Future Service Development Research Articles

개인 간 거래 플랫폼 이용자 특성에 대한 비교분석

Purpose: C2C e-commerce platforms have distinct characteristics from conventional B2C e-commerce platforms, and reflecting this, it can be seen that users of C2C e-commerce platform will have various differentiated characteristics in terms of demographic and product purchase propensity. By comparing and analyzing the characteristics of rapidly growing users of C2C e-commerce platform, it is expected that basic data necessary for corporate strategy and policy development related to the development of mobile platform services that are driving the growth of C2C e-commerce can be provided. For this purpose, this paper tries to examine and identify the differentiated characteristics of users of C2C e-commerce platforms through the comparative analysis with the characteristics of users of B2C e-commerce platforms. Research design, data, and methodology: For this comparative analysis, large-scale nationwide survey data for the period of 2016~2021 were used to construct relevant variables for the analysis. As for the characteristics of users, various demographic characteristics, characteristics related to the use of information and communication devices and services, and characteristics related to product purchase propensity were comprehensively considered as explanatory variables. Two dummy variables are constructed for dependent variables. One indicates whether to have experience of using C2C e-commerce platforms and the other indicates whether to have experience of using B2C e-commerce platforms. Using these two dummy variables as dependent variables, we estimated logit models. Based on the estimation results, we analyzed how user characteristics affect the likelihood of use of C2C e-commerce platforms and the likelihood of use of B2C e-commerce platforms, respectively. By comparing the estimation results, we could examine and identify the differentiated characteristics of users of C2C e-commerce platforms from the characteristics of users of B2C e-commerce platforms. Results: As a result, the use of C2C e-commerce platforms was relatively common among young people. And unlike the use of conventional B2C e-commerce platforms, the use of C2C e-commerce platforms was affected only by household income, not by personal income, not by gender, but by employment status. This difference is related to the proportion of used product transactions and face to face transactions in C2C e-commerce. In addition, as both the C2C and B2C e-commerce platforms are mainly based on mobile Internet services, the characteristics related to the use of information and communication devices and services were similar. Regarding the product purchase propensity, it was found that users of C2C e-commerce platforms mainly focus on used product transactions, so instead of putting value on the latest products, they put value on visible parts such as design and color. In addition, users of B2C e-commerce platforms value additional functions other than those required in the product, but such characteristics did not appear for users of C2C e-commerce platforms. Conclusions: In the past few years, the use of C2C e-commerce platforms has grown rapidly and its proportion continues to grow amid changes in the consumption paradigm coupled with the evolution of mobile platform services. An understanding of the characteristics of users who purchase products through such C2C e-commerce platforms is very important for operators and policymakers related to C2C e-commerce platform services. It is meaningful in this respect that the results of this paper were able to confirm differences in various aspects in the demographic and product purchase propensity of users of C2C e-commerce platforms. These differences can be seen as reflecting the characteristics of the main consumer group and consumption patterns in the C2C e-commerce. Findings regarding the differentiated characteristics of users of C2C e-commerce platforms can be used as basic data necessary for the future development of mobile platform services for C2C e-commerce. In addition, as the large proportion of face to face transactions generally restricts access to women who shop a lot online, investment and efforts are required to develop services to increase the stability of non-face-to-face transactions. Socially, the encouragement of transaction of used products has benevolent effects of saving resources and alleviating environmental problems, so policy seeking such as legally supporting the stability of C2C transactions is also desirable. However, as it is a newly rapidly growing service based on innovation, policy efforts to induce autonomous investment and efforts of private sector should be prioritized over hasty legal intervention.

A new model for general practice-led, regional, community-based, memory clinics

BackgroundDementia is a major international health issue with high impact on the patient, relatives, and broader society. Routine screening for dementia is limited, despite known benefit of early detection and intervention on quality of care and patient outcomes. Screening is particularly limited in rural and regional areas, despite high burden and projected growth of dementia in these populations. The current study aimed to implement a new general practitioner (GP) led, multidisciplinary, model of care providing dementia detection and referral pathway to a community-based specialist clinic across six regional general practices.MethodsCross-sectional analysis of dementia screening and referral characteristics in the St Anthony Family Medical Practices group based in the regional area of Loddon-Mallee, Victoria. Data were collected on demographics and relevant medical history. Cognitive state was assessed using the Mini-Mental State Examination (MMSE), GP Assessment of Cognition (GPCog), and Geriatric Depression Scale (GDS). Referrals and referral outcomes were recorded for geriatrician, psycho-geriatrician, or both.ResultsEight hundred and eighteenth patients over 65 years were screened, accounting for approximately 24.2% of 65 and over presentations for the practice network. Of those screened, 68.9% were indicated for referral and 30.3% of these were successfully referred. Of the indicated patients who received referrals, 34.2% declined. Many who declined referral had intermediate scores on the cognitive assessments utilized.ConclusionStandardised models of care, integrated within community services, are necessary to improve access to early detection, referral and quality management of dementia. The St Anthony Memory Service model will be invaluable in informing future service development, and in particular the development of services for people living with dementia in rural and regional communities.

Predicting Vehicle Behavior Using Multi-task Ensemble Learning

Vehicle utilization analysis is an essential tool for manufacturers to understand customer needs, improve equipment uptime, and to collect information for future vehicle and service development. Typically today, this behavioral modeling is done on high-resolution time-resolved data with features such as GPS position and fuel consumption. However, high-resolution data is costly to transfer and sensitive from a privacy perspective. Therefore, such data is typically only collected when the customer pays for extra services relying on that data. This motivated us to develop a multi-task ensemble approach to transfer knowledge from the high-resolution data and enable vehicle behavior prediction from low-resolution but high dimensional data that is aggregated over time in the vehicles.This study proposes a multi-task snapshot-stacked ensemble (MTSSE) deep neural network for vehicle behavior prediction by considering vehicles’ low-resolution operational life records. The multi-task ensemble approach utilizes the measurements to map the low-frequency vehicle usage to the vehicle behaviors defined from the high-resolution time-resolved data. Two data sources are integrated and used: high-resolution data called Dynafleet, and low-resolution so-called Logged Vehicle Data (LVD). The experimental results demonstrate the proposed approach’s effectiveness in predicting the vehicle behavior from low frequency data. With the suggested multi-task snapshot-stacked ensemble deep network, it is shown how low-resolution sensor data can highly contribute to predicting multiple vehicle behaviors simultaneously while using only one single training process.

The Nature and Types of Community Palliative and end-of-Life Care Services: A Content Analysis of Service Provider Websites in Hong Kong.

To analyze the nature and types of community palliative and end-of-life care (PEoLC) services in Hong Kong in order to inform future service development. This cross-sectional descriptive study systematically searched the eligible websites of service providers concerning community PEoLC services for patients and their family caregivers using the Hong Kong version of the Google Search engine in August 2021. Search terms included different traditional Chinese translations of palliative care, end-of- lifecare, and hospice care. For the included websites, information regarding the characteristics and types of PEoLC services were extracted and coded using content analysis. Sixteen websites providing community PEoLC services were included in this analysis, which were almost all provided by non-governmental organizations (NGOs). Around half of the service providers targeted the geriatric group and served the population in some major geographic areas and districts only. Ten types of services were identified, including (1) information and advice; (2) psychological support; (3) dying and bereavement care; (4) spiritual support; (5) medical and nursing care; (6) leisure and social well-being activities; (7) support with household and other practical tasks; (8) referral resources; (9) financial support; and (10) caregiving skills training. Existing community PEoLC services in Hong Kong are provided mainly by NGOs, with a focus on comprehensive care for patients in some areas and districts but few support services for caregivers. There is a need for continued efforts to optimize the PEoLC services to support patients and caregivers locally.

Family-oriented practice in disability Services in Hong Kong: A cross-sectoral social work perspectives in the fields of intellectual disability and mental illness.

Supporting the families of people with disabilities has become a crucial aim of disability services. In disability services, where people with disabilities are usually positioned at the centre of service provision, family-oriented practice implies practice directions to work with clients' families in service delivery. The study aims at exploring how social workers in intellectual disability services and mental health services deliver a family-oriented practice in Hong Kong. We performed a qualitative analysis, using in-depth interview data collected from two broader studies about social workers' experiences in the fields of intellectual disability and mental illness respectively. Thirteen participants in intellectual disability settings and another 13 participants in mental health settings shared their understanding of and concern with family-oriented practice. Four themes were identified in the participants' accounts regarding the importance of family connectedness, family members' constructions of clients' identity, the scope of activities and the intervention space between individual and family. These findings reflect that family-oriented practice was jointly shaped by clients' family systems and disability service system, and shed light on the strategies for future service development at the broader systematic level.

Scottish Medical Imaging Service - Technical and Governance controls.

ObjectivesThe Scottish Medical Imaging (SMI) service provides linkable, population based, “research-ready” real-world medical images for researchers to develop or validate AI algorithms within the Scottish National Safe Haven. The PICTURES research programme is developing novel methods to enhance the SMI service offering through research in cybersecurity and software/data/infrastructure engineering. ApproachAdditional technical and governance controls were required to enable safe access to medical images. The researcher is isolated from the rest of the trusted research environment (TRE) using a Project Private Zone (PPZ). This enables researchers to build and install their own software stack, and protects the TRE from malicious code. Guidelines are under development for researchers on the safe development of algorithms and the expected relationship between the size of the model and the training dataset. There is associated work on the statistical disclosure control of models to enable safe release of trained models from the TRE. ResultsA policy enabling the use of “Non-standard software” based on prior research, domain knowledge and experience gained from two contrasting research studies was developed. Additional clauses have been added to the legal control – the eDRIS User Agreement – signed by each researcher and their Head of Department. Penalties for attempting to import or use malware, remove data within models or any attempt to deceive or circumvent such controls are severe, and apply to both the individual and their institution. The process of building and deploying a PPZ has been developed allowing researchers to install their own software. No attempt has yet been made to add additional ethical controls; however, a future service development could be validating the performance of researchers’ algorithms on our training dataset. ConclusionThe availability to conduct research using images poses new challenges and risks for those commissioning and operating TREs. The Private Project Zone and our associated governance controls are a huge step towards supporting the needs of researchers in the 21st century.

Impact of the COVID-19 Pandemic on the Global Delivery of Mental Health Services and Telemental Health: Systematic Review.

BackgroundThe COVID-19 pandemic required mental health services around the world to adapt quickly to the new restrictions and regulations put in place to reduce the risk of transmission. As face-to-face contact became difficult, virtual methods were implemented to continue to safely provide mental health care. However, it is unclear to what extent service provision transitioned to telemental health worldwide.ObjectiveWe aimed to systematically review the global research literature on how mental health service provision adapted during the first year of the pandemic.MethodsWe searched systematically for quantitative papers focusing on the impact of the COVID-19 pandemic on mental health services published until April 13, 2021, in the PubMed, Embase, medRxiv, and bioXriv electronic bibliographic databases, using the COVID-19 Open Access Project online platform. The screening process and data extraction were independently completed by at least two authors, and any disagreement was resolved by discussion with a senior member of the team. The findings were summarized narratively in the context of each country’s COVID-19 Stringency Index, which reflects the stringency of a government’s response to COVID-19 restrictions at a specific time.ResultsOf the identified 24,339 records, 101 papers were included after the screening process. Reports on general services (n=72) showed that several countries’ face-to-face services reduced their activities at the start of the pandemic, with reductions in the total number of delivered visits and with some services forced to close. In contrast, telemental health use rapidly increased in many countries across the world at the beginning of the pandemic (n=55), with almost complete virtualization of general and specialistic care services by the end of the first year. Considering the reported COVID-19 Stringency Index values, the increased use of virtual means seems to correspond to periods when the Stringency Index values were at their highest in several countries. However, due to specific care requirements, telemental health could not be used in certain subgroups of patients, such as those on clozapine or depot treatments and those who continued to need face-to-face visits.ConclusionsDuring the pandemic, mental health services had to adapt quickly in the short term, implementing or increasing the use of telemental health services across the globe. Limited access to digital means, poor digital skills, and patients’ preferences and individual needs may have contributed to differences in implementing and accessing telemental health services during the pandemic. In the long term, a blended approach, combining in-person and virtual modalities, that takes into consideration the needs, preferences, and digital skills of patients may better support the future development of mental health services. It will be required to improve confidence with digital device use, training, and experience in all modalities for both clinicians and service users.

Advancing Mental heaLth Provision In PHarmacY (AMPLIPHY): A feasibility study.

Specifically-designed community pharmacy-based services represent opportunities to support people with their mental health. As few such services exist worldwide, the Advancing Mental HeaLth Provision In PharmacY (AMPLIPHY) was designed with stakeholders. The purpose was to support people with their mental health when initiated on new prescription or change in drug, dose or quantity of antidepressant, through a series of consultations (up to 3 months). The aim was to evaluate the feasibility of the AMPLIPHY service. The objectives were to: i) pilot the service; ii) examine anonymous consultation data to understand patients' characteristics, priorities and consultation focus and iii) Evaluate pharmacists' experiences. This service evaluation involved a concurrent mixed methods design. Patient characteristics were extracted from consultation notes and descriptive statistics applied. Content analysis was used to summarise consultation foci and comparisons between patients' priorities with consultation content were made. Pharmacists were interviewed at the start (n=10) and end (n=4) of the pilot with themes identified using thematic analysis. Seventy-six patients participated (63% of recruitment target). The median age was 39 (IQR 28-47) and 62% were female. Seventy percent of patients had one consultation, 26% had two and 4% had three. Prescription for new antidepressant was the most common reason for entry (74%) and sertraline was most prescribed (46%). Consultations commonly focussed on life experience (n=51), medication (n=47), health (n=42), support (n=36) and patients' expression of their feelings (n=31). The pharmacists' experiences were summarised in three themes: i) Motivation, ii) Practicalities and iii) Experience and Outcomes. Pharmacists were motivated to deliver this novel service and some patients were willing to join the service. Analysis of patient demographics, consultation notes and interviews provide insight into the strengths and challenges of the service and provides a blueprint for future service developments.

A participatory action research study to inform combined type 2 diabetes and chronic kidney disease care provided in the context of advanced practice nursing.

To outline the development, implementation and evaluation of an alternative combined type 2 diabetes and chronic kidney disease (CKD) care delivery strategy provided in the context of advanced practice nursing informed by co-created knowledge, between patients and healthcare teams to address identified gaps in care provision. This study was informed by the theoretical underpinnings of critical theory and operationalized using a participatory action research (PAR) design. This approach enabled alignment between the theoretical underpinnings and research methodology to respond to practice-level problems and address issues related to healthcare delivery. The study was undertaken in a series of three cycles of enquiry over a 20month period (July 2018-February 2020) in five geographically diverse specialist diabetes and nephrology centres. Data collection methods included PAR group minute consensus, retrospective chart review, discovery and focus group interviews. Thematic analysis and descriptive statistics were used to analyse the data. Compared with international standard care outcomes, a higher proportion of patients attending combined care achieved best practice recommendations for blood pressure, Hba1c and lipid management (64.3% vs. <40%). Patients attending combined care experienced improved detection and management of CKD-related anaemia. Additionally, the combined care service experienced significantly lower levels of patient's failure to attend scheduled reviews compared with participating standard care services (0% vs. 7%-23.3%). Best practice clinical care outcomes and patient attendance improved when a combined type 2 diabetes and CKD care delivery strategy provided in the context of advanced practice nursing was adopted. This alternative care strategy represented a departure from standard care delivery approaches, in which care for type 2 diabetes and CKD is provided separately and led by physicians. Outcomes demonstrate improved clinical and attendance outcomes which may inform the development of future services led by advanced nurse practitioners.

Exploring the experience of young people receiving treatment for an eating disorder: family therapy for anorexia nervosa and multi-family therapy in an inpatient setting

BackgroundResearch indicates that family therapy for anorexia nervosa (FT-AN) and multi-family therapy (MFT) are effective treatments for adolescents experiencing anorexia nervosa (AN). However, less is known about young people’s experiences of these two treatments, as there is limited qualitative research, and to date no qualitative research within an inpatient setting. It is argued that the lack of such insight limits the development of services for young people experiencing AN.MethodFive young people were recruited to the study from a specialist inpatient unit who were receiving treatment on the AN pathway which included both FT-AN and MFT. Semi structured interviews were undertaken and analysed using Interpretative Phenomenological Analysis.ResultsFour superordinate themes and ten subthemes were developed from the data. The four superordinate themes were: ‘Process of Understanding’, ‘Reviving Connection’, ‘Emerging from the Eating Disorder and ‘Development of I’.ConclusionsThere appeared to be two overarching concepts: the role of the individual and the role of others, that helpfully framed the results. The superordinate themes: ‘Emerging from the Eating Disorder’ and ‘Development of I’ focused on the development of the individual. Conversely, the superordinate themes: ‘The Process of Understanding’ and ‘Reviving Connection’ were centred on the relationships existing within the family system. The results could help inform future service developments regarding inpatient provision and service design.Plain English SummaryThe most widely used and recognised treatment for anorexia nervosa in young people is family therapy for anorexia nervosa (FT-AN). An alternative treatment is multi-family therapy (MFT). Both treatments are deemed to be effective and usually happen in the community. However, some hospitals provide these treatments while the young people are in-patients. There is no research exploring young people’s experiences of these two treatments while in an in-patient unit.Young people who had received both FT-AN and MFT in an inpatient setting were asked to share their experiences of these two treatments. Their stories were analysed by a researcher. The analysis identified four themes: ‘Process of Understanding’, ‘Reviving Connection’, ‘Emerging from the Eating Disorder and ‘Development of I’.The results highlighted that the young people appeared to place more value on the role of others and perhaps others changing enabled them to change. The research highlighted the benefit in others’ understanding and therefore how improving societal understanding more broadly would be helpful. The young people reflected that both they and their parents benefited from FT-AN and MFT in an in-patient setting and it is proposed that this could help inform future service developments regarding inpatient provision.

Social Workers’ Acceptance of Information and Communication Technology (ICT) in Practice during COVID-19: Search for Embracing Ethical Considerations in Hong Kong

This qualitative research examined Hong Kong social workers’ perceptions of the usefulness and ease of adopting information and communication technology (ICT) in their practice during the COVID-19 pandemic. Invitations to participate in this research were sent to various social welfare agencies, resulting in the recruitment of 23 social workers with different work experiences. In-depth interviews followed by thematic analysis were employed to explore participants’ experiences of using ICT in their practice during the pandemic and factors influencing their readiness to use ICT. The results showed that various factors influenced social workers’ perceptions of the usefulness and ease of using ICT, including digital service output quality, shared expectations and subjective norms, technology self-efficacy, and organizational support. The research further identified ethical considerations that posed challenges to ICT utilization. The research provides insights into social work management regarding the strategies of enhancing social workers’ motivation and acceptance of utilizing ICT. Recommendations on future development and research of digital social work services were discussed.

Chronic pain in children and adolescents in Manitoba: A retrospective chart review to inform the development of a provincial service for pediatric chronic pain

ABSTRACT Background In the absence of an interdisciplinary service for pediatric chronic pain in Manitoba, pain management has been offered through a single provider outpatient setting with consultative services from physiotherapy, occupational therapy, and psychiatry since October 2015. Aims The aim of this study was to characterize the patient population of this clinic to understand needs and inform future service development for pediatric chronic pain. Methods Demographics and disease characteristics of all patients seen in this clinic between October 1, 2015, and February 28, 2019, were analyzed retrospectively from electronic medical records. Results A total of 157 patients, mean age 13.1 (sd ±3.0) years, 75.2% female, with a median duration of pain of 20.5 (interquartile range [IQR] = 10.0–45.8) months at their first visit were included in the study. At baseline, 74.0% of patients experienced insomnia, 76.6% fatigue, 86.5% symptoms of anxiety, and 58.69% symptoms of depression; 80.1% showed withdrawal from physical activity, 67.1% missed school, and 10.2% reported opioid usage. Throughout their care in clinic, 83.4% of patients received physiotherapy, 17.8% occupational therapy, 49.7% mental health support, and 51.6% care from multiple services. The clinic experienced a significant increase in median referrals from 1.0 to 5.0 (IQR = 2.0–9.0) per month and wait time from 35.0 to 97.0 (IQR = 88.0–251.0) days during the observation period. Conclusions Developing an interdisciplinary service for pediatric chronic pain will provide an opportunity to improve access, coordination, and comprehensiveness of care and to employ culturally sensitive services to improve care for children and youth living with chronic pain in Manitoba and possibly other jurisdictions with similar demographics and needs.

Family-centred care for children with traumatic brain injury and/or spinal cord injury: a qualitative study of service provider perspectives during the COVID-19 pandemic

ObjectivesCOVID-19 has led to rapid changes in rehabilitation service provision for young people living with traumatic brain and/or spinal cord injury. The aim of this project was to understand the...

E-government information search by English-as-a Second Language speakers: The effects of language proficiency and document reading level

A rapid increase in the use of web-based technologies – and corresponding changes in government and local council policies – in recent years, means that many vital services are now provided solely online. While this has many potential benefits, it can place additional burdens on certain demographic groups, some of whom may become considerably disadvantaged or even disenfranchised. This is particularly problematic for English-as-a Second Language (ESL) speakers, who are often immigrants or refugees and thus have a greater need to access these e-government services, and who may struggle to understand and assess the relevance of complex documents. In this work we investigate the search behaviours and performance of native English speakers and two different groups of ESL speakers when completing e-government tasks, and the effect of document readability/complexity. In contrast with previous work, our results show significant differences between groups of varying language proficiency in terms of objective search performance, time on task, and self-perceived performance and confidence. We also demonstrate that document reading level moderates the effect of language proficiency on objective search performance. The findings contribute to our existing understanding of how English language proficiency affects search for e-government topics, and have important implications for the future development of e-government services to ensure more equitable access and use.

A systematic literature review and meta-analysis on digital health interventions for people living with dementia and Mild Cognitive Impairment.

ObjectivesDigital health interventions enable services to support people living with dementia and Mild Cognitive Impairment (MCI) remotely. This literature review gathers evidence on the effectiveness of digital health interventions on physical, cognitive, behavioural and psychological outcomes, and Activities of Daily Living in people living with dementia and MCI.Methods/DesignSearches, using nine databases, were run in November 2021. Two authors carried out study selection/appraisal using the Critical Appraisal Skills Programme checklist. Study characteristics were extracted through the Cochrane handbook for systematic reviews of interventions data extraction form. Data on digital health interventions were extracted through the template for intervention description and replication (TIDieR) checklist and guide. Intervention effectiveness was determined through effect sizes. Meta‐analyses were performed to pool data on intervention effectiveness.ResultsTwenty studies were included in the review, with a diverse range of interventions, modes of delivery, activities, duration, length, frequency, and intensity. Compared to controls, the interventions produced a moderate effect on cognitive abilities (SMD = 0.36; 95% CI = −0.03 to 0.76; I 2 = 61%), and a negative moderate effect on basic ADLs (SMD = −0.40; 95% CI = −0.86 to 0.05; I 2 = 69%). Stepping exergames generated the largest effect sizes on physical and cognitive abilities. Supervised training produced larger effect sizes than unsupervised interventions.ConclusionSupervised intervention delivery is linked to greatest benefits. A mix of remote and face‐to‐face delivery could maximise benefits and optimise costs. Accessibility, acceptability and sustainability of digital interventions for end‐users must be pre‐requisites for the development of future successful services.

MO350: Transfer Times for Renal Patients to a Tertiary Centre

BACKGROUND AND AIMSThe renal unit at Sunderland Royal Hospital (SRH) provides tertiary services to an area of North East England covering South Tyneside, Sunderland and County Durham. An AKI service was commenced in September 2020 at University Hospital North Durham (UHND), which is part of the County Durham and Darlington NHS Foundation Trust (CDDFT) with aims to improve recognition and treatment, support early discharge planning, and prevent severe injury for patients with AKI and renal conditions. The service comprises two specialist nurses and a team of consultant renal physicians providing in-reach at UHND across Monday–Friday 52 weeks/year, with over 700 patients seen within the first 12 months of operation.With the introduction of this service, we carried out a review of transfer times for patients requiring transfer from UHND to SRH for inpatient renal management. Delays in patient transfer between hospitals can result in deferred treatment and poor patient outcomes, hence the importance of analysing the benchmarking the first year's performance to inform future service development both regionally and nationally. With the use of this data, we hope to share our model with other teams and trusts with the goal of enhancing and streamlining the referral methods to renal services.METHODWe examined transfer data for 36 patients from CDDFT to the renal unit at SRH over a 12-month period from August 2020 to July 2021. This information looked at transfers from the time of consultant acceptance to the time of arrival on the ward and was compiled in conjunction with the AKI specialist nurses at CDDFT. Using the computer system and phone records, we were able to accurately document time of acceptance to time of arrival. Data was split into categories to enable further comparison; pre-June 2021 (when haematology patients were excluded from the inpatient ward at SRH due to protective isolation during COVID-19) increasing the availability of acute renal beds and June 2021 onwards. Additionally, we analysed patients with acute kidney injury versus those that were known to us with chronic kidney disease, and times by week days and where emergency cover is usual.RESULTSThe data showed a median time between acceptance and arrival for patients accepted pre-June 2021 of 8 h 7 min compared with 6 h 18 min from June 2021 onwards. Median time between acceptance and arrival of acute patients was 8 h 7 min compared with 6 h 35 min for chronic kidney disease patients. Acceptance and arrival times varied also depending on time of transfer; 6 h 29 min during working hours on a weekday, 9 h 23 min out-of-hours on a weekday and 8 h 48 min on a weekend. The overall median transfer time from acceptance to arrival across all categories was 7 h 38 min.CONCLUSIONCurrently, no standard national target exists for the transfer of patients to tertiary renal services, however there are ongoing discussions surrounding this and how it could be implemented. There are difficulties in compiling data to effect change in referral methods, in part due to the inter-trust movement of patients and challenges in coding; however, our initial findings support the positive impact of the AKI service at CDDFT and highlight the scope for further service development across the region. For example, in commissioning at software to streamline, process audit data using a web-based portal, accessible to all parties and extending nurse presence across 7 days due to the delayed times for weekend and evening transfers. Additionally, we were encouraged that our prevalent patients, usually dialysis recipients, experienced the shortest wait.FIGURE 1:Median Time Between Acceptance and Arrival Based on Time of Patient Transfer.

Organisational models at the emergency department to reduce hospital admissions among paediatric patients: a systematic literature review.

Paediatric attendances at the emergency department (ED) are often admitted to the hospital less than 24 h to allow time for more extended evaluation. Innovative organisational models could prevent these hospital admissions without compromising safety or quality of delivered care. Therefore, this systematic review identifies evidence on organisational models at the ED with the primary aim to reduce hospital admissions among paediatric patients. Following the PRISMA guidelines, three bibliographic databases (Ovid Medline, Embase, and Cochrane Library) were searched. Studies on organisational models in Western countries, published between January 2009 and January 2021, which applied a comparative design or review and studied at least hospital admission rates, were included. Analyses were mainly descriptive because of the high heterogeneity among included publications. The primary outcome is hospital admission rates. Secondary outcomes are ED length of stay (LOS), waiting time, and patient satisfaction. Sixteen publications described several innovative organisational models ranging from the creation of dedicated units for paediatric patients, innovative staffing models to bringing paediatric critical care physicians to patients at rural EDs. However, the effect on hospital admission rates and other outcomes are inconclusive, and some organisational models may improve certain outcomes in certain settings or vice versa. It appears that a paediatric consultation liaison team has the most consistent effect on hospital admission rates and LOS of paediatric patients presenting with mental problems at the ED. Implementing new innovative organisational models at the ED for paediatric patients could be worthwhile to decrease hospital admissions. However, the existing evidence is of rather weak quality. Future service developments should, therefore, be conducted in a way that allows objective evaluation.

Intelligent Big Data Framework for the Technical Design of Public Management Applications in Sports

Public sports services (PSS) are an important element in the development of China’s public service industry and promoting theoretical research on PSS at the present time has just become an inevitable requirement for the development of sports. The main purpose of the work in this paper is the study of public management data in sport through intelligent big data analysis, with the participation of knowledge graphs, migrating relevant algorithms from other application areas, and optimizing them on this basis. It provides an objective review and analysis of the weaknesses of current sport public management research, etc. Based on informative data sources and in-depth theoretical analysis, it provides an objective description and analysis of the current situation of the development of sport public management services and an outlook on the future development of public sport services.

Perceptions of telehealth in real-world oncological care: An exploration of matched patient- and clinician-reported acceptability data from an Australian cancer centre.

BackgroundPrior to 2020, the use of telehealth in cancer care was limited, but COVID‐19 necessitated its rapid and widespread adoption into routine care delivery. This study aimed to evaluate perceptions of telehealth through a dyadic exploration of matched cancer patient‐ and clinician‐reported acceptability data and to explore factors that may predict greater suitability for telehealth.MethodsA prospective, cross‐sectional, exploratory survey study assessed (matched) patient‐ and clinician‐reported perceptions of telehealth consultations occurring at a metropolitan, tertiary‐based cancer centre in Victoria, Australia.ResultsOne‐hundred and fifty‐five matched patient‐ and clinician‐reported data were included. High rates of acceptability with telehealth were reported by patients (93%) and clinicians (91%), who mostly shared concordant views (86%). Factors significantly associated with increased acceptability for telehealth, included, for clinicians, greater familiarity with the patient (OR 8.20, 95% CI: 1.50–45.06, p = 0.02), and younger patient age (OR 1.06, 95% CI: 0.99–1.13, p = 0.05), and for patients was earlier stage disease (≤stage III) (OR 5.29, 95% CI: 1.08–25.82, p = 0.04). Lower acceptability for telehealth according to clinicians was associated with poorer patient performance status (OR 0.04, 95% CI 1.00–1.08, p = 0.04) and for patients with the need for an interpreter (0R 0.06, 95% CI: 0.008–0.51, p = 0.009).ConclusionWhile overall telehealth is acceptable in cancer care, our findings raise important implications for future service development, notably that it may be less optimal for patients with higher complexity of need—including those with more advanced disease, poorer performance status, those less well known to treating clinicians and those identified to have additional language barriers.

Service user satisfaction with care in a specialist service for young people with attention deficit hyperactivity disorder.

Consumer satisfaction is considered one of the most important measures of service quality in child mental health; however, there is limited understanding of factors that influence satisfaction. The objective of this study was to investigate key factors influencing satisfaction with care (SWC) in ADMiRE, a specialist service for young people (YP) with attention deficit hyperactivity disorder (ADHD). Parents/carers (n = 67) and YP > 9 years (n = 44) attending ADMiRE completed an anonymous Experience of Service Questionnaire (ESQ), a quantitative/qualitative measure of service user satisfaction. Parents/carers also completed symptom severity rating scales. Data were analysed to determine (i) overall SWC, (ii) the relationship between parent- and youth-reported SWC and (iii) the impact of symptom severity on SWC. Thematic analysis of qualitative ESQ data was completed. Parents/carers were significantly more satisfied than YP (p = 0.028). Symptom severity did not impact significantly on parent/carer satisfaction. YP with severe hyperactive/impulsive and inattentive ADHD symptoms were significantly less satisfied with care than those with less severe ADHD symptoms (p = 0.022 and p = 0.017 respectively). Factors related to the therapeutic alliance were identified as being particularly important to both parents/carers and YP. This is the first Irish study that has investigated the impact of symptom severity on service user satisfaction in a child mental health service. The results highlight the different perspectives of YP and parents and provide novel insights into the impact of symptom severity on service user satisfaction. The importance of the therapeutic alliance should not be underestimated in future development of services.