RIVPACS database documentation. Final report

With the advent of the EU Water Framework Directive the concept of the 'reference condition' has become explicit within the legislative framework of the European Union. Reference condition has been established as a quality standard against which assessments of biological degradation must be compared. It is therefore essential that Member States can demonstrate that the biological datasets used to define their reference conditions meet the criteria of the WFD. The RIVPACS reference site dataset is therefore central to the definition of reference conditions for macroinvertebrates in streams and rivers in the United Kingdom. Objectives of research: • To establish the ownership of the RIVPACS reference site dataset • To liaise with all stakeholders of the dataset to establish unhindered access to the RIVPACS reference site dataset for the UK agencies (in perpetuity) • To deliver the RIVPACS reference site dataset to the UK agencies and to the public domain in a readily accessible database together will its accompanying physicochemical variables (both existing and newly collated as part of this project), historical and current anthropogenic stress data, and a range of calculated biotic indices. Key findings and recommendations: Ownership of the RIVPACS dataset resides with no single organization and several different organizations consider that they own different portions of the dataset. Formal permissions to release the dataset into the public domain have been obtained from all twelve extant organizations that have been identified as having funded various phases of RIVPACS research. In addition, CEH/NERC has also agreed to release the RIVPACS dataset to the public domain. Terms and conditions relating to the end use of the RIVPACS dataset have now been established. The RIVPACS database has been assembled in Microsoft® Access and can now be downloaded from the CEH web site. This report details the terms and conditions that apply to all end users of the database and it documents the tables given in the database, their structure and the origin of their data. A separate Pressure Data Analysis report describes the screening of the RIVPACS sites in terms of the current and emerging definitions of reference condition

Development of a tool to improve performance debriefing and learning:the paediatric Objective Structured Assessment of Debriefing (OSAD) tool

Abstract Background Simulation is an important educational tool to improve medical training and patient safety. Debriefing after simulation is crucial to maximise learning and to translate the lessons learnt to improve real clinical performance, and thus to reduce medical error. Currently there are few tools to improve performance debriefing and learning after simulations of serious paediatric situations. Purpose The purpose of this study was to develop a tool to guide and assess debriefings after simulations of serious paediatric situations, applying the current evidence base and user-based research. Study design A literature review and semistructured interviews (performed in 2010) to identify important features of a paediatric simulation debriefing. Emergent theme analysis was used to identify key components of an effective debriefing which could be used as a tool for assessing debriefing effectiveness. Results The literature review identified 34 relevant studies. Interviews were carried out with 16 paediatricians, both debriefing facilitators and learners. In total, 307 features of a debriefing were identified. These were grouped into eight dimensions representing the key components of a paediatric debriefing: the facilitator’s approach, learning environment, engagement of learners, reaction, descriptive reflection, analysis, diagnosis and application. These eight dimensions were used to create a tool, the Objective Structured Assessment of Debriefing (OSAD). Each dimension can be scored on a five-point Likert scale containing descriptions for scores 1, 3 and 5 to serve as anchors and aid scoring. Conclusions The study identified the important features of a paediatric simulation debriefing, which were developed into the OSAD tool. OSAD offers a structured approach to paediatric simulation debriefing, and is based on evidence from published literature and views of simulation facilitators and learners. OSAD may be used as a guide or assessment tool to improve the quality of debriefing after paediatric simulation. </jats:sec

Effects of sampling and sub-sampling variation using the STAR-AQEM sampling protocol on the precision of macroinvertebrate metrics

As part of the extensive field sampling programme within the European Union STAR project, replicate macroinvertebrate samples were taken using the STAR-AQEM sampling method at each of 2–13 sites of varying ecological quality within each of 15 stream types spread over 12 countries throughout Europe. The STAR-AQEM method requires the sub-sampling and taxonomic identification of at least one-sixth of the sample and at least 700 individuals. Replicate sub-samples were also taken at most of these sites. Sub-sampling effects caused more than 50% of the overall variance between replicate samples values for 12 of the 27 macroinvertebrate metrics analysed and was generally greatest for metrics that depend on the number of taxa present. The sampling precision of each metric was estimated by the overall replicate sampling variance as a percentage Psamp of the total variance in metric values within a stream type. Average over all stream types, the three Saprobic indices had the lowest percentage sampling variances with median values of only 3–6%. Most of the metrics had typical replicate sampling variances of 8–18% of the total variability within a stream type; this gives rise to estimated rates of mis-classifying sites to ecological status class of between 22 and 55% with an average of about 40%. This suggests that the precision of such metrics based on the STAR-AQEM method is only sufficient to indicate gross changes in the ecological status of sites, but there will be considerable uncertainty in the assignment of sites to adjacent status classes. These estimates can be used to provide information on the effects of STAR-AQEM sampling variation on the expected uncertainty in multi-metric assessments of the ecological status of sites in the same or similar stream types, where only one sample has been taken at a point in time and thus there is no replicatio

Techniques to aid the implementation of novel clinical information systems:A systematic review

AbstractBackgroundThis systematic review identifies and evaluates techniques that aid the implementation of novel clinical information systems (CIS) within healthcare.MethodsWe searched electronic databases (MEDLINE, EMBASE, PsycINFO and HMIC Health Management Information Consortium). Desktop reviews for all potentially eligible studies were also conducted via reference lists and forward citation searches. 14,198 abstracts were identified through the initial electronic search. 63 articles were retained following title and abstract reviews, and submitted for full text evaluation. Of these, 18 papers met eligibility criteria.ResultsThe 5 techniques that emerged from the review and that can assist CIS implementation were: system piloting, eliciting acceptance, use of simulation, training and education, and provision of incentives. These techniques were evaluated with a range of study endpoints (including system utilisation, clinical effectiveness, user satisfaction, attitudes towards system training, and attitudes towards implementation). Consideration of the clinical context in which the CIS was implemented was a consistent theme in the evidence-base.ConclusionsAlthough some evidence is available for the effectiveness of the 5 implementation techniques found in this review, the variable endpoints and the non-comparable study designs mean that the evidencebase needs further developing. We discuss the potential role of simulation and clinical leadership, particularly in relation to surgeons, in CIS implementation and we propose practical advice for CIS implementation and evaluation within hospital settings