The use of 'Positive Greetings at the Door' to increase on-task behaviour in a vocational training centre

Background : Preliminary studies suggest ‘Positive Greetings at the Door’ is a simple, low cost, antecedent intervention, for promoting engagement and reducing the risk of disruptive behaviour at the beginning of lessons. Method and materials : Three single case ABAB reversal designs were used in a vocational training centre for adults with intellectual disabilities. Real time duration recording was used to measure on-task behaviour. Interval recording was used to investigate staff delivery of verbal attention. Functional assessments of off-task behaviour were completed. Results : Results revealed that staff greetings produced increases in on-task behaviour, during the first ten minutes, from a mean of 54% during baseline to a mean of 79% during intervention phases. Staff greetings appear to set the occasion for staff to interact more frequently with participants. Conclusions : ‘Positive Greetings at the Door’ may be an antecedent manipulation that is low cost, technically undemanding, function-independent and effective in improving on-task behaviour

A total population study of challenging behaviour and evaluation of Positive Behavioural Support outcomes.

Positive Behavioural Support (PBS) is a multicomponent framework designed to address the multiple factors that influence an individual’s behaviour, with a focus on improving quality of life (Kincaid et al. 2002). PBS, in the UK, has largely been implemented by peripatetic community teams, in developmental disability (DD) services. High prevalence of challenging behaviour in individuals with DD (Jones et al. 2008) is a result of the interaction between vulnerability, environmental and impact factors (Hastings et al. 2013). This thesis will attempt to expand existing knowledge on all three of these aspects in relation to PBS as an intervention model. The thesis begins by presenting a total population study regarding the prevalence of challenging behaviour (chapter 2). This study investigates the associated correlates of challenging behaviour, and is the first study to consider the cumulative association of these correlates and propose ways to measure cumulative risk. Chapter 3 considers an impact of challenging behaviour – the high incidence of psychotropic medication use - and explores prescribing patterns associated with various topographies of challenging behaviour. In chapter 4, population data from the Behaviour Problems Inventory – Short Form (Rojahn et al. 2012) are used to estimate norms, clinically significant change and reliable change statistics. This chapter also provides guidance through examples on how this information can be used in research and clinical practice to enable practitioners to evaluate behaviour change in a more robust manner. Chapter 5 is an evaluation of outcome data from a peripatetic PBS service and, for the first time in research, considers statistically meaningful behaviour change (utilising evidence from Chapter 4), quality of life and social validity impacts. Finally, in chapter 6, findings from the four empirical studies are discussed in relation to theoretical implications. Implications for further research and practice in the field of PBS are proposed in chapter 6

Outcomes from a community‐based Positive Behavioural Support team for children and adults with developmental disabilities

Background: Previous evaluations of community PBS teams have not investigated whether behaviour change is both statistically reliable and clinically significant. Few previous studies have reported quality of life (QoL) and social validity outcomes. Method: The present authors collected data on 85 people referred to a specialist PBS team. The present authors used a unique set of multiple measures and statistical change metrics to evaluate outcome. Results: Statistically significant improvements in QoL and health‐related QoL (HRQoL), with medium to large effect sizes, were demonstrated following PBS input. Mean Behaviour Problems Inventory‐Short Form scores reduced from 37.74 (SD = 30.54) at baseline to 12.12 (SD = 12.24) at follow‐up, with a large effect size (d = 0.84). Stakeholders reported valuing the process and outcomes of PBS, findings which support the social validity of PBS for people with developmental disabilities. Conclusion: This study demonstrates successful PBS outcomes in QoL, HRQoL, challenging behaviour and social validity in a community setting

Not such an ordinary life:a comparison of employment, marital status and housing profiles of adults with and without intellectual disabilities

Purpose Having paid work, relationships and a choice of where to live are common policy priorities for adults with intellectual disabilities. The purpose of this paper is to compare outcomes with respect to these three priorities between adults with intellectual disability and the general population in Jersey. Design/methodology/approach Data were collected from 217 adults with intellectual disability known to services, and 2,350 adults without intellectual disability using a stratified random sample. Data on employment, marital status and accommodation profiles were compared. Findings In sum, 87 per cent of adults with intellectual disability were currently single vs 16 per cent of adults without intellectual disability; 23 per cent of working-age adults with intellectual disability were in paid employment vs 92 per cent of working-age adults without intellectual disability; and 57 per cent of adults with intellectual disability lived-in sheltered housing vs 2 per cent of adults without intellectual disability. Social implications Very few adults with intellectual disability are in paid employment or intimate relationships, and the majority live in sheltered, supported housing, with very few owning their own home. There is a significant disconnect between policy and reality. Considerable work is required to make an ordinary life the reality for adults with intellectual disability. Originality/value This study adds to the body of evidence that suggests people with intellectual disabilities are less likely to experience an ordinary life. Furthermore, it illustrates that despite Jersey being an affluent society, the same difficulties and barriers exist there for persons with an intellectual disability as in other jurisdictions

Prevalence of psychotropic medication use and association with challenging behaviour in adults with an intellectual disability:a total population study

Background There is a high prevalence of psychotropic medication use in adults with Intellectual Disabilities (ID), often in the absence of psychiatric disorder, also associated with challenging behaviour. Previous research has focused on specific sample frames or data from primary care providers. There is also a lack of consistency in the definition of challenging behaviour used. Methods We adopted a total population sampling method. Medication data on 265 adults with ID were classified according to the Anatomical Therapeutic Chemical classification system. The Behaviour Problems Inventory – short form classified challenging behaviours. We examined the association between challenging behaviour and the use of psychotropic medication, and whether any association would still be present after accounting for socio-demographic and clinical characteristics. Results 70.57% of adults with ID were prescribed at least one class of any medication (mean per person =2.62; range 0–14). Psychotropic medications were used by 37.73% of participants with antipsychotics the commonest type used by 21.89% of individuals. Polypharmacy and high dosages were common. Generalised Linear Models indicated significant associations between psychotropic medication and the presence of a psychiatric diagnosis, challenging behaviour, older age and type of residence. Male gender was additionally associated with antipsychotic medication. Conclusions The use of a total population sample identified via multiple routes is less likely to overestimate prevalence rates of medication use. Current challenging behaviour was a predictor of medication use after controlling for other variables. Data indicate that there may be differences in prescribing patterns associated with different topographies of challenging behaviours

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

A total population study of challenging behaviour and evaluation of Positive Behavioural Support outcomes

Positive Behavioural Support (PBS) is a multicomponent framework designed to address the multiple factors that influence an individual’s behaviour, with a focus on improving quality of life (Kincaid et al. 2002). PBS, in the UK, has largely been implemented by peripatetic community teams, in developmental disability (DD) services. High prevalence of challenging behaviour in individuals with DD (Jones et al. 2008) is a result of the interaction between vulnerability, environmental and impact factors (Hastings et al. 2013). This thesis will attempt to expand existing knowledge on all three of these aspects in relation to PBS as an intervention model. The thesis begins by presenting a total population study regarding the prevalence of challenging behaviour (chapter 2). This study investigates the associated correlates of challenging behaviour, and is the first study to consider the cumulative association of these correlates and propose ways to measure cumulative risk. Chapter 3 considers an impact of challenging behaviour – the high incidence of psychotropic medication use - and explores prescribing patterns associated with various topographies of challenging behaviour. In chapter 4, population data from the Behaviour Problems Inventory – Short Form (Rojahn et al. 2012) are used to estimate norms, clinically significant change and reliable change statistics. This chapter also provides guidance through examples on how this information can be used in research and clinical practice to enable practitioners to evaluate behaviour change in a more robust manner. Chapter 5 is an evaluation of outcome data from a peripatetic PBS service and, for the first time in research, considers statistically meaningful behaviour change (utilising evidence from Chapter 4), quality of life and social validity impacts. Finally, in chapter 6, findings from the four empirical studies are discussed in relation to theoretical implications. Implications for further research and practice in the field of PBS are proposed in chapter 6

Polypharmacy and psychotropic polypharmacy in adults with intellectual disability:a cross‐sectional total population study

Background Adults with intellectual disability (ID) are prescribed high levels of medication, with polypharmacy and psychotropic polypharmacy common. However, reported rates vary between studies, and there has been an over‐reliance on obtaining data from convenience samples. The objective of this study was to determine the prevalence of medication use and polypharmacy in a population‐level sample of adults with IDs. Factors associated with polypharmacy and psychotropic polypharmacy are explored. Methods We used a total population sample of 217 adults with IDs known to services in Jersey (sampling frame n = 285). The Anatomical Therapeutic Chemical classification system was used to categorise medications that participants were currently taking on a regular basis. We examined associations of polypharmacy and psychotropic polypharmacy with socio‐economic status, health and demographic variables using univariate and multivariate analyses. Results A total of 83.4% of participants were prescribed medication, with high doses common. Of the participants, 38.2% were exposed to polypharmacy while 23% of participants were exposed to psychotropic polypharmacy. After controlling for demographic, health and socio‐economic characteristics, polypharmacy was significantly associated with older age, increased severity of ID, living in a residential setting and having increased comorbidities. Psychotropic polypharmacy was associated with being male, being aged 50+ years and having had a psychiatric diagnosis over the life course. Being prescribed psychotropic drugs above the defined daily dose was not associated with having had a psychiatric diagnosis over the life course, suggesting the possibility of ‘off label’ prescribing. Conclusions Our results indicate that medication use, in high doses, alongside polypharmacy and psychotropic polypharmacy are highly prevalent in adults with ID. The exposure to multiple medications increases the risk of developing adverse drug events, drug–drug interactions and medication‐related problems. Future population‐level, prospective cohort studies should examine the prevalence of polypharmacy and psychotropic polypharmacy using standardised definitions and consider the potential impact of adverse drug events, drug–drug interactions and medication‐related problems in this population

The prevalence of potential drug-drug interactions in adults with intellectual disability

Background There is a high use of medications in adults with intellectual disability (ID). One implication of taking multiple medications is the potential for drug–drug interactions (DDIs). However, despite this being well highlighted in the mainstream literature, little is known about the incidence or associations of DDIs in the ID population. Methods This study describes the prevalence, patterns and associations of potential DDIs in a total administrative sample of adults with ID known to services in Jersey. Demographic, health‐related and medication data were collected from 217 adults known to ID services. Data were collected using a face‐to‐face survey. The Anatomical Therapeutic Chemical classification system was used to categorise medications, and Stockley's Drug Interaction Checker was used to classify potential DDIs. Drug–drug pairings were considered to be of clinical significance if they were to be ‘avoided, adjusted, monitored or required further information’. Results Potential DDIs of clinical significance were common. Exposure to potential DDIs of clinical significance was associated with being female, taking more than five medications (polypharmacy), living in residential care and having more health conditions. A simple regression was used to understand the effect of number of prescribed medications on potential DDIs of clinical significance. Every prescribed drug led to a 0.87 (95% confidence interval: 0.72–1.00) increase in having a potential DDI of clinical significance. Conclusion Adults with ID who live in residential care, who are female, exposed to polypharmacy and have more health conditions may be more likely to have potential DDIs of clinical significance. Urgent consideration needs to be given to the potential of DDIs in this population given their exposure to high levels of medication

The MARS PETCARE BIOBANK protocol: establishing a longitudinal study of health and disease in dogs and cats

Abstract Background The veterinary care of cats and dogs is increasingly embracing innovations first applied to human health, including an increased emphasis on preventative care and precision medicine. Large scale human population biobanks have advanced research in these areas; however, few have been established in veterinary medicine. The MARS PETCARE BIOBANK™ (MPB) is a prospective study that aims to build a longitudinal bank of biological samples, with paired medical and lifestyle data, from 20,000 initially healthy cats and dogs (10,000 / species), recruited through veterinary hospitals over a ten-year period. Here, we describe the MPB protocol and discuss its potential as a platform to increase understanding of why and how diseases develop and how to advance personalised veterinary healthcare. Methods At regular intervals, extensive diet, health and lifestyle information, electronic medical records, clinicopathology and activity data are collected, genotypes, whole genome sequences and faecal metagenomes analysed, and blood, plasma, serum, and faecal samples stored for future research. Discussion Proposed areas for research include the early detection and progression of age-related disease, risk factors for common conditions, the influence of the microbiome on health and disease and, through genome wide association studies, the identification of candidate loci for disease associated genetic variants. Genomic data will be open access and research proposals for access to data and samples will be considered. Over the coming years, the MPB will provide the longitudinal data and systematically collected biological samples required to generate important insights into companion animal health, identifying biomarkers of disease, supporting earlier identification of risk, and enabling individually tailored interventions to manage disease