A realist evaluation of the development of extended pharmacist roles and services in community pharmacies.

BACKGROUND: Internationally, community pharmacy models of care have been moving away from a focus on dispensing to extended, clinically-focused roles for pharmacists. OBJECTIVES: To identify how community pharmacy strategies were being implemented in Aotearoa New Zealand; how changes were expected to influence health and health system outcomes; what extended services were being delivered; the responses of pharmacists, other health professionals and consumers to these developments; and the contexts and mechanisms supporting the successful implementation of new community pharmacy services. METHODS: A realist evaluation methodology was employed, to explore a complex policy intervention. Realist evaluation explores the contexts (C) within which initiatives are introduced and identifies the mechanisms (M) triggered by different contexts to produce outcomes (O). Realist evaluation processes iteratively develop, test, and refine CMO configurations. In this study, initial programme theories were developed through key government and professional policy documents, then refined through key informant interviews, a survey and interviews with pharmacists and intern (pre-registration) pharmacists, and finally, 10 case studies of diverse community pharmacies. RESULTS: Four intermediate health service outcomes were identified: development of extended community pharmacist services; consumers using extended community pharmacist services; more integrated, collaborative primary health care services; and a fit-for-purpose community pharmacy workforce. Enabling and constraining contexts are detailed for each outcome, along with the mechanisms that they trigger (or inhibit). CONCLUSIONS: There are wide-ranging and disparate levers to support the further development of extended community pharmacy services. These include aligning funding with desired services, undergraduate educators and professional leaders setting expectations for the pharmacists' role in practice, and the availability of sufficient funding and time for both specific extended service accreditation and broader postgraduate training. However, no simple "fix" can be universally applied internationally, nor even in pharmacies within a single jurisdiction, to facilitate service development.

Grammaticality Judgments of Tense and Agreement by Children With and Without Developmental Language Disorder Across Dialects of English.

PURPOSE: Within General American English (GAE), the grammar weaknesses of children with developmental language disorder (DLD) have been documented with many tasks, including grammaticality judgments. Recently, Vaughn et al. replicated this finding with a judgment task targeting tense and agreement (T/A) structures for children who spoke African American English (AAE), a dialect that contains a greater variety of T/A forms than GAE. In the current study, we further tested this finding for children who spoke Southern White English (SWE), another dialect that contains a greater variety of T/A forms than GAE but less variety than AAE. Then, combining the SWE and AAE data, we explored the effects of a child's dialect, clinical group, and production of T/A forms on the children's judgments. METHOD: The data were from 88 SWE-speaking children (DLD, n = 18; typically developing [TD], n = 70) and 91 AAE-speaking children (DLD, n = 34; TD, n = 57) previously studied. As in the AAE study, the SWE judgment data were examined both with A' scores and percentages of acceptability, with comparisons between dialects made on percentages of acceptability. RESULTS: As in AAE, the SWE DLD group had significantly different A' scores and percentages of acceptability than the SWE TD group for all sentence types, including those with T/A structures. Additional analyses indicated that the judgments of the TD but not the DLD groups showed dialect effects. Except for verbal -s, overt production and grammaticality judgments were correlated for the TD but not for the DLD groups. CONCLUSIONS: Children with DLD across dialects of English present grammar difficulties that affect their ability to make judgments about sentences. More cross-dialectal research is needed to better understand the grammatical weaknesses of childhood DLD, especially for structures such as verbal -s that are expressed differently across dialects of English.

Cohort profile: Nga Kawekawe o Mate Korona | Impacts of COVID-19 in Aotearoa - a prospective, national cohort study of people with COVID-19 in New Zealand.

PURPOSE: The COVID-19 pandemic has had significant health, social and economic impacts around the world. We established a national, population-based longitudinal cohort to investigate the immediate and longer-term physical, psychological and economic impacts of COVID-19 on affected people in Aotearoa New Zealand (Aotearoa), with the resulting evidence to assist in designing appropriate health and well-being services for people with COVID-19. PARTICIPANTS: All people residing in Aotearoa aged 16 years or over, who had a confirmed or probable diagnosis of COVID-19 prior to December 2021, were invited to participate. Those living in dementia units were excluded. Participation involved taking part in one or more of four online surveys and/or in-depth interviews. The first wave of data collection took place from February to June 2022. FINDINGS TO DATE: By 30 November 2021, of 8735 people in Aotearoa aged 16+ who had COVID-19, 8712 were eligible for the study and 8012 had valid addresses so were able to be contacted to take part. A total of 990 people, including 161 Tangata Whenua (Maori, Indigenous peoples of Aotearoa) completed one or more surveys; in addition, 62 took part in in-depth interviews. Two hundred and seventeen people (20%) reported symptoms consistent with long COVID. Key areas of adverse impacts were experiences of stigma, mental distress, poor experiences of health services and barriers to healthcare, each being significantly more pronounced among disabled people and/or those with long COVID. FUTURE PLANS: Further data collection is planned to follow-up cohort participants. This cohort will be supplemented by the inclusion of a cohort of people with long COVID following Omicron infection. Future follow-ups will assess longitudinal changes to health and well-being impacts, including mental health, social, workplace/education and economic impacts of COVID-19.

Grammaticality Judgments of Tense and Agreement by Child Speakers of African American English: Effects of Clinical Status, Surface Form, and Grammatical Structure.

PURPOSE: We examined the grammaticality judgments of tense and agreement (T/A) structures by children with and without developmental language disorder (DLD) within African American English (AAE). The children's judgments of T/A forms were also compared to their judgments of two control forms and, for some analyses, examined by surface form (i.e., overt, zero) and type of structure (i.e., BE, past tense, verbal -s). METHOD: The judgments were from 91 AAE-speaking kindergartners (DLD = 34; typically developing = 57), elicited using items from the Rice/Wexler Test of Early Grammatical Impairment. The data were analyzed twice, once using General American English as the reference and A' scores and once using AAE as the reference and percentages of acceptability. RESULTS: Although the groups differed using both metrics, the percentages of acceptability tied the DLD T/A deficit to judgments of the overt forms, while also revealing a general DLD weakness judging sentences that are ungrammatical in AAE. Judgments of the overt T/A forms by both groups correlated with their productions of these forms and their language test scores, and both groups showed structure-specific form preferences ("is": overt > zero vs. verbal -s: overt = zero). CONCLUSION: The findings demonstrate the utility of grammaticality judgment tasks for revealing weaknesses in T/A within AAE-speaking children with DLD, while also calling for more studies using AAE as the dialect reference when designing stimuli and coding systems. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22534588.

The Establishment and Spread of a Newly Introduced Begomovirus in a Dry Tropical Environment Using Tomato Yellow Leaf Curl Virus as a Case Study.

Early detection of tomato yellow leaf curl virus (TYLCV) in a previously unaffected tomato production district in Australia allowed its spread to be evaluated spatially and temporally. The population dynamics of the TYLCV vector, Bemisia argentifolii (silverleaf whitefly, SLW), were also evaluated. The district is a dry tropical environment with a clear break to commercial production during the summer wet season. The incidence of TYLCV within crops and its prevalence through the district was influenced by weather, location, vector movements, and the use of Ty-1 virus-resistant hybrids. Rainfall had an important influence, with late summer and early autumn rain suppressing the levels of SLW and, by contrast, a dry summer supporting faster population growth. The use of Ty-1 hybrids appears to have reduced the incidence of TYLCV in this district. There was limited use of Ty-1 hybrids during 2013, and by season end, crops had moderate levels of SLW and high virus incidence. The 2015 and early 2016 season had high SLW populations, but TYLCV incidence was lower than in 2013, possibly due to the widespread adoption of the Ty-1 hybrids reducing virus spread. This study provides valuable epidemiology data for future incursions of begomoviruses, and other viruses spread by SLW.

Thermal tolerance of an invasive drywood termite, Cryptotermes brevis (Blattodea: Kalotermitidae).

West Indian drywood termites (Cryptotermes brevis, Blattodea: Kalotermitidae) are an important invasive termite in many countries including Australia where they are spreading across two eastern states. Fumigation is often used to eliminate infestations, but it is costly, has negative environmental effects and does not prevent reinfestation. Heat treatment has been suggested as an alternative. Many insect pest mitigation strategies recommend 30 min exposure at 56 °C, but this may be difficult to achieve in structural applications. The potential for heating at lower temperatures was explored to determine the effect on termite survival and gut fauna. Exposure to 40 °C up to an hour did not kill the termites; however, 1-h exposure at 45 °C was lethal. Exposure for little as 3 min at 50 °C or 2 min at 55 °C was lethal. Protozoa levels were lower in termites that survived shorter exposures, but there appeared to be some recovery over time. The results suggest that short term exposures to 50 or 55 °C could be used to eliminate infestations, creating an opportunity for localized spot heating as a mitigation measure.

A national survey of pharmacists and interns in Aotearoa New Zealand: provision and views of extended services in community pharmacies.

BACKGROUND: Changes in pharmacy models of care, services and funding have been occurring internationally, moving away from the traditional dispensing role to more extended patient-facing roles utilising pharmacists' clinical skills. This study aimed to identify the extended services offered by community pharmacy in Aotearoa New Zealand and the barriers and facilitators to extended services provision. The study is unique in that it includes intern (pre-registration) pharmacists. METHODS: An online survey, conducted in 2018, of all pharmacists and intern (pre-registration) pharmacists working in a community pharmacy. Data were analysed using descriptive statistics and regression analyses. RESULTS: The results are based on replies from 553 community pharmacists and 59 intern pharmacists (response rate: 19 and 26% respectively). Both pharmacists (83%) and interns (85%) want to work at the top of their scope of practice. Wide variation exists in the specific services individual pharmacists offer. Most pharmacists were accredited to supply the emergency contraceptive pill (95%), sildenafil for erectile dysfunction (86%) and trimethoprim for uncomplicated urinary tract infection (85%). Fewer were able to immunise (34%) or to supply selected oral contraceptives (44%). Just under a quarter could provide a Medicines Use Review (MUR) or Community Pharmacy Anticoagulation Management Service (CPAMS). Of the pharmacists not already accredited, 85% intended to gain accreditation to supply selected oral contraceptives, 40% to become vaccinators, 37% to offer CPAMS and 30% MUR. Interns expressed strong interest in becoming accredited for all extended services. Poisson regression analyses showed key factors supporting the likelihood of providing extended services were owner and management support and appropriate space and equipment. Being excited about the opportunities in community pharmacy, having employer funding and time for training and sufficient support staff were also statistically significant. CONCLUSIONS: Pharmacists need time and a supportive management structure to enable them to deliver extended services. Health policy with a greater strategic emphasis on funding services and pharmacist training, and developing technician support roles, will help to minimise or eliminate some of the barriers to role expansion both in Aotearoa New Zealand and internationally.

Marking of Tense and Agreement in Language Samples by Children With and Without Specific Language Impairment in African American English and Southern White English: Evaluation of Scoring Approaches and Cut Scores Across Structures.

Purpose As follow-up to a previous study of probes, we evaluated the marking of tense and agreement (T/A) in language samples by children with specific language impairment (SLI) and typically developing controls in African American English (AAE) and Southern White English (SWE) while also examining the clinical utility of different scoring approaches and cut scores across structures. Method The samples came from 70 AAE- and 36 SWE-speaking kindergartners, evenly divided between the SLI and typically developing groups. The structures were past tense, verbal -s, auxiliary BE present, and auxiliary BE past. The scoring approaches were unmodified, modified, and strategic; these approaches varied in the scoring of forms classified as nonmainstream and other. The cut scores were dialect-universal and dialect-specific. Results Although low numbers of some forms limited the analyses, the results generally supported those previously found for the probes. The children produced a large and diverse inventory of mainstream and nonmainstream T/A forms within the samples; strategic scoring led to the greatest differences between the clinical groups while reducing effects of the children's dialects; and dialect-specific cut scores resulted in better clinical classification accuracies, with measures of past tense leading to the highest levels of classification accuracy. Conclusions For children with SLI, the findings contribute to studies that call for a paradigm shift in how children's T/A deficits are assessed and treated across dialects. A comparison of findings from the samples and probes indicates that probes may be the better task for identifying T/A deficits in children with SLI in AAE and SWE. Supplemental Material https://doi.org/10.23641/asha.13564709.

Is the use of health services by older adults in New Zealand associated with their housing tenure?

AIM: To explore associations between tenure and the health service use of older New Zealanders. METHODS: Analysis of pooled data for adults aged 55+ from three New Zealand Health Surveys (2013/14, 2014/15, 2015/16) comparing owner-occupiers, private renters and public renters. RESULTS: Public renters, and in some age groups private renters, reported more visits to the GP and a higher proportion reported using a public hospital service in the last year. Renters were less likely than owner-occupiers to have used some privately paid services (visiting a dental health worker or optician). Renters averaged lower co-payments for their last GP visit, but financial barriers to accessing a GP, after-hours medical centre use and not collecting prescriptions were more likely to be reported by renters than owner-occupiers-particularly those that rent publicly. CONCLUSIONS: New Zealanders are simultaneously living longer while having declining opportunities to enter home ownership. Older renters are more likely to live in poorer health and, overall, are more likely to use some (public) health services than owner-occupiers yet are more likely to have unmet health needs. The increasing reliance on renting among older people has implications for population health and wellbeing, health service delivery and transitions to residential care.

Taking the pulse of the health services research community: a cross-sectional survey of research impact, barriers and support.

Objective This study reports on the characteristics of individuals conducting health service research (HSR) in Australia and New Zealand, the perceived accessibility of resources for HSR, the self-reported impact of HSR projects and perceived barriers to conducting HSR. Methods A sampling frame was compiled from funding announcements, trial registers and HSR organisation membership. Listed researchers were invited to complete online surveys. Close-ended survey items were analysed using basic descriptive statistics. Goodness of fit tests determined potential associations between researcher affiliation and access to resources for HSR. Open-ended survey items were analysed using thematic analysis. Results In all, 424 researchers participated in the study (22% response rate). Respondents held roles as health service researchers (76%), educators (34%) and health professionals (19%). Most were employed by a university (64%), and 57% held a permanent contract. Although 63% reported network support for HSR, smaller proportions reported executive (48%) or financial (26%) support. The least accessible resources were economists (52%), consumers (49%) and practice change experts (34%); researchers affiliated with health services were less likely to report access to statisticians (P<0.001), economists (P<0.001), librarians (P=0.02) and practice change experts (P=0.02) than university-affiliated researchers. Common impacts included conference presentations (94%), publication of peer-reviewed articles (87%) and health professional benefits (77%). Qualitative data emphasised barriers such as embedding research culture within services and engaging with policy makers. Conclusions The data highlight opportunities to sustain the HSR community through dedicated funding, improved access to methodological expertise and greater engagement with end-users. What is known about the topic? HSR faces several challenges, such as inequitable funding allocation and difficulties in quantifying the effects of HSR on changing health policy or practice. What does this paper add? Despite a vibrant and experienced HSR community, this study highlights some key barriers to realising a greater effect on the health and well-being of Australian and New Zealand communities through HSR. These barriers include limited financial resources, methodological expertise, organisational support and opportunities to engage with potential collaborators. What are the implications for practitioners? Funding is required to develop HSR infrastructure, support collaboration between health services and universities and combine knowledge of the system with research experience and expertise. Formal training programs for health service staff and researchers, from short courses to PhD programs, will support broader interest and involvement in HSR.

Specific Language Impairment in African American English and Southern White English: Measures of Tense and Agreement With Dialect-Informed Probes and Strategic Scoring.

Purpose In African American English and Southern White English, we examined whether children with specific language impairment (SLI) overtly mark tense and agreement structures at lower percentages than typically developing (TD) controls, while also examining the effects of dialect, structure, and scoring approach. Method One hundred six kindergartners completed 4 dialect-informed probes targeting 8 tense and agreement structures. The 3 scoring approaches varied in the treatment of nonmainstream English forms and responses coded as Other (i.e., those not obligating the target structure). The unmodified approach counted as correct only mainstream overt forms out of all responses, the modified approach counted as correct all mainstream and nonmainstream overt forms and zero forms out of all responses, and the strategic approach counted as correct all mainstream and nonmainstream overt forms out of all responses except those coded as Other. Results With the probes combined and separated, the unmodified and strategic scoring approaches showed lower percentages of overt marking by the SLI groups than by the TD groups; this was not always the case for the modified scoring approach. With strategic scoring and dialect-specific cut scores, classification accuracy (SLI vs. TD) was highest for the 8 individual structures considered together, the past tense probe, and the past tense probe irregular items. Dialect and structure effects and dialect differences in classification accuracy also existed. Conclusions African American English- and Southern White English-speaking kindergartners with SLI overtly mark tense and agreement at lower percentages than same dialect-speaking TD controls. Strategic scoring of dialect-informed probes targeting tense and agreement should be pursued in research and clinical practice.

Nonword Repetition Across Two Dialects of English: Effects of Specific Language Impairment and Nonmainstream Form Density.

Purpose Nonword repetition (NWR) has been proposed as a culturally and linguistically fair measure of children's language abilities that is useful for the identification of specific language impairment (SLI). However, Moyle, Heilmann, and Finneran (2014) suggested that the density of a child's nonmainstream forms also influences NWR in ways that could complicate its use. Using speakers of either African American English (AAE) or Southern White English (SWE), we asked if NWR performance differed in children with SLI and same dialect-speaking typically developing (TD) children and if nonmainstream form density impacted their scores. Method The participants were 106 kindergartners (AAE: SLI n = 35; TD n = 35; SWE: SLI n = 18; TD n = 18; groups matched for age and IQ) who performed the NWR task of Dollaghan and Campbell (1998) . Nonmainstream form density measures were gathered from listener judgments of conversational samples. Results NWR performance differed between those with and without SLI, but the difference was smaller in AAE than in SWE, especially at the longest syllable length. Nonmainstream form density was found to further explain NWR performance beyond the children's SLI status for AAE speakers; density and SLI status were confounded for the SWE speakers, making it harder to disentangle the effects of each in that dialect. Conclusions Results indicate the NWR may differ in diagnostic utility between speakers of different dialects. Results also support Moyle et al.'s (2014) finding that density affects NWR. Thus, NWR is more sensitive to dialectal differences than originally assumed.

SF-12 indicators of health following the 22 February 2011 Christchurch earthquake.

AIM: To explore the health status of people who experienced the magnitude 6.3 earthquake in Christchurch on 22 February 2011, across time and in comparison with other New Zealanders. METHODS: Data from five New Zealand Health Surveys (2011/12, 2012/13, 2013/14, 2014/15 and 2015/16), which each sampled around 13,000 people, aged 15+ years, living in New Zealand. Respondents completed the SF-12 questionnaire and were asked if they experienced the earthquake. About 1,000 respondents in each survey had. The survey data were pooled and the physical and mental health composite scores were created from the SF-12 data. RESULTS: Those who experienced the earthquake had, on average, better mental and physical health composite scores in 2011/12, although not all scores were significantly better. In 2013/14, all mental and physical health composite scores indicated, on average, worse health status, and for men the differences were significant. The age groups most affected were 45-64 for women and 45-64 and 65+ for men. Some improvement occurred from 2014/15 onwards. CONCLUSION: The pattern of an initial improvement in health, followed by a deterioration and subsequent improvement follows the heroic/honeymoon/disillusionment/reconstruction model of response to a disaster.

The health of older New Zealanders in relation to housing tenure: analysis of pooled data from three consecutive, annual New Zealand Health Surveys.

OBJECTIVE: To explore relationships between the housing tenure of older New Zealanders and their health-related behaviours, and physical and mental health. METHODS: Pooled data were analysed for 15,626 older adults (aged 55+) from three consecutive, annual, nationally representative New Zealand Health Surveys to compare owner-occupiers, private renters and public renters. RESULTS: Most in the sample were owner-occupiers (83.2%), with 12.4% private renters and 4.5% public renters. A higher proportion of renters aged 75+ were female. Maori and Pacific people were more likely to be renters. Renters were more likely to be living alone, on lower annual incomes. Overall measures of physical and mental health showed a health gradient, with public renters in the poorest health and owner-occupiers in the best health. CONCLUSIONS: Rental tenure is associated with poorer health. Implications for public health: Older renters tend to be economically disadvantaged and in poorer health than owner-occupiers. Over time, the proportion of older renters has been increasing. This will have implications for policy and for services in meeting the diverse care and support needs of older people. Higher rates of renting among Maori and Pacific people and older females means that these groups are particularly vulnerable to any negative impact of renting on health.

The social networks of New Zealand patients with multimorbidity and the work of those nominated as their 'significant supporters': An exploratory study.

Social networks are informal relationships often with social ties and voluntary or mandatory obligations that can positively support a patient with multimorbidity. This exploratory study sought insights into the social networks of New Zealand people with multimorbidity and also the work of those nominated as providing significant support. Ten participants were recruited from general practice as part of an education programme in which health professional students discussed living with multimorbidity and completed a social network template together with patients. Each patient nominated an individual from their social network whom they considered provided significant support. A researcher interviewed each supporter about their experience of providing support, and their view of the patient's social network. Significant supporters included three classified as 'lay' supporters (sister, wife and daughter) and seven classified as 'professional' supporters (exercise physiologist, general practitioners, nurse, medical specialists). The activities described by supporters was classified according to Vassilev et al.'s expansion of Corbin and Strauss's 1985 classification of work in chronic illness, including the categories of "illness," "everyday" and "emotional" work. Irrespective of whether supporters were lay or professional, they gave examples of each category. While this is expected of lay supporters, it is not expected of professional supporters who are typically viewed as undertaking illness work. Lay supporters described a complex array of activities sometimes impacting on their own personal well-being, making them more akin to meeting the formal definition of being a carer, while professional supports gave objective yet professionally invested descriptions. The work of lay and professional supporters is complementary in the provision of support for those with multimorbidity. Consideration should be given to the role of lay supporters and to their own needs if they are to be able to sustain their support work with patients.

The 'wayfinding' experience of family carers who learn to manage technical health procedures at home: a grounded theory study.

BACKGROUND: With more care taking place in the home, family carers play an important role in supporting patients. Some family carers undertake technical health procedures generally managed by health professionals in hospital settings (e.g. managing a tracheostomy or enteral feeding). AIM: To explore how family carers learn to manage technical health procedures in order to help health professionals better understand and support this process. DESIGN AND METHODS: A grounded theory study using data from interviews with 26 New Zealand family carers who managed technical health procedures including nasogastric or gastrostomy feeding, stoma care, urinary catheterisation, tracheostomy management, intravenous therapy, diabetes management and complex wound dressings. Most (20 participants) were caring for their child and the remaining six for their spouse, parent or grandparent. Following grounded theory methods, each interview was coded soon after completion. Additional data were compared with existing material, and as analysis proceeded, initial codes were grouped into higher order concepts until a core concept was developed. Interviewing continued until no new ideas emerged and concepts were well defined. FINDINGS: The core concept of 'wayfinding' indicates that the learning process for family carers is active, individualised and multi-influenced, developing over time as a response to lived experience. Health professional support was concentrated on the initial phase of carers' training, reducing and becoming more reactive as carers took responsibility for day-to-day management. CONCLUSION: Wayfinding involves self-navigation by carers, in contrast to patient navigator models which provide continuing professional assistance to patients receiving cancer or chronic care services. Wayfinding by carers raises questions about how carers should be best supported in their initial and ongoing learning as the management of these procedures changes over time.

GPs' views and experiences of prescribing non-steroidal anti-inflammatory drugs: a qualitative study.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed in primary care despite being a high-risk drug group causing significant adverse events, yet little is known about GPs' perceptions of NSAID risks and benefits. AIM: To explore GPs' experiences with NSAID prescribing and views about the risks and benefits of this group of medicines. DESIGN & SETTING: A qualitative, inductive study in general practice. METHOD: Individual interviews with 15 GPs using a semi-structured interview guide. Interviews were audiorecorded and transcribed. An inductive, thematic approach was used for analysis. Sampling continued until data saturation was achieved. RESULTS: Three main themes illustrate GPs' key concerns with managing NSAID risks. The first theme was perceptions of risks and benefits of NSAIDs: GPs expressed differing attitudes towards prescribing medication generally. GPs were aware of the general risks of NSAIDs but weighed these up against specific risk factors and potential benefits for particular patients. They were most concerned about long-term use, risks for children, older people, and patients with comorbidities. The second theme was assessing and mitigating risks when prescribing NSAIDs: GPs considered gastric, cardiac, and renal risks of patients as well as drug interactions. Mitigation strategies included alternative treatment, choice and dose of NSAID, and use of gastroprotective agents. The final theme was other factors impacting on NSAID risks: particularly patient expectations and over-the-counter (OTC) availability. CONCLUSION: NSAID prescribing is a complex balance between pragmatism and potential adverse events. Given the costs of morbidity, hospitalisation, and patient demand there is an urgent need to secure a more detailed evidence base and develop practical pathways to support safer prescribing.

Social networks of patients with multimorbidity: a qualitative study of patients' and supporters' views.

INTRODUCTION Multimorbidity impacts on patients' health and wellbeing, but relationships experienced within social networks can support people to live well. AIM This study sought to elicit the views of New Zealanders with multimorbidity about their social networks and the views of their nominated supporters. METHODS Ten patients with multimorbidity and their nominated supporters each independently recorded their views of the patient's social network on a five-concentric-circle template, indicating supporting role and importance to each patient. Sets of patients' and nominated supporters' templates were compared followed by comparing matched pairs of patient-supporter templates. Nominated supporters' views about the patients' networks and why they were nominated were collated. RESULTS Three patients nominated family members as supporters and seven nominated health professionals. Nominated family members identified a greater range of supporters than nominated health professionals. Nominated family members perceived that they played an integral role, whereas health professionals were less comfortable viewing relationships with patients in this way. Family members were not surprised to be nominated as supporters, and some described a considerable burden of care. Health professionals described themselves as coordinators of support and having positive relationships with patients. DISCUSSION Patients with multimorbidity have rich and diverse social networks. They view partners, family and health professionals as providing significant support. Family members are more aware of their role and have a deeper understanding of other network members than health professionals. Further research is needed on the use of social networks in clinical practice to support the health and wellbeing of those with multimorbidity.

Becoming an expert carer: the process of family carers learning to manage technical health procedures at home.

AIMS: To describe the learning process of family carers who manage technical health procedures (such as enteral tube feeding, intravenous therapy, dialysis or tracheostomy care) at home. BACKGROUND: Increasingly, complex procedures are being undertaken at home but little attention has been paid to the experiences of family carers who manage such procedures. DESIGN: Grounded theory, following Charmaz's constructivist approach. METHODS: Interviews with 26 family carers who managed technical health procedures and 15 health professionals who taught carers such procedures. Data collection took place in New Zealand over 19 months during 2011-2013. Grounded theory procedures of iterative data collection, coding and analysis were followed, with the gradual development of theoretical ideas. FINDINGS: The learning journey comprised three phases: (1) an initial, concentrated period of training; (2) novice carers taking responsibility for day-to-day care of procedures while continuing their learning; and (3) with time, experience and ongoing self-directed learning, the development of expertise. Teaching and support by health professionals (predominantly nurses) was focussed on the initial phase, but carers' learning continued throughout, developed through their own experience and using additional sources of information (notably the Internet and other carers). CONCLUSION: Further work is needed to determine the best educational process for carers, including where to locate training, who should teach them, optimal teaching methods and how structured or individualized teaching should be. Supporting carers well also benefits patient care.

Sentence Recall by Children With SLI Across Two Nonmainstream Dialects of English.

PURPOSE: The inability to accurately recall sentences has proven to be a clinical marker of specific language impairment (SLI); this task yields moderate-to-high levels of sensitivity and specificity. However, it is not yet known if these results hold for speakers of dialects whose nonmainstream grammatical productions overlap with those that are produced at high rates by children with SLI. METHOD: Using matched groups of 70 African American English speakers and 36 Southern White English speakers and dialect-strategic scoring, we examined children's sentence recall abilities as a function of their dialect and clinical status (SLI vs. typically developing [TD]). RESULTS: For both dialects, the SLI group earned lower sentence recall scores than the TD group with sensitivity and specificity values ranging from .80 to .94, depending on the analysis. Children with SLI, as compared with TD controls, manifested lower levels of verbatim recall, more ungrammatical recalls when the recall was not exact, and higher levels of error on targeted functional categories, especially those marking tense. CONCLUSION: When matched groups are examined and dialect-strategic scoring is used, sentence recall yields moderate-to-high levels of diagnostic accuracy to identify SLI within speakers of nonmainstream dialects of English.