scholarly journals 05 Profile of a Geriatric Neurosurgical Service

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Kareena Malone ◽  
Fiona Kinsella
Keyword(s):  
Catchment Area ◽  
Surgical Intervention ◽  
Traumatic Event ◽  
Service Planning ◽  
Service Development ◽  
Irish Population ◽  
Complex Needs ◽  
National Trauma ◽  
Data Points ◽  
National Profile

Abstract Background According to the 2016 CSO figures the age category of 65 and older saw the largest increase in the Irish population since 2011, rising by 102,174 to 637,567, a rise of 19.1%. This remains a major concern for a North Dublin teaching hospital as its catchment area has a 20% higher proportion of > 65’s and > 85’s than the national average. This catchment area profile has the potential to impact on the profile of the in-catchment admissions while the National profile will impact on the national specialities including neurosurgery. Aim To profile the geriatric neurosurgical population and provide insight that facilitates future service planning and delivery. Methods To accurately capture the data, all ward lists for the month of June and July 2017 were reviewed to identify appropriate patients. All patients on any ward within the hospital, under the care of a neurosurgeon, were included in the data collection. Patients in intensive care that did not transfer to the wards were excluded. Data points including age, sex, consultant, co-morbidities, mobility status and surgical intervention were captured. Results 120 patients ≥ 65 years were admitted to the neurosurgical service between June and July 2017; 45 (38%) between 60-69, 60 (50%) 70-79, 13(10%) 80-80 and two (2%) ninety years or older. The two most common reasons for admission were non-traumatic cerebral bleeds (N= 40; 34%) and cerebral tumours (N= 38; 32%). Patients had on average four co-morbidities, with cardiac being the most common. 17 patients were admitted post a traumatic event; 13 low impact falls, 3 high impact falls and one assault. The average LOS for these patients was 11.3 days. Conclusion This profile highlights the complex needs of this population and the increasing burden on existing neurosurgical resources as the population continues to age. Future resource allocation and service development, including the National Trauma Strategy, needs to consider the needs of the aging neurosurgical population.

scholarly journals 444 Acute Surgical Admissions at the End of Life: An Analysis of Deaths in Non-operatively Managed Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Clements ◽  
M El Boghdady ◽  
A Alijani
Keyword(s):  
Surgical Intervention ◽  
Care Service ◽  
Palliative Care Service ◽  
Service Planning ◽  
Do Not Resuscitate ◽  
Bowel Ischaemia ◽  
Time To Death ◽  
Surgical Emergencies ◽  
Data Points ◽  
Comorbidity Index

Abstract Aim Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission. Method This single-centre retrospective, observational study collected data points for a 12-month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis. Results 72 patients were included. 68.1% of patients died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis, or new malignancy (median 2 vs 7 days, p < 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death. Conclusions Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.

scholarly journals TP9.2.7Acute Surgical Admissions at the End of Life: an Analysis of Deaths in Non-operatively Managed Patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hollie Clements ◽  
Michael El Boghdady ◽  
Afshin Alijani
Keyword(s):  
Surgical Intervention ◽  
Care Service ◽  
Palliative Care Service ◽  
Service Planning ◽  
Do Not Resuscitate ◽  
Bowel Ischaemia ◽  
Time To Death ◽  
Surgical Emergencies ◽  
Data Points ◽  
Comorbidity Index

Abstract Aims Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission. Methods This single-centre retrospective, observational study collected data points for a 12 month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis. Results 72 patients were included. 68.1% of patients died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis or new malignancy (median 2 vs 7 days, p < 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death. Conclusion Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.

scholarly journals Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John Downey ◽  
Katie Shearn ◽  
Nicola Brown ◽  
Ross Wadey ◽  
Jeff Breckon
Keyword(s):  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Developed Countries ◽  
Realist Evaluation ◽  
Service Planning ◽  
Service Development ◽  
Activity Levels ◽  
Programme Theory ◽  
Implementation Framework ◽  
Exercise Referral

Abstract Background Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom. Methods An eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework. Results Three programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice. Conclusions The findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development.

A service evaluation of a specialist migrant maternity service from the user's perspective

2020 ◽  
Vol 28 (9) ◽  
pp. 652-659
Author(s):  
Alex Filby ◽  
Wendy Robertson ◽  
Eugenia Afonso
Keyword(s):  
Maternal Nutrition ◽  
Service Evaluation ◽  
Service Development ◽  
Maternity Service ◽  
College Hospital ◽  
Complex Needs ◽  
Level Of Satisfaction ◽  
Awareness Raising ◽  
High Level ◽  
Depth Interviews

Background Meeting the complex needs of pregnant migrants requires an innovative approach. Migrant women's experiences and opinions should directly guide service development if these needs are to be met effectively. Aims To evaluate the specialist migrant maternity service provided by Kings College Hospital London based upon users' experience and satisfaction. Methods A qualitative service evaluation via semi-structured, multi-lingual, in-depth interviews with 10 service users. Data was analysed using a general inductive approach for thematic analysis. Findings Positive aspects: access to midwife and referrals, provision of essentials and transport, respect and kindness of caregivers. Negative aspects: poor maternal nutrition, lack of access to hygienic infant-feeding equipment, lack of social support building and lack of service signposting. Conclusion Women conveyed a high level of satisfaction with the service. The negative aspects that persist are, arguably, not within the immediate remit of the maternity team, yet they negatively affect the health of these women, and therefore merit awareness raising if holistic care is to be achieved. Seven service recommendations have been made.

Profile of Young People Attending Alcohol and Other Drug Treatment Services in Aotearoa, New Zealand: Clinical File Search

2008 ◽  
Vol 42 (11) ◽  
pp. 963-968 ◽  
Author(s):  
Ria Schroder ◽  
Doug Sellman ◽  
Chris Frampton ◽  
Daryle Deering
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
New Zealand ◽  
Young People ◽  
Mental Health Disorder ◽  
Service Development ◽  
Complex Needs ◽  
Treatment Services ◽  
Aotearoa New Zealand ◽  
Clinical File

Objective: The aim of the present study was to provide a profile of young people attending alcohol and other drug (AOD) treatment services in Aotearoa, New Zealand. Method: Data were gathered from a clinical file search of 184 randomly selected young people aged 13–19 years who had attended one of eight youth AOD treatment services in New Zealand during 2003 or 2004. These services represented eight of the 11 youth-specific AOD services available to youth in New Zealand. Results: Young people who attend youth-specific AOD services in New Zealand present with a range of complex needs including substance use and mental health issues, criminality, family conflict and disengagement from school. A total of 62.0% were male, 56.4% had criminal convictions, 40.6% had spent some time in Child, Youth and Family Services care and 53.8% were reported to have a coexisting substance use and mental health disorder. Low rates of reporting of substance use and mental health diagnoses in treatment files suggest that substance use and mental health disorders among this population are likely to be higher than those reported. Conclusions: This paper provides a unique profile of young people attending youth-specific AOD treatments in New Zealand. Such information is useful in informing treatment planning and funding and ensuring that service development occurs to specifically meet the complex needs of this patient group.

scholarly journals 274 From Clinical Care Programme to Frailty Pathway; a Multidisciplinary, Interagency Journey

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Amanda Casey ◽  
Chie Wei Fan ◽  
Joseph Duggan
Keyword(s):  
Older Persons ◽  
Care Pathway ◽  
Clinical Care ◽  
Service Planning ◽  
Healthcare Organisation ◽  
Readmission Rates ◽  
Care Programme ◽  
Community Healthcare ◽  
Complex Needs ◽  
Steering Group

Abstract Background The National Clinical Programme for Older Persons was introduced in the Model 4 Adult teaching hospital in 2012 with the development of a Specialist Geriatric Ward, supported by an existing Day Hospital and access to post acute rehabilitation in the local model 3 hospital. The continuing growth of the population over 70 years in the catchment area and the increasing awareness of the complex needs of this group of patients required a new way of thinking and working. Methods Using Lean methodology the group restructured the focus of the care pathway for older persons using evidence based practice and data collection. Workstreams have been identified and iterative project charters established to guide and empower staff to design and evaluate the supports they provide. Key internal and external stakeholders were identified and invited to participate in the ongoing steering group and the voice of the customer was used to underpin targeted improvements. Results The hospital now has a structured framework for the delivery and evaluation of care provided to older persons attending our services. Overall governance is provided by a Frailty Steering Group with strong clinical leadership and is informed by agreed quality indicators and realtime data. Despite increases in numbers requiring admission, length of stay has decreased, readmission rates have remained stable and a greater proportion of our patients are accessing both offsite rehabilitation and home supports on discharge. Conclusion This is an ongoing project with medium and long term goals identified across all workstreams. The evidence and data gathered will inform service planning and resource allocation. A number of collaborative research proposals are now being considered from across acute hospital and Community Healthcare Organisation.

Case Study of Cluster Analysis in Intercity Passenger Rail Planning and Marketing

2011 ◽  
Author(s):  
Ben Sperry ◽  
Curtis Morgan
Keyword(s):  
Cluster Analysis ◽  
Development Planning ◽  
Lessons Learned ◽  
Service Planning ◽  
Service Development ◽  
Valuable Insight ◽  
Passenger Rail ◽  
Analysis Methodology ◽  
Rail Service

Recent policy and regulatory initiatives have established new momentum for intercity passenger rail among planners, policymakers, and the general public. As a result, there is a great interest in developing new passenger rail lines and expanding existing routes in intercity corridors across the country. Moving forward, there exists a need to understand how current passenger rail services are being utilized, who is riding them, and what changes could be implemented to existing routes to attract ridership — as well as to document lessons learned from existing lines that can aid service development planning for newly proposed routes. In this paper, cluster analysis is applied to passenger survey data obtained in 2007 from riders of three Amtrak routes in the state of Michigan, USA. Cluster analysis is a multivariate data analysis method used extensively in marketing and customer profile research which seeks to identify similarities among potential customers that are not immediately evident using traditional grouping techniques. Data used in the formation of the passenger clusters include traveler alternatives to the passenger rail service and the importance of service attributes, on-board activities, and station amenities. These variables and other data from the passenger survey are then used to characterize the identified clusters in terms of what kinds of passengers are in each cluster and how these passengers benefit from the rail service. The passenger clusters are also analyzed for their potential response to service improvements such as reduced travel time, increased service frequencies, or improved intermodal connections. The findings of this case study can be applied in a number of activities related to intercity passenger rail service planning for existing as well as proposed routes. The findings provide valuable insight into the needs and preferences of current passengers and can be used to formulate strategies for equipment investments or the development of new on-board amenities. From a policy perspective, passengers’ preferences for alternative travel modes in the absence of the rail service reveal how the rail service supports intercity mobility for each of the clusters. Finally, from the cluster profile, potential strategies to attract new riders can be identified. The results show that clustering analysis methodology applied in this case study is a valuable tool for intercity passenger rail planning.

Bridging the ocean: Kiribati Australia alliance in mental health

2017 ◽  
Vol 25 (5) ◽  
pp. 474-477
Author(s):  
Brigid Ryan ◽  
Manrenga Viane ◽  
Fran Timmins ◽  
Alex Smith ◽  
Claire Anstey
Keyword(s):  
Mental Health ◽  
Psychiatric Treatment ◽  
Service Planning ◽  
International Exchange ◽  
Service Development ◽  
Community Based ◽  
Custodial Care ◽  
General Training ◽  
Short Time ◽  
Acute Psychiatric Treatment

Objective: The objective of this study was to demonstrate the benefits of collaboration between Australia and Kiribati, a Pacific island nation, to enhance Kiribati’s mental health system. Method: The collaboration involved a training program for a Kiribati senior mental health leader in Melbourne, Australia, and service planning including prioritisation of key areas for development. Results: As well as receiving general training in community-based mental health, the Kiribati mental health leader gained skills in modification of the inpatient environment, with plans for implementation in Kiribati within the current limited resources. Future planning will focus on shifting from an emphasis on acute psychiatric treatment and custodial care to a recovery-oriented approach. Conclusion: The international exchange was a positive experience for both the Kiribati participants and their Australian colleagues. Knowledge transfer was achieved in a short time, and service development appropriate and realistic for the Kiribati environment was planned.

scholarly journals Closing the UK care home data gap – methodological challenges and solutions

2020 ◽  
Vol 5 (4) ◽  
Author(s):  
Jennifer Kirsty Burton ◽  
Claire Goodman ◽  
Bruce Guthrie ◽  
Adam L Gordon ◽  
Barbara Hanratty ◽  
...  
Keyword(s):  
Large Scale ◽  
Care Delivery ◽  
Care Home ◽  
Routine Data ◽  
Service Planning ◽  
Data Sources ◽  
Care Homes ◽  
Service Development ◽  
Individual Level ◽  
Data Gap

UK care home residents are invisible in national datasets. The COVID-19 pandemic has exposed data failings that have hindered service development and research for years. Fundamental gaps, in terms of population and service demographics coupled with difficulties identifying the population in routine data are a significant limitation. These challenges are a key factor underpinning the failure to provide timely and responsive policy decisions to support care homes. In this commentary we propose changes that could address this data gap, priorities include: (1) Reliable identification of care home residents and their tenure;  (2) Common identifiers to facilitate linkage between data sources from different sectors; (3) Individual-level, anonymised data inclusive of mortality irrespective of where death occurs; (4) Investment in capacity for large-scale, anonymised linked data analysis within social care working in partnership with academics; (5) Recognition of the need for collaborative working to use novel data sources, working to understand their meaning and ensure correct interpretation; (6) Better integration of information governance, enabling safe access for legitimate analyses from all relevant sectors; (7) A core national dataset for care homes developed in collaboration with key stakeholders to support integrated care delivery, service planning, commissioning, policy and research. Our suggestions are immediately actionable with political will and investment. We should seize this opportunity to capitalise on the spotlight the pandemic has thrown on the vulnerable populations living in care homes to invest in data-informed approaches to support care, evidence-based policy making and research.  

scholarly journals Collaboration in RDM activities – Practices and development at Aalto University

2017 ◽  
Author(s):  
Maria Söderholm ◽  
Anne Sunikka
Keyword(s):  
Data Management ◽  
Data Storage ◽  
Research Data ◽  
Service Planning ◽  
Open Access Publishing ◽  
Service Development ◽  
It Services ◽  
Data Services ◽  
Service Portfolio ◽  
Starting Point

Watch the VIDEO here. Presenter – Maria SöderholmResearch data management (RDM) is a complex and dynamic topic, and demands diverse expertise, skills and knowledge. The RDM expertise includes subtopics like collection/provision of data; storage and processing of data; long-term preservation requirements of the data; and funders’ demands and solutions to share, re-find and re-use research data. Usually the expertise related to these RDM subtopics is spread to several university units, both academic and administrative. Therefore, many tasks related to RDM, for example, day-to-day practices, the supply of services and the development work are best carried out in a network-based cooperation.In the presentation, we will introduce our RDM related partnership and networking of Aalto University. As a starting point, we introduce the internal service development working principles that our RDM network work is based on. However, the focus will be on describing our RDM working group and development activities.Aalto’s Research Data Management Programme forms the backbone for RDM work. It establishes seven separate action points for RDM activities: 1) open access  publishing; 2) implementation of data management planning tool; 3) metadata catalogue for open data; 4) data publishing; 5) comprehensive repository service for storage, back-up and collaboration; 6) combining openness and innovation; and 7) RDM awareness building activities. The actors in the RDM network consist of Research and Innovation Services (leading the group), IT Services, and Learning Centre (previously Library).In the presentation, we will introduce the core actors in more detail, paying attention to the complementarity of the roles; and the activities and the aims, which steer the work. We also discuss the meaning and consequences of the network-based cooperation for the working group.First, the RDM group acts as a joint platform for comprehensive RDM information. Important means of data gathering are surveys and informal discussion with researcher. In the future, formal group discussions on RDM needs are hosted. The previous discussions with researchers have underlined the importance of arranging services for both disciplinary and data specific needs in addition to common university level service needs.Second, the group is a messenger of the RDM topics. Our task is to rise internal RDM awareness and disseminate national and international information and development trends in the university.The third and the most challenging aim is the RDM service planning and delivery. Our task is to identify the existing in-house services, to map the suitable services provided by national and international agents as well as to recognize the needs for new services. Our service portfolio covers both consultation/informational services and technical, hands-on services. However, many of our research data services are still in the planning or piloting stage, thus cooperation with researchers is essential.In our experience, the network-based collaboration model that foster individuals’ interconnectedness is crucial for surviving with the built-in dynamism of RDM. This model provides a non-hierarchical and flexible environment for actions to meet the increasing expectations for research data services we face from the funders, governments, and researchers.

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