Experiences and impact of psychiatric inpatient admissions far away from home: a qualitative study with young people, parents/carers and healthcare professionals.

BACKGROUND: There are significant clinical, policy and societal concerns about the impact on young people (YP), from admission to psychiatric wards far from home. However, research evidence is scarce. AIMS: To investigate the impact of at-distance admissions to general adolescent units, from the perspectives of YP, parents/carers and healthcare professionals (HCPs) including service commissioners, to inform clinical practice, service development and policy. METHOD: Semistructured interviews with purposive samples of YP aged 13-17 years (n=28) and parents/carers (n=19) across five large regions in England, and a national sample of HCPs (n=51), were analysed using a framework approach. RESULTS: There was considerable agreement between YP, parents/carers and HCPs on the challenges of at-distance admissions. YP and parents/carers had limited or no involvement in decision-making processes around admission and highlighted a lack of available information about individual units. Being far from home posed challenges with maintaining home contact and practical/financial challenges for families visiting. HCPs struggled with ensuring continuity of care, particularly around maintaining access to local clinical teams and educational support. However, some YP perceived separation from their local environment as beneficial because it removed them from unhelpful environments. At-distance admissions provided respite for some families struggling to support their child. CONCLUSIONS: At-distance admissions lead to additional distress, uncertainty, compromised continuity of care and educational, financial and other practical difficulties, some of which could be better mitigated. For a minority, there are some benefits from such admissions. CLINICAL IMPLICATIONS: Standardised online information, accessible prior to admission, is needed for all Child and Adolescent Mental Health Services units. Additional practical and financial burden placed on families needs greater recognition and consideration of potential sources of support. Policy changes should incorporate findings that at-distance or adult ward admissions may be preferable in certain circumstances.

The impact of supportive leadership on employee outcomes during organizational mergers: An organizational-level field study.

Past merger and acquisition research has reported mixed findings on the impact of mergers on workforces. To address these ambiguities and advance merger research at the organizational level of analysis, we present a natural quasi-experiment focusing on mergers in the English National Health Service. Building on organizational support theory and conservation of resources theory, we propose that merger events represent environmental stressors, with negative implications for employees' subjective (job satisfaction) and objective (absenteeism) outcomes. However, extending previous theorizing, we argue that by increasing their supportive leadership, midlevel management can compensate for the resource losses incurred during mergers, and in doing so, minimize the adverse impact on their workforces. We test our predictions in the context of multiple primary care trust mergers, which took place in 2006. We analyzed the annual staff surveys, combined with objective information on employee absenteeism, and compared merging organizations with nonmerging organizations before (2005) and after (2007) the mergers. As expected, employees of merging (vs. not merging) organizations showed stronger decreases in job satisfaction, and these decreases in subjective outcomes were associated with increases in absenteeism over the course of the merger process. However, consistent with our propositions, we found that increases in supportive leadership during the merger period served to mitigate these negative outcomes. Our results highlight the organizational-level implications of mergers and the role that midlevel management can play in compensating for the losses experienced during (stressful) merger events. We discuss the implications for dynamic models of merger integration and leadership during change. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impact of a perioperative oral opioid substitution protocol during the nationwide intravenous opioid shortage: A single center, interrupted time series with segmented regression analysis.

INTRODUCTION: To mitigate the recent nationwide shortage of intravenous opioids, we developed a standardized perioperative oral opioid guideline anchored with appropriate use of nonopioid analgesia, neuraxial and loco-regional techniques. We hypothesize that adoption of this new guideline was associated with: 1) equivalent patient reported pain scores in the post-anesthesia care unit (PACU); and 2) equivalent total opioid use (oral and parenteral) during the perioperative period. METHODS: Cases performed from July 1, 2017 to May 31, 2019 were screened. All opioids administered were converted to intravenous morphine milligram equivalents. Segmented regression analyses of interrupted time series were performed examining the change in opioid use, PACU pain scores and number of non-opioid analgesic medications used before and after the protocol implementation in April 2018. RESULTS: After exclusions, 29, 621 cases were included in the analysis. No significant differences in demographic, ASA status, case length and surgical procedure type were present in the pre and post-intervention period. A significant decrease in total (Estimate: -39.9 mg, SE: 6.9 mg, p < 0.001) and parenteral (Estimate: -51.6 mg, SE: 7.1 mg, p < 0.001) opioid use with a significant increase in oral opioid use (Estimate: 9.4 mg, SE: 1.1 mg, p < 0.001) was noted after the intervention. Pain scores were not significantly different between the pre- and post-intervention period (Estimate: 0.05, SE: 0.13, p = 0.69). CONCLUSION: We report our experience with a primary perioperative oral based opioid regimen that is associated with decreased total opioid consumption and equivalent patient reported pain scores.

Visual co-orientation and expectations about attentional orientation in pileated gibbons (Hylobates pileatus).

This study investigated attentional processes in a sample of captive gibbons. An initial aim of the research was to examine subjects' ability to co-orient with photographic images of both conspecific and human models. The gibbons' expectancies about the focus of another's attention was then also assessed, with an expectancy violation paradigm revealing subjects' sensitivity to an incompatibility between visual orientation and the position of a target object. The gibbons were exposed to two conditions; consistent sequences in which the stimulus individual directed attention towards a target object, and inconsistent sequences in which the model's attentional focus was incompatible with the location of this article. Analyses of the subjects' responses were made according to the direction of gazes and the time spent inspecting the depicted model in each of these conditions. The results reveal a tendency for visual co-orientation with both conspecific and human models, suggesting that gibbons are competent in detecting the visual orientation of other species as well as their own. Furthermore, the subjects' tendency to look longer and check back to the depicted model in response to violations in the relationship between an agent and object (target appearing in an opposite direction to model's gaze), suggests that they possess some knowledge of how visual gaze direction relates to external stimuli.

Redefining gender-based power to move beyond interpersonal approaches to HIV prevention.

Drawing on the recent work of Teitelman et al, this article explores the notion of gender-based power imbalances in the production of HIV risk. It focuses on the need to extend an understanding of gender-based power beyond the interpersonal realm and as a broader social problem, defined collectively within public arenas. The public arenas model is used to explore how gender-based power is currently defined and how its definitions can be expanded. We consider how HIV prevention policy solutions need to extend beyond interpersonal definitions to incorporate conceptions of gender-based power that include how broader social inequalities and power imbalances influence condom negotiations.

Effect of aspirin on hypothalamic-pituitary-adrenal function and on neuropsychological performance in healthy adults: a pilot study.

RATIONALE: Hypothalamic-pituitary-adrenal axis dysregulation predicts poor clinical and biochemical response to antidepressants. Antiglucocorticoids have therapeutic benefits but most have a troublesome adverse event profile. Aspects of neuropsychological performance, notably working memory, are susceptible to corticosteroid modulation and are impaired in depression. Aspirin has been shown to attenuate the adrenocorticotropic hormone (ACTH) and cortisol response to physiological challenge suggesting its potential to act as an augmenting agent in depression. OBJECTIVES: To examine the effect of sub-acute (300 mg daily for 7 days) aspirin pre-treatment on the cortisol awakening response and the effect of acute (600 mg) and sub-acute aspirin on the neuroendocrine and neuropsychological response to the arginine vasopressin analogue, desmopressin. RESULTS: We demonstrated that aspirin pre-treatment did not attenuate the cortisol or ACTH response to desmopressin but, as hypothesised, significantly reduced the cortisol awakening response and improved working memory. CONCLUSIONS: Further studies to examine the impact of aspirin on neuropsychological performance and HPA axis function are warranted.