Service Developments Research Articles

Mental health stigma and discrimination in Ethiopia: evidence synthesis to inform stigma reduction interventions

BackgroundPeople with mental illnesses are at an increased risk of experiencing human rights violations, stigma and discrimination. Even though mental health stigma and discrimination are universal, there appears to be a higher burden in low- and middle-income countries. Anti-stigma interventions need to be grounded in local evidence. The aim of this paper was to synthesize evidence on mental health stigma and discrimination in Ethiopia to inform the development of anti-stigma interventions.MethodsThis evidence synthesis was conducted as a part of formative work for the International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership research program. Electronic searches were conducted using PubMed for scientific articles, and Google Search and Google Scholar were used for grey literature. Records fulfilling eligibility criteria were selected for the evidence synthesis. The findings were synthesized using a framework designed to capture features of mental health stigma to inform cultural adaptation of anti-stigma interventions.ResultsA total of 37 records (2 grey literature and 35 scientific articles) were included in the evidence synthesis. Some of these records were described more than once depending on themes of the synthesis. The records were synthesized under the themes of explanatory models of stigma (3 records on labels and 4 records on symptoms and causes), perceived and experienced forms of stigma (7 records on public stigma, 6 records on structural stigma, 2 records on courtesy stigma and 4 records on self-stigma), impact of stigma on help-seeking (6 records) and interventions to reduce stigma (12 records). Only two intervention studies assessed stigma reduction— one study showed reduced discrimination due to improved access to effective mental health care, whereas the other study did not find evidence on reduction of discrimination following a community-based rehabilitation intervention in combination with facility-based care.ConclusionThere is widespread stigma and discrimination in Ethiopia which has contributed to under-utilization of available mental health services in the country. This should be addressed with contextually designed and effective stigma reduction interventions that engage stakeholders (service users, service providers, community representatives and service developers and policy makers) so that the United Nations universal health coverage goal for mental health can be achieved in Ethiopia.

Development of a nurse-led transport service for non-critical neonates and children in Northern Ireland.

While the transport and retrieval of critically ill children has been extensively researched and audited, nurse-led repatriation and retrieval of non-critical children and neonates has only recently become a full-time nursing position in Northern Ireland. In January 2020, the Northern Ireland Specialist Transport and Retrieval (NISTAR) service developed a nurse-led transport team for this patient population and created a new role - the non-critical paediatric transport nurse - which incorporates the skills of a children's nurse. The aim of the service is to transport children and neonates safely between the regional paediatric unit and local district general hospital paediatric wards in Northern Ireland. The nurse-led service also transfers children with non-critical complex cardiac conditions between paediatric wards in Northern Ireland and the national centre for paediatric cardiology and cardiothoracic surgery in Dublin, Ireland. This article describes the role of the nurse-led transport team and discusses clinical governance, training requirements and the safe transfer of children with complex cardiac conditions. The NISTAR team won the child health category at the 2021 RCN Nursing Awards.

Chaplains Work in Primary Care

Health is holistic, but health services are often not. Primary care is the first point of contact for patients in the UK, and at least two in every three present with complex bio-psycho-socio-economic issues. In Scotland, the Community Chaplaincy Listening (CCL) service was created to see if chaplains could help. CCL involves specially trained chaplains listening to patients referred to them by general practitioners (GP) for spiritual support. Between 2018 and 2019, 143 people used CCL and completed baseline and post-discharge outcome measures. Mean Scottish PROM scores rose from 7.94 (± 3.4) at baseline to 12 (± 3.5) post discharge, a statistically and clinically significant rise of 4.06 (95% CI, 3–5.12), t(50) = 7.7, p < 0.0001, d = 1.08. The improvement was seen whether patients self-described as religious, spiritual, both, or neither. Health-related quality of life outcomes were mixed but patients referred to the service scored some of the lowest baseline EQ-5D-3L scores ever seen in the literature. Together these results suggest that CCL worked in primary care, especially for patients historically considered “difficult to treat.” Limitations of the study are considered alongside implications for commissioners and service developers.

Bringing political science back into public administration research

AbstractThe paper critically reviews the consequences of a bifurcation of Political Science and Public Administration. This divorce of two closely related academic fields has removed political explanations to key developments in the public service from Public Administration research and thus it tends to provide a partial view of the reality that it seeks to capture. There are several developments underway in the public sector, which underscore the political nature of public administration. These developments include the rise of administration politics; a growing emphasis on strategic management; governance‐driven democratization and administrative micro‐politics; the increasing significance of interactive and collaborative forms of governance; the rise of multilevel governance; and the development toward a more active citizenship. We find that in all of these areas, public administration research would benefit from incorporating a political science understanding of power, democracy, governance and citizenship.

Developing an Optimal Peer-to-Peer Ride-Matching Problem Algorithm with Ride Transfers

Thanks to recent developments in ride-hailing transit services throughout the world, the peer-to-peer (P2P) ride-matching problem has been actively considered in academia in recent years. P2P ride-matching not only reduces travel costs for riders but also benefits drivers by saving them money in exchange for their additional travel time. However, assigning riders to drivers in an efficient way is a complex problem that requires focusing on maximizing the benefits for both riders and drivers. This study aims to formulate a multi-driver multi-rider (MDMR) P2P ride-matching problem, based on rational preferences and cost allocation for both driver and rider, which also allows riders to transfer between multiple drivers for their travels if needed. Tabu Search (TS) for system-optimal ride-matching and a Greedy Matching (GM) algorithm for stable ride-matching were developed to solve ride-matching cases. The results show that the developed algorithm can successfully solve the proposed P2P MDMR ride-matching problem. MDMR P2P ride-matching can be used in areas where not much demand for ride-sharing exists, or for long-distance travel. Also it can be applied to designs for a more efficient on-demand transit network which can allow for transfers between routes. Moreover, the comparison of results between two implemented approaches shows that system-optimal centralized ride-matching can bring more cost savings for all participants in the system, although it may not always be stable when riders and drivers can choose their ride-matching for their own maximum benefit.

Website-Based Academic Service Development with ADDIE Design in Higher Education

This study aims to develop a website-based academic service at the Islamic Educational Management Study Program at an Islamic university in Palopo. Research and development (RD) using ADDIE Design was employed to develop the website. The data collection technique used was an observation, interviews with five students, the distribution of questionnaires, and documentation, among other methods. The data analysis technique was carried out qualitatively and quantitatively through data analysis techniques of validity, practicality, and effectiveness. At the Islamic Educational Management Study Program, an Islamic university in Palopo, this research results in the development of website-based academic services, which students can use to obtain educational services with a high level of validity from the layout/design, the material/website, and the language in the product in the very valid category, according to the findings. Regarding the practicality and effectiveness of the website-based academic services developed for use, they fall into "very practical and very effective" for use in the program. The findings of this study have implications for the critical role that management information systems play in providing excellent service to the entire academic community in higher education, as described above.

Eco-crisis and mental health of children and young people: Do child mental health professionals have a role?

Child mental health professionals have an extremely important role to play in their distinct roles as clinicians, therapists, researchers, policy makers, advocates, preventative public health professionals and service developers pertaining to eco-crisis in the child and adolescent populations. This article provides examples of how this can be done.

A Scalable Service to Improve Health Care Quality Through Precision Audit and Feedback: Proposal for a Randomized Controlled Trial.

BackgroundHealth care delivery organizations lack evidence-based strategies for using quality measurement data to improve performance. Audit and feedback (A&F), the delivery of clinical performance summaries to providers, demonstrates the potential for large effects on clinical practice but is currently implemented as a blunt one size fits most intervention. Each provider in a care setting typically receives a performance summary of identical metrics in a common format despite the growing recognition that precisionizing interventions hold significant promise in improving their impact. A precision approach to A&F prioritizes the display of information in a single metric that, for each recipient, carries the highest value for performance improvement, such as when the metric’s level drops below a peer benchmark or minimum standard for the first time, thereby revealing an actionable performance gap. Furthermore, precision A&F uses an optimal message format (including framing and visual displays) based on what is known about the recipient and the intended gist meaning being communicated to improve message interpretation while reducing the cognitive processing burden. Well-established psychological principles, frameworks, and theories form a feedback intervention knowledge base to achieve precision A&F. From an informatics perspective, precision A&F requires a knowledge-based system that enables mass customization by representing knowledge configurable at the group and individual levels.ObjectiveThis study aims to implement and evaluate a demonstration system for precision A&F in anesthesia care and to assess the effect of precision feedback emails on care quality and outcomes in a national quality improvement consortium.MethodsWe propose to achieve our aims by conducting 3 studies: a requirements analysis and preferences elicitation study using human-centered design and conjoint analysis methods, a software service development and implementation study, and a cluster randomized controlled trial of a precision A&F service with a concurrent process evaluation. This study will be conducted with the Multicenter Perioperative Outcomes Group, a national anesthesia quality improvement consortium with >60 member hospitals in >20 US states. This study will extend the Multicenter Perioperative Outcomes Group quality improvement infrastructure by using existing data and performance measurement processes.ResultsThe proposal was funded in September 2021 with a 4-year timeline. Data collection for Aim 1 began in March 2022. We plan for a 24-month trial timeline, with the intervention period of the trial beginning in March 2024.ConclusionsThe proposed aims will collectively demonstrate a precision feedback service developed using an open-source technical infrastructure for computable knowledge management. By implementing and evaluating a demonstration system for precision feedback, we create the potential to observe the conditions under which feedback interventions are effective.International Registered Report Identifier (IRRID)PRR1-10.2196/34990

Medication management for patients with Parkinson's: the impact of a nurse specialist and non-medical prescribing in the hospital setting

Background Parkinson's UK conducted the Get it On Time campaign in 2006 to highlight the difficulties people with Parkinson's experience when admitted to hospital. Aim This article reports on two related audits that focus on the impact of non-medical prescribing in a hospital setting for patients who are admitted with Parkinson's disease. Method An audit was undertaken to identify what was happening in a one district general hospital. Service developments were implemented with the introduction of a hospital-based Parkinson's specialist nurse with the non-medical prescribing qualification providing early assessment and liaison with the treating surgical and medical teams to ensure the Parkinson's condition was managed. A second audit was completed to assess the impact. Results At baseline patients experienced frequent medication errors and extended length of stay. The evaluation audit revealed a reduced length of stay and a decrease in medication errors. Conclusion The implementation of a Parkinson's specialist nurse with the non-medical prescribing qualification along with an alert system, helped improve the outcomes for patients with Parkinson's on admission to hospital. The reduction in length of stay demonstrated cost savings. Evidencing the positive outcome of this service improvement, has allowed the continuation of the specialist nursing role and is recommended as one aspect of developing hospital services for people with Parkinson's.

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.

Содержание патентных прав на служебные изобретения, служебные полезные модели, служебные промышленные образцы

Introduction: the paper considers the study of the specifics of patent rights for official results of intellectual activity in the scientific, technical, artistic, and design spheres. Methods: the methodological framework for the research is the dialectical method of cognition, as well as such general scientific methods as analysis, synthesis, induction, and deduction. Among the specific scientific research methods, comparative-legal, normative and dogmatic methods are used. Results: the study analyzes the features of patent rights for service inventions, service utility models, service industrial designs, as guarantees provided by the state for the performance of legally significant actions concerning these objects. The list of patent rights for service developments, their main characteristics is defined. Special attention is paid to the personal non-property rights of the author; the current legislation and the opinions of civilists on the scope of the right to a name are analyzed. Conclusions: it is established that the issue of ownership of the right to the name of the author of the invention, utility model, and industrial design is not regulated at the legislative level, which may entail the infringement of legal authorities exercised by the author of official decisions. As a result of the study, the legislative consolidation of the right to a name in the list of patent rights is proposed, as an absolute subjective legal authority of the author of an invention, utility model, industrial design, whose scope should be considered equally as a legally secured opportunity for the author to require the indication of his name, and the ability to remain anonymous in publications about the protected decision.

Transforming OpenAPI Specification 3.0 documents into RDF-based semantic web services

Web services are provided with documents that at the very least specify the endpoint, input parameters, and output or response of each operation to expose their capabilities. This should be considered through an understandable format for humans and/or machines. In the Representational State Transfer (REST) architectural style, the OpenAPI Specification (OAS) is used as a reference to create web service descriptions. However, it only supports syntactic interoperability, leading to the incapability of supporting the automated selection process. To overcome this, OAS documents must be enhanced by including semantics to each resource to provide “understandable” services. Therefore, this study aims to develop a system capable of transforming resources in OAS documents into RDF-based semantic web services. To begin, a relational database schema based on the OAS structure is created to store all objects in the OAS document. The published open-linked vocabulary was then used to create the ontology, which maps resources and their relationships on the RDF data model. To build RDF-based semantic web services, R2RML was used to generate the relational database model into triple RDF. The proposed system was also tested through prototyping and using a dataset of 106 OAS documents, which were downloaded from APIs.guru between 5–10 May 2021. The number of triple RDFs generated per document varied with resource rate. An OAS document generates 36 to 16,505 triple RDF in a dataset. The end product was a triple RDF knowledge base maintained by a graph management database. It is now possible to find service operations, input and output parameters, and service composition requirements utilizing the repository semantic web services using SPARQL. On the other hand, the use of relational databases to store OAS resources increased reuse efficiency by approximately 48%, owing to service developers designing interoperability between uniform parameter services, which were then used as input and output.

Exploring the contexts, mechanisms and outcomes of a torture, abuse and dental anxiety service in Norway: a realist evaluation

BackgroundTorture, abuse and dental anxiety (TADA) are often precursors to developing a pathological relationship with dental care due to elevated anxiety. Consequently, patients who suffer from one or more of these tend to avoid dental services. This could leave them with severe tooth decay, which could affect their general and psychosocial health. Norwegian dental services have implemented the TADA service to specifically alleviate dental anxiety and restore oral health for the TADA patient group. However, the service has not been evaluated, and there is a need to understand how and why this service works, for whom, under what circumstances. Therefore, this study aimed to develop theories on how the service’s structure alleviates dental anxiety and restores these patients’ oral health. Although developed in a Norwegian context, these theories may be applicable to other national and international contexts.MethodsThis realist evaluation comprised multiple sequential methods of service and policy documents (n = 13), followed by interviews with service developers (n = 12).ResultsThe analysis suggests that, by subsidising the TADA service, the Norwegian state has removed financial barriers for patients. This has improved their access to the service and, hence, their service uptake. National guidelines on service delivery are perceived as open to interpretation, and can hereby meet the needs of a heterogeneous patient group. The services have become tailored according to the available regional resources and heterogeneous needs of the patient population. A perceived lack of explicit national leadership and cooperative practices has resulted in regional service teams becoming self-reliant and insular. While this has led to cohesion within each regional service, it is not conducive to interservice collaborations. Lastly, the complexity of migration processes and poor dissemination practices is presumed to be the cause of the lack of recruitment of torture survivors to the service.ConclusionsPolicy documents and service developers described the TADA service as a hybrid bottom-up/top-down service that allows teams to practise discretion and tailor their approach to meet individual needs. Being free of charge has improved access to the service by vulnerable groups, but the service still struggles to reach torture survivors.

The Rapid Development of Virtual Care Tools in Response to COVID-19: Case Studies in Three Australian Health Services.

BackgroundNews of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people while maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefits; however, such rapid-cycle development also created risks.ObjectiveThe aim of this study was to understand the sociotechnical aspects of the rapid-cycle development of seven different COVID-19 virtual care tools, and to identify enablers, barriers, and risks at three health services in Victoria, Australia.MethodsA qualitative, embedded, multiple case study design was adopted. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyze structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools.ResultsThe overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and for protecting staff. However, the governance, digital maturity, and specific use cases at each institution shaped the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes posed barriers. Existing relationships with technical service developers enabled strong solutions, which in some cases were highly scalable. Conventional project methodologies such as steering committees, scope, budget control, tight functional specification, consumer engagement and codesign, universal accessibility, and postimplementation evaluation were ignored almost universally in this environment.ConclusionsThese three health services took a variety of approaches to the rapid-cycle development of virtual care tools to meet their urgent needs for triaging and remote monitoring during the first year of the COVID-19 pandemic. Their experiences provided insights into many social and technical barriers and enablers to the development of virtual care tools. If these are addressed proactively, they will improve clinical governance and technical management of future virtual care. Some changes can be made within individual health services, while others entail health system policy reforms. Enhancing the environment for virtual care tool design and implementation now will yield returns not only during future health emergencies but also in many more routine care settings.

Kebijakan Pelayanan Publik Pemerintah Daerah di Era Disrupsi

Openness in the development of policy making is a must in local governments to carry out good public services in accordance with Good Governance. The purpose of this research is to see the development of the concept of administration to public administration in implementing local government decisions. So that the openness of a policy by involving community participation results in satisfaction with public services for the wider community. The research methodology uses a qualitative descriptive approach to the problem of openness to policy developments in public services by local governments. As a result, the community can enjoy and feel the involvement of participation in a decision-making process carried out by the local government. The legal basis for making public policy implementation by the government is the principle of decentralization, namely the granting of regional autonomy to local governments. As guaranteed in Law No. 32/2004 article 14 on mandatory local government affairs

Trevor Mann (1916-1996): Paediatrician responsible for the development of hospital services for children in Brighton, England.

Trevor Philip Mann (1916-1996) was the first consultant paediatrician at the Royal Alexandra Children's Hospital (RACH) in Brighton, since its foundation in 1881. Here, he was responsible for significant service developments, including establishing a department of paediatric surgery and the first neonatal unit in England outside of London. Mann grew up in South London, and aged 14 had a lengthy admission to hospital with tuberculosis. He studied medicine at St Mary's Hospital, London. During World War II he was a Royal Navy Surgeon-Lieutenant, aboard the Atlantic destroyer, HMS Georgetown, and with the Russian convoys, before completing paediatric training in London. Here, he was involved in treating paediatric tuberculous meningitis; clinical work that formed part of one of the earliest randomised controlled trials. In 1951 Mann moved to the RACH where he researched infantile infectious gastroenteritis and introduced (now commonplace) practices at the hospital, including barrier nursing. He lived in Rottingdean, Sussex, and enjoyed sailing, gardening and wood turning. Mann's impact on paediatric care in Brighton was recognised by the hospital, naming the Trevor Mann Baby Unit in his honour, upon his retirement in 1981. This article seeks to record his contributions and reconnect local clinicians with his memory.

An Echo of the Remanent

Thousands of medieval manuscripts have survived to the present day only as literal fragments of their former selves: cut up for binding scrap in the early modern period, initials and miniatures trimmed for framing by collectors and dealers in the Victorian era, and entire codices cut up leaf by leaf by modern biblioclasts. There are at least thirty-thousand fragments in North American collections and exponentially more in Europe and elsewhere. The potential for discovery, pedagogy, scholarship, and public engagement is enormous, and the work has only barely begun. Recent developments in data modeling and image service are making it possible for scholars to digitally reconstruct these broken books, enabling important outcomes for research and teaching. The essays in this volume will engage with medieval manuscript fragments and fragmentology in different ways. This introductory essay surveys the history of fragmenting, fragments, and fragmentology.

Critical Care Pharmacy Program Accreditation Standards Framework and Core Competencies in Saudi Arabia

Clinical pharmacy services in Saudi Arabia are expanding steadily, particularly with notable developments in critical care pharmacy services and training programs, including four critical care residency programs localized in Riyadh and one program in Jeddah. The Scientific Council of Pharmacy leads extensive efforts to advance clinical pharmacy practice and training under the Saudi Commission for Health Specialties (SCFHS), the accrediting body for critical care training programs and all other specialties. Despite launching critical care pharmacy programs in 2013, currently available accreditation standards and competency assessments for specialized residency programs in critical care were established in 2020. These accreditation standards and competency assessment modalities have been found to have significant areas of improvement based on the feedback of practicing critical care pharmacy residency program directors and trainees over the past few years. This is an opinion paper based on a consensus of critical care and emergency medicine pharmacy experts which recommends updating the current accreditation standards framework and competency assessment blueprint for specialized critical care pharmacy programs. Additionally, it highlights the need to modify the accreditation standards framework for critical care pharmacy programs. Further evaluation of these modalities can be revised as deemed reasonable by governmental authorities by recruiting practicing critical care clinical pharmacy experts.

Serenity Integrated Mentoring and the High Intensity Network: a scheme that raises serious questions for practice and governance in UK psychiatry.

Serenity Integrated Mentoring (SIM) involved the police and mental health crisis services working in a single team, developing case management plans that allowed a seamless move from offers of therapeutic engagement (by the mental health team) to use of coercive measures (by the police) with those who persisted with frequent crisis presentations. Withdrawn after widespread criticism, the scheme raises important questions - about the practice of mental health professionals who are involved in decisions about using criminal sanctions for people presenting in crisis, about the ethical and legal status of the sharing of confidential clinical information with the police, and about the processes that professional bodies use in promoting, monitoring and responding to controversial service developments.

Analisis Penerapan Surat online Dalam Pelayanan Administrasi 4.0 di Sekretariatan Dewan Perwakilan Rakyat Kabupaten Nagan Raya

The application of online mail is a mechanism in improving the quality of an administrative service in the 4.0 era. by using an online letter of satisfaction in providing services to the community and also to service operations. The purpose of using online mail is one of the developments of services that are carried out effectively and efficiently for administration which has been used manually in the form of hard files. In today's digital era, there are many things that can be done to create satisfaction and service loyalty in an excellent manner. The method in this online mail research is using qualitative by focusing on the problems that occur in the agency in using online mail as an alternative to modern services. The results of this study are the Nagan Raya Surat online DPRK Agency is a change made to provide very efficient and effective services for the community, agencies in delivering administration and reducing standard administration for staffing.