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To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments and interventions in this setting. Within a quality improvement framework, staff were trained, a clinical protocol developed and clinical interventions made accessible.
Thirty per cent of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. Forty-two per cent of women were assessed, representing a 3.5-fold increase in uptake. Twenty-one per cent of women initiated SRH interventions, of which 14% had all their SRH needs met. Staff, patients and carers highlighted the acceptability and importance of SRH care, if interventions were appropriately timed and patients’ individual risk profiles were considered. Barriers to access included lack of routine enquiry, illness acuity and impact of the COVID-19 pandemic.
SRH needs for PICU admissions are greater than previously realised. Providing a nurse-led SRH assessment is acceptable, feasible and beneficial for PICU patients.
PICU inpatients are likely to be at increased risk of having unmet SRH needs due to barriers to accessing services. Since May 2018, an in-reach SRH assessment has been available to all psychiatric inpatients on ES1 ward, if referred. Analysis of referrals over 15 months identified only 24 had been made during this time.
To assess the SRH needs of women admitted to ES1 PICU, the feasibility of providing a SRH in-reach clinic, and the acceptability of delivering a nurse lead referral programme.
A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on ES1 over a seven-month period. A staff training needs assessment was performed followed by training, a protocol was developed, staff attitudes were explored, and patient engagement was sought.
A total of 41% (32/77) of patients were referred, which was a 29% increase. 53.1% (17/32) of the total referrals had a true SRH need, equating to a 10% increase and 22% (17/77) of all PICU admissions. 90% of referrals were made by nursing staff. A staff focus group (n15) highlighted the acceptability and perceived importance of offering SRH care in PICU, if interventions were appropriately timed and the patient’s individual risk profile was considered.
Results identify that SRH needs for PICU admissions are greater than previously realised. Providing a nurse led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients. This project has resulted in service improvements including offering asymptomatic STI testing to all PICU admissions.
To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments/interventions in this setting. Secondary aims were to explore the barriers to access and the feasibility of providing SRH assessments and interventions in the PICU.
A retrospective analysis of fifteen months’ activity data found that only 25 SRH referrals had been made across 205 PICU admissions. This low referral rate of 12% likely reflected pathway barriers and was unlikely to represent the actual clinical need in female PICU patients. A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on the PICU over a seven-month period. Within a quality improvement framework, a staff training needs assessment was performed, training delivered, a protocol developed, staff attitudes explored, and patient and carer engagement sought.
A quality improvement approach streamlined SRH assessments on the PICU and resulted in 42% of women being assessed and a 3.5-fold increase in uptake. At least 30% of the women in the PICU had unmet SRH needs identified and proceeded to a specialist appointment. This amounts to a minimum 2.5-fold increase in SRH unmet need detection.
The most common SRH needs were complex gynaecological issues (such as period problems, pelvic pain, vaginal discharge), STI advice/testing and contraception advice/options. 21% of women initiated SRH interventions, and 14% completed all the interventions required for their needs. The most common interventions were in the areas of contraception advice/family planning and STI advice/testing.
Staff confidence on assessing SRH topics was identified as a barrier to access with a positive shift noted after bespoke SRH training was implemented and a protocol introduced: on a scale of 0-10 (with 10 being high), 81.3% of staff rated their confidence 8 or above in relation to discussing contraception/sexually transmitted infections (pre-training: 25.0%), and 93.8% in relation to discussing risky behaviours (pre-training: 18.8%). All 11 patient and carer participants felt it was important to have a forum to talk about SRH and 8 (72.7%) agreed it was important in the PICU.
Results identify that SRH needs for PICU admissions are greater than previously realised. Staff highlighted the acceptability and importance of SRH care, if interventions are appropriately timed and the patient's individual risk profile considered. Providing a nurse led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients.
During the thirteenth century the political forces of an older feudal nobility and an emergent guild-based republicanism had begun to vie for control within individual cities. By the early fourteenth century one or the other had gained the upper hand within a given city, and these shaped the new urban politics within which a new generation of oral poets emerged. For courtly performers like Antonio da Ferrara and Francesco di Vannozzo, these feudal environments provided a more traditional patronage environment that held oral poets to older patterns of chronic itinerancy, hybrid forms of entertainment, and poetic activity subject to the priorities of aristocratic patrons. The public and socially fluid environments of the commercial republics fostered a different sort of canterino, one more rooted in place, communally engaged with socially heterogeneous audiences, and reflective of a rapidly growing vernacular literary culture. The outstanding figure here is the Florentine canterino, Antonio Pucci. A section devoted to Dante, Boccaccio, and Petrarch reveals a surprisingly reciprocal engagement with oral poets, whose mixed orality made them important agents in the dissemination of the poetry and stylistic elements of the tre corone, while the literate culture of the time continued to be shaped by oral practice.
Besides Florence, the other formative context for the humanist cultivation of singing to the lyre were the educational environments in which the studia humanitatis was implemented. The primary sources are the humanist educational treatises written during the first half of the fifteenth century by figures like Pier Paolo Vergerio, Leonardo Bruni, and Battista Guarini. A careful re-reading of these sources reveals their attention to the aural qualities of written texts, especially poetry, and to the promotion of singing verse to the lyre as a way to develop proper diction, as an aid to the memorization of texts, and as a form of recreation with clear ancient precedent. The fundamentally oral aspect of humanist culture proceeds from its pedagogical and practical emphasis on rhetorical eloquence, and the view of cantare ad lyram as an integral aspect of rhetoric guaranteed for it a wide dissemination through the rapidly growing apparatus of humanist schools and universities. A final section devoted to the relatively unknown correspondence of Michele Verino, a student of the University of Florence with a predilection for singing to the lyre, complements the prescriptive approach of the educational treatises with the actual practices of a student enrolled in the studia humanitatis.
Cantare ad lyram reached the summit of its popularity in Rome during ca. 1490–1530. Like the humanist-trained scholars, artists, and clerics who came to Rome from elsewhere, the practice of cantare ad lyram was compelled to adapt to the unique patronage environment of the city, which was distinguished by its emphasis on Latin language, a clerical environment quite unlike the secular world of the courts, and a robust and varied patronage structure. The first part of this chapter is devoted to Latin Rome and focused on the brothers Raffaele and Aurelio Brandolini (including Raffaele’s De musica et poetica, a humanist defense of cantare ad lyram), and on the remarkable Roman banqueting scene that was the city’s primary venue for the elite poetic performances advocated and practiced by the Brandolinis. The second section on vernacular Rome seeks to place the extraordinary singer-poet Serafino Aquilano in the context of the language debates associated with Paolo Cortesi’s Roman Academy, in part through fresh readings of Vincenzo Calmeta’s biography of Serafino, and Angelo Collocci’s Apologia in defense of Serafino’s poetry. The chapter closes with a short study of Raphael’s Parnassus with a view to understanding its relationship to contemporary Roman performance practice of cantare ad lyram.
The fifteenth century was the golden age of civic canterino activity, and Florence was its heart. Though two other centers for which evidence survives, Siena and Perugia, are also treated in this chapter, what these documents make clear is that, although capable canterini could still emerge elsewhere in Italy, Florence was the source from which other cities recruited. The rich Florentine archives make it possible to construct a detailed and nuanced view of canterino activity in the city, which thrived in Medici palaces, artisan workshops, piazzas, and the civic government in the Palazzo Vecchio. This chapter explores the careers and poetry of the most famous canterini of the day, Niccolò cieco d’Arezzo, Antonio di Guido, and Cristoforo Fiorentino (called L’Altissimo), and their relationship to Piazza San Martino during its highpoint as a performance venue. This chapter also explores classical memory technique as it came to be appropriated by the Florentine canterini, evidence of which are four vernacular memory treatises that can be linked directly to these singers. The contents of these treatises are summarized and explained with reference to the surviving poetry of the canterini, and as a means to understanding how poetic and musical improvisation worked.
This little-known work of the great Florentine artist has only recently been re-identified (by me) as the portrait of a professional canterino. It is of great interest both for the status accorded to the sitter, a well-dressed individual in the preoccupied act of tuning his lira da braccio, as if about to perform, and for the Petrarch inscription etched into the back of the instrument which faces the viewer. It dates from the early 1480s, and so dates from a period when both civic and humanist practices of singing to the lyre were in full flood in Florence. The sitter could be a practitioner of either, or perhaps the distinction did not matter at the time. This short essay explores this ambiguity.
As Charles Dempsey has argued, humanist culture often came about not through the revival of ancient models, but through the recasting of contemporary vernacular culture in light of ancient models. A central thesis of this book is that the ubiquitous humanist practice of solo singing to the lyre took shape principally in Florence, in the circles of Marsilio Ficino and Lorenzo de’ Medici/Angelo Poliziano, through adaptation of certain aspects of traditional canterino practice. This chapter sets forth what we know about the cantare ad lyram activity in these circles, establishes its clear relationship to civic practices, and argues for its integral role in both the Neoplatonic philosophy of Ficino and the vernacular poetics of Lorenzo and Poliziano. This leads to new perspectives on both Ficino’s “Orphic singing to the lyre” and Lorenzo’s lifelong involvement with singing to the lyre, both of which are typically regarded as idiosyncratic and tangential to their serious intellectual pursuits. This chapter also provides the occasion for considering the extraordinary figure of Baccio Ugolini, one of the great improvvisatori of his day, and a reassessment of Poliziano’s Fabula d’Orfeo in which Baccio sang the title role in 1480.
This is the first of two such short digressions that enable me to focus on a specific issue in a manner different from the chapters. In most of the cities of central and northern Italy a specific location, usually a piazza, became the traditional venue for poetic performance. By far the most famous and well-documented of these is Piazza San Martino in Florence, and it was arguably the city’s most famous soundscape. This essay explores the history and significance of this location in the heart of the Florentine wool district as a place that resisted control by special interests. Contrary to current perceptions, San Martino was not a low-brow venue for “wandering” hacks and mediocre poetry, but a prestigious and managed site where the full expressive range of Tuscan vernacular poetry was on display and in a continual state of forging and transmission.
This short chapter draws together the surviving evidence of the earliest practitioners of oral poetry in Italy, and lays the foundation for a number of themes that recur in later chapters: the rapidly shifting status of vernacular language, and the attendant shifts in the status and venues of those who, like these oral poets, made a living from it. Among the varied cast of characters that included poets of all ranks, were the prototypes of the professional canterini who mesmerized audiences in piazzas with dramatic renderings of narrative cantari, served the dynastic ambitions of the courts, and articulated the civic values of communal priors and captains. Depending on whether the historical witnesses were ecclesiastical (Salimbene de Adam, Thomas Aquinas) or secular (Giovanni da Viterbo, Lovato de’ Lovati), these early civic performers were regarded with varying degrees of suspicion, condescension, fascination, and admiration.