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The U.S. healthcare system struggles to provide adequate language assistance to medical practitioners and patients. As a result, health providers and patients rely on ad hoc interpreters, including children, to communicate. Bilingual children who regularly interpret for others, whom we refer to as child language brokers, are important linguistic and cultural conduits for their communities and bridge language differences in vital contexts, such as health and medical settings. In this paper, we explore the experiences of 17 adolescent language brokers and consider the settings, tasks, and people they engage with when language brokering for health. Findings illustrate that child language brokering is a real and important component for immigrant family health, that child language brokering for health is not a uniform experience, and that language brokering for health can sometimes have severe ramifications.

To increase community health knowledge, the El Paso Health Education and Awareness Team (EP-HEAT) was established at Paul L. Foster School of Medicine. The Medical Student Run Clinic (MSRC) emphasizes community health care access. "Promotores de salud" (community health workers) increase health care awareness and connect predominantly underserved communities with resources. Surveys were conducted to determine how EP-HEAT and MSRC patients' communication with promotores affected their access to health care and communication skills. Surveys demonstrated that 91% of EP-HEAT members agreed that working with promotores improved their communication ability. All MSRC patients surveyed stated interacting with promotores helped improve health care communication in various ways.

This study aimed to assess differences in emotion and elaboration quality between clinical and community child cohorts in both past reminiscing and future worry conversations. We analyzed 54 Australian parents (46 mothers, 8 fathers) and their 8- to 12-year-old children (M = 9.63, SD = 1.29; 28 boys, 26 girls) in reminiscing interactions. Dyads were recruited from local schools (community cohort, n = 26) or a children's psychology clinic waitlist (clinical cohort, n = 28). Clinical cohort children engaged in less emotion exploration in both past and future conversations, as did parents for future conversations. Elaboration quality did not differ. Parent-son dyads differed in the clinical cohort, exhibiting significantly lower emotion resolution than the community cohort, or parent-daughter dyads when discussing past events. These findings suggest that discussing anticipated negative events may be a relevant point of family-based intervention for anxious children. Additionally, this study highlights the importance of parent-son emotional discussion.

Rheumatic diseases are known to be associated with the development of metabolic syndrome, which increases mortality rates due to cardiovascular complications. Although a variety of self-management programs for rheumatic diseases have been developed, few have concentrated on metabolic syndrome. This study aimed to develop and verify a blended (a mixture of telephone and online interventions) metabolic syndrome self-management program. The program was developed in four stages: analysis to identify program contents, website design, website development, and validity testing. A quasi-experimental nonequivalent control group, pretest-posttest design was adopted to verify the program effectiveness in 54 patients with rheumatic disease. The program was initially implemented via telephone for 4 weeks and then self-administered via a web-based platform for 20 weeks. Indices of metabolic syndrome and self-management and quality of life scores were measured as outcome variables. Data were collected three times: before intervention, after 4 weeks of telephone interventions, and after 20 weeks of online self-interventions. The devised program had a significant overall effect on metabolic syndrome indices, metabolic syndrome-related self-management behaviors, and quality of life. Detailed analysis showed the program effectively reduced body mass index, waist circumference, systolic blood pressure, and blood glucose levels and improved metabolic syndrome self-management behaviors. Based on our findings, it can be expected that the use of this program may retard or prevent the progression of metabolic syndrome by improving some metabolic syndrome indices and metabolic syndrome-related self-management behaviors, which are key components of care in rheumatic disease patients with metabolic syndrome. This web-based program appears to be beneficial in public health care settings because it is cost-effective, readily available, and may provide long-term support.

Hypoxia-ischaemia (HI) can result in structural brain abnormalities, which in turn can lead to behavioural deficits in various cognitive and motor domains, in both adult and paediatric populations. Cardiorespiratory arrest (CA) is a major cause of hypoxia-ischaemia in adults, but it is relatively rare in infants and children. While the effects of adult CA on brain and cognition have been widely studied, to date, there are no studies examining the neurodevelopmental outcome of children who suffered CA early in life. Here, we studied the long-term outcome of 28 children who suffered early CA (i.e., before age 16). They were compared to a group of control participants (n = 28) matched for age, sex and socio-economic status. The patient group had impairments in the domains of memory, language and academic attainment (measured using standardised tests). Individual scores within the impaired range were most commonly found within the memory domain (79%), followed by academic attainment (50%), and language (36%). The patient group also had reduced whole brain grey matter volume, and reduced volume and fractional anisotropy of the white matter. In addition, lower performance on memory tests was correlated with bilaterally reduced volume of the hippocampi, thalami, and striatum, while lower attainment scores were correlated with bilateral reduction of fractional anisotropy in the superior cerebellar peduncle, the main output tract of the cerebellum. We conclude that patients who suffered early CA are at risk of developing specific cognitive deficits associated with structural brain abnormalities.

Aim: Evidence shows that 20%-30% of patients who aspirate do so silently. Research to date has not demonstrated clear evidence to indicate which patients are at higher risk of silent aspiration. Our aim was to use univariate logistic regression analysis of retrospective case review to determine potential patterns of silent aspiration. Materials and methods: We conducted a retrospective analysis of 455 fiberoptic endoscopic evaluation of swallowing (FEES) reports. The patients were divided into four groups: G1 -- neurological diseases (n = 93), G2 -- head and neck surgery (n = 200), G3 -- gastroenterological diseases (n = 94) and G4 -- other patients (n = 68). Data included the occurrence or absence of saliva penetration or aspiration, of silent fluid/solid food penetration or aspiration, type of penetration or aspiration, occurrence of cranial nerve paresis, radiotherapy and tracheostomy. Univariate logistic regression was used to evaluate independent risk factors of silent aspiration in the study population. Three models with different independent variables were considered. Results: There is a statistically significant difference in the frequency of occurrence of silent penetration and aspiration within the groups (p < 0.001), with intraglutative being most frequent. Fluid and food penetration and aspiration correlated with saliva penetration and aspiration in all groups (p < 0.001). Cranial nerve paresis (IX and X), radiotherapy and tracheostomy correlate with saliva penetration and aspiration (p = 0.020 for cranial nerve paresis; p = 0.004 for radiotherapy; p < 0.001 for tracheostomy). One hundred and fifteen patients (45.81%) in the subgroup of patients with intraglutative aspiration had cranial nerve paresis (IX, X or IX-X). Conclusions: Patients who should be prioritised or considered to be at a higher need of instrumental swallowing evaluation are those with IX and X cranial nerve paresis, tracheostomy and those who have had radiotherapy, with saliva swallowing problems, especially after paraganglioma, thyroid and parathyroid glands and middle and posterior fossa tumour surgery.

Background: Dysphagia affects over half of adults after stroke. Dysphagia rehabilitation aims to improve swallowing and reduce negative outcomes for these adults. However, significant variability exists in dysphagia rehabilitation. Research is needed to explore the underlying clinician-specific and workplace factors that contribute to variability in dysphagia rehabilitation after stroke. Aim: To explore factors influencing speech pathology practice in dysphagia rehabilitation after stroke. Methods & Procedures: We used a phenomenological approach with an interpretivist perspective. Twenty speech pathologists working in dysphagia rehabilitation participated from different workplace settings around Australia. Five semi-structured focus groups were conducted online. Data were inductively analysed using thematic analysis with a coding reliability method. Outcomes & Results: Four themes were discussed within focus groups: (1) relationship between experienced and less experienced clinicians: 'Following what other people have done', (2) need for collaborative learning: 'A safe space to share and train', (3) variation between settings impacts on continuity of care: 'There's a difference between community and acute', and (4) working effectively with multidisciplinary teams (MDT): 'An MDT which can listen to the voice of speech pathology'. Conclusions & Implications: Relationships between senior and junior speech pathologists, within speech pathology and MDT, and across inpatient and community settings influenced speech pathology practice. Flattened hierarchies in speech pathology, collaborative learning in workplaces, mutual respect within teams and connection across inpatient and community settings could improve the quality and consistency of dysphagia rehabilitation after stroke.

Background: Healthcare professionals (HCPs) have a responsibility to conduct assessments of decision-making capacity that comply with the Mental Capacity Act 2005 (MCA). Current best-practice guidance, such as the Mental Capacity Code of Practice and National Institute for Health and Care Excellence decision-making and mental capacity guidance, does not stipulate how to accomplish this in practice, for example, what questions should be asked, how options and information should be provided. In addition, HCPs struggle to assess the capacity of individuals with communication difficulties. Aims: This study was a service evaluation that aimed to objectively analyse, using Conversation Analysis (CA), how real-life capacity assessments were conducted in a hospital setting with patients with acquired brain injury (ABI)-related communication difficulties. A second aim was to establish the feasibility of using CA to advance knowledge of the conduct of capacity assessment. Methods & Procedures: Four naturally occurring capacity assessments were video-recorded. Recordings involved speech and language therapists, occupational therapists, neuropsychologists and patients with communication difficulties as a result of ABI. The methods and findings of CA were used to investigate the interactional behaviours of HCPs and patients during assessments of decision-making capacity. The analysis was informed by our knowledge of the MCA best practice guidance. Outcomes & Results: An overall structure of capacity assessment that enacted some of the best-practice MCA guidance was identified in one recording, consisting of six phases: (i) opening, (ii) preparation, (iii) option-listing, (iv) test, (v) decision, and (vi) close. The preparation phase consisted of two sub-components: information gathering and information giving. Variation from this structure was observed across the dataset, notably in the way in which options were (or were not) presented. Conclusions & Implications: CA is a feasible empirical method for exploring the structure and conduct of capacity assessments. CA identifies and provides ways of describing interactional behaviours that align with and diverge from best-practice MCA guidance. Future CA studies including a wider range of health and social care professionals and patients have the potential to inform evidence based training for HCPs who conduct assessments of decision-making capacity.

Simulation is accepted as an effective method of learning procedural skills. However, the translational outcomes of skills acquired through simulation still warrants investigation. We designed this study to assess if skills laboratory training in addition to bedside learning (intervention group [IG]) would provide better learning results than bedside learning alone (control group [CG]) in the context of venipuncture training. This prospective, cluster-randomized, single-blind study took place at the Faculty of Medicine, University of Kelaniya, Sri Lanka. Seventeen clusters of second-year medical students were randomly assigned to either IG or CG. The IG trained on venipuncture in the skills laboratory, receiving instruction after modified Payton's Four Step Method. Following the training, students of both IG and CG underwent bedside learning for one month. Afterward, students of both groups performed venipuncture on actual patients in a clinical setting. An independent, blinded assessor scored students' performance using the Integrated Procedural Protocol Instrument (IPPI) and a checklist. Patients assessed students' performance with the Communication Assessment Tool (CAT). Eight and nine clusters were randomized to the intervention and control groups, respectively. IG completed significantly more single steps of the procedure correctly (IG: 19.36 ± 3.87 for checklist items; CG: 15.57 ± 4.95; p < 0.001). IG also scored significantly better on IPPI ratings (median: IG: 27 (12) vs. CG: 21 (8); p < 0.001). Rated by patients, students' communication skills did not significantly differ between the two groups. Simulation-based venipuncture training enabled students to perform the procedure on actual patients with a higher technical accuracy than students who learned venipuncture at the bedside. Students were able to transfer the skills acquired through venipuncture training at the skill laboratory to the bedside.

Medical training has become a global phenomenon, and the Physician's Charter (PC), as a missionary document, is key to training those outside the Global North. Undergraduate and postgraduate students in the medical profession are sometimes trained in contexts foreign to their social and ontological backgrounds. This might lead to confusion and blunders, creating an impression of what might look and feel unprofessional to those unfamiliar with the local context. Understanding the cultural backgrounds of the trainees is crucial, and the reverse is also as important. It is essential for clinicians and trainees to understand the cultural backgrounds of their patients to avoid miscommunication. In this phenomenological study, we recruited participants in 2020 who were in their first to fourth year of study of medical training during the #FeesMustFall protests. We used data from this extensive study looking at students' experiences during their training amidst protest and social upheavals in a South African tertiary institution. For this paper, we examined what professionalism means to the student participants using an African Ubuntu lens. Ubuntu and the Collective Finger theory were used to investigate what professionalism means to participants. The Ubuntu philosophy was compared to the PC. In the findings, the clinical space is hierarchical, silencing and the opposite of what Ubuntu means. In comparison to the PC, respect is overarching while compassion and responsibility are the most comparable to the Charter. This study adds an African voice to the professionalism discourse while showing African elements that could be aligned to the PC to challenge the current global discourses.

Population-adjusted indirect comparisons, developed in the 2010s, enable comparisons between two treatments in different studies by balancing patient characteristics in the case where individual patient-level data (IPD) are available for only one study. Health technology assessment (HTA) bodies increasingly rely on these methods to inform funding decisions, typically using unanchored indirect comparisons (i.e., without a common comparator), due to the need to evaluate comparative efficacy and safety for single-arm trials. Unanchored matching-adjusted indirect comparison (MAIC) and unanchored simulated treatment comparison (STC) are currently the only two approaches available for population-adjusted indirect comparisons based on single-arm trials. However, there is a notable underutilisation of unanchored STC in HTA, largely due to a lack of understanding of its implementation. We therefore develop a novel way to implement unanchored STC by incorporating standardisation/marginalisation and the NORmal To Anything (NORTA) algorithm for sampling covariates. This methodology aims to derive a suitable marginal treatment effect without aggregation bias for HTA evaluations. We use a non-parametric bootstrap and propose separately calculating the standard error for the IPD study and the comparator study to ensure the appropriate quantification of the uncertainty associated with the estimated treatment effect. The performance of our proposed unanchored STC approach is evaluated through a comprehensive simulation study focused on binary outcomes. Our findings demonstrate that the proposed approach is asymptotically unbiased. We argue that unanchored STC should be considered when conducting unanchored indirect comparisons with single-arm studies, presenting a robust approach for HTA decision-making.

During drug development, evidence can emerge to suggest a treatment is more effective in a specific patient subgroup. Whilst early trials may be conducted in biomarker-mixed populations, later trials are more likely to enroll biomarker-positive patients alone, thus leading to trials of the same treatment investigated in different populations. When conducting a meta-analysis, a conservative approach would be to combine only trials conducted in the biomarker-positive subgroup. However, this discards potentially useful information on treatment effects in the biomarker-positive subgroup concealed within observed treatment effects in biomarker-mixed populations. We extend standard random-effects meta-analysis to combine treatment effects obtained from trials with different populations to estimate pooled treatment effects in a biomarker subgroup of interest. The model assumes a systematic difference in treatment effects between biomarker-positive and biomarker-negative subgroups, which is estimated from trials which report either or both treatment effects. The systematic difference and proportion of biomarker-negative patients in biomarker-mixed studies are used to interpolate treatment effects in the biomarker-positive subgroup from observed treatment effects in the biomarker-mixed population. The developed methods are applied to an illustrative example in metastatic colorectal cancer and evaluated in a simulation study. In the example, the developed method improved precision of the pooled treatment effect estimate compared with standard random-effects meta-analysis of trials investigating only biomarker-positive patients. The simulation study confirmed that when the systematic difference in treatment effects between biomarker subgroups is not very large, the developed method can improve precision of estimation of pooled treatment effects while maintaining low bias.

Some patients benefit from a treatment while others may do so less or do not benefit at all. We have previously developed a two-stage network meta-regression prediction model that synthesized randomized trials and evaluates how treatment effects vary across patient characteristics. In this article, we extended this model to combine different sources of types in different formats: aggregate data (AD) and individual participant data (IPD) from randomized and non-randomized evidence. In the first stage, a prognostic model is developed to predict the baseline risk of the outcome using a large cohort study. In the second stage, we recalibrated this prognostic model to improve our predictions for patients enrolled in randomized trials. In the third stage, we used the baseline risk as effect modifier in a network meta-regression model combining AD, IPD randomized clinical trial to estimate heterogeneous treatment effects. We illustrated the approach in the re-analysis of a network of studies comparing three drugs for relapsing--remitting multiple sclerosis. Several patient characteristics influence the baseline risk of relapse, which in turn modifies the effect of the drugs. The proposed model makes personalized predictions for health outcomes under several treatment options and encompasses all relevant randomized and non-randomized evidence.

Autism spectrum disorder (ASD) is a neuropsychiatric condition that may be associated with negative health outcomes. This retrospective cohort study reveals the odds of hospitalization and mortality based on ASD for a population of insured patients with COVID-19. The odds of hospitalization and mortality for people with ASD were found to be greater than individuals without ASD when adjusted for sociodemographic characteristics. Hospitalization and mortality was associated with a dose-response increase to comorbidity counts (1 to 5+). Odds of mortality remained greater for those with ASD when adjusting for comorbid health conditions. ASD is a risk factor for COVID-19 mortality. Comorbid health conditions play a particular role in increasing the odds of COVID-19 related hospitalization and death for ASD patients.

Background. Health-promoting behaviors and positive lifestyle changes are crucial for effective stroke prevention. However, individuals at high risk of stroke exhibit poor health behavior due to a deficiency of individual motivation. Moreover, there are only a few studies on health-promoting behaviors that have applied behavior change theories in individuals at high risk of stroke. Objective. This study aimed to use the theory of the planned behavior (TPB) model to investigate determinants of health-promoting behaviors for stroke prevention and control. Method. In this cross-sectional study, 263 participants were recruited from five community health centers in Qingdao. Confirmatory factor analysis was performed to assess the reliability and validity of the constructs, and structural equation modeling was used to analyze the proposed relationships between the TPB-related variables. Results. The attitudes, subjective norms, and perceptions of behavioral control positively influenced behavioral intention. The behavioral intention had a positive effect on health-promoting behaviors. Attitudes, subjective norms, and perceived behavioral control were influenced primarily by the mediating variable behavioral intention to affect health-promoting behaviors. Stroke knowledge was an influential facilitator of behavioral attitudes, subjective norms, and perceived behavior control. Conclusion. The TPB-based model is suitable for explaining health-promoting behaviors in individuals at risk of stroke and for guiding the development of effective health management programs. A comprehensive person-centered motivation behavior strategy that is based on health education and complemented by social support and health resource optimization is critical in promoting health behavior motivation and health promotion behaviors in stroke high-risk groups.

Background: In people with intellectual disabilities and mental disorders and/or challenging behaviours, rates of psychotropic drug prescription are high. In clinical treatments and evaluations, all stakeholders should be involved in a process of shared decision-making (SDM). We aimed to investigate the perspectives of clients and their carers on clients' treatments with psychotropic drugs. Methods: We conducted a survey among adults with intellectual disabilities in a Dutch mental healthcare centre providing community, outpatient and inpatient care. Data were collected between January and June 2022. Questions focused on experiences with the provision of information, treatment involvement and SDM and participants' wishes in this regard. Findings: Respondents (57 clients and 21 carers) were largely satisfied with the overall care from their clinicians, and with how information on the pharmacological treatment was provided verbally, but written information was insufficient or not provided. Seventy per cent of clients and 60% of carers reported being involved in medication decision-making. However, over 75% of participants desired greater involvement in SDM and over 60% in medication reviews. Conclusions: Service users and representatives were satisfied about the treatment and verbal information on their psychotropic drug use. The provision of written information, the SDM process and ongoing evaluation of psychotropic medication use could be improved.

Background: Integrated primary care (IPC) can address prevalent behavioral health concerns identified in pediatric office visits, but research on IPC consultation patterns is limited. Objective: This study investigated variation in consultation rates across presenting problems, patient sociodemographic factors, and IPC treatment duration. Method: Retrospective electronic health record data were extracted for 970 patients seen in 12 pediatric primary care sites and for whom behavioral health consultation was requested between June 2018 and December 2019. Logistic regressions were used to examine associations between sociodemographic variables, consultation reasons, and IPC visit type. We used multiple linear regression to assess the association between consultation reason and treatment duration. Results: Anxiety (36.2%) and disruptive behavior (29.7%) were the most common consultation reasons. Consultation requests for internalizing (anxiety, mood) problems were more prevalent in school-aged children and adolescents, whereas consultations for disruptive behavior (tantrums) and health-related issues (toileting, sleep concerns) were common in early childhood. Girls were less likely to receive consultation requests for attention deficit/hyperactivity disorder (ADHD) and autism/developmental concerns compared to boys, but more likely to receive consultation for internalizing problems. Consultation requests varied by patient race, ethnicity, visit type, and insurance type. Treatment duration after consultation was longer among patients with consultation requests for ADHD and for depression/mood concerns. Conclusions: Age-related behavioral health consultation patterns in IPC conform with expected developmental trends; however, sociodemographic findings suggest opportunities for enhancing care. Additional research is needed on IPC consultation given its promise for early identification, prevention, and treatment of pediatric mental health concerns.

Here we demonstrate how data from the clinical pulmonary function lab can help students learn about the principle of airway-parenchymal interdependence. We examined the relationship between airway conductance (Gaw) and lung volume (thoracic gas volume, TGV) in 48 patients: 17 healthy; 20 with emphysema, expected to have reduced airway-parenchymal interdependence; and 11 with pulmonary fibrosis, expected to have increased airway-parenchymal interdependence. Our findings support these expectations, with the slope of Gaw vs. TGV being steeper among those with pulmonary fibrosis and flatter among those with emphysema, compared to the slope of the healthy group. This type of analytic approach, using real-world patient data readily available from any pulmonary function laboratory, can be used to explore other fundamental principles of respiratory physiology.

This study examined hospitalizations in a large, all-payer, nationally representative sample of inpatient hospitalizations in the US and identified differences in rates of hospitalization for conditions by race and ethnicity in autistic adults. Conditions examined included mood disorders, epilepsy, schizophrenia, and ambulatory care sensitive conditions (ACSCs). Compared to white, non-Hispanic autistic adults, Black, Hispanic, Asian or Pacific Islander (API), and autistic adults of another race had lower prevalence of admission for a principal diagnosis of a mood disorder. Conversely, Black, Hispanic, API, and autistic adults of another race had higher odds of admission for epilepsy than white autistic adults. Black and Hispanic autistic adults were more likely to have schizophrenia as a principal diagnosis compared to white autistic adults, but only Black autistic adults had increased odds for admission for an ACSCs compared to white autistic adults. Differences in diagnosis prevalence among hospitalized autistic adults may suggest differential access to comprehensive outpatient care that could prevent such hospitalizations, while also pointing to concerns of differential validity of diagnostic tools and treatment approaches. Insurance policy and programs should prioritize optimizing outpatient care to ensure access to care and emphasize the need for equitable treatment.

Although augmentative and alternative communication (AAC) strategies are often used by autistic youth, little is known about the use of AAC in inpatient psychiatric settings. This study evaluated how demographic and clinical factors (e.g., language level, IQ) related to AAC use in a well-characterized sample of 527 autistic youth (78.7% male, mean age 12.94) who participated in the Autism Inpatient Collection. AAC use was common, with 42.5% of caregivers reporting at least one form of AAC. White children were more likely to use AAC than non-white children at the bivariate level. In regression analyses, young children were more likely to use AAC than older children. These results suggest the importance of provider training and improved equitable access to AAC.

While patient engagement in healthcare professions education (HPE) has significantly increased in the past decades, a theoretical gap remains. What are the varied reasons as to why patients get involved with HPE programs? With a focus on understanding what drives patient involvement with HPE programs, this study examined how a patient as teacher (PAT) program was experienced by medical students, patient teachers, and faculty within a medical school. Through a phenomenographic approach, this study captures and describes the different ways our study participants experienced a PAT program (the 'phenomenon'). 24 semi-structured interviews were conducted in total, comprised of interviews with patient teachers (N = 10), medical students (N = 10) and program facilitators (N = 4) who participated in a PAT program. Our focus was on participants' description of the program and was grounded in their experiences of as well as their beliefs about it. Our findings captured 4 layers representing the qualitatively different (yet interrelated) ways in which participants experienced/perceived and conceptualized the various aspects of their experience with the PAT program: (1) A productive disruption of the learning space; (2) A re-humanization within healthcare; (3) A means of empowerment and agency; (4) A catalyst for change and emancipation. Our outcome space results can be visually illustrated by a nesting "Matryoshka" doll, representing the four layers and depicting the process of uncovering the less conscious layers of sense-making within this phenomenon. HPE programs that are co-produced with patients and actively involve patients as teachers have the potential, but not guarantee, to be emancipatory. To engage in PAT programs that exhibit an emancipatory potential, we need to consider transformative paradigms of education, which are aligned with social change, and disrupt the traditional teacher-learner hierarchy.

Background: Person-centred services are inherently related to patients/caregivers' needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change. Aim: This study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers. Methods & Procedures: Using concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement. Results: Twelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. Conclusion: These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers.

Introduction: Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions. Methods & Procedures: The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey. Results: Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events. Conclusion & Implications: The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services.

Background: Although existing studies have shown that both repetitive transcranial magnetic stimulation (rTMS) and music therapy have advantages in the treatment of non-fluent aphasia, the efficacy of the combination of these two methods remains to be investigated. Aims: To investigate the clinical efficacy of low-frequency rTMS combined with music therapy on language function and depression in patients with non-fluent aphasia after stroke. Methods & Procedures: A single-blind parallel randomised controlled trial was conducted. Sixty patients (mean duration = 93.78 days) with non-fluent aphasia after stroke were randomly divided into a traditional therapy group (n = 20), a music therapy group (n = 20) and a combined therapy group (n = 20, 1 Hz). The language function and depression were evaluated before and 3 weeks after treatment with the Chinese version of the Western Aphasia Battery scale, Boston Diagnostic Aphasia Examination scale and Stroke Aphasic Depression Questionnaire Hospital Version scale. Outcomes & Results: The combined therapy group was significantly better in all outcomes than the traditional therapy group and was significantly better in depression than the music therapy group. The music therapy group was significantly better in repetition and depression than the traditional therapy group. Language improvement was positively correlated with depression improvement. For adverse events, only two patients in the combined therapy group showed slight dizziness during rTMS treatment and their symptoms improved after rest. Conclusions & Implications: Our preliminary randomised controlled study indicates that low-frequency rTMS combined with music therapy is feasible and safe in improving language function and depression in non-fluent aphasia patients after stroke.

Background: The COVID-19 pandemic resulted in rapid changes to head and neck cancer (HNC) services. Multidisciplinary team (MDT) face-to-face appointments were converted to telehealth appointments (telephone and video-call) to reduce the risk of COVID-19 transmission. The literature exploring HNC patient experience of these appointment types is limited. Aims: To explore patient experience of telehealth appointments at one UK centre during the COVID-19 pandemic, as well as the variables that may influence patient preference for virtual or face-to-face appointments. Methods & Procedures: A survey-based study design was used, with closed questions and open text options to capture the views of the participants. Quantitative data were analysed using descriptive statistics. Open text data was used to add depth to the findings. Outcomes & Results: A total of 23 participant surveys were returned. Six categories were identified: Usability; Information receiving & giving; Satisfaction; Emotions and comfort; Rapport; and Travel time and cost. Overall, participants gave positive responses to each category and indicated that telehealth appointments met their needs. Areas for clinical consideration are highlighted. Variables such as age, travel distance from hospital site, fear of COVID-19 and information technology (IT) access did not appear to influence patient preference for appointment type. Conclusions & Implications: Going forward, telehealth may be considered for use in combination with face-to-face appointments in the HNC pathway. Areas for further development include a 'telehealth screening tool' that may help to identify those patients most appropriate for these appointment types, or who require support to access them.

Background: Above cuff vocalisation (ACV) involves the application of an external flow of air via the subglottic port of a tracheostomy. ACV can facilitate vocalisation and may improve swallowing and quality of life for patients with a tracheostomy. A recent systematic review highlighted the limited evidence available for the acceptability, effectiveness, safety or optimal implementation of ACV. Aims: To explore the experience of healthcare professionals (HCPs) using ACV and their perceptions of best practice. Methods and Procedures: Semi-structured interviews were conducted with a range of HCPs with experience using ACV. Topics included: experiences with ACV, management of ACV, opinions about ACV, impact of COVID-19, future directions for ACV and impact on length of stay. Interviews were conducted online from December 2020 to March 2022. Data were analysed using reflexive thematic analysis. Outcomes and Results: Twenty-four HCPs were interviewed from seven countries and five professional groups. Four interconnected themes were developed: (1) moral distress amplifying the need to fix patients; (2) subjectivity and uncertainty leading to variations in practice and purpose; (3) knowledge and experience leading to control and caution; and (4) worth a try or a last resort. Theme four contained three sub-themes: (a) part of the toolbox; (b) useful but limited tool; and (c) following the patient's lead. The moral distress experienced by HCPs and their essential 'need to fix' patients seems to underpin the varied opinions of ACV. These opinions appear to be formed primarily on the basis of experience, because of the underlying subjectivities and uncertainties. As knowledge and experience with ACV increased, and adverse events were experienced, most HCPs became more cautious in their approach to ACV. Conclusions and Implications: More research is needed to reduce the subjectivities and uncertainties surrounding ACV. The implementation of standardised procedures, processes, and competencies may help to reduce the frequency of adverse events and support a more controlled approach. Widening the focus of the purpose of ACV to include swallowing may help to maximise the potential benefits.

Many research institutions and funders have recently stated their commitment to actively support and promote 'Equality, Diversity and Inclusion' (EDI) in various aspects of health research including Patient and Public Involvement (PPI). However, translating this commitment into specific research projects presents significant challenges that existing approaches, practical guidelines and initiatives have not adequately addressed. In this paper, we explore how the lack of clear justifications for the EDI commitment in existing guidelines inadvertently complicates the work of those involved with PPI and we stress the need for conceptual clarity for any EDI effort to yield meaningful results. Our focus centres on the first principle of the EDI discourse, 'equality', particularly in the form of 'equality of opportunity' as outlined in current guidance provided by the National Institute of Health Research in the United Kingdom. We examine challenges related to justifying and implementing a general, unspecified commitment to equality of opportunity and explain that this reflects a lack of consensus regarding the moral value of PPI in research -- a profound problem that remains unaddressed. We then discuss how the presence of several opposing moral perspectives on PPI, makes determining the most appropriate way of addressing barriers to involvement complex and controversial, raising ethical implications for the work of health researchers, PPI specialists and coordinators. Finally we make suggestions on how future research can enrich the concept of 'equality of opportunity' in PPI and improve practice. While our primary focus is on the NIHR, a strong advocate of PPI in research, this analysis will point to normative and ethical considerations that may be relevant to other research institutions and funding organisations aiming to promote equality of opportunity in their public and patient involvement strategies.

Diabetic foot ulcers (DFUs) impact a substantial proportion of patients with diabetes, with high recurrence rates, severe complications, and significant financial burden to health care systems. Adherence to treatment advice (e.g., limiting weight-bearing activity) is low with patients reporting dissatisfaction with the way in which advice is communicated. This study aimed to address this problem via the systematic development of a motivation communication training program. The program was designed to support diabetes-specialist podiatrists in empowering patients to actively engage with treatment. The development process followed an intervention mapping approach. Needs assessment involved observations of 24 patient-practitioner consultations within a diabetes-specialist foot clinic. This informed specification of a theory of change (self-determination theory) and relevant evidence-based communication strategies (drawing from motivational interviewing). The training program was developed iteratively with changes made following feedback from five diabetic foot health care professionals. The resulting training program, consisting of six one-hour face-to-face sessions over an 8-week period, was delivered to a further six diabetes specialist podiatrists, with five participating in post-program telephone interviews to assess acceptability. Deductive thematic analysis of interview data revealed positive aspects of the training (e.g., valuable and relevant content), ideas for improvement (e.g., online resources and context-specific video examples), the acceptability of motivation strategies, and challenges putting the strategies into practice (such as time constraints and breaking old communication habits). This study contributes to our understanding of integrating motivation principles into routine consultations and holds potential for enhancing adherence to treatment recommendations in patients living with diabetic foot ulcers.

Simulated treatment comparison (STC) is an established method for performing population adjustment for the indirect comparison of two treatments, where individual patient data (IPD) are available for one trial but only aggregate level information is available for the other. The most commonly used method is what we call 'standard STC'. Here we fit an outcome model using data from the trial with IPD, and then substitute mean covariate values from the trial where only aggregate level data are available, to predict what the first of these trial's outcomes would have been if its population had been the same as the second. However, this type of STC methodology does not involve simulation and can result in bias when the link function used in the outcome model is non-linear. An alternative approach is to use the fitted outcome model to simulate patient profiles in the trial for which IPD are available, but in the other trial's population. This stochastic alternative presents additional challenges. We examine the history of STC and propose two new simulation-based methods that resolve many of the difficulties associated with the current stochastic approach. A virtue of the simulation-based STC methods is that the marginal estimands are then clearly targeted. We illustrate all methods using a numerical example and explore their use in a simulation study.

The need to encourage critical thinking and academically engage nursing students in a clinical environment compels faculty use of assorted teaching strategies, including concept mapping and flipped learning. Though nurse educators encourage both strategies, concurrent use of both methods in clinical teaching is rare. Thus, this study examined the use of concept mapping in a flipped clinical course to encourage students' engagement and critical thinking. Twelve baccalaureate nursing students in a second-year medical-surgical clinical course provided the data for this basic qualitative study by completing journals or diaries throughout the course and through individual semi-structured interviews at course exit. Open coding of interview transcripts and journals in conjunction with constant comparative analysis helped develop categories and themes. Several overlapping themes emerged from interview and journal data. Nursing students indicated that they developed different ways of thinking, learned from many people, became actively involved in learning and expanded their thinking, connected information, determined clinical priorities and made decisions, became confident and knowledgeable in their ability to recall information and transfer knowledge, and experienced increased critical thinking and higher level thinking skills. The results of the study showed the participants derived positive meaning from their learning in a nontraditional flipped clinical with concept mapping. Students were actively engaged in their learning and were able to expand their thinking while working collaboratively with their instructor, patients, and staff.

Limited literacy has a large impact on the U.S. population; about half of adults lack sufficient literacy proficiency. However, not all populations are impacted equally, as there is a significant comorbidity between low literacy and mental illness. The authors have found that smartphones can offer mental health patients with low literacy numerous resources. They will highlight two examples in this article and describe how each can be beneficial to a patient's health. While these resources have great potential, the authors realize that not all patients are able to use their smartphones like this as they lack basic digital literacy. [For part 1 of this Forum on supporting mental health, see EJ1389837. For part 3, see EJ1389833.]

Complex healthcare systems and ambiguous clinical decisions can result in medical errors which threaten patient safety. There is a need for improved awareness of medical errors across healthcare disciplines. We utilised team-based learning (TBL) to pilot an interprofessional patient safety module for senior health professional students. We evaluated the use of TBL within the interprofessional context to achieve student learning outcomes. Twenty-seven students from pharmacy (n=11), nursing (n=8) and medicine (n=8) faculties participated. Data were collected via questionnaires, focus groups, class observation and student test scores. Quantitative data were analysed using descriptive statistics. Framework analysis was used to code qualitative data using social capital as a conceptual framework. In total, 26/27 (96%) of participants completed the questionnaire and 20/27 (70%) attended focus groups. There was no significant difference in prior knowledge between the disciplines. The TBL module enriched the learning environment and enabled students to prepare, problem-solve and interact with facilitators. The TBL pedagogy and interprofessional framework enabled the development of social capital among students. The module demonstrated the potential of interprofessional education to shift knowledge and attitudes towards a greater appreciation of patient safety issues and better prepare health professional students for the workforce. The TBL pedagogy strengthened knowledge sharing and fostered collaboration across disciplines.

The medical fields of anesthesiology and otolaryngology (ENT -- ears, nose, throat) are defined by overlapping clinical expertise as it relates to the management of airway issues. As a result of this shared clinical domain, interdisciplinary educational experiences provide an opportunity for collaboration and a broadened experience for resident physician learning. Our institution developed a two-week rotation in otolaryngology for first-year anesthesiology interns with the goal of utilizing interdisciplinary coaching to develop both technical and non-technical skills in airway management. The purpose of this project is to perform a formal evaluation of this rotation and share our training methods and processes.

Simulated learning programs are an important component of allied health education. Although the role of simulation clinical educators has been highlighted as critical for student learning within simulation, their perceptions of their role have not yet been investigated. This study aimed to explore the experiences of simulation clinical educators. Participants were ten simulation clinical educators who had supported speech-language pathology students' learning during a 5-day simulation program focussed on speech-language pathology practice with adult clients in acute hospital and rehabilitation settings. Educators participated in individual semi-structured interviews exploring their role and their perceptions of the simulation-based learning program. Data were analysed using inductive thematic analysis. Three inter-related themes emerged from participants' views. The major theme of Unique teaching and learning environment incorporated five subthemes: focus on teaching; safe learning environment; authenticity and engagement; structure and intensity of learning, and; feedback opportunities. Two additional themes were identified: Clinical educator role same but different, and Simulation bridges the gap between theory and practice. This study offers new insights into simulation clinical educators' perceptions of their role when supporting students within simulation and highlight the importance of harnessing the unique benefits of simulation as a teaching pedagogy to maximize its impacts on student learning and justify its costs.

Simulation is a valid pedagogical tool used to teach students, observe student clinical skills, and to assess clinical competencies. During the COVID-19 pandemic, a lack of medical speech-language pathology placements required graduate programs to re-examine clinical training. Simulation has proven useful in providing an alternative and safe learning modality. Standardized patients, which are one simulation modality, provide increased standardization and higher fidelity than medical manikins. This is particularly true in the context of both student learning and demonstration of clinical communication skills (CCS) within a simulated learning environment where the simulated patient can interact authentically with the student clinician. CCS are important because they can lead to better treatment outcomes and strengthen the therapeutic alliance. The purpose of this study was to evaluate the evidence for a CCS training in the context of a speaking valve trial with a standardized tracheostomy patient. Results showed that students are demonstrating emerging skills or have already developed CCS in this context. Student questionnaire ratings suggest that this simulation was helpful to their learning as it provided a safe environment for them to practice valuable clinical skills. Simulation appears to be a viable modality to use when training CSD students to improve their CCS.

In this study, we apply theories about self-efficacy, empowerment and motivation to account for the phenomena that people with diabetes Mellitus type 1 express as being influential for people with diabetes' behaviour regarding self-regulation. They must make significant changes to their lifestyle, to keep the disease stabilized. The changes can be cumbersome and hard to implement why people with diabetes receive training in self-regulation. For many people it can be challenging to comply with the recommendations. We conducted field observations and surveys to understand how people with diabetes experience their perceived self-efficacy, and what motivates them to perform blood sugar measurements and physical activities. We found differences in people with diabetes' ability to follow the recommendation based on gender, motivation, and their level of self-efficacy. We also found indications on how a motivational dialog may affect both professionals and people with diabetes. Thus, we suggest that guidance of people with diabetes should be based on an emancipating motivational approach such enabling the possibility of strengthening the people with diabetes' motivation and thereby their self-efficacy. Through these processes, the people with diabetes may become able to achieve a higher level of health literacy such experiencing a better outcome of their self-regulation. With this paper we contribute to the contemporary overall knowledge about the diabetes field, such our investigation focus on people with diabetes ability to act upon information provided by healthcare professionals and how to best approach the issues people with diabetes experience as being essential for their general well-being and everyday lives.

For many instructional designers (ID), subject matter experts (SMEs) are viewed as a necessary evil. Depending upon their day job, SMEs can be challenging to work with due to their schedules and responsibilities outside the ID's project. They can be unaware of the eLearning process, learning models and theories, and expensive -- a SME can easily add thousands of dollars to an already stretched budget. However, if the ID does not have the "expert" knowledge of the content for students to achieve the learning outcomes successfully, it is improbable that the learning event will be meaningful. This paper explores students' learning outcomes in a case-based simulated learning event before and after the inclusion of a SME on an instructional design team.

The aim of the study was to describe the validity and reliability of the Turkish version of Juvenile Arthritis Functional Assessment Report (JAFAR) in children/adolescents with Juvenile Idiopathic Arthritis (JIA). Sixty-nine children/adolescents with JIA were included in the study. JAFAR(TR)-Child and Parent forms were applied to the patients with JIA and to their parents for test retest at one-week intervals, the patients did not receive additional treatment and his/her pharmacological treatment did not change for that week. Test-retest reliability was evaluated by intraclass correlation coefficient (ICC), and internal consistency reliability of multi-item subscales was evaluated by calculating Cronbach's alpha coefficient. Correlations between JAFAR(TR)-Child and Parent with the Pediatric Quality of Life Inventory 3.0. Module Arthritis (PedsQL), the Childhood Health Assessment Questionnaire (CHAQ), and the Juvenile Arthritis Disease Activity Score (JADAS) were evaluated to determine construct validity. The ICC value for the test/retest reliability of JAFAR(TR)-Child was 0.963 and of JAFAR(TR)-Parent was 0.576. JAFAR(TR)-Child total score had low to moderate correlations with PedsQL Child (r=-0.34; p=0.004), CHAQ (r=0.40; p=0.001), and JADAS total score (r=0.42; p=0.000). JAFAR(TR)-Parent total score had moderate to high correlations with PedsQL Parent (r=-0.55; p=0.000), CHAQ (r=0.72; p=0.000) and JADAS total score (r=0.53; p=0.000). The Turkish version of JAFAR was found to be clinically valid and reliable in JIA.

Person-centered approaches to measurement are needed to more fully reach the goals of person-centered practice. Keyform maps, derived from Rasch analysis and principles of person-centered measurement, are thought to be an important tool for translating person-centered measurement into clinical practice. The purpose of this study was to understand the impact of keyform map use in a variety of learning activities embedded across multiple courses in an entry-level occupational therapy curriculum. This paper includes a description of 3 keyform map learning activities and corresponding results. The effects of keyform maps as a signature instructional strategy within entry-level occupational therapy education and implications for future studies are also discussed.

The adult population in the United States is more physically active and are living longer than prior generations. Due to the advancement in surgical techniques and the increased number of active people, there has been a rise in the number of hip and knee replacement surgeries. This rise in the number of surgeries is expected to continue. Post-surgical care is a critical component to a successful patient recovery. After surgery, patients experience limited mobility while the muscles around the impacted joints need time for inflammation to subside. Physicians and other medical providers are concerned with making sure that patients do not experience falls during this time as it may lead to more serious injuries. A sample dataset of patients who underwent elective hip or knee surgery from January 2014 to March 2020 has been provided to analyze other medical conditions that may contribute to the likelihood of a patient falling. The goal is to identify important factors that can assist in predicting the probability of a patient falling after surgery.

Introduction: Autistic people with co-occurring intellectual disability have a high risk of mental disorders. This study aimed to investigate specialized mental health services for this group, emphasizing inpatient/outpatient treatment, patient characteristics, interventions, and outcomes. Methods: The current study used data from a Norwegian multicenter study (the AUP study), 151 participants were included. Statistical analyses included comparisons of the two treatment groups and multiple analyses of variance on outcome measures of behavioral and mental health symptoms for all patients. Results: Seventy-four patients received outpatient treatment and 77 received inpatient treatment. The inpatients had significantly more "severe" mental disorders and received a higher number of interventions. Both groups improved significantly during treatment, inpatients slightly more. Psychotherapy was associated with positive outcomes. Psychopharmacological treatment or duration were not associated with outcomes. Conclusion: Treatment of mental disorders is effective in autistic people with co-occurring intellectual disability. Psychotherapy may be beneficial for these patients.

Physical activity (PA) is an important facet in survivorship care. Standardized curriculum which teaches undergraduate student exercise leaders how to implement PA programs for childhood cancer survivors have not been developed. Delivery of PA programs are limited by resources, so utilizing students to lead PA sessions is a potentially cost-effective approach. The purpose of this study was to learn how to optimize mentorship of student PA leaders in pediatric oncology. The aims were to report on the level of guidance provided to the student PA leaders, share student PA leaders' reflection of their mentorship and the challenges they faced. Student PA leaders designed and delivered a 31-week, virtual PA program to pediatric cancer survivors (5-18-year-olds). Mentors provided feedback on the recorded sessions. PA leaders were interviewed about their perceptions, their experiences and the type of feedback they valued the most. Student PA leaders received the most feedback during the first 2 weeks of the program, suggesting close oversight is needed during this time. Students valued the feedback on improving PA delivery/instruction the most. Students reported feeling anxious prior to sessions, especially when new content would be introduced because they were unsure how the patients would respond to the new activities. Reinforcing that the leaders have the ability to minimize PA barriers and provide support may help to resolve their anxiety of working with this population. Using a similar approach as presented in this paper may be advantageous in the development of high-performing PA leaders.

Background: People who have communication difficulties may benefit from using augmentative and alternative communication (AAC). Understanding and measuring outcomes from the use of AAC is an important part of evaluating the impact of devices and services. Outcome measurement needs to reflect the changing nature of the impact of using AAC on an individual's ability to participate in activities of daily life. There is a limited understanding of the concepts that should inform the evaluation of outcomes from AAC device provision, nor how people's expectations from AAC may change over time. Aims: To inform the development of a patient-reported outcome measure for AAC by understanding more about people's expectations from AAC and how these change over time. Methods & Procedures: A longitudinal qualitative research study was designed and carried out with seven participants over a period of 2 years. Participants were recruited from a regional specialist assessment service for AAC in the south-west of the UK. Four semi-structured interviews were carried out: (1) before assessment for AAC, (2) after assessment, (3) directly after provision of an AAC device and (4) between 6 and 12 months after provision. An original analytic method was used in this study that built on the principles of longitudinal interpretative phenomenology analysis, applied with a dialogic theoretical lens. This approach enabled the inclusion of a range of multimodal and embodied data collected to this study and allowed the research team to draw out salient themes across the cohort group while attending to the influence of time and context on experience. Outcomes & Results: The results confirm and extend the three core concepts that were used to guide analysis: changes; contexts; future possibilities. The contextual and temporal influences on outcomes attainable from AAC for this cohort were also identified and illustrated through cross-case comparison. Deeper, analytic, and conceptual engagement with theory, which was then applied to analysis of the data, provided methodological rigour in the study. The results enhance our understanding of people's hopes and expectations from AAC and how these change over time. Conclusions & Implications: This qualitative longitudinal research study provides new insights into the journeys of people who experience communication disability, and the shifting nature of their sense of identity as they engage with, and learn from using, AAC. The study is significant as it attends to the dynamic nature of experience and how contextual and experiential factors influence people's hopes and expectations from AAC. The paper presents an original application of longitudinal qualitative research methodology with people who use AAC which can be further applied and tested in the field of communication disability research.

Background: The attitudes, perceptions and inherent biases of healthcare professionals (HCPs) have the potential to influence and inform health outcomes of people with intellectual disability. This review aimed to identify what educational interventions have been conducted to improve the attitude, knowledge, and confidence of HCPs in caring for people with intellectual disability. Method: A systematic literature review was conducted using Medline, ERIC and PsycINFO. Inclusion criteria included: articles published after 1980 in English, quantitative and mixed methods studies. Results: Of 1444 articles yielded, 10 met the inclusion criteria. Studies predominantly included doctors and nurses. Almost half (40%) of the studies reported interventions that were effective in changing perceived confidence and attitudes, while 60% achieved improvement in knowledge or skills based on Kirkpatrick classification. Conclusions: Training is valuable in improving knowledge, broadening perspectives, and increasing confidence in managing people with intellectual disability but there are limited studies in this area.

Background: People with an intellectual disability have a higher risk of developing mental disorders compared to the general population. Available evidence suggests those with an intellectual disability receiving inpatient treatment in general psychiatric wards may have certain unique characteristics. Method: Data gathered from a retrospective review of records of adults with intellectual disability admitted to general psychiatry wards in a tertiary psychiatric hospital in Singapore were analysed. Results: Of 290 adults with intellectual disability, 62.8% were males. The median age was 38 years. The median length of stay was 12 days and over 80% had at least one previous admission. Nearly 80% had a mild intellectual disability and 64.5% had at least one psychiatric comorbidity, the majority having schizophrenia or psychotic disorder. Physical aggression was the most common primary reason for admission. Conclusions: The specific profile of patients identified in the study would be helpful in determining priority areas for the development of specialist psychiatric services for people with intellectual disability.

Purpose: This paper aims to focus on the involvement of mental healthcare professionals in a co-design process of a digital healthcare platform. Many people with severe mental disorders need constant support and monitoring, and with long waiting lists and scarce resources in mental healthcare, there is a dire need for innovative digital solutions to counteract those issues. This paper elaborates on a co-design process of a digital platform and mobile app designed for people with mental disorders. The platform primarily considers two perspectives: (i) the patients and (ii) the healthcare professionals. Design/methodology/approach: This paper is based on canonical action research, where the co-design involvement with 13 healthcare professionals is analyzed and their interactions with three primary scenarios are focused. Findings: The main contribution of this paper is three co-design principles: (i) clarity and information accessibility regarding the patient's side, (ii) efficiency and flexibility when it comes to the healthcare professional's side and (iii) a notification function in the mobile application. Originality/value: The theoretical contribution is the conceptualization of the three co-design principles that others can use when designing digital platforms in healthcare in general and psychiatric care in particular. The practical contributions are firstly outlined through the co-design process itself, where scenarios to guide the work are used, and secondly, the improvements made in the digital platform derived from the results of the co-design process.

The aim of this pilot study was to assess the efficacy of a desensitization program developed by dentists and occupational therapists, targeted at autistic adults, to encourage their cooperation in the dental setting. The study group consisted of 18 individuals with autism (10 men and 8 women, aged 18 - 45 years). The patients underwent a baseline examination, after which they were progressively exposed to oral examination maneuvers and ultimately dental procedures. To this end, the participants engaged in a weekly desensitization session performed by an occupational therapist and a monthly assessment session by a dentist applying the Frankl scale, for a maximum period of 30 weeks. During the first session, 44% of the participants completed all oral examination procedures, reaching 94% by the fourth visit and 100% by the seventh visit. None of the participants completed a simple dental treatment up to the third session, subsequently increasing the percentage progressively until reaching a maximum of 61% in the seventh visit. In conclusion, a dental desensitization program implemented by dentists and occupational therapists could help in performing oral examinations and simple therapeutic procedures for a considerable percentage of adults with autism, without having to resort to pharmacological behavioral control techniques.

Background: The emphasis of mental health services has changed to become more recovery focussed and is increasingly looking towards new roles such as peer support as a part of service provision (NHSE, 2019). However, services for people with learning disabilities and mental health difficulties have lagged behind with people with lived experience mainly involved in research and consultation to services rather than delivering interventions. Methods: This article is based on four workshops held as part of a patient and public involvement and engagement (PPIE) consultation on a research study being developed to promote access to recovery colleges for people with learning disabilities. The workshops included three peer supporters with learning disabilities. In the article we describe our groups experiences and views on mental health, recovery and peer support. Findings: Our group discussed our views on mental health, what recovery means and the impact of peer support on us. We also discussed the skills people need to do peer support and the support they need from others to do these roles well. Conclusions: We thought that peer support for people with learning disabilities can challenge stigma and help people with difficult experiences such as low self esteem and loneliness. Staff supporting people with learning disabilities may benefit from more training to implement peer support. More research on the kinds of peer support that are on offer for people with learning disabilities is needed.

Background: A comprehensive multidisciplinary medical guideline for adults with Down syndrome is lacking in the Netherlands. In this study, we aim to explore parents' views on multidisciplinary care and identify which aspects of health care they find most important in the context of developing such a guideline. Method: This qualitative study used semi-structured interviews. Nineteen interviews were conducted with parents of adults with Down syndrome. The main themes and subthemes were identified from the transcripts by using the framework method. Results: Four main themes were identified which should be addressed in the guideline according to the parents: parents' support in medical care, patient-centred care, important medical topics and the organisation of medical care. Conclusions: This study provides insights into parents' opinions about medical care for adults with Down syndrome. These insights are used in the construction of a guideline to improve medical care for adults with Down syndrome.