Literature Collection

Neonatal opiate withdrawal syndrome (NOWS), previously known as neonatal abstinence syndrome (NAS), is a growing public health concern as opiate misuse and opioid-related overdoses, from both prescription and illicit sources, continue to rise in the USA. As more than 90% of females abusing opioids are of child-bearing age, the failure to adequately address the opioid epidemic continues to negatively impact the next generations. Accurate and timely identification of infants at risk for withdrawal from in-utero exposure is critical to ensure high-quality perinatal and neonatal care. Beginning with an evaluation of current best practices and performing a literature review, we identify the challenges to current screening processes and how these limitations limit the ability to provide appropriate care to infants at the risk of withdrawal. We first describe the limitations of the available assays for the detection of opioid and opioid metabolites across different biological sources from both the mother and the infant. We then present a discussion surrounding factors that contribute to maternal willingness to disclose use. Particularly, in light of the limitations of biological screening, any barrier to maternal disclosure further complicates effective care delivery. Barriers to disclosure include legal ramifications and state policies, provider and societal behaviors and biases, and maternal factors. Moving forward, universal prenatal screening surveys coupled with enhanced outreach and education to providers centering on the limitations of both patient report and biological sampling, as well as comprehensive and supportive services for women of reproductive age with substance use disorders, are needed to both enhance detection for NOWS and improve long-term maternal-child health.

In-depth understanding of dementia carer experience can assist clinicians by providing insight into dementia onset, symptoms and management, and help conceptualize and understand the pattern of dementia progress over time and what help is needed. We undertook a qualitative study to understand dementia carers experiences of providing care and reasons for admission to a residential aged care facility (RACF). Three themes were identified: (1) Challenges in the path to diagnosis and care, leading to delays accessing support; (2) Carer role impacted by living circumstances; and (3) Variation in decision support prior to admission to a RACF. Identifying dementia carer experiences, reinforces the need for more timely diagnosis, referral for support and interventions to promote better quality of life for a people living with dementia and their carer and to delay premature RACF placement.

OBJECTIVES: To explore how primary care providers report discussing substance use with transgender and gender diverse (TGD) adult patients within the context of discussing gender-affirming interventions. METHODS: Between March and April 2022, in-depth, semi-structured qualitative interviews were conducted with 15 primary care providers who care for TGD patients in the Northeastern US. Thematic analysis was used to analyze interview data and identify themes. RESULTS: Two primary themes emerged among providers: 1) placing a focus on harm reduction, emphasizing reducing negative consequences of substance use, and 2) using access to gender-affirming interventions as an incentive for patients to change their substance use patterns. CONCLUSIONS: Focusing on harm reduction can emphasize reducing potential adverse outcomes while working with TGD patients towards their gender-affirmation goals. Future research should explore varying approaches to how substance use is discussed with TGD patients, as well as the interpretation of gender-affirming clinical guidelines. PRACTICE IMPLICATIONS: Findings from this study indicate a need for enhancing provider knowledge around the appropriate application of gender-affirming care guidelines. Investing in training efforts to improve gender-affirming care is critical for encouraging approaches that prioritize harm reduction and do not unnecessarily prevent access to gender-affirming interventions.

In this first of three papers, we seek to understand how the new "integrated care" global policy directive, pursuing greater alignment for health and social care systems, will be translated into preparation for practice concerning interprofessional education (IPE) from pre-to-post registration level and for continuing professional development. We ask questions about the implications for leaders and practitioners in the field of IPE and collaborative practice (CP). In seeking to understand this new global policy directive, we explore the plethora of definitions, concepts and perspectives, continuously evolving and at times counterproductive as they try to synthesize complexity, to describe how health and social care systems and practitioners work together. We trace research on how integrated care is understood drawing upon transnational current understandings of integrated working in North America, Europe and the UK. We ask questions of the ambitions of integrated care aligned to forging closer working relationships between health and social care practitioners to tackle modern complex healthcare challenges. In reading the literature we have sought to identify the themes which emerge to direct the field of IPE and CP so that the workforce is prepared to deliver care, as policy makers intended, within locally designed new innovative care systems. We conclude that it remains unclear as to whether these new policy aspirations will achieve the connectivity required, for a supported workforce, committed to working together to deliver care envisaged to help people experiencing complex long-term conditions, disadvantage and health inequalities. In our second paper, we review the developmental pathway for IPE, taking a closer look at preparation for integrated care pathways and collaborative practice, seeking evidence to guide us. Finally, in our third paper, we turn our attention to the implications for the workforce composition, dynamics, and relationships, exploring heightened progressive ever-changing roles and responsibilities, focusing on social work.