A 2019, 'The consequences of traumatic brain injury from the classroom to the courtroom: understanding pathways through structural equation modelling', Disability and Rehabilitation.

The external environment within which UK charitable hospice care operates is changing. More people are dying with conditions other than cancer; however, this disease still dominates modern hospice care. Organisational institutionalism offers a theoretical lens through which to consider the challenges facing the hospice movement. Concepts such as legitimacy, decoupling, deinstitutionalisation, and reinstitutionalisation can help hospice leaders understand the challenges of change and some of the strategies that can be employed at local and national levels. This paper outlines a number of environmental and influencing factors driving and impacting change. A model of institutional change is introduced, explored, and considered from the context of hospice. When it comes to understanding change, legitimacy is a major concept introduced to challenge and pose questions for hospices to address. This paper proposes a model demonstrating a perspective regarding the current structure of services within hospice organisations. The model argues that only hospice care for people with cancer is truly institutionalised and that other areas of care lack comparable legitimacy. It provides 3 directions for hospice in addressing the challenges faced: (i) decoupling, (ii) deinstitutionalisation then reinstitutionalisation, and (iii) a new social movement. The paper concludes with recommendations for future consideration.

BackgroundResearch shows that VR is effective as a tool in managing acute pain (Hoffman & Patterson, 2000; Hoffman & Garcia-Palacios, 2001; Hoffman & Chambers, 2011). There is also evidence that meditation is beneficial in reducing persistent pain, that the effect is cumulative and builds overtime (Morone et al., 2008). We have developed a VR Guided Meditation app narrated by Sir David Attenborough and are planning a mixed method randomised controlled trial to examine whether an immersive meditation experience enables palliative patients to enter a meditative state more easily and achieve long term pain reduction.AimTo test the feasibility and acceptability of using VR Guided Meditation in a hospice setting.Specific Objectives• Compare two types of hardware.• Establish whether the headsets are comfortable.• Find out if the technique has an impact on pain.• Ascertain feedback.Method• Hospice patients were offered the opportunity to participate.• The VR Gear which connects to a mobile phone was compared with an Oculus Rift which connects to a computer. Each was used for 10 min.• Feedback via a structured questionnaire.Results• Participants: six female, 12 male. Age range 33 to 84 years. Sixteen with cancer, two with neurological conditions.• Preference for Oculus Rift was unanimous.• All enjoyed the experience and wished to repeat it.• All described the headsets as comfortable.• None experienced side effects.• All experienced a reduction in pain, ranging from 20% to complete reduction.• Comments: ‘first time in months I forgot I had pain’; ‘ could have stayed there forever’; ‘wonderful’; ‘so distracted I forgot my pain’; ’in another world and didn’t feel a bit of pain.’ConclusionVR Guided Meditation is effective in distracting patients from their pain and it is acceptable and feasible to use in a hospice setting. Research is needed to establish whether its use enables patients to enter a meditative state more effectively leading to longer term benefits.

Objective: To establish whether poor parental supervision is associated with head injury and self-reported reactive aggression (ie, aggression in response to perceived provocation or threat) in adolescents in a Young Offender's Institute, by examining correlations between these variables. Understanding this population is important, as they are at a key pivotal age for intervention to prevent lifelong reoffending. Methods: Ninety-six male participants aged 16 to 18 years were recruited from a UK Young Offender's Institute. Self-report measures of remembered parenting, reactive aggression, and head injury history were administered during individual interviews. Results: Seventy-four percent of participants reported having experienced a lifetime traumatic brain injury (TBI), and 46% of participants reported experiencing at least 1 TBI leading to a loss of consciousness (LOC). We found that poor parental supervision, length of LOC following TBI, and self-reported reactive aggression were all positively correlated. Conclusions: Findings show that there are correlational relationships between poor parental supervision, length of LOC following lifetime TBI, and higher levels of self-reported reactive aggression. This suggests there may be pathways resulting from poor parental supervision leading to both TBI with LOC, and reactive aggression. We advocate for future research with longitudinal designs and larger samples to examine the nature of these interactions, and to establish whether poor parental supervision is a prospective risk factor for more TBIs leading to LOC, and reactive aggression. This is key to understanding whether parenting interventions could help to reduce the disabling effects of TBI in adolescents, and help to prevent contact with the law.

demonstrate our impact in monetary terms, how much value we bring for the money we receive. Aim Establish and deliver implementation of an impact-reporting framework -identifying outcomes, their measurement and value. This project involved a predictive social value analysis that undertook a representative example of hospice activity upon which to base later monitoring. Methods Independent company, Kingston Smith, commissioned to carry out relevant research. Mapped out plan for staff, volunteer, patient, relative and stakeholder engagement events, focus groups, surveys and telephone interviews. March 2019, report produced including end of year financial spend to calculate investment, determine impact, set up calculation model to track social value created by the hospice going forward. Results Total value of impact captured within the scope of the study. Total value that is attributable to the hospice discarding value that is created by influences outside their activity. Return on investment identifiedrepresenting social value. Final report to the Board in July 2019 highlights the detailed calculations, but importantly identifies the range of outcomes experienced by stakeholder groups. The report details the context in which outcomes are created and how impact wholly attributable to the hospice is derived including how outcomes have been valued. A sensitivity analysis will test any remaining assumptions and include a range of ratios according to the variables. Conclusions The full extent of this work will be realised over the coming year as we embed messaging about the impact of our work and its monetary value and see the response from beneficiaries, funders and the public.