New Model Of Service Research Articles

Changes in adult home parenteral nutrition practice over 25 years

Home Parenteral Nutrition (HPN) is the established treatment of intestinal failure. This study considers the changes in practice in a single UK centre over the past twenty-five years. Data was culled from a database used for clinical care and maintained prospectively. Two hundred and five patients were included from 1993 to 2018. Patient numbers increased from 22 during 1999-2003 to 158 during 2014-2018. The median age at discharge increased from 52 years during 1999-2003 to 59 years during 2014-2018. Thirty percent of patients discharged during 1999-2003 had Crohn's disease, reducing to 14% during 2014-2018. Fifteen percent of patients discharged during 1999-2003 had small bowel fistula or obstruction in comparison to 44% during 2014-2018. Only 18 patients were treated with palliative intent, the majority in recent years. An increasing number of patients required help with HPN care over the years. Survival in non-palliative patients was 85% at 1 year, 67% at 3 years, 53% at 5 years and 42% at 10 years. The majority of deaths were due to underlying disease and only 5 of 55 deaths were attributed to HPN alone. HPN dependence in non-palliative patients was 73% at 1 year, 59% at 3 years, 56% at 5 years and 43% at 10 years. Fifty eight patients stopped HPN after reconstructive surgery. Patients experienced 5.1 admissions/1000 HPN days (64.7 admission days/1000 HPN days). Admission rate did not change over the years though the percentage due to catheter problems fell from 52% to 40% while the percentage due to underlying disease or unrelated cause rose. The increase in numbers, age and dependency of HPN patients requires increasing resource and consideration of new models of service. Many patients with short bowel syndrome now survive to old age and the care needs of the HPN patient who has become elderly can be complex. A significant proportion of patients are being referred for HPN as a bridge to reconstructive surgery after surgical complication and this requires close involvement of gastrointestinal surgeons in HPN teams. The need for hospital admissions remains a burden for HPN patients and there is scope for changes in service provision to try to reduce hospital days.

(Р)ЕВОЛЮЦІЯ БАНКІНГУ: ДИСКУСІЇ ТА ПЕРСПЕКТИВИ

The banking paradigm is being transformed because users have changed. They need a new model of service: timely, efficient, profitable and effortless. Banks should be prepared to disclose their data to partners (fintech companies, IT developers, retail chains) using standardized and open application programming interfaces (API). They must also be prepared to connect to new industry platforms, where they act as participants rather than owners of experience and customer relationships. Such a comprehensive transformation takes long time and is determined by the bank’s risk appetite and readiness to digital business. There are classification and main relationships between the terms that denote promising areas of modern banking (Lifestyle-banking, Behavioral banking, Bank-as-a-Service, Open banking, Omnichannel banking, White label banking, Neobanks). It is determined that the concepts of Lifestyle-banking and Behavioral banking are close, but the latter is aimed at the formation of rational financial behavior, which creates a conflict of interests, as financial culture begins to excite the classic bank only when large loan arrears. Omnichannel is an additional characteristic of Lifestyle and Behavioral banks, and all of them are impossible without Open banking. The substructure of Open Banking is the concepts of BaaS and White label banking. To speed up interaction between different stakeholders, Open Banking is based on an API that traditional banks have avoided for security reasons. PSD2 has been introduced as the legal basis for opening bank data of customers with their permission to authorized third-party suppliers. Trends in rethinking banking: digitization of all elements of the banking business; focus on customer needs; cooperation with fintech companies to stimulate innovations; creation of a standardized structure for exchange of banking data through API; abstraction from the peculiarities of each banking system; development of intuitive banking operations; transition to component architectures or modular structures to facilitate and accelerate the development of new services and channels; increasing the level of consumer protection. A comparative characterization of what the banking revolution can give to society as a whole and to each client individually, and the risks that we must be aware of, is given. It is determined what modern banks need to do to increase their competitiveness: review their strategic goals and place more emphasis on consumer experience; use the accumulated analytics for individualized customer service, which will increase profitability; develop a clear and flexible management structure that easily adapts to the changing business environment, provides coherence, adaptability, speed and reliability throughout the ecosystem to turn business components into interchangeable and reusable assembly units of processes or services; identify key indicators, regularly measure them and compile reports, structuring business relationships.

Redefining the reference librarian in the university environment

The reference librarian and the services provided hold more than ever the attention of users at the “Dun?rea de Jos” University Library of Galati (DJULG). The Internet, technology and struggle for survival left a significant mark on both librarians' skills and reference services in the new context of the information society. In order to align with new trends in librarianship and to respond effectively to the increasingly complex demands of users, the reference librarians had to move beyond the traditional and reinvent themselves. As a result, new skills have been acquired and new services emerged in the information landscape of the university library. The paper examines the evolution of the reference services at DJULG over the last ten years, emphasizing the changes of the librarian profile in this area. The variety of information sources, the emergence of new information technologies, the movement on open access have been the main elements that contributed to the professional development of the reference librarian and the implementation of new models of services for users. The case of the university library in this study reveals different profiles of the reference librarian: researcher, educator in information literacy, bibliometrician, wikilibrarian, digital resources manager, reference manager etc. Not far from the truth, we can say that the reference librarian became a chameleon, from the perspective of information evolution and ensuring sustainable library services.

Let’s not go back to ‘normal’! lessons from COVID-19 for professionals working in childhood disability

Purpose The worldwide COVID-19 pandemic has changed almost all aspects of our lives, and the field of childhood disability is no exception. Methods This article is based on an invited lecture by the first author at a conference–the eHealth Summit (“Pediatric Rehabilitation in a Digital Space”)–organized by the other authors and their colleagues in May 2020. Results The first author offers his own experiences and perspectives, supplemented by comments and observations contributed by many of the 9000+ attendees at this talk, as curated by the second and third authors. The basic messages are that while life for families of children with developmental disabilities, and for service providers who work with them, is significantly altered, many important lessons are being learned. Conclusions The comments from participants support the currency of the ideas that were presented, and encourage childhood disability professionals to reflect on what we are learning, so that we can seize the opportunities they afford to do things differently–and we believe better–moving forward. IMPLICATIONS FOR REHABILITATION Ideas generated by colleagues and parents suggest that there may be alternatives to “business as usual” in childhood disability services after the COVID pandemic is over. People are recognizing opportunities, and benefits, to offering services virtually, including being able to see children in their natural environments, saving parents time, money and hassles to attend clinics in person, and perhaps increasing the availability of services. Many issues remain to be investigated systematically, including, among others, what services (assessments and interventions) require hands-on connections, what payment structures can accommodate new models of services, how professionals can work together in a virtual world, and what families will want. Regardless of the final answers to these issues, we believe that we should not simply “go back to normal”; rather, we should expand the range, nature and locations of our services for children with developmental disabilities and their families.

Moving towards ideal and appropriate models of anticoagulation management service.

It is now known that thrombotic disorders such as venous thromboembolism, ischemic stroke, and myocardial infarction contribute significantly to global morbidity and mortality. Anticoagulation service must respond to this new development. Warfarin has continued to provide the backbone for anticoagulation service for decades but with considerable drawbacks. The introduction of nonVitamin K oral anticoagulants (NOACs) has created new challenges. This article seeks to discuss how the establishment of appropriate models of anticoagulation could contain the draw backs of the old anticoagulants and improve on the compliance, availability, affordability, and accessibility of newer anticoagulants. Successful anticoagulation has always been defined by a scientific balancing of the risk of thrombosis and the complication of hemorrhage. To be able to maintain such optimal anticoagulation requires rational drug prescription (physician factor), institutelization of monitoring of therapy (anticoagulation clinic factor) as well as active participation of patients receiving therapy (patient factor). New models of service can be created out of this triad in a bid to replace the old routine medical care model. New models of anticoagulation service should include appropriately trained professionals such as Physicians, Pharmacists, Clinical Pharmacologists, Nurses, and Laboratory Scientists who are knowledgeable in diagnostic, management, and monitoring of anticoagulation. The different models of anticoagulation service discussed in this article clearly demonstrate the need for restructuring of this life saving service particularly in the era of NOAC. Newer models of care that should provide safe, efficacious, and cost-effective services are needed.

Cocreation of a digital patient health hub to enhance education and person-centred integrated care post hip fracture: a mixed-methods study protocol

IntroductionOlder people with hip fractures often require long-term care and a crucial aspect is the provision of quality health information to patients and their carers to support continuity of care....

The Rivers Centre in Scotland: An Attachment-Based Service Model for People With Complex Posttraumatic Stress Disorder.

The Rivers Centre in Edinburgh, Scotland (United Kingdom) operated for nearly 20 years as a traditional specialist trauma service, delivering psychological therapies to an adult population affected by trauma. Embedded in a health and social care system whose characteristics were unhelpful for people with histories of insecure attachment experiences, the Rivers Centre aimed to find a different way of working, and in January 2017, it relaunched with a new model of service. The aim of this paper is to describe the new service model from an organizational perspective in the context of attachment theory. At the heart of the model is the premise that to be effective, a trauma service needs to provide people with an alternative model of attachment. Early signs from service audit data indicate that an attachment-based way of working can improve engagement and can provide a supportive and responsive environment in which people can learn to recover.

Statistical factors associated with utilisation of ototoxicity monitoring services for multi-drug-resistant tuberculosis patients in the Western Cape.

BackgroundSouth Africa is a high-burden multi-drug-resistant tuberculosis (MDR-TB) country. Previously, standard MDR-TB treatment regimen in South Africa included kanamycin, an aminoglycoside, which can cause permanent hearing loss in patients. South African National Tuberculosis Control programme’s guidelines for the management of patients with MDR-TB were revised in 2011 to support outpatient-based models. This, in turn, required reorganisation of ototoxicity monitoring services to support these new models of service delivery.ObjectivesThe aim of this study was to determine factors associated with the utilisation of ototoxicity monitoring services for patients with MDR-TB who accessed treatment as outpatients.MethodA retrospective review of medical records of patients who attended ototoxicity monitoring clinic at a central TB hospital in Cape Town during 2012–2013 was conducted. A total of 801 medical folders were reviewed: 415 (51.8%) males and 386 (48.2%) females, median age 37 (range 7–85) years.ResultsTen per cent of patients attended all the recommended six-monthly appointments. Patients who presented with hearing loss at baseline or developed hearing loss after treatment initiation were more likely to attend their appointments. Patients were also more likely to attend their appointments if a baseline audiometric assessment was conducted within 1 month of MDR-TB treatment initiation.ConclusionThis study revealed that outpatient-based ototoxicity monitoring services were largely underutilised by patients. Development of hearing loss and prompt determination of a baseline audiogram were associated with a higher likelihood of attendance of ototoxicity monitoring appointments. Therefore, utilisation of outpatient-based ototoxicity monitoring services is likely to be improved by identifying patients early and monitoring them closely.

Challenges and opportunities for effective delivery of clinical genetic services in the U.S. healthcare system.

Demand for clinical genetics and genomics services is increasing. As discussed in this study, the clinical genetics and genomics workforce is small. How to meet the demand with a limited workforce requires innovation. Background data regarding the current state of clinical genetic services including volume of services and make-up of the clinical genetics workforce are presented. The study then identifies opportunities to increase access to clinical genetic service providers using new models of service and discusses examples of solutions which have been implemented in some practice settings. Creative uses of technology to increase providers' efficiency are highlighted. Clinical genetics service providers need to rise to the occasion and lead the transformation of clinical genetic service delivery. Many of the examples of solutions described in the study can be implemented by other providers now. Additionally, the described solutions may serve to inspire genetic providers to create their own new solutions, which should then be shared with the provider community.

A budget constrained scheduling algorithm for executing workflow application in infrastructure as a service clouds

Cloud computing technology, which is a new model of service provisioning in distributed systems, has been raised as a way to execute workflow applications. To profit from this technology for executing workflow applications, it is necessary to develop workflow scheduling algorithms that consider different QoS parameters such as execution time and cost. Therefore, in this paper, we focus on two criteria: makespan (completion time) and execution cost of workflow application and propose a scheduling algorithm named CB-DT (Constrained Budget-Decreased Time) which aims to create a schedule that decreases the makespan while satisfying the budget constraint of the workflow application. In the proposed algorithm, the ideas of back-tracking heuristic and scheduling of critical and non-critical tasks are combined together. In order to have smaller makespan, the proposed algorithm tries to select faster and more expensive machines for critical tasks as much as possible using the back-tracking method. Moreover, it tries to schedule non-critical tasks on the low cost machines as far as possible without increasing the makespan. The proposed algorithm is evaluated by a simulation process using WorkflowSim which is based on CloudSim. To evaluate the proposed algorithm, the results of proposed algorithm are compared with the results of IC-Loss (IaaS Cloud-Loss), BHEFT (Budget constrained Heterogeneous Earliest Finish Time) and BDHEFT(Budget and Deadline Constraint Heterogeneous Earliest Finish Time) algorithms. The results showed that the proposed algorithm performs better than IC-Loss, BHEFT and BDHEFT algorithms in most cases.

Scheduling deadline-constrained scientific workflow using chemical reaction optimisation algorithm in clouds

The advent of cloud computing as a new model of service provisioning in distributed systems encourages researchers to investigate its benefits and drawbacks on executing scientific applications such as workflows. One of the most challenging problems in clouds is workflow scheduling, i.e., the problem of satisfying the QoS requirements of the users as well as minimising the cost of workflow execution. In this paper, a novel meta-heuristic method, called chemical reaction optimisation (CRO), is developed to solve deadline-constrained workflow scheduling, which tries to minimise the cost of workflow execution while meeting a user-defined deadline. A set of appropriate parameters can be obtained based on orthogonal experimental design (OED) and factor analysis. Experiments are done in two real workflow applications, and the results demonstrate the effectiveness of the proposed algorithm.

Models for Access to Maternal Smoking Cessation Support: a quasi-experiment to increase the engagement of pregnant women who smoke in National Health Service stop smoking services

BackgroundMaternal smoking is a key cause of poor health outcomes. In Wales, a third of pregnant women smoke before or during pregnancy, the highest prevalence of maternal smoking in the UK. Supporting women to stop smoking during pregnancy is a challenging area of public health. Models for Access to Maternal Smoking Cessation Support (MAMSS) aimed to examine the effectiveness of smoking cessation in pregnancy services delivered by specially trained practitioners. MethodsA non-randomised, quasi-experiment was undertaken across four Health Boards in Wales to assess the effectiveness of new models of service designed to increase the engagement of pregnant women in National Health Service (NHS) stop smoking services. Qualitative approaches were adopted to capture important contextual information and consider multiple perspectives. A flexible, bespoke intervention was offered to pregnant women in intervention sites (delivered by a specialist maternity support worker, a specialist midwife, or a specialist Stop Smoking Wales pregnancy adviser) and compared with usual care delivered by the national stop smoking service. Routine data were collected from maternity records and the NHS Stop Smoking Wales service. The primary outcome was the proportion of smokers who engaged with the service. Power calculations showed that 1168 pregnant smokers were required to detect a 15% difference in the proportion of pregnant smokers engaged with smoking cessation services (5% type I error rate and 90% power). Findings2756 women were identified by midwifery staff as pregnant smokers (978 in intervention and 1778 in control sites). The proportion of smokers who engaged with the service was significantly higher across intervention sites than control sites. The highest proportion was observed in Health Board area 3, which employed a maternity support worker to support women to quit smoking, where 64 of 181 pregnant smokers (35%, 95% CI 29–43) set a quit date and attended at least one treatment session compared with just two of 227 in usual care (1%, 0–3). This model cost about £500 per engaged smoker. Qualitative findings highlighted the acceptability and feasibility of delivering the service models. InterpretationThe maternity support worker model is effective in engaging pregnant women with stop smoking services and has the potential to improve future health outcomes. FundingThe research received funding and support in kind from Public Health Wales NHS Trust and the Health Boards involved. Cwm Taf University Health Board's Research and Development department funded their element of the study.

Implementation and Evaluation of Evidence-Based Psychotherapeutic Practices for Youth in a Mental Health Organization

The current initiative and program evaluation study is a demonstration of the research to practice process in youth-focused psychotherapy. We collaborated within a community-university partnership to create practice and research infrastructure in order to develop, implement, and evaluate two new models of service founded on evidence-based psychotherapeutic practice parameters. The two new service models incorporated validated interventions to address behavior problems in elementary age children, and depression in adolescents, which were delivered in separate but similarly run intensive outpatient programs within a mental health setting. We utilized a rigorous training, technical assistance, fidelity monitoring, and outcome measurement strategy to promote the integrity and quality of services provided. The resultant programs were delivered with acceptable to high fidelity and effects on youth and parenting measures collected during program and from pre to post showed a decrease in targeted problems in youth and positive benefits for families. This initiative and program evaluation adds to the accumulating research-to-practice literature in children's mental health.

Task scheduling strategy based on data replication in scientific Cloud workflows

The invention of Cloud computing as a new model of service provisioning in distributed systems encourages re- searchers to investigate its benefits and drawbacks in executing applications. In recent years, Cloud computing is fast evolving as the target platform for such applications among researchers. Furthermore, new pricing models have been pioneered by Cloud providers that allow users to provision resources and to use them in an efficient manner with significant cost reductions. Ap- proaches for scheduling and data placement is often highly correlated, which take into account a few factors at the same time, and what are the most often adapted to applications data medium and therefore doesn't go to scale. In this work, we propose an optimization approach that takes into account an effective data placement and scheduling of tasks grouped based on data replication in scientific Cloud environments. This proposed approach improve data placement and minimize response time due to scheduling tasks to data centers that contain the majority of the required data.

Optimizing Workflow Scheduling using Max-Min Algorithm in Cloud Environment

With the up rise of fourth paradigm, that is discovery of science over a prolonged period of time, scientific workflows commence to amend their status amongst innumerous science subject areas including physics, astronomy, biology, chemistry, earthquake science and many more. In Scientific workflows, a heavy volume of data processing is required and workflows with up to a few million tasks are not unusual. With the advent of Cloud Computing as a new model of service provisioning in distributed systems, a new direction comes in light for executing scientific applications such as Workflows by deploying resources of Cloud. The scheduling of millions of tasks of workflows, while processing with Cloud resources, in a most profitable manner i.e. minimum computation time is still an attractive research area. The existing scheduling algorithms are brushing off the individual dependent and independent tasks. In this research paper, MaxMin algorithm is implemented for scheduling of workflow tasks that is focalized on the consideration of dependent and independent tasks and process independent tasks in parallel that directly gives profit in minimizing computation time. General Terms Cloud Computing, Scheduling Algorithms.

Integration in Action in the Highlands

For the last three years NHS Highland has been on a journey of transformational change of the delivery of health and social care across the North of Scotland. Under a lead agency mode all adult social care services were transferred to NHS Highland from the Highland Council in April 2012 under a partnership agreement.NHS Highland now holds responsibility for the delivery of all adult services. The aim was to achieve the best possible outcomes for the people of Highland NHS Highland has developed a locality based service with single point of access for professionals, clients, patients and their families co-located and co-producing, utilising the local assets available. Key findings have been that the lead agency model has been without additional bureaucracy but has clarified governance and maximised the expertise of individual professionals. This new model of service has made major service re-design of hospital and community services more acceptable leading proposals which would see rationalisation hospital services and development of community services, transport and community resilience.

Epilepsy services in Ireland: ‘A survey of people with epilepsy in relation to satisfaction, preferences and information provision’

A challenge facing modern health care systems is to develop and implement new models of service that deliver increased capacity while providing a higher-quality, more cost-effective service within resource constraints. Incorporating the experience of people with epilepsy must be seen as central to the effectiveness of service design and delivery. This paper, therefore, reports the views of people with epilepsy with regards to health service delivery in Ireland. A cross-sectional descriptive survey design involving both quantitative and qualitative items was administered to a convenience sample of one hundred and two people with epilepsy (n=102) attending an epilepsy specialist centre. Despite high levels of satisfaction with hospital and primary care, participants offered several suggestions to improve healthcare delivery, such as: less delay in accessing specialist care and hospital appointments; better communication; and easier access to investigatory services. Findings demonstrate that for people with epilepsy the burden of the disorder is substantial and complex encompassing social, psychological and structural difficulties. Poor information provision particularly among women is reported. Furthermore, a lack of empowerment in people with epilepsy is highlighted. This study has implications for the reform and development of epilepsy services in relation to practice, education and research. It provides a basis for an evaluation of current practice and identifies opportunities for future service reorganization to improve the quality and efficiency of healthcare provision.

Patient experience of expanded-scope-of-practice musculoskeletal physiotherapy in the emergency department: a qualitative study.

The increasing number of people presenting to hospital with musculoskeletal conditions places pressure on existing services, and has resulted in expanding the scope of practice of musculoskeletal physiotherapists working in emergency departments (ED). The aim of the present study was to qualitatively explore the perspectives of patients presenting with an isolated musculoskeletal condition seen by a musculoskeletal physiotherapist in the ED of two Australian hospitals situated in contrasting geographical locations. Semistructured interviews were conducted with nine participants from a major metropolitan hospital and 16 participants from a remote hospital. Interviews were transcribed, coded and analysed using a thematic approach. RESULTS. The emerging themes from the two datasets were remarkably similar, so the final themes were merged. The major themes were: (1) participants were satisfied with the process and service provided by the physiotherapist; (2) the personal attributes of the physiotherapists were important to participants; (3) participant confidence in the skills and attributes of the physiotherapist made them a suitable alternative to a doctor in these situations; and (4) the timing and efficiency of the physiotherapy service was better than expected and valued. Participants from both settings described their experience in positive terms, reflecting satisfaction with their management by an expanded scope of practice musculoskeletal physiotherapist.

Development of a new model of service evolutionary level IAAS/PAAS/SAAS

Development of a new model of service evolutionary level IAAS/PAAS/SAAS

Improving linear accelerator service response with a real- time electronic event reporting system.

To track linear accelerator performance issues, an online event recording system was developed in‐house for use by therapists and physicists to log the details of technical problems arising on our institution's four linear accelerators. In use since October 2010, the system was designed so that all clinical physicists would receive email notification when an event was logged. Starting in October 2012, we initiated a pilot project in collaboration with our linear accelerator vendor to explore a new model of service and support, in which event notifications were also sent electronically directly to dedicated engineers at the vendor's technical help desk, who then initiated a response to technical issues. Previously, technical issues were reported by telephone to the vendor's call center, which then disseminated information and coordinated a response with the Technical Support help desk and local service engineers. The purpose of this work was to investigate the improvements to clinical operations resulting from this new service model. The new and old service models were quantitatively compared by reviewing event logs and the oncology information system database in the nine months prior to and after initiation of the project. Here, we focus on events that resulted in an inoperative linear accelerator (“down” machine). Machine downtime, vendor response time, treatment cancellations, and event resolution were evaluated and compared over two equivalent time periods. In 389 clinical days, there were 119 machine‐down events: 59 events before and 60 after introduction of the new model. In the new model, median time to service response decreased from 45 to 8 min, service engineer dispatch time decreased 44%, downtime per event decreased from 45 to 20 min, and treatment cancellations decreased 68%. The decreased vendor response time and reduced number of on‐site visits by a service engineer resulted in decreased downtime and decreased patient treatment cancellations.PACS numbers: 87.56.bd, 87.55.Qr