'A hard-won capability': the experiences of parents managing their babies' medicines after discharge from a neonatal unit.:'A hard-won capability'

IntroductionParents of babies who required neonatal care are responsible for managing their medicines after they are discharged home. There is wide variation in the information and amount of preparation given to parents prior to assuming this challenging task. The aim of the Parent co-Designed Drug Information for parents and Guardians Taking Neonates home (PADDINGToN) study was to explore parents' experiences of managing their babies' medicines post discharge from a neonatal unit and to use this information to develop suitable resources for future families.MethodsA qualitative participatory interpretative approach using a mixture of remote and face-to-face small group interviews or one-to-one interviews was used. Parents were recruited using social media advertisements and convenience sampling from five study sites (four neonatal units in England and one in Ireland). Parents from other neonatal units were invited to take part through social media advertisement. The interviews were audio-recorded and inductive reflexive thematic analysis was used to analyze the data.Results17 parents (14 mothers, 3 fathers) participated. One over-arching theme, 'A hard won capability', and four major interpretive themes were generated from the analysis of the data: Being in NICU and the prospect of going home: emotional and practical challenges; Living the reality of being at home: the uncertainty associated with giving medicines; Being at home: battling the system and a lack of support/knowledge; and Suggesting ways forward: parents' lived insights into improving information and resources.ConclusionDespite the challenges they faced, parents developed strategies for safely and reliably managing medicines administration and they assimilated knowledge, built their confidence and achieved a capability in medicines administration. Their experiences have been used to build a suite of medicines administration resources to support future parents.</jats:sec

Paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT): an e-survey of the experiences of parents and clinicians.

BackgroundLittle evidence exists about parental satisfaction and their influence on referral to paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT).AimThis study aimed to examine the experiences of parents, children and clinicians of OPAT at a large tertiary children's hospital.MethodA prospective e-survey, using closed and open questions, of parents (n = 33) of 33 children who had received OPAT (3 children completed a survey), and clinicians (n = 31) involved in OPAT at a tertiary hospital. Data were collected September 2016 to July 2018.ResultsData were analysed using simple descriptive statistics. The results show that OPAT offered benefits (less stress, re-establishment of family life) compared to hospital-based treatment for parents and children, although some were anxious. Clinicians' referral judgements were based on child, home, and clinical factors. Some clinicians found the process of referral complex.ConclusionMost parents and children were satisfied with the OPAT service and preferred the option of home-based treatment as it promoted the child's comfort and recovery and supported family routines

Practical compassions: repertoires of practice and compassion talk in acute mental healthcare

This article reports an exploratory study of the concept of compassion in the work of 20 mental health practitioners in a UK Midlands facility. Using notions of practice derived from phenomenology and Bourdieusian sociology and notions of emotional labour we identify two contrasting interpretive repertoires in discussions of compassion. The first, the practical compassion repertoire, evokes the practical, physical and bodily aspects of compassion. It involves organising being with patients, playing games, anticipating disruption and taking them outside for cigarettes. Practitioners described being aware that these practical, bodily activities could lead to patients ‘opening up’, disclosing their interior concerns and enabling practical, compassionate mental health work to take place. In contrast, the second, organisational repertoire, concerns organisational constraints on compassionate practice. The shortage of staff, the record-keeping and internal processes of quality control were seen as time-greedy and apt to detract from contact with patients. The findings are discussed in relation to Bourdieu and Merleau-Ponty's phenomenological accounts of practice and habit and set in context in the growing interest in placing compassion centrally in healthcare. We also explore how the exercise of compassion in the way our participants describe it can afford the more effective exercise of medical power

When Feedback Interventions Backfire: Why Higher Performance Feedback May Result in Lower Self-Perceived Competence and Satisfaction with Performance

In relative performance evaluation systems, appraisers may choose to adopt stricter or laxer evaluation criteria. When laxer (vs. stricter) criteria are used, higher absolute performance evaluations become easier (vs. harder) to achieve. Thus, each appraisee's absolute performance feedback and the mean of the distribution of absolute performance feedback are shifted upward (vs. downward). Yet, relative performance remains constant. When evaluation outcomes depend solely on relative performance, can the adoption of laxer (vs. stricter) criteria-leading to higher absolute performance feedback but no change in relative performance-influence appraisees' satisfaction with performance? Despite the ubiquity of such systems in organizations, research has not addressed this question. This article points to an important gap between practitioners' beliefs and research findings. We show that while most appraisers believe that higher absolute performance feedback will automatically result in more satisfaction with performance, the opposite may also happen. Specifically, we find that appraisees with a stronger (vs. weaker) chronic or contextual need to engage in social comparison are more satisfied with lower (vs. higher) absolute performance feedback. Overall, we demonstrate why and how feedback interventions in relative performance evaluation systems may backfire, and suggest a set of practical guidelines for maximizing appraisees' satisfaction with performance in such systems

Using source-specific models to test the impact of sediment source classification on sediment fingerprinting

Sediment fingerprinting estimates sediment source contributions directly from river sediment. Despite being fundamental to the interpretation of sediment fingerprinting results, the classification of sediment sources and its impact on the accuracy of source apportionment remain underinvestigated. This study assessed the impact of source classification on sediment fingerprinting based on diffuse reflectance infrared Fourier transform spectrometry (DRIFTS), using individual, source-specific partial least-squares regression (PLSR) models. The objectives were to (a) perform a model sensitivity analysis through systematically omitting sediment sources and (b) investigate how sediment source-group discrimination and the importance of the groups as actual sources relate to variations in results. Within the Aire catchment (United Kingdom), five sediment sources were classified and sampled (n = 117): grassland topsoil in three lithological areas (limestone, millstone grit, and coal measures); riverbanks; and street dust. Experimental mixtures (n = 54) of the sources were used to develop PLSR models between known quantities of a single source and DRIFTS spectra of the mixtures, which were applied to estimate source contributions from DRIFTS spectra of suspended (n = 200) and bed (n = 5) sediment samples. Dominant sediment sources were limestone topsoil (45 ± 12%) and street dust (43 ± 10%). Millstone and coals topsoil contributed on average 19 ± 13% and 14 ± 10%, and riverbanks 16 ± 18%. Due to the use of individual PLSR models, the sum of all contributions can deviate from 100%; thus, a model sensitivity analysis assessed the impact and accuracy of source classification. Omitting less important sources (e.g., coals topsoil) did not change the contributions of other sources, whereas omitting important, poorly-discriminated sources (e.g., riverbank) increased the contributions of all sources. In other words, variation in source classification substantially alters source apportionment depending on source discrimination and source importance. These results will guide development of procedures for evaluating the appropriate type and number of sediment sources in DRIFTS-PLSR sediment fingerprinting

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Assessing and mitigating large wood-related hazards in mountain streams: recent approaches

The assessment and mitigation of floods in mountain streams, when large wood (LW) is transported, pose several challenges. The process chain consisting of flood propagation, LW recruitment, entrainment, transport, and entrapment triggers, at critical sections such as bridges, unexpected and exacerbated impacts to the exposed built environment. We provide a review on the recent advances in modelling LW dynamics during extreme river floods through computational approaches. Moreover, we describe how scaled flume experiments can enhance process understanding at critical flow sections such as bridges to address risk mitigation problems. Additionally, we present a framework based on Formative Scenario Analysis (FSA) to allow for expert knowledge integration and to subsequently derive consistent hazard process scenarios in steep mountain streams where the application of computational approaches is less reliable. Finally, we discuss how the application of the presented set of assessment methods can support integral flood risk management by explicitly considering LW dynamics since the effectiveness of mitigation critically depends on the acquired process understanding