Entire Journey Research Articles

Patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode: a multi-stage qualitative case study.

To explore how patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode. Acute abdominal pain is one of the most common conditions to present in the acute care setting. Little is known about how patients' fundamental care needs are managed from presentation to post discharge. A multi-stage qualitative case study using the Fundamentals of Care framework as the overarching theoretical and explanatory mechanism. Repeated reflective interviews were conducted with five adult patients over a 6-month period in 2013 at a university hospital in Sweden. The interviews (n=14) were analysed using directed content analysis. Patients' experiences across the acute care episode are presented as five patient narratives and synthesized into five descriptions of the entire hospital journey. The patients talked about the fundamentals of care and had vivid accounts of what they meant to them. The experiences of each of the patients were influenced by the extent to which they felt engaged with the health professionals. The ability to engage or build a rapport was identified as a central component across the fundamental care elements, but it varied in visibility. Consistent pain management, comfort, timely and accurate information, choice and dignity and relationships were identified as essential fundamental care needs of patients experiencing acute abdominal pain regardless of setting, diagnosis, or demographic variables. These were variously achieved and the patients' narratives raised areas for improvement in several areas.

Vitæ Novæ per la modernità: Stilnovismo ed erranza del desiderio in Delfini e Celati

This article analyses the manner in which Dante's Vita Nova informs Antonio Delfini's collection Il ricordo della Basca (1938; 1956) and the novel by Gianni Celati, Lunario del paradiso (1978; 1989; 1996), providing a thematic repertoire as well as a structural model. Reclaimed in the nineteenth century as the archetypal ‘inner autobiography’ and testimony of Dante's early loves, the Vita Nova is shown to be an effective model for exploring the connection between desire, memory and writing, a suitable filter – as in the cases of Delfini and Celati – for the narration of the wandering youth in search of an idealized and elusive love. At the same time, however, the anacronistic revival of the Dantean model is not without consequences: if in the Vita Nova, and subsequently in the Comedìa, Beatrice acts as a Master in the Lacanian sense – the law that guides Dante's entire human, spiritual and literary journey – it is modernity itself, for Lacan, that is placed beneath the sign of elision of the Master's discourse. This ‘evaporation’ of the Law is evident in works such as Basca and Lunario, ‘modernity’s Vitæ Novæ’, and thus situates them in the realm of a wandering that is at the same time existential, erotic and textual.

Evaluating the Service Quality in Multi-modal Transport Networks

The German Highway Capacity Manual HBS (Handbuch fuer die Bemessung von Strassenverkehrsanlagen, FGSV 2015) like other Highway Capacity Manuals provides a collection of methods for evaluating the Level of Service for single road facilities, i.e. a particular network element like a road segment, a ramp, or an intersection. The Level of Service of single road facilities (LOS) is derived from the volume capacity ratio, the delay time or the traffic density.In addition to the HBS the German guidelines provide a complementary Guideline for Integrated Network Planning RIN (Richtlinien für die integrierte Netzgestaltung, FGSV 2008) which is used for categorising transport networks and for evaluating the service quality in multi-modal networks. Here the LOS refers to entire journeys, i.e. to origin-destination-pairs. The most important indicator for evaluating the service quality of a particular od-pair is the direct speed (= direct distance / journey time). Journey time and the resulting direct speed include not only the in-vehicle time but also access and egress times which can reduce the speed of the entire journey significantly, especially in public transport. Additional indictors evaluation the directness and the travel time ratio of competing modes complement the set of indicators for evaluating the service quality. For each indicator the guideline provides evaluations functions for the service levels A to F which depend on the direct distance between origin and destination. This reflects the fact that speeds typically increase with longer distances while detour factor and travel time ratio decreases.The paper summarizes the approach of the guideline for evaluating the service quality and presents experience with the evaluation scheme collected in various applications covering car and public transport networks. It shows how the evaluation results can be used to recognize shortcomings in the network not only on the level of od-pairs but also to identify critical network elements. Finally the paper explains how the two guidelines HBS and RIN are connected.

Enhancing the passenger experience through an integrated approach to self-service opportunities

The aviation industry continues to rapidly adopt passenger self-service functions, but largely in a caseby- case manner, without regard to the benefits of information sharing and integration across the entire passenger journey. This paper provides a focus for the airport operator, airline and key airport stakeholders in improving the passenger’s journey through the entire air travel experience. It specifically presents the requirements for, and benefits of, a well-established integrated passenger self-services programme (IPSSP). In discussing the passenger processing challenges, this paper presents a concise method for establishing an airport-wide IPSSP. Emphasis is given in the later portion of the paper to an analysis of passenger services across all process areas of an airport. Readers will get a better understanding of how an airport operator and its stakeholders can improve the offering of passenger self-services through the establishment of an IPSSP. Key benefits to an IPSSP are greatly enhancing the overall passenger experience, improving passenger flow and providing additional commercial opportunities for the airport operator and its other customers — especially airlines and concessionaires.

The Biblical Foundations of the Pilgrimage

This paper aims to highlight some aspects concerning the phenomenon of religious pilgrimage, insisting on some biblical foundations of the pilgrimage phenomenon, as well as, in a theological approach, on its motivations and significance in Christianity. Religious pilgrimage centres on the desire to experience the encounter with God. Going on pilgrimage is an answer to this inner call: the pilgrim begins his journey with the awareness of being called by God. Some events and persons in the history of Israel anticipate and symbolize aspects and features of religious pilgrimage. The entire journey of the people of Israel through the desert was a pilgrimage made with the hope of reaching the Promised Land. Although during a pilgrimage may occur moments of wandering, difficulties, attempts and sometimes even desperation (events that can be also found in the pilgrimage of the chosen people), the experience of the pilgrimage is a celebration that profoundly marks the personality and spirituality of pilgrims.

Overcoming the barriers of the assisted living market: Developing successful marketing campaigns to connect with an over-50s audience

Despite being overlooked in the past, brands are waking up to the fact that the over-50s is one of the most affluent consumer groups. This paper examines the diversity of this age group, examining the best way to reach an over 50s audience and looking at what barriers need to be overcome in order to meet their needs. Drawing on research and insight from its own social enterprise, Age UK proposes ways in which the manufacturer can take into account the entire customer journey to ensure a brand proposition which is naturally accessible to those in later life.

Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance.

Acute heart failure (AHF) causes high burden of mortality, morbidity, and repeated hospitalizations worldwide. This guidance paper describes the tailored treatment approaches of different clinical scenarios of AHF and CS, focusing on the needs of professionals working in intensive care settings. Tissue congestion and hypoperfusion are the two leading mechanisms of end-organ injury and dysfunction, which are associated with worse outcome in AHF. Diagnosis of AHF is based on clinical assessment, measurement of natriuretic peptides, and imaging modalities. Simultaneously, emphasis should be given in rapidly identifying the underlying trigger of AHF and assessing severity of AHF, as well as in recognizing end-organ injuries. Early initiation of effective treatment is associated with superior outcomes. Oxygen, diuretics, and vasodilators are the key therapies for the initial treatment of AHF. In case of respiratory distress, non-invasive ventilation with pressure support should be promptly started. In patients with severe forms of AHF with cardiogenic shock (CS), inotropes are recommended to achieve hemodynamic stability and restore tissue perfusion. In refractory CS, when hemodynamic stabilization is not achieved, the use of mechanical support with assist devices should be considered early, before the development of irreversible end-organ injuries. A multidisciplinary approach along the entire patient journey from pre-hospital care to hospital discharge is needed to ensure early recognition, risk stratification, and the benefit of available therapies. Medical management should be planned according to the underlying mechanisms of various clinical scenarios of AHF.

Optimal routing and charging of energy‐limited vehicles in traffic networks

SummaryWe study the problem of routing vehicles with energy constraints through a network where there are at least some charging nodes. We seek to minimize the total elapsed time for vehicles to reach their destinations by determining routes, as well as recharging amounts when the vehicles do not have adequate energy for the entire journey. For a single vehicle, we formulate a mixed‐integer nonlinear programming problem and derive properties of the optimal solution allowing it to be decomposed into two simpler problems. For a multi‐vehicle problem, where traffic congestion effects are included, we seek to optimize a system‐wide objective and formulate the problem by grouping vehicles into ‘subflows’. We also provide an alternative flow optimization formulation leading to a computationally simpler problem solution with minimal loss in accuracy. Because the problem size increases with the number of subflows, a proper selection of this number is essential to render the problem computationally manageable and reflects a trade‐off between proximity to optimality and computational effort needed to solve the problem. We propose a criterion and procedure leading to an appropriate choice of the number of subflows. We also quantify the ‘price of anarchy’ for this problem and compare user‐optimal to system‐optimal performance. Finally, when the system consists of both electric vehicles (EVs) and non‐electric vehicles, we formulate a system‐centric optimization problem for optimal routing of both non‐electric vehicles and EVs along with an optimal policy for charging EVs along the way if needed. Numerical results are included to illustrate these approaches. Copyright © 2015 John Wiley & Sons, Ltd.

Caring behaviours of student nurses: Effects of pre-registration nursing education

In an increasing technologised and cost-constrained healthcare environment, the role of pre-registration nursing education in nurturing and developing the professional caring disposition of students is becoming far more critical than before. In view of this growing demand, the aim of this study was to evaluate the impact of Singapore's pre-registration nursing programmes on students' concept of caring. A descriptive quantitative cross-sectional survey collected data using the Caring Behaviour Inventory from first and final year student nurses, nurse lecturers and nurses in practice. The findings based on student surveys indicated a statistically significant reduction in the overall level of caring behaviour in first to final year students. When compared with the findings of lecturers and nurses, less variance to lecturers than to nurses was found amongst the first years' score, and the lowest variance to nurses was demonstrated amongst the final year. A greater reduction was evidenced amongst Singaporean students, which was exaggerated with exposure to pre-enrolled nursing education and magnified with caring job experience. This study indicates more effort is necessary to harness student caring attributes in students' entire educational journey so that expressive caring is not subsumed in the teaching of students to meet demands of complicated contemporary care.

A PILOT LOOKING AT “AN ADVANCED CLINICAL INDEPENDENT PRESCRIBING PHARMACIST”, MY PROSPECTIVE

Aim To assess the impact that a Clinical Independent Prescribing Pharmacist (IPP) could have on the workload of an Emergency Department in a specialist paediatric Hospital. This is part of the Health Education West Midlands Emergency medicine pharmacy work stream. Method This project consisted of three phases. Each phase entailed a clinical pharmacist being assigned to an Emergency Department at a different location. In order to demonstrate the viability of the role over a geographical and cultural cross section of the region, this was the site of phase II of the project. The pilot operated for 4 weeks, working on a variable shift pattern to encompass diurnal changes in patient throughput. Week one, time was spent in triage with nurses, who were responsible for taking observations, history and patients9 presenting complaints, Then applying triage categories; green (standard), yellow (urgent), orange (immediate) assessments required. The pharmacist would code each patient according to their perceived professional ability to manage (PAM) that patient. The categories were community pharmacy (CP), Independent prescriber (IP), Independent prescriber with additional training (IPT), Medical team (MT). Week two, tasks in Week 1 were repeated, but in addition, the patient was followed through their entire journey and each step being documented and categorised according to their PAM categorisation. In addition a day was spent with the emergency nurse practitioner (ENP), looking at minor injuries and a day reviewing all admissions for a 24 hour period, retrospectively assigning one of the four PAM categories. Week 3&4, an advanced nurse practitioner (ANP), a registrar and a consultant were shadowed with the aim of gaining a better understanding of more complicated cases. Each of the PAMs were then reviewed to assess what further training would be needed, to manage these patients. Results Over the four week period 401 patients were observed. Of these five (1.2%) were considered to be cases that could have been managed by a CP or an IP. 24 (6%) could have been dealt with by an IP with some input from a member of the medical team (MT). 172 (42.9%) could have been managed by an IPT, 200 (49.9%) cases required a member of the medical team (MT). Of the 201 patients assessed who were to be managed by CP, IP, IPT, 104 (51.7%) would require additional training in minor injuries and 90 (47.3%) would have required training in clinical examination and diagnostic skills. Conclusion The pilot was viewed positively by ED staff, including registrars. Consultants had concerns that more serious cases may not be assessed appropriately, or that the pharmacist would require too much support. In general the supervising Medical Consultant agreed with the PAMS assessments. This pilot indicated a new role could exist for Advanced Clinical Practice qualified pharmacists in Emergency departments.

Extending the quality and safety agenda from parenteral to oral chemotherapy.

This article describes some of the steps that can be taken across the entire oral chemotherapy journey to improve quality and safety by leveraging existing and emerging tools.

Internet of Things Based Systems for Food Safety Management

The paper is highlighting the advantages of integrating technologies and digital standards in public politics for protecting consumer rights. Today's globalization of food production chains, their extensive complexity and limitations arising from manual insertion and data processing of products information make it impossible for consumers the task of being informed in realtime. This obstacle can be overcome, and the current level of technology and low implementation costs allow full automation of this process. We propose a sensors network architecture based on Internet of Things (IoT) components, which is using autonomous embedded modules and radio identification tags (RFID) that will automatically collect data, covering the entire life cycle of the food product and all the factors that influence its chemical composition. This architecture offers consumers complete data about their food products and how their components were obtained.Keywords: Consumer Rights, Open Data, Digital Society, Food Safety, Internet of Things1 IntroductionFor the moment it is evident that the new trend is to use to the right value the openness of data. The big volumes, complexity, openness of data determine a new mode of management and new technological safeguards for privacy.Related to food safety, an open data environment is a complex architecture as it includes multiple data sources specific to various economic fields (figure no. 1). Each layer of information is added by a direct or indirect participant in the food production ecosystem:* Seeds and genetic material providers are the starting point for the entire food production chain. Using electronic labels the farms can record if the seeds or the genetic material is or not genetically modified.* Fertilizers providers will provide information about the chemical composition of these products or the* The agricultural farm and its surrounding environment. The quality of fresh fruits and vegetables are influenced by the treatments made by the farmer but also by the surrounded environment. The proximity of a large industrial complex may contaminate the products.* The animal growing farms must provide information in how the animals are reproduced and also information on the food supply chain used to deliver nutrients used to grow the livestock.* The food additives producers must provide the scientific and chemical name of the additive. These can be correlated with Open Data libraries that provide further information on long term effect on human health if they are consumed;* The food processing industry* The goods transporter must provide required light and temperature conditions all the time and through the entire journey.* The local food warehouses must provide proper storage facilities and must deliver food products before they reach their validity term;* The local markets, supermarkets and other food resellers* Public or governmental organizations that provide access to knowledge (A2K) and Open Data repositoriesOnce all this data for all these sources is recorded and publicly available in Open Data repositories there is a matter of seconds and customer culture and responsibility to access it and query it in the store. Then the consumer will have all the data needed to take a fully aware decision on buying or not that product. This is also in concordance with Europa 2020 strategy [19].2. IoT based food management systemFood management systems are useful tools that helps analyze food related activities in order to optimize costs. A quickly search on Google Trends of the term food management reveals an almost constant trend from 2005 (figure no. 2) till now with regards to management procedures in food related activities.Most of those searches show interest in undeveloped countries such as Kenya, Nigeria and India (figure no. 3), whereas the most correlated words with the food management syntagma are safety and services. …

The Key Roles for the Nurse in Acute Heart Failure Management.

The key roles for the nurse in the management of heart failure have largely focused on the follow up and monitoring of patients at high risk of hospital (re)admission. Studies reported an improvement in outcome for patients followed up by a multidisciplinary care team in which a nurse was a key player. Such level of care is now recognised in international guidelines. More recent emphasis on the management of acute heart failure has led to a focus on the contribution by nurses to the entire heart failure journey and their roles in improving patient outcome and the delivery of quality care. This paper focuses on the in-patient admission for acute or decompensated heart failure and discusses the involvement of nurses in achieving an effective heart failure service.

A meta-analysis of the effectiveness of park-and-ride facilities

In this paper we present a meta-analysis of Park-and-Ride (P+R) facilities. Our goal is to identify the determinants of effective sites and to assess their contribution with respect to various transport policy objectives. An effective facility predominantly attracts target group users, i.e. users who without the P+R would use the car for the entire journey. Our meta-analysis is based on the results of 40 studies and a total of 180 evaluated P+R sites, mainly from European countries. Linear regression analysis is used to estimate the influence of seven explanatory variables. Public transport mode and point of intercept are identified as the most important factors. The share of commuters, weekday or weekend use and the number of parking spaces have a significant, but limited influence on the effectiveness. The statistics from the dataset and the linear regression results are used to calculate the effects on three main policy objectives. Our analysis indicates that P+R facilities with a destination function intercept about 47 cars per 100 parking spaces provided. Public transport use drops slightly and private car kilometres (to reach the P+R) increase. Facilities with an origin function intercept about 21 cars per 100 parking spaces, private car kilometres are slightly reduced and kilometres in public transport use increases. Our results are useful to assess the impact of future P+R interventions and to formulate regional P+R policies.

System-Centric Minimum-Time Paths for Battery-Powered Vehicles in Networks with Charging Nodes

We study the routing problem for vehicle flows through a road network that includes both battery-powered Electric Vehicles (EVs) and Non-Electric Vehicles (NEVs). We seek to optimize a system-centric (as opposed to user-centric) objective aiming to minimize the total elapsed time for all vehicles to reach their destinations considering both traveling times and recharging times for EVs when the latter do not have adequate energy for the entire journey. Extending prior work where we considered only EVs entering the network, we formulate the problem by grouping all vehicles into a set of “subflows”and provide solutions based on both a Mixed Integer Non-Linear Programming (MINLP) approach and an alternative flow optimization problem. Since the problem size increases with the number of subflows, its proper selection is essential to render the problem manageable, thus reflecting a trade-off between proximity to optimality and computational effort needed to solve the problem. We propose a criterion and procedure leading to a “good” choice for the number of subflows.

Promoting careers in health care for urban youth: What students, parents and educators can teach us.

There are many obstacles that urban youth experience in pursuing health careers, but the benefits of diversifying the classroom and workforce are clear. This is especially true today as educators and policymakers seek to enhance underrepresented minority students' access to health careers, and also achieve the health workforce needed to support the Affordable Care Act. The creation of student pipeline programs began more than 40 years ago, but success has been equivocal. In 2008, Mentoring in Medicine (MIM) conducted a research project to identify how students learn about health careers; develop strategies for an integrated, experiential learning program that encourages underrepresented minority students to pursue careers in health; and translate these into best practices for supporting students through their entire preparatory journey. Six focus groups were conducted with educators, students, and their parents. The inclusion of parents was unusual in studies of this kind. The outcome yielded important and surprising differences between student and parent knowledge, attitudes and beliefs. They informed our understanding of the factors that motivate and deter underrepresented minority students to pursue careers in health care. Specific programmatic strategies emerged that found their place in the subsequent development of new MIM programming that falls into the following three categories: community-based, school-based and Internet based. Best practices derived from these MIM programs are summarized and offered for consideration by other health career education program developers targeting underrepresented minority students, particularly those located in urban settings.

Becoming iron men: the story of the 1963 Loyola Ramblers

Loyola University Chicago was ahead of its time when racial matters were forefront in a long overdue revolution in civil rights. The Ramblers of the 1962-1963 NCAA college basketball season were pioneers in race relations in sport, though most of the time they were simply playing the sport they loved. When the NCAA tournament began in March, the Ramblers engaged in a series for the ages, daring to be the first NCAA Division I school to play five black athletes on the court at once and capturing the most prestigious title in college basketball at a time when states below the Mason-Dixon line still had laws on the books preventing black and white athletes from mixing even in pick-up games. Records were set, rivals faced and one of the most famous and significant contests in college basketball playoff history played out in what incidentally became a model showcase for race relations. Nearly every time the Ramblers took the court, the game was unique in its magnitude. Relying significantly on exclusive interviews with surviving players, now in their seventies, Lew Freedman chronicles the entire journey, the adventure of the season that bound tight for a lifetime the group of men who lived through it.

Clinical laboratories: production industry or medical services?

The current failure to evidence any link between laboratory tests, clinical decision-making and patient outcomes, and the scarcity of financial resources affecting healthcare systems worldwide, have put further pressure on the organization and delivery of laboratory services. Consolidation, merger, and laboratory downsizing have been driven by the need to deliver economies of scale and cut costs per test while boosting productivity. Distorted economics, based on payment models rewarding volume and efficiency rather than quality and clinical effectiveness, have underpinned the entrance of clinical laboratories into the production industry thus forcing them to relinquish their original mission of providing medical services. The sea change in laboratory medicine in recent years, with the introduction of ever newer and ever more complex tests, including 'omics', which impact on clinical decision-making, should encourage clinical laboratories to return to their original mission as long as payments models are changed. Rather than being considered solely in terms of costs, diagnostic testing must be seen in the context of an entire hospital stay or an overall payment for a care pathway: the testing process should be conceived as a part of the patient's entire journey.

Replacing Paper with Digital Recording

Addressing the needs to achieve the highest standards at multidisciplinary team meetings at the Stroke Unit of Broomfield Hospital, an electronic version is applied instead of the traditional paper model. This is to ensure that patients within the unit are receiving appropriate care and their progress is monitored throughout their entire journey. This also enables the stroke team to retrieve old information anywhere in the hospital, electronically, from previous documentations to compare progress of rehabilitation. The electronic model also helps when assessing readmission or those who attend the stroke clinics to clarify new onset changes from residual weakness. The tool kit estimates Barthel Index score for activities of daily living and Rivermead Mobility Index for physical capacity assessment weekly as the team attending the meetings. The goals from all disciplines, physiotherapists, occupational therapists, speech and language therapists, and nurses are clearly documented along with patient cognition, emotion, and perception. This initiative commenced in late April 2013 and the first clinical outcome assessments performed at the beginning of September 2013, enabling the stroke team to assess rehabilitation activities and achievements. Front-line staff expressed satisfaction with the initiative model, which successfully managed to monitor and analyze the rehabilitation activities within the stroke unit.

Boundary management in doctoral supervision: how supervisors negotiate roles and role transitions throughout the supervisory journey

In this paper, boundary management illuminates understanding of the doctoral supervisory relationship. Boundary management is presented as a theoretical vehicle that helps to define and explain roles that supervisors employ at different junctures along the doctoral journey and how transitions between these are negotiated. The paper draws on the work of Ashforth, Kreiner, and Fugate who suggest that the concept of boundaries ‘in numerous disciplines’ refers to ‘physical, temporal, emotional, cognitive and/or relational limits’ that define how, for example, roles are distinguished from one another. Adapting this work to the doctoral supervisory relationship, temporal and cognitive dimensions are defined as primary boundaries and physical emotional and relational aspects as secondary ones. Managing primary boundaries is integral to supervising the entire doctoral journey. However, engaging with secondary dimensions is also critical to shape how supervisors construct and negotiate the key elements of time and cognitive development throughout that journey.