Operational Staff Research Articles

Perceptions of pre-hospital emergency personnel regarding trauma patient care

BackgroundProviding care to trauma patients in pre-hospital emergencies is a vital and life-sustaining factor for individuals. This study was conducted to percept of pre-hospital emergency personnel regarding trauma patient care.MethodsThis qualitative study was done using a conventional content analysis method that employed purposive sampling technique. A total of 12 in-depth semi-structured interviews were conducted with 10 operational staff members of pre-hospital emergency services from May 2021 to September 2022. After recording and transcribing the data, qualitative content analysis, based on Graneheim and Lundman’s approach, was performed on the data.ResultsFrom the data analysis, a total of 478 initial codes were extracted, leading to the identification of two main categories, namely “Stress as an Unavoidable Factor” and “Emotional Impasse”. The first category included three sub-categories of work under stress, associating your family in the face of life-threatening conditions, and worrying about the patient’s fate. Three sub-categories of a long-term mental occupation of the technician with the encounter scene, the feeling of guilt despite trying as much as possible, and emotional distress in certain groups emerged from the second category.Conclusions“Stress as an Unavoidable Factor” and “Emotional Impasse” have been introduced as main categories of perceptions of pre-hospital emergency personnel regarding trauma patient care.

The Innovation Power of Living Labs to Enable Sustainability Transitions: Challenges and Opportunities of On‐Campus Initiatives

ABSTRACTLiving labs are becoming increasingly popular as suitable arrangements for cocreation and innovation by bringing multiple stakeholders together to work on (solving) complex societal challenges. University campuses are ideal places for living labs, and many universities use such arrangements for various experiments in relation to sustainable future initiatives. Despite the popularity of the living lab concept, much remains unclear about their ways of operation and their potential to innovate. This study aims to show some of the current challenges of on‐campus living labs involved with experiments concerning the energy transition. A total of six different living labs were examined based on semistructured interviews with different stakeholders ranging from researchers to operational staff members. Our results show several internal and external challenges, such as the living lab set‐up and multiple operational challenges concerning administration, coordination and governance. More external challenges include the overall embeddedness of living labs within the more traditional organizational structure of the university and the tensions between academic and operational processes. Despite these challenges, we conclude that a university campus is still a fruitful place for living labs to cocreate and innovate. By creating awareness and understanding of the challenges living labs face, future initiatives may be facilitated better so that campus living labs are able to unlock their potential to innovate and contribute to societal challenges sooner rather than later.

Navigating High-Stakes Collaboration: A Critical Analysis of Team Dynamics Among Medical Staff in Pressure-Driven Surgical Operations

In high-stakes surgical operations, effective teamwork among medical staff is critical for ensuring patient safety and positive outcomes. This article presents a critical analysis of team dynamics under pressure, focusing on communication, role clarity, leadership, stress management, and team cohesion. Using case studies and an extensive review of existing literature, the analysis examines the challenges faced by surgical teams, including breakdowns in communication, hierarchical barriers, and stress-induced errors. Additionally, the article explores successful interventions that promote collaborative skills and resilience, such as closed-loop communication protocols, role-flexibility training, and leadership development. The findings suggest that structured teamwork training and stress-management strategies significantly enhance collaborative performance in pressure-driven surgical scenarios. This analysis underscores the importance of continuous team development and adaptive leadership in mitigating risks and improving patient outcomes.

Enhancing Collaborative Leadership in Healthcare: Addressing Ego Conflicts for Organizational Harmony and Improved Patient Care

In today’s complex healthcare environment, fostering collaboration between medical professionals and administrative teams is essential for delivering high- quality patient care. However, non-clinical conflicts, often driven by differences in authority, communication gaps, and ego clashes, can disrupt organizational harmony. These conflicts between doctors, nursing heads, and corporate teams can negatively affect operational efficiency, care outcomes, and staff morale. This article explores the root causes of these conflicts, highlights successful global strategies for resolving them, and provides a comprehensive framework for promoting a culture of mutual respect and teamwork within healthcare settings. By implementing these approaches, healthcare organizations can create a cooperative environment that enhances both staff satisfaction and patient outcomes. Moreover, the article examines how these strategies can be applied globally to address similar challenges across diverse healthcare settings.

How do homeless service users view their own health and healthcare? An ethnographic study

BackgroundThe provision of healthcare to those in homelessness often fails to consider what is important to those receiving care. Using an ethnographic approach grounded in a social constructivist research paradigm, this study aimed to explore the perspectives of homeless service users in Dublin, Ireland on their priority health and healthcare needs. MethodsActive participant observations and informal interviews were conducted with 74 adult clients attending a low-threshold primary care and addiction service between October, 2022 and April, 2023. Participants were selected using purposive, critical case sampling; clinic medical or operations staff identified adult homeless clients of sound mental capacity with whom they had an established rapport. Field note data were collected, anonymised, and analysed using inductive thematic analysis in accordance with the Declaration of Helsinki and the researchers’ institutional Research Ethics Committee. All participants gave informed verbal consent. FindingsClients’ priority concerns relate to their mental health and personal safety, strengthening ties with children and families, finding a sense of purpose, and alleviating physical pain. These challenges are acute both prior to and during experiences of homelessness, coupled with disproportionately high levels of grief, fear, isolation, and fatigue. In terms health services, clients value accessing primary care and harm reduction in a social environment where positive exchanges with friends and providers take place. Conversely, barriers to accessing mental health and addiction services persist including the internalised belief that one is beyond help, lack of access to information on available services and their entry requirements, and lingering stigma within a health system that treats addiction as separate to health. InterpretationHealth initiatives recommended by homeless service users to improve their lives and conditions include the provision of more/more acceptable single occupancy housing, refuge spaces, mental health and parenting supports, residential addiction treatment, and meaningful social activities. Study limitations include the obtention of data from a single site and from only English speakers. FundingThe authors received no specific funding for this work.

EHT and environmental justice at EPA Victoria: Aspirations and regulatory realities

Abstract EPA Victoria (Australia) is a statutory authority that regulates polluting activities and advises other Victorian government departments on relevant policy settings. In 2016, a public health function was installed at EPA Vic to provide emergency health messaging during pollution events, review research evidence of environmental-health relationships and assess industry-contracted health risk assessments of polluting entities. An Environmental Health Tracking Network (EHTN) is under development to support these activities. The EHTN is an agile data and analytical infrastructure for translating expertise across an expanding multidisciplinary network of public health researchers, EPA operational staff and public sector policy makers. Its current interactive dashboards calculate health impacts and associated costs of air pollution scenarios, model land-use influences on land and water contamination and identify coincidences of sociodemographic-, urban environment- and pollution exposure-disadvantage in a high spatial resolution environmental justice (EJ) framework. Regulatory leverage of EHTN intelligence, however, requires legislated EJ thresholds and/or legally tractable costing of industry-externalised human health impacts. Thus, to establish triggers for more stringent conditions on polluting activities and promote equity of interventions and regulations, novel regionally and EJ specific health risk functions are required. Considering these ambitions and challenges, the EHTN at EPA Vic is focussed on 1) identifying and characterising vulnerable populations at high spatial resolution, 2) estimating associated exposure-health effect size modifications using primary epidemiological methods and 3) applying these to health impact and cost assessments of pollution and waste. We seek defensible grounds on which to impose more stringent standards for polluters and redress entrenched social, health and economic disadvantage. Speakers/Panelists Hanna Tolonen THL, Helsinki, Finland

Special Issue on Informatics Education: Vanderbilt Clinical Informatics Center Education Strategy: To Infinity and Beyond!

The Vanderbilt Clinical Informatics Center (VCLIC) is based in the Department of Biomedical Informatics (DBMI) and operates across Vanderbilt University Medical Center (VUMC) and Vanderbilt University (VU) with a goal of enabling and supporting clinical informatics research and practice. VCLIC supports several types of applied clinical informatics teaching, including teaching of students in courses, professional education for staff and faculty throughout VUMC, and workshops and conferences that are open to the public. In this paper, we provide a detailed accounting of our center and institution's methods of educating and training faculty, staff, students, and trainees from across the academic institution and health system on clinical informatics topics, including formal training programs and informal applied learning sessions. Through a host of informal learning events, such as workshops, seminars, conference-style events, bite-size instructive videos, and hackathons, as well as several formal education programs, such as the Clinical Informatics Graduate Course, Master's in Applied Clinical Informatics, Medical Student Integrated Science Course, Graduate Medical Education Elective, and Fellowship in Clinical Informatics, VCLIC and VUMC provide opportunities for faculty, students, trainees, and even staff to engage with Clinical Informatics topics and learn related skills. The described programs have trained hundreds of participants from across the academic and clinical enterprises. Of the VCLIC-held events, the majority of attendees indicated through surveys that they were satisfied, with the average satisfaction score being 4.63/5, and all events averaging a satisfaction score of greater than 4. Across the 20 events VCLIC has held, our largest audiences are DBMI, HealthIT operational staff, and students from the medical and nursing schools. VCLIC has created and delivered a successful suite of formal and informal educational events and programs to disseminate clinical informatics knowledge and skills to learners across the academic institution and healthcare system.

A Focused Literature Review of Missed Care in Residential Aged Care

Missed care is any aspect of required care that is omitted (either in part or whole) or delayed. Residential Aged Care Facilities (RACFs) are susceptible to missed care due to a range of factors, including residents’ complex needs, workforce composition, and constraints placed on resource availability. This focused literature review aims to evaluate the current evidence on missed care, including an analysis of the concept, causes, and outcomes of missed care in residential aged care in Australia. Within most of the available literature, missed care is typically considered only within the context of nursing. It is noted that although the nature and identification of missed care were discussed extensively to provide a broad picture of the phenomenon, including possible prevalence and outcomes, they need to explicitly discuss the impact of missed care on residents, families, and other clinical and operational staff. Further research is needed to inform and improve the care of the elders in RACFs, considering this gap in the literature. This review has identified potential areas for enquiry into missed care to inform policy and practice to improve the care of elderly residents in RACFs.

Optimization of Warehouse Operations for Upstream Service Companies in the Oil & Gas Industry: A Case Study of XYZ Company

The oil and gas (O&G) sector drives various parts of Malaysia's economy and accounts for 19% of government revenue in 2021. The volatility of oil prices and the COVID-19 pandemic problem in recent years has taught O&G enterprises, especially upstream players, to focus on business needs and employ cost optimization techniques to compete and survive uncertain circumstances. This study seeks to analyze and describe the warehouse operations setup of an onshore supply base service organization that manages and maintains offshore O&G facilities. This study examines space utilization variables from several supply chain perspectives, particularly operations performance. Semi-structured interviews, site observations, and documentation review are used to collect data for the single-case study. The study findings suggest the organization under study has a basic warehouse setup with lean operations staff to complete business functions. In general, the warehouse arrangement for the organization under investigation is comparable to a distribution center, where 70% of warehouse activities comprise, material receiving, handling, and distribution (loading) to several offshore locations. Findings also showed that two factors, namely: material handling flow and movement, and inventory movement affect warehouse space utilization. The volume of material handled by the warehouse based on business demand, as well as the seasonal trend from offshore activities contribute to the frequency of material loading and impact the material throughput and transit time, which were found to have an impact on space utilization too.

Об изменении подхода к правовому регулированию проведения оперативно-розыскных мероприятий

The article analyzes proposals to improve operational investigative legislation, for example, proposals to improve the purpose and objectives of the Police Department, to change the system of operational investigative measures. A separate area of improvement of the system of norms should be called the coordination of operational investigative measures in relation to solving specific tasks of the ORD. The article concludes that operational investigative activities in relation to each area in which they are conducted are different. In some cases, all operational investigative capabilities are needed, and, accordingly, the right to conduct all operational investigative measures should be granted. In other cases, all the capabilities of the HORDES are not required, all tasks can be solved with a limited amount of funds. This thesis was verified by questioning the operational staff. The paper describes the results of the study, which provides data on the demand for individual MPas in relation to the directions of the MPas.

Effect of implementing an integrated oncology dashboard on clinical and operational quality in a community-based cancer network.

420 Background: MaineHealth Cancer Care Network (MHCCN) encompasses nine regional cancer centers and one affiliate cancer center located in rural south-central Maine and New Hampshire. MHCCN developed an integrated operational dashboard to improve clinical and operational performance. In this report, we detail improvements in a variety of quality metrics after implementation of the dashboard. Methods: Extracts from various non-interoperable data sources were integrated using a MS Power BI platform to create the dashboard. Divided into pages— summary, growth, service excellence, innovation and transformation —the dashboard provides searchable and regularly updated snapshots of numerous relevant metrics in these domains. Access to the dashboard was extended to all clinical and operational staff, with data reviewed bi-monthly in provider and operational meetings. The dashboard played a pivotal role in identifying MHCCN’s 2023 key performance indicator, specifically the electronic health record (EHR)-based TNM staging, along with notable care gaps such as underutilization of the NCCN distress thermometer (DT) for psychosocial distress assessment. Bottlenecks to timely care delivery were similarly identified by leveraging time to treatment data in the service excellence page. Targeted quality improvement initiatives were devised to address the gaps. Results: EHR-based structured TNM staging by providers improved from 29% in Fiscal Year (FY) 2022 to 47% in FY 2023 and 64% in FY 2024 year-to-date (YTD). Use of the NCCN DT improved from 1.1% in FY 2022 to 30.9% in FY 2023 and 49.9% in FY 2024 YTD. Process changes resulting from identifying delayed scheduling of PET scans as a bottleneck reduced the lead time from scan ordering to scan appointment from 18 days (January-July 2023) to 9 days (January-April 2024). Leveraging access to monthly productivity data through the dashboard, provider compensation reform incorporating production-based incentives was launched in July 2023, improving throughput and access as well as provider recruitment and retention. Information transparency from a freely accessible dashboard contributed to a 0.67-point gain in the 2023 Gallup provider core engagement CE3 score, reaching 3.45 (on a five-point scale). Conclusions: Clinical and operational metrics are often fragmented across different platforms, leading to inefficiencies and limited insights. Creating a system-wide integrated quality dashboard improved data visibility, provider engagement and led to measurable improvement in quality metrics across various domains.

Age and length characteristics of female and male Walleye broodstock collected at a spawning operation

AbstractObjectiveThe need to augment of Walleye Sander vitreus populations may increase as these populations face challenges of changing habitats and climatic conditions. Since little has been published outside of agency reports on wild broodstocks, the intent of this study was to describe sex‐specific Walleye spawning participation from a Great Plains broodstock operation. Specific objectives will assess standardization to collect target number of broodstock effort, catch per unit effort, and length and age participation of female and male broodstock.MethodsWalleye were collected at Sherman Reservoir, Nebraska, during April spawn collection operations from 2015 to 2019. Gill nets were used to collect female Walleye, and boat electrofishing was used to collect male Walleye. Catch per effort was calculated for each sex, fish were measured to nearest 1‐cm length‐group, and a dorsal spine was taken from a subset of fish per length‐group. Mean lengths and ages were calculated for each year of the study. Data were combined for all years of the project to display percent contribution by length and age.ResultThe amount of effort to capture 100 female and male Walleye varied by 4× and 2.5×, respectively, over the 5 years of sampling. Mean lengths and ages (±SE) of female (65 ± 1 cm; 10.4 ± 0.1 years) and male (43 ± 1 cm; 6.3 ± 0.1 years) Walleye collected were consistent during this study. The female Walleye collected represented 14 different ages, but ages 9–12 comprised 66% of all captured broodstock. The collected male Walleye also demonstrated age‐compressed spawning tendencies, with ages 4–7 accounting for 74% of collected individuals that represented 13 different ages.ConclusionThese results can define the anticipated variability in catch that can be expected at broodstock collection operations along with connection to specific lengths and ages of Walleye. Additionally, recognition that female and male Walleye broodstock contributions are consistently coming from four specific ages that are not the same year‐classes may allow spawning operation staff to anticipate brood availability and ultimately improve the planning efficiency of these operations.

Problems affecting procurement performance in Metro Kalibo Water District

The purpose of the study is to assess the problems affecting procurement performance that may be used to develop procurement methods and procedures for enhanced operational efficiency in Metro Kalibo Water District in the Philippines. The research design used in this study was descriptive-quantitative design. The respondents of the study were the ninety-nine employees of Metro Kalibo Water District. The study covered the period of one calendar year, from January 1, 2023 to December 31, 2023, and was limited only to demographic profile of employees, problems affecting procurement performance, and the measures to address the problems affecting procurement performance in Metro Kalibo Water District. The assessment of procurement performance at Metro Kalibo Water District is enriched by a diverse and highly educated workforce, including many with advanced degrees. This diversity provides a comprehensive range of expertise, with balanced input from both operational and managerial staff, and perspectives from employees with varying lengths of service. The distribution across different salary grades further enhances the multifaceted understanding of procurement functions. The Metro Kalibo Water District highlights the importance of effective procurement planning, clear procedures, staff competency, and adequate resource allocation. There is a significant relationship between employee demographics and procurement problems, as well as between these problems and the measures to address them, emphasizing the interconnected nature of these factors in achieving efficiency and transparency.

Commanders Requirements: What Do New Zealand Commanders and their Staffs Expect of Military Intelligence Officers in the 21st Century

Military intelligence supports commanders, operations and planning staffs, and their evolving needs. With few foundations for what is expected of military-intelligence officers in scholarly literature, this article attempts to determine what military-intelligence soldiers, planning officers, operational staff, and commanders expect of military-intelligence officers in the 21st century operating environment. Literature, training doctrine, and public resources provide no data or succinct analysis justifying how New Zealand military-intelligence officers comprehend what their roles required of them. This research surveyed New Zealand Defence Force personnel to determine what they believe is best military-intelligence practice. While commanders’ preferences differ, doctrine indicates military-intelligence officers should train for the most likely situations, and therefore commanders’ most likely expectations.2 This article presents analysis of what is required to be a good military-intelligence officer.

Commanders Requirements: What Do New Zealand Commanders and their Staffs Expect of Military Intelligence Officers in the 21st Century

Military intelligence supports commanders, operations and planning staffs, and their evolving needs. With few foundations for what is expected of military-intelligence officers in scholarly literature, this article attempts to determine what military-intelligence soldiers, planning officers, operational staff, and commanders expect of military-intelligence officers in the 21st century operating environment. Literature, training doctrine, and public resources provide no data or succinct analysis justifying how New Zealand military-intelligence officers comprehend what their roles required of them. This research surveyed New Zealand Defence Force personnel to determine what they believe is best military-intelligence practice. While commanders’ preferences differ, doctrine indicates military-intelligence officers should train for the most likely situations, and therefore commanders’ most likely expectations. This article presents analysis of what is required to be a good military-intelligence officer.

Socio-economic Diversity and Employee Turnover in the Insurance Industry in Kenya

Aim: The aim of this study was to examine the nexus between socio-economic diversity and employee turnover in the Insurance Industry in Kenya. The study also aimed to evaluate the moderating effect of firm characteristics on the relationship between socio-economic diversity and employee turnover in the insurance industry in Kenya. Methods: This study adopted a combination of descriptive and correlational research designs. The insurance companies from which data was collected were the top 5 insurance companies based on market share in general insurance. The employees of those companies were drawn from the following cadres: middle-level managers, heads of departments, supervisors, and operational staff. This study utilized multi-stage sampling technique involving deliberate sampling and stratified random sampling. A sample size of 338 employees was used in the study and data was collected using a semi structured questionnaire. Descriptive analysis entailed means and standard deviations while inferential analysis entailed regression analysis. Results: The study found a positive and significant relationship between socio-economic diversity and employee turnover in the insurance industry in Kenya. It was also found that firm characteristics have no significant moderating effect on the relationship between socio-economic diversity and employee turnover in the insurance industry in Kenya Conclusion: The study concluded that through effective and competitive salaries, rewarding and giving benefits and commissions to the employees without favoring others, the employees would not think of leaving their respective companies. Recommendations: The insurance companies through the management should ensure that they come up with competitive compensation structures for their workers, ensuring that varied pay is justified to mitigate employee turnover. The insurance companies should offer competitive salaries. Benefits, and commissions, should be given competitively to employees who are talented and who contribute much to the companies. This helps in steering employee productivity and retention thus enhancing firm performance. The Insurance Regulatory Authority and the Association of Kenya Insurers should put in place effective policies to ensure that the companies pay their employee's reasonable salaries.

Personality Traits and Employee Turnover in the Insurance Industry in Kenya

Aim: The aim of this study was to examine the relationship between personality traits and employee turnover in the Insurance Industry in Kenya. The study also aimed to evaluate the moderating effect of firm characteristics on the relationship between personality traits and employee turnover in the Insurance Industry in Kenya. Methods: This study adopted a combination of descriptive and correlational research designs. The insurance companies from which data was collected were the top 5 insurance companies based on market share in general insurance. The employees of those companies were drawn from the following cadres: middle-level managers, heads of departments, supervisors, and operational staff. This study utilized multi-stage sampling technique involving deliberate sampling and stratified random sampling. A sample size of 338 employees was used in the study and data was collected using a semi structured questionnaire. Descriptive analysis entailed means and standard deviations while inferential analysis entailed regression analysis. Results: Results showed that there was a positive and significant relationship between personality traits and employee turnover in the Insurance Industry in Kenya. It was also found that firm characteristics have no significant moderating effect on the relationship between personality traits and employee turnover in the Insurance Industry in Kenya Conclusion: The personality traits utilized in the management of employees by the organizational management in insurance firms determines the retention and turnover of employees in those companies. Recommendations: The management of insurance companies should increase the use of aptitude tests during recruitment to determine the personality traits of employees so that when they engage them in various jobs. Their personality traits would enhance the performance of their jobs and cause them to be retained in their jobs for a long period before thinking of going elsewhere and hence leading to insurance companies using lots of money on the high frequency of recruiting of employees.

Implementation of the Green Port Concept in PT. Terminal Petikemas Surabaya

This research aims to implement the Green Port concept at PT Terminal Petikemas Surabaya. This research method uses descriptive qualitative methods including interviews, notes, field notes, pictures, and video recordings. The data collection technique used direct observation of the green port process at PT Terminal Petikemas Surabaya, interviews with operational staff, engineers, and field workers at PT Terminal Petikemas Surabaya, and documentation. The results of this study are a). The implementation of the green port concept at PT Terminal Peti Kemas Surabaya succeeded in improving environmental quality and operational efficiency, reducing carbon emissions and costs. These efforts reflect TPS commitment to sustainability, creating a competitive green port, and providing long-term benefits to the environment, economy and surrounding communities. b). Efforts to support the green port concept and improve sustainability include the use of renewable energy, energy use optimization, waste management, environmentally friendly transportation, education and training, and regular environmental monitoring. These efforts demonstrate the terminal's commitment to reducing environmental impacts and improving operational efficiency. c). The implementation of the green port concept at Surabaya Container Terminal has reduced emissions and carbon footprint, increased energy efficiency, managed waste well, and improved air and water quality. Equipment modernization and operational automation have also increased productivity and reduced waiting time. These positive impacts not only support environmental and operational sustainability, but also enhance the port's reputation and the quality of life of the surrounding community.

Investigating innovations in outpatient services: a mixed-methods rapid evaluation.

Within outpatient services, a broad range of innovations are being pursued to better manage care and reduce unnecessary appointments. One of the least-studied innovations is Patient-Initiated Follow-Up, which allows patients to book appointments if and when they need them, rather than follow a standard schedule. To use routine national hospital data to identify innovations in outpatient services implemented, in recent years, within the National Health Service in England. To carry out a rapid mixed-methods evaluation of the implementation and impact of Patient-Initiated Follow-Up. The project was carried out in four sequential workstreams: (1) a rapid scoping review of outpatient innovations; (2) the application of indicator saturation methodology for scanning national patient-level data to identify potentially successful local interventions; (3) interviews with hospitals identified in workstream 2; and (4) a rapid mixed-methods evaluation of Patient-Initiated Follow-Up. The evaluation of Patient-Initiated Follow-Up comprised an evidence review, interviews with 36 clinical and operational staff at 5 National Health Service acute trusts, a workshop with staff from 13 National Health Service acute trusts, interviews with four patients, analysis of national and local data, and development of an evaluation guide. Using indicator saturation, we identified nine services with notable changes in follow-up to first attendance ratios. Of three sites interviewed, two queried the data findings and one attributed the change to a clinical assessment service. Models of Patient-Initiated Follow-Up varied widely between hospital and clinical specialty, with a significant degree of variation in the approach to patient selection, patient monitoring and discharge. The success of implementation was dependent on several factors, for example, clinical condition, staff capacity and information technology systems. From the analysis of national data, we found evidence of an association between greater use of Patient-Initiated Follow-Up and a lower frequency of outpatient attendance within 15 out of 29 specialties and higher frequency of outpatient attendance within 7 specialties. Four specialties had less frequent emergency department visits associated with increasing Patient-Initiated Follow-Up rates. Patient-Initiated Follow-Up was viewed by staff and the few patients we interviewed as a positive intervention, although there was varied impact on individual staff roles and workload. It is important that sites and services undertake their own evaluations of Patient-Initiated Follow-Up. To this end we have developed an evaluation guide to support trusts with data collection and methods. The Patient-Initiated Follow-Up evaluation was affected by a lack of patient-level data showing who is on a Patient-Initiated Follow-Up pathway. Engagement with local services was also challenging, given the pressures facing sites and staff. Patient recruitment was low, which affected the ability to understand experiences of patients directly. The study provides useful insights into the evolving national outpatient transformation policy and for local practice. Patient-Initiated Follow-Up is often perceived as a positive intervention for staff and patients, but the impact on individual outcomes, health inequalities, wider patient experience, workload and capacity is still uncertain. Further research should include patient-level analysis to determine clinical outcomes for individual patients on Patient-Initiated Follow-Up and health inequalities, and more extensive investigation of patient experiences. This study is registered with the Research Registry (UIN: researchregistry8864). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/138/17) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 38. See the NIHR Funding and Awards website for further award information.

Overview of T and D–T results in JET with ITER-like wall

Abstract In 2021 JET exploited its unique capabilities to operate with T and D–T fuel with an ITER-like Be/W wall (JET-ILW). This second major JET D–T campaign (DTE2), after DTE1 in 1997, represented the culmination of a series of JET enhancements—new fusion diagnostics, new T injection capabilities, refurbishment of the T plant, increased auxiliary heating, in-vessel calibration of 14 MeV neutron yield monitors—as well as significant advances in plasma theory and modelling in the fusion community. DTE2 was complemented by a sequence of isotope physics campaigns encompassing operation in pure tritium at high T-NBI power. Carefully conducted for safe operation with tritium, the new T and D–T experiments used 1 kg of T (vs 100 g in DTE1), yielding the most fusion reactor relevant D–T plasmas to date and expanding our understanding of isotopes and D–T mixture physics. Furthermore, since the JET T and DTE2 campaigns occurred almost 25 years after the last major D–T tokamak experiment, it was also a strategic goal of the European fusion programme to refresh operational experience of a nuclear tokamak to prepare staff for ITER operation. The key physics results of the JET T and DTE2 experiments, carried out within the EUROfusion JET1 work package, are reported in this paper. Progress in the technological exploitation of JET D–T operations, development and validation of nuclear codes, neutronic tools and techniques for ITER operations carried out by EUROfusion (started within the Horizon 2020 Framework Programme and continuing under the Horizon Europe FP) are reported in (Litaudon et al Nucl. Fusion accepted), while JET experience on T and D–T operations is presented in (King et al Nucl. Fusion submitted).