Organizational and individual factors associated with breakdown of residential placements for people with intellectual disabilities

Background People with intellectual disabilities (IDs) whose behaviour challenges services are at increased risk of placement breakdown. Most previous research has tended to focus on the role of individual characteristics in predicting breakdown. A small number of studies have suggested that service variables may impact on intervention effectiveness and hence placement breakdown. Method This study used a non‐experimental group comparison design to investigate potential differences between two groups of residential homes, one of which had experienced placement breakdown, and one of which had successfully maintained placements in the community. Results More residents in the breakdown group had inappropriate sexual behaviours but there were no other differences. Services in the breakdown group had more limited procedural guidance for staff, weaker training, supervision and team meetings and less external professional support. Conclusion Placement characteristics may be an important determinant of community placement success for people with IDs and challenging behaviour. Those selecting and funding residential placements for such people should attend to the technical competence of the placement (in terms of its use of procedural guidance, training and professional advice) and to the extent of support for staff (in terms of training, supervision and team meetings).     

Factors relating to the perceived management of emergency situations: A survey of former Advanced Life Support course participants’ clinical experiences

Background

This study explored individual, team, and setting factors associated with the quality of management of in-hospital emergency situations experienced by former Advanced Life Support (ALS) course participants.

Methods

This study was a survey of former ALS course participants’ long-term experience of management of in-hospital, emergency situations. The survey was carried out in 2012 in Denmark and Norway.

Results

A questionnaire was send to 526 potential responders and (281/479 × 100) 58.7% responded. The results demonstrated that 75% of the emergency situations were perceived as “managed well”. In general, the responders’ confidence in being ALS providers was high, mean 4.3 (SD 0.8), scale 1–5. Significant differences between the perceived “well” and “not well” managed situations were found for all questions, p < 0.001. The largest differences related to perception of co-workers’ ability to apply ALS principles, the team atmosphere and communication. Responders’ ratings of quality of management of emergency situations increased with intensity of setting. However, the ‘clinical setting’ was rated significantly lower as attributor to ability to apply ALS principles compared to ‘co-workers familiarity with ALS principles’, ‘own confidence as ALS-provider’ and ‘own social/inter-personal skills’.

Conclusion

The results of this survey emphasise that ALS providers’ perceived ability to apply ALS skills were substantially affected by teamwork skills and co-workers’ skills. Team related factors associated with successful outcome were related to clear role distribution, clear inter-personal communication and attentive listening, as well as respectful behaviour and positive team atmosphere. Although intensity of setting was attributed to ability to apply ALS principles, this did not affect management of emergency situations to the same extent as individual and team factors.     

Towards the Prevention of Behavioural and Psychiatric Disorders in People with Intellectual Disabilities

Intervention for behavioural and psychiatric disorders in people with intellectual disabilities often only takes place once these conditions are well established and more resistant to change. As an alternative, this paper promotes a public health prevention model and maps out opportunities for intervention at primary, secondary and tertiary levels. The resulting model is partly derived from generic research into these issues and partly on specific evidence on interventions for people with intellectual disabilities; it also contains more theoretical considerations. The additional research that is necessary to demonstrate the efficacy of the interventions identified is also considered. Central to this proposal is a greater integration of issues for people with intellectual disabilities within much broader policy and research agendas.     

Situationally influenced tinnitus coping strategies: a mixed methods approach

Abstract

Purpose: The primary aim of this study was to identify coping strategies used to manage problematic tinnitus situations. A secondary aim was to determine whether different approaches were related to the level of tinnitus distress, anxiety, depression, and insomnia experienced.

Materials and methods: A cross-sectional survey design was implemented. The study sample was adults interested in undertaking an Internet-based intervention for tinnitus. Self-reported measures assessed the level of tinnitus distress, depression, anxiety, and insomnia. An open-ended question was used to obtain information about how problematic tinnitus situations were dealt with. Responses were investigated using qualitative content analysis to identify problematic situations. Further data analysis comprised of both qualitative and quantitative methods.

Results: There were 240 participants (137 males, 103 females), with an average age of 48.16 years (SD: 22.70). Qualitative content analysis identified eight problematic tinnitus situations. Participants had either habituated to their tinnitus (7.9%), used active (63.3%), or passive (28.8%) coping styles to manage these situations. Those who had habituated to tinnitus or used active coping strategies had lower levels of tinnitus distress, anxiety, and depression.

Conclusions: The main problematic tinnitus situations for this cohort were identified. Both active and passive coping styles were applied to approach these situations. The coping strategies used most frequently and utilised in the widest range of problematic situations were using sound enrichment and diverting attention.

• Implications for Rehabilitation

• The main problematic tinnitus situations for this group of participants were identified.

• Overall, a limited range of strategies were used to deal with individual problematic situations. The use of sound enrichment and diverting attention was applied in the widest range of problematic situations.

• The use of both active and passive coping styles was evident to approach these situations. The use of passive strategies in certain situations was associated with higher levels of tinnitus distress, depression, and anxiety over the last week as measured by self-reported questionnaires.

     

长期护理机构老年痴呆患者精神行为症状的症状簇及其照护困扰

  目的  探讨长期照护机构中老年痴呆患者挑战性行为现状及影响因素。  方法  于2017年9 — 11月,便利选取广州市3所长期照护机构340例老年痴呆患者,采用自编一般人口学资料问卷,中文版挑战性行为量表（CBS）进行问卷调查。  结果  99.1 %（357例）的老年痴呆患者存在挑战性行为及管理难度。其中有5种挑战性行为不仅发生频率高,且管理难度大：“缺乏自我照顾能力”发生率为81.8 %,管理难度（6.55 ± 5.216）分、“言行重复”发生率为51.5 %,管理难度（3.55 ± 4.817）分、“缺乏积极性”发生率为43.2 %,管理难度（2.99 ± 4.452）分、“大声叫喊”发生率为43.5 %,管理难度（2.93 ± 4.617）分、“烦躁不安”发生率为42.1 %,管理难度（2.62 ± 4.141）分。生活自理能力较差（OR = 2.869,5.094,P < 0.05）、不接受精神科治疗（OR = 2.252,P < 0.05）、伴随疾病数量≥3种（OR = 2.195,P < 0.05）是老年痴呆患者挑战性行为管理困难的危险因素。  结论  长期照护机构老年痴呆患者普遍存在挑战性行为及管理难度,其管理难度受患者的生活自理能力、精神科治疗状况、伴随疾病种类影响。     

The response to challenging behaviour by care staff: emotional responses, attributions of cause and observations of practice

Background Previous studies have attempted to apply Weiner's attributional model of helping behaviour to care staff who work with service users with intellectual disabilities and challenging behaviours by using studies based on vignettes. The aims of the current study were to investigate the application of Weiner's model to ‘real’ service users with intellectual disabilities and challenging behaviours and to observe the care staff's actual responses to challenging behaviours displayed by service users. Also, to compare care staff attributions, emotions, optimism, willingness to help and observed helping behaviours for self‐injurious behaviours in comparison to other forms of challenging behaviours. Method A total of 27 care staff completed two sets of measures, one set regarding a self‐injurious behaviour and the other regarding other forms of challenging behaviour. An additional 16 staff completed one set of measures. The measures focused on care staff attributions, emotions, optimism and willingness to help. Also, 16 of the care staff were observed interacting with the service users to collect data regarding their responses to challenging behaviours. Results For both self‐injurious behaviours and other forms of challenging behaviour, associations were found between the care staff internal, stable and uncontrollable attribution scores and care staff negative emotion scores. However, no associations were found between the care staff levels of emotion, optimism and willingness to help. Some associations were found between the care staff levels of willingness to help and observed helping behaviours. There were significant differences between the care staff attribution scores with higher scores being obtained for uncontrollable and stable attributions for other forms of challenging behaviours. No significant differences were found between the care staff emotions, optimism, willingness to help and observed helping behaviours. Conclusions The results did not provide support for Weiner's attributional model of helping behaviour. However, a preliminary model of negative care staff behaviour was derived from the exploratory analyses completed. This model proposes that there are associations between internal, stable and uncontrollable attributions and negative emotions in care staff and also between negative emotions and negative behaviours displayed by care staff in response to the actions of service users.     

丽水市十三项呼吸道病原体感染情况及特点分析北大核心CSCD

目的了解丽水市呼吸道病原体感染情况及流行病学特征,为呼吸道传染病诊疗与防控提供科学依据。方法回顾性分析2020年3月至2021年12月丽水市人民医院收治的4035例呼吸道感染患者13项呼吸道病原体PCR毛细电泳核酸检测结果,并分析病原体感染分布特征。结果呼吸道病原体感染患者阳性检出率为32.24%(1301/4035),检出率前5位分别是HRV(16.60%)、HRSV(7.09%)、HPIV(2.87%)、HMPV(2.21%)、HADV(1.96%)。混合感染阳性占比为7.61%(99/1301),Boca病毒(76.0%)与Ch(46.15%)易与其它病原体形成混合感染。不同性别呼吸道病原体感染率差异无统计学意义(P>0.05)。虽然不同季节呼吸道病原体整体感染率差异无统计学意义(P>0.05),但HRV好发于春秋两季,而HPIV在春秋两季感染率较低,春季HRSV感染率较低,HADV在夏秋两季感染率较低,HMPV在冬季较为流行。未成年人呼吸道病原体感染率较高,HRSV、HRV、HPIV、HADV和Boca主要发生于未成年人组,InfB和HMPV在未成年和青年人群感染率都较高。结论未成年人群是呼吸道病原体易感人群,应加强未成年人呼吸道传染病防控。