Search

Assistance dogs are highly trained animals to support individuals with disabilities and medical conditions. Evidence suggests the support provided by an assistance dog can extend beyond physical assistance to therapeutic and communicative domains. However, there is limited research exploring the lived experience of assistance dog placements in the United Kingdom (UK) over an extended period of time. This longitudinal service evaluation was designed to evaluate the placement of assistance dogs, trained by the charity Dogs for Good, with adults and children with autism or a physical disability in the UK. Goals and expectations of being matched with an assistance dog prior to placement, and perceptions of how these dogs have impacted the quality of life of adults and children with autism and/or a physical disability and their families were assessed. Service users who had applied for an assistance dog via the Dogs for Good charity (n = 307) were contacted and invited to complete questionnaires at five different time points (pre-dog placement, and 6-, 12-, 24-, and 36-months post dog-placement). Repeated-measures ANOVAs were conducted to determine if there were significant changes to quality of life over time. Mean quality of life scores improved significantly for all service users. Responses to free-text questions were thematically analysed, and three main themes were identified from the free-text responses: goals and expectations for assistance dog pre-placement (e.g., enhancing independence, physical functioning and wellbeing), the positive impact of the assistance dog post-placement (e.g., promoting independence, development of the human-animal bond, improving wider family dynamics, and reducing stigma), and satisfaction with the service. The findings complement and extend previous insights into the impact of assistance dogs on people with autism or a physical disability. They also highlight some challenges associated with the placement of assistance dogs and indicate the need to consider the development of further targeted support strategies.

Many firms are beginning to replace customer service employees with bots, from humanoid service robots to digital chatbots. Using real human–bot interactions in lab and field settings, we study consumers' evaluations of bot-provided service. We find that service evaluations are more negative when the service provider is a bot versus a human—even when the provided service is identical. This effect is explained by consumers' belief that service automation is motivated by firm benefits (i.e. cutting costs) at the expense of customer benefits (such as service quality). The effect is eliminated when firms share the economic surplus derived from automation with consumers through price discounts. The effect is reversed when service bots provide unambiguously superior service to human employees—a scenario that may soon become reality. Consumers' default reactions to service bots are therefore largely negative but can be equal to or better than reactions to human service providers if firms can demonstrate how automation benefits consumers. [ABSTRACT FROM AUTHOR]

Objective: To explore the perspectives of patients and hearing care providers (HCPs) about an adult remote hearing-aid delivery service implemented during the COVID-19 pandemic. Design: Service evaluation via surveys. The patient survey measured satisfaction with the service, perceived hearing-aid handling skills, and preferences for future services. The HCP survey explored the impact of teleaudiology on outcomes compared to in-person care and factors important for successful teleaudiology. Study sample: 378 patients and 14 HCPs. Results: Patients were highly satisfied with the service and self-reported good hearing-aid handling skills. However, 2 in 3 patients said they would prefer a future hearing-aid fitting to be in-person rather than remote. HCPs thought teleaudiology had positive impacts on convenience, accessibility, and flexibility, but negative impacts on communication, rapport, and the quality of care. HCPs considered computer literacy and individual preferences to be important for successful remote care; the age of the patient was considered less important. Conclusions: Patients were generally highly satisfied with the service and for 1 in 3 it was their preferred mode of future hearing-aid fitting. Future services should be aware that a one-size-fits-all approach will not satisfy all patients and that teleaudiology should be offered on the basis of individual preference. [ABSTRACT FROM AUTHOR]

Objectives The National Health Service in England funds 12 months of weekly s.c. tocilizumab (qwTCZ) for patients with relapsing or refractory GCA. During the coronavirus disease 2019 (COVID-19) pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ. Methods Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse. Results A total of 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median [interquartile range (IQR)] of 12 (12–17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0–5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6%, respectively, had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10–40) mg/day. 33.6% relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P  = 0.0017), in those not in remission at qwTCZ cessation (P  = 0.0036) and in those with large vessel involvement on imaging (P  = 0.0296). Age ≥65 years, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing and conventional synthetic DMARD use were not associated with time to relapse. Conclusion Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One-third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients. [ABSTRACT FROM AUTHOR]

Background: There is a limited amount of research assessing the effectiveness of group therapy on acute inpatient psychiatric wards, and mixed results from research assessing inpatient psychological therapies in general. Previous studies highlight challenges for conducting research on psychiatric inpatient hospitals, such as short admissions, high patient turnover, engagement challenges, acuteness of illness, overmedication and feelings of stigma and disempowerment. Aims: This service evaluation aims to assess whether weekly ward‐based interpersonal group therapy reduces short‐term psychological distress for women on an acute psychiatric inpatient ward in inner‐city London (Tower Hamlets), UK. Methods: This service evaluation compared psychological distress, as measured by the Clinical Outcomes in Routine Evaluation 10 (CORE‐10), pre‐ and post‐intervention for women attending a weekly ward‐based interpersonal therapy group between February 2023 and August 2023. Results: There were 46 participants included in the analysis. There was an 11.3% decrease in the mean CORE‐10 score post‐intervention. Four (9%) patients exhibited significant and reliable change (i.e. short‐term psychological distress reduced to a 'healthy' level). A further three (7%) patients exhibited no significant change. Short‐term psychological distress did not significantly deteriorate for any patients who attended the ward‐based interpersonal therapy group. Conclusion: It is feasible to collect pre‐ and post‐outcome data to assess psychological distress following a weekly ward‐based interpersonal therapy group over a 6‐month period, which meet acceptable a priori sample size calculations. The group appears to have an immediate positive impact for the majority (95%) of patients where short‐term psychological distress reduced or stayed the same; however, this was only significant for 16% of patients. It would be important to collect qualitative data, ideally using multiple methods or data sources for triangulation, in order to corroborate and strengthen the current findings. Practitioners cannot rely solely on the results of this study to demonstrate effectiveness of psychotherapeutic group interventions in acute inpatient settings. [ABSTRACT FROM AUTHOR]

A positive patient experience and person-centred care is at the forefront of all healthcare services and is linked to improved health outcomes. Patient satisfaction surveys are used widely to measure patient experiences and satisfaction with hospitals and can help to evaluate and improve services. This article presents a service evaluation from the patient perspective of their perioperative experience in a neuro-theatre suite of one hospital in Scotland. A patient questionnaire was used to evaluate factors that impact on the patient experience, including service quality, staff/patient interaction, comfort and needs, fears and concerns and information provision. A total of 97 responses to the questionnaire were received and findings showed 98.8% overall satisfaction with the care. Continuous evaluation of services is vital to understanding patient satisfaction with services provided by nurses, thus helping to improve the services. The gap in literature highlights the importance of continuing to use this tool within the perioperative neuro-theatre setting. [ABSTRACT FROM AUTHOR]

The development of information technology has transformed the paradigm in international trade, particularly in the field of export and import. "Customs-Excise Information System And Automation (CEISA) 4.0" is one of the technological innovations that integrates business processes efficiently, including in export and import services. A qualitative approach using a case study methodology is the research methodology used. The data were gathered by conducting in-depth interviews with key individuals inside the organization and by directly observing the export and import service operations utilizing the "Customs-Excise Information System And Automation (CEISA) 4.0." Evaluation was carried out by comparing the processes before and after the implementation of "Customs-Excise Information System And Automation (CEISA) 4.0", as well as evaluating its efficiency, effectiveness, and impact on company performance. The study findings indicate that the use of the "Customs-Excise Information System And Automation (CEISA) 4.0" has had a beneficial effect on enhancing the efficiency and effectiveness of the export and import service procedures at PT. Varia Usaha Dharma Segara. The integration of this technology accelerates administrative processes, minimizes errors, and enhances visibility across the entire supply chain. However, challenges in the implementation and maintenance of this technology also need to be considered, including in terms of human resources and information technology infrastructure. Hence, this study enhances comprehension of the advantages and obstacles associated with the use of "Customs-Excise Information System And Automation (CEISA) 4.0" technology in the domain of export and import services inside trading firms. [ABSTRACT FROM AUTHOR]

The objective of this study is to present patient satisfaction results using the Net Promoter Score (NPS). This is a cross-sectional study carried out with microdata from the Continuous National Household Sample Survey of 2022 and which corresponds to the module on Primary Health Care in which the sample carried out was 48,068 guardians of children under 13 years of age in all federation units. The main variables considered were the score given to the health service in the last service in the 12-month period and the main reason for this score. It should be noted that no region of the country achieved a result defined as a Quality Zone (between 51 and 75), concentrating on a category called Improvement Zone (between 1 and 50). The best performance was in the South region (+33) and the worst performances in the Northeast and Southeast regions (+27). The NPS can be an important ally to quickly assess the patient experience in primary health care services in Brazil. [ABSTRACT FROM AUTHOR]

This article reports on a two-year study of a community-based suicide postvention support service in the UK. Attention centres on the implementation of four integrated elements within the service model: multi-agency working with real-time suicide surveillance, persistent pro-active contact; volunteer-led support; continuous open-ended support. Our approach involved analysing utilisation data and qualitative techniques, including in-depth interviews with a diverse group of stakeholders. The study is the first of its kind to provide an in-depth examination of an innovative approach focusing on the integrated model and its constituent components. Our findings offer evidence-based examples of collaborative service efforts in implementing real-time interventions, with agencies working together to provide timely, co-ordinated, proactive responses and support with the potential to alleviate suffering and prevent loss of life. The value of volunteer-led support and open-ended access and associated challenges are emphasised. Findings hold promise for international impact with policy implications for services worldwide. [ABSTRACT FROM AUTHOR]

Objectives This study evaluated the scale-up of a remote monitoring service, capturing monthly Rheumatoid Arthritis Impact of Disease scores and patient-generated text messages, for patients with rheumatoid arthritis (RA; in remission or with low disease activity) attending routine outpatient clinics across six hospitals. We explored patients and staff experiences and implementation outcomes. Methods A pragmatic, mixed methods approach was used, with active patient involvement throughout. We undertook a rapid review, analysed service-level data, and conducted a patient survey and patient and staff interviews, informed by the Capability, Opportunity, Motivation, Behaviour (COM-B) and Exploration, Preparation, Implementation, Sustainment (EPIS) theoretical frameworks. Results The review included 37 articles, covering themes of patient and clinician acceptability, engagement, feasibility and clinical impact. Service-level data (n  = 202) showed high levels of patient engagement with the service. The patient survey (n  = 155) showed patients felt the service was easy to use, had confidence in it and felt it improved access to care. Patient interview (n  = 22) findings mirrored those of the survey. Motivating factors included increased responsiveness and ease of contact with clinical teams. Views from staff interviews (n  = 16) were more mixed. Some implementation barriers were specific to roll-out sites. Prioritization of staff needs was emphasized. Conclusion Patients were positive about the service and engagement was high. Staff views and engagement were more mixed. Results suggest that equal levels of patient and staff engagement are required for sustainability. These findings further our understanding of the implementation challenges to scaling remote monitoring interventions for patients with rheumatoid arthritis in routine care settings. [ABSTRACT FROM AUTHOR]

Abstract Background Crisis cafés (also known as crisis sanctuaries or havens) are community-based services which support people in mental health crises, aiming to provide an informal, non-clinical and accessible setting. This model is increasingly popular in the UK; however, we are aware of no peer-reviewed literature focused on this model. We aimed to investigate the aims of crisis cafés, how they operate in practice and the factors that affect access to these services and implementation of the intended model. Methods A qualitative approach was used. Semi-structured interviews were conducted with 12 managers of crisis cafés across England. These interviews explored managers’ views on the implementation of their services, and the factors that help and hinder successful implementation. Data were analysed using Braun and Clarke’s reflexive thematic approach. Results We identified five main perceived aims for crisis cafés: providing an alternative to Emergency Departments; improving access to crisis care; providing people in acute distress with someone to talk to in a safe and comfortable space; triaging effectively; and improving crisis planning and people’s coping skills. Factors seen as influencing the effectiveness of crisis cafés included accessibility, being able to deliver person-centred care, relationships with other services, and staffing. These factors could both help and hinder access to care and the implementation of the intended model. There were a number of trade-offs that services had to consider when designing and running a crisis café: (1) Balancing an open-door policy with managing demand for the service through referral routes, (2) Balancing risk management procedures with the remit of offering a non-clinical environment and (3) Increasing awareness of the service in the community whilst avoiding stigmatising perceptions of it. Conclusions Findings illustrate the aims of the crisis café model of care and factors which are influential in its implementation in current practice. Future research is needed to evaluate the efficacy of these services in relation to their aims. Crisis café service users’ views, and views of stakeholders from the wider crisis care system should also be ascertained.

This paper reports on a service evaluation of PeerTalk, a nationwide charity that organises and facilitates peer support groups for individuals with depression. Therefore, the aim was to gather and synthesise benefits perceived by support group attendees. Thematic analysis was undertaken following the collection of data from two group interviews comprising PeerTalk support group attendees. Once those data were analysed, five key themes emerged: (1) talking/listening, (2) socialising, (3) contrast with other services, (4) personal benefits, and (5) structure and accessibility. Two further minor themes were also identified: (6) wider benefits and (7) areas for development that could lead to overall improvements to the service. PeerTalk’s support groups provide multiple opportunities for attendees to meet others who have similar experiences within an environment that does not require formal engagement or commitment. Those that attend find benefit from supporting others and socialising within the group. These benefits are complementary to mainstream services that they may concurrently be involved with, rather than replacing or hindering them. Peer support groups can therefore provide a resource for healthcare professionals to which they can direct individuals who may feel benefit from engaging with other individuals with similar experiences. Sheffield Hallam University granted ethics approval for the study (ER:59716880) prior to its commencement (16 February 2024).

Background/Aims: Outcome measures are essential in clinical practice to demonstrate patient improvement and secure funding for services. The purpose of this service evaluation was to explore levels of patient improvement as measured by the Therapy Outcome Measure in a community intermediate care team. Methods: A total of 232 patients who completed a course of therapy treatment with a community intermediate care team between December 2021 and February 2023 were scored on admission and at discharge using the Therapy Outcome Measure. Changes in scores from admission to discharge were summarised as percentages or median (interquartile range). The authors assessed if receiving input from intermediate care support workers had an impact on the improvement. Additionally, the authors explored if there was a relationship between change in scores and the number of therapy sessions. Results: Across the four Therapy Outcome Measure domains (impairment, activity, participation and wellbeing) the proportion of patients exhibiting a 0.5-point or more increase in scores ranged between 43.5% and 52.2%. Between 0.9% and 3% of patients showed a deterioration in scores and between 47.0% and 54.3% experienced no change in score. Regarding intermediate care support worker input vs no intermediate care support worker input, the proportion of patients that improved by 0.5 points or more was significantly different between the two groups in the impairment domain (67.2% and 43.9% respectively, P=0.003). There were very weak correlations found between the number of therapy sessions and the level of improvement. Conclusions: The Therapy Outcome Measure may be a useful tool for community teams to assess patient outcome measures. More studies are required in other community therapy teams to allow for comparison between services. Implications for practice: The results of this service evaluation may assist allied health professionals in selecting an appropriate outcome measure to use with their patients and the data may also be useful for benchmarking purposes. [ABSTRACT FROM AUTHOR]

Background: The efficacy of telephone triaging has been championed for over a decade and more recent research has shown its value with certain neuropsychological populations (e.g. Traumatic Brain Injury), but further research is needed in other areas of clinical neuropsychology, such as long-Covid services. Aims: The primary aims of this evaluation were 1) to obtain service user feedback on the long-Covid telephone triage service, and 2) to use this feedback to inform future delivery of the long-Covid care and treatment pathway within the clinical neuropsychology service. Method: A cross-sectional survey design was employed, consisting of a 3-part questionnaire that was disseminated to 50 service users via the Smart Survey digital platform, to gain demographic and participant feedback on their experience of the service. Quantitative data was analysed using Smart Survey and a thematic summary of free-form text responses was conducted. Results: A high level of service user satisfaction was found across all elements of the triage service, including waiting time, call expectedness and convenience, satisfaction with clinician, symptom understanding, help/support received, call length, and post-triage follow-up. The evaluation is clearly reflective of the value of the long-Covid triage service, evidenced by service user feedback and how it synchronises with both local and wider NHS strategic visions. The data also corroborates findings from existing literature around the effectiveness of telephone triaging. [ABSTRACT FROM AUTHOR]

New roles have been developed to meet increased demands for children and young people's (CYP) mental health support. In 2017, Children's Wellbeing Practitioners (CWP) and Education Mental Health Practitioners (EMHP) psychological professions' training programmes were introduced. A new Children & Young People's Mental Health Practitioner (CYP-MHP) role has now been piloted with the aim of improving access to CYP mental health support through early intervention, providing psychoeducation, advice and signposting. This pilot provides a new service; CWP/EMHP require training and deliver therapy, whereas CYP-MHP provides a triage/assessment therapeutic service and does not require NHS-funded training. Outcomes of the pilot evaluation demonstrate a place for this role in primary care, where there existed a gap before. [ABSTRACT FROM AUTHOR]

Objective: In the West Midlands regional genetics service, cases of perinatal death with a possible genetic diagnosis are evaluated by the perinatal pathology genetic multidisciplinary team (MDT). The MDT assesses autopsy findings and suggests appropriate genomic assessment. The objective of this retrospective service evaluation was to determine the clinical utility of the MDT in assessing perinatal deaths associated with structural anomaly. This is the first evaluation since the introduction of whole‐genome and whole‐exome sequencing in routine clinical care. Methods: This was a retrospective service evaluation including all cases of perinatal death with an associated structural anomaly and suspected genetic etiology that underwent perinatal MDT assessment between January and December 2021. All cases received a full or partial postmortem examination and at least a chromosomal microarray analysis. Demographic characteristics, phenotype, genotype, MDT recommendations, diagnoses, outcomes and impact of postmortem analysis and genetic testing data were collected from patient case notes. Results: Overall, 123 cases were discussed at the MDT meetings in 2021. Genetic evaluation was recommended in 84 cases and accepted in 64 cases. A range of genetic tests were requested according to indication and availability. Thirty diagnoses were made in 29 cases from 26 unrelated families. The diagnostic yield was 24% (29/123) in all cases or 45% (29/64) in cases with a suspected genetic diagnosis who underwent genetic testing. Postmortem examination provided clinically actionable phenotypic data in 79% of cases. A genetic diagnosis enabled accurate recurrence risk counseling and provision of appropriate follow‐up, including prenatal testing and preimplantation diagnosis for patients with inherited conditions. Conclusions: Genomic testing was a clinically useful addition to (but not a substitute for) postmortem examination in cases of perinatal death associated with structural anomaly. The MDT approach helped assess cases and plan appropriate follow‐up. Expedited whole‐genome sequencing or panel‐agnostic analysis were most appropriate for heterogeneous presentations. This broad approach can also expand knowledge of prenatal phenotypes and detect novel disease genes, and should be a priority in future research. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: Individuals from deprived areas are less likely to attend breast screening. Inequalities in the coverage of breast screening are associated with poorer cancer outcomes. Individuals who have a positive first experience are more likely to attend subsequent mammograms. This work evaluates the provision of an additional telephone call to individuals who have never attended breast screening, to establish whether this increases attendance. Setting and Methods: 1423 patients from four general practitioner practices within socially deprived areas of National Health Service Tayside (UK) comprised the study population. In addition to their standard appointment letter, individuals were to receive a call at least 24 h prior to their appointment. The call identified barriers to screening, and offered a supportive, problem-solving approach to overcoming these barriers. Data collected included: age, Scottish Index of Multiple Deprivation, first-time invite or previous non-attender, if contactable, duration of call, number of days prior to appointment, and confirmation appointment letter was received. The primary outcome was attendance at the screening. Results: Contact by phone was made with 678 (47.6%) of the study population. Of those, 483 (71.2%) attended their appointment, 122 (18%) cancelled and 73 (10.8%) did not attend (DNA), versus 344 (46.2%) attending, 34 (4.6%) cancelling and 367 (49.3%) not attending among those who were not able to be contacted. Those who received a call were more likely to attend their appointment and less likely to DNA compared to individuals not receiving the call. Conclusion: The intervention is simple and low cost; results indicate that the additional call may increase attendance and reduce DNA appointments at breast screening. [ABSTRACT FROM AUTHOR]

BACKGROUND: It is vital to improve the mental health (MH) of young people in Hong Kong, where the suicide rate has nearly doubled among those aged 15‐29 years since 2014. This multi‐method evaluation aimed to assess Coolminds, which promoted MH literacy by engaging students, parents, and educators in secondary schools in Hong Kong. METHODS: Students, parents, and teachers completed self‐report measures before and after attending workshops aimed at raising MH literacy. Pre‐ and post‐survey data were collected between November 2021 and August 2022. Qualitative data from participant feedback and a focus group interview with Coolminds staff were analyzed using descriptive content analysis. RESULTS: The final dataset included 2903 students, 395 parents, and 325 educators from 52 schools. Only 3 schools had engagement with all 3 key groups. Significant improvements in MH knowledge were observed after the Coolminds workshops for all 3 groups. Qualitative analysis identified a reactive approach to MH issues, and bureaucratic and logistical challenges as barriers to implementation. CONCLUSION: Findings support the effectiveness of the Coolminds curriculum in improving MH literacy for each group and the demand for MH promotions in school settings. The implementation challenges indicate the need for future initiatives to better align with local needs and practices. [ABSTRACT FROM AUTHOR]

This paper reports on a service evaluation of PeerTalk, a nationwide charity that organises and facilitates peer support groups for individuals with depression. Therefore, the aim was to gather and synthesise benefits perceived by support group attendees. Thematic analysis was undertaken following the collection of data from two group interviews comprising PeerTalk support group attendees. Once those data were analysed, five key themes emerged: (1) talking/listening, (2) socialising, (3) contrast with other services, (4) personal benefits, and (5) structure and accessibility. Two further minor themes were also identified: (6) wider benefits and (7) areas for development that could lead to overall improvements to the service. PeerTalk's support groups provide multiple opportunities for attendees to meet others who have similar experiences within an environment that does not require formal engagement or commitment. Those that attend find benefit from supporting others and socialising within the group. These benefits are complementary to mainstream services that they may concurrently be involved with, rather than replacing or hindering them. Peer support groups can therefore provide a resource for healthcare professionals to which they can direct individuals who may feel benefit from engaging with other individuals with similar experiences. Sheffield Hallam University granted ethics approval for the study (ER:59716880) prior to its commencement (16 February 2024). [ABSTRACT FROM AUTHOR]

Background/Aims: Service users who have spent time in seclusion describe it as a negative experience, viewing it as punishment. Although occupational therapists work within these settings, there is limited research and documentation of interventions aimed at reducing occupational deprivation in seclusion. A service evaluation was conducted at a medium secure adult mental health unit to better understand the current practices of occupational therapists working in seclusion. Methods: A bespoke tool was developed to capture occupational therapy interventions within a 12-month timeline. Results: Data showed that there were 31 interventions provided across 300 days of seclusion for 16 patients. Therapy lasted between 5 and 45 minutes involving a range of adapted interventions and resources appropriate for positive risk taking. Conclusions: Despite creative and adaptive interventions identified, provision of occupational therapy appeared sporadic and restricted by a 5-day service. This illustrates the need for specialist training and guidelines to support an integrated and consistent approach. [ABSTRACT FROM AUTHOR]

Background/Aims: A Cochrane review reported that epidural analgesia had no effect on the risk of emergency caesarean section; there was a discrepancy between these findings and the author's clinical observations, prompting the author to evaluate labour outcomes for women with and without epidural analgesia. The aim was to establish whether the author's clinical observations were supported by data. Methods: A retrospective review of the outcomes of 200 labours with and without epidural analgesia was carried out, limited to women the author had personally cared for. A subsequent trust-wide analysis of labours was conducted to explore wider trends in analgesia and emergency caesarean section. Results: In the personal review, epidural analgesia was associated with a more than two-fold increase in risk of emergency caesarean section, regardless of the underlying obstetric risk factors (from 14.7% to 36.4%). A similar trend was found across the trust. Conclusions: Epidural analgesia in labour is associated with increased risk of an emergency caesarean section. Potential reasons for the discrepancy with the Cochrane review findings include differences in anaesthetic practice, timing and dilation at the time of receiving epidural analgesia, and evidence that women taking part in a randomised controlled trial experience better outcomes than those receiving routine care. [ABSTRACT FROM AUTHOR]

Summary: Scaled interventions are required to address levels of overweight and obesity and reduce health inequalities. Little data is available on the effectiveness of community weight management programmes for participants self‐selecting to attend across different socio‐economic backgrounds. This analysis investigates 3, 6, and 12‐month outcomes of adults joining a real‐life community weight management programme. Weight, attendance and Indices of Multiple Deprivation (IMD) data from all fee‐paying adults joining Slimming World in 2016 were collated. Data were analysed using descriptive and inferential statistics to determine predictors of weight loss. Mean BMI of 1 094 676 adults (7.6% male) was 33.0 ± 6.4 kg/m2. Mean % weight change at 3, 6, and 12 months was −5.0% ± 3.6%, −5.9% ± 5.2%, and −6.0% ± 5.8%. Those attending 75% sessions achieved greater weight loss with mean weight losses at 3, 6, and 12‐months of 7.7% ± 3.3%, 11.3% ± 5.2%, and 14.1% ± 7.5%, respectively. Effect sizes from comparison of weight change between deprivation deciles were negligible, with similar outcomes in the most and least deprived deciles at 12‐months (−5.7% ± 5.9% vs. −6.2% ± 5.9%). This service evaluation of more than 1 million adults attending a community weight management programme found they were able to achieve and/or maintain an average 6% weight loss at 12 months, with high attenders achieving >14% loss. Men and those with higher levels of deprivation were accessing the support and achieving significant weight losses. Slimming World as a real‐life, scalable weight management programme is well placed to help adults manage their weight and address health inequalities. [ABSTRACT FROM AUTHOR]

Background/Aims: Six-month post-stroke reviews are advocated for all stroke survivors. There is no recommended service model, with many variations in practice. The aim of this service evaluation was to describe and evaluate the 6-month post-stroke review service provision across the South West England Integrated Stroke Delivery Networks. Methods: A mixed-methods service evaluation for 10 services was undertaken, consisting of: a stakeholder meeting to define the scope and review criteria; a mapping exercise to define core service features and activity data; a 12-month retrospective Sentinel Stroke National Audit Programme clinical data audit plus a 1-month prospective audit detailing identified unmet needs, actions to address needs and patient satisfaction; service provider and user guided discussions; and options appraisal synthesising data from all sources to inform service development. Results: Considerable variations in service configuration, processes and outcomes existed across services. Guided discussions with 40 service users and 20 service providers revealed predominantly positive experiences. There was perceived value in the review, a key ingredient being its person-centred nature. However, some felt that the review was generic and more of a tick-box exercise. Many staff appeared unaware of differing 6-month post-stroke review models across the region and rarely used Sentinel Stroke National Audit Programme data to reflect on service outcomes or inform service development. Sharing of good practice across services appeared limited. Conclusions: Data did not support a specific preferred service model. Findings suggested 6-month post-stroke reviews should not be a 'one size fits all' model, with flexibility in format and timing to optimise value. A knowledge sharing and evidence-based culture should be encouraged to nurture service development. [ABSTRACT FROM AUTHOR]

Background: Critical illness survival rates have improved, but patients frequently face prolonged new or worsened physical, cognitive and psychosocial impairments. These difficulties associated with critical care admission are known as post-intensive care syndrome (PICS). Aims: The multidisciplinary Intensive care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) programme was developed to support patients in the recovery period from critical illness. During the COVID-19 pandemic, the psychology support offered by this service was adapted from an in-person group to individual remote review. This audit evaluated both the extent to which this input aligned with the recommended guidelines and the acceptability of this adapted delivery to this patient group, which could help guide post-pandemic psychology input to the service. Study Design: The records of 207 patients were analysed retrospectively. The nature of support offered to a sub-sample of 50 patients detailed in clinical summary letters was compared with the Faculty of Intensive Care Medicine (2019) guidelines. Telephone calls were made to gather feedback on the virtual psychology support from 10 patients. Results: Psychological difficulties were identified by 111 of the 207 patients who attended the virtual clinic. A total of 88 of these patients accepted referral for virtual psychology support and 67 (76%) of those patients attended. The virtual psychology support offered was found to be largely in accordance with ICU aftercare guidance and acceptable to patients. Patients found the summary letters of consultations accurate and helpful. Most patients expressed a preference for in-person support and the opportunity to meet other patients. Conclusions: The adaptations to the psychology support offered by InS:PIRE during the COVID-19 pandemic were found to be largely in line with ICU aftercare psychology guidelines and were acceptable to patients. Further research is needed on future methods of delivering psychology support for this patient group. Relevance to Clinical Practice: This audit highlights issues important to patients in the post-ICU period based on individual consultations not previously possible. Patient opinion was sought on the impact of changing the delivery of post-ICU psychological support, which will help guide future improvements in the service. [ABSTRACT FROM AUTHOR]

Aims: In 2018 the National Institute of Health and Care Research, United Kingdom, launched a 3‐year Senior Nurse and Midwife Research Leader Programme to support nurse and midwifery research leaders to develop research capacity and capability within NHS organisations. We report the results of a service evaluation of the programme strengths, areas for improvement and achievement of programme aims. Design: Partially mixed, concurrent mixed methods programme evaluation, including: (a) meeting evaluation (survey), (b) annual evaluation (survey) and (c) qualitative stakeholder interviews. Methods: Survey results were quantitatively analysed using descriptive statistics. Interviews were audio‐recorded, transcribed, deductively coded using elements within the logic model and analysed using the seven‐stage framework analysis method. Results: Satisfaction with the programme was high (75%). The main perceived benefit of the programme was being part of a network. Challenges included accessing learning resources, lack of opportunity to network and lack of clarity about the programme aims. Meetings were evaluated as relevant and helpful (mean 93%), thought‐provoking (92%), inspiring (91%), at the appropriate level (91%) and aligned with the programme aims (90%). All meetings were ranked as highly beneficial by attendees (92%). Stakeholder feedback on the programme success reflected the importance of leadership, the programme design and content, 'connection and community' and communication with and about the cohort. Overall, the anticipated programme aims were met, evaluating well from both the perspective of those on the programme and the wider stakeholder group. There has been a lack of investment in schemes to support research leadership development for nurses/midwives. A novel programme to support nursing/midwifery research leadership was positively evaluated. The programme is a useful model to support future capacity and capability building for nurses/midwives. The work is reported with reference to the SQUIRE 2 and SRQR checklists. No patient or public contribution. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to provide a preliminary evaluation of the Winnunga Nimmityjah Health and Wellbeing Service which commenced operations at the Australian Capital Territory's adult prison in 2019. Methods: A mixed-method approach was utilised to evaluate the service from 1 January 2019 to 31 December 2020. The quantitative arm described health status and health care engagement of enrolled detainees, and included a comparison of preventative health measures with the Winnunga community-based service. A qualitative arm involved focussed, semi-structured interviews with Winnunga staff members who worked at the prison service. Results: There were 61 detainees enrolled (from 168 requests for enrolment), with 92% identifying as Aboriginal and/or Torres Strait Islander. Health needs among detainees were skewed towards mental illness and substance use. The provision of primary and preventative health care was comparable to or better than the community-based service. Qualitative analysis of staff interviews identified four themes: provision of holistic and community-led care, workforce constraints, access to opioid agonist treatment and challenges working within a correctional facility. Conclusions: Winnunga was the first Aboriginal Community Controlled Health Organisation to deliver holistic health care to First Nations people in an Australian prison. This evaluation highlights the service’s achievements and provides recommendations for improvement and expansion. Implications for public health: Aboriginal community-controlled organisations can provide high quality, culturally safe health and wellbeing services for First Nations people in prison. The findings of this study provide evidence for the development of similar services in other jurisdictions.

Background During pregnancy and the postpartum period, women’s mental health can deteriorate quickly. Timely and easy access to services is critically important; however, little is known about the pathways women take to access services. Previous research has shown that women from ethnic minority groups in the United Kingdom experience more access issues compared to the White British women. Aim To describe pathways taken to specialist community perinatal mental health services and explore how they vary across services and ethnic groups. Methods This is a two-site, longitudinal retrospective service evaluation conducted in Birmingham and London during 6 months (1 July–31 December 2019). Electronic records of 228 women were accessed and data were extracted on help-seeking behaviour, referral process and the type of pathway (i.e. simple or complex). Data were collected using the adapted World Health Organization encounter form and analysed using uni- and multivariable analyses. Results The median time from the start of perinatal mental illness to contact with perinatal mental health services was 20 weeks. The majority of patients accessed perinatal mental health services through primary care (69%) and their pathway was simple, that is they saw one service before perinatal mental health services (63%). The simple pathway was used as a proxy for accessible services. In Birmingham, compared to London, more referrals came from secondary care, more women were experiencing current deterioration in mental health, and more women followed a complex pathway. Despite differences between ethnic groups regarding type of pathway and duration of patient journey, there was no evidence of difference when models controlled for confounders such as clinical presentation, general characteristics and location. The service’s location was the strongest predictor of the type of pathway and duration of patient journey. Limitations The heterogeneity among categorised ethnic groups; data extracted from available electronic records and not validated with patient’s own accounts of their pathways to care; unanalysed declined referrals; the study was conducted before the COVID-19 pandemic and pathways may be different in the post-COVID-19 period. Conclusion The study provides important insights into how patients find their way to community perinatal mental health services. It shows that there is a great degree of variability in the time taken to get into these services, and the pathway taken. This variation does not come from different needs of patients or different clinical presentations but rather from service-level factors. Future work The studied community perinatal mental health services in the United Kingdom operate with a significant degree of variability in the types and characteristics of patient pathways. Future research should explore these issues on the national and international levels. Additionally, future research should explore the reasons for the different pathways taken and the outcomes and risks associated with them. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/14. Plain language summary When women are pregnant or have just had a baby, their mental health can get worse quickly. It is very important for them to get help quickly and easily, but we do not know much about how women find and use perinatal mental health services during this time. Women from ethnic minority backgrounds in the United Kingdom often have more trouble accessing these services than White British women. In this study, we wanted to find out how women from different ethnic groups get to mental health services when they are pregnant or after having a baby. We looked at information from Birmingham and London, collected over 6 months in 2019. We studied the records of 228 women. Here is what we found: The middle time from when perinatal mental illness began until contact with perinatal mental health services was 20 weeks. Most women accessed services through primary care and their journey was straightforward. For example, after contacting their family doctor, they were next seen by the perinatal mental health service. When we looked at things like how unwell someone was, where they lived, and their background, we did not find any big differences between different ethnic groups in how they got to perinatal services. The place where the service was located was the most important factor in deciding how patients got there. Limitations First, we put together individuals from different ethnic groups to study them, but this might hide the differences between each group. Second, we only used information from patients’ records, and we did not check with the patients themselves to make sure everything was right. Lastly, we did this study before the COVID-19 pandemic, so the way people get health care might have changed since then. Conclusion This study is the first to look at how women get to community mental health services for mothers. We found that it takes different amounts of time for women to reach these services, and they follow different paths. This difference does not seem to be because of what the patients need or how unwell they are, but because of how the services work. In the future, we should study what happens and what problems might come from these different ways of getting help.

Abstract The challenge of elderly care presents a formidable task, demanding the collective attention of governmental bodies and diverse sectors of society. The integration of Artificial Intelligence (AI) into the research and development of Social Elderly Care Service (ECS) has emerged as a dominant trend, holding substantial importance in the establishment of an efficient ECS system. This study aims to serve as a comprehensive reference for the advancement of China's ECS system, achieved through the harmonious integration of a social ECS system with AI capabilities. This paper introduces the fundamental theory of AI, delving into the intricacies of the greyscale model of AI. Furthermore, it provides an overview of the current landscape of elderly care and elder care institutions, offering scientific data and insights to propel further research on AI development and system construction. Through an analysis of the existing research status, the study identifies prevalent issues within the AI-ECS integration, emphasizing pivotal factors influencing the construction of a robust social ECS system. To address these concerns, the study puts forth specific and viable policy recommendations. Notably, the questionnaire's statistics underscore that 83% of the elderly populace would opt for AI-driven solutions in selecting intelligent products, thereby underscoring the pivotal role of AI within the social ECS system. The challenges facing elderly care systems, including demographic shifts, resource constraints, and evolving societal norms, demand innovative solutions for providing efficient and effective care. This study addresses these challenges by exploring the integration of Artificial Intelligence (AI) into Social Elderly Care Services (ECS) in China. By delving into the theory of AI and assessing the existing research status, the study identifies key issues in AI-ECS integration and proposes viable policy recommendations. Insights from stakeholder surveys further highlight the importance of AI-driven solutions in meeting the needs of the elderly population.

Introduction: In October 2020, rapid prenatal exome sequencing (pES) was introduced into routine National Health Service (NHS) care in England, requiring the coordination of care from specialist genetics, fetal medicine (FM) and laboratory services. This mixed methods study explored the experiences of professionals involved in delivering the pES service during the first 2 years of its delivery in the NHS. Methods: A survey (n = 159) and semi-structured interviews (n = 63) with healthcare professionals, including clinical geneticists, FM specialists, and clinical scientists (interviews only) were used to address: 1) Views on the pES service; 2) Capacity and resources involved in offering pES; 3) Awareness, knowledge, and educational needs; and 4) Ambitions and goals for the future. Results: Overall, professionals were positive about the pES service with 77% rating it as Good or Excellent. A number of benefits were reported, including the increased opportunity for receiving actionable results for parental decision-making, improving equity of access to genomic tests and fostering close relationships between FM and genetics departments. Nonetheless, there was evidence that the shift to offering pES in a clinical setting had brought some challenges, such as additional clinic time, administrative processes, perceived lack of autonomy in decision-making regarding pES eligibility and difficulty engaging with peripheral maternity units. Concerns were also raised about the lack of confidence and gaps in genomics knowledge amongst non-genetics professionals - especially midwives. However, the findings also highlighted value in both FM, obstetric and genetics professionals benefiting from further training with a focus on recognising and managing prenatally diagnosed genetic conditions. Conclusion: Healthcare professionals are enthusiastic about the benefits of pES, and through multi-collaborative working, have developed relationships that have contributed to effective communication across specialisms. Although limitations on resources and variation in knowledge about pES have impacted service delivery, professionals were hopeful that improvements to infrastructure and the upskilling of all professionals involved in the pathway would optimise the benefits of pES for both parents and professionals. [ABSTRACT FROM AUTHOR]

Objective. The aim of this paper is to gain insight into changes in information needs and habits of users of the online reference service Ask the Librarians provided by Croatian public libraries since 2004. Methodology. Based on the research of Jagoda Ille and Helena Novak and the analysis of user information queries in the fi rst four years of service implementation from 2004 to 2008, an analysis of posted information inquiries was conducted from 2018 to 2022. By using the same methodology and time frame, the aim was to enable a comparative analysis of the obtained data regarding users' level of education, the number and type of information inquiries (divided into four categories: requests for direction, quick or factual information, bibliographic information and other inquiries), user satisfaction and the number of librarians involved in the service. Results. The research results for the period from 2018 to 2022 indicated a higher number of posted inquiries, a change in the educational structure of users and a change in the type of inquiries compared to the fi rst four years of service implementation from 2004 to 2008, as well as a constant increase in the number of librarians involved in the online reference service Ask the Librarians. Originality/Value. The value of the research lies in detecting changes in information inquiries and new information needs of users of the Croatian public libraries' online reference service Ask the Librarians, available to users since 2004. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To increase your awareness of the risk of neutropenic sepsis in patients receiving anticancer treatment • To acknowledge the importance of staff education on neutropenic sepsis and its timely management • To recognise the importance of patient education regarding the prompt reporting of adverse effects. Neutropenic sepsis is a potentially life-threatening complication of systemic anticancer therapy and must be recognised and treated rapidly. National guidance recommends, among other things, that patients with suspected neutropenic sepsis receive intravenous antibiotics within one hour of presentation. Initial observations, assessment and investigations are key to inform management. This article discusses the findings of a service evaluation conducted in a cancer unit in Northern Ireland to assess the initial management of patients with suspected neutropenic sepsis against the targets set by national guidance. The authors identify areas of optimal practice and areas for improvement, and make recommendations on how to enhance the management of neutropenic sepsis, notably through staff education. [ABSTRACT FROM AUTHOR]

The challenge of elderly care presents a formidable task, demanding the collective attention of governmental bodies and diverse sectors of society. The integration of Artificial Intelligence (AI) into the research and development of Social Elderly Care Service (ECS) has emerged as a dominant trend, holding substantial importance in the establishment of an efficient ECS system. This study aims to serve as a comprehensive reference for the advancement of China's ECS system, achieved through the harmonious integration of a social ECS system with AI capabilities. This paper introduces the fundamental theory of AI, delving into the intricacies of the greyscale model of AI. Furthermore, it provides an overview of the current landscape of elderly care and elder care institutions, offering scientific data and insights to propel further research on AI development and system construction. Through an analysis of the existing research status, the study identifies prevalent issues within the AI-ECS integration, emphasizing pivotal factors influencing the construction of a robust social ECS system. To address these concerns, the study puts forth specific and viable policy recommendations. Notably, the questionnaire's statistics underscore that 83% of the elderly populace would opt for AI-driven solutions in selecting intelligent products, thereby underscoring the pivotal role of AI within the social ECS system. The challenges facing elderly care systems, including demographic shifts, resource constraints, and evolving societal norms, demand innovative solutions for providing efficient and effective care. This study addresses these challenges by exploring the integration of Artificial Intelligence (AI) into Social Elderly Care Services (ECS) in China. By delving into the theory of AI and assessing the existing research status, the study identifies key issues in AI-ECS integration and proposes viable policy recommendations. Insights from stakeholder surveys further highlight the importance of AI-driven solutions in meeting the needs of the elderly population. [ABSTRACT FROM AUTHOR]

Background: Existing literature implies there may be gaps in post-treatment support for young people with cancer. This service evaluation explored the needs and experiences of young people when ending cancer treatment in a UK children's hospital to inform service provisions. Methods: Semi-structured interviews were conducted with nine young people, aged 13–18 years, who had finished active cancer treatment and were receiving follow-up care. The data was analysed using thematic analysis. Results: Four main themes were developed: being in the dark (i.e. limited awareness of what happens when treatment ends); separation from the hospital (i.e. the loss of valued support from staff); consequences of cancer (i.e. managing ongoing psychological and physical effects); and getting back to normal life (i.e. shifting from hospital to everyday life). Conclusions: Recommendations for improving clinical practice were made. Greater preparedness for ending treatment could be achieved by clearly setting out ongoing care arrangements, providing resource packs, having opportunities to mark the end of treatment, and offering peer support. To identify specific post-treatment needs, there should be an end of treatment multidisciplinary review and space for young people to share how they are feeling in follow-up medical appointments. [ABSTRACT FROM AUTHOR]

Objectives: Despite significant investment in social prescribing in England over the last decade, we still do not know if it works, or how models of social prescribing fit within wider health and care policy and practice. This study explores current service delivery structures and assesses the feasibility of a national evaluation of the link worker model. Methods: Semi-structured interviews were conducted between May and September 2020, with 25 key informants from across social prescribing services in England. Participants included link workers, voluntary, community and social enterprise staff, and those involved in policy and decision-making for social prescribing services. Interview and workshop transcripts were analysed thematically, adopting a framework approach. Results: We found differences in how services are provided, including by individual link workers, and between organisations and regions. Standards, referral pathways, reporting, and monitoring structures differ or are lacking in voluntary services as compared to clinical services. People can self-refer to a link worker or be referred by a third party, but the lack of standardised processes generated confusion in both public and professional perceptions of the link worker model. We identified challenges in determining the appropriate outcomes and outcome measures needed to assess the impact of the link worker model. Conclusions: The current varied service delivery structures in England poses major challenges for a national impact evaluation. Any future rigorous evaluation needs to be underpinned with national standardised outcomes and process measures which promote uniform data collection. [ABSTRACT FROM AUTHOR]

Background: In England, court‐based mental health liaison and diversion (L&D) services work across courts and police stations to support those with severe mental illness and other vulnerabilities. However, the evidence around how such services support those with neurodevelopmental disorders (NDs) is limited. Aims: This study aimed to evaluate, through the lens of court and clinical staff, the introduction of a L&D service for defendants with NDs, designed to complement the existing L&D service. Methods: A realist evaluation was undertaken involving multiple agencies based within an inner‐city Magistrates' Court in London, England. We developed a logic model based on the initial programme theory focusing on component parts of the new enhanced service, specifically training, screening, signposting and interventions. We conducted semi‐structured interviews with the court staff, judiciary and clinicians from the L&D service. Results: The L&D service for defendants with NDs was successful in identifying and supporting the needs of those defendants. Benefits of this service included knowledge sharing, awareness raising and promoting good practice such as making reasonable adjustments. However, there were challenges for the court practitioners and clinicians in finding and accessing local specialist community services. Conclusion: A L&D service developed for defendants with NDs is feasible and beneficial to staff and clinicians who worked in the court setting leading to good practice being in place for the defendants. Going forward, a local care pathway would need to be agreed between commissioners and stakeholders including the judiciary to ensure timely and equitable access to local services by both defendants and practitioners working across diversion services for individuals with NDs. [ABSTRACT FROM AUTHOR]

\nIntroduction: Quantifying differences in service provision for children and young people (CYP) living with congenital adrenal hyperplasia (CAH) across the UK. Methods: A national service evaluation using online questionnaires circulated to patients and clinicians from secondary and tertiary UK centres managing CYP with CAH and via the “Living with CAH” support group mailing list. Results: Total of 195 responses relating to patients aged 0–20 years attending 33 clinics (43 patients, 152 carers), as well as 34 clinicians from 18 trusts working across the 33 clinics. Only 12% of clinicians were “completely satisfied” with the service provided, compared to 68% of carers and 76% of patients. While 94% of clinicians reported providing formal training to families with CAH, over 80% of both patients and carers reported not attending what they considered formal training. Appetite for further training was higher in carers (86%) than patients (55%), although further “unsure” responses suggested formal training sessions would likely be well attended. Access to psychological services was difficult for 44% of clinicians. Biochemical monitoring of treatment was broadly in keeping with international guidelines, with 67% of clinicians reporting regular use of dried blood spots and 12% reporting regular urinary steroid metabolites. Conclusion: While there is overall good satisfaction with care provision among patients and carers with CAH in the UK, extra resources addressing the psychological and educational needs about the disease and its management would benefit patients and carers. Improved access to allied health professionals and psychologists will help support families and improve patient outcomes. Congenital adrenal hyperplasia (CAH) is a lifelong condition where the body does not produce enough steroids, and thus patients need to take daily steroid replacement. There are differences of opinion in how CAH is treated, and we aimed to find out about these differences in the UK. We surveyed children and young people living with CAH, their parents or carers, and doctors and nurses who look after them throughout the UK. We received 152 responses from carers, 43 from patients, and 34 from clinicians from a total of 33 different clinics. Overall satisfaction with services was high, although, while 94% of clinicians said they provided formal training to families with CAH, over 80% of both patients and carers said that they had not attended what they considered formal training. Most patients and carers said that they would like to engage with further training. Clinicians said they wanted better access to other support for patients, including psychologists. Treatment of CAH was generally in keeping with international guidelines. New methods of monitoring, such as dripping blood onto a card instead of attending hospital for a formal blood test, are increasing with two-thirds of clinicians reporting this method being used. In conclusion, there is good satisfaction with care provision among patients and carers with CAH in the UK. However, there are opportunities for increasing psychological support and family education about the condition to further improve the lives of those living with this disease. [ABSTRACT FROM AUTHOR]

Background: As a result of the complex nature of neurosurgical patients, nasogastric (NG) tube feeding is often implemented for patients who are unable to consume adequate oral intake. During recovery, patients on enteral nutrition (EN) are progressed to oral nutrition, which can result in NGT removal and discontinuation of supportive feeding plans. This is often before patients become established on sufficient oral intake to meet their nutritional requirements. Methods: We conducted an exploration of current NG removal practices in patients (n = 23) across five neurosurgical wards over a 3‐month period to assess practitioner review response times, NG feeding duration, decision making on NG removal, and the influence of dietary recommendations and differing EN protocols on patients' ability to meet their nutritional requirements. Our aim was to use this data to design and implement a protocol to improve consistency of these practices. Results: After oral intake was commenced, only those receiving supplementary EN achieved nutritional targets immediately. Conversely, no patient who had their NGT removed at this stage achieved these targets. Following NG removal, the likelihood of a patient meeting nutritional targets was influenced by the decision maker, supporting the practice of registered dietitian led cessation of NG feeding. These findings led us to develop an "NG Transition Feeding Protocol" to serve as a simple, clear pathway which treating teams can utilise to guide NG feeding decisions. Conclusions: NG feeding supports neurosurgical patients to meet nutritional requirements in the early stages following commencement of oral intake. The development of an "NG Transition Feeding Protocol" may help to improve consistency of transition feeding on neurosurgical wards, allowing time for nutrition assessment to support informed decisions around NG removal. The aim of this protocol is to improve the efficiency of transition feeding, improve dietetic workload efficiency, nursing staff confidence and avoid compromising nutritional status of patients as a result of the early cessation of EN. Key points: We found that once oral nutritional intake was commenced, only those receiving supplementary supplementary nasogastric (NG) feeding were able to meet their nutritional targets in the early stages of dietary reintroduction. Conversely, no patient who had their NG tube removed immediately after the commencement of oral intake met these targets; therefore, premature NG removal risks compromising nutritional status of patients unnecessarily.We observed that following NG removal, the likelihood of a patient meeting nutritional targets was influenced by the decision maker, supporting the practice of registered dietitian‐led cessation of NG feeding.In cases where this did not occur, we found that unclear decision making on who has designated responsibility for NG removal can result in inconsistencies in practice, potentially leading to confusion between multidisciplinary team members about these roles.Our findings have helped define a clear multidisciplinary pathway between speech and language therapist, registered dietitians and nursing colleagues to optimise nutrition support for patients in this setting. The development of an "NG Transition Feeding Protocol" might help to improve consistency of transition feeding on the neurosurgical wards, allowing adequate time for formal nutrition assessment to support informed decisions around NG removal.Our hope is that this protocol will improve the efficiency of transition, which in turn may improve dietetic workload efficiency, nursing staff confidence regarding decision making and avoid compromising nutritional status of patients as a result of the early cessation of enteral feeding. [ABSTRACT FROM AUTHOR]

Background: Few studies have investigated the COVID-19 pandemic's effect on children and adolescents with obsessive–compulsive disorder (OCD). This study aims to investigate whether the pandemic is associated with increased referral of young people with OCD, any changes in their symptom severity and treatment offered. Methods: Service data were used to investigate 58 young people (8–17 years) referred and assessed in the Central and Northwest London NHS Foundation Trust Child and Adolescent Mental Health Service (CAMHS), before and during the COVID-19 pandemic (months March-October 2018–2020). Changes in symptom severity were measured using the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA). Patient records were reviewed to assess if COVID-19 had exacerbated symptoms. Type of treatment offered was compared. Results: 26 (5.62%) assessments to CAMHS related to OCD in 2020, compared to 12 (1.30%) and 20 (2.27%) assessments pre-pandemic (2018 and 2019), showing a significant increase in the proportion of OCD cases (X2 (1, N = 58) = 20.3, p < 0.001). There was no significant difference in any HoNOSCA dimensions on initial assessment. However, 69.2% of patients in 2020 showed symptom worsening over the COVID-period, versus 46.7% of cases first assessed pre-pandemic. Significantly more patients were discharged without being offered treatment pre-pandemic (X2 (2, N = 58) = 12.7, p = 0.002). In 2020, there was an 8.5% increase in the frequency of medication offered. Discussion: The proportion of OCD cases in CAMHS increased in 2020 despite the overall number of CAMHS referrals falling. Furthermore, many cases reportedly worsened during the pandemic, and services will need to address the increased burden of more severe cases. Further larger investigation of this subject is warranted. [ABSTRACT FROM AUTHOR]

Service robots are used in all aspects of the service industry and improve business efficiency dramatically. However, service robot failures are also prevalent. This paper explores the interaction effect between symbolic service recovery and service robot social perception on service evaluations, the underlying mechanism, and the boundary conditions. Through three experiments with multiple service scenarios, such as hotel, restaurant, and tourist attraction, we find that service robots with warm perceptions using humor responses for a service recovery result in better service evaluations, whereas service robots with competent perceptions using rational responses for a service recovery result in better service evaluations. In addition, our research verifies the mediating role of perceived relief and perceived sincerity and identifies the moderating role of the locus of responsibility. We conclude by discussing the implications of these findings for marketers in the services and hospitality industries.服务机器人已经应用在服务行业的各个方面并显著提高企业的效率，但服务机器人服务失败也很普遍。本文探讨了象征性服务补救与服务机器人社会感知对消费者服务评价的交互作用，影响机制及边界条件。通过3个不同服务场景的实验，如酒店、餐馆和旅游景点，我们发现温暖感知的服务机器人使用幽默的回复方式来进行服务补救会使消费者有更好的服务评价; 而能力感知的服务机器人使用理性的回复方式来进行服务补救则更佳。此外，我们的研究验证了感知宽慰和感知真诚的中介作用，并确定了责任点的调节作用。最后，我们讨论了这些发现对服务和酒店业营销人员的影响。 [ABSTRACT FROM AUTHOR]

Background: The Genomic Medicine Service (GMS) was launched in 2018 in England to create a step-change in the use of genomics in the NHS, including offering whole genome sequencing (WGS) as part of routine care. In this qualitative study on pediatric rare disease diagnosis, we used an implementation science framework to identify enablers and barriers which have influenced rollout. Methods: Semi-structured interviews were conducted with seven participants tasked with designing the GMS and 14 tasked with leading the implementation across the seven Genomic Medicine Service Alliances (GMSAs) and/or Genomic Laboratory Hubs (GLHs) between October 2021 and February 2022. Results: Overall, those involved in delivering the service strongly support its aims and ambitions. Challenges include: 1) concerns around the lack of trained and available workforce (clinicians and scientists) to seek consent from patients, interpret findings and communicate results; 2) the lack of a digital, coordinated infrastructure in place to support and standardize delivery with knock-on effects including onerous administrative aspects required to consent patients and order WGS tests; 3) that the “mainstreaming agenda”, whilst considered important, encountered reluctance to become engaged from those who did not see it as a priority or viewed it as being politically rather than clinically driven; 4) the timelines and targets set for the GMS were perceived by some as too ambitious. Interviewees discussed local adaptations and strategies employed to address the various challenges they had encountered, including 1) capacity-building, 2) employing genomic associates and other support staff to support the consent and test ordering process, 3) having “genomic champions” embedded in mainstream services to impart knowledge and best practice, 4) enhancing collaboration between genetic and mainstream specialties, 5) building evaluation into the service and 6) co-creating services with patients and the public. Conclusion: Our findings highlight the challenges of implementing system-wide change within a complex healthcare system. Local as well as national solutions can undoubtedly address many of these barriers over time. [ABSTRACT FROM AUTHOR]

This research investigates consumers' perceptions and evaluations of robot service agents compared with human service agents when service requests are rejected. Six studies were conducted. The results show that when consumers receive a rejection of their service request, they evaluate the service less negatively if the service is handled by a chatbot agent versus a human agent. The reason is that consumers have lower expectations that robots will be able to provide flexible services to them. Consequently, their dissatisfaction with the request rejection is lower when the service is handled by robots. However, the aforementioned effect is not observed (1) when consumers have not experienced the service yet, (2) when their service request has been accepted, or (3) when the service agent conveys emotions to apologize for request rejection. [ABSTRACT FROM AUTHOR]