Nursing care for persons with developmental disabilities: Review of literature on barriers and facilitators faced by nurses to provide care.

AIMS: To identify barriers and facilitators to nursing care of individuals with developmental disabilities (DDs). BACKGROUND: Individuals with DDs experience health disparities. Nurses, although well positioned to provide optimal care to this population, face challenges. DESIGN: Narrative review of extant published peer-reviewed literature. DATA SOURCES: Electronic databases, ProQuest and EBSCO, were searched for studies published in English between 2000 and 2019. REVIEW METHODS: Three reviewers reviewed abstracts and completed data extraction. Knowledge synthesis was completed by evaluating the 17 selected studies. RESULTS: Emerging themes were: (1) barriers and challenges to nursing interventions; (2) facilitators to nursing care; and (3) recommendations for nursing education, policy and practice. CONCLUSION: Nursing has the potential to be a key partner in supporting the health of people with DDs. IMPACT: There is a need for specific education and training, so nurses are better equipped to provide care for people with DDs.

Readers Theatre as an arts-based approach to education: A scoping review on experiences of adult learners and educators.

BACKGROUND: Arts-based educational methodologies have been implemented in nursing and other health disciplines to promote person-centered approaches to care. Readers Theatre has been applied as a tool to promote compassionate and holistic approaches to care. Readers Theatre is a form of drama that requires participants to read aloud a scripted narrative to the audience. OBJECTIVES: To examine the extant literature on experiences of adult learners and educators in utilizing Readers Theatre, and its potential suitability for nurse education. The review question was: "What are the learning experiences of adult students and the teaching experiences of educators in the uptake of Readers Theatre?" DESIGN AND DATA SOURCES: Scoping review guidelines proposed by Arksey and O'Malley were adopted. Academic databases searches were carried out in ProQuest, JSTOR, Scholars Portal, EBSCO, Web of Science, PubMed, Expanded Academic ASAP, and Scopus. REVIEW METHODS: The search and keyword strategy was developed by two reviewers and approved by the lead author, and a librarian. All titles and abstracts were individually examined by the two reviewers with discrepancies discussed and resolved by both parties. Data were extracted for thematic analysis. RESULTS: A total of 31 studies were selected for the final sample. Four themes were identified within the scoping review relevant to Readers Theatre teaching-learning experiences: 1) principles and characteristics; 2) awareness, understanding, caring and empathy; 3) cross-disciplinary collaboration, interdisciplinary education, and knowledge dissemination; and 4) promoting students' skills. CONCLUSIONS: Readers Theatre has the potential to be utilized within a nursing curriculum, and particularly in theory and substantive class-based courses, through active group learning, in the application phase of knowledge acquisition.

Protection of Privacy of Information Rights among Young Adults with Developmental Disabilities.

Protection of privacy of information for young adults with developmental disabilities and their families is essential to promote quality of life, well-being, empowerment, and inclusion. Despite this, the young adults' information privacy rights are increasingly at risk. This paper provides a scoping review, applying Arksey and O'Malley's (2005) approach, of all published peer-reviewed journal articles and gray literature to examine the barriers and facilitators in utilization of legislation that protects the collection, use, disclosure, and access of personal information in Canada. The scoping review process was further expanded with a rigorous reliability method and applied a socio-ecological framework to the final 47 studies. National and international policy and legislation (macro level), organization-based factors (meso), young adults and community interactions (exo), and individual disability related factors (micro) are examined. The review identifies the barriers and highlights the importance of facilitators for acting on personal privacy rights.

Prospective Study Delivering Simultaneous Integrated High-dose Tumor Boost (≤70 Gy) With Image Guided Adaptive Radiation Therapy for Radical Treatment of Localized Muscle-Invasive Bladder Cancer.

PURPOSE: Image guided adaptive radiation therapy offers individualized solutions to improve target coverage and reduce normal tissue irradiation, allowing the opportunity to increase the radiation tumor dose and spare normal bladder tissue. METHODS AND MATERIALS: A library of 3 intensity modulated radiation therapy plans were created (small, medium, and large) from planning computed tomography (CT) scans performed at 30 and 60 minutes; treating the whole bladder to 52 Gy and the tumor to 70 Gy in 32 fractions. A "plan of the day" approach was used for treatment delivery. A post-treatment cone beam CT (CBCT) scan was acquired weekly to assess intrafraction filling and coverage. RESULTS: A total of 18 patients completed treatment to 70 Gy. The plan and treatment for 1 patient was to 68 Gy. Also, 1 patient's plan was to 70 Gy but the patient was treated to a total dose of 65.6 Gy because dose-limiting toxicity occurred before dose escalation. A total of 734 CBCT scans were evaluated. Small, medium, and large plans were used in 36%, 48%, and 16% of cases, respectively. The mean ± standard deviation rate of intrafraction filling at the start of treatment (ie, week 1) was 4.0 ± 4.8 mL/min (range 0.1-19.4) and at end of radiation therapy (ie, week 5 or 6) was 1.1 ± 1.6 mL/min (range 0.01-7.5; P=.002). The mean D98 (dose received by 98% volume) of the tumor boost and bladder as assessed on the post-treatment CBCT scan was 97.07% ± 2.10% (range 89.0%-104%) and 99.97% ± 2.62% (range 96.4%-112.0%). At a median follow-up period of 19 months (range 4-33), no muscle-invasive recurrences had developed. Two patients experienced late toxicity (both grade 3 cystitis) at 5.3 months (now resolved) and 18 months after radiation therapy. CONCLUSIONS: Image guided adaptive radiation therapy using intensity modulated radiation therapy to deliver a simultaneous integrated tumor boost to 70 Gy is feasible, with acceptable toxicity, and will be evaluated in a randomized trial.

A framework for understanding international medical graduate challenges during transition into fellowship programs.

BACKGROUND: Previous studies have highlighted unique needs of international medical graduates (IMG) during their transition into medical training programs; however, limited data exist on IMG needs specific to fellowship training. PURPOSES: We conducted the following mixed-method study to determine IMG fellow training needs during the transition into fellowship training programs in psychiatry and surgery. METHODS: The authors conducted a mixed-methods study consisting of an online survey of IMG fellows and their supervisors in psychiatry or surgery fellowship training programs and individual interviews of IMG fellows. The survey assessed (a) fellows' and supervisors' perceptions on IMG challenges in clinical communication, health systems, and education domains and (b) past orientation initiatives. In the second phase of the study, IMG fellows were interviewed during the latter half of their fellowship training, and perceptions regarding orientation and adaptation to fellowship in Canada were assessed. Survey data were analyzed using descriptive and Mann-Whitney U statistics. Qualitative interviews were analyzed using grounded theory methodology. RESULTS: The survey response rate was 76% (35/46) and 69% (35/51) for IMG fellows and supervisors, respectively. Fellows reported the greatest difficulty with adapting to the hospital system, medical documentation, and balancing one's professional and personal life. Supervisors believed that fellows had the greatest difficulty with managing language and slang in Canada, the healthcare system, and an interprofessional team. In Phase 2, fellows generated themes of disorientation, disconnection, interprofessional team challenges, a need for IMG fellow resources, and a benefit from training in a multicultural setting. CONCLUSIONS: Our study results highlight the need for IMG specific orientation resources for fellows and supervisors. Maslow's Hierarchy of Needs may be a useful framework for understanding IMG training needs.

Predictors of post-bariatric surgery appointment attendance: the role of relationship style.

BACKGROUND: Attendance at bariatric surgery follow-up appointments has been associated with bariatric surgery outcomes. In this prospective study, we sought to examine psychosocial predictors of attendance at post-operative follow-up appointments. METHODS: Consecutive bariatric surgery patients (n = 132) were assessed pre-surgery for demographic variables, depressive symptoms, and relationship style. Patients were followed for 12 months post-surgery and, based on their attendance at follow-up appointments, were classified as post-surgery appointment attenders (attenders--attended at least one appointment after post-operative month 6) or post-surgery appointment non-attenders (non-attenders--did not attend at least one appointment after post-operative month 6). Psychosocial and demographic variables were compared between the attender and non-attender groups. Multivariate logistic regression was used to identify significant predictors of attendance at post-bariatric surgery follow-up appointments. RESULTS: At 12 months post-surgery, 68.2 % of patients were classified as attenders. The non-attender group was significantly older (p = 0.04) and had significantly higher avoidant relationship style scores (p = 0.02). There was a trend towards patients in the non-attender group living a greater distance from the bariatric center (p = 0.05). Avoidant relationship style was identified as the only significant predictor of post-operative appointment non-attendance in the logistic regression analysis. CONCLUSIONS: These findings suggest that avoidant relationship style is an important predictor of post-bariatric surgery appointment non-attendance. Recognition of patients' relationship style by bariatric surgery psychosocial team members may guide the delivery of interventions aimed at engaging this patient group post-surgery.

Costs of vaginal delivery and Caesarean section at a tertiary level public hospital in Islamabad, Pakistan.

BACKGROUND: Public hospitals in developing countries, rather than the preventive and primary healthcare sectors, are the major consumers of healthcare resources. Imbalances in rational, equitable and efficient allocation of scarce resources lie in the scarcity of research & information on economic aspects of health care. The objective of this study was to determine the average cost of a spontaneous vaginal delivery and Caesarean section in a tertiary level government hospital in Islamabad, Pakistan and to estimate the out of pocket expenditures to households using these services. METHODS: This hospital based cost accounting cross sectional study determines the average cost of vaginal delivery and Caesarean section from two perspectives, the patient's and the hospital. From the patient's perspective direct and indirect expenditures of 133 post-partum mothers (65 delivered by Caesarean section & 68 by spontaneous vaginal delivery) admitted in the maternity general ward were determined. From the hospital perspective the step down methodology was adopted, capital and recurrent costs were determined from inputs and cost centers. RESULTS: The average cost for a spontaneous vaginal delivery from the hospital's side was 40 US$ (2688 rupees) and from the patient's perspective was 79 US$ (5278 rupees). The average cost for a Caesarean section from the hospital side was 162 US$ (10,868 rupees) and 204 US$ (13,678 rupees) from the patient's side. Average monthly household income was 141 +/- 87 US$ for spontaneous vaginal delivery and 168 +/- 97 US$ for Caesarean section. Three fourth (74%) of households had a monthly income of less than 149 US$ (10,000 rupees). CONCLUSION: The apparently "free" maternity care at government hospitals involves substantial hidden and unpredicted costs. The anticipated fear of these unpredicted costs may be major factor for many poor households to seek cheaper alternate maternity healthcare.