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Open Access
Article
Publication date: 14 December 2022

Jon Painter, Winola Chio, Liam Black and David Newman

This study aims to understand whether psychotropic prescribing practices for people with intellectual disabilities are in keeping with best practice guidelines.

Abstract

Purpose

This study aims to understand whether psychotropic prescribing practices for people with intellectual disabilities are in keeping with best practice guidelines.

Design/methodology/approach

This service evaluation project was a retrospective analysis of routinely collected data from the care records of all 36 people with intellectual disability discharged from an intellectual disability assessment and treatment unit during the first five years of the Stop Over medicating People with Intellectual Disabilities and/or autistic people (STOMP) initiative. Data were gathered at four time points (pre-admission, discharge, 6- and 12-month follow-up) before being analysed to understand whether psychotropic prescribing differed among people with different clinical characteristics/traits/diagnoses. Changes over time were also explored to ascertain whether and how prescribing altered from admission to discharge, and over the subsequent year of community living.

Findings

Most people with intellectual disabilities left the assessment and treatment unit on fewer regular psychotropic medications and at lower doses than at admission. These optimised regimes were still apparent 12 months post-discharge, suggesting effective discharge planning and community care packages. Inpatients with severe intellectual disabilities generally received more anxiolytics and hypnotics, at higher doses. Autistic people tended to receive more psychotropics in total and at higher cumulative doses, a pattern that persisted post discharge. A third of the sample were admitted on regular anti-psychotic medications despite having no corresponding psychotic diagnosis, a proportion that remained relatively stable through discharge and into the community.

Originality/value

This study highlights subsets of the intellectual disability population at particular risk of receiving high doses of psychotropics and a feasible template for providers intending to undertake STOMP-focused evaluations.

Details

Tizard Learning Disability Review, vol. 28 no. 1/2
Type: Research Article
ISSN: 1359-5474

Keywords

Open Access
Article
Publication date: 15 March 2018

Supattra Changsuphan, Puangpaka Kongvattananon and Chomchuen Somprasert

The purpose of this paper is to reduce or eliminate pain while enabling full advantage and function of daily living activities after hospital discharge. Readiness for discharge

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Abstract

Purpose

The purpose of this paper is to reduce or eliminate pain while enabling full advantage and function of daily living activities after hospital discharge. Readiness for discharge depends largely on prior healthcare team preparations for both patients and their families.

Design/methodology/approach

This integrative review was conducted using the Whittemore and Knafl method, and synthesized published research concerning patients’ readiness for discharge, particularly those who had undergone total hip replacement (THR) surgery.

Findings

Results were categorized into five main themes as physiological experiences, psychological experiences, coping ability, needs from the healthcare team, and family support influential to the readiness of THR patients for discharge.

Originality/value

The preparation for discharge of THR patients should be fully engaged and addressed. Moreover, healthcare professionals should provide care for patients at both the pre- and post-operation phases as well as during the transitional phase from hospital to home.

Details

Journal of Health Research, vol. 32 no. 2
Type: Research Article
ISSN: 2586-940X

Keywords

Open Access
Article
Publication date: 7 December 2021

Benshuo Yang and Haojun Xu

Japan's decision to release nuclear wastewater into the Pacific Ocean in 2023 has sparked strong opposition at home and abroad. In this study, Graph Model for Conflict Resolution…

2735

Abstract

Purpose

Japan's decision to release nuclear wastewater into the Pacific Ocean in 2023 has sparked strong opposition at home and abroad. In this study, Graph Model for Conflict Resolution (GMCR) method is adopted to analyze the conflict problem, and reasonable equilibrium solutions are given to solve the conflict event.

Design/methodology/approach

In this study, GMCR is adopted to solve the conflict problem. First, identify the key decision-makers (DMs) on the issue of nuclear effluent and the relevant options they might adopt. Second, the options of each DM are arranged and combined to form a set of feasible states. Thirdly, the graph model is constructed according to the change of DM's options, and the relative preference of each DM is determined. Finally, the conflict problem is solved according to the definition of GMCR equilibrium.

Findings

Discharging nuclear wastewater into the ocean is not the right choice to solve the problem. Developing more space to store nuclear wastewater is more conducive to the protection of the ocean environment.

Practical implications

It is undesirable for the Japanese government to unilaterally discharge nuclear wastewater into the ocean. Objectively assessing the radioactivity of nuclear wastewater and the cooperation of relevant stakeholders can better solve this conflict.

Originality/value

The problem arising from Japan's releasing plan is complicated because of a lack of information and the existence of multiple stakeholders, while GMCR can help us with a better view of the current circumstance in the conflict.

Details

Marine Economics and Management, vol. 5 no. 1
Type: Research Article
ISSN: 2516-158X

Keywords

Open Access
Article
Publication date: 15 February 2016

Maria Goddard, Panagiotis Kasteridis, Rowena Jacobs, Rita Santos and Anne Mason

The purpose of this paper is to explore the link between one aspect of primary care in England – the annual review by general practitioners for dementia patients – and length of…

3467

Abstract

Purpose

The purpose of this paper is to explore the link between one aspect of primary care in England – the annual review by general practitioners for dementia patients – and length of hospital stay (LoS). The annual review should identify the needs of both patients and carers and co-ordinate services across health and social care to address those needs. If this is done well, timely discharge from hospital may be facilitated.

Design/methodology/approach

The study uses linked national data from 2006/2007 to 2010/2011 on over 36,000 patients, employing sophisticated statistical techniques to isolate the effect of the annual dementia review on LoS.

Findings

Hospital patients discharged to the community have significantly shorter stays if they are cared for by practices that reviewed a higher percentage of their patients with dementia. However, this effect is small and is not evident for patients discharged to care homes or who died in hospital. Longer LoS is associated with a range of co-morbidities, markers of low availability of social care and with intensive provision of informal care.

Practical implications

Although the dementia review has only a modest effect on LoS, the components of the review could improve the health and well-being of those with dementia and their carers.

Originality/value

The study is the first to employ a robust methodology to investigate the impact of the annual dementia review on hospital LoS, an important aspect of the interface between primary and secondary care. There are implications for clinical and financial aspects of health and social care policy.

Details

Journal of Integrated Care, vol. 24 no. 1
Type: Research Article
ISSN: 1476-9018

Keywords

Open Access
Article
Publication date: 4 May 2021

Nadeem Ahmad, Sirajuddin Ahmed, Viola Vambol and Sergij Vambol

All those effluent streams having compromised characteristics pose negative effects on the environment either directly or indirectly. Health care facilities and hospitals also…

1514

Abstract

Purpose

All those effluent streams having compromised characteristics pose negative effects on the environment either directly or indirectly. Health care facilities and hospitals also generate a large amount of effluent like other industries containing harmful and toxic pharmaceutical residual compounds due to uncontrolled use of drugs, besides others. The occurrence of antibiotic in the environment is of utmost concern due to development of resistant genes. These get mixed up with ground and surface water due to lack of proper treatment of hospital wastewater. The effect of pharmaceutical compounds on human society and ecosystem as a whole is quite obvious. There are no strict laws regarding discharge of hospital effluent in many countries. Contrary to this, the authors do not have appropriate treatment facilities and solution to solve day by day increasing complexity of this problem. Moreover, water discharged from different health facilities having variable concentration often gets mixed with municipal sewage, thus remains partially untreated even after passing from conventional treatment plants. The purpose of this paper is to highlight the occurrences and fate of such harmful compounds, need of proper effluent management system as well as conventionally adopted treatment technologies nowadays all around the globe. This mini-review would introduce the subject, the need of the study, the motivation for the study, aim, objectives of the research and methodology to be adopted for such a study.

Design/methodology/approach

Hospital effluents consisting of pathogens, fecal coliforms, Escherichia coli, etc, including phenols, detergents, toxic elements like cyanide and heavy metals such as copper (Cu), iron (Fe), gadolinium (Gd), nickel (Ni), platinum (Pt), among others are commonly detected nowadays. These unwanted compounds along with emerging pollutants are generally not being regulated before getting discharged caused and spread of diseases. Various chemical and biological characteristics of hospital effluents are assessed keeping in the view the threat posed to ecosystem. Several research studies have been done and few are ongoing to explore the different characteristics and compositions of these effluent streams in comparison so as to suggest the suitable conventional treatment techniques and ways to manage the problem. Several antibiotic groups such as ciprofloxacin, ofloxacin, sulfa pyridine, trimethoprim, metronidazole and their metabolites are reported in higher concentration in hospital effluent. The aquatic system also receives a high concentration of pharmaceutical residues more than 14,000 μg/L from treatment plants also and other surface water or even drinking water in Indian cities. Many rivers in southern parts of India receives treated water have detected high concentration drugs and its metabolites. As far as global constraints that need to be discussed, there are only selected pharmaceuticals compounds generally analyzed, issue regarding management and detection based on method of sampling, frequency of analysis and observation, spatial as well as temporal concentration of these concerned micropollutants, accuracy in detecting these compounds, reliability of results and predictions, prioritization and the method of treatment in use for such type of wastewater stream. The complexity of management and treatment as well need to be addressed with following issues at priority: composition and characterization of effluent, compatible and efficient treatment technology that needs to be adopted and the environment risk posed by them. The problem of drugs and its residues was not seen to be reported in latter part of 20th century, but it might be reported locally in some part of globe. This paper covers some aspect about the disposal and regulatory standard around the world toward hospital effluent discharge, its managements and treatment technologies that are adopted and best suitable nowadays various industries and monitoring the efficiencies of existing treatment systems. This mini-review would introduce the subject, the need, the motivation and objectives of the study and methodology can be adopted for such a study.

Findings

The compiled review gives a complete view about the types of antibiotics used in different health care facilities, their residue formation, occurrences in different ecosystems, types of regulations or laws available in different counties related to disposal, different type of treatment technologies, innovative combined treatment schemes and future action needed to tackle such type of effluent after its generation. The thesis also highlights the use of certain innovative materials use for the treatment like nanoparticles. It also discusses about the residues impact on the human health as well as their bioaccumulative nature. If the authors relate the past to the current scenario of pharmaceutical compounds (PhACs) in the environment, the authors will certainly notice that many diseases are nowadays not curable by simple previously prescribed Ab. Many research projects have been done in European countries that have shown the risk of such residues like Pills, Sibell, Poseidon, No pills, Neptune, Knappe, Endetech, etc. In the previous section, it was mentioned that there are no stringent laws for hospital wastewater and in many countries, they are mixed with domestic wastewater. Many difficulties are there with this research due to complex analysis, detection of targeted Ab, affecting waterbodies rate of flow, nature of treatment varies with season to season. The way nature is being degraded and harmful effect are being imposed, it is important to take immediate and decisive steps in this area. Wastewater treatment plants (WWTPs) serves as a nursery for antibiotic-resistant systems, hence monitoring with great attention is also needed. Many trials with different treatment process, in combination, were considered. Many countries are paying great attention to this topic by considering the severity of the risk involved in it.

Research limitations/implications

Previous studies by several scientists show that the pharmaceutical residues in the discharged effluent displayed direct toxic effects, and sometimes, detrimental effects in the mixture were also observed. The discharge of untreated effluent from hospitals and pharmaceuticals and personal care products in the natural ecosystem poses a significant threat to human beings. The pharmaceuticals, like antibiotics, in the aquatic environment, accelerate the development of the antibiotic-resistant genes in bacteria, which causes fatal health risks to animals and human beings. Others, like analgesics, are known to affect development in fishes. They also degrade the water quality and may lead to DNA damage, toxicity in lower organisms like daphnia and have the potential to bioaccumulate. A few commonly used nanoadsorbents for water and wastewater treatment along with their specific properties can also be used. The main advantages of them are high adsorption capacity and superior efficiency, their high reusability, synthesis at room temperatures, super magnetism, quantum confinement effect as well as eco-toxicity. This review will focus on the applicability of different nanoscale materials and their uses in treating wastewater polluted by organic and inorganic compounds, heavy metals, bacteria and viruses. Moreover, the use of various nanoadsorbents and nano-based filtration membranes is also examined.

Practical implications

A number of different pharmaceutical residues derived from various activities like production facilities, domestic use and hospitals have been reported earlier to be present in groundwater, effluents and rivers, they include antibiotics, psycho-actives, analgesics, illicit drugs, antihistamine, etc. In past few years environmental scientists are more concerned toward the effluents generated from medical care facilities, community health centers and hospitals. Various chemical and biological characteristics of hospital effluents have been assessed keeping in the view the common threats pose by them to the entire ecosystem. In this study, seven multispecialty hospitals with nonidentical pretreatment were selected for three aspects i.e. conventional wastewater characteristics, high priority pharmaceuticals and microbial analyses. The present work is to evaluate efficacy of advanced wastewater treatment methods with regard to removal of these three aspects from hospital effluents before discharge into a sewage treatment plant (STP). Based on test results, two out of seven treatment technologies, i.e. MBR and CW effectively reducing conventional parameters and pharmaceuticals from secondary and tertiary treatments except regeneration of microbes were observed in tertiary level by these two treatments.

Social implications

This review has aimed to identify the emerging contaminants, including pharmaceutical residues, highly consumed chemicals that are present in the hospital effluent, along with their physicochemical and biological characteristics. In this, the main objective was to review the occurrences and fate of common drugs and antibiotics present in effluents from hospital wastewaters. As far as global constraints that need to be discussed, there are only selected pharmaceuticals compounds generally analyzed, issue regarding management and detection based on method of sampling, frequency of analysis and observation, spatial as well as temporal concentration of these concerned micropollutants, accuracy in detecting these compounds, reliability of results and predictions, prioritization and the method of treatment in use for such type of wastewater stream are among the major issues (Akter et al., 2012; Ashfaq et al., 2016; García-Mateos et al., 2015; Liu et al., 2014; Mubedi et al., 2013; Prabhasankar et al., 2016; Sun et al., 2016; Suriyanon et al., 2015; Wang et al., 2016; Wen et al., 2004). This paper covers some aspect about the disposal and regulatory standard around the world toward hospital effluent discharge, its managements and treatment technologies that are adopted and best suitable nowadays.

Originality/value

This study many multispecialty hospitals with nonidentical pretreatment were selected for three aspects i.e. conventional wastewater characteristics high priority pharmaceuticals and microbial analyses. The present work is to evaluate efficacy of advanced wastewater treatment methods with regard to removal of these three aspects from hospital effluents before discharge into an STP. Based on test results, two out of different treatment effectively reducing conventional parameters and pharmaceuticals from secondary and tertiary treatments except regeneration of microbes were observed in the tertiary level by these two treatments were studies followed by ozonation and ultraviolet-ray treatment.

Details

Frontiers in Engineering and Built Environment, vol. 1 no. 1
Type: Research Article
ISSN: 2634-2499

Keywords

Open Access
Article
Publication date: 4 June 2019

Aisling Jane Davis and Patricia Mc Clure

Discharge planning home visits (DPHVs) are a routine part of occupational therapy clinical practice. However, there is a dearth of evidence to support or refute their efficacy and…

3344

Abstract

Purpose

Discharge planning home visits (DPHVs) are a routine part of occupational therapy clinical practice. However, there is a dearth of evidence to support or refute their efficacy and limited policies or standards to guide clinical practice. This study aims to investigate current clinical practice during home visits and the value that occupational therapists’ attribute to home visits within an Irish context.

Design/methodology/approach

Data collection was carried out by using a survey questionnaire (postal and electronic options). The study population comprised occupational therapists across 52 sites including acute, rehabilitation and convalescence settings within the Republic of Ireland. In total, 122 occupational therapists that completed the survey questionnaire were recruited for the study.

Findings

Quantitative data identified time spent per visit, departmental size, hospital size, number of visits and report writing times. Information was gathered regarding clinical areas assessed during visits in a Likert scale format. Qualitative data identified benefits, risks, recommendations to improve home visit practice and clinical criteria for home visits. Findings conclude that DPHVs are routinely carried out by occupational therapists and that there is consistency in clinical practice within an Irish setting. Occupational therapists value home visits as clinical assessments and have identified risks during practice, benefits of visits and ways to improve practice.

Originality/value

This study has provided a reflection of clinical practice in the Republic of Ireland. It is the only study of its kind in an Irish setting, and it could be used as a knowledge base regarding current practice on DPHV and occupational therapists’ clinical reasoning regarding home visits. The information gathered in this study could influence policies regarding DPHV and could serve as a comparison to standardise practice and justify the need for DPHV.

Details

Irish Journal of Occupational Therapy, vol. 47 no. 2
Type: Research Article
ISSN: 2398-8819

Keywords

Open Access
Article
Publication date: 15 September 2017

Okan Duru, Joan P. Mileski and Ergun Gunes

The aim of this paper is to investigate the gap between cost-based and time-based revenue recognition schemes in the accounting of ship-owning corporations, and to propose…

6843

Abstract

Purpose

The aim of this paper is to investigate the gap between cost-based and time-based revenue recognition schemes in the accounting of ship-owning corporations, and to propose cost-based revenue recognition (as in general accounting practice) in connection with the performance obligations.

Design/methodology/approach

For a comparative analysis of time-based (traditional approach) and cost-based schemes, a sample of dry bulk ships is selected and voyage estimations are performed by certified professional shipbrokers (Fellow of the Institute of Chartered Shipbrokers) (data collection and voyage estimation by practitioner). Performance obligations are also defined by certified shipbrokers (i.e. survey and expert opinion) and certified public accountant based on common shipping business practice and accounting practice in general.

Findings

Empirical results indicate the significant gap between two alternative schemes. Cost-based revenue recognition accelerates the revenue recognition (benefit of shipowner), and it enables comparability among other industries since cost-based allocation is the common practice in accounting (matching principle, Generally Accepted Accounting Principles).

Research limitations/implications

It is obviously impossible to observe all kinds of freight market transactions for all different kinds of vessel particulars. The sample size does not undervalue the current study since the central idea of this paper is not the verification of the cost-based recognition in all possible transactions.

Practical implications

The proposed approach debiases the existing recognition practice as well as improving the speed of revenue recognition. In the existing practice, time-based recognition is still based on voyage estimations (time estimation). Voyage estimations conventionally answer two questions: “What is the cost of the voyage?” and “What is the duration of the voyage?” Therefore, the proposed approach does not require any additional work done. Common practice also clarifies the cost-based schedule for revenue recognition.

Originality/value

This paper addresses the unconventional accounting practice and its incomparability problem for the first time. To the best of the authors’ knowledge, this paper is also the first study on accounting economics of the shipping business. This paper proposes a practical solution to the debate raised by Financial Accounting Standards Board 2014-09 regulation on accounting standards by utilizing a staging approach and cost-based revenue allocation.

Details

Maritime Business Review, vol. 2 no. 3
Type: Research Article
ISSN: 2397-3757

Keywords

Open Access
Article
Publication date: 12 May 2020

Tomasz Matusiak, Krzysztof Swiderski, Jan Macioszczyk, Piotr Jamroz, Pawel Pohl and Leszek Golonka

The purpose of this paper is to present a study on miniaturized instruments for analytical chemistry with a microplasma as the excitation source.

Abstract

Purpose

The purpose of this paper is to present a study on miniaturized instruments for analytical chemistry with a microplasma as the excitation source.

Design/methodology/approach

The atmospheric pressure glow microdischarge could be ignited inside a ceramic structure between a solid anode and a liquid cathode. As a result of the cathode sputtering of the solution, it was possible to determine its chemical composition by analyzing the emission spectra of the discharge. Cathodes with microfluidic channels and two types of anodes were constructed. Both types were tested through experimentation. Impact of the electrodes geometry on the discharge was established. A cathode aperture of various sizes and anodes made from different materials were used.

Findings

The spectroscopic properties of the discharge and its usefulness in the analysis depended on the ceramic structure. The surface area of the cathode aperture and the flow rate of the solution influence on the detection limits (DLs) of Zn and Cd.

Originality/value

Constructed ceramic structures were able to excite elements and their laboratory-size systems. During the experiments, Zn and Cd were detected with DLs 0.024 and 0.053 mg/L, respectively.

Details

Sensor Review, vol. 40 no. 4
Type: Research Article
ISSN: 0260-2288

Keywords

Content available
Article
Publication date: 28 January 2020

Christos Papaleonidas, Dimitrios V. Lyridis, Alexios Papakostas and Dimitris Antonis Konstantinidis

The purpose of this paper is to improve the tactical planning of the stakeholders of the midstream liquefied natural gas (LNG) supply chain, using an optimisation approach. The…

1293

Abstract

Purpose

The purpose of this paper is to improve the tactical planning of the stakeholders of the midstream liquefied natural gas (LNG) supply chain, using an optimisation approach. The results can contribute to enhance the proactivity on significant investment decisions.

Design/methodology/approach

A decision support tool (DST) is proposed to minimise the operational cost of a fleet of vessels. Mixed integer linear programming (MILP) used to perform contract assignment combined with a genetic algorithm solution are the foundations of the DST. The aforementioned methods present a formulation of the maritime transportation problem from the scope of tramp shipping companies.

Findings

The validation of the DST through a realistic case study illustrates its potential in generating quantitative data about the cost of the midstream LNG supply chain and the annual operations schedule for a fleet of LNG vessels.

Research limitations/implications

The LNG transportation scenarios included assumptions, which were required for resource reasons, such as omission of stochasticity. Notwithstanding the assumptions made, it is to the authors’ belief that the paper meets its objectives as described above.

Practical implications

Potential practitioners may exploit the results to make informed decisions on the operation of LNG vessels, charter rate quotes and/or redeployment of existing fleet.

Originality/value

The research has a novel approach as it combines the creation of practical management tool, with a comprehensive mathematical modelling, for the midstream LNG supply chain. Quantifying future fleet costs is an alternative approach, which may improve the planning procedure of a tramp shipping company.

Details

Maritime Business Review, vol. 5 no. 1
Type: Research Article
ISSN: 2397-3757

Keywords

Content available
Article
Publication date: 21 August 2020

Said El Noshokaty

The purpose of this paper is to resolve three problems in ship routing and scheduling systems. Problem 1 is the anticipation of the future cargo transport demand when the shipping…

Abstract

Purpose

The purpose of this paper is to resolve three problems in ship routing and scheduling systems. Problem 1 is the anticipation of the future cargo transport demand when the shipping models are stochastic based on this demand. Problem 2 is the capacity of these models in processing large number of ships and cargoes within a reasonable time. Problem 3 is the viability of tramp shipping when it comes to real problems.

Design/methodology/approach

A commodity-trade forecasting system is developed, an information technology platform is designed and new shipping elements are added to the models to resolve tramp problems of en-route ship bunkering, low-tide port calls and hold-cleaning cost caused by carrying incompatible cargoes.

Findings

More realistic stochastic cargo quantity and freight can now be anticipated, larger number of ships and cargoes are now processed in time and shipping systems are becoming more viable.

Practical implications

More support goes to ship owners to make better shipping decisions.

Originality/value

New norms are established in forecasting, upscaling and viability in ship routing and scheduling systems.

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