The goal of making friends for youth with disabilities: creating a goal menu

BACKGROUND

Clinicians working with youth with disabilities have acknowledged making friends as a commonly identified client goal. Clinicians find this goal difficult to address, as there are no measures that provide a breakdown of making friends into functional steps. In addition, research on friendship has traditionally focused on characteristics and quality of friendships rather than the friend-making process as a whole. A goal menu, comprised of a variety of steps that address the goal of making friends, would provide guidance to clinicians challenged with this goal in practice.

PURPOSE

To develop an understanding of the friend-making process as a first step towards the development of a goal menu for the goal of making friends.

METHODS

A literature review, youth focus group and expert clinician semi-structured interviews and consultation were used to generate a comprehensive data set. Established qualitative methods were used to sort and group the data into categories. A thematic analysis of the categories was performed.

RESULTS

Analysis revealed four themes integral to the friend-making process: person factors influencing friend-making, making friend-making a priority, opportunity for friend-making and motivation to make friends. An additional theme identified as occasionally involved in the process was a little bit of luck in making friends.

CONCLUSIONS

The themes generated by this research indicate that actionable target areas exist for the somewhat abstract notion of friend-making and the authors recommend that clinicians explore beyond person factors when addressing the goal of making friends. As a next step, the identified themes will provide the foundation for a goal menu, ultimately enabling clinicians to address the goal of making friends in a more efficient and effective manner.

Parents as transition experts? Qualitative findings from a pilot parent-led peer support group

BACKGROUND

This paper focuses on the introduction of parents as 'transition experts' within a paediatric rehabilitation hospital. Through the personal experience of raising a young adult with special healthcare needs, Family Facilitators are knowledgeable about the processes of social and healthcare service transfer and transition to adulthood. Following a needs assessment, a pilot transition support group was established for parents of youth who were eligible for augmentative communication support. The goal was to provide informational, emotional and affirmational support during this stressful period. This study examined the impact of the Family Facilitator-led Transition Peer Support Group on parents' knowledge, skill and level of support in planning for the future.

METHODS

Qualitative methods were used to explore benefits, limitations and outcomes of the parent support group. In addition to a review of 10 narrative field notes maintained for each session by the Family Facilitator and four session feedback forms, a 90-min focus group was conducted with eight core members.

RESULTS

Qualitative examination of the data revealed three themes: (i) increased awareness related to personal challenges in planning and shifting viewpoints on future orientation; (ii) increased active planning with regard to knowledge building and actions taken; and (iii) the value of experiential knowledge.

CONCLUSIONS

Parents reported gaining new knowledge and became more active and future-oriented in their planning. Further, they strongly valued the facilitator role and benefited from the social support provided by the group. Findings provide a unique snapshot of parental needs. Individualized support with an emphasis on citizenship, participation and inclusion were targeted topics. Future work should continue to explore optimal mechanisms for the provision of parent-focused transition support and the inclusion of parents as experts within healthcare settings.

Dietetic guidelines on food and nutrition in the secondary prevention of cardiovascular disease ? evidence from systematic reviews of randomized controlled trials (second update, January 2006)

AIM

To update dietetic guidelines based on systematic review evidence on dietary advice to prevent further events in people with existing cardiovascular disease (CVD) (secondary prevention).

METHODS

The Cochrane Library, MEDLINE and EMBASE were comprehensively searched to January 2005 for systematic reviews on aspects of diet and heart health. Reviews were included if they searched systematically for randomized controlled trials relating to diet and secondary prevention of CVD. Each review was critically appraised by at least two members of the UK Heart Health and Thoracic Dietitians Group. The quality and results of each review were discussed and summarized at a group meeting.

RESULTS

Evidence-based strategies that reduce cardiovascular events in those with CVD include reduction in saturated fat and substitution with unsaturated fats. Individuals who have suffered a myocardial infarction may also benefit from adopting a Mediterranean type diet and increasing intake of omega 3 fats, but it is not clear whether they are beneficial for all patients with CVD. There is no systematic review evidence to support the use of antioxidant vitamins supplements, low glycaemic index diets, or homocysteine lowering therapies in this group.

CONCLUSION

There remains good evidence that reducing saturated fat reduces morbidity in patients with CVD. This advice is consistent for most manifestations of CVD, with the addition of Mediterranean dietary advice and increased omega 3 fats for those who have had a myocardial infarction.

Dietetic guidelines: diet in secondary prevention of cardiovascular disease (first update, June 2003)

AIM

To update dietetic guidelines summarizing the systematic review evidence on dietary advice to prevent further events in people with existing cardiovascular disease (CVD) (secondary prevention).

METHODS

The Cochrane Library, MEDLINE and EMBASE were comprehensively searched to November 2002 for systematic reviews on aspects of diet and heart health. Reviews were included if they searched systematically for randomised controlled trials relating to diet and secondary prevention of CVD. Two members of the UK Heart Health and Thoracic Dietitians Group critically appraised each review. The quality and results of each review were discussed and summarized in a meeting of the whole group.

RESULTS

Providing evidence-based dietary information (including increasing omega-3 fat intake) to all people who have had a myocardial infarction will save more lives than concentrating dietary advice on just those in need of weight loss or lipid lowering. The practice of prioritizing dietetic time in secondary prevention to those with raised lipids is out of date since the advent of statin therapy. However, effective dietary advice for those with angina, stroke, peripheral vascular disease or heart failure is less clear.

CONCLUSION

There is good systematic review evidence that dietary advice to those with coronary heart disease can reduce mortality and morbidity as well as modify some risk factors. Dietary advice that does this most effectively should be prioritized.

Comparison of the susceptibilities of Burkholderia pseudomallei to meropenem and ceftazidime by conventional and intracellular methods

The effect of the two antibiotics ceftazidime and meropenem on a collection of 46 Burkholderia pseudomallei isolates representing clinical and environmental sources across northern Australia was investigated by using a series of in vitro test methods. The susceptibility testing methods used included Kirby-Bauer disk diffusion, Etest MIC, broth microdilution MIC, and a modification of the microdilution method in which Acanthamoeba cells were added to simulate the effect of a professional phagocytic cell on test outcome. In a semiquantitative validation coculture series, the majority of bacteria were intracellular up to a multiplicity of infection of 10 bacteria to one ameba. The optical density and bacterial count (log10 CFU/ml) correlated across the range tested (r2 = 0.77; P < 0.0001). Susceptibility test results were compared against clinical outcomes. The MICs of ceftazidime were consistently higher than those of meropenem by all three methods. The MICs of both agents were significantly higher when Acanthamoeba trophozoites were added to the broth microdilution method. Conventional and intracellular MIC results were consistent for clinical isolates from the Western Australian outbreak cluster despite the wide variety of clinical outcomes. Further development of the intracellular MIC method is expected to help assess the efficacy of antimicrobial agents on this bacterial species in an intracellular setting.

Effects of a wheelchair-mounted rigid pelvic stabilizer on caregiver assistance for children with cerebral palsy

A within-subjects repeated measures (A1, B, A2) design was used to study the impact of a rigid pelvic stabilizer (RPS) compared with a traditional lap belt on the caregiver assistance requirements of six children with cerebral palsy as they completed functional tasks from their wheelchair seating system. Study participants wore a lap belt during the 3-week baseline phases (A1 and A2). The RPS was used during the 5-week intervention phase (B). At baseline, each child and parent identified five bimanual or reaching tasks with which the child had difficulty. Using a six-point scale, each parent (caregiver) rated the degree of assistance the child required to do each task. Parents also maintained a log, recording how many times the child was repositioned daily. The RPS appeared to impact directly on reducing caregiver assistance for 30% of the tasks, as the need for assistance was less during phase B when the RPS was used and was greater during phases A1 and A2 when the lap belt was worn. Five children required repositioning less often during phase B than during the A phases. The RPS reduced the child's need for caregiver assistance for some bimanual and reaching tasks as well as for repositioning.

Psychosocial impact of electronic aids to daily living

Electronic aids to daily living (EADLs) allow persons who have a degenerative neuromuscular condition such as Duchenne's muscular dystrophy to operate a wide variety of household and workplace appliances without assistance (independent of family members or other caregivers). There is very little published research to describe how well EADLs are perceived by users to enhance their sense of personal autonomy, functional independence, and psychological well being. Psychosocial impact is a significant determinant of how users perceive the benefit of assistive devices to their quality of life. This study compared the perceived psychosocial impact of EADLs on a group of device users with the anticipated impact of EADLs reported by a group who were eligible for, but had not yet received, these devices. The perceptions of the user group were measured at two points in time, approximately 6 to 9 months apart, to examine the stability of psychosocial impact. The Psychosocial Impact of Assistive Devices Scale was the instrument used to assess perceived impact. EADLs were found to produce similar degrees of positive impact on users and positive perceptions of anticipated impact on those without devices. The psychosocial impact on users was stable over time. The results indicate that the perceived benefits of EADLs to the autonomy, functional independence, and psychological well being of both users and nonusers are positive and strikingly similar. The study is an important first step in attempting to quantify psychosocial outcomes for EADLs in a way that might facilitate economic analysis of these devices in the future.

The Medical Education Commission report at the turn of then new millennium 2000

The State of Louisiana Medical Education Commission was formed by Act 3 of the 1997 Louisiana Legislature. The members are appointed by the Louisiana State University Health Sciences Center, Tulane University Medical Center, and Alton Ochsner Medical Foundation and report to and advise the Department of Health and Hospitals (DHH). This summation from the Medical Education Committee is designed to answer three questions. First, how does the State of Louisiana compare nationally in the renewal of physician supply and capability? Second, what are the current status and trends of graduate medical education in Louisiana? Third, what recommendations are proposed to continue and improve the important relationship between the State public hospitals and educational programs? The State of Louisiana has participated proportionately relative to population in the growth and progress of medical education in this last century and compares favorably with other states and the nation. Louisiana exceeds national averages in the increase of primary care residency programs and positions and in the retention of trainees in practice sites in the State. The three-year trends in total number of graduate medical education filled positions has been consistent with only 0.4% change, with primary care showing an overall increase of 9%, reflecting increases in Family Medicine (56%) and Medicine/Pediatrics (41%).

Interaction between Burkholderia pseudomallei and Acanthamoeba species results in coiling phagocytosis, endamebic bacterial survival, and escape

Burkholderia pseudomallei causes melioidosis, a potentially fatal disease whose clinical outcomes include rapid-onset septicemia and relapsing and delayed-onset infections. Like other facultative intracellular bacterial pathogens, B. pseudomallei is capable of survival in human phagocytic cells, but unlike mycobacteria, Listeria monocytogenes, and Salmonella serovar Typhimurium, the species has not been reported to survive as an endosymbiont in free-living amebae. We investigated the consequences of exposing Acanthamoeba astronyxis, A. castellani, and A. polyphaga to B. pseudomallei NCTC 10276 in a series of coculture experiments. Bacterial endocytosis was observed in all three Acanthamoeba species. A more extensive range of cellular interactions including bacterial adhesion, incorporation into amebic vacuoles, and separation was observed with A. astronyxis in timed coculture experiments. Amebic trophozoites containing motile intravacuolar bacilli were found throughout 72 h of coculture. Confocal microscopy was used to confirm the intracellular location of endamebic B. pseudomallei cells. Transmission electron microscopy of coculture preparations revealed clusters of intact bacilli in membrane-lined vesicles inside the trophozoite cytoplasm; 5 x 10(2) CFU of bacteria per ml were recovered from lysed amebic trophozoites after 60 min of coculture. Demonstration of an interaction between B. pseudomallei and free-living acanthamebae in vitro raises the possibility that a similar interaction in vivo might affect environmental survival of B. pseudomallei and subsequent human exposure. Endamebic passage of B. pseudomallei warrants further investigation as a potential in vitro model of intracellular B. pseudomallei infection.

Promoting independence for teens and young adults with physical disabilities

The transition to adult roles and responsibilities poses unique challenges for young people with physical disabilities. The Independence Programme (TIP) assists youths to meet these challenges. TIP is client-centred and addresses each participant's occupational performance problems. Participants live in a student residence located near shops, restaurants and other businesses for 20 consecutive days during TIP. This paper describes TIP and results from the evaluation of one summer's programme. Ten youths with physical disabilities, such as cerebral palsy, participated. The programme was evaluated using interviews with each participant at the beginning and end of the programme, and at a four month follow-up with the Canadian Occupational Performance Measure (COPM) (Law et al., 1994a). Participants made clinically important changes in performance and satisfaction of their identified occupations. They rated this programme as the best experience of the summer. Participants valued the opportunities to learn about and access environmental supports, to assume greater independence, and to develop connectedness with peers.

Functional impact of a rigid pelvic stabilizer on children with cerebral palsy who use wheelchairs: users' and caregivers' perceptions

A within-subject ABA design was used to assess the functional impact of a novel wheelchair mounted rigid pelvic stabilizer (RPS) compared with a traditional wheelchair lap belt in a group of six children with cerebral palsy (mean age 10.4 years). The lap belt was worn during the two baseline phases which were each 3 weeks in duration. During a 5 week treatment phase the lap belt was replaced with the RPS device. Using the Canadian Occupational Performance Measure (COPM) each subject's self-evaluated performance ability and satisfaction with performance for five key tasks was measured at the end of each study phase. In addition, a structured weekly interview was conducted with the primary caregivers to assess perceived changes in their child's functional performance with each task. Results of repeated measures ANOVAs were statistically significant, indicating that the RPS as compared to the lap belt is a more effective device. The RPS allowed significantly better occupational performance and satisfaction with performance as measured by the COPM. Single-subject data analyses showed clinically significant changes in task performance and satisfaction with performance when the RPS was worn as compared to the lap belt for all subjects. Caregivers' perception of functional change ratings closely corresponded to subjects' self-rated performance on specific tasks. Visual inspection of subject data also showed that, overall, the increased performance ratings for different tasks during the treatment phase decreased in the second baseline phase, when the RPS was removed, however, performance did not return to initial baseline levels. This suggests that the RPS has a facilitating effect for increasing physical functioning. These results are further discussed in terms of implications for practice, and future research.

Application of the Person-Environment-Occupation Model: a practical tool

Occupational therapy focuses on complex dynamic relationships between people, occupations and environments. Therapists must clearly communicate their practices and how their practice influences outcomes. This paper explores applications of the Person-Environment-Occupation Model (Law et al., 1996) in occupational therapy practice, and delineates how this particular model helps therapists to conceptualize, plan, communicate and evaluate occupational performance interventions. Three case studies illustrate how the model can be used by occupational therapists to systematically approach analysis of occupational performance issues while considering the complexities of human functioning and experience. The ways in which the model facilitates communication within and outside occupational therapy are explained. The Person-Environment-Occupation Model is offered as a tool for therapists to use in client(s)-therapist alliances to enable clients to successfully engage in meaningful occupations in chosen environments.

Clinical and surgical application of reformatted high-resolution CT of the temporal bone

High resolution CT has played a pivotal role in temporal bone imaging since the early 1980s. Although the appearance of MR imaging technology with its superior demonstration of fluid-containing spaces of the inner ear and the posterior fossa structures, CT continues to offer distinct advantages for the evaluation of conductive hearing loss, and petrous apex lesions. With the advent of helical scanning techniques, CT is increasingly the imaging study of choice for definitive preoperative temporal bone imaging.

Aftercare under supervision: implications for CMHNs

This article examines the implications for practice of the Mental Health (Patients in the Community) Act 1995, which came into force on 1 April 1996. The main purpose of this legislation is to introduce a system of 'aftercare under supervision' in the community for certain patients who have previously been detained under the Mental Health Act 1983, before discharge. The nominated 'supervisor' will have responsibility for ensuring that the aftercare plan requirements are fulfilled. As a result of their role as community keyworkers it is likely that community mental health nurses will undertake this role. Careful consideration needs to be paid to education and training in relation to these responsibilities, and practitioners need to become aware of the challenges that such a role is likely to present.

Collaboration puts the ENB Higher Award into practice

The ENB Framework for continuing professional education and Higher Award for nurses, midwives and health visitors was introduced in April 1992. The framework outlines 10 key characteristics to guide practitioners in the integration of theory and practice. This paper describes how a group of teachers and practitioners have applied the framework. They explain how it helps pull theoretical learning and practice together for practitioners. For educators, involvement with practitioners has helped them be more involved in practice. Three-way, or tripartite, tutorial work between the practitioner, the teacher and the facilitator in the clinical area is central to the success of this initiative.

Isolation and characterization of the proteoglycans synthesized by adult human pulp fibroblasts in vitro

The proteoglycans synthesized by fibroblasts derived from healthy human adult dental pulps have been isolated and characterized on the basis of their glycosaminoglycan content, molecular size and charge. The proteoglycans were identified by their labelling with [35S] sulphate and susceptibility to digestion by papain. The sulphated glycosaminoglycans associated with the proteoglycans were identified following specific enzymatic and chemical degradations as chondroitin sulphate, dermatan sulphate and heparan sulphate. Dermatan sulphate and chondroitin sulphate and heparan sulphate were the principal glycosaminoglycans associated with the cell layers. The proteoglycans could be fractionated on the basis of their charge and size into a number of heterogeneous pools. The principal proteoglycans isolated were small and contained either chondroitin sulphate or dermatan sulphate and most likely correspond to decorin and biglycan. Other molecules with features similar to versican and syndecan were also identified.

Detecting conserved regulatory elements with the model genome of the Japanese puffer fish, Fugu rubripes

Comparative vertebrate genome sequencing offers a powerful method for detecting conserved regulatory sequences. We propose that the compact genome of the teleost Fugu rubripes is well suited for this purpose. The evolutionary distance of teleosts from other vertebrates offers the maximum stringency for such evolutionary comparisons. To illustrate the comparative genome approach for F. rubripes, we use sequence comparisons between mouse and Fugu Hoxb-4 noncoding regions to identify conserved sequence blocks. We have used two approaches to test the function of these conserved blocks. In the first, homologous sequences were deleted from a mouse enhancer, resulting in a tissue-specific loss of activity when assayed in transgenic mice. In the second approach, Fugu DNA sequences showing homology to mouse sequences were tested for enhancer activity in transgenic mice. This strategy identified a neural element that mediates a subset of Hoxb-4 expression that is conserved between mammals and teleosts. The comparison of noncoding vertebrate sequences with those of Fugu, coupled to a transgenic bioassay, represents a general approach suitable for many genome projects.

Sculpting with people--an educational experience

This paper explores the technique known as 'sculpting' and examines its application to the education of nurses. It identifies the therapeutic origins of sculpting, the processes and techniques involved and other requirements necessary for its application to nurse education. The experiences of both facilitator and participant are also described. It is argued that experiential learning methods in many cases continue to be met with anxiety and distrust often being carried out by facilitators who lack the skill and expertise to provide for the psychological safety of participants. The neglect or improper use of experiential learning methods denies students a valuable 'educational experience'.

Person-environment assessments in occupational therapy

Occupational therapists have begun to recognize the importance of considering how the environment influences occupational performance. Models of person-environment fit provide a theoretical context within which occupational therapists can consider the influence of the environment on function. The challenge for occupational therapists is to select assessments that incorporate concepts of person-environment fit. However, limited awareness of appropriate environmental assessments that have undergone psychometric testing has limited their introduction into clinical practice. This paper reviews 41 environmental assessments and considers each in terms of its purpose, environmental attribute, environmental application, clinical utility, instrument development, and psychometric testing. A case example illustrates the applicability to the practice of occupational therapy.

A nursing model for helping both clients and carers

This care study charts the progress made in meeting the needs of carers and clients through the use of the systems development model, which has proved to be both flexible and user friendly. The authors explain how the client and his informal carer wife were helped to explore feelings and adapt to new roles.

Contralateral suppression of non-linear click-evoked otoacoustic emissions

Click-evoked otoacoustic emissions from nominal 80 dB pSP (peak sound pressure) 80-microseconds pulses presented at 50 pulses per second were collected from the right ears of eleven normal hearing subjects using an ILO88 Otodynamic Analyzer in the non-linear mode. Clicks, pure tones, and narrow bands of noise were then presented to their left ears through insert earphones. The 80-microseconds contralateral clicks ranged in intensity from 80 dB pSP in 5 dB steps down to 60 dB pSP but data on only 10 of the subjects were collected successfully. The pure tones and narrow bands of noise centered at 250, 500, 1000, 2000, and 4000 Hz were also presented through insert phones at 20, 40, 60 and 80 dB HL (Hearing Level) to all 11 subjects. The mean overall 'echo amplitude' without contralateral stimuli was 11 dB SPL and underwent more than 3 dB of overall suppression in response to the noises which were the most effective of the contralateral suppressors. When we analyzed the echo suppression to noise in 2-ms segments, we found consistent contralateral suppression of 3-4 dB concentrated in the time zones after 8 ms. Time shifts of more than 200 microseconds between the control and experimental traces were also observed in the same zones. The clicks were the next most effective suppressors, but showed their amplitude and time effects in somewhat earlier time zones. The tones were the least effective suppressors suggesting that efferent effects we measured in the human system are not strongly tonotopic. Because 'non-linear' mode high intensity clicks were deliberately selected as stimuli to evoke the TEOAE's, the emissions and their suppression can represent neither the 'true' TEOAE nor all of the efferent system's suppression abilities.

Exogenously administered alpha-bungarotoxin binds to embryonic chick spinal cord: implications for the toxin-induced arrest of naturally occurring motoneuron death

Administration of alpha-bungarotoxin and other curare-like drugs during embryogenesis arrests motoneuron death which normally occurs in the spinal cord from day 6 to day 10 of embryogenesis. The accepted explanation is that such motoneuron rescue is mediated by inhibition of neuromuscular transmission following the blockade of nicotinic cholinoceptors at the neuromuscular junction. In this study we investigated a further possibility, namely that motoneuron rescue might also involve the blockade of alpha-bungarotoxin-sensitive sites within the spinal cord. The kinetic profile of [125I]alpha-bungarotoxin binding was examined in the brachial and lumbar regions of chick spinal cord at embryonic day 15. Binding was specific and apparently saturable within the range 1-34 nM reaching a maximum after 45 min. Specific binding involved a single class of non-interacting sites with a KD of 8.0 nM and a Bmax of 106 +/- 12 fmol/mg of protein. Nicotine displaced specific [125I]alpha-bungarotoxin binding in a concentration-dependent manner. Furthermore, specific binding dissociated slowly in the absence of nicotine. Autoradiographs localizing [125I]alpha-bungarotoxin binding in embryonic spinal cord revealed that, at embryonic day 15, specific toxin binding sites could be detected throughout the gray matter. In contrast, at embryonic day 6, the ventral horn contained the majority of specific binding sites. Exogenously administered [125I]alpha-bungarotoxin reached and bound to nicotine-sensitive sites in the spinal cord at embryonic day 7. To conclude, these data demonstrate that central nicotine-sensitive sites which bind [125I]alpha-bungarotoxin in a saturable and specific manner were present at the beginning of the critical motoneuron death phase of neurogenesis and that they were accessible to exogenously administered toxin. It is proposed that the [125I]alpha-bungarotoxin binding characterized here is to a class of putative alpha-bungarotoxin-sensitive nicotinic cholinoceptors. These studies raise the possibility that alpha-bungarotoxin blockade of such putative nicotinic cholinoceptors within the spinal cord may contribute to toxin-induced arrest of naturally occurring motoneuron death.

Paul Berg, on his 65th birthday

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Scopolamine impairs learning performance of rats in a 14-unit T-maze

To assess involvement of muscarinic cholinergic systems in performance of a shock-motivated 14-unit T-maze task, 3-month old Fischer-344 rats were given an IP injection of scopolamine (0.1, 0.3, 1.0 or 3.0 mg/kg), methylscopolamine (1.0 mg/kg), or saline 30 min prior to maze training on 2 consecutive days. Scopolamine, but not methylscopolamine, impaired all components of acquisition performance. Measures of error performance, run time, shock duration, and number of shocks received were significantly increased but only at the 1.0 and 3.0 mg/kg scopolamine doses. The cognitive component of the task, measured by error performance, appeared most affected. Cognitive performance deficits observed following scopolamine administration in the present study resembled age-related impairments in rats and mice previously observed in this task. The cholinergic hypothesis of geriatric memory dysfunction appears to be implicated by these findings; however, the degree to which memory systems are involved remains unclear. Other performance variables such as discriminative control of stimuli or mechanisms of attention are implicated and discussed.