Conceptual framework for understanding the demand for emergency health services

Background & Objectives Emergency health services (EHS) throughout the world are increasingly congested. As more people use EHS, factors such as population growth and aging cannot fully explain this increase. Also, focus on patients’ clinical characteristics ignores the role that attitudinal and perceptual factors and motivations play in directing their decisions and actions. The aim of this study is to review and synthesize an integrated conceptual framework for understanding social psychological factors underpinning demand for EHS. Methodology A comprehensive search and review of empirical and theoretical studies about the utilization of EHS was conducted using major medical, health, social and behavioral sciences databases. Results A small number of studies used a relevant conceptual framework (e.g. Health Services Utilization Model or Health Belief Model) or their components to analyze patients’ decision to use EHS. The studies evidenced that demand was affected by perceived severity of the condition; perceived costs and benefits (e.g. availability, accessibility and affordability of alternative services); experience, preference and knowledge; perceived and actual social support; and demographic characteristics (e.g. age, sex, socioeconomic status, ethnicity, marital and living circumstances, place of residence). Conclusions Conceptual models that are commonly used in areas like social and behavioral sciences have rarely been applied in the EHS utilization field. Understanding patients’ decision-making and associated factors will lay the groundwork for identification of the evidence to inform improved policy responses and the development of demand management strategies. An integrated conceptual framework will be introduced as part of this study.

Promoting posttraumatic growth in police recruits : preliminary results of a randomised controlled resilience intervention trial

Recent research has demonstrated that the same experiences that may elicit symptoms of post-traumatic stress disorder (PTSD) in emergency service personnel can also provide a catalyst for positive personal changes such as posttraumatic growth (PTG). In this research newly recruited police officers (N = 412) participated in a randomised control trial of a program specifically designed to promote mental health. On entry to the academy, new recruits were randomly allocated, by classrooms, to either a treatment as usual condition (i.e., existing psychoeducation program) or to the intervention group. The Promoting Resilient Officers (PRO) program is a resilience building intervention adapted from an earlier resilience building program in collaboration with the police service. The PRO program also includes additional components on trauma and PTG. The current research included the participants who had experienced trauma prior to or during the research period (N = 246). It was hypothesised that participation in the PRO program would increase levels of PTG and lower levels of PTSD when compared to recruits in the control condition. Using multilevel modelling and post-hoc analyses, results indicated there were significantly higher levels of PTG across multiple dimensions when compared to the control group. There was no effect on PTSD symptoms with both conditions showing a floor effect. The research indicated the potential value of developing interventions that elicit reflections on the potential for positive as well as negative outcomes of experiencing traumatic and other highly challenging events.

Enhancing paramedics procedural skills using a cadaveric model

Background Paramedic education has evolved in recent times from vocational post-employment to tertiary pre-employment supplemented by clinical placement. Simulation is advocated as a means of transferring learned skills to clinical practice. Sole reliance of simulation learning using mannequin-based models may not be sufficient to prepare students for variance in human anatomy. In 2012, we trialled the use of fresh frozen human cadavers to supplement undergraduate paramedic procedural skill training. The purpose of this study is to evaluate whether cadaveric training is an effective adjunct to mannequin simulation and clinical placement. Methods A multi-method approach was adopted. The first step involved a Delphi methodology to formulate and validate the evaluation instrument. The instrument comprised of knowledge-based MCQs, Likert for self-evaluation of procedural skills and behaviours, and open answer. The second step involved a pre-post evaluation of the 2013 cadaveric training. Results One hundred and fourteen students attended the workshop and 96 evaluations were included in the analysis, representing a return rate of 84%. There was statistically significant improved anatomical knowledge after the workshop. Students' self-rated confidence in performing procedural skills on real patients improved significantly after the workshop: inserting laryngeal mask (MD 0.667), oropharyngeal (MD 0.198) and nasopharyngeal (MD 0.600) airways, performing Bag-Valve-Mask (MD 0.379), double (MD 0.344) and triple (MD 0.326,) airway manoeuvre, doing 12-lead electrocardiography (MD 0.729), using McGrath(R) laryngoscope (MD 0.726), using McGrath(R) forceps to remove foreign body (MD 0.632), attempting thoracocentesis (MD 1.240), and putting on a traction splint (MD 0.865). The students commented that the workshop provided context to their theoretical knowledge and that they gained an appreciation of the differences in normal tissue variation. Following engagement in/ completion of the workshop, students were more aware of their own clinical and non-clinical competencies. Conclusions The paramedic profession has evolved beyond patient transport with minimal intervention to providing comprehensive both emergency and non-emergency medical care. With limited availability of clinical placements for undergraduate paramedic training, there is an increasing demand on universities to provide suitable alternatives. Our findings suggested that cadaveric training using fresh frozen cadavers provides an effective adjunct to simulated learning and clinical placements.

Airport security screeners expertise and implications for interface design

This paper describes research investigating expertise and the types of knowledge used by airport security screeners. It applies a multi method approach incorporating eye tracking, concurrent verbal protocol and interviews. Results show that novice and expert security screeners primarily access perceptual knowledge and experience little difficulty during routine situations. During non-routine situations however, experience was found to be a determining factor for effective interactions and problem solving. Experts were found to use strategic knowledge and demonstrated structured use of interface functions integrated into efficient problem solving sequences. Comparatively, novices experienced more knowledge limitations and uncertainty resulting in interaction breakdowns. These breakdowns were characterised by trial and error interaction sequences. This research suggests that the quality of knowledge security screeners have access to has implications on visual and physical interface interactions and their integration into problem solving sequences. Implications and recommendations for the design of interfaces used in the airport security screening context are discussed. The motivations of recommendations are to improve the integration of interactions into problem solving sequences, encourage development of problem scheme knowledge and to support the skills and knowledge of the personnel that interact with security screening systems.

Security in wireless sensor networks : issues and challenges

Wireless Sensor Networks (WSNs) are employed in numerous applications in different areas including military, ecology, and health; for example, to control of important information like the personnel position in a building, as a result, WSNs need security. However, several restrictions such as low capability of computation, small memory, limited resources of energy, and the unreliable channels employ communication in using WSNs can cause difficulty in use of security and protection in WSNs. It is very essential to save WSNs from malevolent attacks in unfriendly situations. Such networks require security plan due to various limitations of resources and the prominent characteristics of a wireless sensor network which is a considerable challenge. This article is an extensive review about problems of WSNs security, which examined recently by researchers and a better understanding of future directions for WSN security.

She'll be right mate : inclusivity experiences of men and women working in projects

Occupational segregation is a major source of labour market rigidity and economic inefficiency due to a waste of human resources. Organisations are repeatedly recognised as gendered constructs exhibiting sustained work segregation, income and status inequality, as well as cultural and individual images of gender, and these are perpetuated through their processes, practices and pressures (Acker, 1990). A large percentage of Australia’s workforce is now employed in project-based or project-oriented organisations, leading to the claim that Australia is a project-based economy. For a continued strong performance in this economy, organisations that employ project personnel will need to consider how they address inclusivity and equality in diversity in project based temporary organisations to ensure the supply of high quality project professionals into the future. This paper investigates the inclusion processes experienced and exercised by men and women working in temporary organisations in project situations through a review of reports on the inclusion processes experienced by 60 project managers and project workers in three project based industries in Australia. Results indicate that temporary organisations are not implementing equality and diversity management strategies at the macro level and project workers are accepting this lack of recognition. However inclusivity and equality at the micro level of the team is seen as vital.

Beyond the barriers : road construction safety issues from the office and the roadside

Conceptually, the management of safety at roadworks can be seen in a three level framework. At the regulatory level, roadworks operate at the interface between the work environment, governed by workplace health and safety regulations, and the road environment, which is subject to road traffic regulations and practices. At the organizational level, national, state and local governments plan and purchase road construction and maintenance which are then delivered in-house or tendered out to large construction companies who often subcontract multiple smaller companies to supply services and labor. At the operational level, roadworks are difficult to isolate from the general public, hindering effective occupational health and safety controls. This study, from the State of Queensland, Australia, examines how well this tripartite framework functions. It includes reviews of organizational policy and procedures documents; interviews with 24 subject matter experts from various road construction and maintenance organizations, and on-site interviews with 66 road construction personnel. The study identified several factors influencing the translation of safety policies into practice including the cost of safety measures in the context of competitive tendering, lack of firm evidence of the effectiveness of safety measures, and pressures to minimize disruption to the travelling public.

Enhancing the capacity of kin caregivers and their families to meet the needs of children left behind

Based on qualitative research of the experiences of 23 kin caregivers and five school personnel, this article explores the role of informal kinship care in addressing the needs of school-age children left behind in rural China. The findings of this study suggest that kin caregivers' child-rearing capacity is limited in the rural context, and they are often overwhelmed by children's diverse and complex needs, particularly their emotional ones. In view of the huge population and their vulnerability, it is imperative for the state to take up its responsibilities and develop specific social work services and other support for children left behind and their families. 根据对23位亲属照顾者和5位学校人员的质性研究，文章探讨在处理中国留守学龄儿童的需要时，非正式亲属照料所担当的角色。研究发现，在农村的亲属照料者的抚养儿童能力有限，而且他们时常在面对儿童众多复杂的需求时应接不暇，问题又以情绪需要尤甚。有见于留守儿童的数目众多和易受伤害，政府急切需要承担相关的责任，为留守儿童及其家庭发展专门的社会工作服务和其他支援。

Blood transfer devices for malaria rapid diagnostic tests : evaluation of accuracy, safety and ease of use

Background: Malaria rapid diagnostic tests (RDTs) are increasingly used by remote health personnel with minimal training in laboratory techniques. RDTs must, therefore, be as simple, safe and reliable as possible. Transfer of blood from the patient to the RDT is critical to safety and accuracy, and poses a significant challenge to many users. Blood transfer devices were evaluated for accuracy and precision of volume transferred, safety and ease of use, to identify the most appropriate devices for use with RDTs in routine clinical care. Methods: Five devices, a loop, straw-pipette, calibrated pipette, glass capillary tube, and a new inverted cup device, were evaluated in Nigeria, the Philippines and Uganda. The 227 participating health workers used each device to transfer blood from a simulated finger-prick site to filter paper. For each transfer, the number of attempts required to collect and deposit blood and any spilling of blood during transfer were recorded. Perceptions of ease of use and safety of each device were recorded for each participant. Blood volume transferred was calculated from the area of blood spots deposited on filter paper. Results: The overall mean volumes transferred by devices differed significantly from the target volume of 5 microliters (p < 0.001). The inverted cup (4.6 microliters) most closely approximated the target volume. The glass capillary was excluded from volume analysis as the estimation method used is not compatible with this device. The calibrated pipette accounted for the largest proportion of blood exposures (23/225, 10%); exposures ranged from 2% to 6% for the other four devices. The inverted cup was considered easiest to use in blood collection (206/ 226, 91%); the straw-pipette and calibrated pipette were rated lowest (143/225 [64%] and 135/225 [60%] respectively). Overall, the inverted cup was the most preferred device (72%, 163/227), followed by the loop (61%, 138/227). Conclusions: The performance of blood transfer devices varied in this evaluation of accuracy, blood safety, ease of use, and user preference. The inverted cup design achieved the highest overall performance, while the loop also performed well. These findings have relevance for any point-of-care diagnostics that require blood sampling.

The BRAKE Driver Awareness Program & Senior Health Education

The BRAKE Driver Awareness Program provides evidence-based behaviour, risk, attitude and knowledge education for young drivers. BRAKE was founded during 2006 by Queensland Police Sergeant Rob Duncan and has been delivered to more than 35,000 senior secondary students since 2007. BRAKE is a participant directed program supported by resources provided at no cost. It includes eight parts able to be delivered in different configurations. BRAKE is endorsed by the Queensland Police and Queensland Ambulance Services. It is recognised by the Queensland Studies Authority as a Queensland Certificate of Education registered life skills course. This session is a must attend for secondary teachers, coordinators, staff in senior leadership positions and other stakeholders seeking a unique approach to adolescent road safety education. It will conclude with an opportunity to consider how BRAKE can be integrated into the senior secondary Health Education curriculum or pastoral care, social action and personal development programs.

A critical success factors model for enterprise resource planning implementation

Enterprise Resource Planning (ERP) systems are integrated enterprise-wide standard information systems that automate all aspects of an organisations’ business processes. The ERP philosophy is that business systems incorporating sales, marketing, manufacturing, distribution, personnel and finance modules can be supported by a single integrated system with all of the company’s data captured in a central database. The ERP packages of vendors such as SAP, Baan, J.D. Edwards and Intentia represent more than a common systems platform for a business. They prescribe information blueprints of how organisation’s business processes should operate. In this paper, the scale and strategic importance of ERP systems is identified and the problem of ERP implementation is defined. Five company examples are analysed using a Critical Success Factors (CSFs) theoretical framework. The paper offers a framework for managers which provides the basis for developing an ERP implementation strategy. The case analysis identifies different approaches to ERP implementation, highlights the critical role of legacy systems in influencing the implementation process, and identifies the importance of business process change and software configuration in addition to factors already cited in the literature such as top management support and communication. The implications of the results and future research opportunities are outlined.

Public policy on corporate audit committees : case study evidence of current practice

Corporate failures and malpractices have led to an increasing emphasis on the governance role of audit committees. The Smith report Audit Committee Combined Code Guidance and the Higgs Review of the Role and Effectiveness of Non-Executive Directors (now incorporated in a Revised Combined Code) represent further attempts to strengthen corporate accountability in the UK. Although the regulatory focus on audit committees indicates confidence in their role as part of the solution to governance failures, questions remain about their efficacy in practice. Against the background of the publication of the Smith report and the wider reliance on audit committees in several countries to help improve corporate accountability, this paper provides research evidence, drawn from an ACCA-sponsored project, on the processes and effects of the audit committees in three UK companies. This study complements other research on audit committees by adopting a case study approach, in order to reflect the importance of investigating audit committee operations from within the organisation and to develop a closer understanding of audit committee impact than is available from generally observable data. The empirical evidence for the case studies was obtained from semi-structured interviews with personnel involved in the audit committee process, internal documents made available by the companies, and publicly available information, including annual reports.

Facilitators of expanded and extended scope of paramedic practice - what makes them work?

Introduction Better integration of health services and redefinition of health workforce roles through expanding and extending traditional scope of clinical practice have been explored nationally and internationally. This paper aims to extend our earlier work by examining models of expanded and extended scope of paramedic practice for attributes which facilitate such a practice. Methods An exploratory multi-case study analysis of Australia, New Zealand, Canada and the United Kingdom expanded and extended paramedic practices were analysed. Results Successful models of advanced practice harness the capacity and personality of the paramedic practitioner, and are supported by enabling infrastructures, specifically: professional development/ education; clinical guideline and policy (boundary); access to physical infrastructure and clinical support from senior medical practitioners; and, ability to directly refer to other health services (service integration). The scope of advanced practice is however influenced by individual employers’ capacity, perceived needs and preference/ prioritises. The potential for advanced paramedic practice is equally applicable to urban as well as rural Australia. The Council of Ambulance Authorities’ Professional Competency Standard provides the form and functions for building on advanced paramedic practice. Recognition of such advanced paramedic practice provides a structure for professional growth, process for career progression and will support workforce retention. Conclusion The achievement of advanced knowledge and skills has positioned the paramedic profession to be recognized as a valuable clinician. The Council of Ambulance Authorities’ Professional Competency Standards provides the form and function for supporting advanced paramedic practice.

The future Australian paramedic workforce : a snapshot of undergraduate paramedic students

Objective Describe the demographics of undergraduate paramedic students enrolled at a major Queensland University and explore the potential impact of demographic change in the paramedic workforce of the future. Method A retrospective, descriptive analysis of de-identified, routinely collected administrative data on students enrolled in the paramedic undergraduate degree program at Queensland University of Technology was undertaken for the period 2005-2013. Quantitative data were examined using the Statistical Package for Social Science version 21. Results A total of 914 students had commenced the paramedic degree since 2005, of whom slightly more than a third (33.4%; SD 9.5%) were enrolled in the double degree with nursing beginning from 2009. Half of the student cohort (52.1%;, SD 4.8%) were female, with the majority (82.9%;, SD 3.4) aged under 25 years old. Most (45.2%;, SD 13) of the student admissions were for graduate entry [i.e. prior tertiary education had been completed], while secondary education entry represented 35.9% (SD 14.9%). Conclusion By contrasting the results of our study to the most recent demographic data of the Australian paramedic workforce, a significant difference in the demographic characteristics of the current and future paramedic workforce is noted. Due to these differences, the need for increased flexibility in employment arrangements should be anticipated. This presentation will explore these characteristics and provide a complementary evidence base on which workforce planning within ambulance services can be conducted.

Heat strain evaluation of overt and covert body armour in a hot and humid environment

The aim of this study was to elucidate the thermophysiological effects of wearing lightweight non-military overt and covert personal body armour (PBA) in a hot and humid environment. Eight healthy males walked on a treadmill for 120 min at 22% of their heart rate reserve in a climate chamber simulating 31 °C (60%RH) wearing either no armour (control), overt or covert PBA in addition to a security guard uniform, in a randomised controlled crossover design. No significant difference between conditions at the end of each trial was observed in core temperature, heart rate or skin temperature (P > 0.05). Covert PBA produced a significantly greater amount of body mass change (−1.81 ± 0.44%) compared to control (−1.07 ± 0.38%, P = 0.009) and overt conditions (−1.27 ± 0.44%, P = 0.025). Although a greater change in body mass was observed after the covert PBA trial; based on the physiological outcome measures recorded, the heat strain encountered while wearing lightweight, non-military overt or covert PBA was negligible compared to no PBA. Practitioner summary The wearing of bullet proof vests or body armour is a requirement of personnel engaged in a wide range of occupations including police, security, customs and even journalists in theatres of war. This randomised controlled crossover study is the first to examine the thermophysiological effects of wearing lightweight non-military overt and covert personal body armour (PBA) in a hot and humid environment. We conclude that the heat strain encountered while wearing both overt and covert lightweight, non-military PBA was negligible compared to no PBA.