Implementing cognitive remediation therapy : lessons from two public mental health services

Objective: Neurocognitive deficits are a core symptom domain of schizophrenia, occurring in 75 -90 % of people with this diagnosis and influencing long term functional outcomes. This article aims to describe the pilot implementation of cognitive remediation therapy (CRT) in two large public mental health services and detail changes made to the delivery of this therapy after this trial. Conclusions: CRT provides an evidence based approach to targeting cognitive deficits but the translation of this therapy from a research setting to clinical practice has not been well evaluated.

Patients perceptions of emergency department services : better specialised staff, convenient and available services

Many factors are identified as contributing to the high demand for emergency department (ED) care. Similarly, there have been many initiatives taken to minimise the impact that is placed on EDs. Many of these, however, do not consider the patient's opinions and motivations. The aim of this cross-sectional study was to understand patients’ perspectives and reasons behind their decision to present to EDs. 911 surveys were collected from patients presenting to eight QLD EDs in 2011. Based on the Principal Component Analysis technique, a six-item scale entitled "Best services at emergency departments" was extracted (α = 0.729) measuring patients' opinions and perspectives. Further, the independent t-tests were conducted between various groups of ED users. The results suggest that multiple users more likely viewed EDs as the best place for their conditions than the first-time users (Median 10.73 v 11.56, p<0.001). Moreover, patients who made the decision to present by themselves had a more favourable perception of the ED services than those for whom the decision was made or others were involved (Median 11.38 v 10.80, p=0.003). Method of arrival did not affect the respondents’ perception of ED (11.13 v 11.00, p=0.65). The results of this research indicate that patients’ perception of ED as the best and most appropriate place for attention to their medical conditions plays an important role in their decision to present and keep returning to ED. Understanding patients’ reasons and decisions enhances the success of planning and implementing alternative services to manage the demand for ED services.

Emergency Health Services (EHS) : demand and service delivery models. monograph 3 : patients’ reasons and perceptions

Executive Summary Emergency health is a critical component of Australia’s health system and emergency departments (EDs) are increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the perspectives of users of both ambulance services and EDs. The research reported here aimed to identify the perspectives of users of emergency health services, both ambulance services and public hospital Emergency Departments and to identify the factors that they took into consideration when exercising their choice of location for acute health care. A cross-sectional survey design was used involving a survey of patients or their carers presenting to the EDs of a stratified sample of eight hospitals. A specific purpose questionnaire was developed based on a novel theoretical model which had been derived from analysis of the literature (Monograph 1). Two survey versions were developed: one for adult patients (self-complete); and one for children (to be completed by parents/guardians). The questionnaires measured perceptions of social support, health status, illness severity, self-efficacy; beliefs and attitudes towards ED and ambulance services; reasons for using these services, and actions taken prior to the service request. The survey was conducted at a stratified sample of eight hospitals representing major cities (four), inner regional (two) and outer regional and remote (two). Due to practical limitations, data were collected for ambulance and ED users within hospital EDs, while patients were waiting for or under treatment. A sample size quota was determined for each ED based on their 2009/10 presentation volumes. The data collection was conducted by four members of the research team and a group of eight interviewers between March and May 2011 (corresponding to autumn season). Of the total of 1608 patients in all eight emergency departments the interviewers were able to approach 1361 (85%) patients and seek their consent to participate in the study. In total, 911 valid surveys were available for analysis (response rate= 67%). These studies demonstrate that patients elected to attend hospital EDs in a considered fashion after weighing up alternatives and there is no evidence of deliberate or ill-informed misuse. • Patients attending ED have high levels of social support and self-efficacy that speak to the considered and purposeful nature of the exercise of choice. • About one third of patients have new conditions while two thirds have chronic illnesses • More than half the attendees (53.1%) had consulted a healthcare professional prior to making the decision. • The decision to seek urgent care at an ED was mostly constructed around the patient’s perception of the urgency and severity of their illness, reinforced by a strong perception that the hospital ED was the correct location for them (better specialised staff, better care for my condition, other options not as suitable). • 33% of the respondent held private hospital insurance but nevertheless attended a public hospital ED. Similarly patients exercised considered and rational judgements in their choice to seek help from the ambulance service. • The decision to call for ambulance assistance was based on a strong perception about the severity of the illness (too severe to use other means of transport) and that other options were not considered appropriate. • The decision also appeared influenced by a perception that the ambulance provided appropriate access to the ED which was considered most appropriate for their particular condition (too severe to go elsewhere, all facilities in one spot, better specialised and better care). • In 43.8% of cases a health care professional advised use of the ambulance. • Only a small number of people perceived that ambulance should be freely available regardless of severity or appropriateness. These findings confirm a growing understanding that the choice of professional emergency health care services is not made lightly but rather made by reasonable people exercising a judgement which is influenced by public awareness of the risks of acute health and which is most often informed by health professionals. It is also made on the basis of a rational weighing up of alternatives and a deliberate and considered choice to seek assistance from a service which the patient perceived was most appropriate to their needs at that time. These findings add weight to dispensing with public perceptions that ED and ambulance congestion is a result of inappropriate choice by patients. The challenge for health services is to better understand the patient’s needs and to design and validate services that meet those needs. The failure of our health system to do so should not be grounds for blaming the patient, claiming inappropriate patient choices.

Embedded digital creative workers and creative services in banking

This chapter explores the roles and functions of both digital creative workers and creative services firms in an industry beyond the core creative industries: banking. The chapter focuses on the design and development of apps and mobile websites for smartphones and tablet computers, with examples drawn principally from the Australian banking sector. While it might be assumed that utility and practicality are more critical and more highly valued in apps development for financial services institutions than innovation and aesthetic design, this chapter illustrates the growing importance placed on creative work in this sector.

Creative services, apps and banks in Australia

This paper is divided in to three parts. The first part discusses recent CCI research on employment in creative services, with particular focus on the 'creative trident' model, and the distinction between cultural production and creative services occupations. The second part discusses the growth of the app economy and related employment details. The third part discusses mobile banking use, financial services and mobile devices, and apps created by or for banks.

Public Economics and the Assessment of Tourism Developments and Policies

Public economics covers both topics in welfare economic of social (as opposed to private) interest and aspects of public finance. This chapter considers the application of two methods of social economic evaluation of tourist developments, namely, social cost-benefit analysis and economic impact analysis. The role of social cost-benefit analysis in the assessment of tourism is illustrated by its application to the evaluation of inbound tourism. This is followed by a discussion of taxes on tourism and subsidies to promote it. The principle focus is on hotel room taxes. The analysis of taxes on tourism involves both public finance and welfare economics issues. The scope for and desirability of applying the user-pays principle to tourism is then examined.

Inside the pleasure dome : cultural tourism on Australia’s Gold Coast

In 2018 the City of the Gold Coast in south-east Queensland, Australia, will host the next Commonwealth Games. The City is made up a 57 km stretch of coastline and hinterland divided by a major highway. The famous surfing beaches are framed by high-rise development while the hinterland is marketed as a green, unspoilt environment. The winning bid for the Games, and discussion about future infrastructure and marketing of the region’s attributes, has focussed attention on the way City residents and policy makers think about their region in broad terms. Whereas in the past tourism marketing has been directed towards the pleasures of sun and surf by day and bright lights by night, various regional tourist stakeholders are beginning to reorient their programs. This paper considers some of the competing aims of the various stakeholders in this region and the interaction of existing ‘cultures’ with new technology and the demands of permanent residents, using data from a case study of e-literary trails developed in Brisbane, the capital city of Queensland. The importance of tourist imaginaries as a basis for using rich accounts of the past for future planning is emphasized.

When the light goes on

Whether superannuation fund members will achieve adequate retirement incomes is, at least in part, dependent on the superannuation choices they make during their working lives. The two important prerequisites of informed choice are access to good quality information and possession of knowledge and skills to evaluate that information.

Grand tours in the glare of the sun : harnessing digital media to develop cultural tourism in Queensland, Australia

It has been well established that highlighting the cultural attributes of a region through stories of place, local histories, and the creative arts boosts tourism income to a region. Cultural tourism also serves to promote the creative industries to visitors and residents alike and, by enhancing a region’s cultural identity, fosters new opportunities for the arts. It can therefore offer considerable potential benefit to the creative economy in Australia. However, in comparison with Europe, where cultural tourism can rely upon an established historical, artistic and literary cultural identity that stretches back to Grand Tours of the seventeenth century, in Queensland, Australia the relatively new enterprise of cultural tourism must compete with visitor expectations of sun, surf and the natural landscapes, which have become the mainstay of tourism advertising. Moreover, in Queensland, it is essential to connect vast distances, diverse communities and a variety of cultural experiences. We must also take account of the expectations of contemporary tourists, who anticipate a digitally mediated travel experience and increasingly seek to connect with local communities in authentic ways. In this paper we consider the unique considerations that must be taken into account in the Queensland context and propose approaches to developing an integrated identity that embraces both the ‘great outdoors’ and the region’s cultural attributes. We make recommendations for providing the types of digitally mediated ‘local’ experiences that cultural tourists now expect, and illustrate the design principles we propose through early, tentative approaches to smart phones, locative media and augmented reality applications for cultural tourism in the region. We conclude by proposing additional ways to formulate a digital strategy in line with the recommendations we make.

Front-line workers as intermediaries : the changing landscape of disability and employment services in Australia

Recent welfare reform in Australia has been constructed around the now-familiar principle of paid work and willingness to work as the fundamental marker of social citizenship. Beginning with the long-term unemployed in Australia in the mid 1990s, the scope of welfare reform has now extended to include people with a disability – which is a category of income support that has been growing in Australia. From the national government’s point of view this growth is a financial concern as it seeks to move as many people as possible into paid work to support the costs of an ageing population (DEWR, 2005). In doing so, the government has changed the meaning of disability in terms of eligibility for financial support from the state, and at the same time redefined the role of people with a disability with regard to work, and the role of the state with regard to the disabled. This has been a matter of some political contention in Australia.

Internet-enabled tourism entrepreneurs. International entrepreneurial values elicited through repertory test and laddering analysis

Although the tourism industry has been dramatically altered due to the Internet, there has been limited research published about international entrepreneurial values and Internet use in tourism firms. The findings of this study point to a relationship between the values of Internet-enabled international entrepreneurs in small-sized to medium-sized enterprises and the inclination of the firm to develop and initiate international activity. The findings of this study suggest that Internet-enabled tourism entrepreneurs share similar construct values. Two effective but underutilized qualitative methods were used in this study. The first method, repertory test, is an efficient technique for exploring constructs in decision making; the second method, laddering analysis, facilitates understanding of the perceived consequences and personal values guiding behaviour.

A systematic review of telemedicine services for residents in long term care facilities

We conducted a systematic review of the literature on telemedicine use in long-term care facilities (LTCFs) and assessed the quality of the published evidence. A database search identified 22 papers which met the inclusion criteria. The quality of the studies was assessed and if they contained economic data, they were rated according to standard criteria. The clinical services provided by telemedicine included allied health (n = 5), dermatology (3), general practice (4), neurology (2), geriatrics (1), psychiatry (4) and multiple specialities (3). Most studies (17) employed real-time telemedicine using videoconferencing. The remaining five used store and forward telemedicine. The papers focused on economics (3), feasibility (9), stakeholder satisfaction (12), reliability (5) and service implementation (2). Overall, the quality of evidence for telemedicine in LTCFs was low. There was only one small randomised controlled trial (RCT). Most studies were observational and qualitative, and focused on utilisation. They were mainly based on surveys and interviews of stakeholders. A few studies evaluated the cost associated with implementing telemedicine services in LTCFs. The present review shows that there is evidence for feasibility and stakeholder satisfaction in using telemedicine in LTCFs in a number of clinical specialities.

A reference station-based GNSS computing mode to support unified precise point positioning and real-time kinematic services

Currently, the GNSS computing modes are of two classes: network-based data processing and user receiver-based processing. A GNSS reference receiver station essentially contributes raw measurement data in either the RINEX file format or as real-time data streams in the RTCM format. Very little computation is carried out by the reference station. The existing network-based processing modes, regardless of whether they are executed in real-time or post-processed modes, are centralised or sequential. This paper describes a distributed GNSS computing framework that incorporates three GNSS modes: reference station-based, user receiver-based and network-based data processing. Raw data streams from each GNSS reference receiver station are processed in a distributed manner, i.e., either at the station itself or at a hosting data server/processor, to generate station-based solutions, or reference receiver-specific parameters. These may include precise receiver clock, zenith tropospheric delay, differential code biases, ambiguity parameters, ionospheric delays, as well as line-of-sight information such as azimuth and elevation angles. Covariance information for estimated parameters may also be optionally provided. In such a mode the nearby precise point positioning (PPP) or real-time kinematic (RTK) users can directly use the corrections from all or some of the stations for real-time precise positioning via a data server. At the user receiver, PPP and RTK techniques are unified under the same observation models, and the distinction is how the user receiver software deals with corrections from the reference station solutions and the ambiguity estimation in the observation equations. Numerical tests demonstrate good convergence behaviour for differential code bias and ambiguity estimates derived individually with single reference stations. With station-based solutions from three reference stations within distances of 22–103 km the user receiver positioning results, with various schemes, show an accuracy improvement of the proposed station-augmented PPP and ambiguity-fixed PPP solutions with respect to the standard float PPP solutions without station augmentation and ambiguity resolutions. Overall, the proposed reference station-based GNSS computing mode can support PPP and RTK positioning services as a simpler alternative to the existing network-based RTK or regionally augmented PPP systems.

Prioritizing process improvement : an example from the Australian financial services sector

Process improvement has become a number one business priority, and more and more project requests are raised in organizations, seeking approval and resources for process-related projects. Realistically, the total of the requested funds exceeds the allocated budget, the number of projects is higher than the available bandwidth, and only some of these (very often only few) can be supported and most never see any light. Relevant resources are scarce, and correct decisions must be made to make sure that those projects that are of best value are implemented. How can decision makers make the right decision on the following: Which project(s) are to be approved and when to commence work on them? Which projects are most aligned with corporate strategy? How can the project’s value to the business be calculated and explained? How can these decisions be made in a fair, justifiable manner that brings the best results to the company and its stakeholders? This chapter describes a business value scoring (BVS) model that was built, tested, and implemented by a leading financial institution in Australia to address these very questions. The chapter discusses the background and motivations for such an initiative and describes the tool in detail. All components and underlying concepts are explained, together with details on its application. This tool has been successfully implemented in the case organization. The chapter provides practical guidelines for organizations that wish to adopt this approach.