Further Development Of Services Research Articles

Implementation of a geriatric oncology service at the Royal Marsden Hospital

IntroductionDespite significant evidence supporting the benefits of comprehensive oncogeriatric assessment in the management of older patients with cancer, the adoption of specialised geriatric oncology programs in the United Kingdom remains limited. Descriptions of clinic structure and models, patient demographics and baseline characteristics, resource utilisation, and predictors of resource utilisation are lacking in this population, which may complicate or impede the planning, resourcing, and development of further services in this subspecialty on a national and regional basis. Materials and MethodsBetween November 2021 and April 2023, 244 patients commencing systemic anticancer treatment at the Royal Marsden Hospital, London underwent geriatric screening using the Senior Adult Oncology Programme-3 (SAOP3) screening tool. Baseline clinical factors (sex, age, Charlson Comorbidity Index score, Cumulative Illness Rating Scale-Geriatric [CIRS-G] score, Katz Index score, Barthel Index score, treatment intent, and Eastern Cooperative Oncology Group Performance Status [ECOG-PS]) were assessed as predictors of geriatric impairments and need for multidisciplinary referral and intervention using a negative binomial regression analysis. Referral rates to multidisciplinary teams were assessed against ECOG-PS score using point-biserial correlation, as well as against a historical control using descriptive statistics. ResultsThe median age of participants was 77; 75.8% were female. Breast cancer was the most prevalent diagnosis (61.9%). Most patients (67.6%) were undergoing treatment in the palliative setting. Two hundred eleven (86.5%) patients were identified as having at least one geriatric impairment. Six hundred forty-nine multidisciplinary referrals were made, of which 583 (86.7%) were accepted by the referred patient. Higher ECOG PS was positively associated with geriatric impairments in physiotherapy, occupational therapy, dietetics, pharmacy, and welfare rights domains, as well as with the overall number of geriatric impairments. DiscussionThe Royal Marsden Senior Adult Oncology Programme represents the first geriatric oncology service in a tertiary cancer centre in the United Kingdom. Following implementation of SAOP3 screening, we observed a substantial increase in referrals to all multidisciplinary teams, suggestive of previously underrecognized needs among this population. The need for multidisciplinary intervention was strongly correlated with baseline ECOG-PS score, but not with other measured clinical variables, including comorbidity or functional indices.

The transition of care from farm-based daycare for people with dementia: The perspective of next of kin

ABSTRACT Purpose The aim of the present study was to explore the next of kin’s experiences with the transition for people with dementia from a farm-based daycare (FDC) to another service in the municipality. Methods The study has a qualitative, descriptive design. Eight semi-structured interviews with next of kin were conducted. The data were analysed in accordance with content analysis. Results Through the analysis three main categories were developed: (1) Bearing the burden, (2) Being in transition, and (3) Feeling supported. The transition period was highly stressful for next of kin due to the exacerbation of their relatives’ dementia symptoms. The next of kin focussed on optimizing the everyday lives of their relatives with dementia, even at the expense of their own well-being. Most participants experienced support from FDC, healthcare services and their informal network. Conclusions The study contributes important insights into the next of kin’s experiences. Good quality service, close dialog, information, and support between the different part in the transition process, can be useful for the further development of services with good quality and to reduce the negative effects of care on next of kin.

Summary of the plenary sessions at European Space Weather Week 15: space weather users and service providers working together now and in the future

During European Space Weather Week 15 two plenary sessions were held to review the status of operational space weather forecasting. The first session addressed the topic of working with space weather service providers now and in the future, the user perspective. The second session provided the service perspective, addressing experiences in forecasting development and operations. Presentations in both sessions provided an overview of international efforts on these topics, and panel discussion topics arising in the first session were used as a basis for panel discussion in the second session. Discussion topics included experiences during the September 2017 space weather events, cross domain impacts, timeliness of notifications, and provision of effective user education. Users highlighted that a severe space weather event did not necessarily lead to severe impacts for each individual user across the different sectors. Service providers were generally confident that timely and reliable information could be provided during severe and extreme events, although stressed that more research and funding were required in this relatively new field of operational space weather forecasting, to ensure continuation of capabilities and further development of services, in particular improved forecasting targeting user needs. Here a summary of the sessions is provided followed by a commentary on the current state-of-the-art and potential next steps towards improvement of services.

The role of internet in formation of passengers of airplanes passengers

The paper uses the diagnostic survey method to analyze consumer preferences in the field of air ticketing, with particular emphasis on the role of modern information technology. On the basis of the research, it has been unequivocally stated that passengers are heavily involved in the use of information technology in the area of ticket purchase and booking, which highlights the great importance of technological innovation in the operation, promotion and further development of services in the air transport market.

Important features of home-based support services for older Australians and their informal carers.

In Australia, newly initiated, publicly subsidised 'Home-Care Packages' designed to assist older people (≥ 65 years of age) living in their own home must now be offered on a 'consumer-directed care' (CDC) basis by service providers. However, CDC models have largely developed in the absence of evidence on users' views and preferences. The aim of this study was to determine what features (attributes) of consumer-directed, home-based support services are important to older people and their informal carers to inform the design of a discrete choice experiment (DCE). Semi-structured, face-to-face interviews were conducted in December 2012-November 2013 with 17 older people receiving home-based support services and 10 informal carers from 5 providers located in South Australia and New South Wales. Salient service characteristics important to participants were determined using thematic and constant comparative analysis and formulated into attributes and attribute levels for presentation within a DCE. Initially, eight broad themes were identified: information and knowledge, choice and control, self-managed continuum, effective co-ordination, effective communication, responsiveness and flexibility, continuity and planning. Attributes were formulated for the DCE by combining overlapping themes such as effective communication and co-ordination, and the self-managed continuum and planning into single attributes. Six salient service features that characterise consumer preferences for the provision of home-based support service models were identified: choice of provider, choice of support worker, flexibility in care activities provided, contact with the service co-ordinator, managing the budget and saving unspent funds. Best practice indicates that qualitative research with individuals who represent the population of interest should guide attribute selection for a DCE and this is the first study to employ such methods in aged care service provision. Further development of services could incorporate methods of consumer engagement such as DCEs which facilitate the identification and quantification of users' views and preferences on alternative models of delivery.

Indian NGOs under Tremendous Pressure-Causes and Effects: A Critical Analysis

The government of India has been implementing various development program activities and reforms through non-governmental organisations (NGOs) in a bid to improve the service delivery. There has been little effort so far; however, to review and synthesise the lessons learned from these experiences and/or for further development of services. This paper aims to estimate the relative technical and scale efficiency of NGOs in India to demonstrate policy implications in the developmental sector. The empirical analysis was used to assess the efficiencies to highlight the importance of internal dynamics of the NGOs for enhancing its social contract. The present article is focusing the Management Efficiency of NGOs and the reasons that drag the NGOs down and put them into controversy. The article highlights some issues pertaining to Management Efficiency of NGOs.

Traumatic Brachial Plexus Injury: The Lived Experience

Introduction: It takes a long time for someone to come to terms with a traumatic brachial plexus injury. The loss of function is akin to physical amputation of the limb, with all the associated body image and psychological effects (Waldram 2003). Numerous studies have been carried out that report on the functional outcomes following traumatic brachial plexus injury, but there is a noticeable lack of qualitative evidence that explores the subjective experiences of people following such an injury. The purpose of this study was to give these people a voice and allow researchers and occupational therapists to learn from the ‘lived experiences’ of those who had incurred such a devastating injury. Method: The research (undertaken by the first author) utilized a qualitative approach informed by phenomenology. This approach permitted the researcher to examine the core concepts of the lived experiences of people with this injury (Strauss 1990). Ten male Irish participants diagnosed with a traumatic brachial plexus injury were interviewed. Thematic analysis and member checking were utilized. Findings: The lack of rehabilitative and counselling services in the health care system was evident. Participants also voiced issues such as unequal opportunities in gaining employment, gender roles, the challenges of pain control, and the devastating effect of depression. Conclusion: The findings from this study will be of direct relevance to further development of services for individuals diagnosed with a traumatic brachial plexus injury.

Investigation of radio sources with the virtual observatory tools: Results and problems

AbstractRadio sources of the RCR catalogue, obtained from observational data of the “Cold” experiment, have been identified, almost completely, with optical objects. For this purpose, we used optical, infrared, and radio sky surveys as well as archive data from the VLA (NRAO) and the 6‐m telescope (SAO). According to spectroscopy and color index constraints, the identified sources are classified as galaxies and quasars; about 20 % of the sources remain unclassified because of being optically faint. We estimated radio luminosities of the sources and found that a majority (60%) of them belong to strong radio sources. Using ratios of FIRST and NVSS flux densities and angular sizes, we prepared a sample of steep spectrum compact sources. The existing infrastructure of the virtual observatory increases the effectiveness of astronomical studies like ours greatly. However, we still cannot consider the virtual observatory a completed project because it requires further development of services providing actualization of user data and better semantic compatibility of information. (© 2013 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)

Experiences of persons with early-onset dementia in everyday life: A qualitative study

The small number of existing studies confirms that people with early-onset dementia (EOD) need special assistance from the beginning and as the disease progresses. There is a need to develop services to respond to the specific needs of persons with EOD. To find out how people experience living with early-onset dementia, and to assess the implications for practice and the development of further services. Grounded theory, a qualitative method, with interviews of 20 informants (aged 54-67 years; 12 of them men) during 2010-2011. One category, the process toward a dementia diagnosis, covered two subcategories; describing changes and being diagnosed. Another category fighting for dignity describes how the informants try to maintain their quality of life, covering two subcategories; intrapsychic challenges and social challenges. Health services should give persons with EOD the ability to maintain contact with society and their voices should not be overlooked.

Access to urgent health care

In the context of this article, access to urgent health care is defined by the patient and carer's needs whenever required and thus includes needs for urgent help both within...

Psychiatry in Kuwait

This paper describes the historical background, development and current status of psychiatric services in Kuwait. In addition, present practices and the outlook for further development of services are outlined.

Wagga Wagga specialist outreach palliative medicine service: A report on the first 12 months of service

This paper reports on and discusses the development of a visiting palliative medicine specialist outreach service for Wagga Wagga New South Wales, Australia, and presents initial data and three case vignettes for reflection. The visiting doctor was flown from Sydney each fortnight for a day and integrated with the local nursing based palliative care team. Demographic data was collected over the initial 12 months of service, which included the location of the consult (hospital, home, nursing home), whom the consult was from (specialist, GP), age of the patient, location of death, type of cancer, as well as the complexity of consultation from the perspective of one of the authors. The majority of referrals were for advice on cancer pain control (62.3%) and other symptoms (26.7%) confirming the expectation. Those patients referred were considered appropriate, with over 75% having a palliative care issue that was considered appropriate for direct patient contact by the specialist in palliative medicine. The provision of a visiting palliative medicine specialist to rural areas has been developed over the last few years in New South Wales and the reporting of the success of this particular service aims to provide evidence for the need and the development of further services, as it is expected that this service would continue but with an increasing number of referrals as the service became increasingly known.

Comparison of functional outcome following acute care in young, middle-aged and elderly patients with traumatic brain injury

Primary objective: To compare functional physical and cognitive outcome of patients in three age groups with mild, moderate and severe traumatic brain injury (TBI) at discharge from acute care.Research design: Retrospective database review.Methods and procedures: Scores on the Extended Glasgow Outcome Scale (GOSE) and on the FIM™ instrument,discharge destination and length-of-stay (LOS) were gathered and compared for 2327 patients with TBI admitted to a level 1 trauma hospital from 1997–2003 divided into three age groups; 971 patients between 18–39 years, 672 between 40–59 years and 684 aged 60–99 years.Main outcomes and results: Relative to younger adults with similar TBI severity, elderly patients showed worse outcome on the GOSE and FIM™ instrument (physical and cognitive ratings) and longer LOS. No difference was observed between the young and middle-aged groups except for cognitive FIM™ ratings and LOS for severe TBI. A higher percentage of elderly patients went to in-patient rehabilitation, to long-term care facilities or died compared to young and middle-aged patients. A higher number of young and middle-aged patients were discharged home.Conclusions: Further development of services in early rehabilitation as well as post-rehabilitation geared to the specific needs of the elderly patient with TBI is required as the population ages.

Family Placement Schemes for Adult Persons with Intellectual Disabilities Living with Elderly Carers

Few family placement schemes involve adult persons, and rarely have they been targeted at older carers. Twenty-five carers, aged 55 years and over, of people with intellectual disabilities using one of two placement schemes in Northern Ireland were studied, along with a further 20 carers recommended for these schemes. Semi-structured individual interviews were used to obtain the views of carers, people with intellectual disabilities and placement providers. The placement schemes were very favourably received. Carers welcomed the break and valued the relationship with the placement provider. Individuals with disability reported greater opportunities to participate in activities. Placement providers were very satisfied with the way the schemes operated: the main complaint was the low level of payments. Key factors affecting the further development of services include recruitment of male providers, registration issues, training of providers and the difficulty in meeting the needs of multiply disabled persons.

A review of education/support groups for adult survivors of child sexual abuse: A qualitative anaiysis

The paper examines the views and experiences of participants in a series of Education/Support Groups for Adult Survivors of Child Sexual Abuse over a three-year period. Twelve adult survivors participated in the study through the use of semi-structured interviews to establish whether the education, support and therapeutic aspects of the programme met their needs. The experiences of adult survivors in their disclosure of child sexual abuse and in accessing appropriate help were also examined with a view to the findings contributing to the further development of services. Overall participation in group work was viewed as a positive experience and the study highlighted a number of particular aspects of the programme regarded as beneficial for adult survivors. Concerns regarding disclosure of sexual abuse and experiences of admission to psychiatric hospital were also identified. As a result of the study a number of recommendations are made in respect of certain areas of the group work programme, service delivery and staff training. This paper aims to highlight the above and contribute its findings to the further development of professional practice and service delivery for adult survivors of sexual abuse. In an attempt to be sensitive in the use of language, we have adopted the term 'survivor' to describe those who have survived this most traumatic of experiences and yet possess great strength, despite the damage that has been inflicted.

Integrating Services in the Recognition and Management of Postpartum Depression

Our study, completed in 1999, linking a mother-baby unit with Maternal and Child Health Nurses (MCHNs) with education, liaison and prioritised tertiary assessment and admission is presented, and issues of service delivery and satisfaction are highlighted. Two hundred and forty three women were recruited antenatally and followed to up to nine months postpartum, 133 forming the study group and 110 the control. MCHNs in the study group were offered an intensive education package, with ongoing six weekly liaison meetings. The intervention was welcomed and feedback positive. Women in the study and control group did not differ in their levels of depression throughout the study. Differences, however, in adjustment to motherhood emerged between women in well-supported affluent areas and those in under-resourced lower socioeconomic areas. MCHNs were seen by women in all areas as the key people to turn to. Those in the lower socioeconomic areas reported greater difficulties in providing a service, and women in these areas were less likely to access services external to their region. Implications for the development of further services and the linking of these supports are discussed.

The history, evolution and principles of services marketing: poised for the new millennium

The development and evolution of services marketing have been extraordinary. Provides a brief historical overview of services marketing, highlights its differences, then presents an extensive list of principles that attempts to reflect the current state of the field and provides a springboard for the further development of services marketing in the next millennium. The list provides guidelines for marketing managers and ideas for further research.

Issues in multidisciplinary teamwork for children with disabilities.

This paper presents a review of key issues surrounding multidisciplinary work in relation to the care of children with disabilities and their families. The discussion is based on experience of working in a child development team and research visits to teams around Britain at the beginning of the 1990s. An outstanding feature of child disability services is their organizational diversity. The research found that district interagency planning groups were a rarity, as were multiagency management groups for teams. Thus it was rare for teams to have clear lines of external accountability. Similarly leadership and management structures within the teams had a profound influence on their effectiveness. Issues are highlighted for identifying good practice and for further development of services.

Health Care Reform Based on an Empowerment Model of Recovery by People With Psychiatric Disabilities

People with psychiatric disabilities have articulated a model of recovery that encourages their empowerment by emphasizing consumer-defined goals, liberty, self-control of symptoms, peer support, elimination of discrimination, and provision of adequate material and social supports. Application of this model to health care reform requires public education to fight discrimination, an end to the use of involuntary interventions in the name of treatment, further development of services run by survivors-consumers and other alternatives to psychiatric hospitalization, and increased involvement of survivors-consumers in decisions related to their treatment and support. To promote empowerment of people with mental health problems, health care reform should include affordable, universal coverage without exclusions for preexisting high-risk conditions, parity of mental health benefits with other benefits, which includes coverage for voluntary services only, and incentives for funding long-term care, alternatives to hospitalization, and holistic healing services.

Special Education in South Korea

The development and current status of special education in South Korea are described and contrasted to that of the United States. South Korean special education was initiated in the 1890s by U.S. missionaries. Later, Japanese influence was considerable, especially on its regular educational programs. Special programs are available for five classifications of disabilities. Its major national special education legislation contains numerous provisions similar to P.L. 94-142. However, various conditions may impede the further development of services, including a high teacher-pupil ratio, the reliance on self-contained programs, negative attitudes toward people with disabilities, and lack of advocacy groups. Further initiatives require considerable research and policy debate among South Koreans.