System hazards in managing laboratory test requests and results in primary care: medical protection database analysis and conceptual model

Objectives To analyse a medical protection organisation's database to identify hazards related to general practice systems for ordering laboratory tests, managing test results and communicating test result outcomes to patients. To integrate these data with other published evidence sources to inform design of a systems-based conceptual model of related hazards. Design A retrospective database analysis. Setting General practices in the UK and Ireland. Participants 778 UK and Ireland general practices participating in a medical protection organisation's clinical risk self-assessment (CRSA) programme from January 2008 to December 2014. Main outcome measures Proportion of practices with system risks; categorisation of identified hazards; most frequently occurring hazards; development of a conceptual model of hazards; and potential impacts on health, well-being and organisational performance. Results CRSA visits were undertaken to 778 UK and Ireland general practices of which a range of systems hazards were recorded across the laboratory test ordering and results management systems in 647 practices (83.2%). A total of 45 discrete hazard categories were identified with a mean of 3.6 per practice (SD=1.94). The most frequently occurring hazard was the inadequate process for matching test requests and results received (n=350, 54.1%). Of the 1604 instances where hazards were recorded, the most frequent was at the ‘postanalytical test stage’ (n=702, 43.8%), followed closely by ‘communication outcomes issues’ (n=628, 39.1%). Conclusions Based on arguably the largest data set currently available on the subject matter, our study findings shed new light on the scale and nature of hazards related to test results handling systems, which can inform future efforts to research and improve the design and reliability of these systems

An exploration of children's experiences of national assessment in schools: how do national assessments influence children's identities?

Abstract The impact of test anxiety on children’s wellbeing is of increasing concern to educationalists (National Union of Teachers/Exam Factories, 2015). In addition, the impact of SATs on children’s well-being is currently at the heart of much media interest (refer to articles in The Guardian 30.4.17 and The Independent 1.5.17). Despite a growing research base, the focus has been largely on the experiences of secondary or college students, and has primarily been investigated using quantitative approaches. The aim of the current study was to develop an understanding of the emotional impact of national assessment on primary aged children, and to explore how the construction of children’s identities might relate to these experiences. Initially twelve children from two schools were identified with Special Educational Needs Coordinators (SENCOs) on the basis of them representing a range of social backgrounds, and emotional and cognitive abilities. A total of eleven children were interviewed twice. The data from five children from year six and a child from year two were then further analysed using Interpretative Phenomenological Analysis. Four superordinate themes emerged from analysis, each with a number of subordinate themes. The theme ‘Support from others’ illustrates the way in which the children’s learning was situated within a social context, from which testing created a rupture, as described in the theme ‘Tests create anxiety’. Children described a tendency to keep negative feelings about testing to themselves, creating a split between the private and the public self. Performance in tests informed children’s sense of value, beyond the confines of the target ability (‘Self-evaluation from feedback’). The theme ‘Who I want to become’ captures a process of negotiation as children became immersed in reflection on their identities, negotiating a compromise between self-evaluation on the basis of the tests and possible future selves. Due to the research method and size of this study, implications from the results have to be treated cautiously. However, it would seem advantageous for schools to address the potential negative effects of testing on emotional well-being, identity and aspiration. Suggested ways of achieving this are increased opportunities for children to express their private anxieties with regard to testing, including discussion with adults in non- teaching roles, and specific interventions that promote well-being and self-esteem in relation to test anxiety and the implications of results. In addition, policy and practice should consider ways to minimise the rupture to learning created by testing

Why Do They Talk That Way?: Teachers\u27 Perceptions of the Language Young Students Bring into the Classroom

The language children bring to the classroom (home language) is often different from the language that is expected or accepted in schools. These language differences are often met with a variety of reactions from teachers. The purpose of this research is threefold: (a) to apply a narrative inquiry design to explore how teachers respond to the language that children bring (home language) to the early childhood classroom and the effects this response has on their work with children; (b) to engage in research efforts that will explore how differences in language may affect or be affected by pedagogy, curriculum development, and teachers\u27 expectations; (c) to understand how teachers feel about their preparation and capacity to address the issue of language diversity. The 4 participants in this study are either current or former teachers of children between the ages of 4 to 8 years. Through the use of narrative inquiry, I have acquired stories from each of the 4 participants. The stories provide insight into these teachers\u27 perceptions of children\u27s language in the classroom. The stories also open discussions on language diversity and the role it plays in early childhood education classrooms as well as how prepared teachers are to deal with language differences. With this study I hope to contribute to the research that focuses on language and language diversity in early childhood education. I would also hope to prompt further research on issues such as teachers\u27 approaches to children\u27s language differences within the classroom, the affects of different approaches to language diversity on pedagogy and curriculum, and finally on culturally sensitive pedagogy

Plant functionality across an environmental gradient

Community assemblages provide insight into ecosystem processes, both spatially and temporally. They interact with biotic and abiotic factors that vary with habitat structure, influencing community composition. Ecological theory demonstrates that species have the potential for a wide fundamental niche, but habitat range may be restricted by factors exposed to species in their realized niche. In barrier island ecosystems, edaphic and environmental characteristics (e.g. elevation and distance to shoreline) are major drivers determining where and how plant communities establish. Physical stressors, such as salt stress and drought influence community grouping and can alter plant function within the environment. With projected increases in sea level rise and storm disturbance it is important to understand how plant communities are organized across barrier islands, as most studies are limited to dune habitats and not inland plant communities. I analyzed plant communities across environmental gradients on a Virginia barrier island from dune to marsh. I established transects on Hog Island and assessed soil characteristics (i.e. carbon, nitrogen, pH), species composition, percent cover and specific leaf area. Elevation and distance to shoreline were obtained using recent Lidar imagery. Bray-Curtis ordination showed that position in landscape is an important driver in structuring dominant species such as the grasses Ammophila breviligulata, Spartina patens, and S. alterniflora. Elevation (r = -0.511) and distance to shoreline (r = 0.551) both show relationships with species composition and distribution across the island. Elevation was important in structuring dominant community types (i.e. dune building and marsh plants). Mantel test was used to determine if relationship exists between species cover and measured edaphic/environmental factors (r = 0.299, p \u3e 0.0001). Percent carbon found in soil within plots was weakly related with distance to the inner portion of the island (r = 0.56). This reflects biotic processes that occur in interior portions of the island. There was no obvious relationship with percent nitrogen due to extremely low levels across the ecosystem. Understanding community structure across coastal ecosystems is necessary for predicting how shorelines and interior communities will be affected with projected sea level rise and increases in storm frequencies. An updated understanding of how biotic and abiotic drivers of community composition will provide information into predictive modeling of plant community and ecosystem level responses to change.https://scholarscompass.vcu.edu/uresposters/1219/thumbnail.jp

Switching patients from other inhaled corticosteroid devices to the Easyhaler(®) : historical, matched-cohort study of real-life asthma patients

Peer reviewedPublisher PD

Repeat prescribing of medications: a system-centred risk management model for primary care organisations

Rationale, aims and objectives: Reducing preventable harm from repeat medication prescriptions is a patient safety priority worldwide. In the United Kingdom, repeat prescriptions items issued has doubled in the last 20 years from 5.8 to 13.3 items per patient per annum. This has significant resource implications and consequences for avoidable patient harms. Consequently, we aimed to test a risk management model to identify, measure, and reduce repeat prescribing system risks in primary care. Methods: All 48 general medical practices in National Health Service (NHS) Lambeth Clinical Commissioning Group (an inner city area of south London in England) were recruited. Multiple interventions were implemented, including educational workshops, a web-based risk monitoring system, and external reviews of repeat prescribing system risks by clinicians. Data were collected via documentation reviews and interviews and subject to basic thematic and descriptive statistical analyses. Results: Across the 48 participating general practices, 62 unique repeat prescribing risks were identified on 505 occasions (eg, practices frequently experiencing difficulty interpreting medication changes on hospital discharge summaries), equating to a mean of 8.1 risks per practice (range: 1-33; SD = 7.13). Seven hundred sixty-seven system improvement actions were recommended across 96 categories (eg, alerting hospitals to illegible writing and delays with discharge summaries) with a mean of 15.6 actions per practice (range: 0-34; SD = 8.0). Conclusions: The risk management model tested uncovered important safety concerns and facilitated the development and communication of related improvement recommendations. System-wide information on hazardous repeat prescribing and how this could be mitigated is very limited. The approach reported may have potential to close this gap and improve the reliability of general practice systems and patient safety, which should be of high interest to primary care organisations internationally

IUPUI Taxonomy for Service Learning Courses

The Center for Service and Learning at Indiana University-Purdue University, Indianapolis has developed a Taxonomy of service learning courses that supports fidelity and quality by identifying six crucial attributes of service learning courses (i.e., diversity of interactions, civic competencies, community activities, critical reflection, reciprocal partnerships, and assessment)

An Introduction to the Integrated Community-Engaged Learning and Ethical Reflection Framework (I-CELER)

Cultivating ethical Science, Technology, Engineering, and Mathematics researchers and practitioners requires movement beyond reducing ethical instruction to the rational exploration of moral quandaries via case studies and into the complexity of the ethical issues that students will encounter within their careers. We designed the Integrated Community-Engaged Learning and Ethical Reflection (I-CELER) framework as a means to promote the ethical becoming of future STEM practitioners. This paper provides a synthesis of and rationale for I-CELER for promoting ethical becoming based on scholarly literature from various social science fields, including social anthropology, moral development, and psychology. This paper proceeds in five parts. First, we introduce the state of the art of engineering ethics instruction; argue for the need of a lens that we describe as ethical becoming; and then detail the Specific Aims of the I-CELER approach. Second, we outline the three interrelated components of the project intervention. Third, we detail our convergent mixed methods research design, including its qualitative and quantitative counterparts. Fourth, we provide a brief description of what a course modified to the I-CELER approach might look like. Finally, we close by detailing the potential impact of this study in light of existing ethics education research within STEM

Women in contact with the Northern Rivers and Mid North Coast LGBTQ communities: Report of the SWASH Lesbian, Bisexual and Queer Women’s Health Survey 2018

A lack of systematic, nuanced research on the health and wellbeing of Australian lesbian, bisexual and queer (LBQ) women has been a significant barrier to understanding, recognising and addressing their health needs. At worst, LBQ women’s health needs have been largely ignored. At best, they have been considered to be synonymous with general women’s health. While sex between women is considered relatively low risk to health, a range of social, psychological and economic factors mean that this minority group has poorer health outcomes than their heterosexual peers. Stigma, family and community rejection and discrimination can impact on health and wellbeing, the delivery of health services, and women’s access to services. The SWASH survey is a comprehensive survey of important health issues relevant to LBQ and other non-heterosexual identifying women engaged with Sydney’s lesbian, gay, bisexual, transgender and queer (LGBTQ) communities. The survey covers sexual health and wellbeing, violence, mental health, tobacco use, illicit drug use, alcohol consumption, and cancer screening behaviours. SWASH has run every two years since 1996, and since 2009 has been run by researchers at the University of Sydney in collaboration with ACON. The survey is regularly revised to reflect the needs of LGBTQ communities and knowledge deficits identified through research literature. Where possible, questions are sourced from established national surveys such as the Australian Health Survey (AHS), National Drug Strategy Household Survey (NDSHS), Australian Study of Health and Relationships (ASHR), and Australian Longitudinal Survey of Women’s Health (ALSWH). SWASH provides a much needed local evidence base to inform best practice in healthcare and prevention for chronic diseases, mental health and wellbeing, sexual and reproductive health and ageing. Full background on the SWASH project and the results from the 2018 survey can be found in the main SWASH report. For the 2018 iteration of SWASH, we undertook sustained community engagement in the Northern Rivers and Mid North Coast region of NSW to generate sufficient numbers for a regional analysis. The SWASH NR-MNC report presents results based on surveys where participants who resided in this region.ACO

RBPT Workshops in Mohali and Tezpur, 2017 Report of the Workshops at IISER, Mohali, and the University of Tezpur, January 2017

These two Workshops were the first part of a multi-year programme, funded by Newton Bhabha Fund, using colleagues from the UK and India, to support development of a more research-based pedagogy in Indian universities and colleges. The Workshops were developed from a pilot in Pune in March 2016. In total, over 150 university lecturers attended the two Workshops and participated in three days of training and development. The detailed programmes are given later in this report but the Workshops’ intended outcomes were to support Indian teachers as they: explored the nature and purpose of Research-Based Pedagogical Tools (RBPT) considered implementation opportunities and issues for RBPTs at their own colleges acquired RBPT-development skills created a draft of an RBPT suitable for their own college linked with other teachers facing similar challenge