title: When things go wrong: An exploration of the effectiveness of Te Whatu Ora – Waikato ‘Patient-at- Risk’ service, from the perspective of healthcare professionals

authors: Harrison , Rangi Marie

subjects: Patient at Risk

abstract: Abstract:

Background: Within an acute hospital, critically ill patients are not always located in the intensive care or high dependency unit. Most often, deteriorating patients are managed in the emergency department or wards (Jevon et al., 2012). Signs of decompensation are subtle, but often occur prior to deterioration or an acute event. Therefore, early recognition and timely management improve patient outcomes and reduce admission into critical care services (Jevon et al., 2012). Internationally, acute care teams have been developed to improve patient outcomes through early identification and escalation. The Waikato Hospital Patient-at-Risk (PaR) team is a wraparound service that act as a safety net to support staff during this time. Conflicting evidence is found in the literature that debates the effectiveness of acute care teams, part of this is due to the composition of acute care teams that differ worldwide, and this study sought to explore the value of the Waikato service.

Objective: To explore the perceived value of the Waikato Hospital Patient-at-Risk service from the perspectives of those who utilise this service and those who provide the service. Furthermore, the study seeks to identify the characteristics of patients treated by the PaR service.
Participants: Interviews were held with a total of 13 participants (Ward Registered Nurses = 7; PaR service Registered Nurses = 5; Medical doctors = 1). Medical notes for 1,212 PaR patients were analysed.

Methods: A mixed method research over two phases. Phase one involved matching medical notes with routinely collected hospital data to explore the correlation between PaR patient characteristics and outcomes. Phase two involved 13 semi-structured interviews with staff from the PaR team and in the wards. Findings from phase one, informed the questions in phase two and interviews underwent a thematic analysis employing a general inductive method of inquiry.

Results: This study identified that patients who are seen by the Waikato hospital Patient-at-risk service experience greater complexities contributing to increased length- of-stay. In addition, this service contributes to increased feelings of safety for staff.

Conclusion: This study identified that there was significant value of the PaR service in relation to teaching and training of junior nurses as well as reassurance of ward staff when patients began to deteriorate.

text: When things go wrong: An exploration of the effectiveness of Te Whatu Ora – Waikato ‘Patient-at- Risk’ service, from the perspective of healthcare professionals Abstract:

Background: Within an acute hospital, critically ill patients are not always located in the intensive care or high dependency unit. Most often, deteriorating patients are managed in the emergency department or wards (Jevon et al., 2012). Signs of decompensation are subtle, but often occur prior to deterioration or an acute event. Therefore, early recognition and timely management improve patient outcomes and reduce admission into critical care services (Jevon et al., 2012). Internationally, acute care teams have been developed to improve patient outcomes through early identification and escalation. The Waikato Hospital Patient-at-Risk (PaR) team is a wraparound service that act as a safety net to support staff during this time. Conflicting evidence is found in the literature that debates the effectiveness of acute care teams, part of this is due to the composition of acute care teams that differ worldwide, and this study sought to explore the value of the Waikato service.

Objective: To explore the perceived value of the Waikato Hospital Patient-at-Risk service from the perspectives of those who utilise this service and those who provide the service. Furthermore, the study seeks to identify the characteristics of patients treated by the PaR service.
Participants: Interviews were held with a total of 13 participants (Ward Registered Nurses = 7; PaR service Registered Nurses = 5; Medical doctors = 1). Medical notes for 1,212 PaR patients were analysed.

Methods: A mixed method research over two phases. Phase one involved matching medical notes with routinely collected hospital data to explore the correlation between PaR patient characteristics and outcomes. Phase two involved 13 semi-structured interviews with staff from the PaR team and in the wards. Findings from phase one, informed the questions in phase two and interviews underwent a thematic analysis employing a general inductive method of inquiry.

Results: This study identified that patients who are seen by the Waikato hospital Patient-at-risk service experience greater complexities contributing to increased length- of-stay. In addition, this service contributes to increased feelings of safety for staff.

Conclusion: This study identified that there was significant value of the PaR service in relation to teaching and training of junior nurses as well as reassurance of ward staff when patients began to deteriorate.

year: 2022

title: Compositional synthesis of supervisors in the form of state machines and state maps

authors: Mohajerani, Sahar

subjects: computer science

abstract: This paper investigates the compositional abstraction-based synthesis of least restrictive, controllable, and nonblocking supervisors for discrete event systems that are given as a large number of finite-state machines. It compares a previous algorithm that synthesises modular supervisors in the form of state machines, with an alternative that records state maps after each abstraction step and uses these to control the system. The state map-based algorithm supports all abstraction methods used previously, and in addition allows for nondeterminism, hiding, and transition removal. It has been implemented in the software tool Supremica and applied to several large industrial models. The experimental results and the complexity analysis show that state maps can be computed efficiently and in many cases require less memory than state machine-based supervisors.

text: Compositional synthesis of supervisors in the form of state machines and state maps This paper investigates the compositional abstraction-based synthesis of least restrictive, controllable, and nonblocking supervisors for discrete event systems that are given as a large number of finite-state machines. It compares a previous algorithm that synthesises modular supervisors in the form of state machines, with an alternative that records state maps after each abstraction step and uses these to control the system. The state map-based algorithm supports all abstraction methods used previously, and in addition allows for nondeterminism, hiding, and transition removal. It has been implemented in the software tool Supremica and applied to several large industrial models. The experimental results and the complexity analysis show that state maps can be computed efficiently and in many cases require less memory than state machine-based supervisors.

year: 2017

title: Balancing openness with Indigenous data sovereignty: An opportunity to leave no one behind in the journey to sequence all of life

authors: Cartney, Ann M. Mc

abstract: The field of genomics has benefited greatly from its "openness" approach to data sharing. However, with the increasing volume of sequence information being created and stored and the growing number of international genomics efforts, the equity of openness is under question. The United Nations Convention of Biodiversity aims to develop and adopt a standard policy on access and benefit-sharing for sequence information across signatory parties. This standardization will have profound implications on genomics research, requiring a new definition of open data sharing. The redefinition of openness is not unwarranted, as its limitations have unintentionally introduced barriers of engagement to some, including Indigenous Peoples. This commentary provides an insight into the key challenges of openness faced by the researchers who aspire to protect and conserve global biodiversity, including Indigenous flora and fauna, and presents immediate, practical solutions that, if implemented, will equip the genomics community with both the diversity and inclusivity required to respectfully protect global biodiversity.

text: Balancing openness with Indigenous data sovereignty: An opportunity to leave no one behind in the journey to sequence all of life The field of genomics has benefited greatly from its "openness" approach to data sharing. However, with the increasing volume of sequence information being created and stored and the growing number of international genomics efforts, the equity of openness is under question. The United Nations Convention of Biodiversity aims to develop and adopt a standard policy on access and benefit-sharing for sequence information across signatory parties. This standardization will have profound implications on genomics research, requiring a new definition of open data sharing. The redefinition of openness is not unwarranted, as its limitations have unintentionally introduced barriers of engagement to some, including Indigenous Peoples. This commentary provides an insight into the key challenges of openness faced by the researchers who aspire to protect and conserve global biodiversity, including Indigenous flora and fauna, and presents immediate, practical solutions that, if implemented, will equip the genomics community with both the diversity and inclusivity required to respectfully protect global biodiversity.

year: 2022