Treatment feasibility of a digital tool for brief self-help behavioural therapy for insomnia (FastAsleep)

Cognitive behavioural therapy for insomnia is efficacious and recommended for insomnia, but availability is scarce. Cognitive behavioural therapy for insomnia self-help interventions could increase availability, especially if unguided. Optimizing cognitive behavioural therapy for insomnia methods and system user-friendliness, we developed a short, digital, self-help programme—FastAsleep—based on the behavioural components of sleep restriction and stimulus control. This study investigated its feasibility and preliminary effects. Thirty media-recruited participants with moderate to severe insomnia were assessed via telephone before using FastAsleep for 4 weeks, and were interviewed afterwards. Self-ratings with web questionnaires were conducted at screening, pre-, mid- and post-treatment, and at 3-month follow-up. Primary outcomes were feasibility (credibility, adherence, system user-friendliness and adverse effects), and secondary outcomes were changes in symptom severity (insomnia, depression and anxiety). Adherence was generally high, participants' feasibility ratings were favourable, and adverse effects matched previously reported levels for cognitive behavioural therapy for insomnia. Symptoms of insomnia decreased after the treatment period (Hedge's g = 1.79, 95% confidence interval = 1.20–2.39), as did symptoms of depression and anxiety. FastAsleep can be considered feasible and promising for alleviating insomnia symptoms among patients fit for self-care. Future controlled trials are needed to establish the efficacy of FastAsleep and its suitability in a stepped care model.     

Issues of reliability and validity in the measurement of challenging behaviour (behavioural difficulties) in learning disability: a discussion of implications for nursing research and practice

• ? The purpose of this paper is to contribute to the debate on issues related to the reliability and validity of measurement of challenging behaviour (behavioural difficulties) in learning disability. A number of practical, theoretical and methodological issues are discussed that have significance for the nurse both as practitioner and/or researcher in learning disability. These issues are equally important to both provider and purchaser of health care in order that resources can be most effectively targeted.
• ? The term ‘challenging behaviour’ would appear to be used both in literature and research synonymously with behavioural difficulties, this has implications for nurses in both their clinical practice and/or research. The author concludes by identifying a need to replace the term challenging behaviour, with ‘behavioural difficulties’. It is argued that such a term is much more explicit in meaning and amenable to operational definition, thus enabling empirical study. Such a proposal will not be accepted by all as justifiable; this is because some might argue that adopting the term behavioural difficulties may be a retrograde step that perpetuates negative imagery and inappropriate labelling of people with a learning disability.

     

Eating despite severe difficulties: assessment of poststroke eating

• ? A programme for the assessment and nursing diagnoses of eating difficulties among stroke patients was tested. The patients' experiences regarding eating were expressed in interviews and dialogues. Eating was observed during both a test meal and regular meals.
• ? The assessments included the prerequisites for eating as well as oral, pharyngeal and oesophageal functions.
• ? General and specific nursing diagnoses as well as life consequences (handicap) were established, based on assessment of disabilities and impairments, and interviewing the patients and their families, respectively. The general nursing diagnoses were formulated on admission after the test meal and these were reformulated to form specific nursing diagnoses after assessments of the functions.
• ? The programme presented proved to be useful in clinical practice. It is emphasized that many assessments must be co-ordinated for each individual.

     

Attentional Difficulties in Middle Childhood and Psychosocial Outcomes in Young Adulthood

The associations between (dimensionally scored) measures of attentional difficulties at age 8 and psychosocial outcomes at age 18 were examined in a birth cohort of New Zealand children. Increasing attentional difficulties during middle childhood were associated with increased risks of academic failure or difficulties, juvenile offending, and substance use behaviours in young adulthood. However, those with early attentional difficulties were a high-risk group characterised by social disadvantages, early conduct difficulties, lower 1Q, and related characteristics. Statistical adjustments showed: (a) that attentional difficulties were related to later academic success even when due allowance was made for potentially confounding factors; and (b) early attentional difficulties were unrelated to later juvenile offending or substance use behaviours after adjustment for confounding. In all cases there was evidence of consistent dose/response relationships between the extent of early attentional difficulties and later academic outcomes, suggesting that these associations were not confined to those with extreme symptoms.     

公立医院改革思路

回顾我国公立医院改革的历程，对如何正确认识医疗服务市场，把握政府在医疗服务市场中的职能定位、多元化办医等几个目前公立医疗机构改革中的难点问题进行了剖析，并提出了医院发展的战略思路。     

从解决"看病难、看病贵"看创建"节约型医院"的积极效应

“看病难、看病贵”问题已成为社会反响强烈的热点问题，问题的产生既有医院自身的内因，又有医疗卫生行业长期积累的体制性、机制性和结构性矛盾，以及人民群众对卫生需求不断提高等外因。医院成为矛盾的集聚地、但不是问题的发源地。医院应从自身出发，通过采取挖掘潜力、强化管理等措施创建“节约型医院”来缓解“看病难、看病贵”问题。     

呼吸机撤机困难策略的比较研究

目的研究呼吸机难撤机患者不同撤机策略的效能及其临床意义。方法选择本院重症监护室呼吸衰竭后呼吸机撤机困难患者75例,随机分为5组,分别采用不同的撤机方法,压力支持（PSV）撤机组（A组）15例,压力支持联合同步间歇指令通气（PSV＋SIMV）组（B组）15例,T管通气撤机组15例（C组）,持续气通正压通气（CPAP）撤机组15例（D组）,同步间歇指令通气（SIMV）撤机组（E组）15例,观察比较不同撤机策略的效能。结果各组撒机前的基线资料比较,差异无统计学意义（P〉0.05）。PSV撤机设置初始压力水平（BaselinePS）,使患者RR〈25bpm,Vt为5～8mL/kg临床效果较好。压力支持撤机、压力支持联合同步间歇指令通气撤机效能明显高于T管撤机、CPAP撤机、SIMV撤机,差异有统计学意义（P〈0.05）。结论本文显示全面评估患者情况、把握撤机时机,是策略性撤机的重要内容;且PSV程序撤机较其他方法有一定优越性。     

早产儿及小于胎龄儿喂养困难研究进展

早产儿及小于胎龄儿喂养困难是普遍存在的问题,发病率高。影响早产儿及小于胎龄儿喂养困难的因素有很多,包括窒息、原发疾病、胎龄、开奶时间、孕期因素、环境因素、激素水平等,该文就早产儿及小于胎龄儿喂养困难病因、治疗进行综述,旨在为早产儿及小于胎龄儿喂养困难的防治及进一步研究提供基础。     

ARFID—Strategies for Dietary Management in Children

Avoidant/Restrictive Food Intake Disorder (ARFID) is a relatively new disease entity in DSM-5 and ICD-11. This disorder continues to pose a diagnostic and therapeutic challenge for many professionals. This disorder can affect people of all ages. The most characteristic pattern is considered to be a lack of interest in eating or avoidance of food intake, which may result in nutritional deficiencies, weight loss or lack of expected weight gain, dependence on enteral feeding or dietary supplements, and impaired psychosocial functioning. This disorder cannot be explained by a current medical condition or co-occurring other psychiatric disorders, but if ARFID co-occurs with another disorder or illness, it necessarily requires extended diagnosis. Its treatment depends on the severity of the nutritional problem and may include hospitalization with multispecialty care (pediatrician, nutritionist, psychologist, psychiatrist, neurologist). The nutritional management strategy may include, inter alia, the use of Food Chaining, and should in the initial stage of therapy be based on products considered “safe” in the patient’s assessment. The role of the dietitian in the management of a patient with ARFID is to monitor weight and height and nutritional status and analyze the foods that should be introduced into the food chain first.