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Background: The multi-disciplinarity of long-term care for people with intellectual disabilities makes organisations seek stability and predictability, complicating implementing innovations. Interventions to implement a method for reducing restrictive measures were analysed through the lens of Normalisation Process Theory to understand the social mechanisms at play. Methods: Process notes, collected during a trial in which a method to reduce restrictive measures was implemented, were analysed guided by implementation interventions defined by Cochrane Effective Practice and Organisation of Care Review Group. These interventions were mapped to social mechanisms of Normalisation Process Theory. Results: Implementation interventions were widely used in which clients' perspectives were expressed (client-related-interventions), and consensus processes were held with care professionals. These interventions initiated NPT's social mechanisms' Coherence, Cognitive Participation and Collective Action. Conclusions: The emphasis on consensus and clients' perspectives when methodically reducing restrictive measures reflects some unique implementation challenges in long-term intellectual disability care.

Introduction: Digital social contact is increasingly being used, which accelerated during the COVID-19 pandemic. This study aimed to determine the consensus among stakeholders regarding recommendations for the use and facilitation of digital social contact for people with intellectual disabilities living in sheltered care facility homes. Methods: This consensus statement was developed in three consecutive rounds of questionnaires (rapid online modified Delphi design). The expert-groups included people with disabilities (N = 6) and their families (N = 10), support professionals (N = 9), behavioural consultants (N = 7), managers of sheltered care facility homes (N = 10), scientists and industry experts (N = 15). Findings: Four main themes were identified: 1. Reasons for and types of digital social contact; 2. Support and training needs; 3. Materials and other requirements needed to enable digital social contact; and 4. Best practices and future developments. For each theme, several recommendations were formulated. Discussion and conclusion: This study resulted in a consensus statement aimed mainly at care professionals, families of people with intellectual disabilities and managers of sheltered care facility homes. Findings show that digital social contact can contribute to societal participation of people with disabilities. Additionally, tailored exploration of digital contact is recommended, as well as aiming for inclusive-by-design technology developments with developers and stakeholders working together. [ABSTRACT FROM AUTHOR]

Background: Attachment research has shown the importance of attachment behaviour for the prevention of dysregulated behaviour due to emotional distress. The support of an attachment figure may be especially important for people with intellectual disability (ID), because they are less adept in dealing with stressful situations on their own. Our purpose was to examine the role of support staff as targets of attachment behaviour for young people with ID by testing the hypothesis that young people who more often engage in attachment interactions with group care staff are less at risk for challenging behaviours. The study design included professional caregivers' report of young persons' attachment behaviour across different relationships to address the relationship-specific nature of attachment behaviour in a group care context. Methods: Support staff rated attachment behaviour of 156 young participants with moderate to severe ID who were attending a group care setting. For each participant, we asked two members of the classroom support staff to fill out the Secure Base Safe Haven Observation list. One of them also rated challenging behaviour (Abberant Behavior Checklist). Results: Young people who showed more secure attachment behaviour towards professional caregivers were less irritable, less lethargic and less stereotypic in their behaviour, even if we controlled for developmental age and Autism Spectrum Disorders. Two results point in the direction of relationship-specific attachment behaviour: the absence of high consistency in a person's attachment behaviour towards two different caregivers and the independent contribution of each of these relationships to explaining differences in lethargy and stereotypies. A certain preference in attachment behaviour towards specific caregivers was not associated with challenging behaviour. Conclusions: Findings suggest that attachment behaviour may be part of young persons' adaptation to the stresses and challenges of group care. Furthermore, adaptation may be determined by the integration of relationships with support staff, because each relationship with a care staff member bears uniquely on challenging behaviour.

In this study, children's attachment relationships with their professional caregivers in center day care were observed for 48 children. We explored whether more positive caregiving was associated with a more secure attachment relationship and whether this association was stronger for more temperamentally irritable children compared to less irritable children. Trained observers coded the attachment relationship in the day care setting using the attachment Q-sort. The observational record of the caregiving environment was used to assess children's individual experience of positive caregiver-child interaction in the classroom. When caregivers showed more frequent positive caregiving behavior, children showed more secure attachment behavior toward their primary professional caregiver. Temperament was not related to attachment security, nor did it serve as a moderator. Consequently, no support for Belsky's susceptibility hypothesis was found.

Do children with intellectual disabilities (ID) show attachment behavior towards their professional caretaker? Five children, varying in chronological age, developmental age and DSM-diagnosis, were observed in a day care setting. Their attachment behavior was described by means of the Attachment Q-sort. Attachment behavior varied within and between children, irrespective of their diagnosis. This data indicates that professional caretakers are potential attachment figures for children with ID. Attachment introduces certain considerations for day care for children with ID, as well as opportunities for prevention and intervention. Implications for research and practice are discussed.

Mothers and primary professional caregivers of 186 children, aged 6-30 months, participated in this study in which a new measure for daily stability in center day care was developed, describing staffing, grouping, and program features. Relative contributions of infants' daily experiences of care stability, quality of care, and mother's daily stress to the child's adjustment to day care were analyzed with hierarchical regressions. The child's adjustment was assessed with the Child Behavior Checklist (Achenbach, 1997) and with the Leiden Inventory for the Child's Well-being in Day Care. Children enrolled in fewer care arrangements showed less internalizing behavior and more well-being in the day care setting. Children had higher well-being scores when trusted caregivers were more available. Mother's family management stress was related to more internalizing problem behavior. Interactions between mother's daily stress and stability in care were found to affect the child's adjustment to day care.

In this study, the concept of "goodness-of-fit" between the child's temperament and the environment, introduced by Thomas and Chess [Temperament and Development, Brunner/Mazel, New York, 1977], is applied within the setting of center day care. Mothers and primary professional caregivers of 186 children, aged 6-30 months, participated in this study. The child's problem behaviors were assessed with the CBCL Teacher Report Form [Achenbach, T. M., Guide for the Caregiver-Teacher Report Form for Ages 2-5, Department of Psychiatry, University of Vermont, Burlington, VT, 1997]. The child's socio-emotional well-being in day care was measured with the Leiden Inventory for the Child's Well-Being in Day Care. The Infant Characteristics Questionnaire measured the child's temperament. Children with an easier temperament showed less internalizing and total problem behavior and more well-being. The results suggest that for children with a more difficult temperament, several parallel care arrangements interfere with the process of adapting to the day care setting. Also, our results indicate that in the group of children with greater availability of trusted caregivers, a more easy-going temperament was associated with more well-being. The association between temperament and well-being was not found in the group of children with less access to trusted caregivers.

Background: Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology.Materials and Methods: We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool.Results: The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P  < 0.001; effect size Cohen's d = -1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P  = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion.Conclusion: We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO.Level Of Evidence: Therapeutic III. [ABSTRACT FROM AUTHOR]

Objective: Boerhaave’s syndrome is a spontaneous rupture of the oesophagus with a lack of diagnostic and treatment consistency in the literature. Therefore, we reviewed all published literature in order to design a treatment algorithm based on the literature. Study Design: A systematic literature review written in the English language since 1975. Results: We reviewed all known literature. Treatment of the Boerhaave syndrome was divided into three categories: conservative, endoscopic and surgical approach. The survival rate of all treatments was 75, 100 and 81%, respectively. Conclusion: Boerhaave’s syndrome should be treated endoscopically when diagnosed within 48 h and when there are no signs of sepsis. However, when a patient is diagnosed within 48 h and has a septic profile, thoracotomy with hemifundoplication and pleural/mediastinal drainage should be performed; and in case of intra-abdominal leakage, a laparotomy for local repair should be performed. When a patient is diagnosed after 48 h, conservative treatment should be followed and only when a patient gets a septic profile is surgical treatment indicated. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

An 87-year-old woman presented with epigastric pain and vomiting. Abdominal examination revealed an epigastric mass of 10 by 15 cm. Computed tomography of the abdomen demonstrated protrusion of peritoneal contents through a large defect in the linea alba.

Background: Tyrosinekinase inhibitors improve the treatment of gastrointestinal stromal tumours (GISTs) and their diagnosis has been facilitated by recently developed immunohistochemical markers. It is hypothesised that in the past, the true incidence of GISTs has been underestimated., Aims: To study the clinicopathological features of previously resected mesenchymal tumours of the gastrointestinal tract and determine the accuracy of previous diagnostic results., Patients and Methods: Patients with mesenchymal tumours of the gastrointestinal tract operated on between 1987 and 2002 were identified using medical and pathologic files. Immunohistochemical staining for CD117, CD34, desmin and S100 was performed, and diagnosis reviewed., Results: Thirty-six mesenchymal tumours were reanalysed. Before revision, diagnosis of GIST was correctly made in only six cases. Supportive use of immunohistochemical markers for accurate diagnosis of the remaining 30 previously undefined mesenchymal tumours yielded 17 additional GISTs. Therefore, 23 of 36 (63%) gastrointestinal mesenchymal tumours were shown to be GISTs., Conclusions: The true incidence of GISTs has been underestimated. There is merit in reviewing the clinical diagnoses of all mesenchymal tumours of the gastrointestinal tract with modern immunohistochemical markers. This may enhance clinical decision making.