An evaluation of a community dietetics intervention on the management of malnutrition for healthcare professionals

Background: Healthcare professionals working in the community setting have limited knowledge of the evidence‐based management of malnutrition. The present study aimed to evaluate a community dietetics intervention, which included an education programme for healthcare professionals in conjunction with the introduction of a community dietetics service for patients ‘at risk’ of malnutrition. Changes in nutritional knowledge and the reported management of malnourished patients were investigated and the acceptability of the intervention was explored. Methods: An education programme, incorporating ‘Malnutrition Universal Screening Tool (MUST)’ training, was implemented in eight of 10 eligible primary care practices (14 general practitioners and nine practice nurses attended), in seven private nursing homes (20 staff nurses attended) and two health centres (53 community nurses attended) in conjunction with a community dietetics service for patients at risk of malnutrition. Nutritional knowledge was assessed before, immediately after, and 6 months after the intervention using self‐administered, multiple‐choice questionnaires. Reported changes in practice and the acceptability of the education programme were considered using self‐administered questionnaires 6 months after the intervention. Results: A significant increase in nutritional knowledge 6 months after the intervention was observed (P < 0.001). The management of malnutrition was reported to be improved, with 69% (38/55) of healthcare professionals reporting to weigh patients ‘more frequently’, whereas 80% (43/54) reported giving dietary advice to prevent or treat malnutrition. Eighty‐percent (44/55) of healthcare professionals stated that ‘MUST’ was an acceptable nutrition screening tool. Conclusion: An education programme supported by a community dietetics service for patients ‘at risk’ of malnutrition increased the nutritional knowledge and improved the reported management of malnourished patients in the community by healthcare professionals.     

Language and literacy outcomes from a pilot intervention study for children with fetal alcohol spectrum disorders in South Africa.

This pilot study investigated the efficacy of a classroom language and literacy intervention in children with fetal alcohol spectrum disorders (FASD) in the Western Cape Province of South Africa. The study forms part of a larger, ongoing study that includes metacognitive and family support interventions in addition to language and literacy training (LLT). For the LLT study, 65 nine-year-old children identified as either FASD or not prenatally exposed to alcohol, were recruited. Forty children with FASD were randomly assigned to either a LLT intervention group or FASD control group (FASD-C). Twenty-five nonalcohol-exposed children were randomly selected as nonexposed controls (NONEXP-C). Prior to intervention and after nine school-term months of treatment, general scholastic tests, teacher and parent questionnaires, classroom observations and specific language and literacy tests were administered to the participants. The nine months assessment reflects the midpoint and the first assessment stage of the overall study. At initial diagnosis and prior to commencement of the interventions, participants with FASD were significantly weaker than NONEXP-C children in reading, spelling, addition, subtraction, phonological awareness, and other tests of early literacy. Teachers rated a range of adaptive behaviors of children with FASD as significantly worse than NONEXP-C. Mean scholastic and language and literacy scores for all groups showed improvement over baseline scores after 9 months of intervention. The mean test scores of children with FASD remained lower than those of NONEXP-C. Comparison of mean baseline to postintervention score changes between the LLT, FASD-C, and NONEXP-C groups revealed that although there were no significant gains by the LLT intervention group over control groups on the general scholastic assessment battery, significantly greater improvements occurred in the LLT intervention group compared to the FASD-C group in specific categories of language and early literacy. These categories were syllable manipulation, letter sound knowledge, written letters, word reading and nonword reading, and spelling. In spite of cognitive and classroom behavioral difficulties, children with FASD from a vulnerable environment demonstrated significant cognitive improvements in specific areas targeted by classroom interventions. To our knowledge, this is the first report of a systematic classroom intervention and resultant cognitive response in children with FASD.     

Documentation and Reimbursable Services for Driver Rehabilitation

Driving is the method of choice to maintain independent community mobility for most older adults. Therefore, occupational therapy practitioners need to evaluate and provide intervention for driver rehabilitation services. Since reimbursement is often seen as a barrier to providing these services, this paper underscores the value of occupational therapy practitioners providing driver rehabilitation services. Appropriate documentation and guidelines for reimbursement from Medicare are addressed with examples of how occupational therapy driver rehabilitation services can be funded by third party payers.     

Practice,Knowledge and Needs of Occupational Therapy Practitioners Providing Services to Parents with Physical Impairments: A Pilot Study

Abstract

This survey study describes practice patterns, knowledge, skills, resources, and needs of occupational therapy practitioners providing services to parents with physical impairments. Participants (n?=?51) primarily worked in outpatient rehabilitation (30%), inpatient rehabilitation (21%), and acute care (15%) settings. Participants reported evaluating and providing interventions for nine role-focused parenting activities. All participants agreed addressing the instrumental activities of daily living (IADL) of parenting should be part of occupational therapy practice. Adaptive equipment and techniques were utilized to increase participation of parents with physical impairments in child rearing. Lack of resources for childcare equipment and need for more training were barriers. Ninety-eight percent of participants agreed advancing the role of occupational therapy for parents with physical impairments is needed.     

脑卒中偏瘫早期介入康复的疗效观察

目的：探讨脑卒中患者早期正规康复治疗的效果。方法：随机将90例初发急性脑血管疾病的患者分为康复组（56例）和对照组（34例L康复组在发病3个月内生命体征平稳后开始进行正规的康复治疗;对照组在发病3个月后生命体征平稳后进行正规的康复治疗。两组分别于治疗前、后1个月,治疗后2个月采用Brunnstrom偏瘫分级标准进行评分。结果：治疗前两组的Brunnstrom偏瘫分级标准评分无统计学意义（x：=0.074,PXL05）。：治疗1个月、2个月后康复组的Brunnstrom偏瘫分级标准评分有显著提高,与对照组相比较有统计学意义（x2=9.32,P〈0.01）。结论：在发病早期对患者进行正规的康复治疗可明显提高患肢的运动功能,降低致残率,提高日常生活能力。     

Social workers’ perceptions of barriers to interpersonal therapy implementation for treating postpartum depression in a primary care setting in Israel

Research on evidence‐based practice (EBP) implementation in social work often neglects to include evaluation of application barriers. This qualitative study examined social workers’ perspectives of provider‐ and organisational‐related barriers to implementing a brief eight‐session interpersonal therapy (IPT) intervention, a time‐limited EBP that addresses reducing depressive symptoms and improving interpersonal functioning. Implementation took place in a primary care setting in Israel and was aimed at treating women who have postpartum depression (PPD) symptoms. Using purposeful sampling, 25 primary care licensed social workers were interviewed between IPT training and implementation regarding their perceived barriers to implementing IPT in practice. Data analysis was facilitated using a phenomenological approach, which entails identifying the shared themes and shared experiences of research participants regarding barriers to implementing IPT. Three themes emerged from the analysis of interviews: Perceived lack of flexibility of IPT intervention in comparison with more familiar methods social workers previously applied, specifically regarding the number of sessions and therapeutic topics included in the IPT protocol; insecurity and hesitance to gain experience with a new method of intervention; and organisational barriers, including difficulties with referrals, the perception of HMOs as health facilities not suitable for therapy, and time constraints. Addressing perceived barriers of social workers toward implementing EBPs, such as IPT for postpartum depression, during the training phase is crucial for enabling appropriate implementation. Future training should include examining practitioners’ attitudes toward implementation of EBPs, as part of standardised training protocols.     

Use of creative activities in occupational therapy practice in sweden

The aim of this study was to describe the prevalence of creative activities in occupational therapy in Sweden and how often Swedish occupational therapists use creative activities as a means of intervention. A web‐mail survey was sent to 2975 Swedish occupational therapists working in health care at regional, county council or primary health care level, and those working in vocational rehabilitation. A total of 1867 (63%) answered the questionnaire and showed that 44% did use creative activities as a means of intervention and most often by practitioners working in psychiatric health care. The most commonly used form of creative activity was arts and crafts followed by gardening. This web‐mail survey was based on a limited amount of items regarding creative activities. Further research should focus on in‐depth inquiries about how occupational therapists and their patients perceive the use of creative activities as a means of treatment in occupational therapy. Copyright © 2012 John Wiley & Sons, Ltd.     

Communicating evidence in clinical documentation

Background/aim: The purpose of this study was to examine occupational therapy practitioners’ and stakeholders’ opinions, perceptions, and attitudes towards communicating evidence in patient documentation. Moreover, it sought to establish relationships between factors that affect the use of evidence in documentation. Methods: A mixed method design was used and two distinct surveys were created by the researchers in order to collect the data. In the first survey, occupational therapy practitioners in the Midwestern region of the USA completed an electronic survey. The second, a Delphi survey, was sent to other stakeholders such as case managers, rehabilitation supervisors, and payers. Results: There were 126 surveys returned and analysed (29% response rate). Data revealed that 63.5% of practitioners believed in communicating evidence in documentation. Clinicians of all education levels agree that practitioners should communicate the evidence when funding is at stake (χ² (6, N = 110) = 15.97, P = 0.014). Participants also agreed that evidence should be communicated when dictated by their department (χ² (2, N = 110) = 6.25, P = 0.012).     

CHIP: Facilitating Interprofessional and Culturally Competent Patient Care Through Experiential Learning in China

Health care professionals have advocated for educating culturally competent practitioners. Immersion in international experiences has an impact on student cultural competency and interprofessional development. The China Honors Interprofessional Program (CHIP) at a university in the Midwest is designed to increase students' cultural competency and interprofessional development. From 2009 to 2013, a total of 25 professional students including twelve occupational therapy students, ten physical therapy students and three nursing students were enrolled in the programme. Using a one group pre and posttest research design, this study evaluated the impact of CHIP on the participating students. Both quantitative and qualitative data were collected in the study. Findings of the study revealed that CHIP has impact on students' cultural competency and professional development including gaining appreciation and understanding of the contributions of other healthcare professionals and knowledge and skills in team work. The findings of the study suggested that international immersion experience such as CHIP is an important way to increase students' cultural competency and interprofessional knowledge and skills. Limitations of the study included the small sample in the study, indirect outcome measures and the possible celling effect of the instruments of the study. Future research studies should include a larger and more representative sample, direct outcome measures such as behaviour observation and more rigorous design such as prospective experimental comparison group design. Future research should also examine the long‐term effects of international experience on the professional development of occupational therapy students. Copyright © 2016 John Wiley & Sons, Ltd.     

Fetal alcohol syndrome: knowledge and attitudes of family medicine clerkship and residency directors

Fetal alcohol spectrum disorders (FASD) are the leading preventable causes of developmental disabilities with serious permanent consequences. Regardless of the increased awareness of fetal alcohol syndrome (FAS), 13% of women in the United States drink alcohol during pregnancy. Health care professionals do not routinely assess the frequency and quantity of alcohol use by their patients. This study examined the knowledge, skills, and practices of family medicine residency and clerkship directors and assessed the time devoted and format of FAS curricula in the programs. A self-administered anonymous survey was sent to the residency and clerkship directors (N = 571). Response rate of clerkship directors was 52% and residency directors 46%. Both groups showed high level of knowledge of FASD and of alcohol counseling practices for pregnant women. Although almost two thirds of the residency programs had FASD integrated in the curriculum, an equivalent fraction of predoctoral programs did not. More than half of the clerkship directors without FASD in their curriculum agreed that a need exists for its inclusion. These findings raise important medical education and policy issues and provide insight into the disparity in FASD content of curricula between predoctoral and family medicine residency programs in the United States. The role of physician counseling in primary prevention of FAS should continue to be stressed in predoctoral and residency education.     

Guideline "Cancer rehabilitation"

Initiated by IKNL (Integraal Kankercentrum Nederland), a multidisciplinary guideline for cancer rehabilitation for adult oncology patients has been developed. The guideline describes the rehabilitation care of adult patients with cancer, during and after treatment. The guideline focuses on (a) prevalence of complaints either resulting from cancer or the treatment, (b) detection of these complaints and indicated referral, (c) the intake procedure before cancer rehabilitation, (d) intervention and evaluation within cancer rehabilitation and (e) the importance of patient empowerment. The guideline is directed at all professionals giving care to patients with cancer. It concerns those (such as medical specialists, general practitioners and nurses) who are responsible for detecting cancer-related complaints and for referral to cancer rehabilitation, as well as health care professionals involved in cancer rehabilitation care (such as consultants in rehabilitation medicine, physiotherapists and psychologists). The main goal of the guideline is that every cancer patient or ex-cancer patient with (residual) complaints resulting from cancer or its treatment receives timely and appropriate cancer rehabilitation.     

认知行为干预高血压患者社区康复的对照研究

目的研究探讨高血压患者心理卫生状况;观察认知行为治疗高血压患者的心理卫生康复状况。方法采用SCL-90、SAS、SDS对高血压患者进行心理评定;采用认知行为治疗、自我行为放松训练方法对高血压患者进行心理康复。结果高血压患者的SCL-90各因子及SAS得分均显著高于正常人群组(P<0.05);人际关系、敌对因子和SDS得分两者无统计学差异(P>0.05);高血压患者通过心理干预后,患者的躯体、强迫、抑郁、敌对、焦虑以及SAS得分较干预前有统计学差异(P<0.05);高血压患者通过心理干预后血压较干预前有显著降低(P<0.05)。结论高血压患者通过认知疗法与心理放松疗法干预后,患者的心理卫生状况有显著改善,对降低血压有一定效果。     

改良森田疗法对社区精神分裂症患者的康复效果评价

目的探索改良森田疗法在社区精神分裂症患者康复工作中运用的实际效果。为拓展精神分裂症患者的社区康复工作方法提供理论依据。方法通过常规随访、康复指导基础上结合改良森田疗法的运用,以社会功能缺陷筛选量表（SDSS）、简明精神病评定量表（BPRS）和生活满意度指数A（LSIA）等量表观察疗法,对社区康复精神分裂症患者的影响,运用SPSS13．0统计软件分析量表结果。结果改良森田疗法干预4周时,干预组与对照组除BPRS中的焦虑忧郁因子外,差异有统计学（P焦虑忧郁=0．02）。改良森田疗法干预结束时,干预组与对照组除了在BPRS中的思维障碍因子外,无显著统计学差异俨思维障碍=0．20）外,其余各量表及其因子得分均呈现显著统计学差异（P〈0．01、P〈0．01、P〈0．01）。改良森田疗法在干预4周时,干预组的BPRS中焦虑忧郁因子与干预前其自身比较出现显著统计学差异变化（P焦虑忧郁=0．02）。干预结束时,干预组与干预4周时自身在SDSS、LSIA、BPRS中的缺乏活力、敌对猜疑、总分上存在显著统计学差异（P均〈0．01）。结论改良森田疗法与常规随访、康复指导结合。对社区中进行康复的精神分裂症患者,在社会适应、精神疾病控制缓解、生活满意度领域,均具有较明显的积极作用。     

Continuing Education in Physical Rehabilitation and Health Issues of Agricultural Workers

Limited attention has been devoted to the cultural and practice competencies needed by occupational therapy and physical therapy professionals who provide services to farming families impacted by chronic health or disability issues. Agricultural occupational safety and health should represent a continuum of services responsive to individuals, families, and agricultural communities across a life span and range of health status changes. Physical rehabilitation professionals have a key role in impacting an agricultural producer’s sense of self-efficacy and capacities for returning to agricultural living and work. However, demonstration of competency is essential in providing person-centered rehabilitation services of assessment, evaluation, treatment planning, interventions, referrals, and discharge issues. The paper highlights methods utilized by a state AgrAbility program and a former National AgrAbility Project to develop a model of continuing education programming for occupational and physical therapists that evaluate and treat agricultural workers after acute injury or exacerbation of chronic health conditions.     

系统式集体音乐治疗对社区精神分裂症情绪及 精神症状影响的研究

目的研究系统式集体音乐治疗(systematic group music therapy,SGMT)模式对社区精神分裂症患者的负性心理及阳性阴性精神症状的影响。方法按系统抽样方法抽取160例病例,按1∶1配对,80例为干预组,另80例为对照组。对干预组实施SGMT干预,对照组接受常规社区精神病康复管理。使用三种量表作为评价工具。结果在实施干预后的第18个月,干预组的焦虑、抑郁平均得分均比对照组平均得分降低(P0.05);干预组阳性阴性症状量表总分、分量表平均分得分与对照组比较均降低,且存在差异,具有统计学意义(P0.05)。结论实施SGMT干预,能有效地改善社区分裂症患者焦虑、抑郁症状,且能改善其阳性阴性精神症状。     

Survey of cognitive rehabilitation practices in the state of Kuwait

Background Rehabilitation professionals must be astute at recognizing, assessing, and treating individuals with cognitive deficits. No research is available to examine cognitive rehabilitation practices applied to individuals with neurological conditions in Kuwait. Objectives: To identify the use of cognitive assessments, the availability of resources, and the barriers to cognitive rehabilitation practices in Kuwait. Methods Face-to-face interviews were conducted with health care professionals working with adult individuals with neurological conditions. These professionals included occupational therapists, speech-language pathologists, psychiatrists, and neurologists. Results The most commonly used cognitive based assessments are MMSE (41%), and MoCA and LOTCA (15.2%). The only clinical assessment used is the Line-Bisection Test (2.2%). The most used occupation-based assessments are FIM (6.5%), COPM (4.3%), the Interest Checklist (2.2%), and the Barthel Index (2.2%). Resources related to cognitive rehabilitation in Kuwait that are unavailable to practitioners include journal clubs (91%), special interest groups (89%), and continuing education programmes (82.6%). Barriers to cognitive rehabilitation practice included lack of sufficient funds for continuing education, lack of time, lack of standardized assessments, and lack of inter-professional teamwork. Conclusion Many adults in Kuwait live with cognitive impairment. There is a need to develop appropriate evidence-based cognitive rehabilitation clinical guidelines in Kuwait.     

Evaluation of a continuing educational intervention for primary health care professionals about nutritional care of patients at home

Objective

Evaluate the effectiveness of a continuing educational intervention on primary health care professionals’ familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care.

Design

Observational cohort study.

Setting

10 primary health care centers in Stockholm County, Sweden.

Participants

140 district nurses/registered nurses and general practitioners/physicians working with home care.

Intervention

87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection.

Measurements

The intervention’s effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression.

Results

In the intra-group analyses, statistically significant changes occurred in the IG’s responses to 28 of 32 items and the CG’s responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0.

Conclusion

The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals’ level of knowledge about important aspects of nutritional care.

     

Rehabilitation of Patients with Motor Neurone Disease — The Occupational Therapist's Role

The value of rehabilitation techniques and the involvement of occupational therapy with patients who have motor neurone disease has been identified by a number of authors and medical practitioners. However, little has been documented about the role of occupational therapy with motor neurone disease patients, despite the fact that the involvement of occupational therapists is often requested. In this paper, the author outlines rehabilitation approaches and techniques which may be utilised by occupational therapists. From this written documentation of the occupational therapy role, occupational therapists can evaluate and explore the effectiveness of these intervention strategies and techniques.