“Medical bag for General Practice” Just in Case: redesigning the doctor’s bag (2012)

This research addressed practice related problems from a medico-legal perspective and aims to provide a working tool that aids GPs to comply with best practice protocols. The resulting bag was developed in collaboration with General Practitioners, clinicians and members of the Medical Defense Union. Using proven methods developed within the Healthcare & Patient Safety Lab (e.g. DOME, Ambulance) to establish an evidence-based brief, this research used task, equipment and consumables analysis to determine minimum requirements and preferred layouts for task optimisation. The research established that clinicians require three distinct functions in their workspace: laying out, organisation and information retrieval. Feedback from clinicians indicates that this working tool allows them to access information and equipment wherever they may be and suggests an improvement from current practice. The research is now into a second year where the design of the bag will be refined and tested. Lifestyle and demographic changes such as the ageing population and increased prevalence of chronic diseases require more consistent standards of primary care, and care that is well coordinated and integrated (Imison, et al., 2011). Many guidelines exist relating to general practice and the doctor’s bag (NSLMC, 2008, RACGP, 2010, RCGP, 2008 and Hiramanek, 2004), however there is no standard in the UK that regulates the shape and materials of the bag or its contents. Doctors may use any sort of vessel to transport their equipment and consumables to a patient’s location. Furthermore, treating a patient in their own home, outside an ideal clinical environment, presents its own complications. A looks-like, works-like bag prototype and information system that will be used in clinical trials, the results of which will determine the manufacturing of a new, standardised bag for clinical treatment used by members of the Medical Defence Union.

Gaining by Giving? Peer Research into Service User and Carer Perceptions of Inclusivity in Higher Education

Service users and carers (SUAC) have made significant contributions to professional training in social work courses in Higher Education (HE) over the past decade in the UK. Such participation has been championed by government, academics and SUAC groups from a range of theoretical and political perspectives. Most research into the effectiveness of SUAC involvement at HE has come from the perspectives of academics and very little SUAC-led research exists. This qualitative peer research was led by two members of the University of Worcester’s SUAC group. Findings were that SUAC perceived their involvement brought benefits to students, staff, the University and the local community. Significant personal benefits such as finding a new support network, increased self-development and greater confidence to manage their own care were identified in ways that suggested that the benefits that can flow from SUAC involvement at HE are perhaps more far-reaching than previously recognised. Barriers to inclusion were less than previously reported in the literature and the humanising effects of SUAC involvement are presented as a partial antidote to an increasingly marketised HE culture.

Occupational therapists’ perceptions of occupation in practice : an exploratory study

Relatório de estágio

O presente relatório de estágio configura-se como o requisito parcial para a obtenção do grau de mestre em Educação Pré-Escolar e Ensino do 1.º Ciclo do Ensino Básico. Apresenta o objetivo fulcral de refletir, de forma indagadora e problematizadora, sobre o desenvolvimento profissional da mestranda, emergente da concretização do estágio profissionalizante nos contextos de Educação Pré-Escolar e 1.º Ciclo do Ensino Básico. No relatório serão abordados quais os pressupostos teóricos e legais que fundamentaram a prática pedagógica da mestranda em ambos os níveis educativos, assim como o modo como estes foram mobilizados pela mesma. A metodologia de investigação-ação constituiu o pilar do desenvolvimento profissional, pessoal e social da formanda, possibilitando que esta adotasse uma postura investigativa, crítica e reflexiva, com vista ao melhoramento do processo de ensino e aprendizagem. Nesta linha de raciocínio, a ação educativa desenvolvida pela mestranda obedeceu a um processo cíclico, através da articulação das etapas de observação, planificação, ação, reflexão e avaliação. Importa salientar, ao longo do estágio, a mestranda procurou que a sua ação pedagógica mobilizasse características inerentes ao paradigma socio construtivista, no qual a criança desempenha o papel crucial na ação. Face ao exposto, o estágio profissionalizante desenvolvido em ambos os contextos educativos caracterizou-se por ser a força motriz para que a mestranda desenvolvesse, construtivamente, as competências profissionais inerentes a um perfil docente duplo. Assim, a mestranda tomou consciência acerca das semelhanças e contrastes evidenciados pelos dois níveis educativos, valorando a importância de uma sequencialidade entre estes. Em suma, a formação permitiu o início da aprendizagem do que é ser educador e professor e a consciencialização da essência da missão de educar.

Scoping review of adherence promotion theories in pelvic floor muscle training : 2011 ics state-of-the-science seminar research paper I of IV

Aims This paper, the first of four emanating from the International Continence Society's 2011 State-of-the-Science Seminar on pelvic-floor-muscle training (PFMT) adherence, aimed to summarize the literature on theoretical models to promote PFMT adherence, as identified in the research, or suggested by the seminar's expert panel, and recommends future directions for clinical practice and research. Methods Existing literature on theories of health behavior were identified through a conventional subject search of electronic databases, reference-list checking, and input from the expert panel. A core eligibility criterion was that the study included a theoretical model to underpin adherence strategies used in an intervention to promote PFM training/exercise. Results A brief critique of 12 theoretical models/theories is provided and, were appropriate, their use in PFMT adherence strategies identified or examples of possible uses in future studies outlined. Conclusion A better theoretical-based understanding of interventions to promote PFMT adherence through changes in health behaviors is required. The results of this scoping review and expert opinions identified several promising models. Future research should explicitly map the theories behind interventions that are thought to improve adherence in various populations (e.g., perinatal women to prevent or lessen urinary incontinence). In addition, identified behavioral theories applied to PFMT require a process whereby their impact can be evaluated.

Pelvic-floor-muscle-training adherence “modifiers” : a review of primary qualitative studies : 2011 ICS State-of-the-Science Seminar research paper III of IV

Aims This review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. Methods Primary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing “modifiers” of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. Results Thirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six “modifiers” of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. Conclusions Individuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the “modifiers” of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence.

Development of an intervention to support medication management in patients with multimorbidity in primary care

The overarching aim of this thesis was to develop an intervention to support patient-centred prescribing in the context of multimorbidity in primary care. Methods A range of research methods were used to address different components of the Medical Research Council, UK (MRC) guidance on the development and evaluation of complex interventions in health care. The existing evidence on GPs’ perceptions of the management of multimorbidity was systematically reviewed. In qualitative interviews, chart-stimulated recall was used to explore the challenges experienced by GPs when prescribing for multimorbid patients. In a cross-sectional study, the psychosocial issues that complicate the management of multimorbidity were examined. To develop the complex intervention, the Behaviour Change Wheel (BCW) was used to integrate behavioural theory with the findings of these three studies. A feasibility study of the new intervention was then conducted with GPs. Results The systematic review revealed four domains of clinical practice where GPs experienced difficulties in multimorbidity. The qualitative interview study showed that GPs responded to these difficulties by ‘satisficing’. In multimorbid patients perceived as stable, GPs preferred to ‘maintain the status quo’ rather than actively change medications. In the cross-sectional study, the significant association between multimorbidity and negative psychosocial factors was shown. These findings informed the development of the ‘Multimorbidity Collaborative Medication Review and Decision-making’ (MY COMRADE) intervention. The intervention involves peer support: two GPs review the medications prescribed to a complex multimorbid patient together. In the feasibility study, GPs reported that the intervention was appropriate for the context of general practice; was widely applicable to their patients with multimorbidity; and recommendations for optimising medications arose from all collaborative reviews. Conclusion Applying theory to empirical data has led to an intervention that is implementable in clinical practice, and has the potential to positively change GPs’ behaviour in the management of medications for patients with multimorbidity.

Scoping review of adherence promotion theories in pelvic floor muscle training : 2011 ics state-of-the-science seminar research paper I of IV

Aims This paper, the first of four emanating from the International Continence Society's 2011 State-of-the-Science Seminar on pelvic-floor-muscle training (PFMT) adherence, aimed to summarize the literature on theoretical models to promote PFMT adherence, as identified in the research, or suggested by the seminar's expert panel, and recommends future directions for clinical practice and research. Methods Existing literature on theories of health behavior were identified through a conventional subject search of electronic databases, reference-list checking, and input from the expert panel. A core eligibility criterion was that the study included a theoretical model to underpin adherence strategies used in an intervention to promote PFM training/exercise. Results A brief critique of 12 theoretical models/theories is provided and, were appropriate, their use in PFMT adherence strategies identified or examples of possible uses in future studies outlined. Conclusion A better theoretical-based understanding of interventions to promote PFMT adherence through changes in health behaviors is required. The results of this scoping review and expert opinions identified several promising models. Future research should explicitly map the theories behind interventions that are thought to improve adherence in various populations (e.g., perinatal women to prevent or lessen urinary incontinence). In addition, identified behavioral theories applied to PFMT require a process whereby their impact can be evaluated.

Pelvic-floor-muscle-training adherence “modifiers” : a review of primary qualitative studies : 2011 ICS State-of-the-Science Seminar research paper III of IV

Aims This review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. Methods Primary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing “modifiers” of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. Results Thirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six “modifiers” of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. Conclusions Individuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the “modifiers” of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence.

Show

Script for non-verbal performance. Research Component: Silent Treatment: Creating Non-verbal Performance Works for Children The research field of theatre for young people draws on theories of child development and popular culture. SHOW explored personal and social development, friendship and creative play through the lens of the experience of girls aged 8-12. This project consolidated and refined innovative approaches to creating non-verbal theatre performance, and addressed challenges inherent in the creation of a performance by adults for young audiences. A significant finding of the project was the unanticipated convergence of creative practice and research into child behaviour and development: the congruence of content (Female bullying) and theatrical form (non-verbal performance: “Within the hidden culture of aggression, girls fight with body language and relationships instead of fists and knives. In this world, friendship is a weapon, and the sting of a shout pales in comparison to a day of someone’s silence. There is no gesture more devastating than the back turning away Simmons, Rachel (2002:3) Odd Girl Out: The Hidden Culture Of Aggression In Girls Schwartz Books The creative development and drafting process focussed on negotiating the conceptual design and practical constraints of incorporating diegetic music and video sources into the narrative. The authorial (and production) challenges of creating a script that could facilitate the re-mount a non-verbal work for a company specialising in text-based theatre . Show was commissioned by the Queensland Theatre Company in 2003, toured into Queensland Schools by the Queensland Arts Council and in 2004 was performed at the Sydney Opera House.

Medeleven

Medeleven was a practice-based research work that challenged conventional notions of how audiences ‘experience’ contemporary dance. It resulted in a 40 minute ‘experiential’ performance that inverted the traditional ‘passive’ presentation paradigm by situating the audience centrally within the creative process. The ‘traditional presentation paradigm’ was inverted in numerous ways including: asking the audience onstage with the performers, placing swings onstage for the audience to play on during the performance and guiding the audience through backstage corridors before entering onstage – all of which added elements of physicality, agency and liminality to the performance not usually available to audience members of contemporary dance. Five dancers moved throughout the space allowing the audience to choose where and how they engaged with this work and the swings were utilised both as a performance space and for audience seating. In addition to these spatial variations, the quadraphonic soundscore created distinct ‘environments’ throughout the stage space that varied individual experience possibilities. By positing performance as an experiential phenomenon, the pivotal objective of this work was to create a live-art experience that extended its performativity to include audience members as active meaning-makers, challenging both their role within this paradigm and their expectations of contemporary dance. The work produced strong responses from the audience with surveys indicating the presentation format, as well as the construction of the work, changed audience experience and ability to connect with the dance work. The research suggested that, in addition to existing research on dance audiences, barriers to engagement with contemporary dance may include how the art is constructed and where the audience is positioned within that creative framework. The research builds upon artistic practices being undertaken throughout the world that challenge the notion of existing ‘passive’ performance paradigms via creative ‘engagement’ with audience.

Adopting building information modeling (BIM) as collaboration platform in the design industry

This paper discusses the preliminary findings of an ongoing research project aimed at developing a technological, operational and strategic analysis of adopting BIM in AEC/FM (Architecture-Engineering-Construction/Facility Management) industry as a collaboration tool. Outcomes of the project will provide specifications and guidelines as well as establish industry standards for implementing BIM in practice. This research primarily focuses on BIM model servers as a collaboration platform, and hence the guidelines are aimed at enhancing collaboration capabilities. This paper reports on the findings from: (1) a critical review of latest BIM literature and commercial applications, and (2) workshops with focus groups on changing work-practice, role of technology, current perception and expectations of BIM. Layout for case studies being undertaken is presented. These findings provide a base to develop comprehensive software specifications and national guidelines for BIM with particular emphasis on BIM model servers as collaboration platforms.

"Theatre of the dancing language" : new possibilities in contemporary Australian playwrighting

This study focuses on trends in contemporary Australian playwrighting, discussing recent investigations into the playwrighting process. The study analyses the current state of this country’s playwrighting industry, with a particular focus on programming trends since 1998. It seeks to explore the implications of this current theatrical climate, in particular the types of work most commonly being favoured for production. It argues that Australian plays are under-represented (compared to non-Australian plays) on ‘mainstream’ stages and that audiences might benefit from more challenging modes of writing than the popular three-act realist play models. The thesis argues that ‘New Lyricism’ might fill this position of offering an innovative Australian playwrighting mode. New Lyricism is characterised by a set of common aesthetics, including a non-linear narrative structure, a poetic use of language and magic realism. Several Australian playwrights who have adopted this mode of writing are identified and their works examined. The author’s play Floodlands is presented as a case study and the author’s creative process is examined in light of the published critical discussions about experimental playwriting work.

The new lows : representing Asian-Australians on television

This project utilises creative practice as research, and involves writing and discussing four sample episodes of a proposed six-part dramatic, black-comedy1 television mini-series titled The New Lows. Combined, the creative project and accompanying exegesis seeks to illuminate and interrogate some of the inherent concerns, pitfalls and politics encountered in writing original Asian-Australian characters for television. Moreover, this thesis seeks to develop and deliberate on characters that would expand, shift and extend concepts of stereotyping and authenticity as they are used in creative writing for television. The protagonists of The New Lows are the contemporary and dysfunctional Asian-Australian Lo family: the Hong Kong immigrants John and Dorothy, and their Australian-born children Wendy, Simon and Tommy. Collectively, they struggle to manage the family business: a decaying suburban Chinese restaurant called Sunny Days, which is stumbling towards imminent commercial death. At the same time, each of the characters must negotiate their own personal catastrophes, which they hide from fellow family members out of shame and fear. Although there is a narrative arc to the series, I have also endeavoured to write each episode as a selfcontained story. Written alongside the creative works is an exegetical component. Through the paradigm of Asian-Australian studies, the exegesis examines the writing process and narrative content of The New Lows, alongside previous representations of Asians on Australian and international television and screen. Concepts discussed include stereotype, ethnicity, otherness, hybridity and authenticity. However, the exegesis also seeks to question the dominant cultural paradigms through which these issues are predominantly discussed. These investigations are particularly relevant, since The New Lows draws upon a suite of characters commonly considered to be stereotypical in Asian-Australian representations.