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Early support should help autistic children lead flourishing lives. We sought to understand parents' experiences of their children's involvement in early intervention and associated research, through focus groups with 23 parents (of 22 children) enrolled in a university-affiliated service. Reflexive thematic analysis revealed four themes. Parents conveyed a strong sense of gratitude (Theme 1) arising from their perceptions of the importance of early intervention and feelings of having 'hit the jackpot' to secure access to the service from which they perceived their children 'gained so much'. They valued the service and staff expertise which made them feel secure (Theme 2). University affiliation and the associated research also contributed to parents' sense of safety, from perceived 'accountability' and 'integrity'. Parents conveyed deep commitment to the service (Theme 3) but shared often-negative experiences as their child's enrolment came to an end (Theme 4) and they expressed feelings of abandonment and disempowerment, being confronted with the reality of needing to secure next-stage support for their children and of perceived critical need for 'conversion of research into practice'. These parents' accounts offer insights into the benefits and ongoing challenges of achieving truly effective supports for autistic preschoolers and their families. Support for autistic children early in life should help them to lead flourishing lives. However, many of the early intervention programmes for young autistic children are time-consuming and costly for families. These programmes are also often conducted in settings that are not closely matched to real life. We spoke to 23 parents (of 22 autistic children) to understand their experiences of their children's involvement in early intervention. Parents told us they were grateful for the opportunity, that they had 'hit the jackpot', and their children had 'gained so much' from the programme. They seemed to value the service because it made them feel safe and secure during an uncertain time in their children's lives. Parents told us they trusted staff, felt that they weren't 'doing it alone', and this 'took that pressure off' and helped them feel empowered. They also spoke of feelings of safety from being linked to the university research programme which offered 'accountability' and 'integrity'. Parents' comments showed a strong commitment to the early intervention model and staff – but also common feelings of abandonment and disempowerment as their child's time with the programme came to an end and they went 'back to the real world' and needed to find new supports for their children. These parents' insights should help to inform the design and delivery of community supports for preschool-aged autistic children and their families, which match the reality of their lived experiences. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the attitudes of professionals in Mental Health Services throughout Spain who are directly or indirectly involved in the use of mechanical restraint and the barriers perceived to reduce its use. The study involved an online anonymous survey using Google Forms completed by Spanish mental health professionals working with service users; the survey assessed their involvement in and general attitudes and beliefs towards mechanical restraint. The survey was completed by 225 participants. Only 13.30% of the participants considered that mechanical restraint use was never necessary to guarantee the safety of users/staff in dangerous situations. Poor staff training (38.0%) and a lack of resources/staff (34.7%) were the most frequent barriers identified for the reduction of mechanical restraint. In the multivariate analysis, participation in learning programs to prevent the use of mechanical restraint was associated with lower acceptance of the use of mechanical restraint, but the result was barely significant (p = 0.050). A high percentage of mental health staff still consider mechanical restraint use necessary for safety reasons. According to the results, the participants perceived that more staff and resources and better training could reduce the use of mechanical restraint in Mental Health Hospitalization Services. [ABSTRACT FROM AUTHOR]

This service evaluation explored foster carers' experiences of remotely accessing the children in care consultation model during the Covid-19 pandemic. The service evaluation utilised the Kirkpatrick evaluation model to collect data at four levels (reaction, learning, behaviour and results) and employed a mixed methodology. Participants were foster carers who had accessed remote consultations between June 2020 and June 2021. Thirteen participants completed questionnaires and eight consented to follow-up interviews. Questionnaires were analysed descriptively, and interviews were analysed thematically. Questionnaires demonstrated that most participants felt listened to, felt they could talk about what mattered to them and felt the consultations were the right length. However, some participants were unsure whether the pace and delivery were suitable for them. The thematic analysis highlighted four themes: (1) Reassurance and support: the consultations provided foster carers with reassurance and support that underpinned their current actions and aided their working relationships with other professionals; (2) Approach and understanding: the sessions provided foster carers with both specific and general approaches to challenges and enhanced their understanding; (3) Online consultation approval/disapproval: foster carers had mixed views regarding the remote delivery, but most valued this; (4) Behaviour change: following consultation, most foster carers experienced a change in behaviour within the household. Recommendations are discussed. Plain language summary: It is recognised that foster carers play a unique role for children in care and that the nature of this role often requires specialised support. One format of specialised support for foster carers is the children in care consultation model. The consultation model allows for the exploration of the difficulties being experienced by the child in care and the needs of the foster carers supporting them. During the Covid-19 pandemic several services began administering these consultations remotely via videoconferencing communication platforms. This shift towards digital ways of working has also continued post-pandemic and many services continue to engage in remotely delivered practices. However, foster carers' experiences of accessing these consultations remotely have not yet been investigated. Therefore, this evaluation aimed to explore foster carers' experiences of remotely accessing the children in care consultation model. Participants were foster carers who accessed remote consultations between June 2020 and July 2021. Thirteen foster carers completed a questionnaire with eight of these volunteering to be interviewed. The questionnaire data revealed that foster carers predominantly felt listened to, felt that they could talk about what mattered to them and felt the consultations were an appropriate length. Most foster carers felt that the consultations covered enough material, were accessible and that they would recommend them to others. However, some foster carers were unsure whether the pace and delivery were suitable for them. The interview data produced four main themes: (1) Reassurance and support; (2) Carer approaches and understanding; (3) Online consultation approval/disapproval; and (4) Behaviour change. Overall, these responses were consistent with the interpretation that remote consultations appear to be predominantly feasible and acceptable to foster carers. Implications are discussed. [ABSTRACT FROM AUTHOR]

Louise Merker,&ast; Soraya Conroy,&ast; Hassan El-Wakeel, Nicola Laurence Department of Breast Surgery, Royal United Hospital, Bath, UK&ast;These authors contributed equally to this workCorrespondence: Louise Merker; Soraya Conroy, Email lmerker@doctors.org.uk; Soraya.conroy@nhs.netIntroduction: The multidisciplinary team (MDT) approach has long been considered the optimal way in which to deliver a high standard of care to patients with breast cancer. With a growing number of patients and ever-increasing complexity of cases, the strain on time and resource of the MDT is becoming increasingly evident. It is therefore essential that local hospital departments adapt their MDT processes to better streamline discussions and optimise efficiency. The Royal United Hospital in Bath is a district general hospital in the UK. Approximately 500 patients with cancers are treated annually, and the MDT discusses approximately 60 patients per week.Methods: To improve our MDT meeting processes and increase productivity, we created a concise MDT template using Microsoft Access™: giving all clinicians the ability to add patients and information in real time. We also allocated weekly preparation time whereby a senior clinician ensured all patients were prepared prior to the meeting with results and potential outcomes prepopulated where possible.Results: We recorded the time spent discussing patients during 6 MDT meetings before and after implementation of changes. Cases were classified by pathology category to determine if there were differences following the preparation changes. Overall, we significantly reduced our average MDT discussion time (p=0.02). We significantly reduced average discussion time in postoperative malignant cases (p< 0.0006) and expected benign core biopsy cases (p< 0.0047), allowing appropriate redistribution of time towards discussion of more complex cases, reflected by the significant increase in time spent discussing complex radiology cases (p< 0.025).Conclusion: We offer an effective method for improving the MDT meeting preparation and presentation by ensuring each patient is appropriately prepared prior to the meeting, and outcomes for those simple cases are already prepopulated. This creates additional time within the meeting to discuss more complex clinical cases while allowing all members of the team an opportunity to discuss all patients if needed.Keywords: breast cancer, multidisciplinary team, MDT, service evaluation, streamlining

This article presents the findings of a service evaluation of a specialist urogynaecology service and highlights the implications for nursing practice. Aims: To evaluate the overall patient experience and the degree to which individual needs were being met, and make improvements to service delivery. Method: A cross-sectional survey questionnaire was sent to a random sample of women (n=350) who were registered on the electronic patient record system from January to June 2020. Two items on the questionnaire related specifically to communication with patients during the first COVID-19 lockdown in March 2020. Routine service data were collected and included in descriptive statistical analysis. Qualitative themes were thematically analysed. Results: The response rate was 39% (n=137). More than 90% of respondents felt listened to during consultations with nursing and medical personnel, and had trust and confidence in their clinical expertise, felt involved with decisions about care and felt comfortable with intimate examinations. Negative responses related to poor communication with administration and rescheduling appointments. Conclusion: Findings resulted in a departmental review of admin processes, which resulted in improvements to administrative systems, staff training, communication and information giving, and directly benefited patients. [ABSTRACT FROM AUTHOR]

Introduction: Art therapy, despite being an evidence-based, safe and acceptable intervention, is not widely available to clients in Scotland. Online delivery has the potential to expand the reach and accessibility, but special considerations need to be given to designing successful online art therapy services, due to the unique emphasis on the role of an image and artmaking alongside the therapeutic relationship. Methods: A pilot online art therapy service was developed and delivered in the Western Isles of Scotland to individual adult clients wishing to increase their psychological wellbeing. This research aimed to assess feasibility and acceptability of the novel service, identify enablers and challenges in setting up and delivering the service, explore participants' expectations and experiences of art therapy and identify any impacts of the service. Mixed-method evaluation incorporated questionnaires, focus groups, interviews and Audio Image Recordings (AIRs). Findings were grouped into themes across several key areas: service setup, research procedures, intervention design and impacts and insights. Recommendations were developed for the first three areas and the last section presents indications of change and gives voice to client experience primarily. Results: Online art therapy was described by clients as a judgement-free zone which allowed freedom to experiment, express, feel and immerse themselves in the creative flow. Other benefits included readiness to accept emotions, increased understanding of self and others and being able to see things from a new perspective. Clients recognised the unique nature of art therapy in relation to other psychological treatments and valued the freedom of expression it offered, including the non-verbal. Discussion: This project demonstrated that online art therapy is not only a feasible an acceptable intervention, but potentially also a powerfully impactful one, capable of instilling a positive change in a surprisingly short period of time. Exploring ways to expand current and introduce new art therapy services is highly recommended. Refinement of an intervention design, tools and research procedures is recommended through further feasibility studies of a larger scale. [ABSTRACT FROM AUTHOR]

Background: Neuropsychological assessment enables clinicians to use standardised tools and systemic formulation approaches to assess cognition and provide targeted psycho-education and rehabilitative input. The research literature is currently limited regarding the perspectives of different stakeholders on the neuropsychological assessment experience, and resulting reports. Aims: This paper explores what professional stakeholders consider to be a 'good' neuropsychological assessment/what is important to them, and examines service user experiences of neuropsychological assessment within a neuropsychology outpatient service. Method: A small-scale service evaluation project comprised an online survey completed by 17 professionals who receive neuropsychological report from this service. A semi-structured schedule was used to guide telephone interviews with nine service users who had recently experienced a neuropsychological assessment. Results: Both professional stakeholder surveys and service user telephone interviews provided feedback regarding what they found helpful and unhelpful in neuropsychological assessments, and suggested areas for improvement including: provision of an information booklet, offering a choice of remote or in-person appointments, and offering follow-up appointments after the assessment. Discussion: Recommendations are made for service improvements, and for future larger-scale research projects within this subject area. [ABSTRACT FROM AUTHOR]

Many patients referred for psychodynamic psychotherapy are also seen by other services. Due to the complex interplay between psychological distress, physical symptoms and care-seeking behaviour, engagement with a psychotherapy department has the potential either to increase or decrease use of other services. This service evaluation compared 268 patients' service use in the year preceding and following contact with an NHS psychodynamic psychotherapy department using t-tests. There were no significant changes from before therapy to afterwards for the sample as a whole. However, for sub-groups who made regular use of services at baseline, a full course of psychotherapy (16+ sessions) was associated with a statistically significant reduction in outpatient contacts, both for mental health (N = 32, mean 11.69 appointment per year pre-therapy vs 5.16 post-therapy, p = 0.01) and medical services (N = 23, from mean 9.65 to 3.00, p < 0.01). No compensatory changes were found in either A&E or inpatient contacts, suggesting this represents an overall reduction in service use. Due to the study design, it was not possible to establish causality; there may be other reasons for this observed reduction such as natural illness course. These findings tentatively support the existing literature that psychodynamic psychotherapy is associated with a reduction in use of wider services. [ABSTRACT FROM AUTHOR]

The context of the COVID-19 pandemic has amplified the need to increase co-production activities to empower communities. The pandemic has further highlighted systemic health and socioeconomic inequities, especially for those from ethnic minority communities and in areas of economic deprivation. This research article presents a complex, collaborative process of co-production we undertook as part of the service design of Community Engagement work within the Better Start Bradford Programme; a program of projects for pregnant women and families with children aged 0-4 years living in an ethnically diverse area. Using theory of change as our underpinning theoretical framework, we co-produced a community engagement logic model or 'strategy'. Our approach involved nine 90-minute workshops with a range of community stakeholders. We used the seven Scottish National Standards for Community Engagement and Communities' self-identified key concepts of 'voice', 'choice' and 'power' to structure the partnership activity. Workshop discussions were analysed using qualitative framework analysis, and we developed a comprehensive, multi-faceted community engagement logic model with the community. Discussions with the community highlighted that (1) the COVID-19 pandemic had opened new avenues of community engagement, primarily virtual ones, and a blended offer of face-to-face and online activities; (2) vital support for community readiness to engage, facilitated through culturally sensitive engagement delivered by trusted sources, transparent governance processes and informal consultation, combined with a flexible approach to adapting to the community's needs; (3) the need for a continuous reflective process of recruitment to key governance roles to include a range of diverse voices to ensure power is given to community voices. A strong two-way feedback loop is at the core of our community engagement strategy, with both the community and the organisation playing equal roles. [ABSTRACT FROM AUTHOR]

In the UK, Attention Deficit Hyperactivity Disorder and waits for assessment, diagnosis, and treatment are all growing problems. This study set out to gather service users' suggestions as to how one specialist ADHD service could improve the experiences of people on their waiting list. Following a semi-structured focus group, an inductive thematic analysis of data yielded three themes: (1) support for psychoeducation in principle, (2) psychoeducation regarding the wider, holistic impact of ADHD, and (3) suggested structures and approaches, as well as (4) a set of general feedback that could inform service developments. Service users supported the notion of psychoeducation sessions to inform people on the waiting list about the wide range of potential impacts of ADHD, the most common psychiatric comorbidities, some potential coping strategies they could try, and the service they could ultimately expect to receive. Some form of one-to-one telephone support was also advocated, primarily to address their concerns about the lack of individualisation group psychoeducation could offer. The potential benefits of these suggestions combined with the low risk of adverse effects makes group psychoeducation a worthwhile waiting list initiative. However, as with any service development, it should be piloted and evaluated before being termed treatment as usual for the service. [ABSTRACT FROM AUTHOR]

The article presents finding from an evaluation of a pilot head and neck cancer service redesign in Thomas Valley Cancer Alliance to enable patients from Swindon and Wiltshire, England to receive follow up and rehabilitation closer to home.

Background: Older people subject to homelessness face many challenges including poor health status, geriatric syndromes, and depression, coupled with barriers in accessing health and aged care services. Many are in need of formal aged care at a younger age than the general population, yet, in Australia, specialised aged-care services to support this vulnerable cohort are limited. Methods: This study was an evaluation of a new purpose-built aged care home for people with high care needs and who are homeless or at risk of homelessness. Over the first 12 months post-admission, the study examined: (1) changes in residents' physical, mental, psychological and social health, and (2) the costs incurred by the study cohort, including any cost benefit derived. Results: Thirty-five residents enrolled in the study between March 2020 – April 2021. At admission, almost half of residents were within the range for dementia, the majority were frail, at high risk for falls, and had scores indicative of depression. Over time, linear mixed-effect models showed significant improvement in personal wellbeing scores, with clinically significant improvements in overall health related quality of life. Levels of physical functional independence, frailty, and global cognition were stable, but cognitive functional ability declined over time. Comparison of 12 month pre- and post- admission cost utility data for a smaller cohort (n = 13) for whom complete data were available, suggested an average per resident saving of approximately AU$32,000, while the QALY indicators remained stable post-admission. Conclusion: While this was a small study with no control group, these preliminary positive outcomes add to the growing body of evidence that supports the need for dedicated services to support older people subject to homelessness. [ABSTRACT FROM AUTHOR]

This article, the second in a three-part series on Long Covid (LC), focuses on how one community-based NHS LC clinic developed and now delivers a 10-week group-based virtual rehabilitation programme (VRP), which aims to provide persons with Long Covid (PwLC) concepts on current thinking in LC, alongside self-management education and support. It highlights the role of embedded clinical research fellows (CRF), and their role in an in-depth service evaluation of the VRP, using established research methods and being peer reviewed/supervised by a research team to support best practice in an evidence poor field. [ABSTRACT FROM AUTHOR]

Purpose: The main purpose of this study is to evaluate the status of rural libraries services in East Azarbaijan province and surveying the villagers’ viewpoints on the libraries’ effect on the reduction of social deprivation. Method: The current research is applied in terms of research objectives and descriptive in terms of data collection, which was carried out using a survey method. Data were collected using a researcher-made questionnaire. The questionnaire’s reliability value based on Alpha Cronbach is 0.79 as and its validity was confirmed by experts. The statistical population of this research includes the users of 18 rural libraries operating in East Azarbaijan province, who numbered 43,635. From these people, 380 ones were selected as the research sample according to Krejcie and Morgan's formula for sample size. The data were analyzed using descriptive and inferential statistics including t-test. Findings: Based on the results, different types of services were identified provided by rural libraries of East Azarbaijan Province. “Making books accessible” is a role that most of the respondents believe that their respective rural libraries do perform. On the other hand, most of the respondents believed that the rural library of their region does not fulfill its role well in the “dissemination of information resources and providing services in the local language” and “making electronic and internet resources accessible”. Regarding the barriers to the use of rural libraries, “the disproportion of the provided services to the needs of the villagers” was identified as the biggest obstacle to the use of rural libraries in East Azarbaijan province. From the viewpoint of rural users, the effect of rural libraries on the “sense of citizenship” and “life satisfaction” is moderate, while the effect of rural libraries on the social alienation (negagtive impact) and social interaction is slightly higher than average. Originality/value: The contributions of this research are in investigating the role of rural libraries in East Azarbaijan province in providing information services and in identifying the views of rural library users on the effect of libraries in reducing social deprivation.

Abstract Background Falls prevention exercise programmes are evidence-based and recommended for improving physical function in older adults. However, few service evaluations exist to assess the effectiveness of community-delivered interventions in practice. Methods We conducted a six-year, retrospective evaluation of the community-delivered Staying Steady programme (Healthworks, United Kingdom). Staying Steady is a 27-week, tailored strength and balance programme delivered in a group setting (1-h, once/week) and at home (30–40 min, 2–3 times/week). Participants were referred by healthcare professionals, or self-referred, due to a history or risk of falling. Routinely collected outcome measures (30-s chair stand, Timed Up and Go, four-stage balance test, and patient reported outcomes; including ‘fear of falling’ and ‘ability to manage health’) were analysed. Factors associated with programme completion were reported. The intervention effect on physical function was analysed in subgroups: participants used arms to chair-stand or a walking-aid at both (‘aided’), neither (‘unaided’), or one assessment timepoint (‘aided at baseline only’ or ‘aided at follow-up only’). Results There were 1,426 referrals; 835 (67.3%) participants enrolled on to the Staying Steady programme, 406 (32.7%) declined, 185 (13.0%) were inappropriately referred and excluded from analysis. After enrolling, 451 (54.0%) participants completed, and 384 (46.0%) dropped out. Chair stand performance improved in participants who were unaided (n = 264; median 2.0 [1.0, 4.0] repetitions; P

Abstract Effective use of health technology may offer a scalable solution to the obesity pandemic. Online digital programmes provide a convenient and flexible way for more people to access regular support. This service evaluation aims to determine whether adults accessing an online weight management programme via a national campaign are successful in losing weight. Data was analysed for adults registering with Slimming World’s online programme using a discounted membership offered as part of PHE’s ‘Better Health’ campaign between July and December 2020. Last-weight carried forward was used to calculate weight outcomes for participants who had the opportunity to complete 12-weeks and recorded ≥ one weight besides baseline. Engagement was determined using number of online weekly weights recorded with high engagers having weight data for ≥ 9 occasions. Socioeconomic status was assessed using postcode data. Resubscription and uploaded weight data were used to determine numbers who continued beyond the offer period. Twenty-seven thousand two hundred forty-eight adults (5.3% males) with mean age 41.0 ± 11.4 years met inclusion criteria. Mean baseline BMI was 33.4 ± 6.8 kg/m2 (29.2% 30–34.9, 18.3% 35–39.9 and 15.1% > 40 kg/m2). Mean weight loss at 12 weeks was 2.7 (± 3) kg representing a mean loss of 3% (± 3.1) body weight with 42.3% achieving ≥ 3% and 22.1% weight loss ≥ 5%. Median number of weigh-ins was six. Men had greater weight losses compared to women (p 0.05). 30.9% were in the lowest two IMD quintiles and absolute and percentage weight change did not differ across deprivation quintiles (p > 0.05). 34.9% continued to access the online support after the offer period. This service evaluation shows that an online programme, offered as part of a national campaign, can offer effective support to a large number of people with different starting BMIs and from different socioeconomic backgrounds. An increased level of engagement leads to better weight losses.

The context of the COVID-19 pandemic has amplified the need to increase co-production activities to empower communities. The pandemic has further highlighted systemic health and socioeconomic inequities, especially for those from ethnic minority communities and in areas of economic deprivation. This research article presents a complex, collaborative process of co-production we undertook as part of the service design of Community Engagement work within the Better Start Bradford Programme; a program of projects for pregnant women and families with children aged 0–4 years living in an ethnically diverse area. Using theory of change as our underpinning theoretical framework, we co-produced a community engagement logic model or ‘strategy’. Our approach involved nine 90-minute workshops with a range of community stakeholders. We used the seven Scottish National Standards for Community Engagement and Communities’ self-identified key concepts of ‘voice’, ‘choice’ and ‘power’ to structure the partnership activity. Workshop discussions were analysed using qualitative framework analysis, and we developed a comprehensive, multi-faceted community engagement logic model with the community. Discussions with the community highlighted that (1) the COVID-19 pandemic had opened new avenues of community engagement, primarily virtual ones, and a blended offer of face-to-face and online activities; (2) vital support for community readiness to engage, facilitated through culturally sensitive engagement delivered by trusted sources, transparent governance processes and informal consultation, combined with a flexible approach to adapting to the community’s needs; (3) the need for a continuous reflective process of recruitment to key governance roles to include a range of diverse voices to ensure power is given to community voices. A strong two-way feedback loop is at the core of our community engagement strategy, with both the community and the organisation playing equal roles.

To enhance the online education service experience, the emotional valence of the user was studied as an evaluation variable, and both qualitative and quantitative research were used to find how to evaluate online education service touchpoints. First, deconstruct the system service interface with the interactive touchpoint matrix, set service evaluation indicators from four aspects, visual guidance, learning resources, after-class evaluation, and interactive feedback, and build an online education service touchpoint evaluation system. Secondly, using Tencent Classroom as the target of research, an online education service rating experiment is created based on the two dimensions of emotional valence and perceptual cognition. With the aid of a questionnaire survey and analytic hierarchy process (AHP), a multidimensional evaluation of online education service touchpoints is accomplished using the learners' emotional enjoyment, activation, dominance, touchpoint satisfaction, and importance as measuring indicators. Finally, concluding the assessment and optimization of online education service touchpoints, the evaluation data for the service are combined, and the evaluation results are generated using visual design. This study includes successful strategies and practical recommendations for boosting interest in e-learning services, user initiative, and excitement for learning. [ABSTRACT FROM AUTHOR]

In order to realize the safe operation and long-term service of South-to-North Water Transfer Project (SNWTP), it is significant to avoid adverse effect led by abnormal state of open channel. Considering the fuzziness of evaluation index and one-sidedness of single method, the evaluation index system of open channel was established with objective analysis method. The improved extension-hierarchical analysis model was proposed to determine the subjective weights based on interval quantization in extension theory, then the subjective and objective weights were combined as fusion weight. The advantages of fuzzy comprehensive evaluation method and grey clustering evaluation method were assembled in order to build the grey-fuzzy evaluation method for open channel. Taking the open channel in the Middle Route of SNWTP as an example, the method and model established in this paper were utilized to evaluate its serviceability and the evaluation results prove their validity and feasibility, which can provide a basis for the operation and maintenance of the open channel projects in the Middle Route of SNWTP. [ABSTRACT FROM AUTHOR]

Background : The mortuary plays an important, under-recognized role in end-of-life care. A ' Life-affirming strategy ' was introduced in the mortuary of a university hospital to enhance respect for the deceased and next-of-kin (NOK). Design: NOK who collected bodies in the mortuary of a university hospital participated in a survey. The satisfaction scores, needs and expectations were compared with a similar survey from 2015. Results: The overall experience for NOK improved significantly compared with 2015. The greatest improvement was achieved in 'mortuary environment', 'attitude of mortuary staff' and 'body viewing arrangement in the mortuary'. The perceived need for additional psychosocial support was significantly reduced. Conclusions: Results demonstrate success of the life-affirming strategy in enhancing end-of-life care for bereaved families. The person-centered approach modernizes and professionalizes mortuary services, with a positive impact on the deceased, NOK, mortuary staff, hospital administration and wider community. [ABSTRACT FROM AUTHOR]

To identify client and service factors associated with changes in health-related quality of life following community rehabilitation. We conducted a retrospective observational cohort study within a community rehabilitation program. Health-related quality of life was measured using the EuroQol five Dimensions, five response level version (EQ-5D-5L). Our primary outcome was the Visual Analogue Scale (VAS) rating of overall health. Analyses were stratified by diagnostic group: traumatic orthopaedic, elective orthopaedic, neurological, medical, and other. The association between client and service factors and discharge VAS scores, adjusted for baseline scores were determined using multivariable regression. EQ-5D-5L data were available for 981 of 1350 participants. Treatment intensity was associated with a seven-point increase (β = 7.22, 95%CI 2.28–12.2, p = 0.004) in VAS scores for traumatic orthopaedic participants. For neurological participants, there was a positive interaction between comorbidities and intensity of therapy (β = 7.9, 95%CI 2.75–13.1, p = 0.003), indicating that greater therapy intensity in those with higher comorbidity scores was associated with an improvement in VAS scores. Age was negatively associated with VAS scores for traumatic orthopaedic participants and socioeconomic status was positively associated with VAS scores for elective orthopaedic participants. Treatment intensity is a modifiable service factor that may positively influence health-related quality of life. In addition to providing information on client progress towards attainment of individual treatment goals, routine collection of patient reported outcome measures within a community rehabilitation program can elicit information that can inform rehabilitation service improvement. Clients of a community rehabilitation program with a neurological or medical condition demonstrate the least improvement in overall health profile and may require additional rehabilitation or supports. Across all diagnostic groups, problems with anxiety and depression were least likely to improve following receipt of community rehabilitation. Improving access to psychological services and associated referral pathways in community rehabilitation services could improve these outcomes. Initiatives aimed at increasing intensity of therapy such as targeted triage and resource allocation, may improve health-related quality of life for clients of a community rehabilitation program with traumatic orthopaedic conditions. For clients with a neurological condition, initiatives aimed at increasing intensity of therapy may improve health-related quality of life in more complex patients with comorbid health conditions. [ABSTRACT FROM AUTHOR]

In this paper, we present and reflect upon the process of evaluating two residential mental health facilities in Thessaloniki, Greece, through the WHO QualityRights tool kit. The QualityRights tool kit is a structured process for assessing quality of care and human rights in mental health and social care facilities, in accordance with the United Nations Convention on the Rights of Persons with Disabilities (CRPD), introduced by the World Health Organization in 2012. We have piloted the use of the Toolkit in two supported accommodation facilities, a hostel and a service supervising independent living in apartments, for individuals with long‐term severe mental health problems in the region of Thessaloniki. In this paper, we present the methodology and process of evaluating the facilities, including the challenges posed to the evaluation process by restrictions due to the Covid‐19 pandemic. We showcase the outcome of this evaluation through presenting a summary of the results and the ensuing recommendations for improvement. Finally, we reflect on the usefulness, appropriateness and relevance of the Toolkit for evaluating mental health care facilities in the particular context of contemporary Greece. [ABSTRACT FROM AUTHOR]

The article analyses players' satisfaction with their football agents and factors that influence differences in level of satisfaction. To analyse the performance relationship between player and agent, their relationship is based on the principal-agent theory. The explorative study includes a dataset from professional German football players (n = 336). A logistic regression model was used to determine relevant factors influencing differences in a player's satisfaction with an agent. Across all leagues, agents generally perform 'classic' transfer and contract-related tasks. It is less common for agents to be delegated tasks requiring expert knowledge in areas such as taxation. Players' level of satisfaction with their agents appears to be rather ambivalent. However, this is significantly influenced by implicit and explicit factors, such as the scope of services and a personal relationship or screening agents in advance, respectively. [ABSTRACT FROM AUTHOR]

Introduction: Sub-acute mental health community services provide a bridging service between hospital and community care. There is limited understanding of the local factors that influence success, and of the funding implications of delivering services in rural areas. Methods: This paper draws from quantitative and qualitative evaluation data from a regional Western Australian service to explore these issues. Results: Consumers satisfaction with the service was high and, overall, admission to the service resulted in positive outcomes. High re-admission rates may be linked to limited community support services following discharge. Discussion: Our results suggest that outcomes may be enhanced by implementing flexible approaches that address the resource limitations of the rural context, and that the current funding model for sub-acute mental health services in rural Australian may not be fit for purpose. More needs to be understood about how these services can be better integrated with existing support services, and how they can be better funded. [ABSTRACT FROM AUTHOR]

The Library and Information Center (LIC) of Patras' University and the Hellenic Open University Distance Library and Information Center constitute two academic libraries that serve two different academic institutions types. By the time of the first phase of the outbreak (spring 2019) they attempted to respond multidimensionally to the emerging needs, aspiring tο a seamless provision of services. Currents' research primary objective is to record and compare their actions identifying any differences in their crisis management behavior. The study offers an overview of services offered by libraries that have limited resources and presents their attempt to remain effective under any circumstances. [ABSTRACT FROM AUTHOR]

Objectives To identify barriers to the use of nailfold capillaroscopy as a diagnostic tool for patients presenting with Raynaud's phenomenon in UK rheumatology centres and to obtain rheumatologists' views on a proposed internet-based standardized system for clinical reporting of nailfold capillaroscopy images. Methods An online survey was developed using expert opinion from clinicians, scientists and health service researchers. The survey was piloted and sent to UK-based rheumatologists using established electronic mailing lists between October 2020 and March 2021. Survey data were analysed using descriptive statistics. Results A total of 104 rheumatologists representing rheumatology centres across the UK responded to the survey. Wide variations in terms of workloads and practices were described. Thirty-four (33%) respondents reported using nailfold capillaroscopy only at their own centre, 33 (32%) referred to other centres, 9 (9%) did both and 28 (27%) did not use capillaroscopy at all. Of the 43 respondents using capillaroscopy on site, 25 (58%) used either a dermatoscope or universal serial bus microscope and 9 (21%) used videocapillaroscopy. Among the 61 respondents not undertaking capillaroscopy on site, barriers included lack of equipment (85%), lack of experience in acquiring images (69%) and lack of expertise in interpreting images (67%). Sixty-six respondents (63%) expressed interest in an internet-based, standardized automated system for reporting images. Conclusion Most UK rheumatologists currently do not perform nailfold capillaroscopy on site. An internet-based nailfold capillaroscopy system for use with low-cost microscopes as well as with videocapillaroscopy could help increase uptake of capillaroscopy and thereby facilitate early diagnosis of SSc across the UK. [ABSTRACT FROM AUTHOR]

As cancer survival rates increase, so does the importance of preventing and alleviating the late effects of radiotherapy. The effect of long-term problems on patients' physical, social and psychological well-being must be addressed along with the importance of developing an understanding of the late effects of treatment to find ways of maximising the quality of life of cancer survivors. The aim of this service evaluation was to establish what support, information and education on post treatment changes women who have undergone pelvic radiotherapy for gynaecological cancer were provided with, and whether it met their needs. An interpretative phenomenological analysis was undertaken to explore the support, information and education on post treatment changes women who have undergone pelvic radiotherapy for gynaecological cancer are currently provided with and whether or not it meets their needs. Semi-structured interviews were conducted to gain insight into the experiences of participants. Researcher reflexivity was considered and ethics permissions granted. This paper reports the themes from analysis; communication and information provision, abandonment, service provision, and sexual health and intimacy. All patients experienced feelings of abandonment at the completion of treatment and those experiencing ongoing side effects needing greater support, particularly to manage side effects affecting the bowel and bladder. This study fills a gap in existing knowledge and identifies that patients with a gynaecological cancer require greater communication and support. The introduction of a therapeutic radiographer led late effects clinic and sexual care after radiotherapy clinic could provide the support and information that patients need to cope with the long-term side effects experienced due to pelvic radiotherapy. This service evaluation highlights the importance of including patient perspectives when designing and developing services. [ABSTRACT FROM AUTHOR]

Many governments have implemented indirect policy instruments as an alternative to direct instruments for providing public services. However, the effectiveness of the instruments from the perspective of recipients has not yet been compared in depth in the literature. This study investigates the recipients' evaluation of the differences between public housing and housing vouchers, which were exogenously assigned by the government to recipients, using ordered logit and generalized ordered logit models to analyze data collected in 2019 from Korean military personnel. The findings indicate that the evaluations of the services delivered by housing vouchers were more positive than those of public housing, and the magnitude of the difference between evaluations varied according to the attributes of the household decision makers and the rural or urban location of the leased house. These findings provide empirically grounded contributions to the selection of policy instruments and uncover the contexts in which each policy instrument may be implemented for the best effect. [ABSTRACT FROM AUTHOR]

The Complementary Health and Wellbeing service has been offering integrative therapies to cancer patients at The Christie Hospital NHS Trust since 1997 and has not undergone an external service evaluation in that time. It is considered a pioneering service. An external academic was invited to undertake a service evaluation based on information and experiences since the implementation of services changes as the result of the COVID 19 pandemic. Service users and therapists were interviewed along with review of quality control data and documentation. Eighteen staff and eight patients were interviewed showing a high functioning and valuable service, offering a range of services to meet the needs of both inoutpatient and outpatient services. All staff are qualified and passionate, with a significant number of research outputs. However, the service is at capacity, and must rethink some delivery to ensure long term sustainability. Services offered include acupuncture, aromatherapy, massage, talking therapies and motivational behavioural changes. There is a high degree of patient satisfaction as the therapies help them manage their life affecting side effects, however accessing or being aware of the service before treatment commenced was a concern for patients. The Complementary Health and Wellbeing Service is well resourced, with all staff paid employees of the NHS trust funded via a charitable part of the trust. There is a self-funding education unit to provide staff training with participants coming from around the world. The therapists are expert practitioners who have undergone specialist training to work in this unique environment, however capacity to meet the needs of the service is limited, and there are gaps in the way patient evaluations are collected, which needs to be addressed for long term viability and future benchmarking. The changes to service to adapt to COVID-19 have become embedded within the service. • Integrative therapies are an established evidenced based practice. • Staff are trained in a range of complementary therapies including massage. • Patients value the service for their recovery, however it is not widely promoted. • Changes made to the service due to the COVID 19 pandemic have now become standard. • Integrative therapies are a cost effective option to manage complex life affecting side effects of cancer treatment. [ABSTRACT FROM AUTHOR]

Penile cancer (PeCa) is a rare cancer with surgical options that affect patients' quality-of-life. Patient-reported outcome measures (PROMs) are uncommonly utilized in this cohort despite their several patient-centered benefits and there are recommendations to further digitalize PROMs. This prospective, population-based study aimed to report the development and feasibility of a novel electronic patient-reported outcome measures (ePROMs) questionnaire for patients with PeCa. A novel ePROMs questionnaire was developed and sent to patients 3 days before outpatient clinic appointments. The questionnaire included up to 30 items on patient symptomology and quality-of-life, including a self-reported quality-of-life score (rated 0 being worst and 100 being best). Data were collected for patients followed up between August 2021 and May 2022. The primary feasibility outcomes, adherence and engagement, were measured by response and drop-out rates. Differences in responders and nonresponders were also ascertained. Secondary outcomes explored the clinical utility of the questionnaire. Responders were subcategorized into 3 groups: circumcision (Ci), partial penectomy (PP) or total penectomy (TP) and differences were analyzed. This study was approved by the local Trust Governance Panel, including for ethical considerations. 220 adult males were sent ePROMs questionnaires, and 141 (64%) responded initially. The mean dropout rate of subsequent questionnaires was 56%. The maximum number of questionnaires sent to and completed by a patient was 8 (n = 1). Nonresponders were older (P <.0001), with poorer performance status (P <.0001) and lower body mass index (P =.0288). TP patients reported the lowest median quality-of-life score 68.50 (8-99), followed by the Ci group (72.0, 37-94) and the PP group (76.0, 10-99). Patients initially engaged and adhered to the ePROMs questionnaire but struggled to maintain this over time. Clinical data gathered by the questionnaire may be utilized to inform patient care. The questionnaire requires additional validation, research, and education. This study reports the development and feasibility of a novel electronic patient-reported outcome measures questionnaire for patients with penile cancer. 220 adult males were sent questionnaires, and 141 (64%) responded initially. The mean dropout rate of subsequent questionnaires was 56%, displaying that over time patients struggled to maintain adherence and engagement. The questionnaire requires additional validation, research, and education. [ABSTRACT FROM AUTHOR]

Abstract Background Community mental healthcare has significantly grown since de-institutionalization. Despite progress, service fragmentation and gaps in service provision remain key barriers to effective community care in England. Recent mental healthcare policies highlighted the need to transform service provision by developing patient-centred, joined-up community mental healthcare. In response to policy guidance, a system-wide community mental healthcare model was developed in Peterborough (England). The “Peterborough Exemplar” is based on two main pillars: (1) the creation of knowledge exchange pathways to strengthen interorganizational relationships, and (2) the development of new, accessible community services addressing existing service gaps. This paper presents the protocol developed to evaluate the Peterborough Exemplar. Methods A quasi-experimental design with an intervention group and a nonequivalent comparator group has been developed to compare service provision provided in Peterborough pre- and post-intervention with services provided in Fenland, a neighbouring area where service users access usual care. Two evaluation methods will be employed to compare service provision between the two groups: (1) outcome measures completed by service users and carers will be analysed to assess quality of life and service satisfaction, and (2) service activity data will be analysed to assess service usage. In addition, qualitative interviews will be conducted with staff members of participating organizations to explore the implementation of the Exemplar in Peterborough and evaluate knowledge exchange processes among local service providers. A matched control approach will be used to compare outcome measures between the two areas. Descriptive and inferential statistics, including chi-square tests, will be used to analyse service activity data and examine differences between the two areas. A thematic analysis will be adopted to analyse qualitative data. Discussion Outcomes of the evaluation will contribute to understanding the contribution of the Peterborough Exemplar on mental health service provision locally. Evaluation findings and intermediate reporting will be shared with organizations involved in the implementation of the Peterborough Exemplar and with local decision-makers to inform the Exemplar delivery. As the Peterborough Exemplar is an Early Implementer (EI) site funded by NHS England, findings will be shared with policy-makers to inform national policy on community mental healthcare and integrated care.

IntroductionSub-acute mental health community services provide a bridging service between hospital and community care. There is limited understanding of the local factors that influence success, and of the funding implications of delivering services in rural areas.MethodsThis paper draws from quantitative and qualitative evaluation data from a regional Western Australian service to explore these issues.ResultsConsumers satisfaction with the service was high and, overall, admission to the service resulted in positive outcomes. High re-admission rates may be linked to limited community support services following discharge.DiscussionOur results suggest that outcomes may be enhanced by implementing flexible approaches that address the resource limitations of the rural context, and that the current funding model for sub-acute mental health services in rural Australian may not be fit for purpose. More needs to be understood about how these services can be better integrated with existing support services, and how they can be better funded.

Why you should read this article: • To understand the value of a tool to measure patients' perceptions of safety in acute settings • To appreciate how the King's Patient Safety Measure can be appropriate for a diverse range of patients • To assess the use of the KPSM as a real-time early warning tool Background: Safety measurement tools have traditionally examined safety climate and culture from the perspective of healthcare professionals. A small number of studies have used tools to measure patients' perceptions of safety. Aim: To develop and check the validity of a questionnaire, the King's Patient Safety Measure (KPSM), that assesses how patients perceive their safety when receiving acute care. Discussion: A cross-sectional survey of 158 patients was undertaken that was constructed to establish the validity and reliability of a 13-item questionnaire. A general linear model statistically tested how patients perceived the safety of their care and whether those views were associated with covariates that included characteristics such as age, gender, ethnic identity, socio-economic factors, how long they stayed in hospital and the way they were admitted to hospital. Conclusion: The KPSM is a validated tool consisting of a single factor that is internally consistent. Implications for practice: The KPSM is appropriate for and potentially applicable to a diverse range of patients and could act as an early warning tool. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Risk factors associated with prolonged episodes of mechanical restraint and other coercive measures are understudied.There have been no studies of this phenomenon in the context of the Andalusian public health system.Knowledge about factors associated with prolonged episodes is essential to increase the understanding of this phenomenon and develop strategies to reduce its occurrence. What does this paper add to existing knowledge?: In Andalusia, prolonged restraint is still frequent and varies depending on the unit.It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. What are the implications for practice?: Interventions at the level of the units could be necessary to prevent prolonged episodes of mechanical restraint.The results suggest the need for stricter control during the shifts on which restraint starts, especially in the first days after the patient's admission.Preventive risk assessment considering clinical and sociodemographic risk factors could help to reduce prolonged restraint. Introduction: Factors associated with prolonged episodes of mechanical restraint and other coercive interventions are not clearly established and have been not studied in Andalusia (Spain). Aim: To study factors associated with prolonged episodes of mechanical restraint. Method: We analysed retrospectively episodes of mechanical restraint (N = 6267, prolonged episode >9.5 hours) in all public mental health hospitalization units (N = 20, 535 beds) that offer health coverage for the autonomous community of Andalusia. The data came from clinical records. A multivariable mixed logistic regression was used. Results: In Andalusia, prolonged restraint is still frequent and varies depending on the unit. It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. Discussion: The results provide evidence that prolonged episodes largely depend on the unit where they occur and that stricter control and regulation are necessary to prevent prolonged episodes. Implications for practice: Interventions at the level of the unit are necessary. Stricter control in the shifts during which there is more risk of prolonged restraint may be necessary, especially in the first days following admission. [ABSTRACT FROM AUTHOR]

Service robots are emerging quickly in the marketplace (e.g., in hotels, restaurants, and healthcare), especially as COVID-19-related health concerns and social distancing guidelines have affected people's desire and ability to interact with other humans. However, while robots can increase efficiency and enable service offerings with reduced human contact, prior research shows a systematic consumer aversion toward service robots relative to human service providers. This potential dilemma raises the managerial question of how firms can overcome consumer aversion and better employ service robots. Drawing on prior research that supports the use of language for building interpersonal relationships, this research examines whether the type of language (social-oriented vs. task-oriented language) a service robot uses can improve consumer responses to and evaluations of the focal service robot, particularly in light of consumers' COVID-19-related stress. The results show that consumers respond more favorably to a service robot that uses a social-oriented (vs. task-oriented) language style, particularly when these consumers experience relatively higher levels of COVID-19-related stress. These findings contribute to initial empirical evidence in marketing for the efficacy of leveraging robots' language style to improve customer evaluations of service robots, especially under stressful circumstances. Overall, the results from two experimental studies not only point to actionable managerial implications but also to a new avenue of research on service robots that examines customer-robot interactions through the lens of language and in contexts that can be stressful for consumers (e.g., healthcare or some financial service settings). [ABSTRACT FROM AUTHOR]

Objective: Previous studies at child and youth mental health services (CYMHS) suggest that children with ADHD have poorer outcomes compared to those with other diagnoses. This study investigates this in more detail. Methods: Children with ADHD were compared to those with ASD and those with emotional disorders, on routinely collected outcomes at CYMHS in Australia (N = 2,513) and the Netherlands (N = 844). Results: Where the emotional disorders group reached a similar level of emotional symptoms at the end-of-treatment as the ADHD and ASD groups, the latter two groups still had higher scores on ADHD and ASD symptoms (attention and peer problems). The poorer outcomes were mainly explained by higher severity at baseline. In Australia, an ADHD and/or ASD diagnosis also independently contributed to worse outcomes. Conclusion: Those with neurodevelopmental disorders within both countries had poorer outcomes than those with emotional disorders. Services should aim to optimize treatment to ensure best possible outcomes. [ABSTRACT FROM AUTHOR]

Objective: To examine the use of maggot debridement therapy (MDT) for individuals with diabetic foot ulcers (DFU) after a change in prescribing policy. Method: A selfcompletion survey/structured questionnaire to assess healthcare professionals' existing knowledge of MDT was given to those specialist services providing wound care treatments for DFUs. Results: The results showed that those responding had a basic understanding of MDT and its use. However, further education is required for the type of wounds that maggots can be applied to, and what enzymes are produced. Enablers and barriers to MDT use also included policy and procedures, time constraints and the 'yuck factor'. Conclusion: While there is good clinical evidence to support the use of MDT, there is a lack of evidence examining the factors that influence healthcare professionals' decisions to recommend this treatment. [ABSTRACT FROM AUTHOR]

Background: Integrated home care (IHC) is one strategy to provide care to people with multiple chronic conditions, and it contributes to the reduction of unnecessary emergency department (ED) use, but there are conflicting results on its effectiveness. In this study, we assessed the frequency and characteristics of ED visits occurring before, during, and after IHC in a large cohort of IHC patients enrolled over 6 years. Methods: The analysis included 39 822 IHC patients identified in Italian administrative databases. Patients were grouped in tertiles according to IHC duration (short, intermediate, and long) and the number of ED visits during IHC was compared to that the 12 months before IHC enrolment and in the 12 months after IHC discharge across IHC duration groups. Results: We observed a reduction in ED visits during IHC. IHC was significantly associated with a reduction in ED visits in the long and short IHC duration groups. A non-significant reduction in ED visits was observed in the intermediate IHC duration group. A 90% reduction in ED visits during IHC and a 45% reduction after IHC was observed in the short IHC duration group. Corresponding reductions were 17% and 64% during and after IHC, respectively, in the long IHC duration group. Conclusion: IHC was effective in reducing ED visits, but expansion of IHC to include additional necessary services could further reduce ED visits. Investment in the creation of a structured, effective network of engaged professionals (including community care services and hospitals) is crucial to achieving this. [ABSTRACT FROM AUTHOR]

Background: Cognitive Behavioural Analysis System of Psychotherapy (CBASP) is an evidenced based treatment model for chronically depressed patients. Aims: The main aim of this service evaluation was to assess the acceptability and clinical impact of CBASP for chronic depression within an Improving Access to Psychological Therapies (IAPT) service. Method: Routinely collected data were analysed for all patients that received CBASP treatment focussing on the recovery rates of these patients in terms of depression, anxiety and social functioning. Interviews were conducted with patients who had recently been discharged from CBASP therapist within one month of the follow-up date, explore their experiences of therapy. Results: Outcome data for 27 patients suggested substantial reduction in scoring on measures of depression and anxiety following CBASP treatment. Across all interviews it was clear that patients developed an insight and understanding of how their behaviours affect the outcome of interpersonal situations. Conclusions: Results from this service evaluation suggest that CBASP is acceptable to service users and has a positive clinical impact in terms of IAPT recovery targets for anxiety, depression and social functioning. [ABSTRACT FROM AUTHOR]