Sensory Processing Assessment and Feedback in the Treatment of Complex Developmental Trauma.

This study explored the impact of a sensory processing assessment, recommendations and feedback process on the functioning at school and after-hours environments of children who had been traumatised by abuse. A mixed methods design (Schoonenboom & Johnson, 2017) was utilized incorporating pre (12 months prior) and post (four to eight months after the report) repeated child focused measure, alongside thematic analysis of participants qualitative survey feedback. The methodology included two stages: firstly, an occupational therapy assessment of young people referred by Own Organisation clinicians for a sensory processing assessment and secondly, an evaluation was conducted of the impact of occupational therapy on the young person's behaviour and their carers. The study found significant improvement in family life and relationships as well as a reduction in impairment as evidenced by decreases in HoNOSCA scores across problems with family life and relationships, non-accidental self-injury, problems with emotional and related symptoms, poor school attendance and on the social subscale. These findings were supported by clinician participant reports. A sensory processing assessment provided young people, their carers and teachers with information which contributed to environmental adaptations. These environmental adaptations were associated with improved functioning and behaviour of young people impacted by child abuse. It is recommended future research attempt to replicate and extend our understanding of how sensory processing assessments and interventions can increase children's wellbeing. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-023-00607-0.

Poles apart? The views of general practitioners and family health services authority advisers on prescribing cost issues.

BACKGROUND: In 1994, an Audit Commission report estimated that Pounds 425 million could be saved from the national drug budget if general practitioners (GPs) altered their prescribing in various ways. AIM: To assess the views of GPs and family health services authority (FHSA) advisers on issues similar to those raised in the Audit Commission report. METHOD: A questionnaire was sent to a 1 in 20 sample of GPs from 33 randomly selected FHSA areas (n = 576) and all FHSA advisers (n = 285). RESULTS: A total of 419 (72.7%) GPs and 234 (82.1%) advisers replied. There were statistically significant differences (P < 0.01) between GPs and advisers on all but one of the statements. In particular, there were marked differences on some of the statements relating to substitution with cheaper similar drugs. Differences were smaller for statements on the use of drugs of limited therapeutic value, the range of drugs prescribed, and practice prescribing policies. Differences were noted between subgroups of GPs in response to some of the statements. CONCLUSION: The majority of GPs in this survey gave responses that were supportive of many of the types of suggestion made by the Audit Commission. However, it is suggested that differences of opinion between GPs and FHSA advisers may have implications for the development of strategies to control prescribing costs.

Do prescribing formularies help GPs prescribe from a narrower range of drugs? A controlled trial of the introduction of prescribing formularies for NSAIDs.

BACKGROUND: Previous studies have suggested that prescribing formularies may promote rational prescribing. The range of drugs prescribed may be one aspect of rational prescribing. AIM: To determine whether the introduction of prescribing formularies helps general practitioners (GPs) to prescribe from a narrower range of non-steroidal anti-inflammatory drugs (NSAIDs). METHOD: General practices in Lincolnshire were offered help in developing prescribing formularies. Ten practices decided to develop a formulary for NSAIDs. Level 3 PACT data were used to determine whether changes in prescribing had occurred with the introduction of the formulary. Matched controls were used to determine whether similar changes had occurred in other practices. RESULTS: Between April and June 1992, and during the same period in 1993, practices that introduced a formulary for NSAIDs reduced the mean number of different drugs used (14.3 versus 13.1, P = 0.04) and increased the percentage of NSAID-defined daily doses coming from the three most commonly used drugs (70.1% versus 74.8%, P = 0.02). Similar changes were not seen in control practices. CONCLUSION: Following the development of a formulary for NSAIDs, practices prescribed from a narrower range of drugs and focused a greater proportion of their prescribing on their three most commonly used drugs.

Educators' knowledge and attitudes regarding stimulants in the treatment of attention deficit hyperactivity disorder.

Educators often are asked to provide information regarding students' responses to medication used for the treatment of attention deficit hyperactivity disorder (ADHD). We designed a questionnaire to determine the knowledge and attitudes of educators regarding stimulants. Two hundred ninety-one regular classroom and special education teachers in two Ohio school systems received the questionnaire; the overall response rate was 65%. Our findings suggest that educators generally believe stimulants are useful for students with ADHD and that they frequently recommend them to parents. However, educators indicated their knowledge of the effects of stimulants was limited and that they had received little education about stimulants. Physicians requesting input from educators regarding students taking stimulants should be aware of the limitations of educators' knowledge and participate in the development of programs to improve that knowledge.

A prescription for improvement? An observational study to identify how general practices vary in their growth in prescribing costs.

OBJECTIVE: To identify how some general practices have low growth in prescribing costs relative to other practices. DESIGN: Observational study. SETTING: Trent region of England. PARTICIPANTS: 162 general practices: 54 with low growth in prescribing costs, 54 with average increases in costs, and 54 with large increases in costs. MAIN OUTCOME MEASURES: Changes in prescribing costs in therapeutic categories in which it has been suggested that savings can be made. RESULTS: There were significant differences between the three groups of practices in terms of their changes in prescribing costs for almost all the variables studied. For the group of practices with lowest growth in costs the most important factors were reducing numbers of prescription items and costs per item; relatively low growth in the costs of "new and expensive" drugs; increasing generic prescribing; and reducing costs for modified release products. This group of practices did not increase costs as much as the others for lipid lowering drugs (P=0.012) and hormone replacement therapy (P=0. 007). The practices with the greatest increases in costs had particularly large increases for proton pump inhibitors, selective serotonin reuptake inhibitors, and modified release products. Compared with the other groups these practices had larger increases in costs for "expensive hospital initiated drugs" (P=0.009). CONCLUSION: General practices vary in their growth in prescribing costs in many ways, with growth in costs for "new and expensive" drugs being particularly important.

Effects of active student response during error correction on the acquisition, maintenance, and generalization of sight words by students with developmental disabilities.

We used an alternating treatments design to compare the effects of active student response error correction and no-response error correction during sight word instruction. Six students with developmental disabilities were provided one-to-one daily sight word instruction on eight sets of 20 unknown words. Each set of 20 words was divided randomly into two equal groups. Student errors during instruction on one group of words were immediately followed by the teacher modeling the word and the student repeating it (active student response instruction). Errors on the other group of words were immediately followed by the teacher modeling the word while the student attended to the word card (no-response instruction). For all 6 students, the active student response error-correction procedure resulted in more words read correctly during instruction, same-day tests, next-day tests, 2-week maintenance tests, and generality tests (words read in sentences).

Magnetic resonance follow-through imaging for evaluation of disease activity in ileal Crohn's disease: an observational, retrospective cohort study.

BACKGROUND: Magnetic resonance follow-through (MRFT) is a new cross-sectional imaging modality with the potential to accurately stage ileal Crohn's disease (CD), while avoiding ionizing radiation and the discomfort associated with enteroclysis. We aimed to assess the reliability of this technique in assessing the extent and activity of ileal CD, and to assess its influence on subsequent management. METHODS: Out of a total of 342 patients undergoing MRFT between 2004 and 2008, 221 were performed in 191 patients with confirmed CD. Case notes were reviewed in detail with documentation of all investigations pre- and post-MRFT. Agreement between inflammatory markers, histopathology, and MRFT findings was determined. RESULTS: Overall, 116/221 (52.5%) of MRFTs showed active ileal CD, and 76/221 (34.4%) quiescent CD, while 29/221 (13.1%) were suboptimal. Overall, 66 strictures and 18 fistulae were identified. There was substantial agreement between active ileal CD on MRFT and histopathology (n = 59; kappa = 0.66; P = 0.0006; sensitivity 85.1%, specificity 85.7%) and fecal calprotectin (n = 14; kappa = 0.72; P = 0.047), while C-reactive protein (CRP) showed moderate agreement (n = 107; kappa = 0.402; P = 0.00028). Management was influenced by MRFT reports following active (52/84, 62% treated medically) or quiescent (48/62, 77.4% managed conservatively) disease. Fibrotic strictures were predominantly treated surgically (7/14, 50%). In all, 13/32 (40.6%) patients with inflammatory ileal strictures required surgery, mostly due to steroid-resistant disease. Overall, 75 MR findings were documented in 221 MRFTs, including 1 renal cancer. CONCLUSIONS: MRFT provides accurate information on ileal CD activity, with close agreement to inflammatory markers and histopathology. It represents a substantial advance in the staging of CD, while avoiding painful enteroclysis and radiation exposure in young patients.

The maintenance of confidentiality in primary care: a survey of policies and procedures.

We investigated policies and procedures for the maintenance of confidentiality in primary care by means of a postal survey of 109 general practices in a large non-metropolitan urban health authority in England. The response rate was 61%. Practices believed a variety of staff should be informed if a patient was HIV-positive, ranging from 'patient's own GP' (100%) to 'clerical staff' (8%). In 88% of practices receptionists occasionally or normally asked patients why they wished to see a doctor, although in 76% such conversations were audible to other patients. Ninety-nine per cent claimed to have a policy on confidentiality, although it existed in writing in 62% and was publicized in only 27%. In 88% of practices non-clinical staff had access to written patient records. Ninety-three per cent provided staff training in confidentiality, but in 34% it was confined to induction. Almost all practices had taken some steps to safeguard confidentiality, but few had explicit, formal confidentiality policies. Information sharing and non-clinical staff access to medical records were extensive, and few practices communicated their arrangements to patients. Practices need to review their policies and procedures for the maintenance of confidentiality.

Prescribing cost savings by GP fundholders: long-term or short-term?

Fundholding general practices have been observed to be more successful than non-fundholders in controlling the growth of their prescribing costs. Debate persists over the likely duration of this fundholding effect. Regression analysis of changes in prescribing costs for a large sample of practices over 5 years supports the view that prescribing cost economies have been short-rather than long-term, and that practices entering fundholding did not engage in strategic, cost-raising behaviour prior to joining the scheme.

A method for the treatment of lead poisoning in the mute swan (Cygnus olor) and its long-term success.

A method for the treatment of lead poisoning in mute swans (Cygnus olor) is described. Chelation therapy, using sodium calcium edetate, was successful in resolving the clinical signs of lead poisoning in 49% of cases. Individually ringed swans were monitored after their release to the wild, in order to assess the long-term benefits of treatment. Re-sighting and recovery data suggested that at least 22% of swans treated for lead poisoning survived the first 2 years. The results indicate that despite treatment, once a swan becomes lead poisoned its chances of survival are reduced by 59% compared with untreated swans living in flocks.

The isolation and measurement of tRNAmeti using RNA/DNA hybridization.

A pBR322 plasmid containing the initiator tRNAmet gene of Xenopus (pt145 - donated by Stuart Clarkson) will specifically bind to mouse initiator tRNAmet (tRNAmeti) when total mouse tRNA, extracted from uninduced Friend erythroleukemia cells, is hybridized to the gene probe. One dimensional electrophoresis of the hybridizing tRNA in 20% polyacrylamide reveals one major band (95%) and a minor band. The hybridizing tRNA has been identified as initiator tRNAmet by RNA sequencing. Hybridization of tRNAtotal to another plasmid containing the Xenopus gene for tRNAasn results in two bound species with different electrophoretic mobilities than the tRNA bound to the initiator tRNAmet gene. pt145 has been used to measure the steady state concentration of initiator tRNAmet in the uninduced and erythroid Friend cell, and in the unfertilized egg and 21 h blastula of the sea urchin. Initiator tRNAmet represents 0.91% and 0.52% of the tRNA populations extracted from uninduced and erythroid Friend cells, respectively. Based upon the total tRNA content per cell, there is a 3.8 fold decrease in initiator tRNAmet per cell during erythroid differentiation. tRNA extracted from unfertilized eggs and 21 h blastula of the sea urchin both have 0.5% of total tRNA as initiator tRNAmet (approximately 1.5 pg).