforms. The Advisory Group also recommends adopting priority-setting approaches for HSR synthesis and increasing the use of findings from systematic reviews in health policy and decision-making

Risk aversion in a performativity culture – what can we learn from teachers’ curriculum decision making in history?

Using the notion of risk aversion, this study explores the decisions teachers make when constructing a curriculum. Adopting a qualitative, grounded approach, this study used semi-structured interviews with nine history teachers to examine the decisions they were making during a period of considerable curriculum change in England. Five key categories were identified, which were then defined as risk averse or high risk. The findings show that teachers largely adopt a low risk approach when constructing a curriculum. In particular choice of content, pedagogical and assessment approaches are affected. Also, changes to the curriculum in high stakes examination courses have a major distorting impact on the curriculum choices for the phase of schooling prior to the examination course. This study would suggest that teachers generally aim to maximise examination outcomes through adopting a low risk approach to curriculum change. However, according to the literature, these low risk approaches appear unlikely to improve examination outcomes, whilst at the same time narrowing students’ experience of the curriculum