Improving the identification of Aboriginal and Torres Strait Islander people in mainstream general practice

The project aim was to identify promising strategies to improve identification processes in mainstream general practice. To achieve this aim, the project explored three primary research questions. • What strategies to improve the identification of Aboriginal and Torres Strait Islander people in mainstream general practice have been trialled before and what is worth trialling (feasible and acceptable) in the future? • How can mainstream general practice be encouraged to improve identification processes for Aboriginal and Torres Strait Islander people? • What are the links between improved identification and quality of care?The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities

Research and development work relating to assistive technology 2010-11 (Department of Health) Presented to Parliament pursuant to Section 22 of the Chronically Sick and Disabled Persons Act 197

Application of GIS to labour market planning in construction

The fluctuations in the demand for construction work have often resulted in skills shortages. This has led to the need for effective construction labour market planning strategies, which enable the construction industry to meet its skills requirements, particularly in periods of peak demand. Existing approaches to construction labour market planning have several limitations. They do not shed light on the socio-economic and spatially influenced issues within which the industry’s skills shortages are rooted. There is, therefore, a need for more appropriate decision-support mechanisms that can take account of spatial problems in terms of skills demand and supply influences. Through industry involvement, this research has explored how GIS can enhance the labour market planning process in construction. The research briefly reviews the nature of labour market planning in construction, introduces geographic information systems, and highlights the opportunities they offer for overcoming the limitations of existing approaches. The implementation of the GIS-based system and its application to a specific labour market planning initiative is then presented. The evaluation of the system by prospective end-users reveals the enablers, barriers and benefits of the system implementation. Organisational issues that had a bearing on the implementation are also examined and recommendations made for further research

Appraisal of free online symptom checkers and applications for self-diagnosis and triage: An Australian evaluation

The internet has impacted society and changed the way companies and individuals operate on a daily basis. Seeking information online via computer or mobile device is common practice. The phrase ‘Google it’ is now part of modern vernacular and is a resource increasingly utilised by young and old alike. Around 80% of Australian’s search health-related information online as it is convenient, cheap, and available 24/7. Symptom checkers are one tool used by consumers to investigate their health issues. Symptom checkers are automated online programs which use computerised algorithms, asking a series of questions to help determine a potential diagnosis and/or provide suitable triage advice. Recent evidence suggests symptom checkers may not work the way they are intended. Inferior or incorrect healthcare information can potentially have serious consequences on the consumer’s wellbeing and may not have the desired effect of directing consumers to the appropriate point of care. This research evaluated the clinical performance of 36 symptom checkers found on websites and smartphone applications that are freely available for use by the Australian general public. Symptom checkers were exposed to 48 clinical vignettes, generating 1858 symptom checker vignette tests (SCVT). Diagnosis was assessed on the inclusion of the correct diagnosis in the first, the top three or top ten differential diagnoses (n = 1,170 SCVT). Triage advice was assessed on whether the triage category recommended was concordant with our assessment (n = 688 SCVT). The correct diagnosis was listed first in 36% (95% CI 31–42) of SCVT, within the top three in 52% (95% CI 47–59) and within the top ten in 58% (95% CI 53–65). Symptom checkers which claimed to utilise artificial intelligence (AI) outperformed non-AI with the first listed diagnosis being accurate in 46% (95% CI 40–57) versus 32% (95% CI 26–38) of SCVT. Individual symptom checker performance varied considerably, with the average rate of correct diagnosis provided first ranging between 12%–-61%. Triage advice provided was concordant with our assessment in 49% (95% CI 44–54) of SCVT. Appropriate triage advice was provided more frequently for emergency care SCVT at 63% (95% CI 52–71) than for non-urgent SCVT at 30% (95% CI 11–39). Symptom checker performance varied considerably in relation to diagnosis. Triage advice was risk-averse, typically recommending more urgent care pathways than necessary. Given this, symptom checkers may not be working to alleviate demand for health services (particularly emergency services) within Australia—counter to marketing materials of some organisations’ symptom checkers. It is important that symptom checkers do not further burden the healthcare system with inappropriate referrals or incorrect care advice. Although, a balance must be struck as avoiding unsuitable triage advice could potentially result in life-threatening consequences for consumers. Nonetheless, the results of this research make clear that the accuracy of diagnosis and triage advice provided from readily available symptom checkers for the Australian public require improvements before everyday consumers can rely entirely on health information provided via these mediums

Exploring, evaluating and improving the development process for Military Load Carrying Equipment

This work sought to explore, evaluate and then improve the process of development for personal Military Load Carriage Equipment (MLCE), such as rucksacks. It was suspected that current MLCE had a number of user interaction deficiencies which should have been addressed during development. Three research questions were posed to determine: the influences on MLCE development, what needed improvement in MLCE development and how MLCE development could be improved. The work was based on eight studies conducted in three phases: the first to explore MLCE development and the observed deficiencies, the second to evaluate MLCE development, and the third to improve it. The chosen research strategy was henomenological, using a grounded theory methodology within which phenomena could emerge. Grounded theory approaches were adopted for this research because they were the best way in which to access the design domain. The research was framed within cycles of reflective action research to enable the researcher to re-orientate the enquiry to make the best use of the research opportunities that arose from the organisational context in which the research was sited. An initial investigation into the development of in-service equipment was done via a comparative case study, using documentary analysis and interviews with authorities in the field. Through this investigation it became clear that MLCE development was based on heuristics and tacit knowledge of manufacturing techniques, and collaboration between professional groups, including: materials / manufacturing, human systems, project management and military personnel. Deficiencies within MLCE development, determined through the comparative study, were validated against current practice through a further case study and additional evaluations. A comparison of outputs from these studies was then reviewed in a grounded manner to gain a holistic understanding of MLCE development. The interaction and importance of the various influences on MLCE development was then better understood, in particular the inadequate understanding of MLCE user needs, and requirement specification. To refine the possible avenues and target audience for an improvement of MLCE development stakeholder interviews were undertaken to develop a better understanding of how military user needs were gathered and applied. Following the interview survey, a tool was developed to analyse video and audio data of soldiers operating with MLCE on current operations. The tool was then reviewed by a panel of MLCE developers and stakeholders. The panel thought that the tool had a number of benefits to MLCE development: improving understanding of soldier environments, improved quality and reliability of information used in development, and as a conduit for concept evaluation. The research has provided a novel perspective on MLCE development, and provided a number of avenues upon which subsequent research could focus. The research has been able to make original contributions to understanding, albeit in a manner limited by the methodologies used.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Using Digital Health Technology to Optimise Older People’s Pain Self-Management Capabilities: A Mixed Methods Study (The DigiTech Pain Project)

Background Arthritic pain is a major cause of illness and disability among older people. As the use of smartphones and apps increases in the lives of older people, there is an opportunity to explore the role of these apps in helping older people better manage their arthritic pain. Aim To explore the feasibility and acceptability of older people using an arthritic pain selfmanagement app to improve their pain symptoms. Methods A parallel convergent, mixed methods design underpinned by Bandura’s Self-Efficacy Theory and the Technology Acceptance Model 2; comprising of the following five studies: (i) Study 1a: an integrative review; (ii) Study 1b: a systematic review; (iii) Study 2a: a phase I feasibility study of pre–post-test design; (iv) Study 2b: a qualitative sub-study involving participants of study; and (v) Study 3: a qualitative interview study with primary care and allied health clinicians. The data from these studies was integrated to answer the project’s research questions. Results Study 1a revealed paucity of evidence on use of apps for older people’s pain selfmanagement. Study 1b indicated that few publicly available pain self-management apps are based on robust evidence. Eighteen older people were recruited into Study 2a, 80% via snowballing. Over 59% of participants were provided face-to-face app download and use training, none had used a pain self-management app in the past. Telephone-based survey and interview data collection was found to be acceptable to older people. Almost 90% of study 2a participants (n=16) took part in study 2b sharing their experiences of using the intervention app. Following four themes emerged: (i) Apps are valuable selfmanagement tool, but they do have the potential for harm; (ii) pain self-management apps need to be strictly relevant to the user; (iii) Clinicians’ involvement is crucial; and (iv) pain self-management apps must be designed with the end user in mind. Study 3 recruited seventeen (n=17) primary care and allied health clinicians who shared their perceptions and attitudes regarding app use by their older patients for pain self-management. Four themes emerged: (i) self-management apps are a potentially useful tool but require careful consideration; (ii) clinicians’ involvement is crucial yet potentially onerous; (iii) no single app is right for every older person; and (iv) patient data access is beneficial but caution is needed for real-time data access. Meta-inference of the data from all five studies indicated that an app intervention involving older people was both feasible and acceptable, with the following caveats: snowballing recruitment may be required; and access to app download and use training is an important element to implement into the study design. Older people and primary care clinicians were keen to engage with pain self-management apps; however, they wanted these apps to offer high level usefulness, adaptability and information sharing features. Future pain self-management apps need to be underpinned by robust evidence, while providing appropriate support and resources to clinicians. Conclusion While older people and their clinicians welcomed the opportunity to use pain self-management apps, their engagement ought to be supported by systems level policies, and high-quality apps. Collaboration among clinicians, older people, researchers and app developers ought to be considered when developing, researching and integrating pain self-management apps

Task Shifting and Health System Design: Report of the Expert Panel on effective ways of investing in Health (EXPH)

Imagine a health professional in any European country who fell asleep in 1960 and awoke in a health facility in 2019. Much of what the observer saw would be quite different. There would be many more patients who were surviving into old age thanks to advances in therapy. Many of the treatments that they were receiving would be much more complex, involving radically new techniques such as laparoscopic or even robotic surgery, and they would be amazed by the advances in diagnostic capacity. Yet, in many health systems, some things would have changed very little. Among them would be the traditional roles of different types of health worker, with responsibility for certain task being reserved for those with particular qualifications based on custom and practice rather than on evidence. This opinion argues that this situation must change. There is now an impressive body of evidence that things can often be done differently. This does not mean that they should be. Change is only appropriate where it helps to achieve the goals of the health system and allows it to provide better care in ways that are more responsive to the needs of users. Tasks can be shifted from health workers to patients and their carers, to machines, and to other health workers. Where these shifts have been evaluated, they often, but not always, are associated with outcomes that are as good or even better than with the status quo. However, the results are often context dependent, and it cannot be assumed that what works in one situation will apply equally to another. What matters is the evidence, rather than traditional, but often obsolete rules. If a health system can ensure that tasks are being undertaken by those most appropriate to do them, it will enhance patient care. However, change is often difficult. Those involved must be convinced of the rationale for change and must be supported in implementing it. This should recognise that any change in roles will have implication for their status and thus existing hierarchies. It may also be necessary to challenge outdated legislative or regulatory barriers. Finally, it is essential the changes are evaluated, results are documented, and lessons are learned, both in relation to what works and in what circumstances. Task shifting, where it is based on robust evidence and implemented effectively, can make a major contribution to health outcomes and to the sustainability of health systems. It is not, however, a panacea for all of the challenges health systems face.Představte si zdravotnického odborníka v kterékoli evropské zemi, který usnul v roce 1960 a probudil se ve zdravotnickém zařízení v roce 2019. Hodně z toho, co by pozorovatel viděl, by bylo úplně jiné. Bylo by mnohem více pacientů, kteří přežili do stáří díky pokrokům v terapii. Mnoho z ošetření, které dostávali, by bylo mnohem složitější, zahrnovalo radikálně nové techniky, jako je laparoskopická nebo dokonce robotická chirurgie, a byl by ohromen pokrokem v diagnostickém rozsahu. Přesto by se v mnoha zdravotnických systémech některé věci změnily jen velmi málo. Mezi nimi by byly tradiční role různých typů zdravotnických pracovníků, přičemž odpovědnost za určitý úkol by byla vyhrazena těm, kteří mají zvláštní kvalifikaci založenou spíše na zvyklostech a praxi než na důkazech. Toto stanovisko tvrdí, že se tato situace musí změnit. Nyní existuje impozantní soubor důkazů, že věci lze často dělat jinak. To neznamená, že by měli být jinak dělány. Změna je vhodná pouze tam, kde pomáhá dosahovat cílů zdravotnického systému a umožňuje jí poskytovat lepší péči způsoby, které lépe reagují na potřeby uživatelů. Úkoly lze převádět ze zdravotnických pracovníků na pacienty a jejich pečovatele, na stroje a další zdravotnické pracovníky. Tam, kde byly tyto posuny vyhodnoceny, jsou často, ale ne vždy, spojeny s výsledky, které jsou stejně dobré nebo dokonce lepší než za současného stavu. Výsledky jsou však často závislé na kontextu a nelze předpokládat, že to, co funguje v jedné situaci, se bude vztahovat stejně na jiné. Důležitý je důkaz spíše než tradiční, ale často zastaralá pravidla. Pokud zdravotní systém může zajistit, že osoby, které jsou pro ně nejvhodnější, plní správně alokované úkoly, zlepší se péče o pacienty. Změna je však často obtížná. Zúčastněné strany musí být přesvědčeny o důvodech změny a musí být podporovány při jejich provádění. Musí uznat, že každá změna rolí bude mít dopad na jejich stav, a tedy na existující hierarchie. Může být také třeba změnit zastaralé legislativní nebo regulační překážky. Nakonec je nezbytné, aby byly změny vyhodnoceny, výsledky zdokumentovány a vedly k ponaučení, co funguje a za jakých okolností. Posun úkolů, činností a kompetencí, pokud je založen na spolehlivých důkazech a je účinně prováděn, může významně přispět k lepším výsledkům v oblasti zdraví a k udržitelnosti zdravotních systémů. Nejedná se však o všelék na všechny výzvy, kterým zdravotnické systémy čelí.Imagine a health professional in any European country who fell asleep in 1960 and awoke in a health facility in 2019. Much of what the observer saw would be quite different. There would be many more patients who were surviving into old age thanks to advances in therapy. Many of the treatments that they were receiving would be much more complex, involving radically new techniques such as laparoscopic or even robotic surgery, and they would be amazed by the advances in diagnostic capacity. Yet, in many health systems, some things would have changed very little. Among them would be the traditional roles of different types of health worker, with responsibility for certain task being reserved for those with particular qualifications based on custom and practice rather than on evidence. This opinion argues that this situation must change. There is now an impressive body of evidence that things can often be done differently. This does not mean that they should be. Change is only appropriate where it helps to achieve the goals of the health system and allows it to provide better care in ways that are more responsive to the needs of users. Tasks can be shifted from health workers to patients and their carers, to machines, and to other health workers. Where these shifts have been evaluated, they often, but not always, are associated with outcomes that are as good or even better than with the status quo. However, the results are often context dependent, and it cannot be assumed that what works in one situation will apply equally to another. What matters is the evidence, rather than traditional, but often obsolete rules. If a health system can ensure that tasks are being undertaken by those most appropriate to do them, it will enhance patient care. However, change is often difficult. Those involved must be convinced of the rationale for change and must be supported in implementing it. This should recognise that any change in roles will have implication for their status and thus existing hierarchies. It may also be necessary to challenge outdated legislative or regulatory barriers. Finally, it is essential the changes are evaluated, results are documented, and lessons are learned, both in relation to what works and in what circumstances. Task shifting, where it is based on robust evidence and implemented effectively, can make a major contribution to health outcomes and to the sustainability of health systems. It is not, however, a panacea for all of the challenges health systems face

Opportunities for greater Lincolnshire's supply chains: full report

A study of the key sector supply chains across Greater Lincolnshire, and identification of barriers and opportuniteis for growth