Consistency In Provision Research Articles

Models of care for voluntary assisted dying: a qualitative study of Queensland's approach in its first year of operation.

ObjectiveVoluntary assisted dying (VAD) began in Queensland in January 2023 but little is known about its practical operation. This research examined models of care for providing VAD in Queensland.MethodsSemi-structured interviews were conducted with 24 participants involved with VAD delivery across Queensland's 16 Health and Hospital Services (HHSs). Participants included HHS VAD Coordinators, nurse practitioners and nurses who acted as administering practitioners, and Queensland VAD Support and Pharmacy Service (QVAD SPS) staff.ResultsFive themes about Queensland VAD models of care were developed: VAD is accessed almost exclusively through the public sector via HHSs, influenced by a Health Service Directive; local models of care vary; nurses play significant roles facilitating access to and providing VAD; QVAD SPS has been instrumental supporting HHSs and ensuring statewide access as back-up VAD provider; and VAD services need more resourcing.ConclusionsThe Queensland approach to providing VAD has been largely successful in ensuring patient access across the state. However, it differs from previous Australian VAD models with access predominantly through the public sector, greater roles played by nurse practitioners/nurses, and VAD being provided by QVAD SPS. Under-resourcing and consistency in provision of VAD services remain challenges.

Preferences for deinfibulation (opening) surgery and female genital mutilation service provision: A qualitative study.

To explore the views of female genital mutilation (FGM) survivors, men and healthcare professionals (HCPs) on the timing of deinfibulation surgery and NHS service provision. Qualitative study informed by the sound of silence framework. Survivors and men were recruited from three FGM prevalent areas of England. HCPs and stakeholders were from across the UK. Forty-four survivors, 13 men and 44 HCPs. Ten participants at two community workshops and 30 stakeholders at a national workshop. Hybrid framework analysis of 101 interviews and three workshops. There was no consensus across groups on the optimal timing of deinfibulation for survivors who wished to be deinfibulated. Within group, survivors expressed a preference for deinfibulation pre-pregnancy and HCPs antenatal deinfibulation. There was no consensus for men. Participants reported that deinfibulation should take place in a hospital setting and be undertaken by a suitable HCP. Decision making around deinfibulation was complex but for those who underwent surgery it helped to mitigate FGM impacts. Although there were examples of good practice, in general, FGM service provision was suboptimal. Deinfibulation services need to be widely advertised. Information should highlight that the procedure can be carried out at different time points, according to preference, and in a hospital by suitable HCPs. Future services should ideally be developed with survivors, to ensure that they are clinically and culturally appropriate. Guidelines would benefit from being updated to reflect the needs of survivors and to ensure consistency in provision.

Use of professional practice guidance resources in pharmacy: a cross-sectional nationwide survey of pharmacists, intern pharmacists, and pharmacy students

BackgroundVariations in practice are commonplace in healthcare where health professionals, such as pharmacists act as autonomous practitioners. This is evident in simulated patient studies, where pharmacists practice does not meet widely accepted standards for medicines supply or treatment of an ailment. To promote best pharmacy practice a myriad of guidance resources including practice guidelines, codes and standards are produced by professional organisations. These resources provide a framework for pharmacy practice and endeavour to facilitate consistency in provision of pharmacy-based services to consumers. Despite their role in specifying essential pharmacist behaviours, there is limited research exploring if and how these resources are used in practice.ObjectiveTo characterise Australian pharmacists’ use of the Pharmaceutical Society of Australia’s Code of Ethics, Professional Practice Guidelines and Professional Practice Standards.MethodsA cross-sectional, self-administered, electronic survey of registered pharmacists, intern pharmacists and pharmacy students living in Australia was conducted in July 2020. Questions considered use of professional practice resources (by resource group) in the preceding 12 months. Data were analysed descriptively.ResultsOf 601 responses included in the analysis 462 (76.9%) of respondents were registered pharmacists, 88 (14.6%) pharmacy students and 51 (8.5%) intern pharmacists. Interns and students accessed overarching practice resources, such as the Professional Practice Standards, Code of Ethics and Dispensing Practice Guidelines more frequently than practising pharmacists. Pharmacists accessed professional practice guidelines, such as Practice Guidelines for the Provision of Immunisation Services Within Pharmacy, more often than students. More pharmacists than interns and students indicated that they would access guidelines to resolve practice and patient care issues. All resources except the Professional Practice Standards for Pharmacists (67.4%) were accessed by less than 50% of respondents in the preceding 12-month period. Reasons for not accessing resources varied between participant and resource groups, and generally were due to a lack of awareness of the resource or not considering them necessary for the individual’s practice.Conclusion(s)Access and use patterns for professional practice guidance resources change with experience. Professional organisations responsible for developing resources should consider these patterns when designing and reviewing resources and related policies. To ensure resources are meeting the needs of the profession, students, interns, and pharmacists should be involved in the review of and design of further resources.

CONSISTENCY OF THE PROVISIONS ON THE ALL-RUSSIAN CIVIL IDENTITY CONTAINED IN THE DOCTRINAL DOCUMENTS ON THE STATE NATIONAL POLICY OF RUSSIA AND THE REPUBLICS-SUBJECTS OF THE FEDERATION

The article contains a comparative analysis of doctrinal documents in the field of state national policy at the federal and regional-republican levels for consistency of provisions on the Russian nation and all-Russian civil identity. The paper considers in detail the interpretation of the relevant provisions in the Strategy of the State National Policy of the Russian Federation for the period up to 2025. The author draws on the publications of Russian ethnopolitologists, which study the practice of politicizing the titular ethnic identity in a number of republics of the Russian Federation with the prospect of identifying ethnic and regional identities. Reference to the corpus of concepts (strategies) of national policy in the republics – subjects of the Russian Federation allowed us to identify the accepted provisions on the all-Russian civil identity contained in the federal Strategy, and the republican-ethnic accents in its interpretation, and the provisions that have not yet been picked up. In particular, the analysis of doctrinal documents of the republics showed that one of the most important provisions of the Federal Strategy on Preservation of Russian Cultural Dominance (a Single Cultural-Civilizational Code), common to all the peoples of Russia, as the basis of all-Russian civil identity has not received a response in concepts (strategies) of the Russian republics.

Family-Centered Care in the Transition to Early Hearing Intervention.

This study aimed to explore and compare families' and professionals' perspectives on the implementation of family-centered care (FCC) (Moeller, Carr, Seaver, Stredler-Brown, & Holzinger, 2013) during the period between diagnosis of hearing loss (HL) and enrollment in early intervention (EI). A convergent mixed-methods study incorporating self-report questionnaires and semistructured in-depth interviews was used. Seventeen family members of children with HL and the 11 professionals who support these families participated in this study. The results suggested that the services engaged during the transition period partially adhered to the principles of FCC, including the provision of timely access to EI services and provision of emotional and social support. However, areas for improvement identified include strengthening family/professional partnerships, shared decision-making processes, collaborative teamwork, program monitoring, and consistency in the provision of information and support. Qualitative and quantitative research findings also indicated a lack of consistency in service provision during the transition period.

Access to intraoperative tumour margin control: a survey of the British Oculoplastic Surgery Society.

BackgroundPeriocular malignancy is common and in most cases will undergo excision with pre-determined margins and subsequent histological examination. Intraoperative margin control (IOMC) modalities such as fast frozen section (FFS), fast paraffin (FP) and Mohs micrographic surgery (MMS) are being increasingly widely used, though there is a lack of information regarding utility. The aim of this study was to survey members of the British Oculoplastic Surgery Society (BOPSS) to determine attitudes and access to different modalities of IOMC.MethodsA 12-question online survey was disseminated via an e-mail to full members of the BOPSS. The survey was hosted using Qualtrics software via the University of Sussex.ResultsThe overall response rate was 64 of 165 (38.8%). MMS was readily available in a neighbouring trust to 23 of 64 respondents (35.9%). Seven respondents (10.9%) reported no regional access to MMS. Twenty-nine members had readily available access to FFS (45.3%) and 37 of 64 to FP (57.8%) in their own institution. There is variation in what tumour types would be considered appropriate for IOMC, though most thought clinically ill-defined (morphoeic) basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) should undergo one form of IOMC (90.6% and 81.3%, respectively).ConclusionThis study highlights variation in availability and utilisation of IOMC amongst oculoplastic surgeons and in different regions of the UK. While the exact place of IOMC in periocular tumour excision is debated, there is a consistent view that it should be available for some tumours. Greater consistency in provision may improve patient outcomes.

A qualitative study of the communication and information needs of people with learning disabilities and epilepsy with physicians, nurses and carers

BackgroundLiving with a chronic condition such as epilepsy can have a debilitating effect on the individual and their carers. Managing epilepsy among people with learning disabilities may present a challenge because of limited communication and may require a multidisciplinary approach. The study investigated the communication and information needs of people with learning disabilities with epilepsy and their physicians, nurses and carers.MethodsQualitative designed was adopted to collect data from 15 community-based people with mild learning disabilities with epilepsy and 13 carers. Recorded data were transcribed verbatim and analysed thematically.ResultsA range of findings emerged related to patient communication and information needs. These included: Knowledge regarding epilepsy; involvement; honesty and openness when giving information and consistency in provision of information.ConclusionPeople with learning disabilities with epilepsy and their carers would like to know more about epilepsy, to be more involved decision makings through communication in the management of epilepsy to enable them feedback information regarding their health.

Unit Pricing in Supermarkets: Review of Past Evidence from Academic and Industry Studies

Unit Pricing in Supermarkets: Review of Past Evidence from Academic and Industry Studies

Energy Resilience Assessment by Using SEM Approach in the Central Java Province, Indonesia

Energy is one of the critical infrastructure for urban and rural development. Although planning and management of the energy provision tend to centralized, the role of local stakeholder is very significant to achieve energy resilience. An assessment of energy resilience is not only related to the disaster condition, but also associated to any effort to solve of uncertainties in normal condition such as supply shortages, low level of ratio electrification, consistency of provision and standardization. This study defined that energy resilience are influenced by five factors namely, stakeholder effort to understand their needs, effort to understand process of energy provision, effort to understand the facility of energy provision, effort to understand efficiency energy consumption and the behaviour to achieve, and the local government concern. By using SEM approach this study examined a model of the five factors that affect resilience energy. According to the assessment from the 8,528 villages in Central Java province of Indonesia, this study founded that the five factors were evidently influence in energy resilience achievement.

Perceptions of current and potential public health involvement of pharmacists in developing nations: The case of Zimbabwe.

There is increasing recognition of the potential significant contribution that pharmacy personnel can make to improve the public's health. However, there is an evidence gap in developing countries on the public health role of pharmacy personnel. This study aimed to explore the current public health activities that pharmacy professionals in Zimbabwe are currently involved in, and the potential of expanding this role. The study utilized individual, face-to-face, semi-structured qualitative interviews with 9 key informants. The sample reflected the diversity of pharmacy practice groups and levels as well as professional experience, and included a representative from a patient group, and a non-pharmacist national level public health expert. Data collection and analysis was an iterative process informed both by the currently available literature on the topic, as well as themes emerging from the data. Framework analysis was utilized with two independent analyses performed. There was a general consensus among participants that pharmacy practice in Zimbabwe was mainly focused on curative services, with very limited involvement in public health oriented activities. The following were identified as pharmacists' current public health activities: supply chain management of pharmaceutical products, provision of medications and other pharmaceutical products to patients, therapy monitoring, identification and monitoring of chronic illnesses, information provision and training of pharmacists. Nevertheless, there were concerns regarding the quality of some of these services, and lack of consistency in provision across pharmacies. Other potential areas for pharmacists' public health practice were identified as emergency response, drug abuse, addressing social determinants of health particularly promoting healthy lifestyles, applied health research, counterfeit and substandard medicines, and advocacy. There is perceived potential for Zimbabwean pharmacists to become more involved in public health oriented services. However, concerns regarding the quality of services and lack of consistency in provision need to be addressed.

Supervisory Accounting: Comparison between Solvency II and Coherent Risk Measures

We examine the ingredients of Solvency II, namely its free capital, provision and solvency capital requirement. They are of course linked by the accounting equality but we claim that they should be more deeply related to each other since solvency naturally should require positivity of available capital. Taken in general, this condition indeed almost dictates a formula to derive provision from free capital. The derivation suggests the property of market consistency of provision and the definition of optimal replicating portfolio. This does not show up in actual building of Solvency II, while we show that coherent risk measures allow an integrated construction.

Learning to Live with Inconsistency in Student Entitlement and Partnership Provision

Consistency of provision of teacher education courses is essential if students are to experience training which is just, fair and equitable. The shift from university‐based to school‐based Initial Teacher Education and Training has brought into sharp focus the consistency of provision as local, rather than central, activities and decisions predominate in the students' experiences. This article examines the issue of consistency through the eyes of a sample of subject mentors who responded to a postal questionnaire which aimed to examine the views of subject mentors on a range of issues relating to mentor training, the mentoring process, challenging students, professional discourse and rewarding mentors. The article concludes that Initial Teacher Education and Training needs to embrace some of the plurality and diversity of postmodern thinking and that those involved in the education and training of teachers should learn to live with inconsistency.