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Aim To introduce dental hygienists ( DHs) in the UK to the principles of research through a practice-based product evaluation programme. Methods The programme consisted of an initial training and orientation day with presentations on evidence-based practice, research methods and the structure of research papers. The programme and its aims were explained in detail, and participants were briefed on the methods to be used. Participants then recruited seven to ten patients from their practices (offices), carried out a baseline assessment of: plaque, gingival health, calculus and staining at anterior teeth, and gave the patients a questionnaire asking about their teeth and then provided a 3-month supply of a test toothpaste. About 10 weeks later, a follow-up assessment of the same variables was performed and the questionnaire was repeated. A second training day followed during which the DHs provided feedback of their experiences and received training in literature searching and critical appraisal of literature including interpretation of results. Results Sixty-five DHs attended the first training day; 31 were able to recruit sufficient patients and attend the second training day. The DHs recruited 168 patients who received baseline and follow-up assessments. All the variables improved overall. Feedback from the DHs was very positive, and patients expressed delight with the care they had received. Conclusions Qualitative feedback for participating DHs suggests the programme met its aim and could be used in the future as a mechanism for helping DHs who want to increase their understanding of research methodology. [ABSTRACT FROM AUTHOR]

Accessible summary: Children with learning disabilities often have problems with their eyesight.We tested the eyes of nine children and checked whether they needed glasses or bigger print.We found that when they got what they needed to see better, their behaviour improved.This is important because children with learning disabilities need to be able to see as well as anyone else. Background: Children with identified special educational needs are at higher risk than other children of having visual needs that are not adequately met. This paper evaluates the impact of addressing the visual needs of these children on behaviour and academic achievements in a number of case studies. Method: Nine children (4–11 years of age, from four classrooms), who attended a special school in a medium‐sized town in the UK, took part in the case studies reported here. The children were part of the Special Education Eyecare (SEE) Project. Six of the children were selected because they had unmet visual needs at baseline and required bespoke interventions to meet these needs; the other three children were selected because their visual needs had been met prior to the study and no further adjustments were needed. Repeated direct observations were conducted to assess the impact of the intervention on the children's behaviour in the classroom. The observer was "blind" with regard to the visual needs of the participants. Parents and teachers completed the Strength and Difficulties Questionnaire (SDQ) for each child, before and after the intervention. School files were analysed to assess effects on academic achievement. Findings: Subsequent to the implementation of bespoke visual adjustments, for example prescription of spectacles or changed seating in classroom, significant and sustained changes were observed with regard to the children's behaviour (i.e., increased engagement with peers and/or teachers and decreased off‐task behaviour). Strength and Difficulties Questionnaire scores showed improvements regarding total difficulties, emotional difficulties, hyperactivity and prosocial (kind and helpful) behaviour. Due to highly variable data in school files, the effects on academic achievement were inconclusive. Discussion: The case studies reported here explored changes in behaviour of children with identified special educational needs after their visual needs were met. Findings show a positive overall effect on the behaviour of these children. [ABSTRACT FROM AUTHOR]

SHIFT has been one of the largest RCTs in the field of systemic family therapy in the UK. The study took place over five years, including three major centres with fifteen Trusts and twenty‐five family therapists who worked with a manualized treatment in CAMHS with adolescents who self‐harmed. While the results are not available at the time of this publication, this paper will briefly describe the pre‐ existing factors which were helpful in developing a successful bid, clinical and managerial elements of ‘real world research’ of complex psychological processes and the construction of the manualized systemic family therapy. It also offers examples of some of the unanticipated events in the life of such a large trial. Practitioner Points: Large trials develop from small studies and clinicians are urged to look for opportunities for research partnershipsInvestment in time for consideration of difficult issues as they arise is essential for effective trial managementThe balance between research rigour and ‘real life’ practice is an inevitable area of tension and requires consideration of both immediate and outcome consequences 尝试和痛苦 – 一种随机对照试验对比下的把干预当作惯常和在实施过程中出现的重要事件上的反思的家庭治疗 人工家庭治疗 摘要: SHIFT目前是英国家庭治疗领域最大的随机对照试验之一。本研究历时5年, 囊括了三个主要的中心在内的15个信托, 25位曾在CAMHS对自残青少年进行人工治疗的家庭治疗师。因为在发表这篇文章的时候, 结果还没有出来, 本文将简短地描述1）有助发展成功bid的已经存在的因素, 2）临床以及管理方面的复杂心理过程的”真实情况研究”元素, 3）以及人工系统家庭治理的建构。本文还提供了生活在这样一种大的的尝试下的一些意想不到事件的例子。 对实践者有用的几点建议: 大的尝试发展自小的研究, 临床工作者急需寻找研究合作者的机会困难事件需要及时解决, 不然就会对有效尝试管理产生重要影响研究活力和”真实生活”实践的平衡是一种不可避免的引起紧张的领域, 这需要对当下和结果的同时考虑 关键词：实证实践, 研究, 儿童和青少年精神健康, 培训 [ABSTRACT FROM AUTHOR]

Joint hypermobility syndrome (JHS) is a heritable disorder associated with excessive joint range of motion and pain in the absence of inflammatory joint disease. It is a relatively common cause of musculoskeletal pain but is generally understood to be under-recognized and poorly managed in clinical practice. The present study therefore aimed to identify how JHS is diagnosed, managed and assessed in routine physiotherapy practice. A survey tool was developed from similar physiotherapy surveys of musculoskeletal practice, a review of the literature, and consultation with researchers and clinicians. Paper copies of the final survey were sent to 201 randomly selected secondary care organizations across the UK and an electronic version was advertised through physiotherapy professional networks. A total of 66 responses (80% women) were received from physiotherapists, with a wide range of clinical experience. Only 32% of respondents reported that they had received formal training in JHS management. The Brighton diagnostic criteria for JHS were not often used (only 31% of respondents). The stated aims of physiotherapy and the specific interventions employed seem well matched, with a focus on advice, education, exercise and self-management. Although pain relief was not reported as a high priority in terms of treatment aims, pain was most often assessed as an outcome, suggesting a mismatch between what clinicians aim to achieve and what they measure. The results suggest that reported management strategies are broadly appropriate to long-term musculoskeletal conditions but additional training specific to JHS may be required, particularly in diagnosis and assessment. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Incorporating user's perspectives in healthcare delivery is important. Simple questionnaires may not capture these as well as a discrete choice experiment (DCE) which enables the exploration of users' trade-offs between different service attributes. Qualitative methods are increasingly used to improve a DCE's face validity, but few studies adequately describe them. This paper describes the qualitative investigations in the development of a DCE questionnaire to elicit parents' perspectives on centralized services for children with cleft lip and palate. METHODS: Semi-structured telephone interviews were conducted with 16 parents from across the UK, except Wales. Data analysis was carried out by the constant comparative method. RESULTS: Five attributes and their levels were inductively identified: usefulness and amount of information (four levels); staff attitude at cleft centres (two levels); continuity of care (two levels); personal costs of attending appointments (four levels); and cleft centres facilities (two levels). An unexpected finding was that parents' sense of responsibility towards their child made a 'willingness-to-travel' attribute unacceptable to them, but they were receptive to a 'willingness-to-pay' attribute. CONCLUSION: Using qualitative methods with service users in attribute development for a DCE helps to uncover issues that may not be apparent to researchers or health service staff. [ABSTRACT FROM AUTHOR]

Members of the British False Memory Society (BFMS) were sent a detailed questionnaire concerning accused families and 282 (70%) replied. In this paper the author focuses on the nature, circumstances, and consequences of the accusations for the accused, as well as the role of therapy. The great majority (87%) of the accusers were female and most of the accusations were directed against the biological father. Only four per cent involved stepfathers. Often the accusations were non-specific and not all were reported as being associated with recovered memories. The accusations appear to have arisen primarily within the context of a therapeutic relationship. Depression, followed by eating disorder, were the most common reasons for seeking therapy. Significant relationship problems were reported as the most common stress factor prior to the accusations being made. The author emphasizes the complex nature of the accusations and distinguishes between beliefs and memories within the context of recovered memories. The reported consequences of the accusations were discontinued contact with the family (59%), legal proceedings being instigated (14%), and the accused person having to seek psychological or psychiatric help because of the stress involved (29%). © 1997 by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Primary progressive aphasia (PPA) describes a heterogeneous group of language‐led dementias. People with this type of dementia are increasingly being referred to speech and language therapy (SLT) services. Yet, there is a paucity of research evidence focusing on PPA interventions and little is known about SLT practice in terms of assessment and provision of intervention. Aims: To survey the practices of SLTs in the areas of assessment and intervention for people with PPA. Methods & Procedures: A 37‐item, pilot‐tested survey was distributed electronically through the Royal College of Speech and Language Therapists (RCSLT), Clinical Excellence Networks (CENs) and social media networks. Survey items included questions on care pathways, assessment and intervention approaches, and future planning. Analysis was conducted using descriptive statistics and thematic analysis. Outcomes & Results: A total of 105 SLTs completed the survey. Respondents reported more frequently using formal assessment tools designed for stroke‐related aphasia than for dementia. Informal interviews were reportedly always used during assessment by almost 80% of respondents. Respondents were significantly more likely to use communication partner training than impairment‐focused interventions. Goal attainment was the most commonly used outcome measure. Respondents provided 88 goal examples, which fell into six themes: communication aid; conversation; functional communication; impairment focused; specific strategy; and communication partner. Additionally, respondents reported addressing areas such as future deterioration in communication and cognition, decision‐making and mental capacity, and driving. Ten (9.4%) respondents reported the existence of a care pathway for people with PPA within their service. Conclusions & Implications: This survey highlights the range of current PPA assessment and intervention practices in use by the respondents. Communication partner training is commonly used by the surveyed SLTs, despite the lack of research evidence examining its effectiveness for PPA. There is a need to develop evidence‐based care pathways for people with PPA in order to advocate for further commissioning of clinical services. [ABSTRACT FROM AUTHOR]

Background: It is unclear on how children with compromised first permanent molars (cFPMs) are currently managed in the UK by either general dental practitioners (GDP) or specialists in paediatric dentistry (SPD). Aim: Explore the current attitudes to the management of compromised first permanent molars amongst UK general dental practitioners and specialists in paediatric dentistry. Design: Self‐completed online questionnaire including three clinical vignettes of 7, 9, and 15 years old with cFPM. All registered SPDs (n = 236), as of May 2017, 500 randomly selected GDPs from England, selected from a national performers list, and 52 Scottish GDPs, part of Scottish dental practice research network, were invited to complete the questionnaire. Results: About 71.6% (n = 53) of SPDs agreed that children with cFPM should be referred to a paediatric specialist for treatment planning, whereas the reverse for GDPs is true, as 86.8% (n = 138) believe they have a responsibility to treat these teeth. Responses to clinical vignettes suggest a slight preference amongst GDPs to restore cFPM, including root canal treatment, whereas SPDs have a slight preference towards extraction. Conclusion: Current pathways for cFPM, amongst UK general dental practitioners and specialists in paediatric dentistry, vary greatly between and within each professional group. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aims of the present study was to examine the associations between the severity of pain and anxiety in a community population reporting joint pain, and to investigate the management of joint pain in the presence of comorbid anxiety. Methods: A population survey was carried out of people aged ≥45 years, registered with eight general practices in Cheshire, Shropshire and Staffordshire, UK. Respondents were asked to report pain intensity in their hands, hips, knees and feet (on a numerical rating scale), anxiety symptoms (Generalized Anxiety Disorder seven‐item [GAD‐7] scale) and guideline‐recommended treatments used to manage pain. Clinical anxiety was defined by a GAD‐7 score of 10 or more. Results: A total of 11,222 respondents with joint pain were included in the analysis, with 1,802 (16.1%) reporting clinical anxiety. Respondents reporting more severe pain were more likely to report clinical anxiety (severe versus mild pain, odds ratio [OR] 5.36, 95% confidence interval [CI] 4.56 to 6.31). The number of pain sites was also positively associated with clinical anxiety (four versus one site; OR 3.64, 95% CI 3.09 to 4.30). Those with clinical anxiety were less likely to undertake general fitness exercises (OR 0.60, 95% CI 0.52 to 0.70), but more likely to diet (OR 1.43, 95% CI 1.21 to 1.69), use walking aids (OR 1.53, 95% CI 1.32 to 1.77) and assistive devices (OR 1.24, 95% CI 1.04 to 1.49), and more likely to use opioids (OR 1.34, 95% CI 1.18 to1.52). Conclusions: Anxiety is common among patients presenting to primary care with joint pain. Patients with anxiety are likely to manage their joint pain differently to those without. Case‐finding to identify and treat anxiety would be appropriate in this population, with caution about opioid prescribing and consideration of exercise as an intervention. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Counselling for Depression (CfD) is a person‐centred experiential therapy developed for implementation in the Improving Access to Psychological Therapies (IAPT) programme. Training in this model has been available across England since 2011. This study aims to investigate counselling practitioners’ experiences of learning the CfD model and implementing CfD in practice settings. Method: Participants were recruited by an email sent to the British Association for Counselling and Psychotherapy's (BACP) CfD Practice Research Network (PRN). Of the 53 CfD practitioners belonging to BACP's CfD PRN, 18 participated in this mixed‐methods piece of research. All 18 participants completed an online questionnaire, and one hour follow‐up semi‐structured interviews were conducted with six of the participants. Results: Descriptive analyses from the online questionnaire indicated a positive experience of CfD training, with practitioners indicating a positive impact on sense of self, practice and skill set. Although a degree of challenge was encountered when training in the CfD model, thematic analysis from the six semi‐structured interviews revealed factors contributing to the positives and challenges experienced on the course. Themes also revealed a predominately negative experience of CfD in practice and service settings, although this was service dependent. Conclusions and implications for practice: The findings can inform future recruitment of trainees to CfD training programmes and the training programme itself. They can also be used to achieve greater congruence between training in CfD and the delivery of the model. Future research may need to focus on the service level factors influencing practitioners’ experiences, and whether this experience is specific to the CfD modality in IAPT. [ABSTRACT FROM AUTHOR]

Background The psychosocial impact of stroke and aphasia is considerable. Aims To explore UK speech-and-language therapists' (SLTs) clinical practice in addressing the psychological and social needs of people with aphasia, including their experiences of working with mental health professionals. Methods & Procedures A 22-item online survey was distributed to UK SLTs via the British Aphasiology Society mailing list and Clinical Excellence Networks. Results were analysed using descriptive statistics and qualitative content analysis. Outcomes & Results UK SLTs ( n = 124) overwhelmingly considered that addressing psychological well-being (93%) and social participation (99%) was part of their role. To achieve this, they frequently/very frequently used supportive listening (100%) and selected holistic goals collaboratively with clients (87%), including social goals (83%). However, only 42% felt confident in addressing the psychological needs of clients. The main barriers to addressing psychosocial well-being were time/caseload pressures (72%); feeling under-skilled/lack of training (64%), and lack of ongoing support (61%). The main barriers to referring on to mental health professionals were that mental health professionals were perceived as under-skilled when working with people with aphasia (44%); were difficult to access (41%); and provided only a limited service (37%). A main theme from the free-text responses was a concern that those with aphasia, particularly more severe aphasia, received inadequate psychological support due to the stretched nature of many mental health services; mental health professionals lacking skills working with aphasia; and SLTs lacking the necessary time, training and support. The main enablers to addressing psychosocial well-being were collaborative working between SLTs and stroke-specialist clinical psychologists; SLTs with training in providing psychological and social therapy; and ongoing support provided by the voluntary sector. Conclusions & Implications The vast majority of SLTs consider the psychosocial well-being of their clients, and work collaboratively with people with aphasia in selecting holistic goals. It is, however, of concern that most respondents felt they lacked confidence and received insufficient training to address psychological well-being. In order to improve psychological services for this client group, there is a strong case that stroke-specialist mental health professionals should strive to make their service truly accessible to people with even severe aphasia, which may involve working more closely with SLTs. Further, improving the skills and confidence of SLTs may be an effective way of addressing psychological distress in people with aphasia. [ABSTRACT FROM AUTHOR]

Background: In the UK, only one in four people with a diagnosis of depression receive any form of treatment. To address this, the Improving Access to Psychological Therapies (IAPT) programme was established with the main therapeutic approach being cognitive behavioural therapy (CBT). This raised concern regarding client choice, prompting the development of a new evidence‐based manualised therapy, namely ‘Counselling for Depression’ [CfD]. To date, the client's view of the effectiveness of CfD has not been researched. Aims: The aims of this study were twofold: (1) to explore and evaluate CfD from the perspective of the client and (2) to inform the counselling profession of the client's perception of what is occurring within this therapeutic approach. Methodology: This qualitative study used Interpretative Phenomenological Analysis, the ideographic aspect valuing each individual narrative and the contribution it makes towards a larger account of the phenomenon from a small group of people. Twelve participants receiving CfD completed a Helpful Aspects of Therapy questionnaire after each counselling session, with ten participating in a semi‐structured interview post counselling. Findings: Four superordinate themes were identified: A helpful process, Client's view of a counsellor, Gains and Negative aspects. Participants perceived this model of therapy as helpful, feeling understood by their counsellors and able to work through issues in a safe therapeutic relationship. Negative findings related to counselling being ‘hard work’ and a dislike of the time limitation that curtailed the work. Implications: Participants believed this type of counselling met their needs, reassuring practitioners that CfD is helpful to their clients. [ABSTRACT FROM AUTHOR]

Aims To assess the management of diabetic ketoacidosis in young people, which differs in the UK between paediatric and adult services, and to evaluate outcomes and extent to which national guidelines are used. Methods A standardized questionnaire was sent to all paediatric and adult diabetes services in England, requesting details of all diabetic ketoacidosis admissions in young people aged > 14 years in paediatric services ('paediatric' patients), and in young adults up to the age of 22 years in adult services ('adult' patients). Results A total of 64 adult patients aged ≤ 22 years (mean age 19.2 years) were reported, of whom seven were aged between 10 and 16 years. A total of 71 paediatric patients were reported [mean (range) age 14.9 (11-18) years]. We found that 85% of paediatric and 69% of adult patients were treated according to national guidelines, 99% of paediatric and 89% of adult patients were treated with 0.9% saline and fixed-rate insulin infusions and 16% of adult patients received an insulin bolus. Insulin treatment was initiated later in paediatric patients than in adult patients (100 vs 39 min; P < 0.001). In 23% of adult patients and 8.8% of paediatric patients, potassium levels were < 3.5 mmol/l ( P < 0.005). The lowest mean potassium levels were 3.8 mmol/l in paediatric and 3.5 mmol/l in adult patients ( P < 0.005). Hypoglycaemia occurred in 42.3% of paediatric and 36% of adult patients. Time to resolution was similar in paediatric and adult patients (16.0 vs 18.2 h), as was duration of hospital stay (2.35 vs 2.53 days). Conclusions Young people were treated according to national guidelines, but the quality of monitoring was variable in both paediatric and adult settings. The incidence of hypoglycaemia and hypokalaemia was unacceptably high. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to test the accuracy of two screening instruments in UK Community health services: Modified Checklist for Autism in Toddlers (M-CHAT) and Social Communication Questionnaire (SCQ) for autism spectrum disorder (ASD). A two-stage screening and in-depth assessment procedure, combined with sampling stratification and statistical weighting, allowed the accuracy of the screens to be estimated in the entire population of referred children.Method: The study included all referrals of children aged 18 to 48 months to community paediatric and speech and language therapy services in two London districts over a 12-month period between September 2004 and September 2005. Parents of 808 children were approached; screen data were obtained on 543 children (67.2%). A stratified subsample of 120 children received an in-depth assessment for ASD as defined by the International Statistical Classification of Diseases and Related Health Problems, 10th edition. Community clinician judgement of likely ASD was available for 98 out of the 120 children.Results: The sensitivity and specificity were 64% (95% confidence intervals; range 51-80%) and 75% (63-85%) for the SCQ, and 82% (72-92%) and 50% (33-64%) for M-CHAT. There was no evidence that the area under the curve differed between the two screening instruments. There was also no evidence that clinician judgement of likely ASD differed from either of the screening tests. The screening tests did not perform well to confirm preliminary clinical judgement to refer (in series), nor as an alternative indicator for referral (in parallel).Interpretation: While screening tests may provide useful information, their accuracy is moderate. Screening information in isolation should not be used to make referral decisions regarding specialized ASD assessment. [ABSTRACT FROM AUTHOR]

Background and Aims Modelling the population impact and cost-effectiveness of smoking cessation aids is limited by lack of knowledge about how the use of aids changes across quit attempts. Here we test whether the quit method used in a previous attempt influences (i) future decisions to quit and/or (ii) treatment/s used during subsequent attempts. Design and Setting Data came from the Smoking Toolkit Study, a United Kingdom national household survey. Participants and Measures Smokers ( n = 5489) who completed a baseline and 6-month follow-up questionnaire. Respondents were asked what treatment/s, grouped as: prescription medication/s [bupropion, varenicline or nicotine replacement therapy (NRT)], over-the-counter NRT or unaided that they had used in their most recent quit attempt (at baseline), and any use of treatment/s for a quit attempt in the last 3 months at follow-up. Results Smokers who had tried to quit at baseline were more likely to report having tried to quit again prior to follow-up [all odds ratios ≥ 2.19 relative to no attempt at baseline, P < 0.001]. Smokers who tried to quit using pharmacological aids were more likely to try to quit again at follow-up (all ORs ≥ 2.19 relative to no attempt at baseline, P < 0.001). Smokers tended to re-try aids used in baseline attempts in future attempts (all ORs ≥ 1.48 relative to no attempt at baseline, P < 0.01). Conclusions Smokers who have tried to quit in the past year are more likely to try to quit again within 6 months regardless of whether they used a pharmacological aid, and they are more likely to re-try aids they had used previously. [ABSTRACT FROM AUTHOR]

Background A substantial minority of adolescents suffer from depression and it is associated with increased risk of suicide, social and educational impairment, and mental health problems in adulthood. A recently conducted randomized controlled trial in England evaluated the effectiveness of a manualized universally delivered age-appropriate CBT programme in school classrooms. The cost-effectiveness of the programme for preventing low mood and depression for all participants from a health and social care sector perspective needs to be determined. Methods A trial-based cost-effectiveness analysis based on a cluster-randomized controlled trial (trial registration - ISRCTN 19083628) comparing classroom-based CBT with usual school provision of Personal Social and Health Education. Per-student cost of intervention was estimated from programme records. The study was undertaken in eight mixed-sex UK secondary schools, and included 3,357 school children aged 12 to 16 years (in the two trial arms evaluated in the cost-effectiveness analysis). The main outcome measures were individual self-reported data on care costs, Quality-Adjusted Life-Years ( QALYs, based on the EQ-5D health-related quality-of-life instrument) and symptoms of depression (Short Mood and Feelings Questionnaire) at baseline, 6 and 12 months. Results Although there was lower quality-adjusted life-years over 12 months (−.05 QALYs per person, 95% confidence interval −.09 to −.005, p = .03) with CBT, this is a 'clinically' negligible difference, which was not found in the complete case analyses. There was little evidence of any between-arm differences in SMFQ scores (0.19, 95% CI −0.57 to 0.95, p = .62), or costs (£142, 95% CI −£132 to £415, p = .31) per person for CBT versus usual school provision. Conclusions Our analysis suggests that the universal provision of classroom-based CBT is unlikely to be either more effective or less costly than usual school provision. [ABSTRACT FROM AUTHOR]

ABSTRACT Overactive bladder ( OAB) is condition, characterized by urinary urgency, frequency and incontinence, which has the potential to disrupt everyday life considerably. Although there is evidence that antimuscarinic treatment is effective at treating physical symptoms, there is currently no systematic exploration of psychological factors associated with OAB after treatment. This study aimed to examine the quality of life, relationships, sexual functioning, psychological wellbeing and illness perceptions of individuals with OAB after they have received treatment. And to determine whether an individual's psychological wellbeing is directly related to the severity of their symptoms, or whether their illness perceptions mediate this relationship. This study used a cross-sectional, questionnaire-based quantitative design with a secondary care outpatient sample who were diagnosed with OAB and had been either previously or currently prescribed drug treatment. Patients reported moderately severe OAB symptoms, with approximately a third reporting moderate/severe anxiety and 12% reporting severe depression. There was no direct relationship between symptom severity and psychological wellbeing ( β = −0·03, t(31) = −0·96, p = 0·34; β = −0·02, t(31) = −0·41, p = 0·68) - this relationship was mediated by the patient's sense of personal control over their OAB ( β = 0·03 ( SE = 0·02), 95% CI [0·004, 0·09]; β = 0·02 ( SE = 0·02), 95% CI [0·0008, 0·08]). Including interventions to improve personal control alongside drug treatment may improve treatment adherence and outcomes. [ABSTRACT FROM AUTHOR]

Objective This study aims to evaluate a novel and brief skills-based therapy for inpatients with anorexia nervosa, which addressed 'cold' and 'hot' cognitions in group format. Method Adult inpatients with anorexia nervosa participated in the cognitive remediation and emotion skills training groups. Participants who attended all group sessions completed patient satisfaction and self-report questionnaires. Results Analysis of the data showed that social anhedonia (measured by the Revised Social Anhedonia Scale) decreased significantly between pre- and post-interventions, with small effect size ( d = 0.39). Motivation (perceived 'importance to change' and 'ability to change') was found to have increased with small effect sizes ( d = 0.23 and d = 0.16), but these changes did not reach statistical significance. The cognitive remediation and emotion skills training group had positive feedback from both the patients and therapists delivering this structured intervention. Conclusion Improved strategies are needed both in supporting inpatients to tolerate the group therapy setting and in helping them to develop the skills necessary for participation. Further larger-scale research in this area is needed to consolidate these findings. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background Increasing fruit and vegetable consumption is a goal for the UK. Therefore, the effectiveness of a fruit and vegetable voucher scheme coupled with key 'five-a-day' consumption messages as a brief intervention in primary care consultations was assessed in the present study. Methods One thousand one hundred and eighty-eight vouchers as a prescription for fruits and vegetables were routinely distributed to patients attending a primary healthcare centre in a deprived area, and 124 volunteer patients routinely attending the centre were included. Telephone-based questionnaires were used to examine changes in consumption over the short and medium term. Other key aspects assessed in the evaluation related to fruit and vegetable purchasing behaviour, knowledge relating to what constitutes a portion size, the relationship between food and health, and barriers to consumption. Results Although 76.2% of participants used the prescription vouchers when purchasing fruits and vegetables, a significant change in the consumption or purchasing behaviour was not observed ( P > 0.05). Participants' level of knowledge relating to the number of portions recommended and the portion size of different fruits and vegetables showed a moderate increase from baseline over the short and medium term. The primary barriers to fruit and vegetable consumption were reported as 'the quality of fresh fruits and vegetables' and 'the money available to spend on food'. Conclusions The use of 'the fruit and vegetable on prescription' scheme was an effective method of engaging participants in improving awareness of key diet-related health messages. However, further intervention is required to produce a significant impact on the actual behaviour change. [ABSTRACT FROM AUTHOR]

Background Many speech and language therapists (SLTs) work with patients who have a tracheostomy. There is limited information about their working practices and the extent to which recent publications and research have influenced the speech and language therapy management of the tracheostomized patient. Aims This study reviews the current patterns of clinical practice for SLTs in the management of adult tracheostomized patients in the UK. Methods & Procedures An online questionnaire was completed by 106 SLTs with prior experience in tracheostomy management. The information from this was explored to determine patterns of practice across various areas of speech and language therapy tracheostomy management including clinical roles and responsibilities, management of communication disorders, and assessment and management of dysphagia and decannulation. These clinical patterns were then examined with respect to the current literature, emerging patterns in evidence-based practice and national practice guidelines. Outcomes & Results The results indicate a moderate to high level of clinical consistency in the majority of areas evaluated across the scope of tracheostomy management in speech and language therapy. Consistency in practice areas such as increased utilization of instrumental assessments and conservative use of the Modified Evans Blue Dye Test indicate clinical application in line with current research. Limited clinical consensus or inconsistencies in evidence-based services were identified in aspects of practice that are supported by conflicting or emerging research evidence. Such areas include involvement in cuff deflation regimes, adoption of specific decannulation procedures and participation in multidisciplinary team management. Conclusions & Implications SLTs in the UK provide a moderate to high level of consistent practice in tracheostomy management. This study identifies areas of tracheostomy management that require further research in order to establish clinical practice guidelines and to address discrepancies between research evidence and clinical implementation. [ABSTRACT FROM AUTHOR]

Background Dysphagia is common after stroke, leading to adverse outcome. There is a paucity of high-quality evidence for dysphagia therapy, thus making it difficult to determine the best approaches to treatment. Clinical decisions are often based on usual practice, however no formal method of monitoring practice patterns exists. Aims To determine speech and language therapists' (SLTs) approaches to direct dysphagia therapy with stroke patients in the UK and Ireland. Methods & Procedures A 24-item questionnaire was developed, piloted and delivered in a web-based cross-sectional survey targeting all SLTs working with stroke patients in the UK and Ireland. Outcomes & Results A total of 138 SLTs responded from a range of clinical settings and levels of experience. There was variation in the responses to all questions. Respondents reported treating patients a median of once a day, 3 days a week for 15 min. The most commonly recommended direct exercises were supervised swallow trials (recommended 'frequently or always' by 73%). Despite most respondents having access to an instrumental swallowing assessment, over half reported rarely or never conducting one before recommending exercises. Most (93%) did not use a protocol for systematically progressing patients' exercises and only 37% reported using standardized outcome measures. Conclusions & Implications This survey gives valuable insight into the direct dysphagia therapy practices of SLTs based in the UK and Ireland working in stroke. It highlights discrepancies between reported approaches and recommendations from existing evidence and clinical guidelines. The variation in responses indicates a need to develop a consensus statement and further research to guide practice. [ABSTRACT FROM AUTHOR]

Background: Attention deficit hyperactivity disorder is increased in children with intellectual disability. Previous research has suggested stimulants are less effective than in typically developing children but no studies have titrated medication for individual optimal dosing or tested the effects for longer than 4 weeks. Method: One hundred and twenty two drug-free children aged 7-15 with hyperkinetic disorder and IQ 30-69 were recruited to a double-blind, placebo-controlled trial that randomized participants using minimization by probability, stratified by referral source and IQ level in a one to one ratio. Methylphenidate was compared with placebo. Dose titration comprised at least 1 week each of low (0.5 mg/kg/day), medium (1.0 mg/kg/day) and high dose (1.5 mg/kg/day). Parent and teacher Attention deficit hyperactivity disorder (ADHD) index of the Conners Rating Scale-Short Version at 16 weeks provided the primary outcome measures. Clinical response was determined with the Clinical Global Impressions scale (CGI-I). Adverse effects were evaluated by a parent-rated questionnaire, weight, pulse and blood pressure. Analyses were by intention to treat. Trial registration: ISRCTN 68384912. Results: Methylphenidate was superior to placebo with effect sizes of 0.39 [95% confidence intervals (CIs) 0.09, 0.70] and 0.52 (95% CIs 0.23, 0.82) for the parent and teacher Conners ADHD index. Four (7%) children on placebo versus 24 (40%) of those on methylphenidate were judged improved or much improved on the CGI. IQ and autistic symptoms did not affect treatment efficacy. Active medication was associated with sleep difficulty, loss of appetite and weight loss but there were no significant differences in pulse or blood pressure. Conclusions: Optimal dosing of methylphenidate is practical and effective in some children with hyperkinetic disorder and intellectual disability. Adverse effects typical of methylphenidate were seen and medication use may require close monitoring in this vulnerable group. [ABSTRACT FROM AUTHOR]

How to cite this article Evans S., Preston F., Daly A., Ashmore C., Holden C. & MacDonald A. (2012) Home enteral tube feeding in inherited metabolic disorders children: a review of long-term carer knowledge and technique. J Hum Nutr Diet. Abstract Background: Home enteral tube feeding (HETF) is commonly used in children with inherited metabolic disorders (IMD). It is unclear how caregiver knowledge and their safety in using tube feeding techniques changes over time. Methods: Caregivers of children with IMD on HETF from one UK IMD centre had annual interviews over 3 years using a structured questionnaire and observation to assess HETF knowledge and safety techniques. Results: Thirty-two caregivers of IMD children (median age 5.3 years; range 0.3-13.6 years) were studied. Seventy-eight percent ( n = 25) of subjects had been on HETF for >5 years. Over 3 years, many caregivers' HETF techniques deteriorated: accurate feed ingredient measurement decreased from 36% to 11%; correct flushing of tubes decreased from 56% to 44%; checking tube position as recommended decreased from 72% to 56%; and correct hand washing decreased from 38% to 25%. Despite improvements, knowledge of some aspects remained poorly understood: dangers of incorrect tube placement increased from 41% to 56%; correct position for night feeding increased from 38% to 56%; and feed ingredient storage decreased from 87% to 38%. Conclusions: The HETF techniques of caregivers of children with IMD declined over time. Caregivers need to understand that HETF, particularly in IMD, is a serious procedure associated with life-threatening risks. Poor HETF practices may cause feed contamination, incorrect feed concentration, feed intolerance, aspiration, peritonitis and even metabolic decompensation. HETF skills should be reassessed annually, with compulsory retraining if basic 'core' HETF competencies are not demonstrated. [ABSTRACT FROM AUTHOR]

Background: The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice. Aims: To investigate the working practices and professional experiences of paediatric SLTs working in the UK through an online survey. Methods & Procedures: The survey was conducted online using Survey Monkey. Therapists were alerted to the survey through the Bulletin of the Royal College of Speech and Language Therapists and by e-mails to national special interest groups. Outcomes & Results: A total of 516 clinicians completed the survey. A large majority worked in the National Health Service (NHS). A varied pattern of working was revealed. Most worked in several settings and saw a range of clients. A typical clinician spends less than one-quarter of their time giving direct therapy and more than one-quarter training parents and other professionals. Nearly half of respondents felt that their time could be better used. Too little time for direct therapy and the time required for administration emerged as their principal concerns. Most clinicians have specialist knowledge of particular client groups and spend more time with them than do non-specialists. Nevertheless, clients are more likely to be treated by a therapist who does not claim to have specialist knowledge of their condition than by one who does. The only clients for whom this is not the case are those with dysphagia. Eighty per cent of respondents felt that proposed changes to the NHS would not benefit the children they treat and there was widespread concern about cuts and the effects of general practitioner commissioning. Despite this, a large majority expected to remain speech and language therapists 5 years from now. Conclusions & Implications : This survey provides an overview of the working practices of paediatric speech and language therapists. Its findings have significant implications for training and workforce development in the profession. [ABSTRACT FROM AUTHOR]

Background: Dysarthria knowledge is predominantly impairment-based. As a result, speech and language therapists (SLTs) have traditionally adopted impairment-focused management practices. However, guidance for best practice suggests that SLTs should consider the client holistically, including the impact of dysarthria beyond the impairment. Aims: To investigate the current assessment and treatment practices used by UK SLTs with clients with progressive dysarthria and to identify whether these satisfy the needs of SLTs in their everyday practice. To investigate the extent to which they consider oromotor abilities, intelligibility, functional communication, participation and interaction to be important regarding assessment and treatment decisions. To explore whether management decisions are affected by level of clinical experience or settings in which SLTs work. Methods & Procedures: An online survey of UK SLTs working with adults with progressive dysarthria. Outcomes & Results: A total of 119 SLTs completed the survey. Respondents considered that targeting the levels of impairment, activity and participation are important in the management of clients with progressive dysarthria, as recommended by clinical guidelines and recent research. However a particularly high proportion of respondents reported the use of impairment-based assessments. Respondents reported lacking the necessary tools to target interaction in assessment and intervention. The intervention that respondents use with clients varies according to the progressive disorder and dysarthria severity. There is evidence for a trend that less experienced SLTs and those working predominantly in hospital-based settings focus on the impairment, whereas more SLTs with more experience and those based in predominantly community-based settings look beyond the impairment. Conclusions & Implications: The values held by SLTs match guideline recommendations for best practice, however the clinical reality is that the assessment of progressive dysarthria remains predominantly impairment-focused. New tools need to be developed and integrated into practice to target interaction in assessment and intervention, to reduce the gap between best practice recommendations and clinical reality. Ongoing research into the effectiveness of SLT intervention with clients with progressive dysarthria is required to guide clinical management decisions. [ABSTRACT FROM AUTHOR]

Background: Computerised Cognitive Behaviour Therapy (cCBT) offers the potential to make evidence based interventions more available and accessible for children and young people. Research is currently limited and proof of concept studies are required to explore the viability and possible therapeutic benefits of cCBT as a universal or targeted intervention in schools. Method: In Study 1, cCBT was provided as a universal intervention to 13 participants who were assigned to either group cCBT or a matched computer gaming condition. In Study 2, cCBT was provided as a targeted intervention by trained school nurses to 12 participants with mild or moderate emotional problems. Results: Both studies found cCBT to result in immediate post intervention benefits and feedback about the programme was very positive. Conclusion: This study provides proof of concept that cCBT provided as a universal or targeted emotional health intervention in schools is viable and may result in immediate therapeutic benefits. These findings are limited by the small sample size and absence of follow-up but suggest that more methodologically robust evaluations should be pursued. [ABSTRACT FROM AUTHOR]

Adam S., Champion H., Daly A., Dawson S., Dixon M., Dunlop C., Eardley J., Evans S., Ferguson C., Jankowski C., Lowry S., MacDonald A., Maritz C., Micciche A., Robertson L., Stafford J., Terry A., Thom R., van Wyk K., Webster D., White F.J. & Wildgoose J. on behalf of the British Inherited Metabolic Diseases Group (BIMDG) Dietitian's Group. (2012) Dietary management of urea cycle disorders: UK practice. J Hum Nutr Diet. 25, 398-404 Abstract Background: There is no published data describing UK dietary management of urea cycle disorders (UCD). The present study describes dietary practices in UK inherited metabolic disorder (IMD) centres. Methods: Cross-sectional data from 16 IMD centres were collected by a questionnaire describing the management of UCD patients on prescribed protein-restricted diets. Results: One hundred and seventy-five patients [ N-acetylglutamate synthase deficiency, n = 3; carbamoyl phosphate synthase deficiency (CPS), n = 8; ornithine transcarbamoylase deficiency (OTC), n = 75; citrullinaemia, n = 41; argininosuccinic aciduria (ASA), n = 36; arginase deficiency, n = 12] were reported; 70% ( n = 123) aged 0-16 years; 30% ( n = 52) >16 years. Prescribed median protein intake decreased with age (0-6 months: 2 g kg−1 day−1; 7-12 months: 1.6 g kg−1 day−1; 1-10 years: 1.3 g kg−1 day−1; 11-16 years: 0.9 g kg−1 day−1 and >16 years: 0.8 g kg−1 day−1) with little variation between disorders. Adult protein prescription ranged 0.4-1.2 g kg−1 day−1 (40-60 g day−1). In the previous 2 years, 30% ( n = 53) were given essential amino acid supplements (EAAs) (CPS, n = 2; OTC, n = 20; citrullinaemia, n = 15; ASA, n = 7; arginase deficiency, n = 9). EAAs were prescribed for low plasma quantitative essential amino acids ( n = 13 centres); inadequate natural protein intake ( n = 11) and poor metabolic control ( n = 9). From diagnosis, one centre prescribed EAAs for all patients and one centre for severe defects only. Only 3% ( n = 6) were given branch chain amino acid supplements. Enteral feeding tubes were used by 25% ( n = 44) for feeds and 3% ( n = 6) for medications. Oral energy supplements were prescribed in 17% ( n = 30) of cases. Conclusions: In the UK, protein restriction based on World Health Organization 'safe intakes of protein', is the principle dietary treatment for UCD. EAA supplements are prescribed mainly on clinical need. Multicentre collaborative research is required to define optimal dietary treatments. [ABSTRACT FROM AUTHOR]

Background: Literature regarding the education, training, clinical support and confidence of speech-language therapists (SLTs) working with patients with a tracheostomy is limited; however, it suggests that many clinicians have reduced clinical confidence when managing this complex population, many face role and team challenges practising in this area, and most are seeking more opportunities for professional development and training. Aims: To investigate the education, training, clinical support and confidence of SLTs in the UK who manage patients with a tracheostomy in order to identify current challenges and inform the future clinical training needs of this professional group. Methods & Procedures: Via an online survey, the clinical training, clinical support and confidence of SLTs with more than one year of clinical experience was examined. A total of 106 SLTs from the UK completed the survey. Within the questionnaire, clinicians were also asked to identify if their workplace had a tracheostomy competency training programme (CTP) to allow further exploration of the preparation, clinical support and confidence of respondents with (43% of respondents) and without (32% of respondents) a CTP. Outcomes & Results: Most SLTs (71%) were confident managing patients with a tracheostomy. The majority were accessing professional development and receiving expert support, though many identified specific areas where more support and training was needed. Less than half the group felt up to date with the current evidence. Only 35% of clinicians felt they worked in an optimal team for tracheostomy management, and poor recognition of the role of the SLT in managing dysphagia in patients with a tracheostomy was an issue for many clinicians, particularly on more general care wards. SLTs in workplaces with a CTP were found to have received significantly more expert support, on-the-job training, access to evidence-based practice and were significantly more confident in managing ventilator-assisted patients. Conclusions & Implications: SLTs are eager to access further professional development and training; however, such training needs to target specific areas of need. The significant difference in the preparation, support and confidence of SLTs with CTPs in their workplace highlights potential benefits that can be achieved through workplace training and support. [ABSTRACT FROM AUTHOR]

Primary objective: This is the first qualitative study that elicited the perceptions of both psychological therapists and their clients in the use of Clinical Outcomes in Routine Evaluation with computer software (CORE‐Net), where instant visual feedback for session tracking was given on a computer screen in the therapy room at each therapy session. The study also examined how therapists viewed its potential value in supervision and provides suggestions for improving training. Research design: The study adopted a convenience sample of four therapists in a primary care counselling setting (PCC – General Practitioner referrals) who were experienced in using CORE‐Net, and five therapists in an NHS employee/occupational support counselling service (OH) who had just begun to use CORE‐Net for session tracking with 10 of their clients. Method: A qualitative methodology was used and interview data were collected from the therapists via focus groups; the clients were interviewed individually face to face. All data was analysed inductively. Findings: The study identified six overarching themes: (i) therapists were initially anxious and resistant; (ii) therapists adapt 'creatively'; (iii) outcome measures help the client/therapist relationship; (iv) clients perceive visual measures as helpful; (v) CORE scores inform supervision; and (vi) proper and ongoing training/support of therapists is necessary. The main limitations are comparability of data and the generalisabilty of results. Conclusions: The implementation of routine outcome measurement (ROM) is a challenge but can be made easier with proper training and supervision. Clients appear happier than their therapists when routine outcome measurement is used. [ABSTRACT FROM AUTHOR]

Summary Introduction: The quality of anticoagulation management is not readily or frequently assessed, particularly between different centres. This study sought to evaluate agreement in oral anticoagulant management decisions between participating centres in UK NEQAS programmes. Methods: Participants were asked to indicate whether they used computerized dosing support software (CDSS) and to complete a series of questions with respect to anticoagulant management provision. Four clinical scenarios were provided, together with past and current International Normalised Ratio (INR) results. Participants were asked to provide recommendations on the target INR they would assign to the patient, the dose of warfarin and a recall interval. Results: Seven hundred and fifty-nine centres returned results, of which 28% were enrolled in the hospital-based EQA programme, and 72% were participants in the point-of-care testing programme. Six hundred (79%) reported use of CDSS. In one straightforward scenario, there was 99% agreement in dose recommendation. However, for three more complex scenarios, differences were apparent in target INRs employed and both dose and recall recommendations. In some cases, differences related to the software system employed. Conclusion: The study emphasizes large variation in the approach to managing these scenarios and warrants further investigation, together with education including promoting national guidelines for the assignment of target ranges. [ABSTRACT FROM AUTHOR]

Background: Non-speech oro-motor exercises (NSOMExs) are described in speech and language therapy manuals and are thought to be much used in acquired dysarthria intervention, though there is no robust evidence of an influence on speech outcome. Opinions differ as to whether, and for which dysarthria presentations, NSOMExs are appropriate. Aims: The investigation sought to collect development-phase data, in accordance with the Medical Research Council (MRC) evaluation of complex interventions. The aims were to establish the extent of use of NSOMExs in acquired disorders, the exercise regimes in use for dysarthria, with which dysarthric populations, and the anticipated clinical outcomes. A further aim was to determine the influencing rationales where NSOMExs were or were not used in dysarthria intervention. Methods & Procedures: Speech and language therapists throughout Scotland, Wales, and Northern Ireland, working with adult-acquired dysarthria, were identified by their service heads. They received postal questionnaires comprising 21 closed and two open questions, covering respondent biographics, use of NSOMExs, anticipated clinical outcomes, and practice influencing rationales. Outcome & Results: One hundred and ninety-one (56% response) completed questionnaires were returned. Eighty-one per cent of respondents used NSOMExs in dysarthria. There was no association with years of speech and language therapy experience. Those who used and those who did not use NSOMExs provided similar influencing rationales, including evidence from their own practice, and Higher Education Institute teaching. More experienced speech and language therapists were more likely than those more recently qualified to be guided by results from their own practice. Input from the attended Higher Education Institute was more influential for those less experienced than for those more experienced. Clinical outcome aims were not confined to speech, but also included improvements in movement, sensory awareness, appearance, emotional status, dysphagia and drooling. NSOMExs were used with many neurological disorders, especially stroke, all dysarthria classes, especially flaccid, and all severity levels. Tongue and lip exercises were more frequent than face, jaw and soft palate. The most common regimes were four to six repetitions of each exercise, during three practice periods daily, each of 6-10 min. Conclusions & Implications: NSOMExs are a frequent component of dysarthria management in the UK-devolved government countries. This confirmation, along with the details of speech and language therapy practice, provides a foundation for clinical research which will compare outcomes for people with dysarthria, whose management includes and does not include NSOMExs. Speech and language therapy practice may be guided by evidence that speech outcome is or is not affected by NSOMExs. [ABSTRACT FROM AUTHOR]