Anthropology and Shamanic considerations

Anthropology and Shamanic consideration

Improving quality of care through routine, successful implementation of evidence-based practice at the bedside: an organizational case study protocol using the Pettigrew and Whipp model of strategic change

BACKGROUND: Evidence-based practice (EBP) is an expected approach to improving the quality of patient care and service delivery in health care systems internationally that is yet to be realized. Given the current evidence-practice gap, numerous authors describe barriers to achieving EBP. One recurrently identified barrier is the setting or context of practice, which is likewise cited as a potential part of the solution to the gap. The purpose of this study is to identify key contextual elements and related strategic processes in organizations that find and use evidence at multiple levels, in an ongoing, integrated fashion, in contrast to those that do not. METHODS: The core theoretical framework for this multi-method explanatory case study is Pettigrew and Whipp's Content, Context, and Process model of strategic change. This framework focuses data collection on three entities: the Why of strategic change, the What of strategic change, and the How of strategic change, in this case related to implementation and normalization of EBP. The data collection plan, designed to capture relevant organizational context and related outcomes, focuses on eight interrelated factors said to characterize a receptive context. Selective, purposive sampling will provide contrasting results between two cases (departments of nursing) and three embedded units in each. Data collection methods will include quantitative tools (e.g., regarding culture) and qualitative approaches including focus groups, interviews, and documents review (e.g., regarding integration and “success”) relevant to the EBP initiative. DISCUSSION: This study should provide information regarding contextual elements and related strategic processes key to successful implementation and sustainability of EBP, specifically in terms of a pervasive pattern in an acute care hospital-based health care setting. Additionally, this study will identify key contextual elements that differentiate successful implementation and sustainability of EBP efforts, both within varying levels of a hospital-based clinical setting and across similar hospital settings interested in EBP

Effects of school-based interventions on mental health stigmatization: a systematic review

Stigmatizing, or discriminatory, perspectives and behaviour, which target individuals on the basis of their mental health, are observed in even the youngest school children. We conducted a systematic review of the published and unpublished, scientific literature concerning the benefits and harms of school-based interventions, which were directed at students 18 years of age or younger to prevent or eliminate such stigmatization. Forty relevant studies were identified, yet only a qualitative synthesis was deemed appropriate. Five limitations within the evidence base constituted barriers to drawing conclusive inferences about the effectiveness and harms of school-based interventions: poor reporting quality, a dearth of randomized controlled trial evidence, poor methods quality for all research designs, considerable clinical heterogeneity, and inconsistent or null results. Nevertheless, certain suggestive evidence derived both from within and beyond our evidence base has allowed us to recommend the development, implementation and evaluation of a curriculum, which fosters the development of empathy and, in turn, an orientation toward social inclusion and inclusiveness. These effects may be achieved largely by bringing especially but not exclusively the youngest children into direct, structured contact with an infant, and likely only the oldest children and youth into direct contact with individuals experiencing mental health difficulties. The possible value of using educational activities, materials and contents to enhance hypothesized benefits accruing to direct contact also requires investigation. Overall, the curriculum might serve as primary prevention for some students and as secondary prevention for others

Veto Players in Post-Conflict DDR Programs: Evidence from Nepal and the DRC

Under what conditions are Disarmament, Demobilization and Reintegration (DDR) programs successfully implemented following intrastate conflict? Previous research is dominated by under-theorized case studies that lack the ability to detect the precise factors and mechanisms that lead to successful DDR. In this article, we draw on game theory and ask how the number of veto players, their policy distance, and their internal cohesion impact DDR implementation. Using empirical evidence from Nepal and the Democratic Republic of Congo, we show that the number of veto players, rather than their distance and cohesion, explains the (lack of) implementation of DDR

Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula

IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.MethodsConsenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.ResultsOf 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.ConclusionEarly ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation

Tamu Shamans' Books: The Challenges of Textualising the Pye-ta Lhu-ta

In this presentation, I discuss my ongoing work with the Tamu-mai, an ethnolinguistic community of central Nepal with whom I have been working collaboratively for two decades. I begin by reviewing a number of Tamu cultural preservation projects in which I have played a part, including the curation of sensitive material culture collections within museums in Europe and Nepal, an extensive video documentation project and studio recordings of traditional Tamu ritual chants and songs. Through these and other examples, I address the challenges of textualisation and the problems that are raised when delicate cultural materials are recorded, archived and disseminated to a wider audience

Shamanic dialogue : history, representation and landscape in Nepal

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Gurkhas’ in the town: migration, language, and healing

The serga pye1 recalls how a group of Tamu-mai2 (Gurung) came upon what is now the ancestral village of Kohla, planted some grain, returned to find that it had produced a high yield, and moved across the Lamjung Himal to settle in the forests above their present villages. Many Tamu-mai consider the move across the Himalaya to be the final stage in their migration, without realizing that they themselves are engaged in an equally historic migration. This article examines the contemporary rural-urban movement of the Tamu-mai, which is intimately tied to the experience of service in the British army, and explores some of the associated social and cultural changes. As people plot new urban geographies, and as the second generation grow up as town-dwellers, a new Tamu social landscape is created and the sense of what it means to be Tamu is shifting. In this new environment, the cultural landscape is being re-drawn. As the map is reformulated, some knowledge and practices have lost their cultural centrality. Language, for example, has been displaced, and few of the second generation speak Tamu Kyui. In contrast, despite a wide choice of alternative options, shamanic healing practices retain their cultural salience

Observing the Elections in Central Nepal

no abstract availabl