Senior Leaders’ Response to Multi-Source Feedback: An Interpretive Multi-Case Study

Senior leaders play impactful and important roles in organizations they lead. Being a CEO or senior leader in an organization can sometimes be the “loneliest job” in the entire organization. They carry a significant burden on their shoulders; ensuring that the organizations they are leading continue to improve, grow and flourish. While they are “on the hook” for those outcomes, how do senior leaders ensure that they get the insight needed to grow and improve themselves? Do colleagues surrounding these leaders provide feedback on how they are doing as leaders in their respective organizations? If so, how do leaders respond to that feedback? Does it provide insight they need to become better leaders? This was an interpretive, multi-case study seeking to understand senior leaders’ perceptions and responses to feedback from others. Four senior leaders and some of their colleagues, representing different industries participated in this study. Interviews were conducted to understand not only the senior leaders’ experiences with feedback, but also the experiences their colleagues have as they provide their leader with feedback. Analysis across the cases revealed four major themes around leaders’ early experiences and their beliefs about feedback, how creating trust enabled constructive feedback to occur, leaders\u27 association of feedback with “needs improvement,” and how the disposition of the leader and the internal environment of the organization impacted the feedback leaders received. This study also provides some insight about the topic of senior leaders and feedback from current literature and research. To grow, an individual needs to understand self. Receipt of feedback provides an opportunity to gain insight that may allow a leader to get to know self better. As Oscar Wilde said, “Be yourself; everyone else is taken.

Velocity-Specific Relationships Among Eccentric and Concentric Force Velocity Profiles and Jumping Performance

The purpose of this study is to determine the relationships among force velocity profiles during eccentric only movements (eFVP), concentric only movements (cFVP), and dynamic performance during a countermovement jump (CMJ), squat jump (SJ), and drop jump (DJ). Nineteen collegiate baseball players (1.85 ± 0.04 m, 86.4 ± 8.2 kg, 21.1 ± 1.8 years) from a single NCAA Division I team performed CMJ, SJ, and DJ, drop landings from varying heights, and hex bar jumps with varying weights. FVPs were created with a linear regression using the drop landings for eFVP and hex bar jumps for cFVP, which were used to calculate slopes and area under the entire FVP and velocity-specific regions. Correlations analyzed the results with bootstrapping for 95% confidence intervals. Area under eFVP correlated with cFVP at r=0.51 (p<0.05), cFVP slope presented strong correlations with CMJ height and DJ height while eFVP slopes did not relate to jumping performance or metrics. Area under the faster regions of cFVP and eFVP produced moderate and strong relationships to jumping performance. The area under the FVP, especially when separated into velocity-specific bands, may be a key metric which can audit or provide insight into velocity-based training program effectiveness and athlete comparisons

Cost of antipsychotic polypharmacy in the treatment of schizophrenia

<p>Abstract</p> <p>Background</p> <p>This study compared the costs of antipsychotic polypharmacy for patients who initiated on 1 of the 3 most commonly prescribed atypical antipsychotics – olanzapine, quetiapine, or risperidone.</p> <p>Methods</p> <p>Data were drawn from a large, prospective, naturalistic, multi-site, nonrandomized study of treatment for schizophrenia in the United States conducted between July 1997 and September 2003. Participants who were initiated on olanzapine (N = 405), quetiapine (N = 115), or risperidone (N = 276) were followed for 1 year post initiation and compared on: (a) average daily cost of the index antipsychotic while on the index antipsychotic, (b) average daily cost of the coprescribed antipsychotics while on the index antipsychotic, (c) average daily cost of the index antipsychotic and the coprescribed antipsychotics while on the index antipsychotic, (d) total annual cost of antipsychotic medications prescribed in the year following initiation on the index antipsychotic, using propensity score-adjusted bootstrap resampling method. Average daily antipsychotic costs and total annual antipsychotic costs were also estimated using more recent (2004) antipsychotic drug prices.</p> <p>Results</p> <p>During the 1 year following initiation on the index antipsychotic, the total average daily cost of the index antipsychotic was higher for quetiapine ($15.33) than olanzapine ($13.90, p < .05) and risperidone ($11.04, p < .01), although the average daily cost of the index antipsychotic was higher for olanzapine ($10.08) than risperidone ($6.74, p < .01) or quetiapine ($6.63, p < .01). Lower total average daily costs were observed in risperidone than olanzapine or quetiapine. Significantly lower average daily cost of concomitant antipsychotic medications for olanzapine ($3.82) compared to quetiapine ($8.70, p < .01) or risperidone-initiated patients ($4.30, p < .01) contributed to the lower average daily cost of all antipsychotic medication for olanzapine-initiated patients. Each dollar spent on the index antipsychotic was accompanied by spending an additional$1.31 on concomitant antipsychotics for quetiapine compared to $0.64 for risperidone and$0.38 for olanzapine-initiated patients. A separate intent-to-treat analysis of the total annual antipsychotic cost found a significantly higher total annual antipsychotic cost for quetiapine-initiated patients ($5320) compared to olanzapine ($4536, p < .01) or risperidone ($3813, p < .01).</p> <p>Conclusion</p> <p>Prevalent antipsychotic polypharmacy adds substantial cost to the treatment of schizophrenia. Comparison of medication costs need to address the costs of all antipsychotics. A better understanding of concomitant antipsychotic costs provides a more accurate portrayal of antipsychotic medication costs in the treatment of schizophrenia.</p

Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics

BACKGROUND: Antipsychotic monotherapy is recognized as the treatment of choice for patients with schizophrenia. Simultaneous treatment with multiple antipsychotics (polypharmacy) is suggested by some expert consensus guidelines as the last resort after exhausting monotherapy alternatives. This study assessed the annual rate and duration of antipsychotic monotherapy and its inverse, antipsychotic polypharmacy, among schizophrenia patients initiated on commonly used atypical antipsychotic medications. METHODS: Data were drawn from a large prospective naturalistic study of patients treated for schizophrenia-spectrum disorders, conducted 7/1997–9/2003. Analyses focused on patients (N = 796) who were initiated during the study on olanzapine (N = 405), quetiapine (N = 115), or risperidone (N = 276). The percentage of patients with monotherapy on the index antipsychotic over the 1-year post initiation, and the cumulative number of days on monotherapy were calculated for all patients and for each of the 3 atypical antipsychotic treatment groups. Analyses employed repeated measures generalized linear models and non-parametric bootstrap re-sampling, controlling for patient characteristics. RESULTS: During the 1-year period, only a third (35.7%) of the patients were treated predominately with monotherapy (>300 days). Most patients (57.7%) had at least one prolonged period of antipsychotic polypharmacy (>60 consecutive days). Patients averaged 195.5 days on monotherapy, 155.7 days on polypharmacy, and 13.9 days without antipsychotic therapy. Olanzapine-initiated patients were significantly more likely to be on monotherapy with the initiating antipsychotic during the 1-year post initiation compared to risperidone (p = .043) or quetiapine (p = .002). The number of monotherapy days was significantly greater for olanzapine than quetiapine (p < .001), but not for olanzapine versus risperidone, or for risperidone versus quetiapine-initiated patients. CONCLUSION: Despite guidelines recommending the use of polypharmacy only as a last resort, the use of antipsychotic polypharmacy for prolonged periods is very common during the treatment of schizophrenia patients in usual care settings. In addition, in this non-randomized naturalistic observational study, the most commonly used atypical antipsychotics significantly differed on the rate and duration of antipsychotic monotherapy. Reasons for and the impact of the predominant use of polypharmacy will require further study

Creativity in Education for Nursing

The maze of academic learning is confining enough without gate- keepers periodically barring the openness of paths. This research paper is an out growth of encountering bars, solving combinations of some, and feeling a need to seek cohorts in opening more complex, alternate paths for would be rovers. I believe roving scholars need more freedom than they have today and that each needs his own way to make truth shine through creation