Randomized clinical trial of the timing it right stroke family support program: Research protocol

Background Family caregivers provide invaluable support to stroke survivors during their recovery, rehabilitation, and community re-integration. Unfortunately, it is not standard clinical practice to prepare and support caregivers in this role and, as a result, many experience stress and poor health that can compromise stroke survivor recovery and threaten the sustainability of keeping the stroke survivor at home. We developed the Timing it Right Stroke Family Support Program (TIRSFSP) to guide the timing of delivering specific types of education and support to meet caregivers' evolving needs. The objective of this multi-site randomized controlled trial is to determine if delivering the TIRSFSP across the stroke care continuum improves caregivers' sense of being supported and emotional well-being. Methods/design Our multi-site single-blinded randomized controlled trial will recruit 300 family caregivers of stroke survivors from urban and rural acute care hospitals. After completing a baseline assessment, participants will be randomly allocated to one of three groups: 1) TIRSFSP guided by a stroke support person (health care professional with stroke care experience), delivered in-person during acute care and by telephone for approximately the first six to 12 months post-stroke; 2) caregiver self-directed TIRSFSP with an initial introduction to the program by a stroke support person, or; 3) standard care receiving the educational resource "Let's Talk about Stroke" prepared by the Heart and Stroke Foundation. Participants will complete three follow-up quantitative assessments 3, 6, and 12-months post-stroke. These include assessments of depression, social support, psychological well-being, stroke knowledge, mastery (sense of control over life), caregiving assistance provided, caregiving impact on everyday life, and indicators of stroke severity and disability. Qualitative methods will also be used to obtain information about caregivers' experiences with the education and support received and the impact on caregivers' perception of being supported and emotional well-being. Discussion This research will determine if the TIRSFSP benefits family caregivers by improving their perception of being supported and emotional well-being. If proven effective, it could be recommended as a model of stroke family education and support that meets the Canadian Stroke Best Practice Guideline recommendation for providing timely education and support to families through transitions.

The YOU CALL-WE CALL randomized clinical trial: Impact of a multimodal support intervention after a mild stroke

Background Comparison of a multimodal intervention WE CALL (study initiated phone support/information provision) versus a passive intervention YOU CALL (participant can contact a resource person) in individuals with first mild stroke. Methods and Results This study is a single-blinded randomized clinical trial. Primary outcome includes unplanned use of health services (participant diaries) for adverse events and quality of life (Euroquol-5D, Quality of Life Index). Secondary outcomes include planned use of health services (diaries), mood (Beck Depression Inventory II), and participation (Assessment of Life Habits [LIFE-H]). Blind assessments were done at baseline, 6, and 12 months. A mixed model approach for statistical analysis on an intention-to-treat basis was used where the group factor was intervention type and occasion factor time, with a significance level of 0.01. We enrolled 186 patients (WE=92; YOU=94) with a mean age of 62.5±12.5 years, and 42.5% were women. No significant differences were seen between groups at 6 months for any outcomes with both groups improving from baseline on all measures (effect sizes ranged from 0.25 to 0.7). The only significant change for both groups from 6 months to 1 year (n=139) was in the social domains of the LIFE-H (increment in score, 0.4/9±1.3 [95% confidence interval, 0.1–0.7]; effect size, 0.3). Qualitatively, the WE CALL intervention was perceived as reassuring, increased insight, and problem solving while decreasing anxiety. Only 6 of 94 (6.4%) YOU CALL participants availed themselves of the intervention. Conclusions Although the 2 groups improved equally over time, WE CALL intervention was perceived as helpful, whereas YOU CALL intervention was not used.

Study protocol of the YOU CALL - WE CALL TRIAL: Impact of a multimodal support intervention after a "mild" stroke

Background More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization. The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support) - "WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to) - "YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life. Method/Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar) and quality of life (EQ-5D and Quality of Life Index). Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar). Blind assessors will gather data at mid-intervention, end of intervention and one year follow up. Discussion If effective, this multimodal intervention could be delivered in both urban and rural environments. For example, existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics, make this intervention, if effective, deliverable and sustainable.

Linking client and employee perceptions of the organization: A study of client satisfaction with health care services

Client satisfaction with health care services has usually been researched in terms of socio-demographic and predispositional characteristics associated with the client. The present study included organizational characteristics as predictors of client satisfaction with health care services. Participants in the research were clients and employees of an Australian public-sector health care organization who responded to separate client and employee questionnaires. Hierarchical regression analyses indicated that, after controlling for a number of client characteristics, organizational characteristics, as perceived by employees, accounted for a significant proportion of additional variance in client satisfaction with health care services. Results of the present study provided some support for the proposition that employee perceptions of the working environment should be considered in a more comprehensive understanding of client satisfaction with health care services. Limitations of the study highlight practical difficulties in the assessment of client outcomes and methodological complexities in linking individual and organizational processes.

Incentivizing innovation: A review of the Brazilian federal innovation support programs

Innovation is the transformation of knowledge of any kind into new products or services in the market. Its importance as a production factor is widely acknowledged. In the age of the knowledge-based economy innovation became critical for any company or even country to compete globally. Many countries are encouraging innovation through various mechanisms, and one of the most widely used is the provision of special incentives for innovation. This paper investigates incentive systems for the growth of technology companies as a strategy to promote knowledge-based economic development. As for the case investigations the study focuses on an emerging economy, Brazil. The research is based upon the available literature, best practices, government policy and review of incentive systems. The findings provide insights from the case study in a country context and some lessons learned for other countries using incentive systems to boost the innovation capabilities of their technology companies.

The role of institutional pressures and top management support in the intention to adopt cloud computing solutions

Purpose – While many studies have predominantly looked at the benefits and risks of cloud computing, little is known whether and to what extent institutional forces play a role in cloud computing adoption. The purpose of this paper is to explore the role of institutional factors in top management team’s (TMT’s) decision to adopt cloud computing services. Design/methodology/approach – A model is developed and tested with data from an Australian survey using the partial least squares modeling technique. Findings – The results suggest that mimetic and coercive pressures influence TMT’s beliefs in the benefits of cloud computing. The results also show that TMT’s beliefs drive TMT’s participation, which in turn affects the intention to increase the adoption of cloud computing solutions. Research limitations/implications – Future studies could incorporate the influences of local actors who might also press for innovation. Practical implications – Given the influence of institutional forces and the plethora of cloud-based solutions on the market, it is recommended that TMTs exercise a high degree of caution when deciding for the types of applications to be outsourced as organizational requirements in terms of performance and security will differ. Originality/value – The paper contributes to the growing empirical literature on cloud computing adoption and offers the institutional framework as an alternative lens with which to interpret cloud-based information technology outsourcing.

Understanding consumer loyalty to technology-based self-services with credence qualities

Purpose This paper aims to use the Model of Goal-Directed Behavior (MGB) to examine the factors affecting consumers’ continued use of emerging technology-based self-services (TBSSs) with credence qualities. Professional services, which traditionally require specialized knowledge and high levels of interpersonal interaction to produce owing to their credence qualities, are increasingly delivered via self-service technologies. Health services delivered via mobile devices, for example, facilitate self-care without direct involvement from health professionals. Design/methodology/approach A mental health service delivered via the Internet and mobile phone, myCompass, was selected as the research context. Twenty interviews were conducted with users of myCompass and the data were thematically analyzed. Findings The findings of the study showcase the unique determinants of consumers’ continued use of TBSSs with credence qualities relative to the more routine services which have been the focus of extant research. The findings further provide support for the utility of the MGB in explaining service continuance, although the importance of distinguishing between extrinsic and intrinsic motivational components of behavioral desire and capturing the impact of social influence beyond subjective norms is also highlighted. Originality/value This study contributes to recent research examining differences in consumer responses across TBSSs and behavioral loyalty to these services. It also provides empirical evidence for broadening and deepening the MGB within this behavioral domain.

What is shared services?

Purpose This chapter discusses the constitution of Shared Services and the value of a consensual agreement of a definition for academe and practice. It explores the operating principles and services, the concepts of internal customer and internal service, and their importance for the practitioner and research communities. Methodology/approach This chapter employed a broad review of the literature to examine Shared Services. The research team used NVivo as a tool to create a database of key articles and books to analyze the key concepts and topics. Findings There is a lack of consensus on the definition of Shared Services in the research and practitioner community. Additionally, the concept of internal customer requires greater exploration and understanding within the context of Shared Services. How Shared Services provides competitive advantage to organizations is also not well understood. Research limitations/implications This discussion provides a challenge to the research community to focus on the contributions of shared services to business management theory. This requires a consensus that is currently nonexistent, to ensure the correct use of the terminology and model. Practical implications By establishing a clearer understanding of what is Shared Services, the academic and the practitioner community, in particular, will gain greater competencies on Shared Services to support change management programs during the implementation phases and minimize implementation costs by lowering organizational and people resistance. The variants in shared services terminology create confusion which is likely to result in ambiguity during implementation and have practical implications on governance, customers and service, benefits realization and performance. Originality/value of chapter This chapter addresses the lack of agreed definition of the term Shared Services and the role of the internal customer and consequent internal service delivery.

Motivation and behavioural patterns of students accessing a peer-facilitated support for learning program

This paper describes the development and use of personas, a Human Computer Interaction (HCI) research methodology, within the STIMulate peer learning program, in order to better understand student behaviour patterns and motivations. STIMulate is a support for learning program at the Queensland University of Technology (QUT) in Brisbane, Australia. The program provides assistance in mathematics, science and information technology (IT) for course work students. A STIMulate space is provided for students to study and obtain one-on-one assistance from Peer Learning Facilitators (PLFs), who are experienced students that have excelled in relevant subject areas. This paper describes personas – archetypal users - that represent the motivations and behavioural patterns of students that utilise STIMulate (particularly the IT stream). The personas were developed based on interviews with PLFs, and subsequently validated by a PLF focus group. Seven different personas were developed. The personas enable us to better understand the characteristics of the students utilising the STIMulate program. The research provides a clearer picture of visiting student motivations and behavioural patterns. This has helped us identify gaps in the services provided, and be more aware of our assumptions about students. The personas have been deployed in PLF training programs, to help PLFs provide a better service to the students. The research findings suggest further study on the resonances between some students and PLFs, which we would like to better elicit.

Changing travel patterns and journeys to health services in Great Britain 1985-2012: An examination health service utilisation using the National Travel Survey

Background This paper examines changing patterns in the utilisation and geographic access to health services in Great Britain using National Travel Survey data (1985-2012). The National Travel Survey (NTS) is a series of household surveys designed to provide data on personal travel and monitor changes in travel behaviour over time. The utilisation rate was derived using the proportion of journeys made to access health services. Geographic access was analysed by separating the concept into its accessibility and mobility dimensions. Methods Variables from the PSU, households, and individuals datasets were used as explanatory variables. Whereas, variables extracted from the journeys dataset were used as dependent variables to identify patterns of utilisation i.e. the proportion of journeys made by different groups to access health facilities in a particular journey distance or time band or by mode of transport; and geographic access to health services. A binary logistic regression analysis was conducted to identify the utilisation rate over the different time periods between different groups. This analysis shows the Odds Ratios (ORs) for different groups making a trip to utilise health services compared to their respective counterparts. Linear multiple regression analyses were conducted to then identify patterns of change in the accessibility and mobility level. Results Analysis of the data has shown that that journey distances to health facilities were signi fi cantly shorter and also gradually reduced over the period in question for Londoners, females, those without a car or on low incomes, and older people. Although rates of utilisation of health services we re Oral Abstracts / Journal of Transport & Health 2 (2015) S5 – S63 S43 signi fi cantly lower because of longer journey times. These fi ndings indicate that the rate of utilisation of health services largely depends on mobility level although previous research studies have traditionally overlooked the mobility dimension. Conclusions This fi nding, therefore, suggests the need to improve geographic access to services together with an enhanced mobility option for disadvantaged groups in order for them to have improved levels of access to health facilities. This research has also found that the volume of car trips to health services also increased steadily over the period 1985-2012 while all other modes accounted for a smaller number of trips. However, it is dif fi cult to conclude from this research whether this increase in the volume of car trips was due to a lack of alternative transport or due to an increase in the level of car-ownership.

Australia's disabling income support system: Tracing the history of the disability pension from 1908 to today

This article is based on a historical-comparative policy and discourse analysis of the principles underpinning the Australian disability income support system. It determines that these principles rely on a conception of disability that sustains a system of coercion and paternalism that perpetuates disability and referred to as disablism. The article examines the construction of disability in Australian income support across four major historical epochs spanning the period 1908-2007. Contextualisation of the policy trajectory and discourses of the contemporary disability pension regime for the time period 2008-now is also provided. Two major themes were found to have interacted with the ideology of disablism. This article argues that a non-disabling provision based on social citizenship, rather than responsible or productive citizenship, counters the tendency for authoritarian and paternal approaches. [Abridged]

Australian data do not support current pharmaceutical benefits scheme criteria for use of tumour necrosis factor-α inhibitors in ankylosing spondylitis

On the basis of local data, we write in support of the conclusions of Smith and Ahern that current Pharmaceu- tical Benefits Scheme (PBS) criteria for tumour necrosis factor (TNF)-a inhibitors in ankylosing spondylitis (AS) are not evidence-based. 1 As a prerequisite to the appropriate use of biological therapy in AS, three aspects of the disease need to be defined: (i) diagnosis, (ii) activity and (iii) therapeutic failure (Table 1)....

Submission to the draft Migration Assurance Policy - Improving the transition to the fixed-line national broadband network review

The rights of individuals to self-determination and participation in social, political and economic life are recognised and supported by Articles 1, 3 and 25 of the International Covenant on Civil and Political Rights 1966.4 Article 1 of the United Nations’ Human Rights Council’s Resolution on the Promotion and Protection of Human Rights on the Internet of July 2012 confirms individuals have the same rights online as offline. Access to the internet is essential and as such the UN: Calls upon all States to promote and facilitate access to the Internet and international cooperation aimed at the development of media and information and communications facilities in all countries (Article 3) Accordingly, access to the internet per se is a fundamental human right, which requires direct State recognition and support.5 The obligations of the State to ensure its citizens are able, and are enabled, to access the internet, are not matters that should be delegated to commercial parties. Quite simply – access to the internet, and high-speed broadband, by whatever means are “essential services” and therefore “should be treated as any other utility service”...

QUT’s research data storage solutions: A launchpad for research journeys

This poster presents key features of how QUT’s integrated research data storage and management services work with researchers through their own individual or team research life cycle. By understanding the characteristics of research data, and the long-term need to store this data, QUT has provided resources and tools that support QUT’s goal of being a research intensive institute. Key to successful delivery and operation has been the focus upon researchers’ individual needs and the collaboration between providers, in particular, Information Technology Services, High Performance Computing and Research Support, and QUT Library. QUT’s Research Data Storage service provides all QUT researchers (staff and Higher Degree Research students (HDRs)) with a secure data repository throughout the research data lifecycle. Three distinct storage areas provide for raw research data to be acquired, project data to be worked on, and published data to be archived. Since the service was launched in late 2014, it has provided research project teams from all QUT faculties with acquisition, working or archival data space. Feedback indicates that the storage suits the unique needs of researchers and their data. As part of the workflow to establish storage space for researchers, Research Support Specialists and Research Data Librarians consult with researchers and HDRs to identify data storage requirements for projects and individual researchers, and to select and implement the most suitable data storage services and facilities. While research can be a journey into the unknown[1], a plan can help navigate through the uncertainty. Intertwined in the storage provision is QUT’s Research Data Management Planning tool. Launched in March 2015, it has already attracted 273 QUT staff and 352 HDR student registrations, and over 620 plans have been created (2/10/2015). Developed in collaboration with Office of Research Ethics and Integrity (OREI), uptake of the plan has exceeded expectations.

“I have to rest all the time because you are not allowed to play”: Exploring children’s perceptions of autonomy during sleep-time in long day care services

Daytime sleep is a significant part of the daily routine for children attending early childhood education and care (ECEC) services in Australia and many other countries. The practice of sleep-time can account for a substantial portion of the day in ECEC and often involves a mandated sleep/rest period for all children, including older preschool-aged children. Yet, there is evidence that children have a reduced need for daytime sleep as they approach school entry age and that continuation of mandated sleep-time in ECEC for preschool-aged children may have a negative impact on their health, development, learning and well-being. Mandated sleep-time practices also go against current quality expectations for services to support children’s agency and autonomy in ECEC. This study documents children’s reports of their experiences of sleep-time in ECEC. Semi-structured interviews were conducted with 54 preschool-aged children (44–63 months) across four long day ECEC services that employed a range of sleep-time practices. Findings provide a snapshot of children’s views and experiences of sleep-time and perceptions of autonomy-supportive practices. These provide a unique platform to support critical reflection on sleep-time policies and practices, with a view to continuous quality improvement in ECEC. This study forms part of a programme of work from the Sleep in Early Childhood research group. Our work examines sleep practices in ECEC, the subsequent staff, parent and child experiences and impacts on family and child learning and development outcomes.