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Autism spectrum conditions (ASC) and borderline personality disorder (BPD) have overlapping symptom profiles. Dialectical behaviour therapy (DBT) is an established treatment for self-harm and BPD, but little research has investigated the outcomes of DBT for ASC populations. This exploratory service evaluation aims to investigate the outcomes of a comprehensive DBT programme for adolescents with a diagnosis of emerging BPD and a co-occurring ASC diagnosis as compared to those without an ASC diagnosis.

Differences from the start to end of treatment in the frequency of self-harming behaviours, BPD symptoms, emotion dysregulation, depression, anxiety, the number of A&E attendances and inpatient bed days, education and work status, and treatment non-completion rates were analysed for those with an ASC diagnosis, and compared between those with an ASC diagnosis and those without.

Significant medium to large reductions in self-harming behaviours, BPD symptoms, emotion dysregulation and inpatient bed days were found for those with an ASC diagnosis by the end of treatment. There were no significant differences between those with an ASC and those without in any outcome or in non-completion rates. These findings indicate that DBT may be a useful treatment model for those with an ASC diagnosis, though all results are preliminary and require replication.

To the best of the authors’ knowledge, this is the first study to report the outcomes of a comprehensive DBT programme for adolescents with an ASC diagnosis, and to compare the changes in outcomes between those with a diagnosis and those without.

The outbreak of the COVID-19 pandemic has significantly impacted healthcare systems, presenting unforeseen challenges that necessitated the implementation of change management strategies to adapt to the new contextual conditions. This study aims to analyze organizational changes within the total hip replacement (THR) surgery pathway at multiple levels, including macro, meso and micro. It employs data triangulation from various sources to gauge the complexity of the change process and comprehend how multi-level decision-making influenced an unexpected shift.

A multicentric, single in-depth case study was conducted using a mixed-methods approach. Data sources included patient-reported outcome measures specific to the THR pathway and carefully structured in-depth interviews administered to managers and clinicians in two healthcare organizations serving the same population.

Decisions made at the macro level resulted in an overall reduction in surgical activities. Organizational changes at the meso level led to a complete cessation or partial reorganization of activities. Micro-level actions for change and adaptation revealed diverse and fragmented change management strategies.

Organizations with segmented structures may require a robust and structured department for coordinating change management responses to prevent the entire system from becoming stuck in the absorptive phase of change. However, it is important to recognize that absorptive solutions can serve as a starting point for genuine innovations in change management.

The utilization of data triangulation enables the authors to visualize how specific changes implemented in response to the pandemic have influenced the observed outcomes. From a managerial perspective, it provides insights into how future innovations could be introduced.

This discussion paper aims to further explore narcissistic vulnerability as a psychological concept in relation to stalking, adding to the literature base by resurrecting this focus and exploring practical implications of this association through proposing a schema therapy (ST) approach.

Stalking results from an interaction of circumstances and a vulnerable personality. Understanding the psychology of those who stalk, before and during stalking episodes, is pivotal in helping the person stalking to desist and thus protect victims. Knowing how to most effectively intervene at the earliest opportunity with those stalking is an area receiving renewed attention. Not least due to the improved identification of stalking, but also the continued absence of empirical evidence on effective intervention approaches. This paper sets out to explore the utility of ST with stalking cases.

Recent research undertaken by Wheatley et al. (2020) with men who had stalked and were detained in prison within the UK highlighted narcissistic vulnerability as a key feature in their personalities. The original study provided support for the linked conceptualisations of narcissistic vulnerability, preoccupied attachment styles and the phenomenon of stalking. This paper extended discussions to explore the utility of ST to address narcissistic vulnerability in stalking cases.

This is an original discussion paper combining research with stalking cases, practitioner specialism, psychological theory and existing empirical literature to argue for the value of ST for addressing stalking.

This paper aims to illustrate by means of a case study how HKT-R Spider reference profiles of recidivists and non-recidivists may be supportive in leave decisions.

The authors describe what is known for recidivists and non-recidivists about changes in risk factors during treatment. The HKT-R Spider is introduced. By comparing a case study to group profiles, the authors illustrate how discussions about leave may be rationalised. From a study among 278 patients to explore the profiles, the authors report the inter agreement, and differences between recidivists and non-recidivists of the clinical HKT-R factors. Intra correlation coefficients, Wilcoxon signed ranks test and independent and paired t-tests are applied. To explore which combination of factors are discriminating between both groups, the authors also performed logistic regression analyses at six treatment stages.

The inter agreement reliability and internal consistency of the clinical HKT-R scale were acceptable to good in all six stages studied. The HKT-R Spider and profiles can be used to assist in evidence-informed decision-making about leave.

Globally recidivists had somewhat higher levels of clinical risk factors at all six decision moments, but the interpretation of HKT-R Spiders profiles should always be adapted to the individual’s context.

Applying the HKT-R Spider reference profiles on individual cases may structure and rationalize discussions lead to decisions based on clinical facts.

This paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of “upstreamist”, health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department.

Patients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019–31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of “upstreamist” system leadership to advance the integration of health care.

Out of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with “upstreamist” system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED.

At a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services.

This research was a large-scale quantitative study drawing upon data from one hospital in the UK to identify risk factors for URV. This quality metric can generate important data to inform the development of integrated health and care services. Further research is required to review URV data for the whole of the NHS and with the new Integrated Health and Care Boards, there is a new impetus to push for this metric to provide robust data to prioritise the need to develop integrated services where there are gaps.

To the best of the authors’ knowledge, this is the first large-scale study of its kind to generate whole hospital data on risk factors for URVs to the emergency department. The URV is an important global quality metric and will continue to generate important data on those patients with specific complaints who return back to the emergency department. This is a critical time for the NHS and at the same time an important opportunity to develop “Esther” patient-centred approaches in the design of integrated health and care services.

This paper aims to explore examine the therapeutic potential of head-mounted display (HMD)-based Virtual Reality Relaxation Therapy (VRRT) sessions for people individuals with dementia in Jordan.

This cross-sectional survey recruited 75 dementia-diagnosed elderly individuals from three Jordanian care homes. A VRRT intervention comprising 10 tailored RT sessions held over the course of five weeks was administered to the participants. Apathy, cognitive performance, anxiety and depression were evaluated before and after the intervention to determine any changes. The Person-Environment Apathy Rating Scale's (PEARS) Arabic translation's validity and reliability were also evaluated.

The VRRT intervention yielded noteworthy results in reducing apathy, as indicated by a substantial decrease in PEARS scores from 17.20 to 11.15. The findings of the study revealed that the participants demonstrated enhanced cognitive abilities, as evidenced by a significant rise in their Saint Louis University Mental Status ratings, which increased from 15.11 to 19.70. The levels of anxiety and depression exhibited a significant decrease subsequent to the implementation of VRRT, with anxiety levels decreasing from 13.66 to 8.23 and depression levels decreasing from 13.62 to 9.33. Furthermore, a notable 70% of participants demonstrated statistically significant decreases in indifference.

This study makes a significant contribution to the advancement of innovative treatment approaches aimed at addressing the needs of the aging population, hence enhancing health outcomes and raising the quality of care in Jordan.

The effectiveness of VRRT in reducing apathy among Jordanian senior citizens residing in nursing homes has not yet been fully investigated. Therefore, this paper seeks to assess the effectiveness of HMD-based VRRT by conducting pre- and post-intervention evaluations. This research aims to provide valuable insights into the applicability and significance of VRRT in the Jordanian context, contributing to the development of culturally appropriate and cutting-edge therapeutic interventions for older individuals in Jordan. Through this study, the authors aim to promote improved health and elevated standards of care for this population.

The overall aim of this chapter is to focus on the process of, and issues warranting consideration for, the evaluation of educational interventions. In particular, to outline some key considerations for educators to follow when assessing the evidence-base for interventions they might be considering for use in their practice. Also, important considerations for those wishing to evaluate the effectiveness of an intervention they have initiated, as well as a useful checklist which summarises this all. Recognising that some readers of this chapter might be practitioners rather than researchers, it has been written with the practitioner in mind in, hopefully, a simple and practical way. There are, however, further opportunities for additional reading and resources signposted throughout for those who wish to read up on any of these areas more. In addition to those cited throughout and referenced in the Reference List at the end. There is also a section that provides the author’s Additional Recommended Readings and Resources to follow-up on. Readers might also want to refer to Chapter 3 in this book which discusses Single versus Multiple PPI approaches.

The study aims to drive conceptual clarity around resistance to information technology projects, integrating multiple facets of the phenomenon from earlier studies.

The study conducts a meta-synthesis of qualitative studies on resistance to technology projects; it analyzes those studies at a case-specific level, compares and contrasts emergent concepts against each other, and “translates” those to the rest of the studies. The study uses the seven-step meta-ethnography method by Noblit and Hare to reciprocally translate emergent concepts to construct the conceptual model.

Through meta-synthesis, the study derives a new conceptual model for resistance to information technology projects, exemplifying how the identified antecedents create user resistance and how the phenomenon progresses within organizations.

This study enriches the observations and conclusions of past individual studies while explicating various facets of the mechanisms that generate and progress technology resistance within organizations. It offers fresh insights into the equivocal nature of the phenomenon and the distinctive ways it progresses from individual to group level.

Many ambitious and costly digital transformation efforts do not succeed due to user resistance. Understanding the mechanisms that create user resistance can help organizations manage technology projects better, thereby reducing the technology assimilation gap and protecting returns on related investments.

There have been extensive studies on technology acceptance (enablers) within organizations, while those relating to technology inhibitors are somewhat limited. However, the symmetry of understanding between enablers and inhibitors is vital for organizations to assimilate promising technologies and transform their business models. This model uses a new lens of sensemaking theory to explain how the antecedents trigger perceived threats and resistance behavior; it highlights the nuances around the development of resistance within individuals and its progression to groups. The resultant model offers better generalizability in organizational contexts.

When scientific information is unclear about the health benefits of foods, people choose to react in different ways. Using a posttest-only control group design, the authors tested how balanced and nonfactual information available on YouTube influences public perception of organic foods.

The authors randomly assigned participants (N = 640) from a southern US land grant university to watch one video: balanced news, nonfactual news, or control. All participants indicated changes in perception about organic foods immediately after the video. The authors analyzed the data using one-way and two-way ANOVA.

The nonfactual news video had the most influence on public perception of organic foods. Results confirmed that the effect of nonfactual information was more for individuals with preexisting beliefs consistent with the message communicated and individuals exposed to average to high levels of health and diet news.

The authors recommend regulatory changes in marketing strategies related to organic foods in the US that encourage balanced information about organic foods rather than promoting credence attributes of organic foods using persuasive information.

The authors findings suggest that, when scientific information about the health benefits of foods is unclear, communication activities should aim to increase healthy skepticism considering the audience's preexisting beliefs and frequency of health and diet news exposure.

This study explored how food allergies have affected food-related behaviors and quality of life of college students with food allergies and identified factors influencing food choice decisions among this group of individuals.

One-on-one interviews were conducted with 26 college students with self-reported or clinically diagnosed food allergies, recruited from two universities located in the southern region of the United States. The participants were asked a series of questions based on a semi-structured discussion guide. Each interview lasted about 30 min; all interviews were audio-recorded and transcribed verbatim. The transcriptions were coded independently by three researchers, and themes were identified.

Food allergies affected the participants' food-related behaviors, including eating, food preparation and shopping, as well as some aspects of their quality of life. Individual factors, such as mood, other diseases, cultural background and sensory properties, also influenced food choices. Friends and families were the two most important social influencers of food choices. Regarding physical environmental factors, cost, convenience, value and variety were considered important in selecting food. However, the participants' food choices were less influenced by food advertisements and social media. Additionally, experiences and complex cuisines were also key factors in making food choices.

Theoretically, this qualitative study applied a food choice decision framework in the context of college students with food allergies. Practical recommendations are provided, particularly to campus dining facilities, to fulfill the needs of college students with food allergies.

This study advanced the understanding of the complexity of food choice decision-making among college students with food allergies. A path diagram specific to food choice among college students with food allergies was developed based on the results of this study. This study also highlighted that food allergy management would involve various behavioral changes and revealed that the food choices are influenced by a wide range of factors.