THE IMPACT OF SOCIAL SUPPORT AND FAMILY RESILIENCE ON PARENTAL STRESS IN FAMILIES WITH A CHILD DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER

Families of children with autism spectrum disorders (ASD) experience significant stress relative to other families. To date, little research has examined the relationship between social support, family resilience and parental stress in families with a child diagnosed with ASD. This study explored the links between perceived social support, family resilience and parental stress in a sample of 50 primary caregivers of children between the ages of 6 and 12 diagnosed with ASD. The Social Support Index (SSI), Family Resilience Assessment Scale (FRAS), and the Parenting Stress Index-Short Form (PSI-SF) were used in this cross-sectional study. Results indicate that most families experienced clinically high levels of stress. Greater family resilience was associated with lower levels of stress. Unexpectedly, higher levels of perceived social support were associated with increased parental stress. This may suggest that families who are experiencing clinically significant levels of stress seek out community supports at higher rates than other families. It may also suggest that some social connections - such as attending religious services and parenting groups - may potentially elevate stress in parents of children with ASD. This and other possibilities are explored with implications for social work intervention. The findings of this study shed new light on the role of social support and family resilience on parental stress in families with a child diagnosed with ASD. Since the results of this study show that more resilient families report less parental stress clinicians need to focus on programming for families that enhance key processes of family resilience and reduce stress

Taming uncertainty? Performance, personalisation and practices of patient safety in an Australian mental health service

The patients implied by the term patient safety are most commonly lying on an operating table or in a hospital bed. They are cast as potential victims of harm resulting from their encounters with a health service, harm which is often attributed to malfunctioning systems or toxic cultures of care. Mental health patients and professionals, and the particularities of the illnesses and interventions which structure their encounters, have often been ignored in this discourse. This study is about what patient safety means from the perspective of professionals in a mental health context, where: risk type and severity are contested and unpredictable; patients are often viewed as a threat to their own safety; and the professional role in keeping patients safe extends to interest in their social and economic circumstances. Emphasis in patient safety research is often given to the causes and consequences of error and harm, but this research brings the day-to-day unfolding of professional work to the fore. This shift in perspective allows for a detailed examination of the strategies staff members use to enact safety, and a concomitant exploration of the degree to which policies and rules penetrate practice. This has been accomplished through the ethnographically-informed design of an inquiry into understandings and enactments of safe care among a multidisciplinary range of staff in a community mental health team and an acute inpatient psychiatric unit in New South Wales, Australia. In the course of daily work, these professionals are found to negotiate a tension between two versions of patient safety. In the fluidity of everyday practice, the safe patient is only ever a transient, fragile phenomenon anchored to a particular time, place, and relationship between clinician and patient. However, the expectation of policymakers, Coroners, and members of the public is that the mental health service should act as guarantor of safety. Theoretical frameworks of socio-material ontology are used to tease out the implications of these sometimes contradictory demands, and to explore the possibility of a patient safety which prioritises therapeutic impact on the patient rather than only the management of their risk

Antiferromagnetic and Orbital Ordering on a Diamond Lattice Near Quantum Criticality

We present neutron scattering measurements on powder samples of the spinel FeSc2S4 that reveal a previously unobserved magnetic ordering transition occurring at 11.8(2)~K. Magnetic ordering occurs subsequent to a subtle cubic-to-tetragonal structural transition which distorts Fe coordinating sulfur tetrahedra lifting the orbital degeneracy. The application of 1~GPa hydrostatic pressure appears to destabilize this N\'eel state, reducing the transition temperature to 8.6(8)~K and redistributing magnetic spectral weight to higher energies. The relative magnitudes of ordered $\langle m \rangle^2\!=\!3.1(2)$ and fluctuating moments $\langle \delta m \rangle^2\!=\!13(1)$ show that the magnetically ordered ground state of FeSc2S4 is drastically renormalized and in proximity to criticality.Comment: 16 pages, 12 figure

Health professional networks as a vector for improving healthcare quality and safety: a systematic review

Background: While there is a considerable corpus of theoretical and empirical literature on networks within and outside of the health sector, multiple research questions are yet to be answered. Objective: To conduct a systematic review of studies of professionals' network structures, identifying factors associated with network effectiveness and sustainability, particularly in relation to quality of care and patient safety. Methods: The authors searched MEDLINE, CINAHL, EMBASE, Web of Science and Business Source Premier from January 1995 to December 2009. Results: A majority of the 26 unique studies identified used social network analysis to examine structural relationships in networks: structural relationships within and between networks, health professionals and their social context, health collaboratives and partnerships, and knowledge sharing networks. Key aspects of networks explored were administrative and clinical exchanges, network performance, integration, stability and influences on the quality of healthcare. More recent studies show that cohesive and collaborative health professional networks can facilitate the coordination of care and contribute to improving quality and safety of care. Structural network vulnerabilities include cliques, professional and gender homophily, and over-reliance on central agencies or individuals. Conclusions: Effective professional networks employ natural structural network features (eg, bridges, brokers, density, centrality, degrees of separation, social capital, trust) in producing collaboratively oriented healthcare. This requires efficient transmission of information and social and professional interaction within and across networks. For those using networks to improve care, recurring success factors are understanding your network's characteristics, attending to its functioning and investing time in facilitating its improvement. Despite this, there is no guarantee that time spent on networks will necessarily improve patient care

Randomized Clinical Trial of Cognitive Behavioral Therapy (CBT) versus Acceptance and Commitment Therapy (ACT) for Mixed Anxiety Disorders

Objective—Randomized comparisons of acceptance-based treatments with traditional cognitive behavioral therapy (CBT) for anxiety disorders are lacking. To address this research gap, we compared acceptance and commitment therapy (ACT) to CBT for heterogeneous anxiety disorders. Method—One hundred twenty eight individuals (52% female, mean age = 38, 33% minority) with one or more DSM-IV anxiety disorders began treatment following randomization to 12 sessions of CBT or ACT; both treatments included behavioral exposure. Assessments at pre-treatment, post-treatment, 6-month, and 12-month follow-up measured anxiety specific (principal disorder Clinical Severity Ratings [CSR], Anxiety Sensitivity Index, Penn State Worry Questionnaire, Fear Questionnaire avoidance) and non-anxiety specific (Quality of Life Index [QOLI], Acceptance and Action Questionnaire-16 [AAQ]) outcomes. Treatment adherence and therapist competency ratings, treatment credibility, and co-occurring mood and anxiety disorders were investigated. Results—CBT and ACT improved similarly across all outcomes from pre- to post-treatment. During follow-up, ACT showed steeper CSR improvements than CBT (p \u3c .05, d = 1.33) and at 12-month follow-up, ACT showed lower CSRs than CBT among completers (p \u3c .05, d = 1.05). At 12-month follow-up, ACT reported higher AAQ than CBT (p = .08, d = .42; Completers: p \u3c .05, d = .59) whereas CBT reported higher QOLI than ACT (p \u3c .05, d = .43). Attrition and comorbidity improvements were similar, although ACT utilized more non-study psychotherapy at 6-month follow-up. Therapist adherence and competency were good; treatment credibility was higher in CBT. Conclusions—Overall improvement was similar between ACT and CBT, indicating that ACT is a highly viable treatment for anxiety disorders

The social and behavioral influences (SBI) study: study design and rationale for studying the effects of race and activation on cancer pain management

Background Racial disparities exist in the care provided to advanced cancer patients. This article describes an investigation designed to advance the science of healthcare disparities by isolating the effects of patient race and patient activation on physician behavior using novel standardized patient (SP) methodology. Methods/design The Social and Behavioral Influences (SBI) Study is a National Cancer Institute sponsored trial conducted in Western New York State, Northern/Central Indiana, and lower Michigan. The trial uses an incomplete randomized block design, randomizing physicians to see patients who are either black or white and who are “typical” or “activated” (e.g., ask questions, express opinions, ask for clarification, etc.). The study will enroll 91 physicians. Discussion The SBI study addresses important gaps in our knowledge about racial disparities and methods to reduce them in patients with advanced cancer by using standardized patient methodology. This study is innovative in aims, design, and methodology and will point the way to interventions that can reduce racial disparities and discrimination and draw links between implicit attitudes and physician behaviors

A realist evaluation of the role of communities of practice in changing healthcare practice

<p>Abstract</p> <p>Background</p> <p>Healthcare organisations seeking to manage knowledge and improve organisational performance are increasingly investing in communities of practice (CoPs). Such investments are being made in the absence of empirical evidence demonstrating the impact of CoPs in improving the delivery of healthcare. A realist evaluation is proposed to address this knowledge gap. Underpinned by the principle that outcomes are determined by the context in which an intervention is implemented, a realist evaluation is well suited to understand the role of CoPs in improving healthcare practice. By applying a realist approach, this study will explore the following questions: What outcomes do CoPs achieve in healthcare? Do these outcomes translate into improved practice in healthcare? What are the contexts and mechanisms by which CoPs improve healthcare?</p> <p>Methods</p> <p>The realist evaluation will be conducted by developing, testing, and refining theories on how, why, and when CoPs improve healthcare practice. When collecting data, context will be defined as the setting in which the CoP operates; mechanisms will be the factors and resources that the community offers to influence a change in behaviour or action; and outcomes will be defined as a change in behaviour or work practice that occurs as a result of accessing resources provided by the CoP.</p> <p>Discussion</p> <p>Realist evaluation is being used increasingly to study social interventions where context plays an important role in determining outcomes. This study further enhances the value of realist evaluations by incorporating a social network analysis component to quantify the structural context associated with CoPs. By identifying key mechanisms and contexts that optimise the effectiveness of CoPs, this study will contribute to creating a framework that will guide future establishment and evaluation of CoPs in healthcare.</p

Comparative evaluation of the treatment efficacy of suberoylanilide hydroxamic acid (SAHA) and paclitaxel in ovarian cancer cell lines and primary ovarian cancer cells from patients

BACKGROUND: In most patients with ovarian cancer, diagnosis occurs after the tumour has disseminated beyond the ovaries. In these cases, post-surgical taxane/platinum combination chemotherapy is the "gold standard". However, most of the patients experience disease relapse and eventually die due to the emergence of chemotherapy resistance. Histone deacetylase inhibitors are novel anticancer agents that hold promise to improve patient outcome. METHODS: We compared a prototypic histone deacetylase inhibitor, suberoylanilide hydroxamic acid (SAHA), and paclitaxel for their treatment efficacy in ovarian cancer cell lines and in primary patient-derived ovarian cancer cells. The primary cancer cells were isolated from malignant ascites collected from five patients with stage III ovarian carcinomas. Cytotoxic activities were evaluated by Alamar Blue assay and by caspase-3 activation. The ability of SAHA to kill drug-resistant 2780AD cells was also assessed. RESULTS: By employing the cell lines OVCAR-3, SK-OV-3, and A2780, we established SAHA at concentrations of 1 to 20 μM to be as efficient in inducing cell death as paclitaxel at concentrations of 3 to 300 nM. Consequently, we treated the patient-derived cancer cells with these doses of the drugs. All five isolates were sensitive to SAHA, with cell killing ranging from 21% to 63% after a 72-h exposure to 20 μM SAHA, while four of them were resistant to paclitaxel (i.e., <10% cell death at 300 nM paclitaxel for 72 hours). Likewise, treatment with SAHA led to an increase in caspase-3 activity in all five isolates, whereas treatment with paclitaxel had no effect on caspase-3 activity in three of them. 2780AD cells were responsive to SAHA but resistant to paclitaxel. CONCLUSION: These ex vivo findings raise the possibility that SAHA may prove effective in the treatment of paclitaxel-resistant ovarian cancer in vivo

Professional conceptualisation and accomplishment of patient safety in mental healthcare: an ethnographic approach

<p>Abstract</p> <p>Background</p> <p>This study seeks to broaden current understandings of what patient safety means in mental healthcare and how it is accomplished. We propose a qualitative observational study of how safety is produced or not produced in the complex context of everyday professional mental health practice. Such an approach intentionally contrasts with much patient safety research which assumes that safety is achieved and improved through top-down policy directives. We seek instead to understand and articulate the connections and dynamic interactions between people, materials, and organisational, legal, moral, professional and historical safety imperatives as they come together at particular times and places to perform safe or unsafe practice. As such we advocate an understanding of patient safety 'from the ground up'.</p> <p>Methods/Design</p> <p>The proposed project employs a six-phase data collection framework in two mental health settings: an inpatient unit and a community team. The first four phases comprise multiple modes of focussed, unobtrusive observation of professionals at work, to enable us to trace the conceptualisation and enactment of safety as revealed in dialogue and narrative, use of artefacts and space, bodily activity and patterns of movement, and in the accomplishment of specific work tasks. An interview phase and a social network analysis phase will subsequently be conducted to offer comparative perspectives on the observational data. This multi-modal and holistic approach to studying patient safety will complement existing research, which is dominated by instrumentalist approaches to discovering factors contributing to error, or developing interventions to prevent or manage adverse events.</p> <p>Discussion</p> <p>This ethnographic research framework, informed by the principles of practice theories and in particular actor-network ideas, provides a tool to aid the understanding of patient safety in mental healthcare. The approach is novel in that it seeks to articulate an 'anatomy of patient safety' as it actually occurs, in terms of the networks of elements coalescing to enable the conceptual and material performance of safety in mental health settings. By looking at <it>how </it>patient safety happens or does not happen, this study will enable us to better understand how we might in future productively tackle its improvement.</p