Enstranglements: performing within, and exiting from, the arts-in-health 'setting'

The following text explores performative art works commissioned within a specific ‘arts and health’ cultural setting, namely that of a medical school within a British university. It examines the degree to which the professional autonomy of the artists (and curator) were 'instrumentalized' and diminished as a result of having to fit into normative frames set by institutional agendas (in this case, that of ‘the neoliberal university’). We ask, to what extent do such 'entanglements', feel more like ‘enstranglements’, suffocating the artist's capacity to envision the world afresh or any differently? What kinds of pressures allow for certain kinds of ‘evidence’ to be read and made visible, (and not others)? Are You Feeling Better? was a 2016 programme curated by Frances Williams, challenging simplistic expectations that the arts hold any automatic power of their own to make ‘things better’ in healthcare. It included two performative projects – The Secret Society of Imperfect Nurses, by Anthony Schrag with student nurses at Kings College London, and Hiding in Plain Sight by Becky Shaw (plus film with Rose Butler) with doctoral researchers in nursing and midwifery. These projects were situated in a climate of UK National Health Service cuts and austerity measures where the advancement of social prescribing looks dangerously like the government abnegating responsibility and offering art as amelioration. The text therefore examines the critical ‘stage’ on which these arts-health projects were performed and the extent to which critical reflection is welcomed within institutional contexts, how learning is framed, expressed aesthetically, as well as understood as art practice (as much as ‘education’ or ‘learning’). It further examines how artistic projects might offer sites of resistance, rejection and mechanisms of support against constricting institutional norms and practices that seek to instrumentalize artistic works to their own ends

Chewing and pooing : the digestive system as a metaphor for practice-research in participatory contexts

The commonality between the panel leaders lies in our use of participatory art methods to explore particular contexts (e.g. hospitals, public galleries, call centres, local authorities) in order to explore the material processes and conditions of these places with the people who work in them. Hope will present Manual Labours: Building as Body taking Nottingham Contemporary as a case study, Schrag will present Fight Club: Physicality and Office Workers within Glasgow City Council and Shaw will present Hiding in Plain Sight: Moving between Care and Research at Florence Nightingale School of Nursing and Midwifery. 34 We propose a panel in which we will each present our methodologies, making use of the metaphor of the digestive system to find out what is being ingested, masticated and digested, and by whom, and what is being excreted at the end of our research processes. We are interested in exploring the processes of exchange, interaction and co-production in the process of investigating the functions and malfunctions of organisations. What is it that is participatory about this practice-research? What are the intersubjective relations between artist-researchers and participants? How can the fleshy, pulsating, masticating, symbiotic aspects of the digestive system help and/or hinder doing practice-research in these settings? We will examine how the artist-researcher and participant fits within the metabolism of the body in which they work and how possible it is to challenge the relationships they have with the specific contexts they work in. We invite feedback and discussion on diverse methodologies which use participatory art methods to explore working environments, examining where the metaphor of digestion fails and where new metaphors, systems and imagery might be needed

Half-eaten: practice-research within organisations

WORKSHOP. The commonality between the workshop leaders lies in our use of art methods to explore particular contexts (e.g. hospitals, public galleries, call centres, local authorities) in order to explore the material processes and conditions of these places. Our workshop explores these methodologies by playing with the metaphor of the digestive system to find out what is being ingested, masticated and digested, by whom and what is being excreted at the end of this process? What is the impact of this shit? How is it distributed and made public? Playing with the conference theme of ‘eating’, this workshop extends the metaphor to ask what position the artist-researcher might hold within the digestive system, particularly when the artist-researcher is embedded within a particular organisation or environment in a residency-type situation. This workshop invites participants to explore how they fit within the metabolic system of the specific body/field in which they work, using the metaphor of the digestive system — particularly ingestion, secretion, mixing, digestion, absorption and excretion. It begins with a contextualisation from the facilitators, exploring what can be understood by viewing their individual projects at Nottingham Contemporary, Glasgow City Council and Florence Nightingale School of Nursing and Midwifery, through the digestion metaphor. It then invites participants to map their own artistic-research processes onto this digestive system to explore where their work is the most effective: i.e. are there processes and relationships that can be seen as choking hazards or constipation? Are they ‘masticators’, particularly adept at chewing, but paying little attention to excretion? We will collectively build up a picture of the digestive system metaphor in relation to the participants’ research experiences

Enstranglements: Undercover in Arts for Health

The UK arts for health movement is ensnared in a double bind of co-opted insider and critical outsider: on one hand seeking to be at the centre of government approved delivery of wellbeing (such as social prescribing) and on the other hand understanding its history as a force critical of dehumanizing clinical practices and environments. Champions of Arts for Health talk about how artists ‘make spaces’ that are an escape from ‘business as usual’ ‘a sanctuary or suspended, protected space, where new things are possible’ (Gould 2005; Kilroy et al. 2007; Putland 2008; Sixsmith & Kagan 2005; White, 2004). Any ‘under the radar’ spaces that are made by Arts for Health, however, still happen in UK health institutions: a context understood as collapsing under its own encluttered weight with conflicting policy, performances, practices, values and cultures. In the following we explore two live rtworks that work with and are formed by, this materially and politically ‘enstrangled’ environment. We explore the multiple and connected points where visibility and the covert already hover in the hospital and explore whether there are other material forms through which to consider being ‘undercover’ such as ‘burrowing’ , as a dark celebration of the material and social affordances of the hospital. Devised by artists Becky Shaw and Anthony Schrag, the two live artworks– Hiding in Plain Sight and The Secret Society for Imperfect Nurses – were part of an education programme for healthcare students developed at King’s College London (KCL), curated by Frances Williams for the ‘UTOPIA 2016’ London festival. We explore the conditions of the commissions and how the particular constraints, contradictions and affordances of the institution, germinated these respective live works. Ironically, the UTOPIA 2016 festival took place within a year of UK National Health Service cuts and austerity measures, precipitating highly visible NHS strikes and protests (that included some of our participants)

Combined assessment of microvascular integrity and contractile reserve improves differentiation of stunning and necrosis after acute anterior wall myocardial infarction

AbstractObjectivesWe sought to determine the relative accuracy of myocardial contrast echocardiography (MCE) and low-dose dobutamine echocardiography (LDDE) in predicting recovery of left ventricular (LV) function in patients with a recent anterior wall myocardial infarction (MI).BackgroundLeft ventricular dysfunction after acute MI may be secondary to myocardial stunning or necrosis. Myocardial contrast echocardiography allows real-time echocardiographic perfusion assessment from a venous injection of a fluorocarbon-based contrast agent. Although this technique is promising, it has not been compared with LDDE.MethodsForty-six patients underwent baseline wall motion assessment, MCE, and LDDE two days after admission, as well as follow-up echocardiography after a mean period of 53 days.ResultsPerfusion by MCE predicted recovery of segmental function with a sensitivity of 69%, specificity of 85%, positive predictive value of 74%, negative predictive value of 81%, and overall accuracy of 78%. Contractile reserve by LDDE predicted recovery of segmental function with a sensitivity of 50%, specificity of 88%, positive predictive value of 72%, negative predictive value of 73%, and overall accuracy of 73%. Concordant test results occurred in 74% of segments and further increased the overall accuracy to 85%. The mean wall motion score at follow-up was significantly better in perfused versus nonperfused segments (1.9 vs. 2.6, p < 0.0001) and in segments with contractile reserve, compared with segments lacking contractile reserve (1.9 vs. 2.5, p < 0.0001).ConclusionsMyocardial contrast echocardiography compares favorably with LDDE in predicting recovery of regional LV dysfunction after acute anterior wall MI. Concordant contractile reserve and myocardial perfusion results further enhance the diagnostic accuracy

Enstranglements: Undercover in Arts for Health

pubhttps://doi.org/10.1080/13528165.2021.208737526pub

Measuring the impact and costs of a universal group based parenting programme : protocol and implementation of a trial

Background Sub-optimal parenting is a common risk factor for a wide range of negative health, social and educational outcomes. Most parenting programmes have been developed in the USA in the context of delinquency prevention for targeted or indicated groups and the main theoretical underpinning for these programmes is behaviour management. The Family Links Nurturing Programme (FLNP) focuses on family relationships as well as behaviour management and is offered on a universal basis. As a result it may be better placed to improve health and educational outcomes. Developed in the UK voluntary sector, FLNP is popular with practitioners, has impressed policy makers throughout the UK, has been found to be effective in before/after and qualitative studies, but lacks a randomised controlled trial (RCT) evidence base. Methods/Design A multi-centre, investigator blind, randomised controlled trial of the FLNP with a target sample of 288 south Wales families who have a child aged 2-4 yrs living in or near to Flying Start/Sure Start areas. Changes in parenting, parent child relations and parent and child wellbeing are assessed with validated measures immediately and at 6 months post intervention. Economic components include cost consequences and cost utility analyses based on parental ranking of states of quality of life. Attendance and completion rates and fidelity to the FLNP course delivery are assessed. A nested qualitative study will assess reasons for participation and non-participation and the perceived value of the programme to families. By the end of May 2010, 287 families have been recruited into the trial across four areas of south Wales. Recruitment has not met the planned timescales with barriers including professional anxiety about families entering the control arm of the trial, family concern about video and audio recording, programme facilitator concern about the recording of FLNP sessions for fidelity purposes and delays due to the new UK research governance procedures. Discussion Whilst there are strong theoretical arguments to support universal provision of parenting programmes, few universal programmes have been subjected to randomised controlled trials. In this paper we describe a RCT protocol with quantitative and qualitative outcome measures and an economic evaluation designed to provide clear evidence with regard to effectiveness and costs. We describe challenges implementing the protocol and how we are addressing these

Patient-reported utilities in advanced or metastatic melanoma, including analysis of utilities by time to death

Background: Health-related quality of life is often collected in clinical studies, and forms a cornerstone of economic evaluation. This study had two objectives, firstly to report and compare pre- and post-progression health state utilities in advanced melanoma when valued by different methods and secondly to explore the validity of progression-based health state utility modelling compared to modelling based upon time to death. Methods: Utilities were generated from the ipilimumab MDX010-20 trial (Clinicaltrials.gov Identifier: NCT00094653) using the condition-specific EORTC QLQ-C30 (via the EORTC-8D) and generic SF-36v2 (via the SF-6D) preference-based measures. Analyses by progression status and time to death were conducted on the patient-level data from the MDX010-20 trial using generalised estimating equations fitted in Stata®, and the predictive abilities of the two approaches compared. Results: Mean utility showed a decrease on disease progression in both the EORTC-8D (0.813 to 0.776) and the SF-6D (0.648 to 0.626). Whilst higher utilities were obtained using the EORTC-8D, the relative decrease in utility on progression was similar between measures. When analysed by time to death, both EORTC-8D and SF-6D showed a large decrease in utility in the 180 days prior to death (from 0.831 to 0.653 and from 0.667 to 0.544, respectively). Compared to progression status alone, the use of time to death gave similar or better estimates of the original data when used to predict patient utility in the MDX010-20 study. Including both progression status and time to death further improved model fit. Utilities seen in MDX010-20 were also broadly comparable with those seen in the literature. Conclusions: Patient-level utility data should be analysed prior to constructing economic models, as analysis solely by progression status may not capture all predictive factors of patient utility and time to death may, as death approaches, be as or more important. Additionally this study adds to the body of evidence showing that different scales lead to different health state values. Further research is needed on how different utility instruments (the SF-6D, EORTC-8D and EQ-5D) relate to each other in different disease areas