Managing patient deterioration: evaluation of what works.

Background: Rapid Response Systems (RRS) have been implemented nationally and internationally to improve patient safety in hospital. However, to date the majority of the RRS research evidence has focused on measuring the effectiveness of the intervention on patient outcomes. To evaluate RRS it has been recommended that a multimodal approach is required to address the broad range of process and outcome measures required to determine the effectiveness of the RRS concept. Aim: The aim of this paper is to evaluate the official RRS programme theoretical assumptions regarding how the programme is meant to work against actual practice in order to determine what works. Methods: The research design was a multiple case study approach of four wards in two hospitals in Northern Ireland. It followed the principles of realist evaluation research which allowed empirical data to be gathered to test and refine RRS programme theory [1]. This approach used a variety of mixed methods to test the programme theories including individual and focus group interviews with a purposive sample of 75 nurses and doctors, observation of ward practices and documentary analysis. The findings from the case studies were analysed and compared within and across cases to identify what works for whom and in what circumstances. Results: The RRS programme theories were critically evaluated and compared with study findings to develop a mid-range theory to explain what works, for whom in what circumstances. The findings of what works suggests that clinical experience, established working relationships, flexible implementation of protocols, ongoing experiential learning, empowerment and pre-emptive management are key to the success of RRS implementation.  Conclusion:These findings highlight the combination of factors that can improve the implementation of RRS and in light of this evidence several recommendations are made to provide policymakers with guidance and direction for their success and sustainability.References: 1.Pawson R and Tilley N. (1997) Realistic Evaluation. Sage Publications; LondonType of submission: Concurrent session Source of funding: Sandra Ryan Fellowship funded by the School of Nursing & Midwifery, Queen’s University of Belfast

“They should stay at their desk until the work’s done”: a qualitative study examining perceptions of sedentary behaviour in a desk-based occupational setting

Background: Workplace sedentary behaviour is a priority target for health promotion. However, little is known about how to effect change. We aimed to explore desk-based office workers’ perceptions of factors that influenced sedentary behaviour at work and to explore the feasibility of using a novel mobile phone application to track their behaviours.

Methods: We invited office employees (n = 12) and managers (n = 2) in a software engineering company to participate in semi-structured interviews to explore perceived barriers and facilitators affecting workplace sedentary behaviour. We assessed participants’ sedentary behaviours using an accelerometer before and after they used a mobile phone application to record their activities at self-selected time intervals daily for 2 weeks. Interviews were analysed using a thematic framework.

Results: Software engineers (5 employees; 2 managers) were interviewed; 13 tested the mobile phone application; 8 returned feedback. Major barriers to reducing workplace sedentary behaviour included the pressure of ‘getting the job done’, the nature of their work requiring sitting at a computer, personal preferences for the use of time at and after work, and a lack of facilities, such as a canteen, to encourage moving from their desks. Facilitators for reduced sedentariness included having a definite reason to leave their desks, social interaction and relief of physical and mental symptoms of prolonged sitting. The findings were similar for participants with different levels of overall physical activity. Valid accelerometer data were tracked for four participants: all reduced their sedentary behaviour. Participants stated that recording data using the phone application added to their day’s work but the extent to which individuals perceived this as a burden varied and was counter-balanced by its perceived value in increasing awareness of sedentary behaviour. Individuals expressed a wish for flexibility in its configuration.

Conclusions: These findings indicate that employers’ and employees’ perceptions of the cultural context and physical environment of their work, as well as personal factors, must be considered in attempting to effect changes that reduce workplace sedentary behaviour. Further research should investigate appropriate individually tailored approaches to this challenge, using a framework of behaviour change theory which takes account of specific work practices, preferences and settings.

Hotel Brand Conversions: What Works and What Doesn’t

As many as one-third of U.S. hotels have been converted from one brand to another in recent years, a process that frequently improves the hotel’s financial performance—although that is not always the case. Using data collected between 1994 and 2012 from PKF Hospitality Research, an analysis of brand conversions by 260 hotels shows that hotels moving downscale generally improved their occupancy, and thus their top-line revenue and profit ratios, compared to a control group of 2,750 hotels that did not change brands. However, hotels that moved upscale did not see notable changes in revenue or profit, nor did hotels that moved across their tier, especially when they stayed within their brand family. Two factors seem to drive the financial results for converted hotels—the relative strength of the brand and the fit between the brand and the property.

Contributos para o estudo da pintura mural na arquitectura palatina lisboeta entre o tardo-barroco e o neoclassicismo, 1775-C. 1820

Tese de mestrado, Arte, Património e Teoria do Restauro, Universidade de Lisboa, Faculdade de Letras, 2011

A iconografia de Santa Maria Madalena em Portugal até ao Concílio de Trento

Tese de mestrado Arte, Património e Teoria do Restauro, Universidade de Lisboa, Faculdade de Letras, 2012

Vox Dei:metáfora(s) da espiritualidade

Tese de doutoramento, Belas-Artes (Pintura), Universidade de Lisboa, Faculdade de Belas-Artes, 2014

Joaquim Rodrigo:a contínua reinvenção da pintura

Tese de doutoramento, História (História da Arte), Universidade de Lisboa, Faculdade de Letras, 2014

The Summer Concert Band, 5th Festival of Contemporary Works, July 18, 1951

Concert program for The Summer Concert Band, 5th Festival of Contemporary Works, July 18, 1951

Hollywood and world cinema influences: tracing intertextuality in the works of two contemporary filmmakers from Francophone Africa; Mahamat Saleh Haroun and Abderrahmane Sissako

Don’t tell me the moon is shining; show me the glint of light on broken glass Anton Chekhov Representations of Africa in cinema are almost as old as cinema itself and date back to Hollywood’s silent era. Most early examples feature the continent as a mere exotic backdrop and include The Sheik (Melford 1921), soon followed, in 1926, by George Fitzmaurice’s Son of the Sheik starring Rudolph Valentino. The next decade brought Van Dyke’s Tarzan movies, Robert Stevenson’s King Solomon’s Mines (1937), and, on the European side, Duvivier’s Pépé le Moko (1936). For representations of Francophone Africa by Africans themselves, the viewing public more or less had to wait, however, until decolonisation in the 1960s (with, for example, Sembene Ousmane’s Borom Sarret and La Noire de…, both released in 1966 and, in 1968, Mandabi). Since then Francophone African cinema has come a long way and has diversified into various strands. Between Borom Sarret and Mahamat-Saleh Haroun’s 2006 Daratt, Saison sèche - or the same director’s Un homme qui crie, almost half a century has elapsed. Over this period, films inevitably have addressed a spectrum of visual, ideological and political tropes. They range from unadorned depictions of the newly independent states and their societies to highly aestheticised productions, not to mention surreal and poetic visions as displayed for instance in Djibril Diop Mambéty’s Touki Bouki (1973). Most of the early films send an overt socio-political message which is a clear and explicit denunciation of a corrupt state of affairs (Souleymane Cissé’s Baara, 1977). They aim to trigger strong emotional and political responses from the viewer, in unambiguous support for the film-maker’s stand. Sembene himself declared: “I consider cinema a means of political action” (Murphy 2000: 221). Similarly, the Mauritanian director Med Hondo wishes to “take up this technical medium and to make it a mouthpiece on behalf of [his] fellow Africans and Arabs” (Jeffries 2002: 11). All this echoes the claims of the Fédération Panafricaine des Cinéastes (FEPACI, founded in 1969), an organisation “dedicated to the liberation of Africa”. In sharp contrast to the incipient momentum given Francophonie by Bourguiba, the Nigerien Hamani Diori and the Senegalese Senghor, who invoked a worldwide communauté organique francophone, FEPACI called for “the creation of an aesthetics of disalienation… [using] didactic... forms to denounce the alienation of countries that were politically independent but culturally and economically dependent on the West” (Diawara 1996: 40). Sembene’s Xala (1974) became the blueprint for this, to this day the best-known vein of Francophone African cinema. Thus considered, this pedigree seems a million miles from mainstream global cinema with its overriding mission to entertain. A question therefore arises: to what extent can a cinema that sprang from such beginnings be seen to interface in any meaningful way with a global film industry that, overwhelmingly and for a century, has indeed entertained the world – with Hollywood at its centre?

A Concert of Works by Ross Lee Finney, 1966

Concert Program for A Concert of Works by Ross Lee Finney, 1966

What works for Nutrition? Stories of success from Vietnam, Uganda and Kenya

This report discusses the drivers of progress in tackling multiple forms of malnutrition in these three countries: Vietnam, Uganda, and Kenya. It also identifies some of the challenges which pose as barriers to sustaining progress. Finally, it makes recommendations for key stakeholders such as governments of high burden countries, donor governments, development partners, and civil society, on their role to promote further success.

Role of Intersectoral Collaboration in Mental Health Policy Formulation And Service Delivery in Saint Lucia

RESUMO: Santa Lúcia pequena ilha de país em desenvolvimento com recursos limitados e é confrontada com uma série de desafios socioeconômicos que exigem soluções criativas e inovadoras. É comprovado que a combinação de recursos entre setores para estabelecer os determinantes social, econômico e ambiental da saúde são uma estratégia útil para melhorar a saúde da população, principalmente a sua saúde mental. Este estudo, o primeiro do seu tipo em Santa Lúcia, procurou examinar até que ponto a disponibilidade de uma política nacional de saúde mental levou a ação intersetorial para o fornecimento de serviços e promoção da saúde mental. Além disso, o estudo examinou o nível de colaboração intersetorial que existe entre as agências que prestam cuidados diretos e serviços de suporte para pessoas com doenças mentais e problemas sérios de saúde mental. O estudo também teve como objetivo identificar os fatores que promovem ou dificultam a colaboração intersectorial e gerar recomendações que possam ser aplicadas para países muito pequenos e com perfis socioeconômicos semelhantes. Os dados gerados a partir de três (3) fontes foram sintetizados para formar uma visão ampla das questões. Uma avaliação da política de saúde mental de 2007, uma avaliação que identifica até que ponto a ação intersetorial atualmente deixa a prestação de serviços de saúde mental e a administração de entrevistas semiestruturadas nas mãos de gestores do programa de diferentes agências em todos os setores. O estudo concluiu que, apesar da disponibilidade de uma política de saúde mental, que articula clara e explicitamente a colaboração intersetorial como área prioritária para ação, quase não existe no sistema de fornecimento atual do serviço. Os provedores de serviços em todos os setores reconhecem que há os benefícios da colaboração intersectorial e com entraves significativos em relação à colaboração intersetorial, que por sua vez, impede uma abordagem nacional para o planejamento e o fornecimento do serviço. A colaboração intersetorial não será possível se os próprios setores dependerem da abordagem direta do setor da saúde ou se a atmosfera geral for ofuscada pela estigmatização das doenças mentais.------------------------------------------------------------------------ABSTRACT: Saint Lucia a small island developing country with limited resources, is faced with a number of socio-economic challenges which require creative and innovative solutions to address. Combining resources across sectors to address the social, economic and environmental determinants of health has proven to be a useful strategy for improving population health in particular mental health. This study, the first of its kind for Saint Lucia sought to examine the extent to which the availability of a national mental health policy led to intersectoral action for mental health promotion and service delivery. In addition the study examined the level of intersectoral collaboration which actually exist between agencies which provide direct care and support services to people with mental illnesses and significant mental health problems. The study also aimed to identify the factors which promote or hinder intersectoral collaboration and generate recommendations which can be applied to extremely small countries with similar socio-economic profiles. Data generated from three (3) sources was synthesized to form a broad picture of the issues. An evaluation of the mental health policy of 2007, an assessment of the extent to which intersectoral action currently exist in mental health service delivery and the administration of semi-structured interviews with program managers from different agencies across sectors to identify implementation issues. The study concluded that despite the availability of a mental health policy which clearly and explicitly articulates intersectoral collaboration as a priority area for action, very little exists in the current service delivery system. Services providers across sectors acknowledge the benefits of intersectoral collaboration and that there are significant barriers to intersectoral collaboration, which in turn hinders a national approach to service planning and delivery. Intersectoral collaboration is not possible if sectors themselves are dependent on a top-down health sector driven and dominated approach, or if the general atmosphere is clouded by stigmatization of mental health illnesses.