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A study was conducted to explore student self-efficacy, motivation, and performance in learning programming online. A questionnaire was administered to 132 students in a Foundation in Engineering programme using the Computer Programming Self-Efficacy Scale and Intrinsic Motivation Inventory. Then, exam performance and Moodle logs were used to complement the findings. Data collected revealed that students with prior programming knowledge had more self-efficacy in simple and complex programming concepts. Students were mainly motivated to learn by interest and value. Students performed better in online programming classes, and their performance was positive correlated with Moodle access and attendance at live online classes. There are a few implications of this study. Online delivery is more appropriate for introductory programming course. However, the quality of online classes is inevitably uncertain due to the impact of uncontrollable external factors. Education regardless of whether face-to-face or online, is a complete package of academic knowledge, social and emotional development.

Objectives: To assess the immediate (first 70 days of use) and long-term (one-year) effectiveness of an electronic medication management (eMM) system to reduce prescribing errors, and their potential and actual harm in paediatrics. Design: A stepped-wedge cluster randomised controlled trial (SWCRCT) over 11 weeks (April–July 2016): 8 clusters randomised for eMM implementation. All medication orders during the trial and for a random sample of medication orders one-year post-eMM implementation (June–September 2017) were reviewed. Clinical prescribing errors were rated for the severity of potential harm on a 5-point scale. Errors (score ≥3 ie potential adverse drug events [ADEs]) identified in the SWCRCT were assessed for actual harm (actual ADEs). Setting: A 310-bed paediatric referral hospital in Sydney, Australia. Participants: Inpatients. Control and Intervention: Paper medication charts (control); eMM (intervention). Primary outcomes: clinical prescribing errors, potential ADEs. Secondary outcomes: procedural errors, clinical prescribing errors for high-risk medications and by error type, clinical errors associated with actual harm (ADEs) during the SWCRCT. Results: 35,260 medication orders for 4,821 patients were reviewed. In the first 70 days of eMM use there was no significant change in overall clinical prescribing error rates (Incident Rate Ratio [IRR] 1.05[95%CI 0.92-1.21], p=0.45). However, potential ADEs significantly increased by 62% (IRR 1.62[95%CI 1.28-2.04], pDiscussion: This is the first randomised controlled trial of the effects of eMM on paediatric prescribing errors. The first 70 days of use showed no overall improvement and an increase in some categories of errors. The results suggest immediate risks to medication safety during the early periods of system use. A year after implementation error rates significantly declined from baseline suggesting long-term benefits to safety. Optimisation of eMM should focus on features to reduce dose errors due to their high frequency and greater capacity to cause harm.

Background Governance of controlled drugs (CDs) in hospitals is resource intensive but important for patient safety and policy compliance. Objectives To explore whether and how storing CDs in an automated dispensing cabinet (ADC) in a children’s hospital intensive care unit (ICU) contributes to the effectiveness and efficiency of CD governance. Methods We conducted a mixed-methods exploratory study, comprising observations, interviews and audits, 3 months after ADC implementation. We observed 54 hours of medications activities in the ICU medication room (with 42 hours of timed data); interviewed nurses (n=19), management (n=1) and pharmacy staff (n=3); reviewed 6 months of ICU incident reports pertaining to CD governance; audited 6 months of CD register data and extracted logs of all ADC transactions for the 3 months following implementation. Data analysis focused on four main CD governance activities: safekeeping/controlling access, documenting use, monitoring, and reporting/investigating. Results Nurses and pharmacists perceived spending less time on CD governance tasks with the ADC. The ADC supported CD governance through automated documentation of CD transactions; ‘blind counts’; automated count discrepancy checks; electronic alerts and reporting functionalities. It changed quality and distribution of governance tasks, such as removing the requirement for ‘nurses with keys’ to access CDs, and allowing pharmacists to generate reports remotely, rather than reviewing registers on the ward. For CDs in the ADC, auditing and monitoring appeared to be ongoing rather than periodic. Such changes appeared to create positive reinforcing loops. However, the ADC also created challenges for CD governance. Most importantly, it was not suitable for all CDs, leading to workarounds and parallel use of a safe plus paper registers. Conclusions ADCs can significantly alter CDs governance in clinical areas. Effects of an ADC on efficiency and effectiveness of governance tasks appear to be complex, going beyond simple time savings or more stringent controls.

Objective To conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS. Materials and Methods We searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed. Results There was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18–8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72–0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence. Discussion and Conclusion Despite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks.

This study explored the gaming principles that fitted well in the theory of learning in good computer games and attempted to incorporate those principles into mathematics education. A qualitative d...

Missed medication doses can affect patient safety in hospitals. The use of automated dispensing cabinets (ADC) in clinical areas may reduce the occurrence of medications being unavailable at the time of need by alerting pharmacy to replenish stock. However, workarounds in ADC use can affect this capability. We studied nurses' use of an ADC in a paediatric intensive care unit with 54 hours of observation, semi-structure interviews (19 nurses; 4 pharmacy/management staff) and review of reported incidents. We found running out of medication a recurrent problem despite the ADC. Contributing factors affecting data entry in the ADC, and therefore replenishment alerts to pharmacy, included: the organisation of medication activities in the ward, nurses' information needs, patients' medication needs, and ADC design. Running out of medications was a 'tragedy of the commons'. Effective solutions may require going beyond user training and directives for accurate data entry, to work process redesign.

Evidence is limited of automated dispensing cabinets (ADCs) impact on effectiveness and efficiency of controlled drugs' (CDs) governance processes. We carried out a mixed-methods study of an ADC in an intensive care unit. We found ADC improved effectiveness and efficiency of governance of CDs through secure storage, alerts and automated recording of transactions. Limitations were associated with ADC design and 'fit' between ADC and some types of CDs.

Evidence is limited of automated dispensing cabinets (ADCs) impact on effectiveness and efficiency of controlled drugs’ (CDs) governance processes. We carried out a mixed-methods study of an ADC in an intensive care unit. We found ADC improved effectiveness and efficiency of governance of CDs through secure storage, alerts and automated recording of transactions. Limitations were associated with ADC design and ‘fit’ between ADC and some types of CDs.

Missed medication doses can affect patient safety in hospitals. The use of automated dispensing cabinets (ADC) in clinical areas may reduce the occurrence of medications being unavailable at the time of need by alerting pharmacy to replenish stock. However, workarounds in ADC use can affect this capability. We studied nurses’ use of an ADC in a paediatric intensive care unit with 54 hours of observation, semi-structure interviews (19 nurses; 4 pharmacy/management staff) and review of reported incidents. We found running out of medication a recurrent problem despite the ADC. Contributing factors affecting data entry in the ADC, and therefore replenishment alerts to pharmacy, included: the organisation of medication activities in the ward, nurses’ information needs, patients’ medication needs, and ADC design. Running out of medications was a ‘tragedy of the commons’. Effective solutions may require going beyond user training and directives for accurate data entry, to work process redesign.

Classifying harm associated with a medication error can be time consuming and labour intensive and limited studies undertake this step. There is no standardised process, and few studies that report harm assessment provide adequate methods to allow for study replication. Studies typically mention that a clinical review panel classified patient harm and provide a reference to a classification tool. Moreover, in many studies it is unclear whether potential or actual harm was classified as studies refer only to ‘error severity’. The tools used to categorise the severity of patient harm vary widely across studies and few have been assessed for inter-rater reliability and criterion validity. In this paper, we describe the systematic process we undertook to synthesise the defining elements and strengths, while mitigating the limitations, of existing harm classification tools to derive the Harm Associated with Medication Error Classification (HAMEC). This new tool provides a harm classification for use across clinical and research settings. The provision of an explicit process for its application and guiding category descriptors are designed to reduce the risk of misclassification and produce results that are comparable across studies. As the World Health Organisation embarks on its international safety challenge of reducing medication-related harm by 50%, accompanying methodological advances are required to measure progress. Electronic supplementary material The online version of this article (10.1007/s40264-019-00823-4) contains supplementary material, which is available to authorized users.

This article explores the potential use metacognitive skills learned in computer games to teach mathematics. This study explored the similarities and differences in the learning of metacognitive skills between computer games and mathematics education. A mixed-methods approach was employed in which a quantitative survey (students, n=174) and a qualitative interview (six mathematics teachers, eight students) were administered to concurrently at two secondary schools in Malaysia. Data collected has shown that there is no direct and explicit connection between the two learning contexts. In computer games, pupils could learn: (a) multitasking, (b) land navigation, (c) teamwork, (d) bottom-up approach to problem solving, and (e) concentration skills. However, it is understandable that a mathematics education (a) is single-tasking, e.g. solves problems step-by-step, (b) uses graphic representation, (c) involves collaborative learning, (d) follows top-down approach to problem-solving, and (e) could use multiple sensory modalities to ameliorate learning.

Objective The operating room is a complex environment in which distractions, interruptions and disruptions (DIDs) are frequent. Our aim was to synthesize research on the relationships between DIDs and (i) operative duration, (ii) team performance, (iii) individual performance and (iv) patient safety outcomes in order to better understand how interventions can be designed to mitigate the negative effects of DIDs. Methods Electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) and reference lists were systematically searched. Included studies were required to report the quantitative outcomes of the association between DIDs and team performance, individual performance and patient safety. Two reviewers independently screened articles for inclusion, assessed study quality and extracted data. A random-effects meta-analysis was performed on a subset of studies reporting total operative time and DIDs. Results Twenty-seven studies were identified. The majority were prospective observational studies (n = 15) of moderate quality. DIDs were often defined, measured and interpreted differently in studies. DIDs were significantly associated with extended operative duration (n = 8), impaired team performance (n = 6), self-reported errors by colleagues (n = 1), surgical errors (n = 1), increased risk and incidence of surgical site infection (n = 4) and fewer patient safety checks (n = 1). A random-effects meta-analysis showed that the proportion of total operative time due to DIDs was 22.0% (95% confidence interval 15.7–29.9). Conclusion DIDs in surgery are associated with a range of negative outcomes. However, significant knowledge gaps exist about the mechanisms that underlie these relationships, as well as the potential clinical and non-clinical benefits that DIDs may deliver. Available evidence indicates that interventions to reduce the negative effects of DIDs are warranted, but current evidence is not sufficient to make recommendations about potentially useful interventions.

BackgroundElectronic medication systems (EMS) have been highly effective in reducing prescribing errors, but little research has investigated their effects on medication administration errors (MAEs).ObjectiveTo assess changes in MAE rates and types associated with EMS implementation.MethodsThis was a controlled before and after study (three intervention and three control wards) at two adult teaching hospitals. Intervention wards used an EMS with no bar-coding. Independent, trained observers shadowed nurses and recorded medications administered and compliance with 10 safety procedures. Observational data were compared against medication charts to identify errors (eg, wrong dose). Potential error severity was classified on a 5-point scale, with those scoring ≥3 identified as serious. Changes in MAE rates preintervention and postintervention by study group, accounting for differences at baseline, were calculated.Results7451 administrations were observed (4176 pre-EMS and 3275 post-EMS). At baseline, 30.2% of administrations contained ≥1 MAE, with wrong intravenous rate, timing, volume and dose the most frequent. Post-EMS, MAEs decreased on intervention wards relative to control wards by 4.2 errors per 100 administrations (95% CI 0.2 to 8.3; p=0.04). Wrong timing errors alone decreased by 3.4 per 100 administrations (95% CI 0.01 to 6.7; pConclusionsImplementation of EMS was associated with a modest, but significant, reduction in overall MAE rate, but halved the proportion of MAEs rated as potentially serious.

BackgroundDouble-checking the administration of medications has been standard practice in paediatric hospitals around the world for decades. While the practice is widespread, evidence of its effectiveness in reducing errors or harm is scarce.ObjectivesTo measure the association between double-checking, and the occurrence and potential severity of medication administration errors (MAEs); check duration; and factors associated with double-checking adherence.MethodsDirect observational study of 298 nurses, administering 5140 medication doses to 1523 patients, across nine wards, in a paediatric hospital. Independent observers recorded details of administrations and double-checking (independent; primed—one nurse shares information which may influence the checking nurse; incomplete; or none) in real time during weekdays and weekends between 07:00 and 22:00. Observational medication data were compared with patients’ medical records by a reviewer (blinded to checking-status), to identify MAEs. MAEs were rated for potential severity. Observations included administrations where double-checking was mandated, or optional. Multivariable regression examined the association between double-checking, MAEs and potential severity; and factors associated with policy adherence.ResultsFor 3563 administrations double-checking was mandated. Of these, 36 (1·0%) received independent double-checks, 3296 (92·5%) primed and 231 (6·5%) no/incomplete double-checks. For 1577 administrations double-checking was not mandatory, but in 26·3% (n=416) nurses chose to double-check. Where double-checking was mandated there was no significant association between double-checking and MAEs (OR 0·89 (0·65–1·21); p=0·44), or potential MAE severity (OR 0·86 (0·65–1·15); p=0·31). Where double-checking was not mandated, but performed, MAEs were less likely to occur (OR 0·71 (0·54–0·95); p=0·02) and had lower potential severity (OR 0·75 (0·57–0·99); p=0·04). Each double-check took an average of 6·4 min (107 hours/1000 administrations).ConclusionsCompliance with mandated double-checking was very high, but rarely independent. Primed double-checking was highly prevalent but compared with single-checking conferred no benefit in terms of reduced errors or severity. Our findings raise questions about if, when and how double-checking policies deliver safety benefits and warrant the considerable resource investments required in modern clinical settings.

Dance therapy can improve motor skills, balance, posture, and gait in people diagnosed with Parkinson’s disease (PD) and healthy older adults (OA). It is not clear how specific movement patterns during dance promote these benefits. The purpose of this cohort study was to identify differences and complexity in dance movement patterns among different dance styles for PD and OA participants in community dance programs using approximate entropy (ApEn) analysis. The hypothesis was that PD participants will show greater ApEn during dance than OA participants and that the unique dance style of tango with more pronounced foot technique and sharp direction changes will show greater ApEn than smoother dance types such as foxtrot and waltz characterized by gradual changes in direction and gliding movement with rise and fall. Individuals participated in one-hour community dance classes. Movement data were captured using porTable 3D motion capture sensors attached to the arms, torso and legs. Classes were also video recorded to assist in analyzing the dance steps. Movement patterns were captured and ApEn was calculated to quantify the complexity of movements. Participants with PD had greater ApEn in right knee flexion during dance movements than left knee flexion (p = 0.02), greater ApEn of right than left hip flexion (p = 0.05), and greater left hip rotation than right (p = 0.03). There was no significant difference in ApEn of body movements (p > 0.4) or mean body movements (p > 0.3) at any body-segment in OA. ApEn analysis is valuable for quantifying the degree of control and predictability of dance movements and could be used as another tool to assess the movement control of dancers and aid in the development of dance therapies.

This article explores how motivation in computer games could be integrated into mathematics education. The scope of the study was confined to four motivation dimensions, namely challenge, control, complexity and collaboration. A phenomenology study was conducted with the purpose to obtain a common understanding of nine teachers and 11 students about mathematics education, particularly focusing on teaching practices and learning difficulties in mathematical problem-solving. Qualitative interviews have revealed that the existing mathematics education is built on drill-and-practice approach with Polya's problem-solving technique, i.e. exam-oriented, rote memorization and the use of predefined strategies. This approach to learning has failed to motivate students to learn (affective) and failed to develop an understanding and creativity (cognitive/metacognitive). Looking from a gaming perspective, mathematics problems should be challenging and complex, and students should be given control to carry out a plan. And finally, collaboration should be encouraged to enable reflective learning.

The majority of Australians support a change in legislation to allow the use of cannabis for medical purposes. Despite strong public support, very little is known about the patterns of medicinal cannabis use among Australians.This study aims to gain a better understanding of Australian medicinal cannabis users and their patterns of use.The nature of calls to the Cannabis Information and Helpline (N = 15701), a free national service for Australians with concerns regarding cannabis use, were investigated to determine the number of calls made by those who inquired about the medicinal use of cannabis (N = 275) and the implied reasons for use among those who identify using cannabis in this way.The majority of medicinal cannabis inquirers mentioned cannabis to alleviate pain. Further, compared to other callers, medicinal cannabis inquirers were more likely to be male, unemployed, older, and have recently started using cannabis.These findings highlight the need for future research to better understand the issues faced by Australians regarding the use of cannabis for medicinal purposes and how they may be meaningfully addressed. Particular focus should be placed toward older, unemployed males.

Background: As policy responses to cannabis use and availability change internationally, levels of cannabis use disorder rise and treatment seeking increases. Diversion to cannabis treatment from the criminal justice system also increases demand in the system. At a time of developing treatment systems in response to this demand, an understanding of the evidence is increasingly important. Objective: To provide a narrative review of the developing evidence-base for psycho-social interventions for cannabis use disorder, including adjunctive cannabinoid agonist therapy. Method: Two researchers independently conducted a literature search for articles published prior to February 2016, located through online search of four electronic databases (Google Scholar, CINAHL, Medline, and PsycINFO). Only randomised controlled trials describing treatment(s) for cannabis use or cannabis use disorder with a measure of either cannabis use frequency or cannabis use disorder severity were included. Non-English papers, review papers, posters, opinion pieces, letters or editorials, case studies (N

The aim of this study was to explore the feasibility of deploying digital game-based learning in Mathematics education among a group of Malaysian secondary students. A mixed methods approach was employed in which a quantitative survey [175 students] and a qualitative interview [8 students, 8 parents and 6 teachers] were administered concurrently. Data collected revealed that students’ attitudes to learning Mathematics with digital games are significantly influenced by their interest in Mathematics, types of games played, and the duration of gameplay. Students prefer guidance from teachers, teachers are unlikely to change their existing teaching practices and parents do not support pedagogical change. Although this study has affirmed well-known challenges in an exam-oriented system, one key point is stressed, i.e. the possible adoption of edutainment is structured around the existing pedagogy. Furthermore, there is a need to create seamless formal-informal educational games to enrich Mathematics education.

The risk of medication errors is high in paediatric inpatient settings. However, estimates of the prevalence of medication errors have not accounted for heterogeneity across studies in error identification methods and definitions, nor contextual differences across wards and the use of electronic or paper medication charts. Our aim was to conduct a systematic review and meta-analysis to provide separate estimates of the prevalence of medication errors among paediatric inpatients, depending on hospital ward and the use of electronic or paper medication charts, that address differences in error identification methods and definitions. We systematically searched five databases to identify studies published between January 2000 and December 2018 that assessed medication error rates by medication chart audit, direct observation or a combination of methods. We identified 71 studies, 19 involved paediatric wards using electronic charts. Most studies assessed prescribing errors with few studies assessing administration errors. Estimates varied by ward type. Studies of paediatric wards using electronic charts generally reported a reduced error prevalence compared to those using paper, although there were some inconsistencies. Error detection methods impacted the rate of administration errors in studies of multiple wards, however, no other difference was found. Definition of medication error did not have a consistent impact on reported error rates. Medication errors are a frequent occurrence in paediatric inpatient settings, particularly in intensive care wards and emergency departments. Hospitals using electronic charts tended to have a lower rate of medication errors compared to those using paper charts. Future research employing controlled designs is needed to determine the true impact of electronic charts and other interventions on medication errors and associated harm among hospitalized children.

The current technique taught for examining the muscles of the upper limb does not differentiate between the various causes of weakness in the arm, in particular peripheral nerve and nerve root lesions. The 5.3.5 rule describes examining the muscles in a specific order: 5 at the shoulder, 3 at the elbow and 5 at the wrist and hand. The examiner records the number of the weak muscles. They then consult the tables to determine the cause of the weakness. This rule enables the diagnosis of all peripheral nerve and nerve root problems (radiculopathy) that cause weakness in the arm. It does not require detailed knowledge of neuroanatomy. It does require the examiner to learn how to examine each muscle so that they do not miss weakness or ‘detect’ weakness when there is none.

The findings of a durability study undertaken on pultruded glass fibre reinforced polymer (GFRP) cladding panels are presented. Sourced at demolition from the Second Severn Crossing Visitors' Centre building in the UK, the panels offered the rare opportunity to assess the characteristics of naturally aged composite material. Mechanical properties were determined and compared with the properties of new, equivalent material. The phenomenon of polymer hardening, typified by a reduction in the material strain limit over time, was investigated by further mechanical testing procedures. By contrasting the properties as found for panels taken from each of the four external walls of the building, factors concerning environmental exposure and factors relating to the original fabrication conditions were investigated. The results indicate that, regardless of the exposure conditions, in 17 years the mechanical material properties appear not to have significantly diminished, despite aesthetic quality suffering due to lack of maintenance. It has, however, been shown that ultraviolet exposure causes a hardening of the resin component of the composite, resulting in an increase in the compressive elastic modulus, but a reduction in the threshold of the brittle fracture of the matrix in tension. This final result has not been documented before and is significant in understanding the long-term performance of composites.

Background Sleep problems during withdrawal from cannabis use are a common experience. The details regarding how abstinence from cannabis impacts sleep are not well described. This article reviews the literature including a measure of cannabis withdrawal and sleep in humans. Methods A literature search using a set of cannabinoid and sleep-related terms was conducted across 8 electronic databases. Human studies that involved the administration of cannabinoids and at least 1 quantitative sleep-related measure were included. Review articles, opinion pieces, letters or editorials, case studies (final N < 8), published abstracts, posters, and non-English articles were excluded. Thirty-six publications were included in the review. Results Sleep was frequently interrupted during cannabis withdrawal, although the specific mechanisms of disruption remain unclear. Conclusions Methodological issues in the majority of studies to date preclude any definitive conclusion on the specific aspects of sleep that are affected.

The arterial system is a closed loop and the pressure within this loop reflects cardiac output, resistance to outflow, volume of fluid within the circulation and stiffness of the arterial wall. Increased resistance to outflow or Bayliss's phenomena cannot be the cause of essential hypertension as it reverses with treatment of hypertension. There is no evidence for increased cardiac output in essential hypertension. Increased blood volume contributes to hypertension in obesity just as it does in hypertension secondary to renal failure. The principle cause of essential hypertension is increasing stiffness of the arterial wall. This is a consequence of arteriosclerosis that commences in utero and progressively increases in severity with increasing age. Arteriosclerotic arterial wall stiffening antedates the onset of essential hypertension by decades. It not only explains the increasing incidence of essential hypertension with increasing age, but it is the only thing that fulfils Koch's first postulate and that is it is present in 100% of individuals with essential hypertension.

The risk of dose errors is high in paediatric inpatient settings. Computerized provider order entry (CPOE) systems with clinical decision support (CDS) may assist in reducing the risk of dosing errors. Although a frequent type of medication error, the prevalence of dose errors is not well described. Dosing error rates in hospitals with or without CPOE have not been compared. Our aim was to conduct a systematic review assessing the prevalence and impact of dose errors in paediatric wards with and without CPOE and/or CDS. We systematically searched five databases to identify studies published between January 2000 and December 2017 that assessed dose error rates by medication chart audit or direct observation. We identified 39 studies, nine of which involved paediatric wards using CPOE with or without CDS. Studies of paediatric wards using paper medication charts reported approximately 8–25% of patients experiencing a dose error, and approximately 2–6% of medication orders and approximately 3–8% of dose administrations contained a dose error, with estimates varying by ward type. The nine studies of paediatric wards using CPOE reported approximately 22% of patients experiencing a dose error, and approximately 1–6% of medication orders and approximately 3–8% of dose administrations contained a dose error. Few studies provided data for individual wards. The severity and prevalence of harm associated with dose errors was rarely assessed and showed inconsistent results. Dose errors occur in approximately 1 in 20 medication orders. Hospitals using CPOE with or without CDS had a lower rate of dose errors compared with those using paper charts. However, few pre/post studies have been conducted and none reported a significant reduction in dose error rates associated with the introduction of CPOE. Future research employing controlled designs is needed to determine the true impact of CPOE on dosing errors among children, and any associated patient harm.

CONTEXT: Patient harm resulting from medication errors drives prevention efforts, yet harm associated with medication errors in children has not been systematically reviewed. OBJECTIVE: To review the incidence and severity of preventable adverse drug events (pADEs) resulting from medication errors in pediatric inpatient settings. DATA SOURCES: Data sources included Cumulative Index of Nursing and Allied Health Literature, Medline, Scopus, the Cochrane Library, and Embase. STUDY SELECTION: Selected studies were published between January 2000 and December 2017, written in the English language, and measured pADEs among pediatric hospital inpatients by chart review or direct observation. DATA EXTRACTION: Data extracted were medication error and harm definitions, pADE incidence and severity rates, items required for quality assessment, and sample details. RESULTS: Twenty-two studies were included. For children in general pediatric wards, incidence was at 0 to 17 pADEs per 1000 patient days or 1.3% of medication errors (of any type) compared with 0 to 29 pADEs per 1000 patient days or 1.5% of medication errors in ICUs. Hospital-wide studies contained reports of up to 74 pADEs per 1000 patient days or 2.6% of medication errors. The severity of pADEs was mainly minor. LIMITATIONS: Limited literature on the severity of pADEs is available. Additional study will better illuminate differences among hospital wards and among those with or without health information technology. CONCLUSIONS: Medication errors in pediatric settings seldom result in patient harm, and if they do, harm is predominantly of minor severity. Implementing health information technologies was associated with reduced incidence of harm.

This was a phenomenology study that explored the potential use of gaming principles in classroom teaching. Eight secondary school students were interviewed. The aim of the interviews was to investigate the students' experience and perceptions about gaming. The motivations (i.e. gaming principles) behind gameplay were identified and these motivations were pushed into the classroom teaching. Data collected has revealed that students like to play computer games mainly due to the role-playing task and the virtual social interaction. Learning from the gaming context, role-playing and collaborative activities should be adopted in the classroom teaching to motivate students to learn and develop various cognitive skills.

In this chapter I look at the way we think of communication and suggest that there is an over-reliance upon linguistic and textual modes at the expense of visual and spatial modes of communication. I argue that schools fail to grasp the significance of the visual nature of communication and the implications for learning within STEM subjects. After making an argument for the importance of visuospatial forms, I provide an extensive review of the cognitive and psychological literature covering various key aspects of visualisation and how it relates to teaching STEM subjects in early secondary education. It is likely that much of this will be novel to STEM teachers yet provides us with new possibilities for opening up classroom pedagogy.

Despite its continued widespread use, relatively few individuals with cannabis use disorders present to treatment services. Compared to other substance use and dependence, there is a dearth of research examining explanations for this observed underutilization of cannabis treatment. The aim of this chapter is to examine these barriers and discuss how they may be addressed to improve rates of treatment utilization. The most prominent access issues identified in the literature were a lack of a perceived need for treatment to stop successfully using and a desire to stop using on one’s own. Less prominent barriers were the concern that entering treatment would invoke negative attitudes from the community or employers, and the belief that treatment was ineffective. As such, it may be important for treatments to minimize the amount of professional contact involved and maximize awareness regarding effective treatment and improve treatment accessibility. Further work is required to identify how to address these issues; however, computer-based interventions appear promising.

Technology-assisted substance use interventions, such as, telephone counseling (referred to as low technology) and online computer-based treatments (referred to as high technology) are unique in the breadth of their accessibility, and typically lower cost. This chapter offers a review of the literature on technology-assisted cannabis-specific interventions. Findings indicate that both telephone counseling and computer-based cannabis treatments could be effective in assisting cannabis users to quit or reduce their use. Randomized controlled trials have identified computer-based cannabis interventions to compare favorably with face-to-face delivered treatments, while research on telephone interventions is just beginning. Comparisons between high and low technology-assisted cannabis interventions show that participant characteristics may have important implications for treatment preference and outcome. Suggestions for future work are discussed, highlighting the importance of large scale and longitudinal research.

While tobacco helplines (quitlines) are thought to be effective, helplines which treat other substance use do not have an established evidence base. A review was conducted of the literature on illicit drug or alcohol (IDA) helplines. The literature search was conducted in five databases. Studies prior to 2014 were included if published in English, and involved the use of a telephone counselling helpline for the treatment of illicit drug or alcohol use. Review papers, opinion pieces, letters or editorials, case studies, published abstracts and posters were excluded. Initial searching identified 2178 articles and after removing duplicates and those meeting the exclusion criteria, there were 36 publications for review. A total of 29 articles provided descriptive information about 19 different IDA helplines which operated in the US (42%), Europe (21%), Australia (21%), Asia (11%) and Canada (5%). These services reported monthly call rates from 3.7 to over 23,000 calls per month. A total of nine articles provided evaluative information on eight different IDA helplines: four articles included a comparison of treatment outcomes against a control group and five articles included information on treatment satisfaction or service utilisation. Together they provide some evidence that these services are effective. Although there was little consistency in the measures used between articles which assessed helpline satisfaction, all but one reported high satisfaction. Although the evidence is mainly supportive of IDA helplines, further work is required to compare treatment outcomes in randomized groups.

The respiratory health effects from tobacco smoking are well described. Cannabis smoke contains a similar profile of carcinogenic chemicals as tobacco smoke but is inhaled more deeply. Although cannabis smoke is known to contain similar harmful and carcinogenic substances to tobacco smoke, relatively little is understood regarding the respiratory health effects from cannabis smoking. There is a need to integrate research on cannabis and respiratory health effects so that gaps in the literature can be identified and the more consistent findings can be consolidated with the purpose of educating smokers and health service providers. This review focuses on several aspects of respiratory health and cannabis use (as well as concurrent cannabis and tobacco use) and provides an update to (i) the pathophysiology; (ii) general respiratory health including symptoms of chronic bronchitis; and (iii) lung cancer.

Technology-based interventions such as those delivered by telephone or online may assist in removing significant barriers to treatment seeking for cannabis use disorder. Little research, however, has addressed differing technology-based treatments regarding their comparative effectiveness, and how user profiles may affect compliance and treatment satisfaction. This study addressed this issue by examining these factors in online (N=225) versus telephone (N=160) delivered interventions for cannabis use, using data obtained from two previously published randomized controlled trials conducted by the current authors. Several differences emerged including stronger treatment effects (medium to large effect sizes in the telephone study versus small effect sizes in the Web study) and lower dropout in the telephone intervention (38% vs. 46%). Additionally, around half of the telephone study participants sought concurrent treatment, compared with 2% of participants in the Web study. Demographics and predictors of treatment engagement, retention and satisfaction also varied between the studies. Findings indicate that both telephone and Web-based treatments can be effective in assisting cannabis users to quit or reduce their use; however, participant characteristics may have important implications for treatment preference and outcome, with those who elect telephone-based treatment experiencing stronger outcomes. Thus, participant preference may shape study populations, adherence, and outcome.

The purpose of this study was to explore the potential use of digital games in learning mathematics at secondary school level in Malaysia. Three secondary school students, three mathematics teachers and three parents were interviewed in this study. All the participants were asked for their views and experiences in mathematics, technology usage and the use of digital games in learning mathematics. The results suggested that students were supportive and positive towards the use of computer games in learning mathematics. Nevertheless, parents preferred conventional teaching approach, in which they recognized personal communication and socialization as a significant component in learning. Although the teachers did not go on to oppose the idea of using computer games for teaching mathematics, they still perceived the use of discursive approaches as the best teaching approach for learning mathematics with digital technologies at best a possible additional complementary feature. In view of that, the combination of classroom teaching and computer games might the best mathematics pedagogy.