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In this chapter, we examine and summarize the evidence for observation care based on age, for example, the pediatric and geriatric population, as the previous chapter did for adults with a given condition or diagnosis, such as chest pain or asthma. The critical questions addressed in this chapter are:
1. Can infants and children (e.g., pediatric patients) be successfully and safely treated in an observation unit setting?
2. Can geriatric patients be successfully and safely treated in an observation unit setting?
This chapter deals with critical issues in observation medicine for adult patients based on a given diagnosis or clinical condition, such as chest pain or asthma. A separate chapter deals with critical issues in observation medicine based on age, for example, observation medicine for pediatric and geriatric patients. The critical questions addressed in this chapter are:
1: In adult patients, when compared with inpatient treatment does the provision of observation services, specifically in a dedicated, protocol-driven observation unit (OU), improve patient outcomes, decrease length of stay (LOS), reduce costs, increase patient satisfaction, and have other benefits, including (but not limited to) decreased readmissions?
2: In adult patients, does the use of OU clinical and administrative methodology (by aggressive early diagnostic and therapeutic management using tools such as protocol-driven therapy) produce equivalent or better results (e.g., patient outcomes, LOS, costs, and adverse events) compared with routine inpatient care?
3: In the adult emergency department (ED), does use of an OU improve key measures of department efficiency, such as decreases in ED LOS, door-to-doctor time, ambulance diversion, and the left-without-being-seen rate?
The history of the theatre from the late sixteenth to late in the nineteenth century is usually framed around dominant periods of national dramatic literatures: theatre of the Spanish golden age; Shakespeare and his contemporaries; the classic theatre of France; the comedy of manners of the English Restoration; Weimar and the golden age of German theatre. Given the longevity, authenticity and the archaeological value of the printed play text, this framing is understandable and inevitable. Nevertheless, these histories with their focus upon ‘great works’ have the effect of identifying the written and spoken word as both the prime instigator and the most important archival souvenir of theatre. Inevitably such theatre histories have shaped our contemporary perception: what we consider to be ‘good’ dramatic literature. For example, beyond the small output of R. B. Sheridan and Oliver Goldsmith, the British eighteenth-century theatre produced few plays that are today considered to be ‘good’ dramatic literature, and yet in terms of audience popularity, famous actors and scenic developments, the period clearly produced great theatre. Likewise, during the period c. 1830–c. 1880, theatre throughout Europe was a hugely popular form that responded fully and widely to social and political events, and yet, in marked contrast to opera, few plays from the period have entered the canon of dramatic literature. There appear, therefore, to be distinctive periods of European theatre history when the co-existence of ‘great’ dramatic literature with ‘great’ theatre did not occur. It would therefore seem to be important to treat with caution modern judgements about what is great dramatic literature and to inflect the assumption that ‘great plays’ are a necessary ingredient of great theatre. Whilst dramatic literature is of considerable importance, it should serve as only one approach to the making of histories of theatre. This essay aims to use the framing of the baroque and the romantic in order to make a narrative of theatre as a spatial and visual phenomenon from the late sixteenth century to the modernist revolt against romantic and material realism, which began in the final decades of the nineteenth century.
Probably the most significant difference between a play written and produced in the mid eighteenth century and one written and produced a hundred years later would be the reliance upon pictorial scenography in the latter. In 1740, with some significant exceptions, the space of the production would display the formal qualities of a scenically neutral theatrical place. This was a place of performance in which scenery served as a decorative background to dramatic action. By 1840 the physical presence of scenic techniques and effects would underpin almost all aspects of production as major elements within dramaturgy and the theatrical experience.
By 1840 the neutral place of performance had been replaced by detailed scenic representations of other worlds involving sophisticated theatrical processes and techniques. This new place of performance was situated within its own discrete architectural space, one that was separated from the audience by a decorated proscenium frame through which the audience looked. Throughout this process of change, important physical and psychological distinctions were established between audience and stage. Fundamentally, however, it would be true to say that spectators in 1740 might have considered it a heresy to connive at losing their sense of identity in the theatre. For that audience, the act of becoming engaged in performance involved balancing a social sense of self alongside admiration of the performer's skill in taking them over the threshold of belief into the world of the play. By 1840 every possible aspect of architecture, scenography and its associated technologies was being used in order to transport the spectator's imagination into the 'other worlds' which the theatre sought to (re)create.
Me, the writer of plays, from my friend the stage designer.
The cities where he worked are no longer there.
When I walk through the cities that still are
At times I say: that blue piece of washing
My friend would have placed it better.
(Poems, p. 415)
The contribution of Brecht to the scenography of the twentieth century goes far beyond important changes in the appearance of the stage. In his writing and in his practice, he deconstructs the human complexity of the 'director-designer relationship' and offers a mode of creating theatre which, in an organic way, links not only the end products of dramaturgy and scenography, but also centralises within this process the working practices of dramatist, director and scenographer. We have to consider therefore the relationship between Brecht's political and philosophical view of theatre and his expectations of scenography; the way in which these expectations developed in the collaboration with Caspar Neher; and finally the reverberant effects which these ideas and practices have had, and still have, upon contemporary theatre.
On 21 February 1896, in the Great Hall of the Polytechnic Institution at 309 Regent Street, London, the first cinema audience in Britain saw a moving picture show – the Cinématographe – of the films of August and Louis Lumière. The show, lasting approximately seventeen minutes, was projected onto a screen 6 feet by 4 feet 6 inches and showed some ten ‘actualities’, including scenes of a landing stage, boating, bathing in the Mediterranean, a collapsing wall and the arrival of a train in a railway station. In some ways, this event might be seen as the achievement of a project begun some 125 years beforehand by Philippe Jacques de Loutherbourg (1740-1812) at Drury Lane. However, Michael Booth cautions that the arrival of film ‘was not at all the culmination of a teleological process in which the theatre struggled clumsily towards the divine glory of cinematic realism, but simply one of the many responses of an increasingly sophisticated entertainment technology to the demand for pictorial realism’. Loutherbourg’s project was to present ‘realistic’ and pictorial images of places and events that his audience would recognize as authentic and topographically accurate. In doing so, he considerably expanded scenographic subject matter to include scenes of significant and noteworthy landscapes, scenes of current events and scenes which presented exotic and far-away places that few in the audience had seen and that were the result of his considerable study and research. This had the effect of endowing theatre and scenography with a sense of purpose and authority that was quite new in the eighteenth century. Since much of this material seemed suited to the travelogue, his project began to make the theatre a ‘window on the world’.