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BackgroundClinical decision support (CDS) tools improve clinical diagnostic decision making and patient safety. The availability of CDS to health care professionals has grown in line with the increased prevalence of apps and smart mobile devices. Despite these benefits, patients may have safety concerns about the use of mobile devices around medical equipment.ObjectiveThis research explored the engagement of junior doctors (JDs) with CDS and the perceptions of patients about their use. There were three objectives for this research: (1) to measure the actual usage of CDS tools on mobile devices (mCDS) by JDs, (2) to explore the perceptions of JDs about the drivers and barriers to using mCDS, and (3) to explore the perceptions of patients about the use of mCDS.MethodsThis study used a mixed-methods approach to study the engagement of JDs with CDS accessed through mobile devices. Usage data were collected on the number of interactions by JDs with mCDS. The perceived drivers and barriers for JDs to using CDS were then explored by interviews. Finally, these findings were contrasted with the perception of patients about the use of mCDS by JDs.ResultsNine of the 16 JDs made a total of 142 recorded interactions with the mCDS over a 4-month period. Only 27 of the 114 interactions (24%) that could be categorized as on-shift or off-shift occurred on-shift. Eight individual, institutional, and cultural barriers to engagement emerged from interviews with the user group. In contrast to reported cautions and concerns about the impact of clinicians’ use of mobile phone on patient health and safety, patients had positive perceptions about the use of mCDS.ConclusionsPatients reported positive perceptions toward mCDS. The usage of mCDS to support clinical decision making was considered to be positive as part of everyday clinical practice. The degree of engagement was found to be limited due to a number of individual, institutional, and cultural barriers. The majority of mCDS engagement occurred outside of the workplace. Further research is required to verify these findings and assess their implications for future policy and practice.

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Aims: This research investigated the effectiveness of an intervention for improving the prescribing and patient safety behaviour among Foundation Year doctors. The intervention consisted of simulated clinical encounters with subsequent personalised, structured, video-enhanced feedback and deliberate practice, undertaken at the start of four-month sub-specialty rotations. Methods: Three prospective, non-randomised control intervention studies were conducted, within two secondary care NHS Trusts in England. The primary outcome measure, error rate per prescriber, was calculated using daily prescribing data. Prescribers were grouped to enable a comparison between experimental and control conditions using regression analysis. A break-even analysis evaluated costeffectiveness.

ObjectivesErrors in the process of prescribing can lead to avoidable harm for patients. Establishing the extent of prescribing errors across medical specialties is critical. This research explores the frequency and types of prescribing errors made by healthcare professionals prescribing in patients with renal disease where prescribing problem-solving and decision-making is complex due to co-existing multimorbidity MethodsAll prescriptions and errors made by prescribers were captured over a four-month period at a UK renal unit. Data was recorded about the medicine associated with error, the nature and severity of error, alongside the prescriber's occupational grade. ResultsThere were 10394 items prescribed and 3.54% with associated prescribing errors. Whilst Foundation year one doctors made almost one error every week (n=15.13) and Foundation year two doctors one every two weeks (n=8.00), other prescribers made one error per month (n=3.94, 95%). The medicines most frequently associated with errors for Foundation doctors were paracetamol (6.51%), calcium acetate (5.33%), meropenem (3.55%), alfacalcidol (3.55%) and tazocin (3.55%), whilst for all other prescribers they were meropenem (6.15%), alfacalcidol (4.62%), co-amoxiclav (4.62%) and tacrolimus (4.62%). The most common types of error for both groups were omitting the indication, using the brand name inappropriately, and prescribing inaccurate doses. ConclusionsThe range of errors made by multi-professional healthcare prescribers confirms complexity of prescribing on a renal unit for patients with kidney disease and multimorbidity. These findings have implications for the types of educational interventions required for reducing avoidable harm and overcoming human factors challenges to improve prescribing behaviour.

Cotton is a major cash crop and backbone of the textile industry in Pakistan which is badly affected by sucking insects. Drought is an important abiotic factor in trichome development. The objective of the study was to determine the effects of drought on trichome density and length. Trichome density was measured in two ways, one through the scaling method and the other through counting the trichome density manually. The scaling method is qualitative grading while quantitative grading includes trichomecount in a card of optimized length. Three scales were finalized to classify leaves on the basis of trichomes which were counted in a specific area (0.25cm2) on abaxial side of the leaf. In drought stress, trichomes density and length were measured and compared to that in normal conditions. Trichome density varies from 12 to 56 in 0.25cm2 under drought stress. On the basis of correlation of trichome density with stomatal conductance, photosynthetic rate, PAR and transpiration ratio under drought and normal conditions, it was concluded that trichome density increased as a result of drought stress.

SRL-enhanced video feedback is effective for improving prescribing competency and developing SRL processes such as goal setting and selfmonitoring skills in simulated clinical encounters. Further research is required to evaluate transferability to other clinical sub-speciality contexts and investigate the effectiveness of the intervention for improving prescribing in non-simulated settings.