Advance care planning documentation strategies; goals-of-care as an alternative to not-for-resuscitation in medical and oncology patients. A pre-post controlled study on quantifiable outcomes

Background: Health services in Tasmania, Victoria and now Western Australia are changing to goals-of-care (GOC) advance care planning (ACP) documentation strategies. Aim: To compare the clinical impact of two different health department-sanctioned ACP documentation strategies. Methods: A non-blinded, pre–post, controlled study over two corresponding 6-month periods in 2016 and 2017 comparing the current discretional not-for-resuscitation (NFR) with a new, inclusive GOC strategy in two medical/oncology wards at a large private hospital. Main outcomes were the uptake of ACP forms per hospitalisation and the timing between hospital admission, ACP form completion and in-patient death. Secondary outcomes included utilisation of the rapid response team (RRT), palliative and critical care services. Results: In total, 650 NFR and 653 GOC patients underwent 1885 admissions (mean Charlson Comorbidity Index = 3.7). GOC patients had a higher uptake of ACP documentation (346 vs 150 ACP forms per 1000 admissions, P \u3c 0.0001) and a higher proportion of ACP forms completed within the first 48 h of admission (58 vs 39%, P = 0.0002) but a higher incidence of altering the initial ACP level of care (P = 0.003). All other measures, including ACP documentation within 48 h of death (P = 0.50), activation of RRT (P = 0.73) and admission to critical (P = 0.62) or palliative (P = 0.81) care services, remained similar. GOC documentation was often incomplete, with most sub-sections left blank between 74 and 87% of occasions. Conclusion: Despite an increased uptake of the GOC form, overall use remained low, written completion was poor, and most quantitative outcomes remained statistically unchanged. Further research is required before a wider GOC implementation can be supported in Australia’s healthcare systems

Propagating chain-free normal forms for EOL systems

We establish two types of normal forms for EOL systems. We first show that each ε-free EOL language can be generated by a propagating EOL system in which each derivation tree is chain-free. By this we mean that it contains at least one path from the root to the grandfather of a leaf in which each node has more than one son. We use this result to prove that each ε-free EOL language can be generated by a propagating EOL system in which each production has a right side of length at most two and which does not contain nonterminal chainproductions, i.e., productions A → B for nonterminals A and B. As applications of our results we give a simple proof for the decidability of the finiteness problem for EOL systems and solve an open problem concerning completeness of EOL forms

Emotion management and occupational therapy student learning on placement: A post-structuralist exploration

Introduction: The role of emotion management and emotional labour has been extensively debated and theorised in nursing and medical literature, but until recently, there has been very little written from an occupational therapy perspective Method: This doctoral research explored the emotional aspects of placement learning with a group of seven third-year occupational therapy students, using a post-structural theoretical framework and methodology. A creative arts–based qualitative methodology was employed. The researcher facilitated creative writing groups in which students produced stories and poems about placement experiences. The writing, the group discussions and the one-to-one conversations were analysed with post-structuralist and narrative theory. Findings: The innovative method produced writing that evokes the placement experiences and captures the students’ endeavours to manage their emotions in order to ‘perform the professional’. The findings reveal the role of emotion management in the discourses of professionalism in the health and social-care environment. Conclusion: The research raises questions for the occupational therapy profession about the hidden emotional aspects of our practice and proposes an alternative view of emotion management to that which is implied in the concept of emotional intelligence

OnTrack: Reflecting on domain specific formal methods for railway designs

OnTrack is a tool that supports workflows for railway verification that has been implemented using model driven engineering frameworks. Starting with graphical scheme plans and finishing with automatically generated formal models set-up for verification, OnTrack allows railway engineers to interact with verification procedures through encapsulating formal methods. OnTrack is grounded on a domain specification language (DSL) capturing scheme plans and supports generation of various formal models using model transformations. In this paper, we detail the role model driven engineering takes within OnTrack and reflect on the use of model driven engineering concepts for developing domain specific formal methods toolsets