Evaluating emergency nurse practitioner service effectiveness on achieving timely analgesia: A pragmatic randomized controlled trial

Objectives The rapid uptake of nurse practitioner (NP) services in Australia has outpaced evaluation of this service model. A randomized controlled trial was conducted to compare the effectiveness of NP service versus standard medical care in the emergency department (ED) of a major referral hospital in Australia. Methods Patients presenting with pain were randomly assigned to receive either standard ED medical care or NP care. Primary investigators were blinded to treatment allocation for data analyses. The primary outcome measure was the proportion of patients receiving analgesia within 30 minutes from being seen by care group. Secondary outcome measures were time to analgesia from presentation and documentation of and changes in pain scores. Results There were 260 patients randomized; 128 received standard care (medical practitioner led), and 130 received NP care. Two patients needed to be excluded due to incomplete consent forms. The proportion of patients who received analgesia within 30 minutes from being seen was 49.2% (n = 64) in the NP group and 29.7% (n = 38) in the standard group, a difference of 19.5% (95% confidence interval [CI] = 7.9% to 31.2%; p = 0.001). Of 165 patients who received analgesia, 64 (84.2%) received analgesia within 30 minutes in the NP group compared to 38 (42.7%) in the standard care group, a difference in proportions of 41.5% (95% CI = 28.3% to 54.7%; p < 0.001). The mean (±SD) time from being seen to analgesia was 25.4 (±39.2) minutes for NP care and 43.0 (±35.5) minutes for standard care, a difference of 17.6 minutes (95% CI = 6.1 to 29.1 minutes; p = 0.003). There was a difference in the median change in pain score of 0.5 between care groups, but this was not statistically significant (p = 0.13). Conclusions Nurse practitioner service effectiveness was demonstrated through superior performance in achieving timely analgesia for ED patients.

Water transformed: Sustainable water solutions for climate change adaptation

This online textbook provides free access to a comprehensive education and training package that brings together the knowledge of how countries, specifically Australia, can adapt to climate change. This resource has been developed formally as part of the Federal Government’s Department of Climate Change’s Climate Change Adaptation Professional Skills program.

Cross-cultural adaptation and validation of the Foot Function Index to Spanish

Background The purpose of this study was to adapt and validate the Foot Function Index to the Spanish (FFI-Sp) following the guidelines of the American Academy of Orthopaedic Surgeons. Methods A cross-sectional study 80 participants with some foot pathology. A statistical analysis was made, including a correlation study with other questionnaires (the Foot Health Status Questionnaire, EuroQol 5-D, Visual Analogue Pain Scale, and the Short Form SF-12 Health Survey). Data analysis included reliability, construct and criterion-related validity and factor analyses. Results The principal components analysis with varimax rotation produced 3 principal factors that explained 80% of the variance. The confirmatory factor analysis showed an acceptable fit with a comparative fit index of 0.78. The FFI-Sp demonstrated excellent internal consistency on the three subscales: pain 0.95; disability 0.96; and activity limitation 0.69, the subscale that scored lowest. The correlation between the FFI-Sp and the other questionnaires was high to moderate. Conclusions The Spanish version of the Foot Function Index (FFI-Sp) is a tool that is a valid and reliable tool with a very good internal consistency for use in the assessment of pain, disability and limitation of the function of the foot, for use both in clinic and research.

A longitudinal study of employee adaptation to organizational change: The role of change-related information and change-related self-efficacy

This study examined the role of information, efficacy, and 3 stressors in predicting adjustment to organizational change. Participants were 589 government employees undergoing an 18-month process of regionalization. To examine if the predictor variables had long-term effects on adjustment, the authors assessed psychological well-being, client engagement, and job satisfaction again at a 2-year follow-up. At Time 1, there was evidence to suggest that information was indirectly related to psychological well-being, client engagement, and job satisfaction, via its positive relationship to efficacy. There also was evidence to suggest that efficacy was related to reduced stress appraisals, thereby heightening client engagement. Last, there was consistent support for the stress-buffering role of Time 1 self-efficacy in the prediction of Time 2 job satisfaction.

Service composition and binding

Service composition enables the creation of services previously unavailable through the aggregation of existing services. The result is called a service composition. Exposing a service composition as a service, the result is called a composed service. It can be distinguished from atomic services. Service composition approaches can be differentiated along two axes: point in time of composition and degree of automation. With design-time and run-time we can identify two different points in time for doing a composition. Additionally we can distinguish between three different degrees of automation: manual, assisted, and automated service composition. © 2008 Springer Berlin Heidelberg.

Introduction to the Proceedings of the Workshop on User-Focused Service Engineering, Consumption and Aggregation (USECA) 2011

The first User-Focused Service Engineering, Consumption and Aggregation workshop (USECA) in 2011 was held in conjunction with the WISE 2011 conference in Sydney, Australia. Web services and related technology are a widely accepted standard architectural paradigm for application development. The idea of reusing existing software components to build new applications has been well documented and supported for the world of enterprise computing and professional developers. However, this powerful idea has not been transferred to end-users who have limited or no computing knowledge. The current methodologies, models, languages and tools developed for Web service composition are suited to IT professionals and people with years of training in computing technologies. It is still hard to imagine any of these technologies being used by business professionals, as opposed to computing professionals. © 2013 Springer-Verlag.

Towards adaptive management of QoS-aware service compositions - Functional architecture

Service compositions enable users to realize their complex needs as a single request. Despite intensive research, especially in the area of business processes, web services and grids, an open and valid question is still how to manage service compositions in order to satisfy both functional and non-functional requirements as well as adapt to dynamic changes. In this paper we propose an (functional) architecture for adaptive management of QoS-aware service compositions. Comparing to the other existing architectures this one offers two major advantages. Firstly, this architecture supports various execution strategies based on dynamic selection and negotiation of services included in a service composition, contracting based on service level agreements, service enactment with flexible support for exception handling, monitoring of service level objectives, and profiling of execution data. Secondly, the architecture is built on the basis of well know existing standards to communicate and exchange data, which significantly reduces effort to integrate existing solutions and tools from different vendors. A first prototype of this architecture has been implemented within an EU-funded Adaptive Service Grid project. © 2006 Springer-Verlag.

Implementing process views in the web service environment

Web service and business process technologies are widely adopted to facilitate business automation and collaboration. Given the complexity of business processes, it is a sought-after feature to show a business process with different views to cater for the diverse interests, authority levels, etc., of different users. Aiming to implement such flexible process views in the Web service environment, this paper presents a novel framework named FlexView to support view abstraction and concretisation of WS-BPEL processes. In the FlexView framework, a rigorous view model is proposed to specify the dependency and correlation between structural components of process views with emphasis on the characteristics of WS-BPEL, and a set of rules are defined to guarantee the structural consistency between process views during transformations. A set of algorithms are developed to shift the abstraction and concretisation operations to the operational level. A prototype is also implemented for the proof-of-concept purpose. © 2010 Springer Science+Business Media, LLC.

A service-oriented architecture for text analytics enabled business applications

Experiences showed that developing business applications that base on text analysis normally requires a lot of time and expertise in the field of computer linguistics. Several approaches of integrating text analysis systems with business applications have been proposed, but so far there has been no coordinated approach which would enable building scalable and flexible applications of text analysis in enterprise scenarios. In this paper, a service-oriented architecture for text processing applications in the business domain is introduced. It comprises various groups of processing components and knowledge resources. The architecture, created as a result of our experiences with building natural language processing applications in business scenarios, allows for the reuse of text analysis and other components, and facilitates the development of business applications. We verify our approach by showing how the proposed architecture can be applied to create a text analytics enabled business application that addresses a concrete business scenario. © 2010 IEEE.

Architecture for service profiling

Service oriented architecture is gaining momentum. However, in order to be successful, the proper and up-to-date description of services is required. Such a description may be provided by service profiling mechanisms, such as one presented in this article. Service profile can be defined as an up-to-date description of a subset of non-functional properties of a service. It allows for service comparison on the basis of non-functional parameters, and choosing the service which is most suited to the needs of a user. In this article the notion of a service profile along with service profiling mechanism is presented as well as the architecture of a profiling system. © 2006 IEEE.

Acoustic adaptation in cross database audio visual SHMM training for phonetic spoken term detection

Visual information in the form of lip movements of the speaker has been shown to improve the performance of speech recognition and search applications. In our previous work, we proposed cross database training of synchronous hidden Markov models (SHMMs) to make use of external large and publicly available audio databases in addition to the relatively small given audio visual database. In this work, the cross database training approach is improved by performing an additional audio adaptation step, which enables audio visual SHMMs to benefit from audio observations of the external audio models before adding visual modality to them. The proposed approach outperforms the baseline cross database training approach in clean and noisy environments in terms of phone recognition accuracy as well as spoken term detection (STD) accuracy.

An exploratory study into managing value creation in tourism service firms: Understanding value creation phases at the intersection of the tourism service firm and their customers

To satisfy customers, managers of tourism services need to understand their customers' value requirements and then develop a unique service value offering based on those requirements. This understanding underpins their effort to provide superior value to customers and deliver the proposed services through employees. Problematically, previous work on value creation (i.e. customer value) has focused separately on either the firm or customer. This theoretical separation does not allow investigation of whether there may be discrepancies between what value firms offer and what value customers perceive they have received. We bring tourism service firms (manager and employee) and customers together and examine the nature of a tourism service provider's value proposition, its contribution to the value offering, and subsequent impact on customers' perceived-value-in-use. We focus on the important role that employees play as boundary spanning workers in the value creation phases, linking the tourism service provider and customer.

Service-learning through multiple client-sponsored projects in an MBA marketing course

This paper outlines an approach for teaching Marketing Principles in an MBA course through service-learning to enable adult learners to connect the lectures’ marketing content to a real-world marketing project. During the course, 40 students in groups of four to five individuals were involved in eight different client-sponsored marketing projects executed simultaneously. The rationale, planning and management of this approach utilised current research on service-learning, living cases and client-sponsored projects in marketing education. The experimental curriculum design is presented in a timeline that mirrors the preparation and management of the group projects and the considerations to be taken into account when initiating and facilitating the projects. Reflections from this iteration of the service-learning design suggest the importance of: detailed project planning, the involvement of students in choosing the projects, the introduction of forms and feedback loops, the role of the instructor in facilitating the students and managing expectations, and the role of the company representative in supporting the groups.

Perceived quality of e‐health services: A conceptual scale development of e‐health service quality based on the C‐OAR‐SE approach

Purpose Health service quality is an important determinant for health service satisfaction and behavioral intentions. The purpose of this paper is to investigate requirements of e‐health services and to develop a measurement model to analyze the construct of “perceived e‐health service quality.” Design/methodology/approach The paper adapts the C‐OAR‐SE procedure for scale development by Rossiter. The focal aspect is the “physician‐patient relationship” which forms the core dyad in the healthcare service provision. Several in‐depth interviews were conducted in Switzerland; first with six patients (as raters), followed by two experts of the healthcare system (as judges). Based on the results and an extensive literature research, the classification of object and attributes is developed for this model. Findings The construct e‐health service quality can be described as an abstract formative object and is operationalized with 13 items: accessibility, competence, information, usability/user friendliness, security, system integration, trust, individualization, empathy, ethical conduct, degree of performance, reliability, and ability to respond. Research limitations/implications Limitations include the number of interviews with patients and experts as well as critical issues associated with C‐OAR‐SE. More empirical research is needed to confirm the quality indicators of e‐health services. Practical implications Health care providers can utilize the results for the evaluation of their service quality. Practitioners can use the hierarchical structure to measure service quality at different levels. The model provides a diagnostic tool to identify poor and/or excellent performance with regard to the e‐service delivery. Originality/value The paper contributes to knowledge with regard to the measurement of e‐health quality and improves the understanding of how customers evaluate the quality of e‐health services.

Quality in group service encounters: A theoretical exploration of the concept of a simultaneous multi‐customer co‐creation process

Purpose The purpose of this paper is to explore the concept of service quality for settings where several customers are involved in the joint creation and consumption of a service. The approach is to provide first insights into the implications of a simultaneous multi‐customer integration on service quality. Design/methodology/approach This conceptual paper undertakes a thorough review of the relevant literature before developing a conceptual model regarding service co‐creation and service quality in customer groups. Findings Group service encounters must be set up carefully to account for the dynamics (social activity) in a customer group and skill set and capabilities (task activity) of each of the individual participants involved in a group service experience. Research limitations/implications Future research should undertake empirical studies to validate and/or modify the suggested model presented in this contribution. Practical implications Managers of service firms should be made aware of the implications and the underlying factors of group services in order to create and manage a group experience successfully. Particular attention should be given to those factors that can be influenced by service providers in managing encounters with multiple customers. Originality/value This article introduces a new conceptual approach for service encounters with groups of customers in a proposed service quality model. In particular, the paper focuses on integrating the impact of customers' co‐creation activities on service quality in a multiple‐actor model.