Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists

Background Normalisation process theory reports the importance of contextual integration in successfully embedding novel interventions, with recent propositions detailing the role that ‘plasticity’ of intervention components and ‘elasticity’ of an intended setting contribute. We report on the introduction of a clinical pathway assessing patient non-responsiveness to treatment for glaucoma and ocular hypertension. The aim of this study was to assess the feasibility of implementing the Cardiff Model of Glaucoma Care into hospital eye services, identifying any issues of acceptability for staff through the filter of normalisation process theory. Methods A prospective observational study was undertaken in four hospital eye services. This incorporated detailed qualitative semi-structured interviews with staff (n = 8) to gather their perceptions on the intervention’s usefulness and practicality. In addition, observational field notes of patient and staff consultations (n = 88) were collected, as well as broader organisational observations from within the research sites (n = 52). Data collection and analysis was informed by the normalisation process theory framework. Results Staff reported the pathway led to beneficial knowledge on managing patient treatment, but the model was sometimes perceived as overly prescriptive. This perception varied significantly based on the composition of clinics in relation to staff experience, staff availability and pre-existing clinical structures. The most commonly recounted barrier came in contextually integrating into sites where wider administrative systems were inflexible to intervention components. Conclusions Flexibility will be the key determinant of whether the clinical pathway can progress to wider implementation. Addressing the complexity and variation associated with practice between clinics required a remodelling of the pathway to maintain its central benefits but enhance its plasticity. Our study therefore helps to confirm propositions developed in relation to normalisation process theory, contextual integration, intervention plasticity, and setting elasticity. This enables the transferability of findings to healthcare settings other than ophthalmology, where any novel intervention is implemented.

Neural Correlates of Causal Inferences and Semantic Priming in People with Williams Syndrome: An fMRI Study

This study aimed at examining the ability of causal inferences and semantic priming of people with Williams syndrome (WS). Previous studies pointed out that people with WS showed deviant sentence comprehension, given advantageous lexical semantics. This study investigated the impairment in connecting words in the semantic network by using neuroimaging techniques to reveal neurological deficits in the contextual integration of people with Williams syndrome. Four types of word pairs were presented: causal, categorical, associative, and functional. Behavioural results revealed that causal word pairs required heavier cognitive processing than functional word pairs. Distinct neural correlates of semantic priming confirmed atypical semantic linkage and possible cause of impairment of contextual integration in people with WS. The findings of normal behaviours and atypical neural correlates in people with WS provide evidence of atypical development resulted from early gene mutations.

„A little Drama“ (G. M. Tucker)

The use of a narrative imperfect in Am 7:10–17 after 7:1–9 and the abrupt shift to 8:1–3 frequently compelled critics to determine its literary form. For diachronic studies defining classifications include ‘third-party report’ and ‘apophthegma’. By contrast, synchronic studies emphasize the contextual integration of Am 7:10–17 and concentrate on a narrative analysis. Within this focus it is striking, that the passage is often associated with a ‘drama’ but without assessing the methodological ramifications of such a claim. The present article takes this ‘synchronic gap’ up and relates it to approaches to view drama as a possible genre for prophetic books. In doing so, a reading of Am 7:10–17 as part of a narrator-mediated discourse using a dramatic mode shows that the passage can be deemed an entrance with three speeches integrated into the wider context of 7:1–8:3. Particularly the classification of 7:10a, 12aα, 14aα as narrator’s discourse using a dramatic mode makes this claim plausible.