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Background and aims: Dysphagia is common after stroke, so feeding through a nasogastric (NG) tube may be necessary. These tubes are frequently dislodged, causing interruption to feeding and hydration, and potential aspiration of feed or fluids into the lungs. Interventions to prevent this may include taping tubes to the face; the application of hand mittens or bandaging patients’ hands; inserting the NG tube into the nostril on the stroke-affected side; and nasal bridles. The aims of this survey were to investigate the management of NG feeding for stroke patients, including current tube confirmation and securing techniques, and associated nurse education. This was part of a three-phased sequential mixed-methods study. This paper reports on the second quantitative phase. Methods: A quantitative postal survey, based on initial qualitative findings, was sent to registered nurses (n=528) from the National Stroke Nurses Forum and Scottish Stroke Nurses Forum, in addition to registered nurses working on stroke units within the local health board. Results: The overall response rate was 59% (n=314/528). Tape was the most commonly used method for securing tube position, followed by inserting the tube on the stroke-affected side. Hand mittens were used more frequently than the nasal bridle; bandaging hands was reported once. Taping was considered to be more acceptable and safer than hand mittens or the nasal bridle, but less effective. Training in inserting NG feeding tubes was received by 56% (n=176/314). Methods used for confirming tube position included aspiration and X-ray. Provision of training in confirmation techniques varied. Conclusions: This study shows that the management of NG feeding for dysphagic stroke patients requires standardisation, as does the education for nurses to ensure that this intervention is carried out safely, effectively and acceptably. [ABSTRACT FROM AUTHOR]

The negative impacts of parental mental health problems on children and adolescents are well known, but the relationship between a child's depression and their parents' health is not so well understood. Being a carer/parent of someone with mental illness can be associated with negative outcomes for the caregiver. This paper reports the associations between the mental health of adolescents with major depression and their parents, before and after treatment of the adolescent's depression. Data were collected as part of the Adolescent Depression Antidepressants and Psychotherapy Trial, a randomised controlled trial of selective serotonin reuptake inhibitors with and without cognitive behaviour therapy in 208 clinic-recruited adolescents with major depression. The baseline severity of depression in the adolescent was significantly associated with both maternal and paternal mental health (as rated by the General Health Questionnaire). This effect was not confounded by other psychiatric symptoms. The degree of improvement in parental and child mental health was positively correlated across time. Our results support the hypothesis that there is a significant association between parental mental health and adolescent depressive symptoms. This study was not able to establish the direction of this association. In clinical practice, the findings demonstrate the importance of considering the mental health of the parents when treating depressed adolescents. [ABSTRACT FROM AUTHOR]

Primary objective: Operant conditioning interventions are effective in the management of post-acute ABI challenging behaviour. However, when this serves an avoidance or escape function, reinforcement approaches may be ineffective. In this paper the utility of a range of operant-derived ABI interventions is considered specifically with regard to behaviour whose prime function is avoidance or escape from rehabilitation activities. Methods and procedures: Efficacy of three operant interventions was determined by describing a single case study whose aggressive behaviour served an avoidance-escape function. Two interventions comprised variants of differential reinforcement: differential reinforcement of incompatible behaviour (DRI) and differential reinforcement of low rates of responding (DRL). The third intervention comprised situational time out (STO) and sustained verbal prompting. Main outcome: Despite reports of the efficacy of DRI and DRL, neither was beneficial in this case. However, STO and sustained verbal prompting proved highly effective in reducing aggression. Conclusions: Results are discussed in relation to two levels of explanation: function and cognition. Special emphasis is laid upon the extent to which interventions actively involve the patient and the degree of intrusiveness necessary for staff to implement therapeutic procedures. The case demonstrates how a scientifically-derived formulation regarding behaviour disorder can support multiple treatment options. [ABSTRACT FROM AUTHOR]

Background Insertion of an acupuncture needle into an acupuncture point typically generates a range of sensations called 'de qi'. Most acupuncturists are taught that obtaining de qi is important when treating patients with pain but this can be quite uncomfortable for patients. Objective This study assesses the importance of the strength of de qi, on the clinical outcome in osteoarthritic pain. Method This study was part of a larger randomised, single-blind, multifactorial trial involving three interventions: real acupuncture (RA), Streitberger needle (SN) and mock electrical stimulation for the treatment of patients with osteoarthritis (OA) of the hip and knee. Patients were treated twice a week for 4 weeks. The two outcomes relevant to this study were pain reduction assessed by visual analogue scale and the Park needling sensation questionnaire, both measured at completion of the study. Two arms of the trial were analysed (RA and SN). Reduction in pain was correlated against strength of de q¡ for both RA and SN. Those who felt de qi were compared with those who did not. Results 147 patients were recruited to the study (140 completed) with a mean pain reduction of 15.2 mm and mean de qi score of 6.2. There was no significant correlation between the strength of de qi and improvement in pain (p = 0.49). There was also no significant difference in pain relief (p = 0.52) between those who felt de qi and those who did not using the de qi subscale of the Park questionnaire. Conclusion These data suggest that the presence and intensity of de qi has no effect on the pain relief obtained for patients with OA. This result may have implications for both acupuncture treatment and for future trial methodology. [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 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: 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]