An experimental investigation of obstacle perception and its relationship to personality and intellectual factors

Thesis (Ed.M.)--Boston Universit

Role Emerging Placements in Physiotherapy: Student Experiences and Practical Considerations

Purpose Physiotherapists work in increasingly diverse areas of practice across both health and social care sectors. Consequently, education providers are being urged to ensure students graduate with the necessary skills to work flexibly in a range of environments in both traditional and emerging roles (1). Role emerging placements (REPs) – i.e. those conducted in settings where there may be little or no existing therapy provision – are commonly used within occupational therapy (OT) to help prepare students for contemporary practice by providing opportunities to improve their problem-solving skills, leadership and autonomy through development of their own professional role (2). There is, however, little published literature on the use of REPs in Physiotherapy. This poster will consider the practicalities and student experiences of REPs in Physiotherapy (3). Method Staff collaborated with OT colleagues to develop REPs with local partners who had identified a need for Physiotherapy. REPs were allocated to a selection of 2nd year and 3rd year students. Students were supported on a daily basis by an onsite-supervisor, and a qualified clinician provided off-site or ‘long-armed’ supervision to help students draw on their knowledge of theory to develop their own role. Students who had undertaken a REP were invited to take part in a focus group, which used a research informed semi-structured topic guide to explore their experiences (3). Six participants volunteered to take part. Group discussions were digitally recorded, professionally transcribed verbatim and thematically analysed. Ethical approval was gained from the University of Worcester. University staff who had been involved in establishing REPs were asked to share their experiences regarding the practicalities of successfully implementing REPs. Results Students completed REPs in a range of settings including; residential and nursing homes, learning disabilities, neurological charities and mental health. REPs require careful planning and preparation and all parties require ongoing support. Thematic analysis of the focus group data revealed five main themes: (1) Establishing a Physiotherapy Role Independently; (2) Finding a Voice and Influencing Change; (3) Developing Professional Identity; (4) Professional Development and (5) Support. The findings highlighted the variability of student experiences in REP settings, however, all appeared to result in professional and personal benefits for the students, through promoting graduate skills that may be attractive to employers. Conclusion REPs appear to offer a non-traditional developmental learning opportunity where physiotherapy students can develop the skills required to deal with change and adapt to new roles. Students reported both positive and negative experiences, but most students felt the REPs had resulted in a number of professional and personal benefits. Adequate time and resources are required to ensure all parties are prepared and supported. Implications REPs have the potential to both increase placement capacity and equip students with the skills to deal with a changing healthcare environment. However, it is important to publicize both the challenges and benefits associated with this placement model. Successful REPs require careful planning and provision of adequate support mechanisms. Development of good practice CSP guidelines would help to facilitate wider use of REPs and educate the profession on their value

Inequalities in the dental health needs and access to dental services among looked after children in Scotland: a population data linkage study

Background: There is limited evidence on the health needs and service access among children and young people who are looked after by the state. The aim of this study was to compare dental treatment needs and access to dental services (as an exemplar of wider health and well-being concerns) among children and young people who are looked after with the general child population. Methods: Population data linkage study utilising national datasets of social work referrals for ‘looked after’ placements, the Scottish census of children in local authority schools, and national health service’s dental health and service datasets. Results: 633 204 children in publicly funded schools in Scotland during the academic year 2011/2012, of whom 10 927 (1.7%) were known to be looked after during that or a previous year (from 2007–2008). The children in the looked after children (LAC) group were more likely to have urgent dental treatment need at 5 years of age: 23%vs10% (n=209/16533), adjusted (for age, sex and area socioeconomic deprivation) OR 2.65 (95% CI 2.30 to 3.05); were less likely to attend a dentist regularly: 51%vs63% (n=5519/388934), 0.55 (0.53 to 0.58) and more likely to have teeth extracted under general anaesthesia: 9%vs5% (n=967/30253), 1.91 (1.78 to 2.04). Conclusions: LAC are more likely to have dental treatment needs and less likely to access dental services even when accounting for sociodemographic factors. Greater efforts are required to integrate child social and healthcare for LAC and to develop preventive care pathways on entering and throughout their time in the care system

On a learning curve for shared decision making: interviews with clinicians using the knee osteoarthritis Option Grid

Rational: Tools used in clinical encounters to illustrate to patients the risks and benefits of treatment options have been shown to increase shared decision making. However, we do not have good information about how these tools are viewed by clinicians, and how clinicians think patients would react to their use. Objective: Our aim was to examine clinicians’ views about the possible and actual use of tools designed to support patients and clinicians to collaborate and deliberate about treatment options, namely Option Grid TM decision aids. Method: We conducted a thematic analysis of qualitative interviews embedded in the intervention phase of a trial of an Option Grid decision aid for Osteoarthritis of the knee. Interviews were conducted with six participating clinicians before they used the tool, and again after clinicians had used the tool with six patients. Results: In the first interview, clinicians voiced concern that the tool would lead to an increase in encounter duration, to patient resistance regarding involvement in decision making, and potential information overload. At the second interview, after minimal training, the clinicians reported that the tool had changed their usual way of communicating, and it was generally acceptable and helpful integrate it into practice. Discussion and Conclusions: After experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow and clinical pathways

Patients' views on the use of an Option Grid for knee osteoarthritis in physiotherapy clinical encounters: an interview study

Background: Patient decision support tools have been developed as a means of providing accurate and accessible information in order for patients to make informed decisions about their care. Option GridsTM are a type of decision support tool specifically designed to be used during clinical encounters. Objective: To explore patients’ views of the Option Grid encounter tool used in clinical consultations with physiotherapists, in comparison to usual care, within a patient population who are likely to be disadvantaged by age and low health literacy. Methods: Semi-structured interviews with 72 patients (36 who had been given an Option Grid in their consultation and 36 who had not). Thematic analysis explored patients’ understanding of treatment options, perceptions of involvement, and readability and utility of the Option Grid. Results: Interviews suggested that the Option Grids facilitated more detailed discussion about the risks and benefits of a wider range of treatment options for osteoarthritis of the knee. Participants indicated that the Option Grid was clear and aided their understanding of a structured progression of the options as their condition advanced, although it was not clear whether the option grid facilitated greater engagement in shared decision making. Discussion and Conclusion: The Option Grid for osteoarthritis of the knee was well received by patient participants who reported that it helped them to understand their options, and made the notion of choice explicit. Use of Option Grids should be considered within routine consultations

Adverse childhood experiences and sources of childhood resilience:a retrospective study of their combined relationships with child health and educational attendance

Abstract Background Adverse childhood experiences (ACEs) including maltreatment and exposure to household stressors can impact the health of children. Community factors that provide support, friendship and opportunities for development may build children’s resilience and protect them against some harmful impacts of ACEs. We examine if a history of ACEs is associated with poor childhood health and school attendance and the extent to which such outcomes are counteracted by community resilience assets. Methods A national (Wales) cross-sectional retrospective survey (n = 2452) using a stratified random probability sampling methodology and including a boost sample (n = 471) of Welsh speakers. Data collection used face-to-face interviews at participants’ places of residence. Outcome measures were self-reported poor childhood health, specific conditions (asthma, allergies, headaches, digestive disorders) and school absenteeism. Results Prevalence of each common childhood condition, poor childhood health and school absenteeism increased with number of ACEs reported. Childhood community resilience assets (being treated fairly, supportive childhood friends, being given opportunities to use your abilities, access to a trusted adult and having someone to look up to) were independently linked to better outcomes. In those with ≥4 ACEs the presence of all significant resilience assets (vs none) reduced adjusted prevalence of poor childhood health from 59.8 to 21.3%. Conclusions Better prevention of ACEs through the combined actions of public services may reduce levels of common childhood conditions, improve school attendance and help alleviate pressures on public services. Whilst the eradication of ACEs remains unlikely, actions to strengthen community resilience assets may partially offset their immediate harms

A Cross-sectional Examination of the Clinical Significance of Autistic Traits in Individuals Experiencing a First Episode of Psychosis

Autism traits are found at elevated rates in individuals with schizophrenia spectrum disorders, however, there is a lack of evidence regarding potential clinical impact. The current research aimed to examine potential associations between autism traits and symptoms of psychosis, social and role functioning, and quality of life. 99 individuals experiencing a first episode of psychosis took part in a cross-sectional interview and self-report questionnaire which assessed current symptoms of psychosis, autism traits, functioning, and quality of life. Participants were found to have a high level of autism traits. Higher autism traits were associated with poorer quality of life, functioning, and current psychotic symptoms. Receiver operating characteristic curve (ROC) analyses indicated that optimal AQ cut-off scores to predict severity of psychosis symptoms, functioning, and quality of life were lower than those used to suggest likely autism-spectrum diagnosis. Results suggest that autism traits are associated with poorer clinical presentation in first-episode psychosis populations, even in those whose traits fall below potentially diagnostic thresholds for autism. Psychosis services should be prepared to adequately address the needs of individuals with higher autism traits

Autism and psychosis: Clinical implications for depression and suicide

There is increasing recognition of the co-occurrence of autism and schizophrenia spectrum disorders. However, the clinical significance of this on outcomes such as depression and suicidal thinking has not been explored. This study examines the association of autism spectrum traits, depressive symptoms and suicidal behaviour in individuals with psychotic experiences. In two cross sectional studies, individuals from a non-help seeking university student sample and patients with first episode psychosis (FEP) service completed standardized measures of autism spectrum traits, psychotic experiences, depressive symptoms and suicidal thinking. In healthy non-help seeking students, increased autism traits and increased subclinical psychotic experiences were significantly associated with depressive symptoms; a significant interaction effect suggests their combined presence has a greater impact on depression. In FEP, high autism traits and positive symptoms were associated with increased depression, hopelessness and suicidality, however there was no significant interaction effect. In FEP a multiple mediation model revealed that the relationship between autism traits and risk for suicidality was mediated through hopelessness. Young people with subclinical psychotic experiences and all patients with FEP should be screened for autism spectrum traits, which may have significant impact on clinical outcomes. Tailored interventions for patients with high levels of autistic spectrum co-morbidities in FEP should be a priority for future research

Who Meets Whom: Access and Lobbying During the Coalition Years

In 2010, the incoming Coalition government announced that it would publish details of meetings between ministers and outside interests. We have collated and coded these data and, in this article, describe patterns of access between 2010 and 2015. In some respects, access is notably fragmented. No single organisation attends more than 2.5% of the 6292 meetings held by ministers. On the contrary, business, collectively, attends fully 45% of all meetings: more than twice the share of any other category of organisation. We also find evidence of distinctive policy communities characterised by high levels of access between particular interests and ministers within specific departments

A Repeated Measures Experiment of Green Exercise to Improve Self-Esteem in UK School Children

Exercising in natural, green environments creates greater improvements in adult's self-esteem than exercise undertaken in urban or indoor settings. No comparable data are available for children. The aim of this study was to determine whether so called 'green exercise' affected changes in self-esteem; enjoyment and perceived exertion in children differently to urban exercise. We assessed cardiorespiratory fitness (20 m shuttle-run) and self-reported physical activity (PAQ-A) in 11 and 12 year olds (n = 75). Each pupil completed two 1.5 mile timed runs, one in an urban and another in a rural environment. Trials were completed one week apart during scheduled physical education lessons allocated using a repeated measures design. Self-esteem was measured before and after each trial, ratings of perceived exertion (RPE) and enjoyment were assessed after completing each trial. We found a significant main effect (F (1,74), = 12.2, p<0.001), for the increase in self-esteem following exercise but there was no condition by exercise interaction (F (1,74), = 0.13, p = 0.72). There were no significant differences in perceived exertion or enjoyment between conditions. There was a negative correlation (r = -0.26, p = 0.04) between habitual physical activity and RPE during the control condition, which was not evident in the green exercise condition (r = -0.07, p = 0.55). Contrary to previous studies in adults, green exercise did not produce significantly greater increases in self-esteem than the urban exercise condition. Green exercise was enjoyed more equally by children with differing levels of habitual physical activity and has the potential to engage less active children in exercise. © 2013 Reed et al