Terms Of Planning Research Articles

The Use of Online Consultation Systems or Remote Consulting in England Characterized Through the Primary Care Health Records of 53 Million People in the OpenSAFELY Platform: Retrospective Cohort Study.

The National Health Service (NHS) Long Term Plan, published in 2019, committed to ensuring that every patient in England has the right to digital-first primary care by 2023-2024. The COVID-19 pandemic and infection prevention and control measures accelerated work by the NHS to enable and stimulate the use of online consultation (OC) systems across all practices for improved access to primary care. We aimed to explore general practice coding activity associated with the use of OC systems in terms of trends, COVID-19 effect, variation, and quality. With the approval of NHS England, the OpenSAFELY platform was used to query and analyze the in situ electronic health records of suppliers The Phoenix Partnership (TPP) and Egton Medical Information Systems, covering >53 million patients in >6400 practices, mainly in 2019-2020. Systematized Medical Nomenclature for Medicine-Clinical Terminology (SNOMED-CT) codes relevant to OC systems and written OCs were identified including eConsultation. Events were described by volumes and population rates, practice coverage, and trends before and after the COVID-19 pandemic. Variation was characterized among practices, by sociodemographics, and by clinical history of long-term conditions. Overall, 3,550,762 relevant coding events were found in practices using TPP, with the code eConsultation detected in 84.56% (2157/2551) of practices. Activity related to digital forms of interaction increased rapidly from March 2020, the onset of the pandemic; namely, in the second half of 2020, >9 monthly eConsultation coding events per 1000 registered population were registered compared to <1 a year prior. However, we found large variations among regions and practices: December 2020 saw the median practice have 0.9 coded instances per 1000 population compared to at least 36 for the highest decile of practices. On sociodemographics, the TPP cohort with OC instances, when compared (univariate analysis) to the cohort with general practitioner consultations, was more predominantly female (661,235/1,087,919, 60.78% vs 9,172,833/17,166,765, 53.43%), aged 18 to 40 years (349,162/1,080,589, 32.31% vs 4,295,711/17,000,942, 25.27%), White (730,389/1,087,919, 67.14% vs 10,887,858/17,166,765, 63.42%), and less deprived (167,889/1,068,887, 15.71% vs 3,376,403/16,867,074, 20.02%). Looking at the eConsultation code through multivariate analysis, it was more commonly recorded among patients with a history of asthma (adjusted odds ratio [aOR] 1.131, 95% CI 1.124-1.137), depression (aOR 1.144, 95% CI 1.138-1.151), or atrial fibrillation (aOR 1.119, 95% CI 1.099-1.139) when compared to other patients with general practitioner consultations, adjusted for long-term conditions, age, and gender. We successfully queried general practice coding activity relevant to the use of OC systems, showing increased adoption and key areas of variation during the pandemic at both sociodemographic and clinical levels. The work can be expanded to support monitoring of coding quality and underlying activity. This study suggests that large-scale impact evaluation studies can be implemented within the OpenSAFELY platform, namely looking at patient outcomes.

Stakeholders’ Perceptions on Influence of Energy Efficiency Practices Adopted on Economic Performance of Selected Small and Medium Sized Manufacturing Enterprises in Nakuru County, Kenya

The adoption of environmental policy among large manufacturing firms has been recognized for enhancing their economic performance. This is crucial for achieving Kenya's Vision 2030, the fourth medium term plan (2023-2027) and the Bottom-Up Economic Transformation Agenda (BETA) for Inclusive Growth. Despite the slow pace, small and medium-sized enterprises (SMEs) are now adopting these policies to reduce their environmental footprint. However, there is limited documentation on how these practices affect their economic performance. Hence, this study aimed at examining stakeholders' perceptions on the influence of adopting energy efficiency practices on the economic performance of selected manufacturing SMEs in Nakuru County. The study was guided by the ecological modernization theory (Win-Win principle). An explanatory sequential mixed-method research design was employed, targeting SME proprietors in the manufacturing sector with a sample size of 76 respondents. Descriptive and inferential statistics (linear regression) was used to analyze quantitative data, while content analysis was used to analyze qualitative data. The study found out that SMEs largely adopted the use of energy-efficient bulbs and turned off lights when not in use. However, they used solar lighting as an energy efficiency practice to a lesser extent because they consider this practice expensive. The study also found that stakeholders perceived that energy efficiency practices adopted had a significant influence on the economic performance of selected manufacturing SMEs. This finding implied that energy efficiency practices adopted by manufacturing SMEs would have an influence on SMEs economic performance. This study recommends that the government, both national and county should sensitize the SMEs as well as allocate financial and technical resources to support SMEs implement and upscale their energy efficiency practices within their operations. The focus of energy efficiency practices should be on those that reduce production costs and enhance competitiveness such as those that improve SMEs customer base

Increasing same-day emergency care activity in an existing ambulatory care unit using quality improvement methodology

This project aimed to increase same-day emergency care (SDEC)-suitable activity within an existing ambulatory medical unit, in line with the recommendations set out in the NHS Long Term Plan. Prior to the project, much of the unit's activity was non-urgent and focused on supporting early discharges. Scoping exercises were undertaken to better understand current activity and identify interventions to increasing same-day referrals from within the urgent and emergency care system. Quality improvement methodology was then used to implement and study a variety of interventions, including but not limited to the development of new condition-based referral pathways. Retrospective review of SDEC activity demonstrated a threefold increase.

PENGELOLAAN E- LAYANAN KONSELING DALAM PENINGKATAN DISIPLIN PESERTA DIDIK BERBASIS WHATSAPP

Counseling services are less effective in conveying relevant and useful information to students, as well as the use of media is not optimal and there is a lack of time in providing counseling services to improve student discipline. Electronic counseling is an alternative that is relevant to technological developments and the needs of today's modern students. However, it is necessary to manage WhatsApp-based e-counseling services to improve student discipline at SMAN 4 Banda Aceh. The aim of this research is to determine the planning, implementation and obstacles to WhatsApp-based e-counseling services in improving student discipline. This research uses a descriptive qualitative approach. The research subjects were guidance and counseling teachers, homeroom teachers, and students. Data collection techniques use observation, interviews and documentation, then the data is analyzed through triangulation techniques. The results of this research show that planning WhatsApp-based e-counseling services was carried out through stages: 1) survey of student needs and interests; 2) communication with parents and homeroom teachers 3) formation of several Whatsapp groups; 4) distribution of tasks to guidance and counseling teachers; 5) and long term planning. The implementation of WhatsApp-based e-counseling services is carried out in stages: 1) Analysis of student needs via the assessment questionnaire link; 2) introduction of WhatsApp-based counseling materials to parents and students; 3) individual counseling and group counseling via WhatsApp; 4) follow-up to students who have not changed; 5) collaboration with parents and homeroom teachers to resolve cases. Obstacles in managing WhatsApp-based e-counseling services include: 1) students are late in filling out assessment questionnaires via the website; 2) misuse of WhatsApp; 3) technological limitations; 4) lack of non-verbal communication between counselors and students

Attitudes, knowledge and understanding towards mind-body practices as an asset for social prescribing in higher education

ABSTRACT Evidence is growing to support mind-body practices (e.g. yoga) as a therapeutic intervention for many health conditions. In the UK, yoga is promoted as a social prescription asset by the National Health Service (NHS), yet the factors influencing its implementation are poorly understood. This study explored the attitudes, knowledge and understanding of mind-body practices as a social prescribing asset amongst health science populations within higher education. Twenty-six health science staff and students completed an online questionnaire. Data analysis used a mixed-methods approach, employing thematic analysis for qualitative data and calculating the net promoter score (NPS) to assess participants’ inclination to recommend mind-body practices as a social prescribing asset. Nineteen participants (73%) were aware of the term ‘social prescription’ and understood it to be a non-clinical, community-based alternative to medication. Whilst participants were aware of the physical benefits of mind-body practices, particularly yoga, they lacked awareness of the social, emotional, and spiritual benefits. Although 42% of participants would recommend mind-body practices as a social prescribing asset (NPS of 15), the opposite was true for yoga (NPS of −15), potentially due to poor knowledge or personal engagement with yoga. This study underlines the importance of increasing understanding and promoting yoga as an adjuvant mind-body practice to achieve social, emotional, and spiritual benefits. Implementing educational strategies to increase knowledge of mind-body practices and yoga, with a focus on social prescribing practice, may help to improve future referral pathways in practice in line with the NHS long term plan.

MODERNISING PAKISTAN’S SHIPPING REGULATIONS AND TRADE FACILITATION AUTHORITIES UNDER CONVENTION ON THE FACILITATION OF INTERNATIONAL MARITIME TRAFFIC 1965

A developing maritime economy like Pakistan can greatly benefit from the comprehensive framework of standards, guidelines, and recommended practices provided by the modern and comprehensive provisions of the Convention on the Facilitation of International Maritime Traffic 1965 (FALC). This study’s objective is to analyse the FALC’s legal provisions and Pakistan's domestic maritime law in relation to ship and port juncture activities in order to make recommendations for updating the country's current statutory rules and regulations in line with international standards, conventions and practices. According to the study, the FALC has significantly facilitated international maritime traffic through the harmonisation and standardisation of its port and shipping procedures. Following the FALC's and the facilitation committee's approved guidelines will improve Pakistan's overall competitive standing as an emerging regional shipping hub, especially under the long term plan for China Pakistan Economic Corridor. Furthermore, it will also allow Pakistan to sustainably transform into a significant maritime transit trade centre in the Western Indian Ocean Region.

O-243 Promoting family building strategies - a global call to action

Promoting family building strategies - a global call to action Study question Are there any strategies that can be improved or implemented to promote family building and slow down the global decline in fertility rates? Summary answer Fertility rates are dangerously decreasing worldwide, therefore current strategies need to be improved and new ones should be developed to face present-day challenges. What is known already Although to different extent, almost half of the countries in the world are below replacement level due to generalized fertility decline. Through the years, many of them have put in place policies to promote natality, with variable results depending on the kind of strategy adopted, on socio-cultural factors and on other local peculiarities. Most commonly used policies include prevention and education, plans aimed at allowing couples to have children (ensuring work stability, financial stability, housing stability), benefits and incentives for families and implementation of childcare services and facilities. Assisted Reproduction Techniques (ART) have also been considered a potential tool to boost fertility rates. Main results and role of chance Quite surprisingly, however, even countries who have been adopting high-quality family-friendly policies are experiencing a decline in fertility rates (e.g. Finland) and strategies that have been effective in the past century may be even counterproductive nowadays. In fact, cultural, psychological, biological and cognitive factors should also be taken into consideration (alongside social and economical ones) and it should not be forgotten that attitude towards having children is not stable and may be subject to sudden, unpredictable changes (e.g. war in Ukraine and Middle East). With specific reference to ART, it has been undergoing tremendous scientific and technical development in the last few decades, fueling the unrealistic expectation that it might solve all fertility problems and allow people to have children at any age. Actually, however, ART success rates are relatively low, especially in specific categories of patients. On the other hand, costs of these treatments are particularly high, which also affect accessibility for some of the patients in need. Financial, physical and emotional toll even of a single ART cycle can be burdensome for most couples, who tend to give up after a couple failed attempts. However, data in literature show that in specific categories of patients, repetition of up to 5-6 cycle can importantly increase success rates. Based on this assumption, the scientific community worldwide should start considering an ART treatment not as a single cycle, but a succession of more cycles, as deemed appropriate based on the patients’ characteristics. Number of cycles offered, planning and pricing should of course be adjusted accordingly. This paradigm shift might be difficult to instill in both professionals’ and patients’ minds, but it might turn out to be tremendously useful for ones as well as the others. Limitation, reasons for caution Although a global intervention in favour of family building is required, individual countries should design multidisciplinary strategies taking into account local and regional peculiarities. The above mentioned paradigm shift might initially encounter resistance from couples and professionals until its benefits are clearly documented. Wider implications of the findings Data show that it is essential that policymakers, healthcare professionals and other institutional stakeholders team up to raise awareness on infertility and to develop long term plans aimed at inverting this insidious trend that is already affecting all society and is destined to get even worse if not immediately tackled in a determined and cooperative way.

Supporting advanced practice: feedback from a mental health, community and primary care advanced practice support project in South Yorkshire, UK

Background: Despite the significant input from Heath Education England (HEE), now NHS England (NHSE), there are still significant variations around advanced practice programmes, support and training, particularly in less developed areas such as mental health, community posts and primary care. To help target these areas, and to support the NHS Long Term Plan (2023) to increase the number of advanced clinical practitioners (ACPs), the Faculty of Advanced Practice South Yorkshire recruited three ACP leads from mental health, community, and primary care backgrounds to establish a support project led by one professional lead. These leads were able to utilise their lived experience of completing the ACP MSc programme and working as an ACP to help trainee advanced clinical practitioners (tACPs) navigate their journey. The ACP leads also developed a variety of educational events, which further supported the trainees' needs. Aim: This article reports the feedback given via an online questionnaire from trainees that accessed the project, which ended in March 2024. Its aim is to highlight the often-undervalued concept of using clinicians personal experience regarding advanced training and practice, to mentor, support and ultimately retain the future ACP workforce. Methods: An email with a link to a questionnaire was sent to 128 tACPs or recently qualified ACPs that had applied for their training via the Faculty of Advanced Practice South Yorkshire. The questionnaire, created in Microsoft Forms, was completed anonymously, and produced both numerical and free-text data. The questionnaire solicited feedback around: the number of contacts they had and how they contacted; the ACP leads; types of support accessed; and the educational events available. Free text answers were analysed by the author (CJ) and a second reviewer (SF) to generate a consensus on themes. Results: A total of 64 clinicians responded, of which 43 were tACPs, 10 were ACPs, five had other job titles (community matron, pharmacist, practice nurse) and five did not state what their job title was. Responses suggest that the support accessed from the project was highly beneficial and could not be gained elsewhere. A key factor in the project's success was the ACP leads' lived experience of having previously completed advanced practice training, as well as their ability to tailor learning events to the trainees' needs. Conclusion: Meeting the demands of ACP training in areas where the role is less established remains an ongoing challenge. It seems some of these challenges relate to the lack of practical support being provided by employers or higher education institutions, such as lived experience of completing the task of ACP training. Support projects, like the one discussed in this article, appear aptly placed to help fulfil these needs and begs the question ‘why aren't there more?’, especially when advanced practitioners are fundamental to the future healthcare workforce.

Widening access to older people’s clinical psychology: Piloting a summer shadowing programme in older adults services

Within recent years, there has been an expansion of UK clinical psychology courses, additional psychological professions and increased attention to psychological wellbeing as part of the NHS Long Term Plan (NHS England, 2019). It has been an energetic time for clinical psychology and in turn, older adult clinical psychology. However, despite the expansion of training places, pervasive social inequalities have meant that for some a career in clinical psychology is less accessible, meaning that the psychology workforce is less diverse. This, in combination with lack of parity in investment for Older Adult Services, can mean older adults’ access to more representative psychological professionals remain hindered. The current paper explores a recent shadowing programme that our small psychology team and older adults’ mental health team piloted in the summer of 2023. Eight female students were able to complete the programme and provided insightful feedback on the experience. We reflect on future learnings and recommendations of setting up such projects in older adult services.

An evaluation of outpatient service provision in the National Health Service in Great Britain: A freedom of information request.

The National Health Service (NHS) Long Term Plan was published in January 2019. One of its objectives was restructuring outpatient services, as part of an Outpatient Transformation initiative. Monitoring of trusts' adherence to the objectives of the Long Term Plan is therefore required to benchmark progress against national objectives. We aimed to explore whether outpatient transformation initiatives and phlebotomy services that are managed by outpatients are appropriately staffed and to evaluate trusts' adherence to the objectives outlined in the Long Term Plan. A freedom of information (FOI) request was sent in January 2023 to 153 trusts across Great Britain (time span: 1 January 2022-31 December 2022). Parameters requested included number of outpatients seen/discharged, phlebotomy episodes, number of sites/wards covered by phlebotomy, target/actual did not attend (DNA) rates, time since inception of the outpatient transformation project (OTP), advice and refer (A&R) and patient-initiated follow-up (PIFU), phlebotomy and outpatient managerial establishment and use of electronic notes and patient portals. A total of 117 trusts (76.5%) provided responses to the FOI request. The mean number of new outpatients seen face-to-face was 185,810. Of 73 trusts reporting both actual and target DNA rates, 62 (84.9%) did not meet their DNA targets. The actual DNA rate was significantly greater than the target DNA rate across trusts (p < 0.001, mean: 8.8% vs. 6.5%, respectively). A total of 58 different electronic systems and 29 patient portals were utilised across trusts. Thirty-six trusts (30.3%) did not have an outpatient transformation project manager and 16 trusts (13.7%) did not initiate an OTP. With phlebotomy provision, the mean number of outpatient phlebotomy episodes was lower than inpatient episodes (83,383 vs. 91,020, respectively). There are deficiencies in current outpatient establishments that may hinder the achievement of objectives set in the NHS Long Term Plan. Changes at all levels of healthcare are required, with increased reliance on technologies and investment in support for transformation management.

A national research survey of childhood autism assessment services in the UK: empirical evidence of diagnostic practice, challenges and improvement opportunities

BackgroundThe UK National Health Service (NHS) Long Term Plan aims to reduce waiting times for childhood autism diagnostic assessment and improve parent and child satisfaction. This empirical research investigated current...

Advancing familial hypercholesterolaemia (FH) screening in primary care: an updated systematic review of systematic screening methods for identificaton of FH.

Familial Hypercholesterolaemia (FH) is a greatly underdiagnosed and treatable genetic lipid disorder which significantly increases risk of premature cardiovascular disease. The prevalence of monogenic FH is thought to be 1 in 250-350. The NHS Long Term Plan aims to increase FH detection to at least 25% over 5 years in collaboration with primary care, supported by the NHS genomics programme. This systematic review evaluates systematic screening methods for FH in adults aged ≥18 years in primary care. Seven databases [Cochrane, PubMed, Ovid, CINAHL, ProQuest, Web of Science, Scopus], four clinical trial registries [ISRCTN, ANZCTR, Clinicaltrials.gov, WHO-ICTRP] and relevant grey literature [OpenGrey] from March 2020 to May 2023 were searched. Only studies including adults were eligible. Risk of bias was assessed using ROBINS-I. 831 records were screened. No randomised, controlled studies were identified. From full-text review, five eligible non-randomised studies out of 57 (6.90%) were identified. The included studies all used automated FH case-identification from electronic medical records (EMR) and were high quality studies with a moderate risk of bias. Narrative synthesis reported outcomes which included three algorithmic studies, with a pooled detection rate, DR 14.4% (95%CI 11.67-16.62), one supervised Machine Learning [Ensemble] study, DR 15.5% (95%CI 15.47-15.53) and one study utilising a hybrid diagnostic EMR model and/or FH genotype confirmation DR 25.0% (95%CI 16.30-35.8). No adverse effects were reported in these studies. Incorporating automated case-finding from EMR with clinical follow-up in primary care can enhance FH identification. Pathways incorporating genotyping showed the best detection rate.

Information aggregation as potential for value addition to organizations: A review

In the development of Kenya Vision 2030 Third Medium Term Plan (MTP III) 2018-2022, the Blue Economy (BE) sector was recognised as one of the emerging economic fronts that are expected to significantly contribute to Kenya’s economic growth. Subsequently, there were calls to develop and manage a BE database. Despite these calls, there is currently no comprehensive database containing BE related data for Kenya, in an accessible manner to the public. As a response to these calls, our research team sought to explore different types of information aggregators. The study adopted exploratory design and reports the review of three aggregators. From the review results, the study proposed the design and development of a digital platform for aggregating information on the BE ecosystem in Kenya. The digital platform provides potential value addition to the host organisation in the form of: attracting external funding; raising its reputation and online visibility and adding value to the community.

Implementation of a client–centric model of customer service (based on the example of customer service in the field of telecommunications and communications)

Growing competitive pressure and problems of customer churn in the telecommunications industry determine the need for an intensive transition to customer–centric service. The article studies the features of the implementation of a client–centric model of customer service using the example of customer service in the field of telecommunications and communications. The key stages and principles of transition to a customer–centric model are formulated, and the maturity levels of the customer relationship management system are highlighted. Based on the analysis of scientific literature on the research topic, the features and key approaches to managing customer service, development and strategic planning in the activities of telecommunications companies are determined. Objective differences are established in building relationships with B2C and B2B client segments. Based on the results of the study, recommendations are formulated for the implementation of a client–centric model of client service in the field of telecommunications and communications, suggesting a transition to an integrated construction of a client–centric business model for the telecommunications business. It is emphasized that despite the historical tendency towards short–term planning in the telecommunications industry, a customer–centric business model is becoming increasingly in demand in inextricable connection with the ecosystem approach and maximum customer retention.

Understanding financial statements

Financial statements are used to show the financial perfor­mance and status of businesses of all types. These statements can be used to analyze, manage and improve the performance of a business. It is important for a veterinary business owner or manager to understand what each of the business statements measures within their business. Further, it is important to learn how to use the information presented in the statements to help them manage both the daily business and assist in long term planning for the business. This presentation explains the financial statements and how to use them to make better busi­ness decisions in a veterinary practice and other businesses or organizations a veterinarian may be associated with.

Community rehabilitation for people with severe and enduring mental health difficulties: a description and evaluation of a new community enhanced rehabilitation team

Background/Aims The community enhanced rehabilitation team was implemented in 2021 as part of the NHS Long Term Plan. This evaluation assesses whether the team is meeting its aims and objectives.. Methods Qualitative and quantitative methods were used to assess the team's progress. This included semi-structured interviews with service users, staff questionnaires and a review of data collected as part of routine clinical care.. Results Findings showed 117 interventions had been provided via the community enhanced rehabilitation team since May 2021. Service user anxiety had reduced following intervention, and service users were less likely to be re-hospitalised if they were under the community enhanced rehabilitation team compared to other teams. Conclusions The community enhanced rehabilitation team is meeting its aims and objectives, suggesting this is an effective model for community rehabilitation teams. Implications for practice Community enhanced rehabilitation teams can be created using this model as an example.

Adapting the EQ-5D-3L for adults with mild to moderate learning disabilities

BackgroundApproximately 1.5 million adults in the UK have a learning disability. The difference between age at death for this group and the general population is 26 years for females and 22 years for males. The NHS Long Term Plan (January 2019) recognises learning disabilities as a clinical priority area. People with a learning disability are often excluded from research by design or lack of reasonable adjustments, and self-reported health status/health-related quality of life questionnaires such as the EQ-5D are often not appropriate for this population. Here, we systematically examine the EQ-5D-3L (its wording, content, and format) using qualitative methods to inform the adaption of the measure for use with adults with mild to moderate learning disabilities.MethodsThink-aloud interviews with carers/advocates of learning-disabled adults were undertaken to explore the difficulties with completing the EQ-5D-3L. Alternative wording, language, structure, and images were developed using focus groups, stakeholder reference groups, and an expert panel. Data analysis followed a framework method.ResultsThe dimensions and levels within the EQ-5D-3L were deemed appropriate for adults with mild to moderate learning disabilities. Consensus on wording, structure, and images was reached through an iterative process, and an adapted version of the EQ-5D-3L was finalised.ConclusionThe EQ-5D-3L adapted for adults with mild to moderate intellectual/learning disabilities can facilitate measurement of self-reported health status. Research is underway to assess the potential use of the adaptation for economic evaluation.

Patients’ views and behaviours in relation to asthma inhalers use and their impact on environmental sustainability: a cross-sectional survey study

Abstract Introduction Approximately 60 million inhalers are used annually in England, contributing 3% to the National Health Service (NHS) carbon footprint. Of these, 2 out of 3 are metered-dose inhalers (MDIs) containing greenhouse gas propellants.[1] The carbon footprint of an MDI device is around 500g CO2 equivalent, in contrast with the 20g CO2 equivalent of a dry powder inhaler (DPI).[2] The NHS Long Term Plan introduced measures on environmental sustainability, leading to the National Institute of Health Care and Excellence (NICE) launching a ‘shared decision aid’ to promote the discussion of options for inhaler devices. This landmark policy step could be more effective if received with patient support and informed behaviours of patients with regard to inhalers. Research is therefore needed to identify patients’ views and behaviours on this matter. Aim To identify patients’ views and behaviours related to environmental sustainability aspects of their use of inhalers for the management of asthma. Methods An anonymous self-completion paper-based questionnaire was administered to patients with a clinical diagnosis of asthma. These were recruited opportunistically via 10 community pharmacies in the South of England during the month of February 2020. They were provided information about the study and invited to participate by pharmacy staff when collecting prescriptions. Participants had to be prescribed at least one MDI inhaler and not to be using a DPI, and report on the use, disposal and views regarding their environmental impact. Responses to the questionnaire were coded and analysed using descriptive statistics. Results A total of 149 surveys were completed by patients, of which 47% (n=70) were male and 53% (n=79) were female. The age range of respondents varied with the majority 45.6% being 18-29 years old, followed by 21.5% in the 60-69 years category. Of these, 30.2% (n=48) were aware of MDI inhalers having an impact on carbon footprint, and 53% (n=79) on plastic pollution. A majority (81%) of patients stated that they were involved or partially involved in their inhaler choice. Only 62% (n=92) said they would be willing to switch their MDI to a more environmentally friendly inhaler with equal effectiveness, 15.4% (n=23) reported they would not be willing to do so and 22.1% (n=33) were not sure. Unwanted inhalers were returned by 43% (n=64) of participants for appropriate disposal, with 55% (n=82) of respondents being unaware of this option. A majority (91%, n=136) of participants said they would like further information about their inhalers and their impact on the environment. Conclusion There is scope for a more environmentally friendly management of asthma and the use of inhalers. Healthcare professionals are involving patients in decision making when prescribing, and pharmacists could contribute to this when dispensing. Patients would welcome information on the impact of inhalers on the environment and further research could identify more precisely on what aspects, alongside barriers preventing a switch to more environmentally friendly options. A small sample size and geographical area were limitations of this study, which could be overcome by further researching issues identified in this survey.

Customer Demand Forecast Using Time Series Approach

Nowadays we are living in an uncertain time (pandemics, wars, inflation, shortages) and for companies, predicting the future of the business becomes more and more difficult. From this point of view, we can resort to statistical forecasting methods that, based on on past data and current external trends, can predict figures for the short and long term planning. The motive, the scope, behind this study is to develop a forecasting model using time series that can help the organisations and the managers in taking better decisions, on time, for the future of the company. The data that were used for this paper are focusing on forecasting the demands for the sales budgets only, starting with the historical data from a company in the glass mould manufacturing area. If we examine the current literature, we can find that there a few studies, with real business data regarding budgeting, therefore this study is relevant and important for the researchers and practitioners. This paper aims to illustrate how we can use the time series statistical method and the linear equation regression that can help the organisations to forecast and plan the business. The main findings after developing the model are that it allows smoothing the fluctuations of the series over time (especially if we find outliers) and eliminating the influence of seasonality, in order to obain in the end a good accuracy of the predictions. In order to measure the quality of the forecasting we can use many indicators, such as Mean Absolute Percentage Error.

Place-leadership and power in the futures domain: the case of Euskadi 2040

ABSTRACT In an era when uncertainty and complexity are more tangible than ever, decision-makers are under pressure to turn from short-term politics and departmentalization to safeguard not only current wellbeing but also the wellbeing of future generations via longer term planning and visioning. In regions, as multilevel governance systems, no actor has the power to determine the decisions of others. Place leadership demands the mobilization of different actors to define an effective strategy for future development, by combining institutional, interpretive and network power in a dynamic manner. This paper reflects on how leadership and power shape shared vision in regional foresight processes, and the role of academic knowledge. We conduct an in-depth single case study analysis of ‘Euskadi 2040’, the visioning initiative launched by the Basque regional government in collaboration with the research institute Orkestra. We articulate five main contributions of research institutes: facilitating the systemic character of the vision; incorporating academic action-oriented knowledge; supporting the divergence from traditional linear planning paradigms towards flexible learning-centred approaches to policy; promoting an interinstitutional and multi-agent shared discourse; and lastly, leveraging knowledge transfer within international networks.