Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM)

Background Dementia has an enormous impact on the lives of individuals and families, and on health and social services, and this will increase as the population ages. The needs of people with dementia and their carers for information and support are inadequately addressed at all key points in the illness trajectory. Methods The Unit is working specifically on an evaluation of the impact of the Mental Capacity Act 2005, and will develop practice guidance to enhance concordance with the Act. Phase One of the study has involved baseline interviews with practitioners across a wide range of services to establish knowledge and expectations of the Act, and to consider change processes when new policy and legislation are implemented. Findings Phase 1, involving baseline interviews with 115 practitioners, identified variable knowledge and understanding about the principles of the Act. Phase 2 is exploring everyday decision-making by people with memory problems and their carers

University Knowledge Commercialisation through an Institutional Logics Perspective: The case of Oman

University Knowledge Commercialisation‘ (UKC) has come to be seen as a stimulant for developing economic performance. Regardless of the increasing body of literature in the UKC, it is revealed to be undertheorized, whilst existing theories are the result of inductive theorizing based on successful KC stories within the western context. Moreover, the literature provides modest practical directions and pay insufficient attention to the role of mechanisms, such as power, mimetic isomorphism, and intermediation, in bridging differences in institutional logics between actors. These gaps inspired the study aim, which is to explore the implication of such mechanisms in bridging differences in logics within UKC institutionally emerging context, Oman. Through a qualitative, multiple case-study approach, data was collected from four contract research projects through semi-structured interviews. The first three interviews served as a pilot study, the results of which were then used to formulate the second stage which was interviews with participants from academia, industry, and government. This approach improves the internal validity of the research, and provides a rich picture of the Omani UKC emerging institutional environment. The findings suggest that the influences of power, mimetic isomorphism, and intermediation have significantly shaped bridging, though not always positively, in logics in the Omani UKC context. The findings show that adverse influences in this process included: asymmetric power relationships, mimetic isomorphism‘s simplistic view of logics convergence and negligence of institutional fragmentation, and insufficient intermediation activities. The novelty of introducing the concept of power adds a new theoretical dimension into the UKC and ILP theories. Additionally, the novelty of using case of Oman as an empirical study added new contribution into the field. In addition, this study contributes to a better understanding of the Omani policy actions with regard to shift to an effective UKC approach

How much shall we bet? Defining surreal futures

This work comprises a critical thesis ‘How Much Shall We Bet? Defining Surreal Futures’, assessing the scope for stronger cross-pollination between poetry and futures studies and examining a potential hybrid poet-futurist praxis; and a portfolio of futures poetry in a range of lyrical and conceptual modes, The Bunny Assembly. Presented prior to the critical thesis, a fragmentary essay ‘Weak Signals’ introduces the main themes of this research through an account of my experiences attending the 2016 annual meeting of the World Futures Society. Chapter 1 describes the origins and rationale for the research, key lines of enquiry and underpinning conceptual frameworks adopted, including a discussion of why the topic was explored using the methodology of creative Practice-as-Research. Chapter 2 gives an overview of the academic discipline of futures studies and assesses how contemporary futures studies balances analytic and imaginative techniques to identify possible, probable and preferable futures, in order to identify any existing links to poetic techniques. Chapter 3 demonstrates how, although the roles of poet and prophet are historically linked, much contemporary poetry has had unexpectedly little to say on the topic of the future. It is shown through a quantitative review of sample texts that where recent poetry has addressed the topic of the future, it has more often presented clichéd declinist or dystopian visions Sixteen distinct strategies for developing poetic futures are identified in Chapter 4 by combining the steps of a typical forecasting methodology used in futures studies with a simple classification of lyrical and conceptual poetic approaches. These strategies are then evaluated to identify the extent to which they are useful in generating novel and provocative insight about the future. This chapter concludes with discussions of three features which proved effective in writing about the future: ethnographic writing, humour and aphorism. Chapter 5 consolidates poetic and futurist activities into a proposed praxis for the poet-futurist: what one should do differently as a poet if one is a futurist, and vice versa. This praxis is reviewed in the context of competing visions of the future of poetry. To conclude, the thesis assesses the value of systematic poetic investigation of the future with a particular emphasis on the role of poetry in challenging clichéd declinist or dystopian forecasts and inspiring action to realise more hopeful futures

Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM)

BACKGROUND: The needs of people with dementia and their carers are inadequately addressed at all key points in the illness trajectory, from diagnosis through to end-of-life care. The EVIDEM (Evidence-based Interventions in Dementia) research and development programme (2007–12) was designed to help change this situation within real-life settings. OBJECTIVES: The EVIDEM projects were (1) evaluation of an educational package designed to enhance general practitioners’ (GPs’) diagnostic and management skills; (2) evaluation of exercise as therapy for behavioural and psychological symptoms of dementia (BPSD); (3) development of a toolkit for managing incontinence in people with dementia living at home; (4) development of a toolkit for palliative care for people with dementia; and (5) development of practice guidance on the use of the Mental Capacity Act (MCA) 2005. DESIGN: Mixed quantitative and qualitative methods from case studies to large database analyses, including longitudinal surveys, randomised controlled trials and research register development, with patient and public involvement built into all projects. SETTING: General practices, community services, third-sector organisations and care homes in the area of the North Thames Dementia and Neurodegenerative Diseases Research Network local research network. PARTICIPANTS: People with dementia, their family and professional carers, GPs and community mental health team members, staff in local authority social services and third-sector bodies, and care home staff. MAIN OUTCOME MEASURES: Dementia management reviews and case identification in general practice; changes in behavioural and psychological symptoms measured with the Neuropsychiatric Inventory (NPI); extent and impact of incontinence in community-dwelling people with dementia; mapping of pathways to death of people with dementia in care homes, and testing of a model of collaborative working between primary care and care homes; and understandings of the MCA 2005 among practitioners working with people with dementia. RESULTS: An educational intervention in general practice did not alter management or case identification. Exercise as a therapy for BPSD did not reduce NPI scores significantly, but had a significant positive effect on carer burden. Incontinence is twice as common in community-dwelling people with dementia than their peers, and is a hidden taboo within a stigma. Distinct trajectories of dying were identified (anticipated, unexpected and uncertain), and collaboration between NHS primary care and care homes was improved, with cost savings. The MCA 2005 legislation provided a useful working framework for practitioners working with people with dementia. CONCLUSIONS: A tailored educational intervention for general practice does not change practice, even when incentives, policy pressure and consumer demand create a favourable environment for change; exercise has potential as a therapy for BPSD and deserves further investigation; incontinence is a common but unrecognised problem for people with dementia in the community; changes in relationships between care homes and general practice can be achieved, with benefits for people with dementia at the end of life and for the UK NHS; application of the MCA 2005 will continue to improve but educational reinforcements will help this. Increased research capacity in dementia in the community was achieved. This study suggests that further work is required to enhance clinical practice around dementia in general practice; investigate the apparent beneficial effect of physical activity on BPSD and carer well-being; develop case-finding methods for incontinence in people with dementia; optimise working relationships between NHS staff and care homes; and reinforce practitioner understanding of the MCA 2005. TRIAL REGISTRATION: EVIDEM: ED-NCT00866099; EVIDEM: E-ISRCTN01423159. FUNDING: This project was funded by the Programme Grants for Applied Research programme of the National Institute for Health Research

“Living this written life”: An examination of narrative as a means of conceptualising and strengthening parliamentary engagement in the UK

This thesis presents a study of citizens’ engagement with the UK Parliament, at a critical time for this institution and for representative democracy in general. Long-term trends in political participation (in a UK and global context) have contributed to a widely-perceived crisis of representative democracy, characterised by popular dissatisfaction, disinterest, and disengagement. This thesis examines perceptions toward the UK Parliament and parliamentary engagement through institutional and citizen perspectives. In doing so we provide a definition of parliamentary engagement as an ongoing, meaningful dialogue between institution and individual(s). Utilising an innovative theoretical framework, we investigate specific parliamentary engagement initiatives, narratives and discourses, and discuss what these indicate about the nature (or existence) of Parliament’s ‘culture’ of engagement. The way(s) in which Parliament is defined, conceptualised and represented – by citizens, and within Parliament – is a means by which this institution’s practical and symbolic role can be better understood. These definitions, conceptualisations and representations are examined as narratives, a framework that also allows us to examine several engagement initiatives (which make conscious reference to narrative and storytelling) in terms of objectives, intended audience(s), and influence. In addition, Parliament’s wider engagement efforts (and those of outside organisations) will be investigated first-hand, analysing the initial and retrospective perceptions of the citizens who experience them. These aims also inform our discussions with parliamentary staff and officials, helping to construct an ‘institutional perspective’ on engagement. In doing so, we find Parliament to be an enduringly ‘abstract’ institution (according to citizens and staff); a narrative that problematises relatability and identification (as well as broader, deeper engagement). This narrative is reinforced by several factors, including the ad-hoc nature of parliamentary engagement – understood variously across departments, teams and individuals – and an institutional dichotomy of ‘stories’ and ‘information’ when addressing public input, as well as a continued absence of corporate identity