The main objective of the paper is to create context sensitive decision support services within flexible Quality Assurance (QA) of software development projects and their resulting products. The new QA process is supported by an Internet solution composed of several knowledge, context sensitive services based on open standards that is able to detect changes in the scope and requirements of an application (or changes in its development process) and provide the adequate set of assessments as a basis for an accurate measurement of the quality of the process and product at any time and allow for effective decision making within QA. The Internet Services monitor the different stages of the software development process, interoperating with the existing applications and systems to provide quantitative information about the quality of each phase (i.e. project management, requirements gathering, functional and technical design, development and testing), the project as a whole and the resulting product. They also monitor context under which the SW is developed and decisions on QA have to be made. Data obtained in real-time by the monitoring services are used in an indistinctive way by software engineers, designers, developers, testers and managers alike for different collaborative decision making. The paper is one of the first attempts to apply context sensitivity to support decision making in QA for SW development. The approach is assessed in 2 different business cases in order to validate the results under different conditions. The first business case belongs to a large software company developing large Internet projects based on Rational Unified Process methodology. The second business case belongs to a SME developing complex projects based on agile methodologies.
The best of palliative medicine and care is underpinned by multi-professional working to optimise symptom management and quality of life once disease specific treatments are no longer appropriate. However, physical and emotional issues are common much earlier in the disease trajectory, during diagnosis and challenging treatments, but aren't always addressed as vigorously as later. The concept of Enhanced Supportive Care is to change this, offering the benefits of good palliative care and medicine alongside active anti-cancer treatments. There's international evidence that this can lead to improved symptom management, quality of life and survival. Thus, NHS England is championing a national pilot, of which we're part, offering ALL patients receiving systemic anti-cancer therapies with palliative intent referral to the ESC team.
Method
Discussions with oncologists, palliative care teams, cancer site specific nurses and chemotherapy team, explaining the background and concept. Working closely with oncology IT team designing electronic referral and data collection pathways. Team development – initially a palliative care and oncology trained nurse supported by a palliative oncology consultant, later adding a GP. 'Tools'- King's Fund Patient Outcome Score (IPOS) – primary tool and Hospital Anxiety and Depression Score (HADS). Changing mind-sets promoting PRO-active rather than RE-active referrals.
Results
Rising referrals – 35 in February, 72 in November. Reduction of scores (improvements) in all domains of IPOS, other than nausea and fatigue, improved quality of life and avoided admissions.
Conclusion and future
Introducing this new service has been challenging and exciting, involving broadening the 'multi-disciplinary team'concept, diplomacy, tact and collaborative working, promoting our skills as an additional benefit, not in competition with other professionals, focusing on the patients quality of life. Our long-term goal is remit expansion to all patients receiving anti-cancer therapies, irrespective of disease stage and treatment intent.
Background and aims: Sepsis is a life-threatening illness with a mortality rate of 30–60%. The Aboriginal childhood population of the Kimberley region of northwest Australia suffered a post-neonatal mortality rate from preventable sepsis ten times that of the non-Aboriginal population. Aims: To reduce the incidence of death from sepsis through an intervention strategy: the Febrile Child Policy (FCP). Methods: This study has been approved through the WA Department of Health ethics process. The FCP required health staff to follow explicit steps in clinical assessment using standardised cut-points for vital signs; investigation by septic workup with urinalysis and culture, throat swab, blood culture, CRP and WCC; and treatment by parenteral antibiotic in all children under the age of 5 years who presented with a febrile illness and no obvious source of infection. The evidence of benefit from deaths prevented was assessed by a comparison of childhood deaths in the 5 years prior (Epoch 1) and the 3 years following (Epoch 2) the implementation of the FCP. Results: The post-neonatal mortality rate for Aboriginal babies fell from 8.2 in Epoch 1 to 4.9 per 1000 in Epoch 2, but remained the same for non-Aboriginal babies (0.8; 0). There were no recorded deaths during Epoch 2 for children presenting with febrile illnesses. Conclusions: The FCP successfully raised clinicians’ index of suspicion for potentially lethal sepsis; prevented sepsis-related mortality; and reduced social and financial health care burdens. Due to low statistical power the statistical significance of benefit of the FCP will take years to become apparent, the clinical benefit is evident.
Coproduction, a collaborative model of research that includes stakeholders in the research process, has been widely advocated as a means of facilitating research use and impact. We summarise the arguments in favour of coproduction, the different approaches to establishing coproductive work and their costs, and offer some advice as to when and how to consider coproduction. Despite the multiplicity of reasons and incentives to coproduce, there is little consensus about what coproduction is, why we do it, what effects we are trying to achieve, or the best coproduction techniques to achieve policy, practice or population health change. Furthermore, coproduction is not free risk or cost. Tensions can arise throughout coproduced research processes between the different interests involved. We identify five types of costs associated with coproduced research affecting the research itself, the research process, professional risks for researchers and stakeholders, personal risks for researchers and stakeholders, and risks to the wider cause of scholarship. Yet, these costs are rarely referred to in the literature, which generally calls for greater inclusion of stakeholders in research processes, focusing exclusively on potential positives. There are few tools to help researchers avoid or alleviate risks to themselves and their stakeholders. First, we recommend identifying specific motivations for coproduction and clarifying exactly which outcomes are required for whom for any particular piece of research. Second, we suggest selecting strategies specifically designed to enable these outcomes to be achieved, and properly evaluated. Finally, in the absence of strong evidence about the impact and process of coproduction, we advise a cautious approach to coproduction. This would involve conscious and reflective research practice, evaluation of how coproduced research practices change outcomes, and exploration of the costs and benefits of coproduction. We propose some preliminary advice to help decide when coproduction is likely to be more or less useful.
Background: With the aim of making it easier for researchers to produce policy-relevant research, the UK Government now requires all departments and arms-length bodies to publish annually-updated statements of their evidence needs, called ‘Areas of Research Interest’ (ARIs). We describe how ARIs are produced, and how they are used to support this aim.Aims and objectives: In this paper we offer a description of ARIs and their development by UK governmental departments, and an assessment of how different stakeholders, including academia and funders, have responded to or otherwise used the ARIs.Key conclusions: ARIs are a mechanism for organisations to share their research interests with external audiences in the form of a published document. In addition to this primary aim, they also have a much broader set of uses, including connecting departments with each other and helping intermediaries shape engagement plans. All groups would benefit from more robust evidence to choose effective engagement mechanisms, and more can be done to make the ARIs discoverable and useable. Overall, the ARIs are a useful tool to illuminate, and begin to connect different parts of the research-policy system.
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