Near-Peer Facilitation of a Soft Skills Program for Young Adults With Autism.

IMPORTANCE: Young adults with autism spectrum disorder (ASD) experience poor employment outcomes. Teaching soft skills and using peer-based interventions improve outcomes for people with ASD. OBJECTIVE: To evaluate the preliminary efficacy of a soft skills intervention and the feasibility of delivery to a group of young adults with ASD by near-peer occupational therapy master's-level students. DESIGN: Pretest-posttest single-group design. SETTING: College campus. PARTICIPANTS: Convenience sample of 14 young adults (M age = 21.57 yr) with ASD. INTERVENTION: The Assistive Soft Skills and Employment Training (ASSET) program is a 12-session, manualized, soft skills group intervention previously validated with the ASD population. Topics include communication, attitude and enthusiasm, teamwork, networking, professionalism, and stress management. OUTCOMES AND MEASURES: Social functioning, self-efficacy, and adaptive behavior were measured preintervention and immediately postintervention using standardized self-report rating scales. Participant satisfaction and experience were assessed using program-specific measures. RESULTS: Participants made statistically significant improvements, with medium to large effect sizes in social functioning, self-efficacy, and adaptive behavior. They reported high levels of satisfaction and a positive experience with the program content and delivery. CONCLUSIONS AND RELEVANCE: This study provides evidence of participant satisfaction and perceived soft skills improvement and confidence, in addition to the preliminary efficacy of master's-level students as near-peer facilitators of the ASSET program with an ASD population. What This Article Adds: The results suggest that trained and supervised master's-level students can effectively deliver a manualized intervention as near-peer facilitators, elicit positive feedback and high levels of participant satisfaction, and replicate and extend previously reported participant gains.

Rapid transition from in-person to videoconferencing psychotherapy in a counselor training clinic: A safety and feasibility study during the COVID-19 pandemic.

Due to the COVID-19 pandemic, many counselor training clinics rapidly transitioned in-person (IP) services to videoconferencing psychotherapy (VCP). Because VCP is a relatively new technology, more research is needed to establish whether this delivery format is a safe and acceptable substitute for IP services in counselor training clinics. The purpose of this study is to explore questions related to how clients perceive VCP versus IP in terms of credibility and expectancy. Results from this investigation demonstrate that clients who participate in VCP, without first meeting their counselor in person, may initially question the credibility and effectiveness of VCP. However, results demonstrated improvement, in both groups, across the duration of therapy. These findings provide both initial support for the safety of VCP in counselor training clinics and justification for further research.

Disclose or not? Effect of impression management tactics on hireability of persons with epilepsy.

OBJECTIVE: The purpose of this study is to determine the effect of assertive impression management (IM) tactics, such as personal storytelling and self-promotion, on job interview outcomes of people with epilepsy. Specifically, the effect of IM on interviewers' subjective impressions and evaluation of hireability of job candidates with epilepsy were examined. METHODS: Ninety-nine master's level graduate students majoring in business or human resources were randomly assigned to three experimental conditions to view one of three 15-min video clips of a job applicant interviewing for a technical computer sales position. The three experimental conditions were (1) job applicant who did not disclose any disability, (2) job applicant with epilepsy who did not use IM tactics, and (3) job applicant with epilepsy who used IM tactics. After watching the job interview video portraying the experimental conditions, participants were asked to rate the job applicant in terms of general impression and hireability for the described position. RESULTS: The use of IM was found to have a significant effect on job interview outcomes (p < 0.01). Post hoc comparisons indicated that the average rating of business/human resources students on both general impression and hireability for the job applicant with epilepsy and IM condition were significantly higher than for the job applicant with epilepsy who did not use IM condition. Furthermore, mediation analysis revealed that general impression is a mediator for the relationship between IM and interview outcomes. SIGNIFICANCE: This study demonstrates that IM has a significant and positive effect on job interview outcomes for persons with epilepsy. IM can be used as a powerful strategy for empowering people with epilepsy to combat disability stigma, and offset negative perceptions of employers about the potential of this population to be productive workers.

Specialty Certification for Burn Nursing: Value, Beliefs, and Benefits.

Specialty certification for burn nursing will be available in 2023. This review outlines the path taken from specialty recognition by the American Nurses Association to the Certified Burn Registered Nurse certification. Clinical expertise, knowledge, skill, mastery of professional issues, and competence are hallmark features of a nurse specialty certification. A review of resources will illustrate the evolution of burn nursing practice with the development of burn nursing standards, competencies, and characteristics of the professional burn nurse. Resources are identified which outline the value of specialty certification, providing an overview for the impact of burn nursing certification on professional development, nurse satisfaction, and patient outcomes. Burn nurses play a key role in the care and recovery of the burn-injured patient. Since 2017, members of the burn nurse community have taken steps to confirm the role of the modern burn nurse and document standards. As a community, we are now poised to advance our specialty one step further and support the development of a national burn nurse certification examination. This paper provides a historical account of the path taken for burn nurse specialty recognition and national certification to date. The value and impact of specialty certification in general is outlined, thus providing a comprehensive overview for the value and impact of certification on professional development, nurse satisfaction, and patient outcomes.

Burn Injuries Associated with At-Home Hair Braiding.

Hair braiding that incorporates synthetic extensions has increased in popularity across all age groups. As part of the styling process, the ends of the braid are commonly dipped in scalding water; an increasing number of patients have presented to our center after containers of recently boiled water are accidentally tipped over and spilled onto patients. A retrospective chart review was performed of all patients who sustained burn injuries related to at-home hair braiding presenting to an ABA-verified burn center between January 1, 2006 and July 31, 2020. A total of 41 patients presented over the study period, and the frequency of this type of burn increased over time, with 54% of injuries occurring in the past 3 years (2018-2020). The mean patient age was 7.5 years, and the majority of patients were under 18 years of age (97%), female (95%), and African-American (98%). Seventy-three percent of injuries occurred in the home and 88% involved another person in the hair braiding process. The mean TBSA burned was 5% (range 1-20%). The most commonly involved areas were the back (54%), thigh/leg (37%), and neck (24%). Ninety percent were partial-thickness injuries only, with 10% having some degree of full-thickness injury. Ninety percent of patients required inpatient admission, and 34% of patients required at least one operative procedure. Hair braiding, with the use of scalding water to seal and set the ends of braids, can lead to burn injuries that require hospitalization and the need for surgical intervention.

Behaviors of young children around microwave ovens.

BACKGROUND: Scald burn injuries are the leading cause of burn-related emergency room visits and hospitalizations for young children. A portion of these injuries occur when children are removing items from microwave ovens. This study assessed the ability of typically developing children aged 15 months to 5 years to operate, open, and remove the contents from a microwave oven. METHODS: The Denver Developmental Screening Test II was administered to confirm typical development of the 40 subjects recruited. All children recruited and enrolled in this study showed no developmental delays in any domain in the Denver Developmental Screening Test II. Children were observed for the ability to open both a push and pull microwave oven door, to start the microwave oven, and to remove a cup from the microwave oven. RESULTS: All children aged 4 years were able to open the microwaves, turn on the microwave, and remove the contents. Of the children aged 3 years, 87.5% were able to perform all study tasks. For children aged 2 years, 90% were able to open both microwaves, turn on the microwave, and remove the contents. In this study, children as young as 17 months could start a microwave oven, open the door, and remove the contents putting them at significant risk for scald burn injury. CONCLUSIONS: Prevention efforts to improve supervision and caregiver education have not lead to a significant reduction in scald injuries in young children. A redesign of microwave ovens might prevent young children from being able to open them thereby reducing risk of scald injury by this mechanism.

Building Skills, Confidence, and Wellness: Psychosocial Effects of Soft Skills Training for Young Adults with Autism.

Recognizing that social functioning and mental health are linked to social participation and employment outcomes, this pilot study examined the preliminary outcomes of an eight-session, work-related social skills training program designed for young adults with high-functioning autism (HFASD). Results indicate statistically significant improvements in social cognition, social function, and social confidence. Furthermore, participants (n = 26) reported statistically significant reductions in anxiety, and a trend toward lessening depressive symptoms. These results suggest that: (1) social skills training is suitable for individuals with HFASD and clinically-significant levels of anxiety and/or depression, and (2) bolstered social functioning may have broader, cyclical impacts on social confidence, psychological wellness, and social and vocational participation in this population.

Development, feasibility, and preliminary efficacy of an employment-related social skills intervention for young adults with high-functioning autism.

This article details the iterative development, feasibility, and preliminary efficacy of an 8-week work-related social skills intervention, Assistive Soft Skills and Employment Training, for young adults with high-functioning autism spectrum disorder. In this mixed-methods study, pre- and post-intervention surveys, interviews, and functional measures were used to gather information on the program's feasibility, user acceptability, practicality, and preliminary efficacy. Results indicate that Assistive Soft Skills and Employment Training graduates showed significant improvements in work-related social skills knowledge, social functioning, and social/empathy self-efficacy. Participants and group facilitators also reported high satisfaction with program activities, training modalities, frequency, and duration of the intervention. Results support expanded use of group-based, work-related, social skills interventions for young adults with high-functioning autism spectrum disorder. Moreover, these findings, though preliminary, suggest that manualized, empirically based programs like Assistive Soft Skills and Employment Training promote improved social functioning, self-confidence, engagement, and adherence to training, as well as broader impacts, including improved sense of belonging and greater employability in this traditionally underserved population.

Urban Frostbite: Strategies for Limb Salvage.

Under ideal circumstances, severely frostbitten extremities are rapidly rewarmed and treated with thrombolytic therapy within 6 to 24 hours. In an "inner city," urban environment, most patients who suffer frostbite injuries present in a delayed fashion, sustain repeated injuries further complicated by psychological issues or intoxication, and are rarely ideal candidates for thrombolytic therapy within the prescribed timeframe. We describe our experience with the treatment of urban frostbite injuries. A retrospective review of patients with cold injuries sustained between November 2013 and March 2014 treated at a verified burn center in an urban setting was performed. Fifty-three patients were treated (42 males, 11 females). Average patient age was 41.8 years (range 2-84 years). No patients met criteria for thrombolytic therapy due to multiple freeze-thaw cycles or presentation greater than 24 hours after rewarming. Deep frostbite was seen in 10 patients. Of these patients, nine underwent debridement, resulting in partial limb amputations at levels guided by Tri-phasic technetium (Tc-99m) bone scans. Wound closure and limb-length salvage was then achieved by: free flap coverage (n = 2), local flaps (n = 8), split-thickness skin grafting (n = 22), and secondary intention healing (n = 6). While tissue plasminogen activator has been successful in reducing the need for digital amputation following frostbite injuries, in our experience, this treatment modality is not applicable to the urban patient population who often present late and after cycles of reinjury. Therefore, our approach focused on salvaging limb length with durable coverage, as the injuries were unable to be reversed.

Disruption to social dyadic interactions but not emotional/anxiety-related behaviour in mice with heterozygous 'knockout' of the schizophrenia risk gene neuregulin-1.

Clinical genetic studies have implicated neuregulin-1 [NRG1] as a leading susceptibility gene for schizophrenia. NRG1 is known to play a significant role in the developing brain, which is consistent with the prevailing neurodevelopmental model of schizophrenia. Thus, the emotional and social phenotype of adult mice with heterozygous 'knockout' of transmembrane [TM]-domain NRG1 was examined further in both sexes. Emotional/anxiety-related behaviour was assessed using the elevated plus-maze and the light-dark test. Social behaviour was examined in terms of dyadic interactions between NRG1 mutants and an unfamiliar C57BL6 conspecific in a novel environment. There was no effect of NRG1 genotype on performance in either test of emotionality/anxiety. However, previous reports of hyperactivity in NRG1 mutants were confirmed in both paradigms. In the test of social interaction, aggressive following was increased in NRG1 mutants of both sexes, together with an increase in walkovers in female mutants. These findings elaborate the specificity of the NRG1 phenotype for the social rather than the emotional/anxiety-related domain. They indicate that NRG1 is involved in the regulation of reciprocal social interaction behaviour and thus suggest a putative role for NRG1 in a schizophrenia-related endophenotype.

Social-cognitive predictors of vocational outcomes in transition youth with epilepsy: Application of social cognitive career theory.

OBJECTIVE: This study examined the utility of social-cognitive career theory (SCCT; Lent, Brown, & Hackett, 1994) as a framework to investigate career self-efficacy, outcome expectations, goals, and contextual supports and barriers as predictors of choice actions among transition-age individuals with epilepsy. Moreover, these SCCT constructs are offered as an operational definition of work participation in this population. METHOD: Using a quantitative descriptive research design and hierarchical regression analysis (HRA), 90 transition-age individuals with epilepsy, age 18-25, were recruited from affiliates of the Epilepsy Foundation and invited to complete an online survey comprised of a series of self-report social-cognitive measures. RESULTS: The HRA findings indicated that self-efficacy, outcome expectations, and environmental supports were significant predictors of work participation in youth and young adults with epilepsy. The final model accounted for 58% of the variance in work participation, which is considered a large effect size. CONCLUSIONS: The research findings provide support for the use of the SCCT framework to identify predictors of work participation and to provide guidance for designing customized vocational rehabilitation services and career development interventions for individuals with epilepsy in the transition from adolescence to adulthood. (PsycINFO Database Record

The Utility and Versatility of Perforator-Based Propeller Flaps in Burn Care.

The majority of surgical burn care involves the use of skin grafts. However, there are cases when flaps are required or provide superior outcomes both in the acute setting and for postburn reconstruction. Rarely discussed in the context of burn care, the perforator-based propeller flap is an important option to consider. We describe our experience with perforator-based propeller flaps in the acute and reconstructive phases of burn care. We reviewed demographics, indications, operative details, and outcomes for patients whose burn care included the use of a perforator-based propeller flap at our institution from May 2007 to April 2015. Details of the surgical technique and individual cases are also discussed. Twenty-one perforator-based propeller flaps were used in the care of 17 burn patients. Six flaps (29%) were used in the acute phase for coverage of exposed joints, tendons, cartilage, and bone; coverage of open wounds; and preservation of range of motion (ROM) by minimizing scar contracture. Fifteen flaps (71%) were used for reconstruction of postburn deformities including coverage of chronic wounds, for coverage after scar contracture release, and to improve ROM. The majority of flaps (94% at follow-up) exhibited stable soft tissue coverage and good or improved ROM of adjacent joints. Three cases of partial flap loss and one case of total flap loss occurred. Perforator-based propeller flaps provide reliable vascularized soft tissue for coverage of vital structures and wounds, contracture release, and preservation of ROM across joints. Despite a relatively significant risk of minor complications particularly in the coverage of chronic wounds, our study supports their utility in both the acute and reconstructive phases of burn care.

Toxic Epidermal Necrolysis with Gastrointestinal Involvement: A Case Report and Review of the Literature.

Gastrointestinal involvement is a rare complication of toxic epidermal necrolysis syndrome (TENS) that results in sloughing of the intestinal epithelium. Prior case reports have noted the potential susceptibility of the entire gastrointestinal tract, from oropharynx and esophagus to sigmoid colon and rectum. Given its infrequency, the effect of gastrointestinal involvement on the treatment and prognosis of TENS is poorly understood. Here, the authors report a case of gastrointestinal symptoms in a patient diagnosed with toxic epidermal necrolysis, likely representing gastrointestinal involvement. In addition, the authors describe the histopathologic and endoscopic characteristics of the involved mucosa, clinical course, and present a review of the literature of this rare but potentially impactful complication of TENS.

Is palmar surface area a reliable tool to estimate burn surface areas in obese patients?

Estimating TBSA burned is critical to the initial management and fluid resuscitation of patients who have sustained burn injuries. TBSA of scattered burn injuries are frequently estimated using the patient's percentage palmar surface area (%PSA), which is taught as being 1% of the TBSA. This study investigates the relationship of %PSA to TBSA as the body mass index (BMI) increases. Age, sex, race, weight, height, and PSA was collected from obese and nonobese volunteers. TBSA was calculated using the Mosteller, DuBois-DuBois, Livingston and Scott, and Yu formulas. The %PSA relative to TBSA was calculated in obese and nonobese volunteers. Data from 100 subjects were collected. Fifty subjects had a BMI >30 and 50 had a BMI <30. The average age was 41 years (22-77 years old). There were 68 women and 32 men. The %PSA ranged from 0.49% of TBSA with a BMI of 58.7 to 1.15% of TBSA with a BMI of 22.6. This correlation of %PSA to BMI was statistically significant with all of the formulas. We should not assume that the %PSA is always 1% of TBSA, especially in obese patients.

Prospective randomized controlled trial comparing two methods of securing skin grafts using negative pressure wound therapy: vacuum-assisted closure and gauze suction.

Negative pressure wound therapy (NPWT) has revolutionized the management of complicated wounds and has contributed an additional modality for securing split thickness skin grafts (STSG). The standard for NPWT is the vacuum-assisted closure (VAC) device. The authors' institution has accumulated experience using standard gauze sealed with an occlusive dressing and wall suction (GSUC) as their primary mode for NPWT. The authors report a randomized controlled trial comparing the efficacy of the GSUC vs the VAC in securing STSG. A prospective, randomized, controlled trial was conducted in 157 wounds in 104 patients requiring STSG from August 2009 to July 2012. All wounds were randomized to VAC or GSUC treatment and assessed for skin graft adherence/take. At postoperative day 4 or 5, NPWT was discontinued, and the size of the graft and any nonadherent areas were measured and recorded. Concomitant comorbidities, wound location, etiology, study failures, and reoperative rates were also reviewed. In all, 77 and 80 wounds were randomized to the GSUC and VAC study arms. Patient demographics were similar between both groups in terms of age, sex, comorbidities, etiology, and wound location. In all, 64 of 80 wounds in the GSUC group and 60 of 77 wounds in the VAC group had full take of the skin graft by postoperative day 4 or 5 (P = .80). The mean percent take in the GSUC group was 96.12% vs 96.21% in the VAC arm (P = .98). The use of NPWT in securing STSG is a useful method to promote adherence and healing. This study demonstrates that a low-cost, readily accessible system utilizing gauze dressings and wall suction (GSUC) results in comparable skin graft take in comparison to the VAC device.

Prehospital and emergency department burn care.

Burn-injured patients have special needs in the prehospital and emergency department settings. This article addresses the nursing priorities in prehospital and emergency department care.

Association of lower limb injury with boot cleat design and playing surface in elite soccer.

Reducing external injury risk factors associated with the boot-surface interaction is important in reducing the incidence and severity of foot and ankle injury. A review of prospective football (soccer) injury epidemiology studies determined that the incidence of noncontact ankle sprain injury is relatively high. Research on the impact of cleat shape and configuration and boot design on the boot-surface interaction is providing new understanding of the impact on player biomechanics and injury risk but is not keeping pace with commercial advances in boot design and innovation in natural and synthetic turf surface technology.

Antishear therapy for toxic epidermal necrolysis: an alternative treatment approach.

BACKGROUND: Toxic epidermal necrolysis syndrome is a devastating disease, with mortality rates ranging between 20 and 60 percent. This study evaluated an alternative treatment approach using antishear wound care and compared outcomes using the severity of illness score for toxic epidermal necrolysis syndrome (SCORTEN) system. METHODS: Records of 48 patients with a histopathologic diagnosis of toxic epidermal necrolysis syndrome treated with burn equivalent critical care and antishear wound care from September of 1985 to April of 2004 were reviewed. Observed mortality data were compared with those expected using the SCORTEN, and the standardized mortality ratio was calculated. RESULTS: The overall mortality rate was 27 percent. Factors affecting mortality were advancing age, time to burn unit admission, multisystem organ failure, and presence of comorbidities (p = 0.02, p = 0.02, p < 0.001, and p = 0.003, respectively). Chronic renal insufficiency and malignancy were two independent risk factors for nonsurvival (p = 0.04 and p = 0.004, respectively). Patients with a SCORTEN score of 2 or less had no mortality rate in this series. Observed and predicted mortality rates were comparable for patients with SCORTEN scores of 3 or greater. Patients with combined scores of 3 or less had a standardized mortality ratio score of 0.58 (42 percent mortality reduction). Overall, the standardized mortality ratio was 0.89 (11 percent mortality reduction). CONCLUSIONS: Transfer to a burn intensive care unit and initiation of critical care and wound protocols similar to those used for burn patients are recommended for patients with toxic epidermal necrolysis syndrome. Antishear wound care provides an effective alternative wound care approach with equivalent mortality rates.