10,457 research outputs found

    Implementing an intervention to enhance care delivery and consistency for people with hip fracture and cognitive impairment in acute hospital wards: a mixed methods process evaluation of a randomised controlled feasibility trial (PERFECTED)

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    Objectives: To determine how, and under what circumstances, the PERFECT-ER intervention was implemented in five acute hospital wards and impacted on staff practices and perceptions. Design: Mixed methods process evaluation (undertaken between 2016 and 2018). Setting: Five acute hospital wards across three different UK regions. Participants: Patients (n=3) admitted to acute wards with hip fracture and cognitive impairment, their relatives (n=29) and hospital staff (n=63). Interventions: PERFECT-ER, a multicomponent intervention designed to enhance the recovery of patients with hip fracture and cognitive impairment was implemented for 18 months. PERFECT-ER was implemented at ward level ensuring that multiple new and existing practices were undertaken consistently, on the assumption that collectively, small individual advances would improve care delivery for patients. Primary and secondary outcome measures: Implementation of the PERFECT-ER intervention examined through regular intervention scores, service improvement staff reports and action plans, and semi-structured interviews and focus groups. Results: The process evaluation identified points of implementation vulnerability and strength. All wards implemented some elements of PERFECT-ER. Implementation was fragile when ward pressures were high and when ward staff perceived the relative priority of intervention practices to be low. Adaptations to the implementation process may have reduced whole-ward staff engagement with implementation. However, strategical enlistment of senior ward influencers (such as ward managers, orthogeriatricians) combined with service improvement lead in-ward peer pressure tactics facilitated implementation processes. Conclusions: Our study suggests that implementation was expediated when senior staff were on board as opinion leaders and formally appointed internal implementation leaders exerted their power. Within hierarchical settings such as acute wards, key individuals appeared to influence implementation through endorsement and sometimes enforcement. This indicates that whole-ward interventions may not always require cognitive engagement from all ward staff to implement changes. Future ward-level implementation studies could consider how best to engage staff and most importantly, which staff to best target. Trial registration number ISRCTN99336264

    Annual SHOT Report 2018

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    SHOT is affiliated to the Royal College of PathologistsAll NHS organisations must move away from a blame culture towards a just and learning culture. All clinical and laboratory staff should be encouraged to become familiar with human factors and ergonomics concepts. All transfusion decisions must be made after carefully assessing the risks and benefits of transfusion therapy. Collaboration and co-ordination among staff is vital

    Anuário científico da Escola Superior de Tecnologia da Saúde de Lisboa - 2021

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    É com grande prazer que apresentamos a mais recente edição (a 11.ª) do Anuário Científico da Escola Superior de Tecnologia da Saúde de Lisboa. Como instituição de ensino superior, temos o compromisso de promover e incentivar a pesquisa científica em todas as áreas do conhecimento que contemplam a nossa missão. Esta publicação tem como objetivo divulgar toda a produção científica desenvolvida pelos Professores, Investigadores, Estudantes e Pessoal não Docente da ESTeSL durante 2021. Este Anuário é, assim, o reflexo do trabalho árduo e dedicado da nossa comunidade, que se empenhou na produção de conteúdo científico de elevada qualidade e partilhada com a Sociedade na forma de livros, capítulos de livros, artigos publicados em revistas nacionais e internacionais, resumos de comunicações orais e pósteres, bem como resultado dos trabalhos de 1º e 2º ciclo. Com isto, o conteúdo desta publicação abrange uma ampla variedade de tópicos, desde temas mais fundamentais até estudos de aplicação prática em contextos específicos de Saúde, refletindo desta forma a pluralidade e diversidade de áreas que definem, e tornam única, a ESTeSL. Acreditamos que a investigação e pesquisa científica é um eixo fundamental para o desenvolvimento da sociedade e é por isso que incentivamos os nossos estudantes a envolverem-se em atividades de pesquisa e prática baseada na evidência desde o início dos seus estudos na ESTeSL. Esta publicação é um exemplo do sucesso desses esforços, sendo a maior de sempre, o que faz com que estejamos muito orgulhosos em partilhar os resultados e descobertas dos nossos investigadores com a comunidade científica e o público em geral. Esperamos que este Anuário inspire e motive outros estudantes, profissionais de saúde, professores e outros colaboradores a continuarem a explorar novas ideias e contribuir para o avanço da ciência e da tecnologia no corpo de conhecimento próprio das áreas que compõe a ESTeSL. Agradecemos a todos os envolvidos na produção deste anuário e desejamos uma leitura inspiradora e agradável.info:eu-repo/semantics/publishedVersio

    Implementing Health Impact Assessment as a Required Component of Government Policymaking: A Multi-Level Exploration of the Determinants of Healthy Public Policy

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    It is widely understood that the public policies of ‘non-health’ government sectors have greater impacts on population health than those of the traditional healthcare realm. Health Impact Assessment (HIA) is a decision support tool that identifies and promotes the health benefits of policies while also mitigating their unintended negative consequences. Despite numerous calls to do so, the Ontario government has yet to implement HIA as a required component of policy development. This dissertation therefore sought to identify the contexts and factors that may both enable and impede HIA use at the sub-national (i.e., provincial, territorial, or state) government level. The three integrated articles of this dissertation provide insights into specific aspects of the policy process as they relate to HIA. Chapter one details a case study of purposive information-seeking among public servants within Ontario’s Ministry of Education (MOE). Situated within Ontario’s Ministry of Health (MOH), chapter two presents a case study of policy collaboration between health and ‘non-health’ ministries. Finally, chapter three details a framework analysis of the political factors supporting health impact tool use in two sub-national jurisdictions – namely, Québec and South Australia. MOE respondents (N=9) identified four components of policymaking ‘due diligence’, including evidence retrieval, consultation and collaboration, referencing, and risk analysis. As prospective HIA users, they also confirmed that information is not routinely sought to mitigate the potential negative health impacts of education-based policies. MOH respondents (N=8) identified the bureaucratic hierarchy as the brokering mechanism for inter-ministerial policy development. As prospective HIA stewards, they also confirmed that the ministry does not proactively flag the potential negative health impacts of non-health sector policies. Finally, ‘lessons learned’ from case articles specific to Québec (n=12) and South Australia (n=17) identified the political factors supporting tool use at different stages of the policy cycle, including agenda setting (‘policy elites’ and ‘political culture’), implementation (‘jurisdiction’), and sustained implementation (‘institutional power’). This work provides important insights into ‘real life’ policymaking. By highlighting existing facilitators of and barriers to HIA use, the findings offer a useful starting point from which proponents may tailor context-specific strategies to sustainably implement HIA at the sub-national government level

    The determinants of value addition: a crtitical analysis of global software engineering industry in Sri Lanka

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    It was evident through the literature that the perceived value delivery of the global software engineering industry is low due to various facts. Therefore, this research concerns global software product companies in Sri Lanka to explore the software engineering methods and practices in increasing the value addition. The overall aim of the study is to identify the key determinants for value addition in the global software engineering industry and critically evaluate the impact of them for the software product companies to help maximise the value addition to ultimately assure the sustainability of the industry. An exploratory research approach was used initially since findings would emerge while the study unfolds. Mixed method was employed as the literature itself was inadequate to investigate the problem effectively to formulate the research framework. Twenty-three face-to-face online interviews were conducted with the subject matter experts covering all the disciplines from the targeted organisations which was combined with the literature findings as well as the outcomes of the market research outcomes conducted by both government and nongovernment institutes. Data from the interviews were analysed using NVivo 12. The findings of the existing literature were verified through the exploratory study and the outcomes were used to formulate the questionnaire for the public survey. 371 responses were considered after cleansing the total responses received for the data analysis through SPSS 21 with alpha level 0.05. Internal consistency test was done before the descriptive analysis. After assuring the reliability of the dataset, the correlation test, multiple regression test and analysis of variance (ANOVA) test were carried out to fulfil the requirements of meeting the research objectives. Five determinants for value addition were identified along with the key themes for each area. They are staffing, delivery process, use of tools, governance, and technology infrastructure. The cross-functional and self-organised teams built around the value streams, employing a properly interconnected software delivery process with the right governance in the delivery pipelines, selection of tools and providing the right infrastructure increases the value delivery. Moreover, the constraints for value addition are poor interconnection in the internal processes, rigid functional hierarchies, inaccurate selections and uses of tools, inflexible team arrangements and inadequate focus for the technology infrastructure. The findings add to the existing body of knowledge on increasing the value addition by employing effective processes, practices and tools and the impacts of inaccurate applications the same in the global software engineering industry

    Marvellous real in the Middle East: a comparative study of magical realism in contemporary women’s fiction

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    Magical realism has been studied extensively in relation to Latin America and subsequently in other parts of the world, yet the Middle East has not received adequate attention in academic scholarship. This PhD study examines a selection of contemporary female-authored narratives from the Middle East to establish an understanding of the practice of magical realism in this region. The selected texts for this study are: Raja Alem’s Fatma and My Thousand and One Nights; Shahrnush Parsipur’s Women Without Men and Touba and the Meaning of Night; Elif Shafak’s The Bastard of Istanbul and Gina B. Nahai’s Moonlight on the Avenue of Faith. This study firstly explores the concept of magical realism as a mode of writing and determines its relationship to the Middle Eastern context. It then evaluates the texts under scrutiny by examining how the narrative of magical realism is constructed and what the sources are of the magical component in these texts, specifically in relation to Middle Eastern mythology. It also investigates the ideological aspect behind the employment of magical realism and whether it serves any political goal. The analysis of the selected texts is approached from three standpoints, that is, from literary, mythological and ideological perspectives. I argue that magical realism serves various purposes and that it is applied from perspectives that can be regarded as marginal to their communities’ dominant values, to subvert mainstream ideology. I also demonstrate that the Middle East is a crucial place to investigate magical realism because of the numerous complex cultural values that interact with each other in this region, and which enrich the practice of magical realism
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