Managing gaming phenomena in the Tuscan performance evaluation system.

The problem of gaming in performance evaluation systems is a known phenomenon (Bevan, 2006, Bevan Hood, 2006) that can take place especially when there are economic incentives related to specific targets. In all Tuscan Local Health Authorities (LHAs) and Teaching Hospitals (THs) a multidimensional performance evaluation system has been adopted since 2005, based on administrative and non-administrative data benchmarking. The goal of the Tuscany performance measurement system is to give a general outline for the management of the LHAs and THs, both for evaluating performance and for enhancing and promoting the results of the healthcare system. The performance evaluation system consists of 130 indicators classified in six dimensions: Population health assessment; Regional health system; Quality; Patient satisfaction; Staff satisfaction; Efficiency and financial performance After three years of the performance evaluation system’s adoption, integrated with an incentive system, improvements were achieved in most of the indicators monitored. The paper reports the effects of the performance evaluation system and how gaming phenomena were managed with a special focus on data manipulation. Methods The research team focused the analysis on the larger performance improvements during the years 2005-2007 to evaluate whether gaming phenomena have been taking place. The findings of this analysis were reported and discussed with top managers and professionals through individual interviews and group meetings in order to detect the determinants of the results obtained. In 2007 LHAs and THs whose indicators clearly show large improvement were highlighted during meetings with the top management asking them how his/her organization reaches its results. Results Gaming has been found in indicators concerning small and specific areas, such as the rate of hospitalization for heart failure, while indicators that concern larger phenomena, such as the pre-surgical length of stay, were less involved. The request of evidence to explain the improvement obtained has been a deterrent to gaming behaviors. Conclusions The results suggest that further development is needed to analyse suspicious cases. The public presentation of data and the request for evidence to explain large improvements in peer review meetings ease the accountability process. In addition these can be a deterrent for future activities.Gaming phenomena, Health service improvement, reputational level

Implementation of Modified Constraint-induced Therapy in Upper Limb Stroke Rehabilitation in an Inpatient Rehabilitation Hospital

Background: Despite increasing and strong evidence of modified constraint-induced therapy (mCIT) as an effective intervention approach for patients with chronic and subacute stroke in outpatient settings, it is still not widely used for the rehabilitation of patients with acute stroke who are typically admitted to inpatient rehabilitation hospitals. Purpose: The purpose of this study is to implement an evidence-based approach using mCIT in the upper extremity rehabilitation of patients with acute stroke in an inpatient rehabilitation hospital and to demonstrate its feasibility and efficacy in increasing the motor recovery, and the amount and quality of arm use when compared to traditional occupational therapy intervention. Theoretical Framework: The theoretical framework is based on behaviorist theory, and the model of human occupational (MOHO). Methods. The study is a quasi-experimental, multiple baseline, randomized, pretest-posttest control-group design study, using a dose-matched control intervention, traditional rehabilitation (TR) for comparison with mCIT. A total of six participants admitted to an inpatient rehabilitation within two weeks of their first stroke and who met the eligibility criteria were randomly assigned to the two groups. The participants were assessed on outcome measures namely the Canadian Occupational Performance Measure, the Fugl-Meyer Assessment, the Wolf Motor Function Test, and the Motor Activity Log before and after intervention. Results: Four of the 6 participants completed the study according to the study protocol. This study demonstrated significant improvement in motor recovery, improved arm function, more frequent and effective use of the affected arm, and clinically significant improvement in the participants’ perception of occupational performance and satisfaction with performance by both intervention approaches. It has also demonstrated greater improvement following intervention with mCIT compared with TR in all outcome measures studied except in the client’s perception of satisfaction with performance, with significantly greater change in affected arm motor recovery and the frequency of affected arm use. Conclusions: The findings of this study demonstrate the feasibility and efficacy of mCIT in upper limb rehabilitation of patients with acute stroke in an inpatient rehabilitation hospital. This strengthens the case for the routine implementation of this evidence-based intervention approach that has been strongly demonstrated in patients with subacute and chronic stroke

Faculty open educational practices at a regional university

Open educational resources (OER), which are cost-free, openly licensed educational materials available in a variety of languages and formats, have in recent years accumulated abundant evidence of disruptive potential to surmount barriers to learning. This is certainly good news to the world of education, especially higher education, which has experienced steady growth in its cost to students. Evidence also shows, however, a low uptake of this concept in higher education. A key reason for this is a lack of awareness, understanding, and acceptance of OER and their related practices amongst faculty. If one intent of a higher educational institution, such as is that of the University of the South Pacific (USP), is to provide greater affordability for students through OER, ushering faculty towards OER is thus paramount, for they are the ones who normally choose and assign educational resources. As an initial step toward moving the USP closer to its aspirations, a survey study was undertaken aiming to describe the current status of OER uptake and open educational practices (OEP) by faculty, with the purpose of gathering information for planning future activities in this area. This paper reports results from the survey examining USP faculty: teaching practices, OER awareness, OER use, participation in OEP staff development, awareness of student OER use, barriers to OER adoption, and impact of OER use. The paper concludes with a discussion of current status and expected future steps for propelling faculty towards integrating OER in USP courses

Effectiveness of first-person and third-person motor imagery in relearning daily hand tasks in people with stroke living in the community

Stroke is the leading cause of adult disability worldwide, and the number of people with disability following stroke is rapidly increasing. Currently, there are several approaches used in stroke rehabilitation. Research suggests that therapy should be task-specific and repetitive to enhance neural plasticity enabling sensory-motor function. Furthermore, a need for easily applicable and cost-effective techniques for stroke rehabilitation is also recognised. Motor imagery (MI) has been identified as a potential technique to enhance motor recovery following stroke. When practising MI, one can utilise either the First-Person Motor Imagery (FPMI) or Third-Person Motor Imagery (TPMI). However, the specific effects of the two different perspectives have not been investigated previously, on people with stroke living in the community. Therefore, this PhD aimed to address the above gap in the literature and for the clinical practice. The objectives of this research were threefold, that is, to investigate whether; 1) the FPMI and TPMI intervention programs enhance performance-based upper extremity and hand function, self-perceived upper extremity and hand function, self-perceived daily functions and quality of life in comparison to a conventional occupational therapy program (active control); 2) the FPMI intervention program was more effective in improving performance-based upper extremity and hand function in comparison to the TPMI and active control programs; and 3) the TPMI intervention program was more effective in enhancing self-perceived upper extremity and hand function, self-perceived daily functions and quality of life in comparison to the FPMI and active control programs. This study revealed that both the FPMI and TPMI interventions were equally effective and significantly better in enhancing performance-based upper extremity and hand function in comparison to the active control group. Both the FPMI and TPMI groups showed a further improvement in self-perceived upper extremity and hand function than the active control group and the TPMI group showed improvement in upper extremity function than the FPMI group at follow up. In addition, the TPMI group showed a long-term improvement in quality of life. Although, there was no significant group difference in daily functions in the tree groups, analysis of within group data showed improved daily functions in all groups. These results suggest that when the rehabilitation professionals aim to enhance upper extremity function, either the FPMI or TPMI can be used. However, when the key focus is enhancing quality of life, using TPMI seems to be a better option

International conference Nurses' wellbeing & patients' outcomes, SIGMA Alpha Alpha Beta Chapter

Book of abstracts- International conference Nurses' wellbeing & patients' outcomes, SIGMA Alpha Alpha Beta Chapter 2021.Libro degli abstract della International conference Nurses' wellbeing & patients' outcomes, SIGMA Alpha Alpha Beta Chapter 2021

HR Selection Distortions: A theoretical framework for the Fiji Public Service

Despite being frequently perceived as a pertinent issue necessary to critically examine how incumbents are selected on merit, HR selection distortions is typically illdefined and poorly explained in much debate, hence, more precision in terms of contextualization of practice is needed. Through explaining and synthesizing the work of a number of scholars from different disciplines, the paper develops a theoretical framework for a meta- analysis, which begins with an exploration of the relationship between HR selection, networking and relational ties, employee’s justice perceptions, group heterogeneity and worker performance in Fiji’s public service institutions. The theoretical framework provides the leeway for the research questions to be answerable and the postulated hypotheses testable. However, more needs to be done to explain not only the nature and emergence of HR selection distortions but also the very real problems it faces in sustaining itself, let alone transforming the hiring processes in Fiji’s public service. The value of the paper lies in its theoretical innovation, drawing on a range of disciplines, and its attempt to situate HR selection distortions precisely, conceptually, theoretically, and practically

Lifestyle and physical activity patterns of Greek children : the applicability of a school based intervention programme.

The promotion of an active lifestyle has become a priority in Western societies and school plays a dominant role. The primary objectives of this thesis were i) to examine the lifestyle and physical activity (PA) patterns of a sample of Greek children and ii) to examine the applicability of a school based intervention programme in promoting PA and sport participation. For the purposes of this study the Physical Activity and Lifestyle Questionnaire (PALQ) was developed and examined for its validity and reliability to assess habitual PA of Greek students. Afterwards, a need analysis was carried out in a) a cross sectional sample of 911 students from an urban area (11, 14 and 17 years olds, b) 103 elementary and secondary PE teachers, and c) 17 schools. The students answered the PALQ in order to depict a profile of their lifestyle and PA patterns. The teachers answered a questionnaire in order to evaluate their knowledge, attitudes and self­efficacy towards teaching health related exercise (HRE). A checklist has been used in order to establish the nature and extent of PA promotion in a sample of elementary and secondary schools. The results showed that: a) a large proportion of students adopted a sedentary lifestyle and were inadequately active to obtain health benefits, b) teachers' had limited ability in promoting effectively HR issues, and c) schools provided limited sport programmes and facilities. The overall finding of the need analysis justified the need for intervention and advocated the adoption of an ecological approach to promote PA Based on the Active School initiative (Almond & McGeorge, 1995), a school based intervention programme has been set up in order to a) promote students' participation in physical activity and sport and to enhance their knowledge on health related (HR) issues, b) increase teachers' knowledge and effectiveness on teaching HR exercise. The decisions about the intervention contents and priorities were based on the findings of the need analysis taking into consideration the cost and the resources. The intervention strategy and the implementation process focused on: a) the teachers' training, b) the creation and the provision of the necessary resources (PE curriculum, a handbook and a CD-Rom for the teachers and two books for the students), c) the creation of a positive and enjoyable learning PE environment, and d) the co-operation between school and out of school health and sport alliances. The intervention programme was applied in 9 elementary and 5 secondary schools for a period of six months and involved 15 PE teachers. A quasi-experimental design with a control group was applied (experimental group N1=699 and control group N2=213). A number of different parameters were estimated at the beginning, during and at the end of the program. The intervention process was monitored on a weekly basis by the author and the school teachers. The effectiveness of the intervention was evaluated in terms of: a) students' behaviour, fitness, self-efficacy, intrinsic motivation, intentions, and attitudes related to PA, b) teachers' knowledge, attitudes and self-efficacy on teaching HR issues, and c) the broader impact of the programme on the school ethos. The intervention implementation and effectiveness was also assessed by an external evaluator. The overall purpose of the intervention was to examine the applicability of promoting PA throughout school environment by creating an innovative and realistic framework for school physical education lesson. The findings of this thesis were very encouraging. Significant differences have been observed in most of the evaluated variables both, for students (fitness, attitudes, self-efficacy, PA level), for teachers (knowledge) and schools' ethos. However, this pioneer study revealed a number of key considerations and issues in designing intervention programmes to promote PA throughout schools in urban areas

Dissociation and interpersonal autonomic physiology in psychotherapy research: an integrative view encompassing psychodynamic and neuroscience theoretical frameworks

Interpersonal autonomic physiology is an interdisciplinary research field, assessing the relational interdependence of two (or more) interacting individual both at the behavioral and psychophysiological levels. Despite its quite long tradition, only eight studies since 1955 have focused on the interaction of psychotherapy dyads, and none of them have focused on the shared processual level, assessing dynamic phenomena such as dissociation. We longitudinally observed two brief psychodynamic psychotherapies, entirely audio and video-recorded (16 sessions, weekly frequency, 45 min.). Autonomic nervous system measures were continuously collected during each session. Personality, empathy, dissociative features and clinical progress measures were collected prior and post therapy, and after each clinical session. Two-independent judges, trained psychotherapist, codified the interactions\u2019 micro-processes. Time-series based analyses were performed to assess interpersonal synchronization and de-synchronization in patient\u2019s and therapist\u2019s physiological activity. Psychophysiological synchrony revealed a clear association with empathic attunement, while desynchronization phases (range of length 30-150 sec.) showed a linkage with dissociative processes, usually associated to the patient\u2019s narrative core relational trauma. Our findings are discussed under the perspective of psychodynamic models of Stern (\u201cpresent moment\u201d), Sander, Beebe and Lachmann (dyad system model of interaction), Lanius (Trauma model), and the neuroscientific frameworks proposed by Thayer (neurovisceral integration model), and Porges (polyvagal theory). The collected data allows to attempt an integration of these theoretical approaches under the light of Complex Dynamic Systems. The rich theoretical work and the encouraging clinical results might represents a new fascinating frontier of research in psychotherapy

Effectiveness of a Structured Circuit Class therapy model in stroke rehabilitation: A single blind randomized controlled trial

Philosophiae Doctor - PhD (Physiotherapy)Stroke is a debilitating medical and neurological condition. It is the leading cause of adult disability worldwide. Disability from stroke covers the three key classifications of the WHO-ICF framework on human function centred on health and health related issues, implying that the disability in stroke involve structural and activity limitations to participation restriction. Rehabilitation remains the hallmark of managing the plethora of neurological deficits accompanying stroke. Currently, the key advocacy in neuroscientific studies for stroke rehabilitation is that therapy should be directed towards task specificity. Task Specific Training most recently, the form of Circuit Class Therapy and the intensity of multiple repetition of the task has been identified as physiological mechanisms behind sustained motor learning following stroke.Circuit Class Therapy (CCT) is a form of Task Specific Training (TST) that involves the practice of structuring tasks in a circuit or series of workstations. It offers the patient the ability to practice multiple tasks in a conducive environmental because of its three key features of utilisation of different workstations that allow people to practice intensively in a meaningful and progressive way to suit their respective needs; the efficient utilisation of therapists'/trainees' time; and the group dynamics such as peer support and social support. Although these features are attainable following CCT challenges remain in selecting the most efficient intensity that could produce these benefits in stroke survivors. This study investigated the effectiveness of differing intensities of CCT in the rehabilitation of stroke survivors using the ICF framework to guide patients� response assessments after training