Applying Quality Improvement methods to address gaps in medicines reconciliation at transfers of care from an acute UK hospital

© Published by the BMJ Publishing Group Limited.Objectives Reliable reconciliation of medicines at admission and discharge from hospital is key to reducing unintentional prescribing discrepancies at transitions of healthcare. We introduced a team approach to the reconciliation process at an acute hospital with the aim of improving the provision of information and documentation of reliable medication lists to enable clear, timely communications on discharge. Setting An acute 400-bedded teaching hospital in London, UK. Participants The effects of change were measured in a simple random sample of 10 adult patients a week on the acute admissions unit over 18â €...months. Interventions Quality improvement methods were used throughout. Interventions included education and training of staff involved at ward level and in the pharmacy department, introduction of medication documentation templates for electronic prescribing and for communicating information on medicines in discharge summaries co-designed with patient representatives. Results Statistical process control analysis showed reliable documentation (complete, verified and intentional changes clarified) of current medication on 49.2% of patients discharge summaries. This appears to have improved (to 85.2%) according to a poststudy audit the year after the project end. Pharmacist involvement in discharge reconciliation increased significantly, and improvements in the numbers of medicines prescribed in error, or omitted from the discharge prescription, are demonstrated. Variation in weekly measures is seen throughout but particularly at periods of changeover of new doctors and introduction of new systems. Conclusions New processes led to a sustained increase in reconciled medications and, thereby, an improvement in the number of patients discharged from hospital with unintentional discrepancies (errors or omissions) on their discharge prescription. The initiatives were pharmacist-led but involved close working and shared understanding about roles and responsibilities between doctors, nurses, therapists, patients and their carers

The use of morphological description in neighbourhood planning: form-based assessment of physical character and design rules

Despite ongoing efforts to encourage the use of urban morphology tools into current practice, uptake remains limited. Shortcomings are largely attributed to time and resource intensive methods of historical settlement transformation study. However, developments in quantitative morphological approaches offer new possibilities for efficiency and easier adoption of research tools in practice. This paper proposes the use of typo-morphology methods to inform the adoption of form-based design guidance in neighbourhood master plans. The aim of the study is to develop a comprehensive yet flexible method for form-based character assessment (FBCA) of residential streets. The resulting FBCA classification identifies streets where compliance with form-based design rules could be tightened. The FBCA method is empirically tested in the context of the local neighbourhood plan for Radlett, Hertfordshire in the United Kingdom, offering reflections from practice on the usefulness and limitations of the method

Radionuclides from Windscale discharges I: Nonequilibrium tracer experiments in high-latitude oceanography

The releases of soluble radionuclides from the nuclear fuel reprocessing plant at Windscale represent for some artificial radionuclides a major addition to the inventories due to nuclear test fallout on the northern hemisphere…

Radionuclides from Windscale discharges II: Their dispersion in Scottish and Norwegian coastal circulation

Measurement of the concentrations of 134Cs, 137Cs, 90Sr, 238Pu, and 239, 240Pu in Scottish and Norwegian coastal waters in 1976 and 1978 provides information on dispersal pathways, transport times, and dilution in these waters of radioactive waste discharged to the Irish Sea from the Windscale nuclear fuel reprocessing plant in Cumbria, U. K...

An Imaging Fabry-Perot System for the Robert Stobie Spectrograph on the Southern African Large Telescope

We present the design of the Fabry-Perot system of the Robert Stobie Spectrograph on the 10-meter class Southern African Large Telescope and its characterization as measured in the laboratory. This system provides spectroscopic imaging at any desired wavelength spanning a bandpass 430 - 860 nm, at four different spectral resolving powers ranging from 300 to 9000. Our laboratory tests revealed a wavelength dependence of the etalon gap and parallelism with a maximum variation between 600 - 720 nm that arises because of the complex structure of the broadband multi-layer dielectric coatings. We also report an unanticipated optical effect of this multi-layer coating structure that produces a significant, and wavelength dependent, change in the apparent shape of the etalon plates. This change is caused by two effects: the physical non-uniformities or thickness variations in the coating layers, and the wavelength dependence of the phase change upon refection that can amplify these non-uniformities. We discuss the impact of these coating effects on the resolving power, finesse, and throughput of the system. This Fabry-Perot system will provide a powerful tool for imaging spectroscopy on one of the world's largest telescopes.Comment: 17 pages, 14 figures, accepted for publication in The Astronomical Journa

Variable iron-line emission near the black hole of Markarian 766

We investigate the link between ionised Fe X-ray line emission and continuum emission in the bright nearby AGN, Mrk 766. A new long (433 ks) XMM-Newton observation is analysed, together with archival data from 2000 and 2001. The contribution from ionised line emission is measured and its time variations on short (5-20 ks) timescales are correlated with the continuum emission. The ionised line flux is found to be highly variable and to be strongly correlated with the continuum flux, demonstrating an origin for the ionised line emission that is co-located with the continuum emission. Most likely the emission is ionised reflection from the accretion disc within a few A.U. of the central black hole, and its detection marks the first time that such an origin has been identified other than by fitting to spectral line profiles. Future observations may be able to measure a time lag and hence achieve reverberation mapping of AGN at X-ray energies.Comment: Accepted for publication, Astronomy and Astrophysics letter

Recent warming on Spitsbergen - influence of atmospheric circulation and sea ice cover

Spitsbergen has experienced some of the most severe temperature changes in the Arctic during the last three decades. This study relates the recent warming to variations in large-scale atmospheric circulation (AC), air mass characteristics, and sea ice concentration (SIC), both regionally around Spitsbergen and locally in three fjords. We find substantial warming for all AC patterns for all seasons, with greatest temperature increase in winter. A major part of the warming can be attributed to changes in air mass characteristics associated with situations of both cyclonic and anticyclonic air advection from north and east and situations with a nonadvectional anticyclonic ridge. In total, six specific AC types (out of 21), which occur on average 41% of days in a year, contribute approximately 80% of the recent warming. The relationship between the land-based surface air temperature (SAT) and local and regional SIC was highly significant, particularly for the most contributing AC types. The high correlation between SAT and SIC for air masses from east and north of Spitsbergen suggests that a major part of the atmospheric warming observed in Spitsbergen is driven by heat exchange from the larger open water area in the Barents Sea and region north of Spitsbergen. Finally, our results show that changes in frequencies of AC play a minor role to the total recent surface warming. Thus, the strong warming in Spitsbergen in the latest decades is not driven by increased frequencies of “warm” AC types but rather from sea ice decline, higher sea surface temperatures, and a general background warming

Fast Spectral Variability from Cygnus X-1

We have developed an algorithm that, starting from the observed properties of the X-ray spectrum and fast variability of an X-ray binary allows the production of synthetic data reproducing observables such as power density spectra and time lags, as well as their energy dependence. This allows to reconstruct the variability of parameters of the energy spectrum and to reduce substantially the effects of Poisson noise, allowing to study fast spectral variations. We have applied the algorithm to Rossi X-ray Timing Explorer data of the black-hole binary Cygnus X-1, fitting the energy spectrum with a simplified power law model. We recovered the distribution of the power law spectral indices on time-scales as low as 62 ms as being limited between 1.6 and 1.8. The index is positively correlated with the flux even on such time-scales.Comment: 14 pages, 19 figures, accepted by MNRA

Peer Mentoring: Benefits to First-Time College Students and Their Peer Mentors

The experiences of first-year, first-time college students are impacted by a variety of challenges that pose a threat to student success and retention. One intervention universities are implementing to address these challenges are peer mentorship programs. While the benefits to first-time students of peer mentorship programs are well-researched, there is a lack of research on the benefits for mentors themselves. The purpose of this study was to examine the perceived and demonstrable benefits for peer mentors working within a first-year seminar. This mixed-methods study assessed both first-time student achievement outcomes (i.e., first-term GPA and one-year persistence; N = 7,154) as well as the professional and personal development benefits of peer mentors (n = 52). Results showed first-time students who participated in the peer mentor program had significantly higher student achievement and peer mentors themselves had increased academic self-efficacy, improved communication, leadership, and interpersonal presence, and strengthened social and professional networks

Theta Phase-dependent Modulation of Perception by Concurrent Transcranial Alternating Current Stimulation and Periodic Visual Stimulation

Background: Sensory perception can be modulated by the phase of neural oscillations, especially in the theta and alpha ranges. Oscillatory activity in the visual cortex can be entrained by transcranial alternating current stimulation (tACS) as well as periodic visual stimulation (i.e., flicker). Combined tACS and visual flicker stimulation modulates blood- oxygen-level-dependent (BOLD) responses and concurrent 4 Hz auditory click-trains and tACS modulates auditory perception in a phase-dependent way. Objective: In the present study, we investigated if phase synchrony between concurrent tACS and periodic visual stimulation (i.e., flicker) can modulate performance on a visual matching task. Methods: Participants completed a visual matching task on a flickering visual stimulus while receiving either in-phase (0°) or asynchronous (180°, 90°, or 270°) tACS at alpha or theta frequency. Stimulation was applied over either occipital cortex or dorsolateral prefrontal cortex (DLPFC). Results: Visual performance was significantly better during theta frequency tACS over the visual cortex when it was in-phase (0°) with visual stimulus flicker, compared to anti-phase (180°). This effect did not appear with alpha frequency flicker or with DLPFC stimulation. Furthermore, a control sham group showed no effect. There were no significant performance differences amongst the asynchronous (180°, 90°, and 270°) phase conditions. Conclusion: Extending previous studies on visual and auditory perception, our results support a crucial role of oscillatory phase in sensory perception and demonstrate a behaviourally relevant combination of visual flicker and tACS. The spatial and frequency specificity of our results have implications for research on the functional organisation of perception