How much time do nurses have for patients? A longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals.

Background: Time nurses spend with patients is associated with improved patient outcomes, reduced errors, and patient and nurse satisfaction. Few studies have measured how nurses distribute their time across tasks. We aimed to quantify how nurses distribute their time across tasks, with patients, in individual tasks, and engagement with other health care providers; and how work patterns changed over a two year period.

Indole RSK inhibitors. Part 1: discovery and initial SAR.

A series of inhibitors for the 90 kDa ribosomal S6 kinase (RSK) based on an 1-oxo-2,3,4,5-tetrahydro-1H-[1,4]diazepino[1,2-a]indole-8-carboxamide scaffold were identified through high throughput screening. An RSK crystal structure and exploratory SAR were used to define the series pharmacophore. Compounds with good cell potency, such as compounds 43, 44, and 55 were identified, and form the basis for subsequent kinase selectivity optimization.

Implementing electronic medication management at an Australian teaching hospital.

We describe the implementation of an electronic medication management system (eMMS) in an Australian teaching hospital, to inform future similar exercises. The success of eMMS implementation depends on: a positive workplace culture (leadership, teamwork and clinician ownership); acceptance of the major impact on work practices by all staff; timely system response to user feedback; training and support for clinicians; a usable system; adequate decision support.

Contested innovation: the diffusion of interprofessionalism across a health system.

Objective: Interprofessionalism (IP) has emerged as a new movement in healthcare in response to workforce shortages, quality and safety issues and professional power dynamics. Stakeholders can push for IP (e.g.

How and why are communities of practice established in the healthcare sector? A systematic review of the literature.

Background: Communities of Practice (CoPs) are promoted in the healthcare sector as a means of generating and sharing knowledge and improving organisational performance. However CoPs vary considerably in the way they are structured and operate in the sector. If CoPs are to be cultivated to benefit healthcare organisations, there is a need to examine and understand their application to date.

Nickel(II) α-diimine catalyst for Grignard metathesis (GRIM) polymerization.

A nickel α-diimine catalyst was used for Grignard metathesis (GRIM) polymerization of 2,5-dibromo 3-hexylthiophene and 2-bromo-5-iodo-3-hexylthiophene monomers. GRIM polymerization of 2-bromo-5-iodo-3-hexylthiophene generated regioregular polymers with molecular weights ranging from 3,000 to 12,000 g · mol(-1). The nickel α-diimine catalyst was also successfully used for the GRIM polymerization of a bulky benzodithiophene monomer.

Strengthening organizational performance through accreditation research-a framework for twelve interrelated studies: the ACCREDIT project study protocol.

Background: Service accreditation is a structured process of recognising and promoting performance and adherence to standards. Typically, accreditation agencies either receive standards from an authorized body or develop new and upgrade existing standards through research and expert views. They then apply standards, criteria and performance indicators, testing their effects, and monitoring compliance with them.

Medication decision-making on hospital ward-rounds.

This research explored the decision-making process of selecting medicines for prescription on hospital ward-rounds. We aimed to determine when and with whom medications were discussed, and in particular, whether shared decision making (SDM) occurred on ward-rounds. As a low level of computerized decision support was in place in the hospital at the time, we also examined whether the decision support aided in any medication discussions.

Innovation in intensive care nursing work practices with PACS.

Doctors are the main users of x-rays and other medical images in hospitals and as such picture archive and communication systems (PACS) have been designed to improve their work processes and clinical care by providing them with faster access to images. Nurses working in intensive care units (ICUs) also access images as an integral part of their work, yet no studies have examined the impact of PACS on the work of intensive care nurses. Our study aimed to examine whether and how ICU nurses view and use images and whether access to PACS promotes innovation in work practices.

Does PACS facilitate work practice innovation in the intensive care unit?

Picture Archiving and Communication Systems (PACS) allow the fast delivery of imaging studies to clinicians at the point-of-care, supporting quicker decision-making. PACS has the potential to have a significant impact in the Intensive Care Unit (ICU) where critical decisions are made on a daily basis, particularly during ward rounds. We aimed to examine how accessing image information is integrated into ward rounds and if the presence of PACS produced innovations in ward round practices.

What do physicians tell laboratories when requesting tests? A multi-method examination of information supplied to the microbiology laboratory before and after the introduction of electronic ordering.

Background: The provision of relevant clinical information on pathology requests is an important part of facilitating appropriate laboratory utilization and accurate results interpretation and reporting.

Purpose: (1) To determine the quantity and importance of handwritten clinical information provided by physicians to the Microbiology Department of a hospital pathology service; and (2) to examine the impact of a Computerized Provider Order Entry (CPOE) system on the nature of clinical information communication to the laboratory.

Methods: A multi-method and multi-stage investigation which included: (a) a retrospective audit of all handwritten Microbiology requests received over a 1-month period in the Microbiology Department of a large metropolitan teaching hospital; (b) the administration of a survey to laboratory professionals to investigate the impact of different clinical information on the processing and/or interpretation of tests; (c) an expert panel consisting of medical staff and senior scientists to assess the survey findings and their impact on pathology practice and patient care; and (d) a comparison of the provision and value of clinical information before CPOE, and across 3 years after its implementation.

Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience.

Background: Intravenous medication administrations have a high incidence of error but there is limited evidence of associated factors or error severity.

Objective: To measure the frequency, type and severity of intravenous administration errors in hospitals and the associations between errors, procedural failures and nurse experience.

Methods: Prospective observational study of 107 nurses preparing and administering 568 intravenous medications on six wards across two teaching hospitals.

The influence of computerized decision support on prescribing during ward-rounds: are the decision-makers targeted?

Objective: To assess whether a low level of decision support within a hospital computerized provider order entry system has an observable influence on the medication ordering process on ward-rounds and to assess prescribers' views of the decision support features.

Methods: 14 specialty teams (46 doctors) were shadowed by the investigator while on their ward-rounds and 16 prescribers from these teams were interviewed.

Results: Senior doctors were highly influential in prescribing decisions during ward-rounds but rarely used the computerized provider order entry system.

A realist evaluation of the role of communities of practice in changing healthcare practice.

Background: Healthcare organisations seeking to manage knowledge and improve organisational performance are increasingly investing in communities of practice (CoPs). Such investments are being made in the absence of empirical evidence demonstrating the impact of CoPs in improving the delivery of healthcare. A realist evaluation is proposed to address this knowledge gap.

What makes a leaf tough? Patterns of correlated evolution between leaf toughness traits and demographic rates among 197 shade-tolerant woody species in a neotropical forest.

Slow-growing juveniles of shade-tolerant plant species are predicted to have tough leaves because of the high cost of leaf replacement in shade relative to potential carbon gain. We assessed the degree of correlated evolution among eight traits associated with leaf toughness and the relationships of those traits with the growth and mortality rates of 197 tree and shrub species from the understory of the 50-ha forest dynamics plot on Barro Colorado Island, Panama. Path analysis with phylogenetically independent contrasts revealed that leaves attained material toughness (resistance to fracture per unit fracture area) through increases in tissue density, percent cellulose per unit dry mass, and vein fracture toughness.

Validation of the Work Observation Method By Activity Timing (WOMBAT) method of conducting time-motion observations in critical care settings: an observational study.

Background: Electronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs.

Time matters--a theoretical and empirical examination of the temporal landscape of a hospital pathology service and the impact of e-health.

One of the challenges associated with the implementation of e-health systems is the effect they have on the temporal landscape (how time is conceived, structured and monitored) of an organisation particularly as it relates to the way that work is prioritised, allocated, synchronised and coordinated. This study aims to identify the impact of the introduction of a new e-health system on key aspects of the temporal and organisational functioning of a hospital pathology service. The study employed qualitative methods including interviews, focus groups and observation sessions.

A simulation framework for mapping risks in clinical processes: the case of in-patient transfers.

Objective: To model how individual violations in routine clinical processes cumulatively contribute to the risk of adverse events in hospital using an agent-based simulation framework.

Design: An agent-based simulation was designed to model the cascade of common violations that contribute to the risk of adverse events in routine clinical processes. Clinicians and the information systems that support them were represented as a group of interacting agents using data from direct observations.

The Structural Biology Knowledgebase: a portal to protein structures, sequences, functions, and methods.

The Protein Structure Initiative's Structural Biology Knowledgebase (SBKB, URL: http://sbkb.org ) is an open web resource designed to turn the products of the structural genomics and structural biology efforts into knowledge that can be used by the biological community to understand living systems and disease. Here we will present examples on how to use the SBKB to enable biological research.

The use of computerized provider order entry to improve the effectiveness and efficiency of coagulation testing.

Effective pathology services require timely communication of patient-related information between the laboratory and clinicians. The aim of this study was to measure the effect of a computerized provider order entry (CPOE) system on the frequency with which clinicians notify the Hematology Laboratory of details on heparin or warfarin treatments when ordering activated partial thromboplastin time (aPTT) or the prothrombin time (PT) and international normalized ratio (INR). Although information about the total number of patients on warfarin or heparin was unavailable, it was possible to ascertain that the percentage of abnormal results for each year ranged from 39% in 2005 to 45%, 40%, and 38% in the years 2006 to 2008.

The role of computerized decision support in reducing errors in selecting medicines for prescription: narrative review.

This narrative review includes a summary of research examining prescribing errors, prescription decision making and the role computerized decision support plays in this decision-making process. A reduction in medication prescribing errors, specifically a reduction in the selection of inappropriate medications, is expected to result from the implementation of an effective computerized decision support system. Previous research has investigated the impact of the implementation of electronic systems on medication errors more broadly.

Comprehensive medical assessments for monitoring and improving the health of residents in aged care facilities: existing comprehensive medical assessments coverage and trial of a new service model.

Aim: To measure comprehensive medical assessment (CMA) completions among aged care residents in Australia; and to report the outcomes of a CMA service trial.

Methods: A population-based descriptive study of CMA completions using Medicare data; and a qualitative study of an intervention trial carried out at a 115-bed residential aged care facility in Sydney, Australia. Fifty residents participated in the trial; 15 interviews were conducted.

The impact of computerized provider order entry systems on medical-imaging services: a systematic review.

Background: Computerized provider order entry (CPOE) systems have been strongly promoted as a means to improve the quality and efficiency of healthcare.

Methods: This systematic review aimed to assess the evidence of the impact of CPOE on medical-imaging services and patient outcomes.

Results: Fourteen studies met the inclusion criteria, most of which (10/14) used a pre-/postintervention comparison design.

Interpreting social network metrics in healthcare organisations: a review and guide to validating small networks.

Social network analysis is an increasingly popular sociological method used to describe and understand the social aspects of communication patterns in the health care sector. The networks studied in this area are special because they are small, and for these sizes, the metrics calculated during analysis are sensitive to the number of people in the network and the density of observed communication. Validation is of particular value in controlling for these factors and in assisting in the accurate interpretation of network findings, yet such approaches are rarely applied.

The safety implications of missed test results for hospitalised patients: a systematic review.

Background: Failure to follow-up test results is a critical safety issue. The objective was to systematically review evidence quantifying the extent of failure to follow-up test results and the impact on patient outcomes.

Methods: The authors searched Medline, CINAHL, Embase, Inspec and the Cochrane Database from 1990 to March 2010 for English-language articles which quantified the proportion of diagnostic tests not followed up for hospital patients.