Future Service Development Research Articles

Design and verification of universal virtual shopping store application

The aim of this study was to design the user experience for a head-mounted display (HMD)-based universal virtual shopping store by conducting a literature analysis and employing video ethnography techniques. Subsequently, a prototype was developed to validate the outcomes. Despite the growing trend of contactless shopping, with various brands launching virtual store platforms, these often lack the elements and experiences that users find satisfying. To address this gap, we analysed users’ offline shopping experiences using video ethnography. The insights gained informed the development of a prototype that adopts a universal design approach, incorporating key features and interface designs tailored for a virtual store environment. The prototype includes innovative features include tutorials, avatar-based virtual fitting, user location/orientation control, and voice guidance. It also incorporates design features such as colour customisation, high contrast, central interface placement, and visual cues for differentiating product types. To validate the prototype’s usability, a study was conducted with 30 university students in their 20s (mean age 23.3 years, SD = 1.8), revealing high levels of satisfaction with its functionality and interface design. Further, in-depth interviews revealed that the appropriate design of features and interfaces, aligned with shopping goals and intentions, significantly enhanced interest in and engagement with virtual shopping. The prototype’s key features, representative of the main outcomes of this study, provide valuable insights for the future development of related services.

Seeking a care–life balance: family carers’ perspectives on how quality of life can improve when caring for an older person living with dementia

Many family carers of older people living with dementia report reduced quality of life, but limited research has investigated what they believe could improve it. Our thematic analysis of in-depth interviews with 23 family carers questions the standardisation of carer support and the appropriateness of the current scope of services, and suggests strengthening carers’ independent right to support. We propose the notion of a ‘care–life balance’, which also draws attention to the different logics inherent in informal and formal care that future service development should seek to reconcile to better support families affected by dementia.

The Experiences and Perceptions of First Contact Practitioners in Primary Care-A Qualitative Systematic Review.

First Contact Practitioners (FCP) have developed as a more advanced physiotherapy clinical role delivering specialist MSK services in GP practice settings. They aim to support GPs in effectively managing increasing patient workloads. As FCPs are now a more established NHS role, it is important to understand how these clinicians perceive their roles to guide and support future service development. To review the current evidence regarding the experience of FCPs in the UK. To understand how FCPs perceive their role. To gain an insight into FCP practice which can inform future primary research studies. A systematic review of FCP primary qualitative research studies. Multiple database and grey literature search with screening following PRISMA guidelines. Qualitative critical appraisal and analysis used tools and frameworks from the Joanna Briggs Institute. The review reports on 11 included studies which informed the creation of six key concepts impacting upon FCP role experience and perceptions. These were complexity, competency and role development, role understanding, job satisfaction, wellbeing and burnout and service delivery. FCP clinicians feel broadly positive about their roles, although they report a clear risk of burnout and associated negative impact on their wellbeing. Job satisfaction is linked to adequate training and developing the competencies required to manage patients in an environment of clinical uncertainty. Having access to regular clinical mentorship is a key requirement and FCPs must adapt to the specific demands of work in a GP practice environment.

Pharmacist-led hospital intervention reduces unintentional patient-generated medication discrepancies after hospital discharge.

Medication reconciliation can significantly reduce clinically important medication errors at hospital discharge, but its impact on post-discharge medication management has not been investigated. We aimed to investigate the incidence of patient-generated medication discrepancies 30days after hospital discharge and the impact of a pharmacist-led medication reconciliation coupled with patient counselling on clinically important discrepancies caused by patients. A pragmatic, prospective, controlled clinical trial was conducted at the University Clinic Golnik, Slovenia. Adult patients were divided into an intervention group and a control group. The intervention group received pharmacist-led medication reconciliation at admission and discharge, plus patient counselling at discharge. Medication discrepancies were identified by comparing the therapy prescribed in the discharge letters with the therapy 30days after discharge, obtained through telephone patient interviews. Discrepancies were classified as intentional or unintentional, and their clinical importance was assessed. The study included 254 patients (57.9% male, median age 71years), with 136 in the intervention group and 118 in the control group. Discrepancies occurred with a quarter of the medicines (617/2,441; 25.3%) at 30days after hospital discharge, and patients themselves caused half of the discrepancies (323/617; 52.4%), either intentionally (171/617; 27.7%) or unintentionally (152/617; 24.6%). Clinically important discrepancies occurred in 18.7% of intentional and 45.4% of unintentional patient-generated changes. The intervention significantly reduced the likelihood of clinically important unintentional patient-generated discrepancies (OR 0.204; 95%CI: 0.093-0.448), but not clinically important intentional patient-generated discrepancies (OR 2.525; 95%CI: 0.843-7.563). The latter were more frequent among younger, male patients and patients hospitalized for respiratory diseases. The study emphasizes the importance of addressing discrepancies made by patients after hospital discharge, which can result in potentially harmful outcomes. It also shows that a pharmacist-led hospital intervention can significantly reduce discrepancies in the early post-discharge period. These findings can guide the development of future services to improve patient support for medication management after hospitalization.

Physiotherapy management of acute perineal trauma: a patient satisfaction survey

Pelvic floor muscle (PFM) training is recommended in the immediate postpartum period because it can restore PFM function and prevent pelvic floor dysfunction. There are no national physiotherapy guidelines on how to deliver this intervention in the acute period. There is also no consensus on the need for outpatient follow-up to treat pelvic floor dysfunction that arises from perineal trauma, or as a preventative strategy in the long term. The aim of this study was to evaluate a current service provided for women with acute perineal trauma. The authors assessed patient satisfaction and compliance with physiotherapy advice, and identified preferences for future service development. One hundred and thirty patients completed satisfaction questionnaires after receiving inpatient physiotherapy treatment. Thirty consented to completing a retrospective telephone consultation about their care at 6–8 weeks postpartum. The questionnaire found high levels of satisfaction, and recorded a National Health Service Friends and Family Test score of 93. In the telephone consultation, 87% of the women reported that they were complying with ongoing PFM training. Eighty-five per cent of women who completed the questionnaire suggested that outpatient physiotherapy follow-up would be useful. Fifty per cent stated that options inclusive of outpatient follow-up would be useful for onward service development. Because of the high levels of satisfaction recorded and high compliance with the information provided in the acute postpartum period, it was concluded that the service should continue as it is. It is hoped that this service evaluation can be utilized as a benchmark for other acute and outpatient pelvic health physiotherapy services.

IMPACT organizational survey highlighting provision of services for patients with locally advanced and recurrent colorectal cancer across Great Britain and Ireland.

Locally advanced and recurrent colorectal cancer represents a complex clinical entity, which requires multidisciplinary decision-making and management. The aim of this work is to understand the provision of clinical services in this cohort of patients across Great Britain and Ireland (GB&I) as a key essential step to help facilitate future service development and improvement. A cross-sectional, organizational survey was sent to all colorectal cancer multidisciplinary teams (MDTs) across GB&I. It consisted of 12 key questions addressing the provision of specialist services and advanced surgical techniques. Results are reported in line with the CHERRIES guideline. One hundred and seventy-five MDTs across GB&I participated, with 142 English, 13 Welsh, 14 Scottish, 3 Northern Irish and 3 Irish MDTs. The overall response rate was 93.5% (175/187). Ninety (51.4%) hospital sites reported having a specialist dedicated or subsection MDT. Specialist advanced nursing support was available in 46 (26.2%) hospitals, with a dedicated advanced colorectal cancer outpatient clinic available in 31 (17.7%) hospitals. One hundred and thirteen MDTs (64.5%) offered surgery for advanced colonic cancer, 82 (46.8%) for recurrent colonic cancer, 58 (33.1%) for advanced rectal cancer and 39 (22.2%) for recurrent rectal cancer. A variable number of MDTs offered specialist surgical techniques, including distal sacrectomy [33 (18.9%)], high sacrectomy [16 (9.1%)], complex vascular resection ± reconstruction [33 (18.9%)] and extended lymphadenectomy (pelvic sidewall or para-aortic) [44 (25.1%)]. The IMPACT organizational survey highlights the current variation in the delivery and provision of clinical services for patients with advanced and recurrent colorectal cancer across Great Britain and Ireland.

Text analytics and new service development: a hybrid thematic analysis with systematic literature review approach

PurposeThis study addresses the gap in understanding text analytics within the service domain, focusing on new service development to provide insights into key research themes and trends in text analytics approaches to service development. It explores the benefits and challenges of implementing these approaches and identifies potential research opportunities for future service development. Importantly, this study offers insights to assist service providers to make data-driven decisions for developing new services and optimising existing ones.Design/methodology/approachThis research introduces the hybrid thematic analysis with a systematic literature review (SLR-TA). It delves into the various aspects of text analytics in service development by analysing 124 research papers published from 2012 to 2023. This approach not only identifies key practical applications but also evaluates the benefits and difficulties of applying text analytics in this domain, thereby ensuring the reliability and validity of the findings.FindingsThe study highlights an increasing focus on text analytics within the service industry over the examined period. Using the SLR-TA approach, it identifies eight themes in previous studies and finds that “Service Quality” had the most research interest, comprising 42% of studies, while there was less emphasis on designing new services. The study categorises research into four types: Case, Concept, Tools and Implementation, with case studies comprising 68% of the total.Originality/valueThis study is groundbreaking in conducting a thorough and systematic analysis of a broad collection of articles. It provides a comprehensive view of text analytics approaches in the service sector, particularly in developing new services and service innovation. This study lays out distinct guidelines for future research and offers valuable insights to foster research recommendations.

“But if you do not keep doing it, you won’t maintain”. A qualitative study on the perspectives of speech-language pathologists on maintenance of therapy gains in aphasia

ABSTRACT Background Maintaining therapy gains in the long term is necessary for therapy to be considered successful. Yet, this topic has received limited attention in aphasia rehabilitation research. Unfortunately, for some people with chronic aphasia, maintaining the gains achieved in therapy can be difficult and many experience reduced communicative functioning over time. Understanding the perspectives of speech-language pathologists (SLPs) on maintenance is vital. As key agents in aphasia therapy, their views are crucial for understanding current practice, identifying service gaps, and informing future research on the maintenance of therapy gains. Aim The aim of this research was to explore speech-language pathologists’ perspectives on maintaining therapy gains in chronic aphasia and to understand their beliefs about the factors that influence the maintenance of gains made during aphasia rehabilitation. Methods & Procedures In-depth semi-structured interviews were conducted with seven SLPs who worked with people with chronic aphasia. Inductive thematic data analysis was used to identify themes. Outcomes & Results Six themes were identified, representing SLPs’ beliefs about maintenance and their perceptions of factors important for preserving therapy gains in aphasia rehabilitation. These were: 1) Ongoing communication activity; 2) Meaningful person-centred goals; 3) The challenge of translating functional goals to participation; 4) Individual capacity and resource availability; 5) Home support; and 6) Services. The results illustrate the complexity and interplay of factors that may both facilitate and hinder the maintenance of therapy gains. Conclusions SLPs in this study believe that aphasia rehabilitation interventions should involve meaningful, personalised, enjoyable real-life experiences to optimise maintenance of therapy gains. Moreover, they believe that maintenance must be at the centre of aphasia rehabilitation research and clinical practice, requiring new models of care for chronic aphasia. These insights may provide direction for the development of future interventions and services to enhance long-term maintenance for people with chronic aphasia.

“I’ve Got No Skills to Maintain – to Keep That Going”: A Qualitative Study of People with Chronic Aphasia and Their Partners About Factors Contributing to the Maintenance of Aphasia Therapy Gains

ABSTRACT Background The maintenance of therapy gains is critical for successful aphasia rehabilitation, a topic often overlooked in both research and clinical practice. For some people with chronic aphasia, maintaining therapeutic gains can be challenging, potentially resulting in diminished communicative function over time. Furthermore, maintaining therapy gains may necessitate consistent, deliberate effort; however, little is known about the factors supporting this process. People living with chronic aphasia and their family members may provide critical insights into the behavioural factors that impact the maintenance of therapy gains. Understanding these factors will be crucial for developing long-lasting, effective aphasia interventions. Aim In this study, we explored the perspectives and practices of people with chronic aphasia and their partners concerning the maintenance of gains from therapy for post-stroke chronic aphasia. Methods & Procedures Eight in-depth, semi-structured interviews were conducted, involving four people with chronic aphasia and four partners. We employed inductive thematic data analysis to identify emergent themes. Outcomes & Results Five themes were identified that were perceived to influence the maintenance of gains made during aphasia rehabilitation. These were: 1) Beliefs about change: improvement, decline, and maintenance; 2) Personal abilities impact improvement and maintenance; 3) External support impacts improvement and maintenance; 4) Engaging in ongoing real-life communication impacts improvement and maintenance; and 5) Knowledge and services gaps in maintenance. The findings demonstrate the complexity and interaction of factors that potentially facilitate or hinder the maintenance of therapy gains in chronic aphasia. Conclusions People with chronic aphasia and their partners report having a limited understanding of the necessity and methods for maintaining therapy gains. They also describe a lack of services to support this. A lack of knowledge and services could hinder the ability to maintain therapeutic benefits. Our study also suggests various behavioural factors are involved in maintaining gains. Forming meaningful real-life communication routines may potentially optimise such gains. These findings highlight the necessity of placing maintenance at the heart of aphasia rehabilitation, informing future interventions and service development.

Understanding sexual health service access for gay, bisexual and other men who have sex with men in Ireland during the COVID-19 crisis: Findings from the EMERGE survey.

In the Republic of Ireland, the COVID-19 crisis led to sexual health service closures while clinical staff were redeployed to the pandemic response. Gay, bisexual and other men who have sex with men (gbMSM) face pre-existing sexual health inequalities which may have been exacerbated. The aim of this study is to understand sexual health service accessibility for gbMSM in Ireland during the COVID-19 crisis. EMERGE recruited 980 gbMSM in Ireland (June-July 2021) to an anonymous online survey investigating well-being and service access through geo-location sexual networking apps (Grindr/Growlr), social media (Facebook/Instagram/Twitter) and collaborators. We fit multiple regression models reporting odds ratios (ORs) to understand how demographic and behavioural characteristics (age, sexual orientation, HIV testing history/status, region of residence, region of birth and education) were associated with ability to access services. Of the respondents, 410 gbMSM accessed sexual health services with some or no difficulty and 176 attempted but were unable to access services during the COVID-19 crisis. A further 382 gbMSM did not attempt to access services and were excluded from this sample and analysis. Baseline: mean age 35.4 years, 88% gay, 83% previously tested for HIV, 69% Dublin-based, 71% born in Ireland and 74% with high level of education. In multiple regression, gbMSM aged 56+ years (aOR = 0.38, 95%CI:0.16, 0.88), not previously tested for HIV (aOR = 0.46, 95%CI:0.23, 0.93) and with medium and low education (aOR = 0.55 95%CI:0.35, 0.85) had lowest odds of successfully accessing services. GbMSM with HIV were most likely to be able to access services successfully (aOR = 2.68 95%CI:1.83, 6.08). Most disrupted services were: STI testing, HIV testing and PrEP. Service access difficulties were found to largely map onto pre-existing sexual health inequalities for gbMSM. Future service development efforts should prioritise (re)engaging older gbMSM, those who have not previously tested for HIV and those without high levels of education.

Advances in Pediatric Telehealth Education and Training: A National Survey.

Background: The COVID-19 pandemic accelerated the formal integration of telehealth into education curricula and training programs, prompting the need to reevaluate the current landscape and inform a research agenda. We developed a survey to assess telehealth education and training curriculum, competencies, certification, and research across pediatric medical centers. Methods: Questions were derived from a previously published national survey and de novo. The survey was distributed across national pediatric professional associations. Results: In total, 32 respondents representing medical centers (86.5%) were providing telehealth education and/or training. Most were internally developed didactic (78.6%) and experiential (64.3%) curricula. Respondents who included education and/or training in telehealth research protocols and conducted telehealth research (74%) reported mandatory or optional training in tele-research. A form of certification was preferred by most organizations (>60%). Conclusion: Telehealth education and training are key factors within current and future service development, provision, and research to demonstrate competencies and positively impact patient care.

High-precision services of BeiDou navigation satellite system (BDS): current state, achievements, and future directions

With the rapid development of technologies such as autonomous driving and robotic navigation, the demand for accurate and reliable positioning results with BDS has increased. The current status and future development of BDS high precision services are reviewed. The operational PPP-B2b of BDS-3 achieves positioning accuracy at decimeter-level within 14 min and has the drawbacks in regional coverage and long convergence time compared with the international counterparts, such as CLAS of QZSS and HAS of Galileo. A development frame for multi-layer BDS high-precision services is proposed by considering its construction cost, compatibility of user terminal, operating maintenance burden, and service level. The global high-precision service with the improved orbit and clock accuracy enhanced with the inter-satellite link is taken as the most fundamental layer. By incorporating inter-satellite link observations, the orbit errors URE and clock errors are significantly reduced to approximately 0.05 m and 0.16 ns, respectively, which will expand PPP service to global. Based on this, the regional PPP-AR and PPP-RTK services with improved convergence performance are taken as the second layer. With PPP-AR, the convergence time drops to 10 min. With PPP-RTK, the convergence time would be further shortened to less than 3 min. The LEO enhanced PPP service is taken as the third layer which overcomes both drawbacks of the long convergence time of the inter-satellite link enhanced service (the first layer) and the regional coverage of the PPP-AR/PPP-RTK services (the second layer). The simulation results show that by introducing a LEO constellation of 288 satellites, the LEO enhanced PPP can achieve positioning accuracy better than 5 cm within approximately 1 min. In addition, the integration of LEO constellation and PPP-RTK is further proposed to enable instantaneous convergence. The implementation challenges are also presented.

Proactive review for people with diabetes in hospital: a cluster randomised feasibility trial with process evaluation, protocol V3.1

BackgroundDiabetes inpatient specialist services vary across the country, with limited evidence to guide service delivery. Currently, referrals to diabetes inpatient specialists are usually ‘reactive’ after diabetes-related events have taken place, which are associated with an increased risk of morbidity/mortality and increased length of hospital stay. We propose that a proactive diabetes review model of care, delivered by diabetes inpatient specialist nurses, may contribute to the prevention of such diabetes-related events and result in a reduction in the risk of harm.MethodWe will conduct a cluster randomised feasibility study with process evaluation. The proactive diabetes review model (PDRM) is a complex intervention that focuses on the prevention of potentially modifiable diabetes-related harms. All eligible patients will receive a comprehensive, structured diabetes review that aims to identify and prevent potentially modifiable diabetes-related harms through utilising a standardised review structure. Reviews are undertaken by a diabetes inpatient specialist nurse within one working day of admission. This differs from usual care where patients are often only seen after diabetes-related harms have taken place. The trial duration will be approximately 32 weeks, with intervention delivery throughout. There will be an initial 8-week run-in phase, followed by a 24-week data collection phase. Eight wards will be equally randomised to either PDRM or usual care. Adult patients with a known diagnosis of diabetes admitted to an included ward will be eligible. Data collection will be limited to that typically collected as part of usual care. Data collected will include descriptive data at both the ward and patient level and glucose measures, such as frequency and results of capillary glucose testing, ketonaemia and hypoglycaemic events. The analysis aims to determine the fidelity and acceptability of the intervention and the feasibility of a future definitive trial. Whilst this study is primarily about trial feasibility, the findings of the process evaluation may lead to changes to both trial processes and modifications to the intervention. A qualitative process evaluation will be conducted in parallel to the trial. A minimum of 22 patients, nurses, doctors, and managers will be recruited with methods including direct non-participant observation and semi-structured interviews. The feasibility of a future definitive trial will be assessed by evaluating recruitment and randomisation processes, staffing resources and quality of available data.DiscussionThe aim of this cluster randomised feasibility trial with a process evaluation is to explore the feasibility of a definitive trial and identify appropriate outcome measures. If a trial is feasible and the effectiveness of PDRM can be evaluated, this could inform the future development of inpatient diabetes services nationally.Trial registrationUK Clinical Research Network, 51,167. ISRCTN, ISRCTN70402110. Registered on 21 February 2022.

Dampak Teknologi Inovatif, Word of Mouth dan Motivasi Hedonis terhadap Pemakaian Shoppe Paylater

This research aims to analyze the influence of innovative technology, word of mouth, and hedonic motivation on people's use of Shopee Paylater in 2023. The research method uses a short study approach with primary data collection. The research results show that innovative technology does not significantly influence users' interest in using the PayLater feature in the Shopee application. However, word of mouth has a significant influence, showing that positive recommendations from other people can influence perceptions of Shopee Paylater. Apart from that, hedonic motivation also has a significant effect, indicating that enjoyment in using Shopee PayLater is an important factor in user interest in the service. In conclusion, this research provides important insights for the future development of digital financial services, by considering the factors that influence user adoption. Keywords: Hedonic, Word of Mouth, Shoppe Paylater, Innovative Technology

Ocean ecosystem services: modeling a factor development process to create sustainable value for decisions

PurposeThe purpose of this paper is to model a process for moving toward sustainable ecosystem service decisions in a Coastal Biodiversity and discuss the directions of the process for decision-makers to apply in ocean ecosystem services.Design/methodology/approachAfter the development of theoretical approaches to understand their prospects for the future development of ecosystem services, the authors worked on a process for developing factors for sustainable decision-making. It uses the Delphi method to develop all the factors supported by six dimensions in two specific moments: deductive-inductive and inductive-deductive.FindingsThis process of modeling the factors expands the possibility of adaptive governance to make prior and subsequent decisions using factors related to dimensions, stakeholders and benefits, risks, opportunities and costs.Research limitations/implicationsConsidering the limitations, future studies could use another database to widen the view in terms of the studies, factors, dimensions and other additional information to maintain the evolution of this process in ocean ecosystem services decision-making. Another limitation arose in the number of projects and experts defining the factors. This may prevent the opportunity to have more impact in terms of future decisions if more sources are used in the market. In addition, time and the access to experts during this modeling process demonstrate a limitation, as does the time for feedback.Practical implicationsThis set of factors developed for adaptive governance decision-making can be applied to develop a prior alignment of stakeholder interests with sustainable practices.Social implicationsThis set of factors developed with the intervention of experts reinforces the importance of sustainable collective decisions on ocean ecosystem services. This is a joint approach with participants in the NextOcean project, sponsored by the European Commissions (EC)’s Horizon 2020 program. An Earth Observation-based Consortia aims to create sustainable value for Space, Land and Oceans.Originality/valueThis modeling process generated dimensions and factors to support adaptive governance stakeholders in making sustainable decisions in a coastal biodiversity zone.

A short-term “behavioural support” service for autistic adults without an intellectual disability: a pilot evaluation

Purpose A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot. Design/methodology/approach This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels. Findings The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals. Originality/value This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

Public preferences for pharmacogenetic testing in the NHS: Embedding a discrete choice experiment within service design to better meet user needs.

Genetic testing can be used to improve the safety and effectiveness of commonly prescribed medicines-a concept known as pharmacogenetics. This study aimed to quantify members of the UK public's preferences for a pharmacogenetic service to be delivered in primary care in the National Health Service. Members of the UK population were surveyed via an online panel company. Respondents completed 1 of 2 survey versions, asking respondents to select their preferred pharmacogenetic testing service in the context of a presentation of low mood or pain. A conditional logit model was estimated, before the best functional form for the dataset was identified. Preference heterogeneity was identified via latent class analysis. Coefficients from the final selected models were used to estimate uptake in the context of different hypothetical pharmacogenetic services. Responses from 1993 individuals were included in the analysis. There were no differences observed in preference between the 2 clinical scenarios. Conditional logit analysis, using maximum likelihood estimation, indicated that respondents preferred to have noninvasive tests and wanted their data to be shared between different healthcare organizations to guide future prescribing. There was a preference for regional over national data sharing initiatives, and respondents preferred to have access to their data. Predicted uptake varied considerably, ranging from 51% to >99%, depending on design of the service. This study identifies public preferences for a pharmacogenetic testing service and demonstrates how predicted uptake can be impacted by relatively minor adaptations. This highlights areas for prioritization during development of future pharmacogenetic services.

The Profile and Characteristics of Young People Accessing Recently Implemented Community Forensic Child and Adolescent Mental Health Services (F:CAMHS) in Northern Ireland

Children under the age of 18 who are known to forensic child and adolescent mental health services often present with complex psychosocial and behavioural needs that are elevated compared with those in the general youth population. The Forensic Child and Adolescent Mental Health Service for Northern Ireland (FCAMHSNI) was commissioned in 2014 to support these children. Despite almost a decade of implementation, the profile and characteristics in the service remain under-analysed, impeding service improvement and making international comparisons more difficult. The primary aim of the current study was to address the regional gaps in how the needs of those accessing FCAMHSNI are understood. A secondary aim was to capture comparable data. Data on 107 accepted referrals are included in the analyses. The majority of cases within this time period were male (81.1%, n = 86) and the majority of presenting behaviours were related to violence and aggression 62.3% (n = 48). However, some forms of violence, such as harmful sexual behaviour, was relatively low when compared with other jurisdictions. Specific demographic characteristics such as gender and religious background appeared to be significant risk factors for referral to the service. Almost all of the sample are known to have experienced at least one potentially traumatic event (95.2%) and in more than one-third of cases, service users presented with co-morbid issues (35.6%, n = 37). These observations are discussed. This study adds to the growing international literature around the needs of forensically involved youth and helps to inform future service development and provision.

Mental Health Conditions in Partners and Adult Children of Stroke Survivors

Family caregiving after critical illness has been associated with several adverse health outcomes, including various aspects of mental health, but research focusing specifically on family members of stroke survivors is limited. To examine the associations of stroke in a partner or parent with the risk of depression, substance use disorders, anxiety disorders, and self-harm or suicide. This nationwide, population-based cohort study used data from Danish nationwide administrative and clinical registries (2004-2021). Participants included partners and adult children of survivors of stroke. Data analysis was performed from March to December 2023. Having a partner or parent who survived stroke. The Aalen-Johansen estimator was used to compute propensity score-weighted 3-year absolute risks, risk differences, and risk ratios for depression, substance use disorders, anxiety disorders, and self-harm or suicide among partners or children of survivors of stroke compared with partners or children of survivors of myocardial infarction (MI) and matched individuals from the general population. The study included a total of 1 923 732 individuals: 70 917 partners of stroke survivors (median [IQR] age, 68 [59-76] years; 46 369 women [65%]), 70 664 partners of MI survivors (median [IQR] age, 65 [55-73] years; 51 849 women [73%]), 354 570 partners of individuals from the general population (median [IQR] age, 68 [59-76] years; 231 833 women [65%]), 207 386 adult children of stroke survivors (median [IQR] age, 45 [36-52] years; 99 382 women [48%]), 183 309 adult children of MI survivors (median [IQR] age, 42 [33-49] years; 88 078 women [48%]), and 1 036 886 adult children of individuals from the general population (median [IQR] age, 45 [36-52] years; 496 875 women [48%]). Baseline characteristics were well balanced across cohorts after propensity score weighting. Among partners of stroke survivors, the 3-year absolute risk was 1.0% for depression, 0.7% for substance use disorders, 0.3% for anxiety disorders, and 0.04% for self-harm or suicide. Risk ratio point estimates for the assessed outcomes ranged from 1.14 to 1.42 compared with the general population and from 1.04 to 1.09 compared with partners of MI survivors. The elevated risk of depression in partners of stroke survivors was more pronounced after severe or moderate stroke than after mild stroke. Among adult children of stroke survivors, the 3-year absolute risk was 0.6% for depression, 0.6% for substance use disorders, 0.2% for anxiety disorders, and 0.05% for self-harm or suicide. Both absolute risks and risk ratios for adult children of stroke survivors were smaller than those reported in the partner analyses. In this cohort study of partners and adult children of stroke survivors, risks of several mental health conditions and self-harm or suicide were moderately higher compared with the general population and, to a lesser extent, partners and adult children of MI survivors. These findings highlight the potential consequences of stroke among family members, particularly partners, and its findings may possibly serve as a quantitative foundation for the development of future stroke rehabilitation services.

Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis

AimOlder adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes following an ED visit including ED reattendance within 30 days. Interventions to reduce older adults’ risk of adverse outcomes following an ED attendance are proliferating and often focus on improving the transition from the ED to the community. To optimise the effectiveness of interventions it is important to determine how older adults experience the transition from the ED to the community. This study aims to systematically review and synthesise qualitative studies reporting older adults’ experiences of transition to the community from the ED.MethodsSix databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES, PsycINFO, and Social Science Full Text) were searched in March 2022 and 2023. A seven-step approach to meta-ethnography, as described by Noblit and Hare, was used to synthesise findings across included studies. The methodological quality of the included studies was appraised using the 10-item Critical Appraisal Skills Programme (CASP) checklist for qualitative research. A study protocol was registered on PROSPERO (Registration: CRD42022287990).FindingsTen studies were included, and synthesis led to the development of five themes. Unresolved symptoms reported by older adults on discharge impact their ability to manage at home (theme 1). Limited community services and unresolved symptoms drive early ED reattendance for some older adults (theme 2). Although older adults value practical support and assistance transporting home from the ED this is infrequently provided (theme 3). Accessible health information and interactions are important for understanding and self-managing health conditions on discharge from the ED (theme 4). Fragmented Care between ED and community is common, stressful and impacts on older adult’s ability to manage health conditions (theme 5). A line of argument synthesis integrated these themes into one overarching concept; after an ED visit older adults often struggle to manage changed, complex, health and care needs at home, in the absence of comprehensive support and guidance.Discussion/ conclusionKey areas for consideration in future service and intervention development are identified in this study; ED healthcare providers should adapt their communication to the needs of older adults, provide accessible information and explicitly address expectations about symptom resolution during discharge planning. Concurrently, community health services need to be responsive to older adults’ changed health and care needs after an ED visit to achieve care integration. Those developing transitional care interventions should consider older adults needs for integration of care, symptom management, clear communication and information from providers and desire to return to daily life.