A triage approach to improve the relevance of marine ecosystem services assessments

Ecosystem services assessments are increasingly being used to inform marine policy and planning. These assessments involve significant time, effort, and expertise. It is important at the outset to determine which of many ecosystem services should be quantified and which measures of ecological output, economic impact, or value should be assessed. Furthermore, the literature shows that in practice such assessments are unevenly applied and rarely used effectively in decision-making processes. We develop a structured decision-making approach, called a triage, to assess what types of ecosystem services should be assessed to improve the uptake and usefulness of such information in marine planning. Two case studies, in France and the United Kingdom, provide examples of the application of the triage approach.

Providing psychological services for people with diabetes

Previous research and service development guidelines have highlighted the importance of psychological issues in diabetes care, and both people with diabetes and diabetes professionals recognise the need for specialist psychological input. This article outlines the development of a service delivery model for psychological services in diabetes care, based on a patient needs assessment and the advice of diabetes professionals. This involved an assessment of the psychological needs of people with diabetes within an urban Health Trust in Northern Ireland, and the collation of the views of local diabetes professionals. Questionnaires to assess for depression, anxiety, binge eating behaviour and diabetes-specific worries were completed by 300 people with diabetes. The participants were accessed through both primary and secondary care diabetes teams. As expected, a high level of psychological distress relative to population norms was illustrated by the patient needs assessment. Particularly high levels of binge eating behaviour were reported, and levels of distress were higher for community-managed patients than for hospital-managed patients. The diabetes professionals unanimously agreed that there is a need for specialist psychological input and contributed to the service delivery model which is outlined in this article.