The implicit theory of historical change in the work of Alan S. Milward

Alan S. Milward was an economic historian who developed an implicit theory of historical change. His interpretation which was neither liberal nor Marxist posited that social, political, and economic change, for it to be sustainable, had to be a gradual process rather than one resulting from a sudden, cataclysmic revolutionary event occurring in one sector of the economy or society. Benign change depended much less on natural resource endowment or technological developments than on the ability of state institutions to respond to changing political demands from within each society. State bureaucracies were fundamental to formulating those political demands and advising politicians of ways to meet them. Since each society was different there was no single model of development to be adopted or which could be imposed successfully by one nation-state on others, either through force or through foreign aid programs. Nor could development be promoted simply by copying the model of a more successful economy. Each nation-state had to find its own response to the political demands arising from within its society. Integration occurred when a number of nation– states shared similar political objectives which they could not meet individually but could meet collectively. It was not simply the result of their increasing interdependence. It was how and whether nation-states responded to these domestic demands which determined the nature of historical change.historical change,development,World Wars,Third Reich,Blitzkrieg,New Order,Vichy,Fascism,Grossraumwirtschaft,German question,reconstruction,golden age,integration,supranationality,Bretton Woods

Palliative care for people with dementia living at home: a systematic review of interventions

Background: The European Association for Palliative Care White Paper defined optimal palliative care in dementia based on evidence and expert consensus. Yet, we know little on how to achieve this for people with dementia living and dying at home. Aims: To examine evidence on home palliative care interventions in dementia, in terms of their effectiveness on end-of-life care outcomes, factors influencing implementation, the extent to which they address the European Association for Palliative Care palliative care domains and evidence gaps. Design: A systematic review of home palliative care interventions in dementia. Data sources: The review adhered to the PRISMA guidelines and the protocol was registered with PROSPERO (CRD42018093607). We searched four electronic databases up to April 2018 (PubMed, Scopus, Cochrane library and CINAHL) and conducted lateral searches. Results: We retrieved eight relevant studies, none of which was of high quality. The evidence, albeit of generally weak quality, showed the potential benefits of the interventions in improving end-of-life care outcomes, for example, behavioural disturbances. The interventions most commonly focused on optimal symptom management, continuity of care and psychosocial support. Other European Association for Palliative Care domains identified as important in palliative care for people with dementia, for example, prognostication of dying or avoidance of burdensome interventions were under-reported. No direct evidence on facilitators and barriers to implementation was found. Conclusions: The review highlights the paucity of high-quality dementia-specific research in this area and recommends key areas for future work, for example, the need for process evaluation to identify facilitators and barriers to implementing interventions.Peer reviewedFinal Published versio

Improving living and dying for people with advanced dementia living in care homes: a realist review of Namaste Care and other multisensory interventions

© The Author(s). 2018Background: Seventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might work, on what outcomes, and in what circumstances. Methods: This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories, and their validation with a purposive sample of stakeholders. Twenty stakeholders - user/patient representatives, dementia care providers, care home staff, researchers -took part in interviews and/or workshops. Results: We included 85 papers. Eight focused on Namaste Care and the remainder on other types of sensory interventions such as music therapy or massage. We identified three context-mechanism-outcome configurations which together provide an explanatory account of what needs to be in place for Namaste Care to work for people living with advanced dementia. This includes: providing structured access to social and physical stimulation, equipping care home staff to cope effectively with complex behaviours and variable responses, and providing a framework for person-centred care. A key overarching theme concerned the importance of activities that enabled the development of moments of connection for people with advanced dementia. Conclusions: This realist review provides a coherent account of how Namaste Care, and other multisensory interventions might work. It provides practitioners and researchers with a framework to judge the feasibility and likely success of Namaste Care in long term settings. Key for staff and residents is that the intervention triggers feelings of familiarity, reassurance, engagement and connection.Peer reviewe

Using video consultation technology between care homes and health and social care professionals: a scoping review and interview study during COVID-19 pandemic

© 2022 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. This is the accepted manuscript version of an article which has been published in final form athttps://doi.org/10.1093/ageing/afab279Background the COVID-19 pandemic disproportionately affected care home residents’ and staffs’ access to health care and advice. Health and social care professionals adapted rapidly to using video consultation (videoconferencing) technology without guidance. We sought to identify enablers and barriers to their use in supporting care home residents and staff. Methods a scoping review of the evidence on remote consultations between healthcare services and care homes. Interviews with English health and social care professionals about their experiences during the pandemic. Findings were synthesised using the non-adoption, abandonment, scale-up, spread, sustainability framework. Results 18 papers were included in the review. Twelve interviews were completed. Documented enablers and barriers affecting the uptake and use of technology (e.g. reliable internet; reduced travelling) resonated with participants. Interviews demonstrated rapid, widespread technology adoption overcame barriers anticipated from the literature, often strengthening working relationships with care homes. Novel implementation issues included using multiple platforms and how resident data were managed. Healthcare professionals had access to more bespoke digital platforms than their social care counterparts. Participants alternated between platforms depending on individual context or what their organisation supported. All participants supported ongoing use of technologies to supplement in-person consultations. Conclusions the evidence on what needs to be in place for video consultations to work with care homes was partly confirmed. The pandemic context demolished many documented barriers to engagement and provided reassurance that residents’ assessments were possible. It exposed the need to study further differing resident requirements and investment in digital infrastructure for adequate information management between organisations.Peer reviewe

Using non-participant observation to uncover mechanisms: insights from a realist evaluation

This article outlines how a realist evaluation of dementia care in hospitals used non-participant observation to support the refinement and testing of mechanisms likely to lead to the use of person-centred care. We found that comments and explanations of their actions from hospital staff during observation periods provided insights into the reasoning that generated their actions for care in real time. This informed subsequent data collection and analysis. Two worked examples of mechanisms first identified during non-participant observation demonstrate (1) how they were uncovered, and (2) how this informed research activities for theory refinement. Early, iterative engagement with the analytic process, primarily involving reflection and debate with the research team, maximised the potential of observation data to support surfacing underlying mechanisms, linking them to specific contexts and outcomes.Peer reviewedFinal Accepted Versio

Trialling HyFlex at TU Dublin – stakeholders’ voices and experiences

HyFlex is a multi-modal instructional approach that offers students the opportunity to engage with modules face-to-face and online in a mode that best suits their learning style and situation. Covid-19 forced many universities and lecturers to offer HyFlex opportunities. This emergency flip and required agility to deliver HyFlex provides the opportunity to learn from the experiences of using this mode of teaching and learning. This research presents the results of a survey of 44 lecturers who were part of the HyFlex Community of Practice (COP) or who were employing HyFlex in their practice, and 490 students who engaged with HyFlex at Technological University Dublin (TU Dublin), Ireland. Mini vignettes are used to provide deeper insight. Key findings are that HyFlex was viewed positively by both students and lecturers, and 92% of students would recommend this form of attendance in the future. From a lecturer\u27s perspective, key challenges related to the technology, student engagement and high cognitive load. The research showed that some students who avail of university learning supports preferred the HyFlex approach as it felt that it gave them equal opportunity and allowed them to learn in a way that suited them best. While the majority of students believe that the HyFlex approach resulted in the same level of academic rigour and quality as face-to-face delivery, several lecturers had some concerns. This research is valuable as it positions HyFlex as a feasible form of delivery at a time when a new University Educational Model (UEM) is being developed for TU Dublin. However, it is particularly valuable as it identifies key issues and gives voice to various stakeholders, which is important in terms of contributing to international and institutional debates and policies going forward regarding the changing pedagogical landscape post-Covid

The therapeutic potential of using film as an intervention in counselling and psychotherapy: A narrative inquiry

Despite increasing interest in the use of film as a therapeutic method in counselling and psychotherapy, there is a paucity of research into the lived experience of therapists who use film in their work, and no available research into the ways in which clients create meaning from the experience of this therapeutic intervention known as cinematherapy. The purpose of this study was to investigate the therapeutic potential of using film as an intervention in clinical practice, and to gain understanding of how clients in therapy might experience this. In-depth interviews, informed by a phenomenological, interpretive approach, were used to explore the experience of eight practitioners who used film therapeutically, and eight film viewers whose lives had been influenced by film, two of whom had experienced the use of film as clients. A narrative inquiry approach, drawing on constructivism and social constructionism, was employed to present and analyse the data. The practitioners' narratives identified the formative influence of film in their professional lives, and how and why film continued to provide them with an important frame of reference. The film viewers' narratives described the complex emotional experiences involved in the activity of viewing a film, and the overall impact that film had on their lives. Those who had experienced film in therapy as clients told stories of transformation experienced through these encounters. The narratives, many of which reflected a range of therapeutic approaches including the influence of Winnicott's (1971) concept of the use of cultural phenomena, were examined in the light of the literature relating to the clinical use of film, and the diverse range of literature related to the film-viewing experience. This research contributes to a deeper understanding of the therapeutic use of film at the levels of both practice and theory. By suggesting how and why film may be used appropriately and effectively as a therapeutic intervention in a range of contexts, this study provides an appreciation of what is possible when film is brought into the therapeutic space

Costs of care for persons with opioid dependence in commercial integrated health systems

BACKGROUND: When used in general medical practices, buprenorphine is an effective treatment for opioid dependence, yet little is known about how use of buprenorphine affects the utilization and cost of health care in commercial health systems. METHODS: The objective of this retrospective cohort study was to examine how buprenorphine affects patterns of medical care, addiction medicine services, and costs from the health system perspective. Individuals with two or more opioid-dependence diagnoses per year, in two large health systems (System A: n = 1836; System B: n = 4204) over the time span 2007–2008 were included. Propensity scores were used to help adjust for group differences. RESULTS: Patients receiving buprenorphine plus addiction counseling had significantly lower total health care costs than patients with little or no addiction treatment (mean health care costs with buprenorphine treatment = $13,578; vs. mean health care costs with no addiction treatment =$31,055; p < .0001), while those receiving buprenorphine plus addiction counseling and those with addiction counseling only did not differ significantly in total health care costs (mean costs with counseling only: $17,017; p = .5897). In comparison to patients receiving buprenorphine plus counseling, those with little or no addiction treatment had significantly greater use of primary care (p < .001), other medical visits (p = .001), and emergency services (p = .020). Patients with counseling only (compared to patients with buprenorphine plus counseling) used less inpatient detoxification (p < .001), and had significantly more PC visits (p = .001), other medical visits (p = .005), and mental health visits (p = .002). CONCLUSIONS: Buprenorphine is a viable alternative to other treatment approaches for opioid dependence in commercial integrated health systems, with total costs of health care similar to abstinence-based counseling. Patients with buprenorphine plus counseling had reduced use of general medical services compared to the alternatives