Optimising prescribing practices in older adults with multimorbidity: a scoping review of guidelines

ObjectiveInappropriate polypharmacy occurs when multiple medications are prescribed without clear indications or where harms outweigh their benefits. The aims of this scoping review are to (1) identify prescribing guidelines that are available for older adults with multimorbidity and (2) to identify cross-cutting themes used in these guidelines.DesignScoping review.Data sourcesPubMed, Embase, Web of Science, the Cochrane Library databases, Cumulative Index to Nursing and Allied Health Literature, grey literature sources, six key geriatrics journals, and reference lists of identified review papers. The search was conducted in November 2018 and updated in September 2019.Study selectionGeneral prescribing guidelines tailored to or for adults including older adults with multimorbidity.Data extractionData for publication description, guideline characteristics, information for users and criteria were extracted. The synthesis contains summarised qualitative descriptions of the studies and guideline characteristics as well as identified cross-cutting themes.ResultsOur search strategy yielded 10 427 unique citations, of which 70 fulfilled the inclusion criteria for synthesis. Among these, there were 61 unique guidelines and tools which used implicit, explicit, mixed or other approaches in the prescriber decision-making process. There are 11 cross-cutting themes identified in the guidelines. Prescriber-related themes are: conduct a comprehensive assessment before prescribing, identify patients’ needs, goals and priorities, adopt shared decision-making, consider evidence-based recommendations, use clinical prescribing tools, incorporate multidisciplinary inputs and embrace technology-enabled prescribing. Wider organisation-related and system-related themes related to education, training and the work environment are also identified.ConclusionsFrom guidelines and tools identified, eleven cross-cutting themes provide a usable knowledge base when seeking to optimise prescribing among older adults with multimorbidity. Incorporating these themes in an approach that uses mixed criteria and implementation information could facilitate greater uptake of published prescribing recommendations.

Designing Training Programs to Introduce Emerging Technologies to Future Workers—A Pilot Study Based on the Example of Artificial Intelligence Enhanced Robotics

Implementing an Emerging Technology (ET) is a difficult task due to people lacking ET-related knowledge and skills or having skeptical and negative attitudes towards the ET. As learners construct their understanding about an ET and develop related skills by actually passing through the ET Innovation Process (IP) stages (Awareness, Acceptance and Adoption), it could be useful to provide them with training that imitates certain IP stages. Using Artificial Intelligence Enhanced Robotics (AIER) as the example ET, we designed a two-day workshop to lead learners (n = 16) through the AIER IP Awareness stage, and a six-week training course with eight contact days to simulate the AIER IP Acceptance stage to learners (n = 10). Using online surveys and quantitative content analysis methods we confirmed that the workshop format increased the AIER-related self-confidence and general knowledge in 78% of participants, while the training course helped more than half of the participants to construct usable knowledge about a specific AIER and to see its possibilities in their specific work-place contexts. This paper is the pilot of using the Technology-Enhanced Learning Innovation Process (TELIP) model, first tested on a STEAM innovation, outside the educational context, for developing appropriate training approaches for specific ET IP stages.

Writing as a critical moment in professional discourse

Written texts mediate action and serve as accounts of action in most contemporary professional domains. Echoing Candlin’s call for applied and social linguists to explore ‘critical moments’ in discourse, I argue that ‘writing’ constitutes just such a critical moment, because of its contested position in professional domains and the dominant ideology underpinning writing evident both in ‘intellectual’ (academic) and ‘expert’ (professional) orientations. A key challenge is to find ways of understanding writing which are not constrained by existing ‘intellectual’ and ‘expert’ orientations and which can contribute to useable knowledge for professional practice. I draw on specific examples from ethnographically oriented research projects with professionals in two domains (academia and social work) to illustrate how a dominant ideology of writing is enacted. This enactment is explored further by focusing on ICT-mediated ‘expert systems’ in social work, illustrating how an increasingly used, specific technology of writing is impacting professional practice. I conclude by considering the difficulties and possibilities of collaboratively building usable knowledge about writing for professional practice.

Philosophy of sustainability experimentation _ experimental legacy, normativity and transfer of evidence

The recent proliferation of types and accounts of experimentation in sustainability science still lacks philosophical reflection. The present paper introduces this burgeoning topic to the philosophy of science by identifying key notions and dynamics in sustainability experimentation, by discussing taxonomies of sustainability experimentation and by focusing on barriers to the transfer of evidence. It integrates three topics: the philosophy of experimentation; the sustainability science literature on experimentation; and discussions on values in science coming from the general philosophy of science, the social sciences, and sustainability science. The aim is to improve understanding of how sustainability experimentation has evolved, from a broader picture of the history and philosophy of science, with a specific focus on understanding evidence production and how evidence traveling in and from sustainability experiments can be improved, particularly in the context of complex and pervasive normative commitments of the research. By engaging in these topics, this research is one of the first philosophical accounts of sustainability experimentation, contributing both to the knowledge on specific philosophies of science and to the further development of an evidence-based sustainability science through a better understanding of the barriers to more relevant and usable knowledge.

Knowledge management as a strategic asset for customer service delivery at a contact centre in South Africa

Knowledge Management (KM) is often touted as a panacea for organisations aiming to be efficient and competitive. While the world today has undoubtedly entered an information era, how organisations convert information to usable knowledge has become of significant importance. Furthermore, the growing emphasis on managing and utilizing knowledge to improve organisational functioning, efficiency and competitiveness has reintroduced KM as a possible strategic asset for organisations. To explore this idea, empirical work was conducted on a contact centre making use of KM practices as a means to enhance the transmission of knowledge to their employees and in turn, to their clients. Further objectives of this research were to identify how KM was understood in this organisation, the benefits and challenges it presented, how it manifested in relation to the idea of leadership and ultimately, if it could be considered a strategic asset for organisations of this nature.

Research on the strategy of intelligent analysis to improve sports person psychological experience in the era of artificial intelligence

Artificial intelligence (AI) is an excellent potential technology that is evolving day-to-day and a critical avenue for exploration in the world of computer science & engineering. Owing to the vast volume of data and the eventual need to turn this data into usable knowledge and realistic solutions, artificial intelligence approaches and methods have gained substantial prominence in the knowledge economy and community world in general. AI revolutionizes and raises athletics to an entirely different level. Although it is clear that analytics and predictive research have long played a vital role in sports, AI has a massive effect on how games are played, structured, and engaged by the public. Apart from these, AI helps to analyze the mental stability of the athletes. This research proposes the Artificial Intelligence assisted Effective Monitoring System (AIEMS) for the specific intelligent analysis of sports people’s psychological experience. The comparative analysis suggests the best AI strategies for analyzing mental stability using different criteria and resource factors. It is observed that the growth in the present incarnation indicates a promising future concerning AI use in elite athletes. The study ends with the predictive efficiency of particular AI approaches and procedures for further predictive analysis focused on retrospective methods. The experimental results show that the proposed AIEMS model enhances the athlete performance ratio of 98.8%, emotion state prediction of 95.7%, accuracy ratio of 97.3%, perception level of 98.1%, and reduces the anxiety and depression level of 15.4% compared to other existing models.

Post-match video-based feedback: A longitudinal work-based coach development program stimulating changes in coaches’ knowledge and understanding

The literature regarding formal coach education and development highlights issues of transference of usable knowledge to the real-world context. This study sought to engage coaches from a Spanish football academy in a longitudinal work-based coach development program (CDP) focused on the delivery of post-match feedback. The CDP was delivered over a 23-month period through collaboration between a sport pedagogue researcher-practitioner, the Academy Management Team, and an experienced research team. The study adopted a case study design, utilizing a multiple method data collection strategy that occurred in several stages: 1) Systematic observations (Sep–Dec 2018) and 2) debrief (Jan 2019), where baseline coach behaviors and underpinning knowledge were recorded; 3) a workshop and a directed task (Mar 2019), encouraging coaches to apply new knowledge; 4) a directed task 2 and reflective interview (Apr/May 2019), facilitating coaches’ reflection on their past deliveries and rationalization and planning of their forthcoming sessions’ delivery and 5) a consolidation interview (Apr 2020), capturing knowledge stabilization. Qualitative data suggest that there was an increased understanding in the adoption of behaviors including corrective feedback, silence, questioning, and player participation throughout the CDP. In addition, coaches’ self-reflection found acceptance of their coaching delivery or a disconnect between their desired and actual behaviors during the delivery of video-based feedback. This study provides a preliminary framework for further implementation and exploration in developing coaches’ knowledge and understanding of delivering post-match video-based feedback.

How the SP System May Promote Sustainability in Energy Consumption in IT Systems

The SP System (SPS), referring to the SP Theory of Intelligence and its realisation as the SP Computer Model, has the potential to reduce demands for energy from IT, especially in AI applications and in the processing of big data, in addition to reductions in CO2 emissions when the energy comes from the burning of fossil fuels. The biological foundations of the SPS suggest that with further development, the SPS may approach the extraordinarily low (20 W)energy demands of the human brain. Some of these savings may arise in the SPS because, like people, the SPS may learn usable knowledge from a single exposure or experience. As a comparison, deep neural networks (DNNs) need many repetitions, with much consumption of energy, for the learning of one concept. Another potential saving with the SPS is that like people, it can incorporate old learning in new. This contrasts with DNNs where new learning wipes out old learning (‘catastrophic forgetting’). Other ways in which the mature SPS is likely to prove relatively parsimonious in its demands for energy arise from the central role of information compression (IC) in the organisation and workings of the system: by making data smaller, there is less to process; because the efficiency of searching for matches between patterns can be improved by exploiting probabilities that arise from the intimate connection between IC and probabilities; and because, with SPS-derived ’Model-Based Codings’ of data, there can be substantial reductions in the demand for energy in transmitting data from one place to another.

Co-development, co-production and co-dissemination of scientific research: a case study to demonstrate mutual benefits

Inadequate and inequitable distribution of research capacity and resources limits both the opportunity for leadership and participation in science. It also results in biases of effort, poor and misinterpretation of global patterns and the availability of limited usable knowledge for current challenges. Increased participation in ocean research and decision-making is needed to account for many stressors and challenges. The current intergovernmental attention on the ocean (e.g. UN Decade of Ocean Science for Sustainable Development) and the development of technologies that permit exploration and accelerate exploitation suggest that it is timely to focus on the ocean and its stewardship. Employing the principles of co-development, co-production and co-dissemination, this paper uses a case study of a deep reef project in Seychelles to illustrate some activities that can be employed to magnify research outcomes and legacy. We provide examples that range from ministerial briefings and planning meetings to joint fieldwork, grant allocation and co-authoring outputs. These activities helped us to align priorities, promote authentic interactions and focus on equitable science. Finally, reflecting on our experiences, we acknowledge the benefits brought by respectful and long-term partnerships, the variety of activities needed to develop these and challenges of maintaining them. In the future, we also want to include more opportunities for regional peer-to-peer learning and technology transfer.