Background: Elderly patients with cardiovascular disease are relatively undertreated and undertested. Objectives: To investigate whether, and how, individual doctors are influenced by a patient's age in their investigation and treatment of angina. Design: Process-based judgment analysis using electronic patients, semistructured interviews. Setting: Primary Care, Care of the Elderly and Cardiology in England. Participants: Eighty five doctors: 29 cardiologists, 28 care of the elderly specialists and 28 general practitioners (GPs). Main outcome measures: Testing and treatment decisions on hypothetical patients. Results: Forty six per cent of GPs and care of the elderly doctors, and 48% of cardiologists treated patients aged 65+ differently to those under 65, independent of comorbidity. This effect was evident on several decisions: elderly patients were less likely to be prescribed a statin given a cholesterol test, referred to a cardiologist, given an exercise tolerance test, angiography and revascularisation; more likely to have their current prescriptions changed and to be given a follow-up appointment. There was no effect of specialty, gender or years of training on influence of patient age. Those doctors who were influenced by age were on average five years older than those who were not. Interviews revealed that some doctors saw old age as a contraindication to treat. Conclusions: Age, independent of comorbidity, presentation and patients' wishes, directly influenced decision-making about angina investigation and treatment by half of the doctors in the primary and secondary care samples. Doctors explicitly reasoned about the direct influence of age and age-associated influences.
A sequence of auditory stimuli interpolated between the initial presentation of a tone and a comparison tone impairs recognition performance. Notably, the impairment is much less with interpolated speech than with tones. Six experiments converge on the conclusion that this pattern of impairment is due more to the organization of the interpolated sequence than to its similarity to the to-be-remembered standard. Factors that contribute to the coherence of the interpolated sequence into a stream distinct from the initial tone are primary determinants of the level of impairment. This is demonstrated by manipulating factors that contribute to the coherence of the interpolated sequence by the action of temporal, spatial, timbral, and tonal attributes. However, the relative immunity of recognition performance to the interpolation of unprocessed digit sequences is not explained wholly by such coherence.
The consequences of Serious Mental Illness (SMI) on parent and child outcomes can be profound. Supporting parents to manage their caregiving roles alongside parental SMI successfully has been recognised as a public health priority. To meet this priority and develop effective and acceptable interventions, it is imperative that parents’ experiences and support needs are understood. This systematic review aimed to synthesise qualitative research that explored parents’ experiences and perceptions of the impact of SMI on their parenting and their corresponding support needs. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. Five databases were searched for terms associated with SMI, parenting, and qualitative research. Twenty-nine studies involving 562 parents who experienced SMI met inclusion criteria, and the methodological quality of included studies was appraised using the Critical Appraisal Skills Programme. After findings were synthesised using thematic synthesis, six themes were identified: (1) The constrained parent, (2) parenting difficulties, (3) the strained child, (4) inescapable threat, (5) combatting threat, and (6) wrap-around support needs. Novel insights into the centrality of SMI-related parenting difficulties and threat perceptions across parent, family, healthcare, and wider social systems on strained parent–child and distanced parent–support relationships were highlighted. Systemic practice change initiatives via compassionate and inclusive system-wide support were recommended.
This study suggests that cognitive behavioral therapy (CBT) for major depressive disorder may help those who experience sudden gains to sustain this symptom improvement over the course of treatment and follow-up. The sustained behavioral focus in behavioral activation (BA) therapy may help individuals who experience a depression spike to apply concrete emotion regulation strategies that are also useful over the 18-month follow-up period.
ObjectivesPsychosis can present parents with complex parenting challenges and significant adverse outcomes for parents and their children have been reported. However, remarkably little is known about how parenting is experienced by these parents. Therefore, this qualitative study aimed to understand the lived experiences of parents with psychosis, including how parenting support was experienced.Design and MethodsUsing interpretative phenomenological analysis (IPA), eight biological parents (five mothers and three fathers) with psychosis were recruited and interviewed from early intervention in psychosis services in the Northwest of England.ResultsThree superordinate themes and seven subordinate themes were identified. Theme 1 ‘Living with the Struggle: Painfully Disconnected’ captured a persistent parenting struggle that distanced parents from their children and support due to all‐consuming experiences of psychosis, fear and risk‐focused service support. Theme 2 ‘Desired and Vulnerable Position: Comfortably Connected’ captured parental experiences of symptom relief through connection with their children, alongside parental need to be integrated with the systems around them. Theme 3 ‘Exposed: Parenting Under a Spotlight’ represented parental experiences of inescapable observation and judgement from the systems around them.ConclusionsNovel insights into the role of misaligned parent and service priorities in parental perceptions of powerlessness, shame and disconnection from their children, valued parenting identities, and system supports are presented. Systemic interventions that target stigma, provide system‐wide psychoeducation and promote person‐centred, compassionate and meaningful connections between parents and the systems they live within are needed to promote better parenting outcomes.
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