Creating virtual communities of practice for learning technology in higher education: Issues, challenges and experiences

The need for a Web portal to support the rapidly growing field of learning technology has been well established through a number of national surveys and scoping studies over recent years. The overarching vision has been the provision of a virtual environment to assist in informing and developing professional practice in the use of learning technologies. This paper outlines the issues and challenges in creating such a portal through the experiences of developing the RESULTs Network. In the paper, design and participation issues are considered within the wider context of online and networked approaches to supporting practice and professional development. User participation methodologies and technical developments for RESULTs are described in relation to a review of existing representations of practice and a comprehensive survey amongst the learning technology users’ community. An outline of key achievements and experiences is presented, followed by some conclusions regarding the cultural and political issues in creating a viable and sustainable facility and suggestions for possible future direction in national provision

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

External Evaluation for the BCE-CT Project

Strand one: Effectiveness of project activities and processe

Creating virtual communities of practice for learning technology in higher education: a response by the author

Cathy Gunn's response to the paper was highly gratifying and raises a set of interesting points that I welcome the opportunity to explore more deeply. There were many considerations too complex to address in the paper and we accept the danger of oversimplification. Our summary of the RESULTs Network development was effectively a first attempt to match human values and behaviours to technical systems. Gunn suggests that a key element missing from our scenario is in having ‘a compelling reason for users to access the resources and participate in the communities provided'. The factors at play in terms of ‘motivation to participate' were extensively researched in the user participation study. A full reading is available in Beetham (2001). Nevertheless, there remains an important question about the process of adoption and participation. I would like therefore to take up the challenge of considering further the idea that communities of practice must ‘evolve' and cannot be ‘created'

The Equity in Prescription Medicines Use Study: Using community pharmacy databases to study medicines utilisation

Purpose Pharmacy dispensing databases provide a comprehensive source of data on medicines use free from many of the biases inherent in administrative databases. There are challenges associated with using pharmacy databases however. This paper describes the methods we used, and their performance, so that other researchers considering using pharmacy databases may benefit from our experiences. Methods Data were collected from all nine pharmacy dispensing databases in an isolated New Zealand town for the period October 2005–September 2006. Probabilistic record matching was used to link individuals across pharmacies. Patient addresses from the pharmacy data were geo-located to small areas so an area measure of socioeconomic deprivation could be assigned. Medicines were coded according to the ATC-DDD drug classification system. Results Data on 619,264 dispensings were collected. Record matching reduced an initial pool of individuals from 54,484 to 38,027. Socioeconomic deprivation ranks were assigned for 30,972 (93%) of the 33,375 unique addresses identified, or 36,048 (95%) of individuals. ATC codes were assigned to 613,490 (99%) of the dispensings, with DDDs assigned to 561,223 (91%). Overall, 93% of dispensing records had complete demographic and drug information. Conclusions The methods described in this paper generated a rich dataset for medicines use research. These methods, while initially resource-intensive, can to a great extent be automated and applied to other locations, and will hopefully prove useful to other researchers facing similar challenges with using pharmacy databases. However, it is difficult to envisage these methods being viable on a long-term or national scale