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Introduction: Parent/carers of disabled children want timely and personalized support. Research suggests that technology may address some limitations associated with traditional methods of communication with therapists (e.g. letter, telephone). This exploratory study examined United Kingdom (UK) parents and carers views on the use of digital technology (i.e. computers/phones) in supporting their child and the potential for its greater use in the care of children with complex needs. Methods: An online survey was distributed via special schools and support forums/networks. Questions explored use of and attitudes to digital technology in the care of children with complex needs. Descriptive statistical analyses and content analyses were undertaken on the data. Results: Respondents were 43 parents/carers whose children used rehabilitation services prior to the COVID-19 pandemic. The majority used digital technology frequently to support their child and saw the potential for greater use in rehabilitation services – provided this was not at the expense of in-person therapist contact. Conclusion: Parents and carers held positive views of digital technology as a tool to support their child and enhance rehabilitation services. Recommendations include regular service consultation on parental/child attitudes to digital service delivery and longitudinal studies to assess related health outcomes. [ABSTRACT FROM AUTHOR]

Background: The impact of any scientific article has traditionally been measured by the number of citations received. More recently, alternative metrics (altmetrics) reflect the digital dissemination of knowledge across the online mediasphere. Purpose: To evaluate and compare the characteristics of top-cited articles with those of top Altmetric articles related to nuclear medicine (NM). Material and Methods: We performed a search of the Web of Science and Altmetric databases using 114 search terms to identify the 50 top-cited and 50 top Altmetric articles, respectively, in the field of NM. We then compared the following characteristics of the selected articles: publication type; journal category; country of origin; year of publication; topic; imaging modality; and accessibility. Chi-square tests were performed for statistical analysis. Results: There were no overlaps between the 50 top-cited and 50 top Altmetric articles. In general, compared to the leading Altmetric articles in this field, the cited articles were: more frequently review works published in NM and radiology journals (76% vs. 13%, P = 0.000); published in or before 2005 (84% vs. 0%, P = 0.000); the majority were related to oncology (56% vs. 44%, P = 0.000); and originated from the Netherlands (12% vs. 0%, P = 0.000). Compared to the top-cited articles, the leading Altmetric articles were: more frequently original articles published in other clinical field journals (54% vs. 0%, P = 0.000); primarily published between 2016 and 2018 (70% vs. 0%, P = 0.000); focused on neurology (50% vs. 22%, P = 0.000); and originated from the UK (18% vs. 2%, P = 0.000). Conclusion: Citation counts and Altmetric scores represent unique perspectives for evaluating the impact of NM research. [ABSTRACT FROM AUTHOR]

In economically developed countries there is a rapidly increasing number of older people living and dying in care homes. The relative isolation of nursing care homes from the development of palliative care, the poor retention and recruitment of staff, and the lack of medical cover, hinder the provision of quality end-of-life care. End-of-life care strategies internationally highlight the benefit of using tools to help improve end-of-life care in care homes. All seven private nursing care homes within one district in Scotland undertook to implement, as a package, two end-of-life care tools, namely, the Gold Standards Framework for Care Homes (GSFCH) and an adapted Liverpool Care Pathway for Care Homes (LCP). A model of high facilitation, visiting the homes every 10—14 days with significant in-house staff training, was used to implement the 18-month programme. The notes of 228 residents who had died prior to and during the project were examined, alongside a staff audit looking at the effect that the project had on practice. A nurse researcher undertook qualitative interviews of bereaved relatives, pre-/post-implementation. This paper reports the results of an in-depth evaluation of professional practices and residents outcomes. There was a highly statistically significant increase in use of Do Not Attempt Resuscitation (DNAR) documentation, advance care planning and use of the LCP. An apparent reduction in unnecessary hospital admissions and a reduction in hospital deaths from 15% deaths pre-study to 8% deaths post-study were also found. Further work is needed to assess the optimum input required for successful implementation. [ABSTRACT FROM PUBLISHER]

Background: Healthcare-associated infections (HCAIs) pose a significant threat to the health and safety of patients, staff, and visitors. Infection prevention and control (IPC) teams play a crucial role in ensuring that systems and processes are in place to keep everyone safe within the healthcare environment. Aim: The aim of this study was to identify components of infection prevention services, priorities, indicators of successes and how they are measured, and facilitators and barriers to success. Methods: A s urvey questionnaire was developed and circulated to infection prevention leaders and managers. Findings/results: Seventy IPC leaders/managers completed the survey. Participants were responsible for a range of IPC services within and across healthcare organisations, with significant variations to IPC delivery components. Additionally, a range of budget availability was reported. Several IPC service requirements were considered core work of IPC teams, including providing IPC advice and support, surveillance and audit and education and training. Discussion: An optimal IPC service needs to be in place to ensure HCAIs are minimised or prevented. In a post pandemic era, this is more important than ever before. This is also as crucial for the health and wellbeing of those working in IPC, who have endured unprecedented demand for their services during the pandemic. [ABSTRACT FROM AUTHOR]

Enhancing Audio Description is a research project that explores how sound design, first-person narration, and binaural audio could be utilised to provide accessible versions of films for visually impaired audiences, presenting an alternative to current audio description (AD) practices. This article explores such techniques in the context of the redesign of the short film 'Pearl', by discussing the creative process as well as evaluating the feedback supplied by visually impaired audiences. The research presented in this article demonstrates that the methods proposed were as successful as traditional AD in terms of providing information, enjoyment, and accessibility to audiences, demonstrating that both practices can coexist and, as a result, cater for the different stylistic preferences of end users. [ABSTRACT FROM AUTHOR]

Background: Reactions to treatment are common following acupuncture. Understanding how these reactions are interpreted by patients is largely unexplored. Objective: To examine patients' ratings of the severity and bothersomeness of a range of common treatment reactions, and to assess their impact on willingness to try acupuncture again. Methods: Self-reported ratings of the frequency, severity and bothersomeness of treatment reactions from 133 patients in the acupuncture arm of a pragmatic randomised controlled trial of acupuncture for chronic back pain are described and analysed. Results: A total of 133 acupuncture patients reported at 3 months reactions that they had experienced at any time during a course of up to 10 acupuncture treatment sessions. They received a total of 1150 treatments, an average of 8.6 sessions per patient. All patients reported treatment reactions, most commonly relaxation (84%, n = 112), which was significantly associated with willingness to try acupuncture again, {%2 = 7.860, df = 1,p = 0.005). Only 16% (n=21) were unwilling to experience a specific treatment reaction again, and 9% (n = 12) were unwilling to try acupuncture again. The most 'bothersome' reaction was a temporary worsening of symptoms (29%, n=38), though this was not associated with an unwillingness to try acupuncture again [%2 = 0.382, df = 1, p>0.536). Those unwilling to try acupuncture again reported significantly less reduction in their pain at 3 months (mean (SE) SF-36 bodily pain score at 3 months 30.453 (3.598) vs 19.30 (1.128); p = 0.003). Conclusion: Among this group of patients seeking help for low back pain, the experience of treatment reactions was universal. There was no evidence that the bothersomeness of treatment reactions was associated with patient's willingness to try acupuncture again. The benefit of pain reduction over the course of treatment appeared to outweigh self-rated bothersome reactions to treatment. [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]

This study is the first to test the efficacy of principle-based correctional counseling (PBCC) for improving the self-control and mental health of people incarcerated for sexual violence (SV). A total of 132 males incarcerated for SV were assigned to a treatment group that received cognitive behavior therapy (CBT) supplemented with intensive PBCC and a waitlist control group that received only CBT. Results using paired t -tests and an analysis of covariance (ANCOVA) to control for pretest scores showed that compared with the control group, treatment participants showed a significant increase in affective well-being and a significant decrease in low self-control, depression, anxiety, and anger. [ABSTRACT FROM AUTHOR]

This research was the first in the United Kingdom to examine the prevalence and nature of nonconsensual sharing of sexually explicit messages, pictures, and videos and to examine whether this varies according to gender and by role (i.e., perpetrator, victim, or as dual role of perpetrator/victim). In a sample of 391 young adults (aged 18-25 years), questionnaire data on subjective norms, consensual and nonconsensual sharing, and their motivations for these behaviors were collected. Perpetration of and victimization through nonconsensual sharing was experienced by a substantial number of individuals. There was an association between reporting perpetration of nonconsensual sharing and experiencing victimization. An association was also found between reporting being pressured (i.e., coerced) to send sexually explicit material and experiencing victimization of nonconsensual sharing, which suggests that these behaviors may form part of a continuum of violence and abuse, potentially within intimate relationships. No association was found between gender and (a) perpetration or (b) victimization. However, from a gendered perspective, females perceived there was greater social pressure to post messages, pictures, and videos, compared with males. Motivations for nonconsensual sharing were commonly explained as for fun/a joke, and generally not thought of as problematic, although some victims perceived motivations to be more negative and/or related to revenge/causing distress. Given that this research examined nonconsensual sharing across messages, pictures, and videos for both victimization and perpetration and found it was both perpetrated and experienced by females and males, this does not support the common perception that this is a male perpetrated behavior against women. This has implications for education, policy, intervention, and prevention, with approaches needing to be inclusive of both males and females when addressing perpetration and victimization. [ABSTRACT FROM AUTHOR]

Effectively recognizing, identifying, and utilizing emotional stimuli is essential for successful social interactions, with deficits in these robustly identified as risk factors for offending. Psychological understanding of street gang membership is limited, particularly surrounding emotional dispositions distinguishing street gang from non-gang offenders. This study examined how street gang members compare with non-gang offenders on trait emotional intelligence (TEI), antisocial personality disorder (ASPD), callous–unemotional traits, anger rumination, and aggression. Recruited through volunteer sampling, participants included 73 (44 street gang and 29 non-gang) male offenders incarcerated at a U.K. Category C prison. Participants completed seven questionnaires assessing emotional dispositions, social desirability, and, consistent with the Eurogang definition, street gang membership. To compare participants' demographics and identify the predictors of street gang membership, chi-square and discriminant function analyses were conducted. With a significant discriminant function, Λ =.80, χ2(6) = 14.96, p =.021, high levels of ASPD, anger rumination, and aggression and low levels of TEI predict street gang membership. Compared with non-gang prisoners, street gang prisoners did not differ on callous–unemotional traits, age, or ethnicity. Results suggest that, compared with non-gang prisoners, street gang members were more likely to possess dysfunctional emotional dispositions. Findings from this research have important implications in terms of developing interventions for street gang membership. Specifically, this research supports the need for gang-specific early intervention and prevention programs, with emotion-focused components. Ideas for future research are discussed, including the identification of further sociocognitive, personality, and emotional traits distinguishing street gang from non-gang offenders. [ABSTRACT FROM AUTHOR]

Objectives: Chronic pain is often experienced alongside other long-term conditions (LTCs), yet our understanding of this, particularly in relation to multimorbidity (≥2 LTCs) is poor. We aimed to examine associations between the presence/extent of chronic pain with type/number of LTCs experienced. Methods: We examined the relationship between number/type of LTCs (N = 45) in UK Biobank participants (n = 500,295) who self-reported chronic pain lasting ≥3 months in seven body sites or widespread. Relative risk ratios (RRR) for presence/extent of chronic pain sites were compared using logistic regression adjusted for sociodemographic (sex/ age/socioeconomic status) and lifestyle factors (smoking/alcohol intake/BMI/physical activity). Results: 218,648 participants self-reported chronic pain. Of these, 69.1% reported ≥1 LTC and 36.2% reported ≥2 LTCs. In 31/45 LTCs examined, >50% of participants experienced chronic pain. Chronic pain was common with migraine/ headache and irritable bowel syndrome where pain is a primary symptom, but also with mental health conditions and diseases of the digestive system. Participants with >4 LTCs were over three times as likely to have chronic pain (RRR 3.56, 95% confidence intervals (CIs) 3.44-3.68) and 20 times as likely to have widespread chronic pain (RRR 20.13, 95% CI 18.26-22.19) as those with no LTCs. Conclusions: Chronic pain is extremely common across a wide range of LTCs. People with multimorbidity were at higher risk of having a greater extent of chronic pain. These results show that chronic pain is a key factor for consideration in the management of patients with LTCs or multimorbidity. [ABSTRACT FROM AUTHOR]

Background: Day care services support older people living with long-term conditions (LTC's). Aims: The aims of the study were to determine outcomes in terms of loneliness and health-related quality of life for older people with LTCs attending day care services in the United Kingdom. Methods: Newly referred older people with LTCs to day care services in North West of England and Wales were invited to participate. The EQ-5D-3L and De Jong Loneliness questionnaires were completed at recruitment, 6 and 12 weeks. Results: Ninty-four older people (64% female), age range 65–99 years; mean number of LTCs 4.3 (range: 2–9) were recruited. About 52% lived alone and 36% lived in one of the 20% most deprived local authorities in England and Wales. Outcomes over 12 weeks were comparable for paid, blended, and for volunteer-led services. Conclusion: Following the Covid-19 pandemic, it is increasingly urgent to support older people with LTCs who may have lost physical and cognitive function during lockdown and to support their recovery. Our study suggests that volunteers can provide services and complement the care provided by paid staff, freeing up resources and enabling increasing numbers of older people to be supported. [ABSTRACT FROM AUTHOR]

Objective: To establish the prevalence of unmet need for spasticity management in care home residents in two counties of the United Kingdom. Design: Cross-sectional observational study with a six-month follow-up arm for participants with identified unmet needs. Setting: 22 care homes in Derbyshire and Nottinghamshire. Subjects: 60 care home residents with upper motor neuron syndrome–related spasticity. Interventions: No intervention. When unmet needs around spasticity management were identified, the participant's general practitioner was advised of these in writing. Main measures: Resistance to Passive Movement Scale to assess spasticity; recording of (a) the presence of factors which may aggravate spasticity, (b) potential complications of spasticity, (c) spasticity-related needs and (d) current interventions to manage spasticity. Two assessors judged the presence or absence of needs for spasticity management and whether these needs were met by current care. Results: Out of 60 participants, 14 had no spasticity-related needs; 46 had spasticity-related needs; 11 had needs which were being met by current care and 35 participants had spasticity-related needs at baseline which were not being met by their current care. These were most frequently related to the risk of contracture development or problems with skin hygiene or integrity in the upper limb. In total, 6 participants had one or more pressure sores and 35 participants had one or more established joint contractures. A total of 31 participants were available for follow-up. Informing general practitioners of unmet needs resulted in no change to spasticity management in 23/31 cases. Conclusion: Care home residents in this study had high levels of unmet need for spasticity management. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine prevalence of pre-stroke frailty in acute stroke and describe validity of a Frailty Index–based assessment. Design: Cross-sectional. Setting: Single UK urban teaching hospital. Subjects: Consecutive acute stroke unit admissions, recruited in four waves (May 2016–August 2018). We performed the assessments within first week and attempted to include all admissions. Main measures: Our primary measure was a Frailty Index, based on cumulative disorders. A proportion of participants were also assessed with the 'Frail non-disabled' questionnaire. We evaluated concurrent validity of Frailty Index against variables associated with frailty in non-stroke populations. We described predictive validity of Frailty Index for stroke severity and delirium. We described convergent validity, quantifying agreement between frailty assessments and a measure of pre-stroke disability (modified Rankin Scale) using kappa statistics and correlations. Results: We included 546 patients. A Frailty Index–defined frailty syndrome was observed in 427 of 545 patients (78%), of whom, 151 (28%) had frank frailty and 276 (51%) were pre-frail. Phenotypic frailty was observed in 72 of 258 patients (28%). We demonstrated concurrent validity via significant associations with all variables (all p < 0.01). We demonstrated predictive validity for stroke severity and delirium (p < 0.01). Agreement between the frailty measures was poor (kappa = –0.06) and convergent validity was moderate (Frail non-disabled 'Cramer's V' = 0.25; modified Rankin Scale 'Cramer's V' = 0.47). Conclusion: Frailty is present in around one in four patients with acute stroke; if pre-frailty is included, then a frailty syndrome is seen in three out of four patients. The Frailty Index is a valid measure of frailty in stroke; however, there is little agreement between this scale and other measurements of frailty. [ABSTRACT FROM AUTHOR]

Objective: To examine whether stroke survivors in inpatient rehabilitation with pre-existing cognitive impairment receive less therapy than those without. Design: Prospective observational cohort. Setting: Four UK inpatient stroke rehabilitation units. Participants: A total of 139 stroke patients receiving rehabilitation, able to give informed consent/had an individual available to act as personal consultee. In total, 33 participants were categorized with pre-existing cognitive impairment based on routine documentation by clinicians and 106 without. Measures: Number of inpatient therapy sessions received during the first eight weeks post-stroke, referral to early supported discharge, and length of stay. Results: On average, participants with pre-existing cognitive impairment received 40 total physiotherapy and occupational therapy sessions compared to 56 for those without (mean difference = 16.0, 95% confidence interval (CI) = 2.9, 29.2), which was not fully explained by adjusting for potential confounders (age, sex, National Institutes of Health Stroke Scale (NIHSS), and pre-stroke modified Rankin Scale (mRS)). While those with pre-existing cognitive impairment received nine fewer single-discipline physiotherapy sessions (95% CI = 3.7, 14.8), they received similar amounts of single-discipline occupational therapy, psychology, and speech and language therapy; two more non-patient-facing occupational therapy sessions (95% CI = –4.3, –0.6); and nine fewer patient-facing occupational therapy sessions (95% CI = 3.5, 14.9). There was no evidence to suggest they were discharged earlier, but of the 85 participants discharged within eight weeks, 8 (42%) with pre-existing cognitive impairment were referred to early supported discharge compared to 47 (75%) without. Conclusion: People in stroke rehabilitation with pre-existing cognitive impairments receive less therapy than those without, but it remains unknown whether this affects outcomes. [ABSTRACT FROM AUTHOR]

Background: Little is known about how social and cultural variants interact with gender identity development. This article aims to identify the ethnicities of children and young people referred to the United Kingdom's national Gender Identity Development Service (GIDS), and compare the ethnicity data with the UK child population and referrals to Child and Adolescent Mental Health Services (CAMHS). Methods: GIDS referrals made between April 2012 and April 2015 for children and young people were retrieved. Ethnicity data were obtained by the '16 + 1' ethnicity list. Chi-square and t -tests were performed on the demographics. Results: Less than 10% of the 995 referrals at GIDS were from Black and minority ethnic (BME) groups – an underrepresentation as compared with both the national population and CAMHS figures. No significant differences in ethnic representation were found between the demographic birth-assigned sexes, across age groups, or year of referral. Conclusions: Hypotheses proposed for this underrepresentation take into account both the potential barriers to accessing services and the possibility of cross-cultural variations in the conceptualisations of gender, gender roles and gender diversity. Ethnicity, culture and religion, and their overlapping relationship with gender need further exploration. [ABSTRACT FROM AUTHOR]

Objective: Qualitative research has identified personal costs and benefits for peer supporters associated with their role; however, quantitative evidence is sparse. This study used quantitative methods to explore relationships in experiences of providing peer support with constructs of empowerment, hope, recovery, quality of life and internalised stigma. Differences were examined for those in statutory versus non-statutory services; who had themselves received peer support versus those who had not and who identified having had negative experiences in clinical teams versus those without such experiences. Methods: A cross-sectional online and postal survey was undertaken in tandem with a linked consensus study. In all, 147 peer supporters were recruited from a variety of organisations across the United Kingdom. Validated questionnaires were used to examine constructs. Instruments created for the study measured peer support experiences, and personal costs and benefits involved. Correlations were calculated and results informed further regression analysis. Chi-square tests and independent samples t-tests tested group differences. Results: Peer supporters indicated they experienced almost twice as many role-related personal benefits than personal costs. Benefits included improvements to mental health and well-being, reduced use of services, increased social functioning and development of skills. Total number of personal costs experienced was significantly negatively related to peer supporters' empowerment and quality of life. There were no significant differences between the groups examined. Conclusions and Implications for Practice: An accumulation of personal costs may result in reduced quality of life; however, costs can be minimised by organisations. Limitations of the research are discussed and recommendations for future research are made including the need for longitudinal research. [ABSTRACT FROM AUTHOR]

This study examines the subjective experience of living with epilepsy or psychogenic nonepileptic seizures (PNES) by thematically comparing individuals' written accounts of their condition. Five key differences emerged. Theme 1: "Seizure onset" revealed differences in how individuals think about and ruminate over the possible causes of their condition. Theme 2: "Emotive tone" demonstrated that writings of those with epilepsy reflected stable emotions (no intense emotional reactions), whereas those of writers with PNES reflected anxiety and low mood. Theme 3: "Seizure symptoms" showed differences in the conceptualization of seizures. Theme 4: "Treatment" explored differences in the diagnostic journey and experiences of health care professionals. Theme 5: "Daily life" revealed that those with epilepsy perceived sequelae and seizures as something that must be fought, whereas those with PNES tended to describe their seizures as a place they enter and something that has destroyed their lives. The findings have implications for treatment and management. [ABSTRACT FROM AUTHOR]

Background: While studies have evaluated caregiver outcomes in heart failure, the burden and support needs when caring for someone with advanced heart failure at the end of life have yet to be outlined. Aim: To identify psychosocial factors associated with caregiver burden and evaluate the support needs of caregivers in advanced heart failure. Design: A sequential mixed methods study comprising two phases: (1) postal survey with advanced heart failure patients and their caregivers and (2) interviews with current and bereaved caregivers. Correlation, chi-square, t test, regression and thematic analysis were undertaken on the data. Participants: Advanced heart failure patients (n = 112) and their caregivers (n = 84) were recruited from secondary care settings across the United Kingdom and Ireland. For phase 2 interviews, current caregivers (n = 20) were purposively recruited from phase 1, and bereaved caregivers (n = 10) were purposively recruited via voluntary organisation, social media and email. Results: More than half the caregivers (53%) had levels of distress associated with depression (Zarit Burden score >24). Caregiver depression score, preparedness for caregiving and patients' depression score predicted caregiver burden. Qualitative analysis identified an overarching theme of lack of future care planning and four subthemes: (1) seeking emotional support from someone who understands, (2) want information on prognostication, (3) lack of knowledge on how to and where to get support and (4) require knowledge on what to expect at the end of life. Conclusion: Caregivers have unmet needs and feel unprepared for the future. Implementation of future care planning by clinical teams should address patient and caregiver support needs and in turn alleviate caregiver burden. [ABSTRACT FROM AUTHOR]

This article presents a profile of intimate partner homicides (IPH) committed within London incorporating a gendered comparison of the perpetrators’ relationships. Data was sourced from the original police files for offenses committed in the capital between 1998 and 2009 (N = 207; 173 male and 34 female perpetrators). In common with other international descriptive studies, the results indicate comparative differences between partners according to perpetrator gender in terms of age profiles, employment status, experience of mental health issues, intoxication at time of killing, and possession of criminal convictions. Gender-based IPH descriptive studies have tended to focus on a collation of either victim or perpetrator or relationship characteristics, often in isolation from one another. Assessments of how parties interact within fatal relationships are invariably absent, and yet, it is the relationship that forms the backdrop against which the fatal acts are perpetrated. This study, therefore, not only provides an insight into the profile of IPH committed within London where none had previously existed but also demonstrates the advantages of incorporating relationship concordance measures. The inclusion of such measures when researching IPH assists homicide investigators in understanding the dynamics taking place within the cohort of fatal relationships they police. It also provides researchers a useful platform to enhance understanding of this crucial aspect, for it is the relationship itself which is what defines IPH and distinguishes as a unique subset of homicide. [ABSTRACT FROM AUTHOR]

Objectives This study assessed the effectiveness and patient experience of the ClariVein® endovenous occlusion catheter for varicose veins from a large single-centre series in the UK. Methods A total of 300 patients (371 legs) underwent ClariVein® treatment for their varicose veins; 184 for great saphenous vein (GSV) incompetence, 62 bilateral GSV, 23 short saphenous vein (SSV), 6 bilateral SSV and 25 combined unilateral great saphenous vein and SSV. Patients were reviewed at an interval of two months post procedure and underwent Duplex ultrasound assessment. Postoperative complications were recorded along with patient satisfaction. Results All 393 procedures were completed successfully under local anaesthetic. Complete occlusion of the treated vein was initially achieved in all the patients, but at eight weeks’ follow-up, there was only partial obliteration in 13/393 (3.3%) veins. These were all successfully treated with ultrasound-guided foam sclerotherapy. Procedures were well tolerated with a mean pain score of 0.8 (0–10). No significant complications were reported. Conclusions ClariVein® can be used to ablate long and short saphenous varicose veins on a walk-in–walk-out basis. Bilateral procedures can be successfully performed, and these are well tolerated as can multiple veins in the same leg. Early results are promising but further evaluation and longer term follow-up are required. [ABSTRACT FROM AUTHOR]

Few studies have examined how customer behaviour shapes the outcomes of employees’ emotion regulation. Drawing on existing literature, this article tests two alternative models of customer affiliative behaviour (e.g. smiling, engaging in short conversation), employee emotion regulation (surface acting, deep acting) and employee outcomes (emotional exhaustion, objective task performance). In one model, customer affiliative behaviour is a mechanism that mediates the relationship between employee emotion regulation and outcomes, and in the other model customer affiliative behaviour moderates this relationship. The models were tested on data drawn from a daily diary study of 49 supermarket checkout operators and store performance records. The findings from multilevel analyses make a significant contribution to understanding how a key part of the social context during service interactions (i.e. customer affiliative behaviour) is a mechanism and moderator of employee emotion regulation. Results show that the effects of deep and surface acting on employee well-being are mediated by customer affiliative behaviour, and that relationship between surface acting and task performance is mediated by customer affiliative behaviour and emotional exhaustion. In addition, customer affiliative behaviour moderated the relationship between deep acting and emotional exhaustion, and the indirect effect of deep acting on task performance through emotional exhaustion. [ABSTRACT FROM AUTHOR]

Background: Stronger generalist end-of-life care at home for people with cancer is called for but the quality of end-of-life care delivered by general practitioners has been questioned. Aim: To determine the degree of and factors associated with bereaved relatives’ satisfaction with home end-of-life care delivered by general practitioners to cancer patients. Design: Population-based mortality followback survey. Setting/participants: Bereaved relatives of people who died of cancer in London, United Kingdom (identified from death registrations in 2009–2010), were invited to complete a postal questionnaire surveying the deceased’s final 3 months of life. Results: Questionnaires were completed for 596 decedents of whom 548 spent at least 1 day at home in the last 3 months of life. Of the respondents, 55% (95% confidence interval: 51%–59%) reported excellent/very good home care by general practitioners, compared with 78% (95% confidence interval: 74%–82%) for specialist palliative care providers and 68% (95% confidence interval: 64%–73%) for district/community/private nurses. The odds of high satisfaction (excellent/very good) with end-of-life care by general practitioners doubled if general practitioners made three or more compared with one or no home visits in the patient’s last 3 months of life (adjusted odds ratio: 2.54 (95% confidence interval: 1.52–4.24)) and halved if the patient died at hospital rather than at home (adjusted odds ratio: 0.55 (95% confidence interval: 0.31–0.998)). Conclusion: There is considerable room for improvement in the satisfaction with home care provided by general practitioners to terminally ill cancer patients. Ensuring an adequate offer of home visits by general practitioners may help to achieve this goal. [ABSTRACT FROM AUTHOR]

Previous word learning studies suggest that children with autism spectrum disorder may have difficulty understanding pictorial symbols. Here we investigate the ability of children with autism spectrum disorder and language-matched typically developing children to contextualize symbolic information communicated by pictures in a search task that did not involve word learning. Out of the participant’s view, a small toy was concealed underneath one of four unique occluders that were individuated by familiar nameable objects or unfamiliar unnamable objects. Children were shown a picture of the hiding location and then searched for the toy. Over three sessions, children completed trials with color photographs, black-and-white line drawings, and abstract color pictures. The results reveal zero group differences; neither children with autism spectrum disorder nor typically developing children were influenced by occluder familiarity, and both groups’ errorless retrieval rates were above-chance with all three picture types. However, both groups made significantly more errorless retrievals in the most-iconic photograph trials, and performance was universally predicted by receptive language. Therefore, our findings indicate that children with autism spectrum disorder and young typically developing children can contextualize pictures and use them to adaptively guide their behavior in real time and space. However, this ability is significantly influenced by receptive language development and pictorial iconicity. [ABSTRACT FROM PUBLISHER]

Anxiety is a major problem for many people with Asperger’s syndrome who may have qualitatively different fears from a non-Asperger’s syndrome population. Research has relied on measures developed for non-Asperger’s syndrome populations that require reporting past experiences of anxiety, which may confound assessment in people with Asperger’s syndrome due to problems with autobiographical memory as are often reported in this group.Experience sampling methodology was used to record real-time everyday experiences in 20 adults with Asperger’s syndrome and 20 neurotypical adults. Within-subject analysis was used to explore the phenomenology of thoughts occurring in people with Asperger’s syndrome when they were anxious. Comparisons were made with the group that did not have Asperger’s syndrome. The Asperger’s syndrome group were significantly more anxious than the comparison group. Factors associated with feelings of anxiety in the Asperger’s syndrome group were high levels of self-focus, worries about everyday events and periods of rumination lasting over 10 min. People in the Asperger’s syndrome group also had a tendency to think in the image form, but this was not associated with feelings of anxiety. The results are discussed with reference to psychological models of Asperger’s syndrome, cognitive models of anxiety and implications for psychological therapy for this group. [ABSTRACT FROM PUBLISHER]

The article discusses the use of Social Judgment Theory method for occupational therapy in Great Britain, Australia and New Zealand. It highlights the importance of automobile driving as an instrumental activity of daily living for community mobility of many individuals. It cites the integration of occupational therapy to the drivers with acquired illness or disability that deteriorate health condition.

A UK literacy intervention – Paired Reading – was replicated in seven Swedish local authorities, with 81 foster children aged 8–12 participating in a 16-week trial. Ability was measured pre/post intervention with age-standardised literacy tests and a short version of the WISC-IV. Results confirm and expand findings from the UK, namely that: almost all foster carers and children completed the programme (attrition 2.4%), average improvement in reading age was 11 months, basically the same as in the UK; younger children (aged 8–9) improved significantly on all four administered standardised reading tests, and on the WISC-IV Vocabulary subtest. Older children (aged 10–12) improved significantly on three of five literacy tests and on the WISC-IV Vocabulary subtest. On the short version of WISC-IV, vocabulary improvements over time reduced the proportion of children who could be classified as having ‘weak cognitive skills’ (IQ<85) from 54% to 36%. This finding is in line with results from other studies, indicating that scores from cognitive tests of pre-teen children in out-of-home care should not be regarded as fixed and can be improved by effective interventions. [ABSTRACT FROM AUTHOR]

The article described a study that evaluated the impact of screening for Down's syndrome on the prevalence of live births and antenatal diagnoses of Edwards and Patau syndrome. As mentioned, the study concluded that around 700 women per year had a pregnancy with Edwards or Patau syndrome, with over 90% of these pregnancies were detected antenatally, with the increased use of first trimester screening for Down's syndrome resulting in the reduction in the mean gestational age at diagnosis.

Anecdotal reports and empirical evidence suggest that sensory processing issues are a key feature of autism spectrum conditions. This study set out to investigate whether adults with autism spectrum conditions report more sensory over-responsivity than adults without autism spectrum conditions. Another goal of the study was to identify whether autistic traits in adults with and without autism spectrum conditions were associated with sensory over-responsivity. Adults with (n = 221) and without (n = 181) autism spectrum conditions participated in an online survey. The Autism Spectrum Quotient, the Raven Matrices and the Sensory Processing Scale were used to characterize the sample. Adults with autism spectrum conditions reported more sensory over-responsivity than control participants across various sensory domains (visual, auditory, tactile, olfactory, gustatory and proprioceptive). Sensory over-responsivity correlated positively with autistic traits (Autism Spectrum Quotient) at a significant level across groups and within groups. Adults with autism spectrum conditions experience sensory over-responsivity to daily sensory stimuli to a high degree. A positive relationship exists between sensory over-responsivity and autistic traits. Understanding sensory over-responsivity and ways of measuring it in adults with autism spectrum conditions has implications for research and clinical settings. [ABSTRACT FROM PUBLISHER]

Healthcare is delivered in a dynamic environment with frequent changes in populations, methods, equipment and settings. Infection prevention and control practitioners (IPCPs) must ensure that they are competent in addressing the challenges they face and are equipped to develop infection prevention and control (IPC) services in line with a changing world of healthcare provision. A multifaceted Framework was developed to assist IPCPs to enhance competence at an individual, team and organisational level to enable quality performance and improved quality of care. However, if these aspirations are to be met, it is vital that competency frameworks are fit for purpose or they risk being ignored. The aim of this unique study was to evaluate short and medium term outcomes as set out in the Outcome Logic Model to assist with the evaluation of the impact and success of the Framework. This study found that while the Framework is being used effectively in some areas, it is not being used as much or in the ways that were anticipated. The findings will enable future work on revision, communication and dissemination, and will provide intelligence to those initiating education and training in the utilisation of the competences. [ABSTRACT FROM PUBLISHER]

Can the topic of a conversation, when heavily associated with a particular dialect region, influence how a speaker realizes a linguistic variable? We interviewed fans of English Premier League soccer at a pub in Columbus, Ohio. Nine speakers of British English and eleven speakers of American English were interviewed about their favorite American football and English soccer teams. We present evidence that the soccer fans in this speech community produce variants more consistent with Standard American English when talking about American football than English soccer. Specifically, speakers were overall more /r/-ful (F3 values were lower in rhotic environments) when talking about their favorite American football team. Numeric trends in the data also suggest that exposure to both American and British English, being a fan of both sports, and task may mediate these effects. [ABSTRACT FROM PUBLISHER]

The article presents a study which measured the effects of publicized uptake breast cancer screening at the Marmot Review and associated press coverage. The researchers compared uptake of breast cancer screening before and after the Marmot Review publication through mixed predictors. The study found no difference in uptake breast cancer screening above its normal seasonal variation.

Abstract: The relationship between contralateral hip arthritis and co-morbid medical conditions that affect a patient's ability to walk, and outcome following total hip arthroplasty (THA) is not fully understood. We investigated this relationship in a prospective, multi-centre study. 1497 hips (1428 patients) were recruited. At five years follow-up there was complete data for 1053 hips. We recorded Oxford Hip Score (OHS) and Charnley Class (CC) both preoperatively and at one and five years after surgery. Preoperatively there was a significant difference in OHS between CC categories and OHS deteriorated from CC-A to CC-C (p<0.001). The absolute OHS was significantly worse in CC-C compared to CC-A. Patients who remained in CC-A at five year follow-up had a larger change in OHS (mean 24) compared to those who had changed from CC-A to CC-C at five years (mean 21) p<0.001. The OHS an outcome measure frequently used for THA is influenced by several extraneous factors which may be present preoperatively but also change over time. These factors include the condition of the opposite hip as well as other disease processes that affect a patient's locomotion and therefore interpretation of OHS in isolation without additional information may not be appropriate. [ABSTRACT FROM AUTHOR]

Objective: The correlates of parental burden in schizophrenia may differ between ethnic groups, but few studies have examined this in a UK setting. Our aim was to identify the correlates of burden in a UK sample of first-generation North Indian Punjabi Sikh parents and their white British counterparts. Method: Test the association of burden with a series of clinical, social and service use variables and control for potential confounding factors in a model predicting drivers of burden in a combined sample of the above. Results: The strongest correlates of burden were patient symptoms and parental distress. Differences in correlates of burden between the groups emerged when individual components of service use and parental social network were tested. The group comparisons also revealed differences in expressed emotion (EE) and social networks. Conclusion: The similarities in sources of burden between the groups could be explained by a commonality of socio- cultural and economic experience, resulting from the successful acculturation and affluence of this British Sikh group. The differences between the groups may be related to enduring cultural factors such as kin support, since larger family groups were associated with low burden in the British Sikh group. The nature of EE in this British Sikh group may explain why it was not associated with burden in this sample. [ABSTRACT FROM AUTHOR]

The article discusses a nursing workforce planning and development (WP&D) study that evaluates palliative care ward staffing by collecting data in hospice and palliative care wards. The study aimed and succeeded in adapting the workforce planning method used by the National Health Service (NHS), comparing hospices with existing data and developing multipliers to help hospice managers to adjust teams to suit local workloads.

The DAPPLE (Dynamic Assessment of Preschoolers’ Proficiency in Learning English) is currently being developed in response to a clinical need. Children exposed to English as an additional language may be referred to speech and language therapy because their proficiency in English is not the same as their monolingual peers. Some, but not all, of these children are likely to have a core language learning difficulty. Clinicians need to be able to distinguish disorder from difference due to a child’s language learning context. The assessment used a test–teach–test format to examine children’s ability to learn vocabulary, sentence structure and phonology. The assessment, which takes less than 60 minutes to administer, was given to 26 children who were bilingual: 12 currently on a speech and language therapy caseload and 14 children matched for age and socio-economic status who had never been referred to speech and language therapy. The DAPPLE data clearly discriminated the two groups. The caseload group required a greater amount of prompting to identify targeted words in the receptive vocabulary assessment and performed less well in the post-teaching expressive component. For sentence structure, the caseload group required more cues to acquire the targeted clause elements in the teaching phase. The caseload group made more phoneme errors at the initial and final assessments than the controls, and the type of errors made differed. Teaching resulted in greater positive change in percent phonemes correct for the caseload participants. Qualitative analyses of individual children’s performance on the DAPPLE suggested that it has the potential to discriminate core language deficits from difference due to a bilingual language learning context. Future directions for development of the test are considered. [ABSTRACT FROM PUBLISHER]

The aim of this study was to determine the incidence of surgical site infection (SSI) after vasectomy and to identify associated patient and perioperative risk factors, including the operating room environment (non-ventilated treatment room or ventilated operating theatre). This study used an active 30-day surveillance follow-up programme with telephone interviews and home visits. Patients were recruited over an 18 month period. Demographics, patient details and perioperative procedures were documented on the day of surgery. Patients were telephoned 10 and 30 days post procedure. Of 1,155 patients enrolled, 994 (86%) completed the full 30-day follow-up. Of these, 25 (2.5%) developed an SSI. The mean number of days until presentation with an SSI was 13. No statistically significant difference was found in rates of SSI when vasectomies were undertaken in either ventilated operating theatres or non-ventilated treatment rooms. [ABSTRACT FROM AUTHOR]

Autobiographical and clinical accounts, as well as a limited neuropsychological research literature, suggest that, in some situations, men and women with autism spectrum conditions (ASCs) may have difficulty making decisions. Little is known, however, about how people with ASCs experience decision-making or how they might best be supported to make decisions for themselves. In this study, we compared the decision-making experiences of adults with and without ASCs (n=38 and n=40, respectively) using a novel questionnaire and the General Decision Making Style inventory (GDMS, Scott & Bruce, 1995). The participants with ASCs reported experiencing several problems in decision-making more frequently than the comparison group, and were more likely to report avoidance of decision-making, as measured using the GDMS. The findings highlight areas of potential future research and inform suggestions for supporting adults with ASCs during decision-making [ABSTRACT FROM PUBLISHER]

Aims: Little has been reported on self-harm among the UK Armed Forces, partly due to the difficulties in recording self-harm, within an often-difficult-to-reach population. This study assesses the lifetime prevalence of attempted suicide and self-harm within currently serving and ex-service personnel of the UK Armed Forces. Methods: Telephone interviews were conducted with 821 personnel who had previously participated in the King's Centre for Military Health Research military health study. Within the telephone interview, participants were asked about attempted suicide and episodes of self-harm. Results: A lifetime prevalence of 5.6% for intentional self-harm (self-harm or attempted suicide) was reported. Intentional self-harm was associated with psychological morbidity (in particular, post-traumatic stress disorder) and adverse experiences in childhood. Ex-service personnel reported lifetime prevalence more than double that of serving personnel (10.5% vs 4.2%, respectively). Participants reporting intentional self-harm were younger (34.4 years vs 39.8 years). Conclusion: A lifetime prevalence of 5.6% for attempted suicide and self-harm is higher than previous research has suggested. Younger service personnel, those who have experienced adversity in childhood, those with other psychological morbidity, and ex-service personnel are more likely to report self-harm behaviours. [ABSTRACT FROM AUTHOR]

Membership in well-structured teams, which show clarity in team and individual goals, meet regularly, and recognize diverse skills of their members, is known to reduce stress. This study examined how membership of well-structured teams was associated with lower levels of strain, when testing a work stressors-to-strains relationship model across the three levels of team structure, namely well-structured,poorly structured (do not fulfill all the criteria of well-structured teams) and no team. The work stressors tested, were quantitative overload and hostile environment, whereas strains were measured through job satisfaction and intention to leave job. This investigation was carried out on a random sample of 65,142 respondents in acute/specialist National Health Service hospitals across the UK. Using multivariate analysis of variance, statistically significant differences between means across the three groups of team structure, with mostly moderate effect sizes, were found for the study variables. Those in well-structured teams have the highest levels of job satisfaction and the least intention to leave job. Multigroup structural equation modelling confirmed the model's robustness across the three groups of team structure. Work stressors explained 45%, 50% and 65% of the variance of strains for well-structured, poorly structured and no team membership, respectively. An increase of one standard deviation in work stressors, resulted in an increase in 0.67, 0.70 and 0.81 standard deviations in strains for well-structured, poorly structured and no team membership, respectively. This investigation is an eye-opener for hospitals to work towards achieving well-structured teams, as this study shows weaker stressor-to-strain relationships for members of these teams. [ABSTRACT FROM AUTHOR]

Objectives The UK National Health Service Bowel Cancer Screening Programme (BCSP) is based on a strategy of biennial faecal occult blood (FOB) testing. Positive results are classified as 'abnormal' or 'weak positive' based on the number of positive windows per kit or need for repeat testing. Colonoscopy is offered to both groups. We evaluate the relationship between FOB test positivity and clinical outcome in the BCSP. Setting The South of Tyne and Tees (UK) Bowel Cancer Screening Centres. Methods Data were collected prospectively on all individuals who were offered FOB testing and colonoscopy between February 2007 and February 2009. Univariable and multivariable analyses were performed to investigate the relationship between FOB test positivity and clinical outcome. Results Following FOB testing, 1524 individuals underwent colonoscopy, 1259 (83%) after a 'weak positive' and 265 (17%) an 'abnormal' result. Cancer was detected in 180 (11.8%) and adenomas in 758 (49.7%). Individuals with an 'abnormal' result were more likely to have cancer or be 'high risk' for the development of future adenomas (110/265, 41.5%) than those with 'weak positive' results, (236/1259, 18.7%, P < 0.0001). Those with Dukes stage B, C or D cancers or cancers proximal to the splenic flexure were more likely to have an 'abnormal' result. Conclusions The majority of colonoscopies were performed following 'weak positive' FOB results. Those with an 'abnormal' result were more likely to be diagnosed with cancer. The high yield of pathology in both the 'abnormal' and 'weak positive' groups justifies the need for colonoscopy in both. [ABSTRACT FROM AUTHOR]

Background: Caregiver burden in mental illness is believed to differ between ethnic groups, but few studies have examined this in schizophrenia in the UK.Aim: To measure burden in British North Indian Sikh and white British parents with a son or daughter with established schizophrenia managed in outpatient care.Method: A cross-cultural cohort study measuring family factors, patient psychopathology and levels of burden and distress.Results: Overall levels of burden were low with no significant differences between the groups. Burden subscale scores showed Indian parents were more affected by psychotic behaviours than white parents. The groups also differed on several sociodemographic variables.Conclusion: In stabilized community patients, the overall extent of burden experienced by both Indian and white parents is low and comparable. However, Indian parents were more burdened by psychotic behaviours. This may be a result of co-residence as Indian patients are more likely to live with their families. Social and economic factors in the country of residence and levels of acculturation may also influence levels of burden and the illness behaviours found most bothersome by parents. [ABSTRACT FROM PUBLISHER]

Introduction: The Government plans to transform adult social care in England. Future services will place more emphasis on prevention and enablement, and promoting personalisation and choice. Self-assessment is one possible facilitator of this agenda. However, little is known about its utility in social care. This evaluation examined how eight local authorities employed self-assessment in the provisionof community equipment and adaptations, and explored the implications for service delivery. Method: A multiple case study was employed, using a mixed methods approach. This drew on internal documents, management interviews, and service user and administrative records. Findings: Self-assessment was primarily used to facilitate service access. Although the authorities differed in the way in which they operationalised self-assessment, professional staff were almost always involved. The differences between people receiving self and traditional assessments were modest, but the people undertaking self-assessments in preventative services formed a particularly healthy subgroup. There was little consensus about the items suitable for provision through self-assessment. Conclusion: The concept of self-assessment was variously interpreted and not all its possible uses were explored. Nevertheless, the evaluation suggested that self-assessment can facilitate access to community equipment and adaptations and has the potential to extend the population traditionally served by social care services, thereby addressing the preventative agenda. [ABSTRACT FROM AUTHOR]

Thousands of people respond to the British Association for Adoption and Fostering's annual adoption recruitment campaign National Adoption Week (NAW), but little is known about what happens to enquirers after they receive the information pack. In this article, Emma Ward investigates the success of the campaign and whether the profile of enquirers adds insight into their likelihood of starting the adoption process and showing interest in older children. The findings of a survey completed by 493 enquirers to the 2003 campaign are presented. The study found that NAW is successful in generating applications and maintaining interest. The well-reported preference for younger children by prospective parents was confirmed, but enquirers also displayed a willingness to consider older children with complex needs. Enquirers motivated by infertility were more likely to start the adoption process while those with other motivations were more inclined to be (actively) interested in non-infant children. Respondents' expectations of the adoption process and the system for approving candidates were seen as significant barriers. [ABSTRACT FROM AUTHOR]