Creating Excellence in Dementia Care: A Research Review for Ireland's National Dementia Strategy

Examines the prevalence and economic and social costs of dementia; policies, practices, and data on health and social care services in community-based, acute care, and long-term residential settings; and proposed elements for a new strategy

Service Selection using Predictive Models and Monte-Carlo Tree Search

This article proposes a method for automated service selection to improve treatment efficacy and reduce re-hospitalization costs. A predictive model is developed using the National Home and Hospice Care Survey (NHHCS) dataset to quantify the effect of care services on the risk of re-hospitalization. By taking the patient's characteristics and other selected services into account, the model is able to indicate the overall effectiveness of a combination of services for a specific NHHCS patient. The developed model is incorporated in Monte-Carlo Tree Search (MCTS) to determine optimal combinations of services that minimize the risk of emergency re-hospitalization. MCTS serves as a risk minimization algorithm in this case, using the predictive model for guidance during the search. Using this method on the NHHCS dataset, a significant reduction in risk of re-hospitalization is observed compared to the original selections made by clinicians. An 11.89 percentage points risk reduction is achieved on average. Higher reductions of roughly 40 percentage points on average are observed for NHHCS patients in the highest risk categories. These results seem to indicate that there is enormous potential for improving service selection in the near future

Practice nurses as case managers in a collaborative care model for managing depression among patients with heart disease or diabetes : The D_TECT and TrueBlue studies in primary care

A successful feasibility study called D_TECT (Depression Treatment Evaluation Care Team) used a collaborative approach to detect, monitor and treat depression among patients with existing type 2 diabetes mellitus (T2DM) or coronary heart disease (CHD) in primary care. It was developed by the Greater Green Triangle Department of Rural Health and conducted in general practices in rural areas. The model mobilised existing resources and funding paths available in general practice, including general practitioners, practice nurses and existing Medicare-funded enhanced primary care items

Implementing the EffTox dose-finding design in the Matchpoint trial

Background: The Matchpoint trial aims to identify the optimal dose of ponatinib to give with conventional chemotherapy consisting of fludarabine, cytarabine and idarubicin to chronic myeloid leukaemia patients in blastic transformation phase. The dose should be both tolerable and efficacious. This paper describes our experience implementing EffTox in the Matchpoint trial. Methods: EffTox is a Bayesian adaptive dose-finding trial design that jointly scrutinises binary efficacy and toxicity outcomes. We describe a nomenclature for succinctly describing outcomes in phase I/II dose-finding trials. We use dose-transition pathways, where doses are calculated for each feasible set of outcomes in future cohorts. We introduce the phenomenon of dose ambivalence, where EffTox can recommend different doses after observing the same outcomes. We also describe our experiences with outcome ambiguity, where the categorical evaluation of some primary outcomes is temporarily delayed. Results: We arrived at an EffTox parameterisation that is simulated to perform well over a range of scenarios. In scenarios where dose ambivalence manifested, we were guided by the dose-transition pathways. This technique facilitates planning, and also helped us overcome short-term outcome ambiguity. Conclusions: EffTox is an efficient and powerful design, but not without its challenges. Joint phase I/II clinical trial designs will likely become increasingly important in coming years as we further investigate non-cytotoxic treatments and streamline the drug approval process. We hope this account of the problems we faced and the solutions we used will help others implement this dose-finding clinical trial design. Trial registration: Matchpoint was added to the European Clinical Trials Database (2012-005629-65) on 2013-12-30

Mediterranean models of Welfare towards families and women

After tracing a Malta’s short historical excursus with its effects on female condition, family’s structure and concept, organizational model of non profit sector, the paper gives a survey of the most recent economic and demographic trends with special attention to families’ well-being and women’s working and social conditions, based not only on statistical data of Malta’s National Institute of Statistics and of Eurostat, but also on the results of some empirical studies based on some surveys carried out into the archipelago. The main islands’ social problems are outlined with the indication of the principal sources of aid to face peoples’ different needs (first of all family, followed by the State, while the Third Sector, with its strong component of foundations, heritage of English culture, is not pre-eminent yet). The paper also shows that the same citizens’ expectations of satisfaction of social needs are still mainly placed in the State, according to the collective image. After drawing this scenario, the paper makes a short history of Malta’s Welfare State specially considering legislation concerning families and women. In addition to the description of the legislative measures, a deeper investigation is also devoted to other programs realized at european and national level: Equal Program (2004-2006) and Malta’s latest “Action Plan”, alias the National Social Plan in its general lines of policy towards families and women. Besides the illustration of the services provided to families by the Ministry of Family and Social Solidarity in the context of the National Action Plan, three other articulations of the Plan are briefly examined: Gender Equity National Action Plan (2003-2004), National Action Plan on Poverty and Social Exclusion (2004-2006), National Action Plan for Employment (2004). The correlative institutional framework is also reviewed: the National Family Commission established in 2001 and the National Commission for the Promotion of Equality for Men and Women considered by the “Equality for Men and Women Act” of 2003. Finally the paper classifies Malta’s Welfare State among the Mediterranean models of social assistance for its specific characteristics though, differently from the evolutive tendencies of these last ones, the passage from Welfare State to Welfare Mix is still problematic and slow in Malta. In spite of the increasing forms of collaboration between public and non profit organizations, Malta’s Third Sector has still a too weak role, in comparison with family and State, in supporting people’s life on both factual and symbolic dimension. In this missing transition, specially as regards elderly care, Malta can not see yet the growth, inside Welfare Mix, of the more informal components formed by immigrated women to detriment of the services offered by private or non profit organizations (“care drain” phenomenon), which is very strongly in course in other Mediterranean countries (Italy, Spain, Greece).Family and Social Policy, Social Segregation, Poverty

Development of simulation and machine learning solutions for social issues

When developing solutions for social issues, it can be difficult to evaluate the impact they may have without a real world implementation. This may not be possible for reasons such as resource, time, and monetary constraints. To resolve these issues, simulation and machine learning models can be used to mimic reality and provide a picture of how these solutions would fare. In Chapters 3 and 4, a deep learning approach to simulating homelessness populations in Canada is presented. This model would provide policy makers with a tool to test different solutions for this societal problem without the need to wait for approvals or funding from local officials. In addition to this solution, data enhancement techniques are presented as a comprehensive dataset on homeless population transitions for such a model to learn from does not exist. Lastly, Chapter 5 presents a transfer learning architecture to detect tents in satellite images. The motivation for this work was that “tent camps” are common for homeless populations to live in and by having a solution to detect these from images, policy makers can easily see where to focus resources such as shelters for example. Similar to the constraint present with the homelessness simulation, a comprehensive dataset on tents in satellite images does not exists. Therefore, this chapter also presents a solution to generate an comprehensive dataset for the architecture to learn from. The result of this thesis is developed solutions to social issues that utilize the power of machine learning and simulation models

Joint Labor-Management Training Programs for Healthcare Worker Advancement and Retention

[Excerpt] Filling vacancies and retaining workers in shortage areas such as nursing and other allied health occupations remains a challenge in today’s healthcare industry. At the same time, low-wage workers in the healthcare industry often lack the educational credentials necessary to move into higher-paying occupations. This study seeks to understand the role of multi-employer joint labor-management healthcare worker training in meeting the needs of employers for career ladder advancement in their incumbent workforce. The study focuses on hospital employers and their experience with strategies for the advancement of low-wage and entry level workers into healthcare career pathways

East Lancashire Research 2008

East Lancashire Research 200

BROADENING THE PERSPECTIVE OF ECONOMIC EVALUATION IN HEALTH CARE – A CASE STUDY IN DEMENTIA CARE IN THE UK

My thesis is an investigation of the methods to implement a broader societal perspective in economic evaluation. I proposed two potential approaches that could be used to implement a societal perspective in economic evaluation: An extended cost-per-QALY approach and a CCA-MCDA approach. The investigation was conducted in a case study of dementia care. The case study concerned the evaluation of 4 mutually exclusive options for primary care to early detect people with dementia. I reviewed previous economic evaluation studies in dementia and developed a new cost-effectiveness model for this evaluation. The model provided estimates for costs including health care, government-funded social care, privately funded social care and informal care. Benefits were measured in terms of patient QALYs and carer QALYs. Using the model’s estimates as the initial basis, I applied the principles of the extended cost-per-QALY approach and the CCA-MCDA to implement a broader societal perspective in the economic evaluation in the case study