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Background The Editorial Board of EJNMMI Radiopharmacy and Chemistry releases a biannual highlight commentary to update the readership on trends in the field of radiopharmaceutical development. Main Body This selection of highlights provides commentary on 21 different topics selected by each coauthoring Editorial Board member addressing a variety of aspects ranging from novel radiochemistry to first-in-human application of novel radiopharmaceuticals. Conclusion Trends in radiochemistry and radiopharmacy are highlighted. Hot topics cover the entire scope of EJNMMI Radiopharmacy and Chemistry, demonstrating the progress in the research field, and include new PET-labelling methods for 11C and 18F, the importance of choosing the proper chelator for a given radioactive metal ion, implications of total body PET on use of radiopharmaceuticals, legislation issues and radionuclide therapy including the emerging role of 161Tb.

Background The Editorial Board of EJNMMI Radiopharmacy and Chemistry releases a biyearly highlight commentary to update the readership on trends in the field of radiopharmaceutical development. Results This commentary of highlights has resulted in 23 different topics selected by each member of the Editorial Board addressing a variety of aspects ranging from novel radiochemistry to first in man application of novel radiopharmaceuticals and also a contribution in relation to MRI-agents is included. Conclusion Trends in (radio)chemistry and radiopharmacy are highlighted demonstrating the progress in the research field being the scope of EJNMMI Radiopharmacy and Chemistry.

IntroductionMany clinical education programmes have not incorporated the use of the electronic health record (EHR) into their curriculum. It is important to incorporate technologies that will be used in real-world settings to better prepare students for clinical practice.ObjectivesTo undertake a review of literature to identify a training evaluation framework; to conduct a self-completion survey, pretraining and post-training, to determine students’ perceptions on the benefit of using EHR training system.SettingNursing School, University, North West England, UK; University Ethic Committee Approval Received.ParticipantsRegistered nurses undertaking a validated return to practice course; 24 participants for the first cohort who completed pretraining questionnaire and 23 for the second post-training cohort.ResultsThe statistical results show that the students perceived that the training improved their capability in employing digital systems with statistically significant difference in the assessed preproficiency and post proficiency in the use of digital clinical systems (premedians and post medians are 2 and 5 on 10-point Likert scale, p=0.041). There was also an indication of an improvement in the knowledge of EHR systems although not statistically significant. Most students perceived it increased their knowledge on digital systems.ConclusionStudents perceived an increase in proficiency with the EHR. There was evidence of improvement in confidence in the use of the EHR, but this confidence would be enhanced by additional use of the system. Some desire to increase confidence further and to develop knowledge of digital systems was expressed.

Background. This paper provides an overview of complex adaptive systems (CAS) theories and value in enabling change in an adaptive organisation. A CAS approach is interpreted here as a framework that assists thinking about the nature of quality improvement programmes with a focus on the people involved.

Aim To obtain insight into the perceived quality of electronic records received by GP2GP transfer, from the perspective of staff within the receiving practice. Methods A pilot study using a self-completion online survey.We used textual analysis and descriptive statistics to report the findings. Results Respondents considered a significantly higher proportion of their own records to be accurate, complete and useful compared with records transferred from other practices (PConclusion The results suggest that respondents value the GP2GP record transfer system. They perceive issues with record quality, which require significant resources to rectify. Textual analysis suggests that difficulties in mapping data structures between systems may underlie some of the perceived issues. Further research is needed to confirm these initial findings on differential perception and explore their underlying causes.

Objective To identify key elements and characteristics of complex adaptive systems (CAS) relevant to implementing clinical governance, drawing on lessons from quality improvement programmes and the use of informatics in primary care. Method The research strategy includes a literature review to develop theoretical models of clinical governance of quality improvement in primary care organisations (PCOs) and a survey of PCOs. Results Complex adaptive system theories are a valuable tool to help make sense of natural phenomena, which include human responses to problem solving within the sampled PCOs. The research commenced with a survey; 76% (n16) of respondents preferred to support the implementation of clinical governance initiatives guided by outputs from general practice electronic health records. There was considerable variation in the way in which consultation data was captured, recorded and organised. Incentivised information sharing led to consensus on coding policies and models of data recording ahead of national contractual requirements. Informatics was acknowledged as a mechanism to link electronic health record outputs, quality improvement and resources. Investment in informatics was identified as a development priority in order to embed clinical governance principles in practice. Conclusions Complex adaptive system theory usefully describes evolutionary change processes, providing insight into how the origins of quality assurance were predicated on rational reductionism and linearity. New forms of governance do not neutralise previous models, but add further dimensions to them. Clinical governance models have moved from deterministic and 'objective' factors to incorporate cultural aspects with feedback about quality enabled by informatics. The socio-technical lessons highlighted should inform healthcare management.

Background \ud Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider.\ud \ud Aim\ud To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care.\ud \ud Design and setting\ud A systematic review was conducted that focused on all studies about online record access and transactional services in primary care.\ud \ud Method\ud Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King’s Fund, Nuffield Health, PsycINFO, OpenGrey (1999–2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted.\ud \ud Results\ud A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy.\ud \ud Conclusion\ud While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so.

This pilot initiative uses an approach that focuses on improving the whole business of primary care, its processes and its people. The Health Informatics Programme for Coronary Heart Disease (HIP for CHD) addresses the two faces of clinical governance but has a prime focus on the development of learning organisations. The project has developed a methodology and an associated set of tools that it has tested and evaluated in a small number of pilot sites. The work of HIP for CHD is focused on coronary heart disease but the methodology is equally applicable to other clinical areas. In particular, HIP for CHD provides an approach that allows the diverse strands of all of the National Service Frameworks to be handled in a joined-up way in primary care.

OBJECTIVES: To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues.SETTING: Primary care.PARTICIPANTS: A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol.PRIMARY AND SECONDARY OUTCOME MEASURES: Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services.RESULTS: No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt.CONCLUSIONS: Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1 SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42012003091.

These three educational pathways appear to offer a range of complementary entry routes, targeting different student groups. However, we in the health informatics community need to consider what additional support potential students might receive to ease their passage from learner to a career in health informatics. Our suggestions for the UK, which could be replicated internationally, are: • The BCS should consider improved access to its healthcare specialist groups and conferences for students on recognised courses. • The NHS should systematically develop work experience placements for health informatics students on approved courses. • UKCHIP could consider providing provisional registration for newly-qualified health informaticians while they acquire the necessary experience for full registration. It could approve specific courses for particular levels of registration. • Journals and conferences associated with the major health informatics associations could consider much lower subscriptions for health informatics students. Higher education is developing a professional health informatics community. The time is right for school leavers to have a direct route into this career. Within the next five years larger numbers of school leavers will start to move into health informatics de novo. © 2005 PHCSG, British Computer Society.

The UK has no research nuclear reactors and relies on the importation of 99Mo and other medical radioisotopes (e.g. Iodine-131) from overseas (excluding PET radioisotopes). The UK is therefore vulnerable not only to global shortages, but to problems with shipping and importation of the products. In this context Professor Erika Denton UK national Clinical Director for Diagnostics requested that the British Nuclear Medicine Society lead a working group with stakeholders including representatives from the Science & Technology Facilities Council (STFC) to prepare a report. The group had a first meeting on 10 April 2013 followed by a working group meeting with presentations on 9th September 2013 where the scope of the work required to produce a report was agreed. The objectives of the report are: to describe the status of the use of medical radioisotopes in the UK; to anticipate the potential impact of shortages for the UK; to assess potential alternative avenues of medical radioisotope production for the UK market; and to explore ways of mitigating the impact of medical radioisotopes on patient care pathways. The report incorporates details of a visit to the Cyclotron Facilities at Edmonton, Alberta and at TRIUMF, Vancouver BC in Canada by members of the report team., 121 pages