Using stakeholder perspectives to develop an ePrescribing toolkit for NHS Hospitals: A questionnaire study

Objective: To evaluate how an online toolkit may support ePrescribing deployments in National Health Service hospitals, by assessing the type of knowledge-based resources currently sought by key stakeholders. Design: Questionnaire-based survey of attendees at a national ePrescribing symposium. Setting: 2013 National ePrescribing Symposium in London, UK. Participants: Eighty-four delegates were eligible for inclusion in the survey, of whom 70 completed and returned the questionnaire. Main outcome measures: Estimate of the usefulness and type of content to be included in an ePrescribing toolkit. Results: Interest in a toolkit designed to support the implementation and use of ePrescribing systems was high (n = 64; 91.4%). As could be expected given the current dearth of such a resource, few respondents (n = 2; 2.9%) had access or used an ePrescribing toolkit at the time of the survey. Anticipated users for the toolkit included implementation (n = 62; 88.6%) and information technology (n = 61; 87.1%) teams, pharmacists (n = 61; 87.1%), doctors (n = 58; 82.9%) and nurses (n = 56; 80.0%). Summary guidance for every stage of the implementation (n = 48; 68.6%), planning and monitoring tools (n = 47; 67.1%) and case studies of hospitals’ experiences (n = 45; 64.3%) were considered the most useful types of content. Conclusions There is a clear need for reliable and up-to-date knowledge to support ePrescribing system deployments and longer term use. The findings highlight how a toolkit may become a useful instrument for the management of knowledge in the field, not least by allowing the exchange of ideas and shared learning

Epithelial and extracellular matrix injury in quartz-inflamed lung: role of the alveolar macrophage.

The bronchoalveolar leukocytes from quartz-inflamed lung were separated into macrophage-enriched and neutrophil-enriched populations on density gradients. Neutrophil-enriched populations showed the greatest activity in causing injury to epithelial cells and fibronectin in vitro. Inflammatory macrophage-enriched populations from quartz-exposed lung had the ability to cause fibronectin degradation but could not cause detachment injury to epithelial cells over and above that caused by control alveolar macrophages. Fibronectin damage in vivo could be an important factor in disordering the connective tissue scaffold of the lung, thereby favoring fibrosis. In vitro quartz stimulated more production of cytokines by alveolar macrophages than the inert particulate titanium dioxide. Cytokines could be important in upregulating adhesion molecules in the membranes of lung cells in vivo; this process could aid leukocyte/lung cell contact, allowing epithelial injury to be expressed, and could also be a factor leading to pathological change

Asymptotic solvers for ordinary differential equations with multiple frequencies

We construct asymptotic expansions for ordinary differential equations with highly oscillatory forcing terms, focusing on the case of multiple, non-commensurate frequencies. We derive an asymptotic expansion in inverse powers of the oscillatory parameter and use its truncation as an exceedingly effective means to discretize the differential equation in question. Numerical examples illustrate the effectiveness of the method

InGaN/GaN Laser Diodes with High Order Notched Gratings

We report on InGaN/GaN distributed feedback laser diodes with high order gratings emitting at a single wavelength around 428 nm. The 39th order notched gratings have the advantage of a simplified fabrication route with no need for overgrowth. The laser ridge and grating were formed by electron beam lithography followed by ICP etching. The as-cleaved lasers emitted in the pulsed regime with a peak single-mode output power of 15 mW. Optimization of the grating design should lead to higher power single wavelength operation

A Systematic Review Of The Types And Causes Of Prescribing Errors Generated From Using Computerized Provider Order Entry Systems in Primary and Secondary Care

Objective To understand the different types and causes of prescribing errors associated with computerized provider order entry (CPOE) systems, and recommend improvements in these systems. Materials and Methods We conducted a systematic review of the literature published between January 2004 and June 2015 using three large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline. Studies that reported qualitative data about the types and causes of these errors were included. A narrative synthesis of all eligible studies was undertaken. Results A total of 1185 publications were identified, of which 34 were included in the review. We identified 8 key themes associated with CPOE-related prescribing errors: computer screen display, drop-down menus and auto-population, wording, default settings, nonintuitive or inflexible ordering, repeat prescriptions and automated processes, users’ work processes, and clinical decision support systems. Displaying an incomplete list of a patient’s medications on the computer screen often contributed to prescribing errors. Lack of system flexibility resulted in users employing error-prone workarounds, such as the addition of contradictory free-text comments. Users’ misinterpretations of how text was presented in CPOE systems were also linked with the occurrence of prescribing errors. Discussion and Conclusions Human factors design is important to reduce error rates. Drop-down menus should be designed with safeguards to decrease the likelihood of selection errors. Development of more sophisticated clinical decision support, which can perform checks on free-text, may also prevent errors. Further research is needed to ensure that systems minimize error likelihood and meet users’ workflow expectations

The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting

Background Experts suggest that formulary alerts at the time of medication order entry are the most effective form of clinical decision support to automate formulary management. Objective Our objectives were to quantify the frequency of inappropriate nonformulary medication (NFM) alert overrides in the inpatient setting and provide insight on how the design of formulary alerts could be improved. Methods Alert overrides of the top 11 (n = 206) most-utilized and highest-costing NFMs, from January 1 to December 31, 2012, were randomly selected for appropriateness evaluation. Using an empirically developed appropriateness algorithm, appropriateness of NFM alert overrides was assessed by 2 pharmacists via chart review. Appropriateness agreement of overrides was assessed with a Cohen’s kappa. We also assessed which types of NFMs were most likely to be inappropriately overridden, the override reasons that were disproportionately provided in the inappropriate overrides, and the specific reasons the overrides were considered inappropriate. Results Approximately 17.2% (n = 35.4/206) of NFM alerts were inappropriately overridden. Non-oral NFM alerts were more likely to be inappropriately overridden compared to orals. Alerts overridden with “blank” reasons were more likely to be inappropriate. The failure to first try a formulary alternative was the most common reason for alerts being overridden inappropriately. Conclusion Approximately 1 in 5 NFM alert overrides are overridden inappropriately. Future research should evaluate the impact of mandating a valid override reason and adding a list of formulary alternatives to each NFM alert; we speculate these NFM alert features may decrease the frequency of inappropriate overrides

Correlation between p-GaN growth environment with electrical and optical properties of blue LEDs

Two blue (450 nm) light–emitting diodes (LED), which only differ in top p-GaN layer growth conditions, were comparatively investigated. I-V, C-V, TLM, Electroluminescence (EL) and Photoluminescence (PL) techniques were applied to clarify a correlation between MOCVD carrier gas and internal properties. The A-structure grown in the pure N2 environment demonstrated better parameters than the B-structure grown in the N2/H2 (1:1) gas mixture. The mixed growth atmosphere leaded to an increase of sheet resistances of p-GaN layer. EL and PL measurements confirmed the advantage of the pure N2 utilization, and C(VR) measurement pointed the increase of static charge concentration near the p-GaN interface in the B structure

Distributed feedback InGaN/GaN laser diodes

We have realised InGaN/GaN distributed feedback laser diodes emitting at a single wavelength in the 42X nm wavelength range. Laser diodes based on Gallium Nitride (GaN) are useful devices in a wide range of applications including atomic spectroscopy, data storage and optical communications. To fully exploit some of these application areas there is a need for a GaN laser diode with high spectral purity, e.g. in atomic clocks, where a narrow line width blue laser source can be used to target the atomic cooling transition. Previously, GaN DFB lasers have been realised using buried or surface gratings. Buried gratings require complex overgrowth steps which can introduce epi-defects. Surface gratings designs, can compromise the quality of the p-type contact due to dry etch damage and are prone to increased optical losses in the grating regions. In our approach the grating is etched into the sidewall of the ridge. Advantages include a simpler fabrication route and design freedom over the grating coupling strength.Our intended application for these devices is cooling of the Sr+ ion and for this objective the laser characteristics of SMSR, linewidth, and power are critical. We investigate how these characteristics are affected by adjusting laser design parameters such as grating coupling coefficient and cavity length

Recent progress in distributed feedback InGaN/GaN laser diodes

Laser diodes based on Gallium Nitride (GaN) are useful devices in a wide range of applications including atomic spectroscopy, data storage and optical communications. To fully exploit some of these application areas there is a need for a GaN laser diode with high spectral purity, e.g. in atomic clocks, where a narrow linewidth blue laser source can be used to target the atomic cooling transition. We report on the continuous wave, room temperature operation of a distributed feedback laser diode (DFB-LD) with high-order notched gratings. The design, fabrication and characterization of DFB devices based on the (Al,In) GaN material system is described. A single peak emission at 408.6 nm with an optical power of 20 mW at 225 mA and a side mode suppression ratio (SMSR) of 35 dB was achieved. Additionally, we demonstrate the use of a GaN DFB-LD as a transmitter in visible optical communications system. We also present results from a DFB-LD optimized for laser cooling of Sr+

GaN-based distributed feedback laser diodes for optical communications

Over the past 20 years, research into Gallium Nitride (GaN) has evolved from LED lighting to Laser Diodes (LDs), with applications ranging from quantum to medical and into communications. Previously, off-the-shelf GaN LDs have been reported with a view on free space and underwater communications. However, there are applications where the ability to select a single emitted wavelength is highly desirable, namely in atomic clocks or in filtered free-space communications systems. To accomplish this, Distributed Feedback (DFB) geometries are utilised. Due to the complexity of overgrowth steps for buried gratings in III-Nitride material systems, GaN DFBs have a grating etched into the sidewall to ensure single mode operation, with wavelengths ranging from 405nm to 435nm achieved. The main motivation in developing these devices is for the cooling of strontium ions (Sr+) in atomic clock applications, but their feasibility for optical communications have also been investigated. Data transmission rates exceeding 1 Gbit/s have been observed in unfiltered systems, and work is currently ongoing to examine their viability for filtered communications. Ultimately, transmission through Wavelength Division Multiplexing (WDM) or Orthogonal Frequency Division Multiplexing (OFDM) is desired, to ensure that data is communicated more coherently and efficiently. We present results on the characterisation of GaN DFBs, and demonstrate their capability for use in filtered optical communications systems