A qualitative study of community pharmacists’ awareness of and involvement with intermediate care facilities

Rationale, aims and objectives: Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery and maximising independence. The introduction of IC has created a new interface between primary and secondary care. Older people are known to be at an increased risk of medication-related problems when transferring between healthcare settings and pharmacists are often not included as part of IC multidisciplinary teams. This study aimed to explore community pharmacists’ (CPs) awareness of IC services and to investigate their views of and attitudes towards the medicines management aspects of such services, including the transfer of medication information.

Method: Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with CPs practising in the vicinity of IC facilities in Northern Ireland, UK.

Results: Interviews were conducted with 16 CPs. Three themes were identified and named ‘left out of the loop’, ‘chasing things up’ and ‘closing the loop’. CPs felt that they were often ‘left out of the loop’ with regards to both their involvement with local IC services and communication across the healthcare interfaces. As a result, CPs resorted to ‘chasing things up’ as they had to proactively try to obtain information relating to patients’ medications. CPs viewed themselves as ideally placed to facilitate medicines management across the healthcare interfaces (i.e., ‘closing the loop’), but several barriers to potential services were identified.

Conclusion: CPs have limited involvement with IC services. There is a need for improvement of effective communication of patients’ medication information between secondary care, IC and community pharmacy. Increasing CP involvement may contribute to improving continuity of care across such healthcare interfaces, thereby increasing the person-centeredness of service provision.

The Effect of Community-Based Specialist Palliative Care Teams on Place of Care

BACKGROUND: Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death.

OBJECTIVE: The study objective was to examine the place of care in the last 30 days of life.

METHODS: In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort.

RESULTS: After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p < 0.001) than the unexposed group. On the last day of life (place of death), the exposed group had 18% die in an in-patient hospital bed compared to 29% in usual care.

CONCLUSION: Examining place of care in the last month can effectively illustrate the service use trajectory over time.

Bullying Experiences of Child and Adolescent Mental Health Service-users: A Pilot Survey

Victims and perpetrators of bullying experience a variety of psychological problems. The aim of the current pilot study was to explore the bullying experiences of Child and Adolescent Mental Health (CAMHS) service-users. The investigation was conducted as a cross-sectional survey at a community-based specialist CAMH service. A modified version of the Revised Olweus Bully/Victim Questionnaire was used to assess bullying experiences. Participants comprised an opportunity sample of 26 adolescent male and female CAMH service-users. Results indicated that 61.5% of participants reported being bullied. Clear links were made between being bullied and the mental health of participants, with 62.5% of bullied participants reporting that being bullied was a ‘‘moderately importantvery important’’ reason for their attendance at the CAMH service. Therapists at the CAMH service made appropriate enquiries about young people being victims of bullying, but more enquiries could be made about young peoples’ experiences as perpetrators. Service-users favoured therapist-led bullying interventions such as assertiveness training, therapy and/or psychological coping strategies, and social skills training. These findings underline the need for ecological approaches to dealing with bullying, and suggest that CAMH services could play an important role in establishing and supporting such interventions.

Establishment of stackable community networks

Uma das áreas de investigação em Telecomunicações de interesse crescente prende-se com os futuros sistemas de comunicações móveis de 4a geração e além destes. Nos últimos anos tem sido desenvolvido o conceito de redes comunitárias, no qual os utilizadores se agregam de acordo com interesses comuns. Estes conceitos têm sido explorados de uma forma horizontal em diferentes camadas da comunicação, desde as redes comunitárias de comunicação (Seattle Wireless ou Personal Telco, p.ex.) até às redes de interesses peer-to-peer. No entanto, estas redes são usualmente vistas como redes de overlay, ou simplesmente redes de associação livre. Na prática, a noção de uma rede auto-organizada, completamente orientada ao serviço/comunidade, integralmente suportada em termos de arquitetura, não existe. Assim este trabalho apresenta uma realização original nesta área de criação de redes comunitárias, com uma arquitetura subjacente orientada a serviço, e que suporta integralmente múltiplas redes comunitárias no mesmo dispositivo, com todas as características de segurança, confiança e disponibilização de serviço necessárias neste tipo de cenários (um nó pode pertencer simultaneamente a mais do que uma rede comunitária). Devido à sua importância para os sistemas de redes comunitárias, foi dado particular atenção a aspetos de gestão de recursos e controlo de acessos. Ambos realizados de uma forma descentralizada e considerando mecanismos dotados de grande escalabilidade. Para isso, é apresentada uma linguagem de políticas que suporta a criação de comunidades virtuais. Esta linguagem não é apenas utilizada para o mapeamento da estrutura social dos membros da comunidade, como para, gerir dispositivos, recursos e serviços detidos pelos membros, de uma forma controlada e distribuída.

Heterotopias of mental health care: The role of space in experiences of distress, madness and mental health service use.

The change from an institutional to community care model of mental health services can be seen as a fundamental spatial change in the lives of service users (Payne, 1999; Symonds & Kelly, 1998; Wolch & Philo, 2000). It has been argued that little attention has been paid to the experience of the specific sites of mental health care, due to a utopic (idealised and placeless) idea of ‘community’ present in ‘community care’ (Symonds, 1998). This project hence explored the role of space in service users’ experiences, both of mental health care, and community living. Seventeen ‘spatial interviews’ with service users, utilising participatory mapping techniques (Gould & White, 1974; Herlihy & Knapp, 2003; Pain & Francis, 2003), plus seven, already published first person narratives of distress (Hornstein, 2009), were analysed using thematic analysis (Braun & Clarke, 2006). Mental health service sites are argued to have been described as heterotopias (Foucault, 1986a) of a ‘control society’ (Deleuze, 1992), dominated by observation and the administration of risk (Rose, 1998a), which can in turn be seen to make visible (Hetherington, 2011) to service users a passive and stigmatised subject position (Scheff, 1974; 1999). Such visible positioning can be seen to ‘modulate’ (Deleuze, 1992) participants’ experiences in mainstream space. The management of space has hence been argued to be a central issue in the production and management of distress and madness in the community, both in terms of a differential experience of spaces as ‘concordant’ or ‘discordant’ with distress, and with movement through space being described as a key mediator of experiences of distress. It is argued that this consideration of space has profound implications for the ‘social inclusion’ agenda (Spandler, 2007; Wallcraft, 2001).

Development, implementation, and evaluation of the Apollo model of pediatric rehabilitation service delivery

This article presents the experience of a rehabilitation program that un- dertook the challenge to reorganize its services to address accessibility issues and im- prove service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to im- prove the quality of services provided to children with disabilities, their families, and their communities.

Development and implementation of a new service delivery model for children with disabilities : implications for DCD

There is a general consensus that new service delivery models are needed for children with developmental coordination disorder (DCD). Emerging principles to guide service delivery include the use of graduated levels of intensity and evidence-based services that focus on function and participation. Interdisciplinary, community-based service delivery models based on best practice principles are needed. In this case report, we propose the Apollo model as an example of an innovative service delivery model for children with DCD. We describe the context that led to the creation of a program for children with DCD, describe the service delivery model and services, and share lessons learned through implementation. The Apollo model has 5 components: first contact, service delivery coordination, community-, group- and individual-interventions. This model guided the development of a streamlined set of services offered to children with DCD, including early-intake to share educational information with families, community interventions, inter-disciplinary and occupational therapy groups and individual interventions. Following implementation of the Apollo model, waiting times decreased and numbers of children receiving services increased, without compromising service quality. Lessons learned are shared to facilitate development of other practice models to support children with DCD.

How has the Personalisation of Social Care Impacted on Service Users with Dementia?

The personalisation agenda is a government initiative aimed at transforming adult social care through giving service users choice and control over the care they receive. A key part of this agenda is the provision of direct payments; cash payments made to individuals eligible for social care services which allow them to manage their own care. Research suggests that direct payments can enable people with dementia to stay in their own home for longer and experience greater choice, flexibility and an improved social life. However very few people with dementia currently access direct payments. The objective of this research was to explore the social care experiences of people with dementia in relation to their access to and use of direct payments. 26 semi-structured interviews were conducted with people with dementia in receipt of social care services in the community, and their carers and social workers, and focus groups held with two community social work teams. It was found that direct payments tended to be seen as a fall-back option, for example as the only alternative to residential care, or as a solution to problems with traditional services. Direct payments appeared to afford particular benefits to people with dementia in terms of flexibility, continuity of care and access to local facilities. It is therefore important that this group are enabled to access direct payments. The second (ongoing) phase of this research comprises the design and pilot testing of an intervention aimed at improving access to direct payments by people with dementia.

Children's television: the soft underbelly of public service broadcasting

The provision of children's content should be a key constituent of the public service brand, but has often been viewed as a programme category at risk. Certainly in many countries children's television has moved from the 'scarcity' associated with terrestrial provision, to the 'plenty' of digital (see Ellis 2000). However in spite of a range of dedicated public service children's channels in Europe (CBeebies, Kika, Z@ppelin), domestically produced children's television in Europe is notoriously under-resourced if not marginalised. There is a pronounced reliance on imports (particularly on commercial television) notwithstanding the launch by US-owned multinationals (Disney, Nickelodeon, Cartoon Network) of localised versions of their children's television channels in many European countries. Within the broader context of global developments in children's media, this paper starts by outlining the recent and rapid crisis in British children's television and the factors that caused it. This was a crisis, which caught broadcasters and producers by surprise in the middle of 2006, but reflects many of the challenges faced by the children's television sector in other countries. It clearly demonstrated how a combination of the lack of regulatory protection, a change in commercial priorities among broadcasters, advertising restrictions, budgetary pressures and the competitive environment at home and abroad all combined to reinforce the trend towards a contraction of domestic production. The crisis also served to underline the dominance of the BBC - both as a representative of public service principles, and as the dominant producer and commissioner in the market. With the reasons underpinning the crisis explained, the paper will then analyse how the children's television community responded to the crisis and with what effect. Based on interviews, contemporary accounts and documentary evidence the paper will chart the converging and diverging views of broadcasters, producers, regulatory authority Ofcom, and a range of advocacy groups which represent children's interests and the industry. What arguments were elaborated in favour of protecting children's television as an integral part of the public service media brand? Can lessons be learned about how best to ensure the origination of children's media within a public service environment? Can developments in the UK be used to provide insight into how children's media might develop further?

Governing through community? A comparative study of changing management practices in mixed tenure housing development

An important feature of UK housing policy has been the promotion of consortia between local authorities, private developers and housing associations in order to develop mixed tenure estates to meet a wide range of housing needs. Central to this approach has been a focus on the management of neighbourhoods, based on the assumption that high densities and the inter-mixing of tenure exacerbates the potential for incivility and anti-social behaviour and exerts a disproportionate impact on residents' quality of life. Landlord strategies are therefore based on a need to address such issues at an early stage in the development. In some cases community-based, third sector organisations are established in order to manage community assets and to provide a community development service to residents. In others, a common response is to appoint caretakers and wardens to tackle social and environmental problems before they escalate and undermine residents’ quality of life. A number of innovative developments have promoted such neighbourhood governance approaches to housing practice by applying community development methods to address potential management problems. In the process, there is an increasing trend towards strategies that shape behaviour, govern ethical conduct, promote aesthetic standards and determine resident and landlord expectations. These processes can be related to the wider concept of governmentality whereby residents are encouraged to become actively engaged in managing their own environments, based on the assumption that this produces more cohesive, integrated communities and projects positive images. Evidence is emerging from a number of countries that increasingly integrated and mutually supportive roles and relationships between public, private and third sector agencies are transforming neighbourhood governance in similar ways. This paper will review the evidence for this trend towards community governance in mixed housing developments by drawing on a series of UK case studies prepared for two national agencies in 2007. It will review in particular the contractual arrangements with different tenures, identify codes and guidelines promoting 'good neighbour' behaviour and discuss the role of community development trusts and other neighbourhood organisations in providing facilities and services, designed to generate a well integrated community. The second part of the paper will review evidence from the USA and Australia to see how far there is a convergence in this respect in advanced economies. The paper will conclude by discussing the extent to which housing management practice is changing, particularly in areas of mixed development, whether there is a convergence in practice between different countries and how far these trends are supported by theories of governmentality.

Understanding community empowerment in urban regeneration and planning in England: putting policy and practice in context

Community involvement in the fields of town planning and urban regeneration includes a wide range of opportunities for residents and service users to engage with networks, partnerships and centres of power. Both the terminology and degree of the transfer of power to citizens varies in different policy areas and contexts but five core objectives can be identified. This article approaches the subject of community empowerment by exploring the theoretical literature; reviewing recent policy pronouncements relating to community involvement in England and by discussing a recent case study of an Urban II project in London. The conclusions suggest that community empowerment is always likely to be partial and contingent on local circumstances and the wider context.

Remote experimentation network - yielding an inter-university peer-to-peer e-service

The goal of this paper is to discuss the benefits and challenges of yielding an inter-continental network of remote laboratories supported and used by both European and Latin American Institutions of Higher Education. Since remote experimentation, understood as the ability to carry out real-world experiments through a simple Web browser, is already a proven solution for the educational community as a supplement to on-site practical lab work (and in some cases, namely for distance learning courses, a replacement to that work), the purpose is not to discuss its technical, pedagogical, or economical strengths, but rather to raise and try to answer some questions about the underlying benefits and challenges of establishing a peer-to-peer network of remote labs. Ultimately, we regard such a network as a constructive mechanism to help students gain the working and social skills often valued by multinational/global companies, while also providing awareness of local cultural aspects.

Community indentification in peer-t-peer collaborative consumption services

Even though collaborative consumption (CC) is gaining economic importance, research in CC is still in its infancy. Consumers’ reasons for participating have already been investigated but little research on consequences of participation has been conducted. This article examines whether interactions between customers in peer-to-peer CC services influence the willingness to coproduce service outcomes. Drawing on social exchange theory, it is proposed that this effect is mediated by consumers’ identification with the brand community. Furthermore, continuance intention in CC is introduced as a second stage moderator. In a cross-sectional study, customers of peer-to-peer accommodation sharing are surveyed. While customer-to-customer interactions were found to have a positive effect on brand community identification, brand community identification did not positively affect co-production intention. Surprisingly, the effect of brand community identification on co-production intention was negative. Moreover, continuance intention of customers did not moderate this relationship. Bearing in mind current challenges for researchers and companies, theoretical and managerial implications are discussed.

Families of the traumatically brian-injured : a case study approach to perceptions of quality of service, degree of satisfaction, and family needs /

The purpose of this qualitative research study was to foster an understanding of the rehabilitation counselling practice offamilies of the brain-injured. Specifically, the study explores the perceptions of stakeholders in regards to the degree of satisfaction with the quality of service received. Questionnaires were administered, and semi-structured, openended interviews were conducted, with six participating families (n=8). Preliminary data were collected via two instruments: (i) the Family Participant Questionnaire, consisting of participants' sample characteristics, information pertaining to the history of the family, details of the injury, and information relating to the type, use, and need offamily services utilized; and (ii) the Community Integration Questionnaire, a measurement of the degree of social displacementllevel of community integration of the injured family member. Utilizing the procedural steps outlined by Colaizzi's (1978) method of protocol analysis, recommendations for a future program based on related and current family needs are discussed in detail. Substantiating and supporting information are offered to rehabilitation practitioners, educational planners, and policymakers alike, concerning the degree of satisfaction with rehabilitative service, and the means of improving upon the overall quality of health care to families of the brain-injured. Implications for clinical practice and research are also raised for discussion.

The neo-liberal state and the crisis of public service broadcasting in the Anglo-American democracies /

The NeO'liberal State and the Crisis ofPublic Service Broadcasting in the Anglo-American Democracies The purpose ofthis analysis ofthe present condition ofpublic service broadcasting in the Anglo- American democracies was to investigate whether such media can still be regarded as the primarypublic spherefor a dialogue between each nation 's civil society and the State. The motivationfor this thesis was based on a presumption that such fora for public discussion on the central issues of each society have become viewed as less relevant bypoliticians andpolicy-makers and thepublics they were intended to serve in the Anglo-American democracies over thepast two decades. It is speculated that this is the case because ofa beliefthat the post-war consensus between the respective States andpublics that led to the construction of the Keynesian Welfare State and the notion ofpublic service broadcasting has been displaced by an individualistic, neo-liberal, laissez-faire ideology. In other words, broadcasting as a consumer-oriented, commercial commodity has superseded concerns pertaining to the importance ofthe public interest. The methodology employed in this thesis is a comparative analysisfrom a criticalpolitical economy perspective. It was considered appropriate to focus on the United Kingdom, Australia, Canada and the\ United States because they comprise the four largest Anglo-American nations with democratic political systems andprimarily market economies. Justificationfor this particular sample is reinforced by thefact that case study countries also share a common socio-political and economic tradition. The evidence assembledfor this thesis consisted almost exclusively ofexisting literature on the subjects ofpublic service broadcasting, global economic andpolitical integration, and the ascendance ofthe 'free-market ' ethos in Western democracies since the late mid- to late-1970s. In essence, this thesis could be considered as a reinterpretation ofthe existing literature relevant to these issues. Several important common features werefound among the political, economic and broadcasting systems of the four case study nations. It is proposed that the prevalence of the neo-liberal world view throughout the political and policy environments of the four countries has undermined the stability and credibility of each nation 's national public service broadcasting organization, although with varying intensity and effect,. Deregulation ofeach nation 's broadcasting system and the supremacy ofthe notion of 'consumer sovereignty' have marginalized the view of broadcasting on any basis other than strictly economic criteria in thefour case study countries. This thesis concludes that,for a reconstruction ofa trulyparticipatory anddemocraticpublicsphere to be realized in the present as well as thefuture, a reassessment ofthe conventional concept ofthe 'public sphere ' is necessary. Therefore, it is recommended that thefocus ofpolicy-makers in each Anglo-American democracy be redirectedfrom that which conceived ofan all-encompassing, large, state-ownedand operated public broadcasting service toward a view which considers alternativeforms ofpublic communication, such as local community and ethnic broadcasting operations, that are likely to be more responsive to the needs of the increasingly diverse and heterogeneous populations that comprise the modem Anglo-American democracies. The traditional conception of public broadcasters must change in accordance with its contemporary environment if the fundamental principles of the public sphere and public service broadcasting are to be realized.