Fixing the system? The experience of service users of the quasi-market in disability services in Australia

A qualitative study involving semi-structured interviews with 31 people with disabilities and 32 carers in the state of Queensland, Australia, found that their experience of supportive service delivery had not improved despite reforms of the service delivery system driven by a version of the quasi-market model. Instead of delivering increased consumer choice and improved efficiency in service delivery, service users experienced inadequate service supply, service cutbacks, and an increased emphasis on cost subsidisation and assessment processes. Additionally, few consumers felt that individualised funding arrangements had personally delivered the benefits which the quasi-market model and associated policy paradigm had indicated that they should receive. For many consumers, the notion of consumer 'choice' around service provision was fictitious and they felt that any efficiency gains were at the agency level, largely at the consumers' cost. It is concluded that there appears to be no particular benefit to service users of quasi-market reforms, particularly in policy contexts where service delivery systems are historically under-funded.

Service users experiences of a therapeutic group programme in an acute psychiatric inpatient unit.

Psychiatric nurses have been facilitating therapeutic groups in acute psychiatric inpatient units for many years; however, there is a lack of nursing research related to this important aspect of care. This paper reports the findings of a study which aimed to gain an understanding of service users' experiences in relation to therapeutic group activities in an acute inpatient unit. A qualitative descriptive study was undertaken with eight service users in one acute psychiatric inpatient unit in Ireland. Data were collected using in-depth semi-structured interviews and analysed using Burnard's method of thematic content analysis. Several themes emerged from the findings which are presented in this paper.

Contributo para a validação da versão portuguesa do instrumento de avaliação VOICE (service users perceptions of impatient care, Views on Inpatient Care)

RESUMO: Nos últimos anos assistiu-se a um reposicionamento das pessoas portadoras de doença mental na sociedade, no sentido de viverem em pleno os seus direitos, sem restrições. Esta tendência acompanhou as transformações que se têm vivido na forma como os utentes dos serviços de saúde interagem com os mesmos e com os profissionais de saúde, de forma a permitir uma maior autonomização e responsabilização no que concerne ao tratamento da sua doença, a relação que estabelecem com o seu médico, e a participação na avaliação e monitorização da qualidade dos serviços. Mais recentemente, também no mundo científico, esta afirmação se fez sentir, com o surgimento de investigação liderada por utentes, no sentido de estudar de forma adequada questões que partem do seu ponto de vista, e que possibilitem a produção de conhecimento significativa no contexto das suas experiências. Com o presente trabalho pretende-se contribuir para a validação da versão portuguesa do VOICE (Service Users’ Perceptions of Inpatient Care, Views on Inpatient Care) (Evans et al., 2012), instrumento para a avaliação dos serviços de internamento de agudos em psiquiatria, construído a partir de um investigação liderado por utentes e partindo das suas perspectiva. O VOICE é constituído por 19 questões, agrupadas em sete domínios: admissão; cuidados e tratamento; medicação; equipa de técnicos do internamento; terapia e atividades; ambiente e diferenças. O presente estudo envolveu uma amostra de 85 utentes de um serviço de internamento de agudos de uma instituição psiquiátrica do Norte de Portugal. A versão portuguesa do VOICE apresentou boa aceitação por parte dos utentes e boas características psicométricas - a consistência interna foi alta (α = 0,87) e todos, exceto um item (item 6), apresentam elevadas correlações item-total (variando de 0,18 - item 6 a 0,71 - item 11; M = 0,54, DP = 0,15), sugerindo ser um instrumento útil na avaliação dos serviços de internamento de agudos. No futuro torna-se necessário alargar o estudo a outros contextos de internamento e envolvendo amostras mais alargadas.-------------- ABSTRACT: In recent years there has been a gradual process to help people with the experience of mental illness regaining their full rights. Following the advances in the understanding of mental health problems, and the use of medication to help patients overcome symptoms, service-users have become more autonomous and responsible in the way they deal with health professionals, and are now called to participate in assessing and monitoring mental health services and policies. In the context of these transformations we have assisted to the emergence of research led by service-users (in this case of psychiatric and mental health services) in order to emphasize their point of view, and to enable the production of significant knowledge resulting from their experiences, and perceptions. The present study aims to contribute to the dissemination of service-user led research, based on the adaptation and validation of the Portuguese version of the VOICE - Service Users' Perceptions Questionnaire, Views on Inpatient Care. (Evans et al., 2012). The VOICE is composed of 19 questions, grouped in seven domains: admissions, care and treatment, medication, team of technicians during hospitalization, therapy and activities, environment and diversity. The present study involved a sample of 85 inpatient of a psychiatric institution in Northern Portugal. The Portuguese version of the VOICE showed good psychometric properties and was well accepted by patients [high internal consistency (α = 0,87); and high correlation of each item, except item 6, with the total score (ranging from 0.18 on item 6 to 0.71 on item 11; average=0,54; SD=0,15), suggesting it to be a useful tool for assessing inpatient services. In the future there is a need to extend the study to other contexts and include larger samples.

The move to servitization (from a product service system point of view)

Product Service Systems (PSSs) emphasize the substitution of products with services. The term “Servitisation” was introduced by Sandra Vendermerwe in the 80s to represent the addition of services to increase a company’s competitive edge. Key to PSS, and Servitisation more generally, is the “informated product”. The informated product enables health monitoring of the product in use and can be key to a workable PSS. This paper reviews the evolution of servitisation and the associated business benefit. It also then reviews the concept of informated product reconfiguration techniques and remote services that enables PSS to be delivered.

Access to tuberculosis diagnosis in Itaborai City, Rio de Janeiro, Brazil: the patient`s point of view

SETTING: Itaborai Municipality in Rio de Janeiro, Brazil. OBJECTIVE: To evaluate access to tuberculosis (TB) diagnosis for users of the Family Health Program (FHP) and Reference Ambulatory Units (RAUs). DESIGN : A cross-sectional study was conducted in Itaborai City, Rio de Janeiro, Brazil. Between July and October 2007, a sample of 100 TB patients registered consecutively with the TB Control Program was interviewed using the primary care assessment tool. The two highest scores, describing `almost always` and `always`, or `good` and `very good`, were used as a cut-off point to define high quality access to diagnosis. RESULTS: FHP patients were older and had less education than RAU interviewees. Sex and overcrowding did not differ in the two groups. Patient groups did not differ with regard to the number of times care was sought at a unit, transport problems, cost of attending units and availability of consultation within 24 h. Adequate access to diagnosis was identified by 62% of the FHP patients and 53% of the RAU patients (P = 0.01). CONCLUSION: In Itaborai, Rio de Janeiro, TB patients believe that the FHP units provide greater access to TB diagnosis than RAUs. These findings will be used by the Department of Health to improve access to diagnosis in Itaborai.

Nouveautés en médecine interne hospitalière 2007: perspective des chefs de clinique [Highlights 2007 in hospital-based internal medicine: the point of view from the chief residents]

L'année 2007 a été marquée par la publication de plusieurs études internationales concernant directement le quotidien de l'interniste hospitalier. Un résumé de ces travaux ne saurait être qu'un extrait condensé et forcément subjectif d'une croissante et dynamique diversité. Au gré de leurs lectures, de leurs intérêts et de leurs interrogations, les chefs de clinique du Service de médecine interne vous proposent ainsi un parcours original revisitant les thèmes de l'insuffisance cardiaque, du diabète, de l'endocardite, de la BPCO ou de la qualité des soins. Cette variété de sujets illustre à la fois le vaste champ couvert par la médecine interne actuelle, ainsi que les nombreuses incertitudes liées à la pratique médicale moderne basée sur les preuves. In 2007, several international studies brought useful information for the daily work of internists in hospital settings. This summary is of course subjective but reflects the interests and questions of the chief residents of the Department of internal medicine who wrote this article like an original trip in medical literature. This trip will allow you to review some aspects of important fields such as heart failure, diabetes, endocarditis, COPD, and quality of care. Besides the growing diversity of the fields covered by internal medicine, these various topics underline also the uncertainty internists have to face in a practice directed towards evidence.

BUSINESS CONCEPTS OF MOBILE VALUE-ADDED SERVICES FROM OPERATOR’S POINT OF VIEW

Tämä diplomityö on tehty Lappeenrannassa Telecom Business Research Centerin 5T-projektiin liittyen. Työssä tutkitaan matkaviestinnän lisäarvopalveluiden liiketoimintakonsepteja operaattoreiden näkökulmasta. Lisäarvopalvelut laajentavat operaattoreiden palveluvalikoimaa. Niiden osuuden telekommunikaatioalan yritysten ja erityisesti operaattoreiden tuotoista on ennustettu kasvavan huomattavasti. Työn tärkeimpänä tavoitteena on tuoda uusia näkökulmia ja lisätä ymmärrystä lisäarvopalveluiden liiketoimintakonseptin rakentamisprosessista. Tätä tietämystä käytetään edesauttamaan työn empiirisessä osuudessa tutkitun Content Gateway -tuotteen liiketoimintaa. Tarjoamalla nopean liitynnän ja laskutuskanavan ulkopuolisten palveluntarjoajien ja operaattorin välille tämä tuote mahdollistaa operaattorille ja palveluntarjoajille lisäarvopalveluiden liiketoiminnan käynnistämisen. Lisäarvopalveluiden arvonluontiprosessi vaatii lukuisia yhteistyötä tekeviä osapuolia, joiden yhteistoiminta on dynaamista ja tiedonvälitys avointa, interaktiivista ja nopeaa. Arvonluontiin liittyy myös monia konvergoituvia kehityssuuntia. Perinteinen arvoketjuajattelu on riittämätön uuteen, verkottuneeseen toimintaympäristöön ja sen tilalle on tullut modernimpi arvoverkostomalli. Arvoverkosto luo kilpailuetunsa muita verkostoja vastaan jakamalla resurssit ja kompetenssit optimaalisesti ja liittämällä strategisen ja operationaalisen johtamisen kulttuurit toisiinsa. Tässä työssä verrataan arvoverkoston teoreettisia tavoitteita kahteen lisäarvopalveluiden liiketoimintakonseptiin. Näistä ensimmäinen, i-mode –niminen konsepti on valittu vertailuun edistyksellisyytensä ja tulevaa kehitystä ennakoivien ominaispiirteidensä vuoksi. Toinen esimerkkikonsepti on rakennettu edellä mainitun Content Gateway -tuotteen ympärille. Tutkimus sisältää mm. liikekumppaneiden hankinnan, ansaintalogiikoiden ja verkostojen johtamisen analysoinnin. Työn tuloksena on saatu ohjeita siihen, miten operaattori voi rakentaa tällaista konseptia ja mitä seikkoja tulee ottaa huomioon erityisesti sanomapalveluihin liittyvässä liiketoiminnassa.

L'année 2014 mise en perspective par les internistes hospitaliers [What is new in 2014 for the specialist in hospital internal medicine? The point of view of university hospital chief residents].

The year 2014 was rich in significant advances in all areas of internal medicine. Many of them have an impact on our daily practice and on the way we manage one problem or another. From the use of the ultrasound for the diagnosis of pneumonia to the choice of the site of venous access and the type of line, and the increasing complexity of choosing an oral anticoagulant agent, this selection offers to the readers a brief overview of the major advances. The chief residents in the Service of internal medicine of the Lausanne University hospital are pleased to share their readings.

ATTITUDES TOWARD RUSSIAN CUSTOMERS IN THE FINNISH RETAIL TRADE SECTOR – A salesperson’s point of view

The amount of Russian tourists in Finland has increased significantly in the past years. The impact of Russian tourism to the Finnish retail trade sector is enormous, since Russian tourists often spend a lot of money particularly on shopping. Shopping tourism is mainly focused in the near border cities, such as Imatra and Lappeenranta, and in addition in Helsinki metropolitan area. The purpose of this study is to map the attitudes and perceptions of the sales personnel who are working in the Finnish retail trade sector towards Russian customers and to discover which elements affect these attitudes. The theories in this study are based on cultural elements and elements related to sales behavior and performance. Cultural differences between Finland and Russia, cultural distance and cultural intelligence form the cultural aspect of this study. Customer orientation vs. sales orientation (SOCO), adaptive selling, selling skills and job competency, salesperson’s affect and empathy toward customers, and job autonomy form the elements concerning sales behavior and performance. Furthermore, the attitude – behavior link, based on social psychology is addressed. A survey was conducted in two retail trade chains operating in Finland. These retail companies have stores and department stores in different geographical areas in Finland and the survey was conducted in altogether 19 cities. In addition to the theories that were discussed, two expert interviews were conducted in order to get a deeper understanding of the phenomenon at hand. Moreover the interviews helped in the formulation of the hypotheses and the questionnaire design. The questionnaires were sent directly to the stores, where they were placed so that they were available for the sales personnel. Altogether 487 usable responses were collected. The returned questionnaires were analyzed with IBM SPSS 21 statistics program. The results of this study indicated that the attitudes toward Russian customers are more negative compared to other foreign customers. However, the respondents’ attitudes toward and perceptions of Russian customers varied a lot. From the background variables age, education level, length of employment in current workplace, and length of experience in customer service had an effect on the attitudes of the respondents. In addition, the perceptions of Russian customers were more positive in the Eastern Finland compared to Helsinki metropolitan area. The cultural elements; cultural knowledge, cultural distance and cultural intelligence all affected the attitudes of the respondents. From the elements related to sales behavior and performance customer orientation, salesperson’s affect and empathy toward customers, and perceived job autonomy had an effect on the attitudes

On Seliger and Whitham`s variational principle for hydrodynamic systems from the point of view of `fictitious particles`

FAPESP, the Sao Paulo State Research Foundation[04/04611-5]

Factors that prevent or assist the integration of assistive technology into the workplace for people with spinal cord injuries: Perspectives of the users and their employers and co-workers

Examined the barriers faced by people with Spinal Cord Injuries (SCI) when integrating their Assistive Technology (AT) into the workplace, as well as factors that contribute to successful integration. In-depth interviews were taken with 5 men (aged 37-50 yrs) with SCI, 3 of their employers and 2 co-workers. Results indicate that in addition to the barriers previously outlined in the literature related to funding the technology, time delays, information availability, training and maintenance, other issues were highlighted. Implications for service providers are considered in relation to these barriers and the factors that prompted successful integration. The author discusses limitations of the study and makes recommendations for future research. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

The point-of-referral barrier - a factor in the success of telehealth

A feasibility study was carried out to test the hypothesis that, for an effective telehealth service, a full-time coordinator is required to act as a single point of contact for consultation requests. By shifting the responsibility for telepaediatrics from the referrer to the provider, the telehealth process becomes equally (or more) attractive as the conventional alternative. Preliminary results showed that, within six months, telepaediatric activity increased to an average of 8 h per month. Not only did certain health services become more accessible to children and their families in remote areas of Queensland, but significant savings were also made. At least 12 patient transfers were avoided to and from the tertiary facility, with an estimated minimum saving of $18,000 to the health-care provider.