“The whole thing is beyond stress”: Family perspectives on the experience of hospitalisation through to discharge for individuals with severe learning disabilities and complex needs

© 2024 The Authors. British Journal of Learning Disabilities published by John Wiley & Sons Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background People with severe learning disabilities and complex needs are more likely to experience delayed discharge from hospital; however, there is little research into their experience in hospital and as they move out as part of the Transforming Care Programme. Methods Six family members of people with complex needs who had moved out of hospital took part in four focus groups co-facilitated with an expert-by-experience consultant. Participants' relatives had hospital admissions that ranged from 6 weeks to 11 years. Transcripts were analysed using reflexive thematic analysis. Additional reflections are included from an expert-by-experience consultant to capture their unique perspective. Results Family members reported stories of abuse in hospital and parallel experiences of institutionalisation and trauma, resulting in long-lasting impacts on themselves and their relative. Family members felt let down and undervalued by professionals. They described relief when their relatives moved out of hospital, but there were on-going difficulties accessing the right support in the community and so stability felt fragile. Conclusions Key recommendations to support community living include respecting family members' expertise, improving partnership working and offering psychological support for family members and people with complex needs post-discharge.Peer reviewe

Mapping stakeholders to maximise the impact of research on health inequalities for people with learning disabilities: the development of a framework for the Making Positive Moves study

© 2024 The Authors. British Journal of Learning Disabilities published by John Wiley & Sons Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background: People with learning disabilities experience health and social inequalities, and research that could improve health services may not be implemented in real‐life settings. Building stakeholder networks that can share and implement research findings may address this. This paper presents a framework for building a stakeholder network that maximises the likelihood of research recommendations being implemented in practice. This was developed as part of the ‘Making Positive Moves’ (MPM) study, which explores the experiences of people with learning disabilities following discharge from a residential stay within a hospital inpatient setting. Methods: We reviewed the literature on existing theoretical frameworks to support the development of a model for dissemination of the MPM findings. Stakeholder categories were identified through consultation with the MPM researchers, experts by experience and the steering group and a hub and spoke model to represent all stakeholder categories was created. These categories include person moving; family of the person moving; specialist schools; social care; care providers; regulators; third sector organisations; policy organisations; academic community; and NHS professionals. After establishing the categories, we consulted with people with learning disabilities and other stakeholders and conducted online searches to create a stakeholder database. Through information gathering and direct contact with stakeholders, we assessed levels of interest, power and engagement to determine which stakeholders to prioritise in our dissemination activities. The Stakeholder Wheel was created to present the data captured within the database and engagement profiles in an illustrative way. Findings: We use two stakeholder sub‐categories, user‐led organisations and care providers, to demonstrate the methodological approach. The examples illustrate how a scoring system helped us to identify high‐priority stakeholders who we then contacted to collaborate within developing our dissemination strategy to maximise the impact of the MPM research findings. Conclusions: We developed a framework to map stakeholders for the MPM study and enable targeted dissemination to increase the impact of the research. This approach has the potential to reduce health inequalities among people with learning disabilities by increasing the awareness of and ability to implement evidence‐based recommendations in real‐life settings. The stakeholder mapping framework could be applied to research projects associated with learning disabilities to bridge the gap between research and practice and reduce health inequalities.Peer reviewe

Diode-pumped Pr:BaY2F8 cw orange laser

We report the realization of the continuous wave laser emission in the orange at 607 nm from a Pr:BaY2F8 (Pr:BYF) crystal pumped by a blue GaN laser diode. A maximal output power of 78 mW is obtained in a quasi single transverse mode beam. The effect of reabsorption losses at the laser wavelength is also evidencedComment: accepted for publication in Optics Letter

Patterns of nocturnal rehydration in root tissues of Vaccinium corymbosum L. under severe drought conditions

Although roots in dry soil layers are commonly rehydrated by internal hydraulic redistribution during the nocturnal period, patterns of tissue rehydration are poorly understood. Rates of nocturnal rehydration were examined in roots of different orders in Vaccinium corymbosum L. ‘Bluecrop’ (Northern highbush blueberry) grown in a split-pot system with one set of roots in relatively moist soil and the other set of roots in dry soil. Vaccinium is noted for a highly branched and extremely fine root system. It is hypothesized that nocturnal root tissue rehydration would be slow, especially in the distal root orders because of their greater hydraulic constraints (smaller vessel diameters and fewer number of vessels). Vaccinium root hydraulic properties delayed internal water movement. Even when water was readily available to roots in the wet soil and transpiration was minimal, it took a whole night-time period of 12 h for the distal finest roots (1st to 4th order) under dry soil conditions to reach the same water potentials as fine roots in moist soil (1st to 4th order). Even though roots under dry soil equilibrated with roots in moist soil, the equilibrium point reached before sunrise was about –1.2 MPa, indicating that tissues were not fully rehydrated. Using a single-branch root model, it was estimated that individual roots exhibiting the lowest water potentials in dry soil were 1st order roots (distal finest roots of the root system). However, considered at the branch level, root orders with the highest hydraulic resistances corresponded to the lowest orders of the permanent root system (3rd-, 4th-, and 5th-order roots), thus indicating possible locations of hydraulic safety control in the root system of this species

Use of the Behavior Assessment Tool in 18 Pilot Residency Programs

Background: The purpose of this study was to determine the feasibility and evaluate the effectiveness of the American Board of Orthopaedic Surgery Behavior Tool (ABOSBT) for measuring professionalism. Methods: Through collaboration between the American Board of Orthopaedic Surgery and American Orthopaedic Association\u27s Council of Residency Directors, 18 residency programs piloted the use of the ABOSBT. Residents requested assessments from faculty at the end of their clinical rotations, and a 360° request was performed near the end of the academic year. Program Directors (PDs) rated individual resident professionalism (based on historical observation) at the outset of the study, for comparison to the ABOSBT results. Results: Nine thousand eight hundred ninety-two evaluations were completed using the ABOSBT for 449 different residents by 1,012 evaluators. 97.6% of all evaluations were scored level 4 or 5 (high levels of professional behavior) across all of the 5 domains. In total, 2.4% of all evaluations scored level 3 or below reflecting poorer performance. Of 431 residents, the ABOSBT identified 26 of 32 residents who were low performers (2 or more \u3c level 3 scores in a domain) and who also scored below expectations by the PD at the start of the pilot project (81% sensitivity and 57% specificity), including 13 of these residents scoring poorly in all 5 domains. Evaluators found the ABOSBT was easy to use (96%) and that it was an effective tool to assess resident professional behavior (81%). Conclusions: The ABOSBT was able to identify 2.4% low score evaluations ( Level of Evidence: Level II

Commentary driver training: effects of commentary exposure, practice and production on hazard perception and eye movements

Commentary driving typically involves being trained in how to produce a verbal running commentary about what you can see, what you are doing, what might happen and what action you will take to avoid potential hazards, while driving. Although video-based commentary training has been associated with subsequent hazard perception improvements, it can have a negative impact on hazard perception when a live commentary is produced at test (Young, Chapman, & Crundall, 2014). In the current study we use balanced training and testing blocks to isolate the effects of commentary exposure, production of a commentary with and without practice, and learning from earlier self-generation of commentary on behavioural and eye movement measures. Importantly, both commentary exposed and unexposed groups gave hazard perception responses during the commentary video, ensuring that the unexposed control group remained engaged in the procedure throughout. Results show that producing a live commentary is detrimental to concurrent hazard perception, even after practice, and does not enhance any later effect of commentary exposure. Although commentary exposure led to an initial increase in the accuracy of hazard perception responses, this effect was limited to the first occasion of testing, and showed no later benefits relative to engaged hazard exposure

Integrated Molecular Meta-Analysis of 1,000 Pediatric High-Grade and Diffuse Intrinsic Pontine Glioma.

We collated data from 157 unpublished cases of pediatric high-grade glioma and diffuse intrinsic pontine glioma and 20 publicly available datasets in an integrated analysis of >1,000 cases. We identified co-segregating mutations in histone-mutant subgroups including loss of FBXW7 in H3.3G34R/V, TOP3A rearrangements in H3.3K27M, and BCOR mutations in H3.1K27M. Histone wild-type subgroups are refined by the presence of key oncogenic events or methylation profiles more closely resembling lower-grade tumors. Genomic aberrations increase with age, highlighting the infant population as biologically and clinically distinct. Uncommon pathway dysregulation is seen in small subsets of tumors, further defining the molecular diversity of the disease, opening up avenues for biological study and providing a basis for functionally defined future treatment stratification

Using a Delphi process to determine optimal care for patients with pancreatic cancer

Aim Overall 5-year survival for pancreatic cancer is ~5%. Optimising the care that pancreatic cancer patients receive may be one way of improving outcomes. The objective of this study was to establish components of care which Australian health professionals believe important to optimally manage patients with pancreatic cancer. Methods Using a Delphi process, a multi-disciplinary panel of 250 health professionals were invited to provide a list of factors they considered important for optimal care of pancreatic cancer patients. They were then asked to score and then rescore (from one (no importance/disagree) to 10 (very important/agree) the factors. The mean and coefficient of variation scores were calculated and categorised into three levels of importance. Results Overall 63 (66% of those sent the final questionnaire; 25% of those initially invited) health professionals from 9 disciplines completed the final scoring of 55 statements/factors encompassing themes of presentation/staging, surgery and biliary obstruction, multi-disciplinary team details and oncology. Mean scores ranged from 3.7 to 9.7 with the highest related to communication and patient assessment. There was substantial intra- and inter- disciplinary variation in views about MDT membership and roles. Conclusion Overall the opinions of Australian health professionals reflect international guideline recommended care; however they identified a number of additional factors focusing on where patients should be treated, the importance of clear communication and the need for multi-disciplinary care which were not included in current clinical practice guidelines. Differences in priorities between specialty groups were also identified

How are distractibility and hazard prediction in driving related? Role of driving experience as a moderating factor

Distraction constitute one of the ‘five fatal’ behaviours that contribute to road trauma, and some people may be more susceptible to it than others. It is also known that a greater ability to predict danger is related to a lower probability of suffering accidents. It could be hypothesised that drivers with a higher tendency to distraction are worse at predicting traffic hazards, but to what extent might driving experience serve to mitigate this tendency to distraction? The current study collected self-reported attentional errors from drivers by using the Attention-Related Driving Errors Scale (ARDES-Spain) in order to examine whether novice drivers suffered from inattention more than experienced drivers. The results demonstrated that novice drivers scored more highly on ARDES than experienced drivers. ARDES scores were then related to performance in a Hazard Prediction test, where participants had to report what hazard was about to happen in a series of video clips that occlude just as the hazard begins to develop. While experienced drivers were better at the Hazard Prediction test than novice drivers, those participants who reported fewer attention errors were also better able to detect the upcoming hazard following occlusion. In addition, our results demonstrate a relationship between self-reported attentional errors and the ability to predict upcoming hazards on the road, with driving experience having a moderating role. In the case of novice drivers, as their scores in the Manoeuvring Errors ARDES factor increase, their ability in Hazard Prediction diminishes, while for experienced drivers the increase is not significant. Guidance on how to improve training for drivers in order to mitigate the effects of inattention on driving safety can be addressed