Exploration of Occupational Therapy Practice for Children with Autism Spectrum Disorders in the Dominican Republic

Background: To better understand the current practice trends of ASD treatment globally and promote practitioner collaboration, it is important to complete studies in countries where little is known about the diagnosis and treatment of ASD through an occupational lens. The aim of this study was to gain an insight into how occupational therapists in the Dominican Republic evaluate and treat children diagnosed with ASD. Method: This qualitative descriptive study explored the perception of occupational therapists (n = 6) and caregivers of children with ASD (n = 28) through a questionnaire and focus group. Interview transcripts and questionnaire text were analyzed using thematic analysis. Trustworthiness was established through member checking, an audit trail, triangulation, reflexivity, and a thick description. Results: Three themes emerged: caregiver ability to access quality services, importance of caregiver involvement in the treatment process, and value of client-centered care. Conclusion: Promoting cultural humility, which focuses on continuous critical self-reflection and lifelong learning, can lead to improved outcomes for this population from initial diagnosis to the overall treatment process

Bundling Payment Initiatives for Total Hip and Knee Arthroplasties: Perspectives of Health Care Professionals

Background: A broad qualitative research study explored the perceptions of rehabilitation health care professionals and administrative leadership on coordination of care for rehabilitation patients who received hip or knee arthroplasties under the bundling initiative. Method: Data was collected through the conduction of a focus group, email communication, and individual phone interviews. Researchers analyzed data collected from five administrative personnel and eight rehabilitation health care professionals who work in a facility that participates in a bundling initiative payment model. Results: Four major themes were identified: importance of care coordination, increased efficiency and effectiveness, establishing protocols, and challenges of bundling payment. Conclusion: These findings indicate the significance of interprofessional collaboration and communication, establishment of patient autonomy, and adherence to rehabilitation protocols with hip or knee arthroplasties

Exploring maintenance of physical activity behaviour change among people living with and beyond gastrointestinal cancer: a cross-sectional qualitative study and typology.

OBJECTIVES: In the last decade, there has been a rapid expansion of physical activity (PA) promotion programmes and interventions targeting people living with and beyond cancer (LWBC). The impact that these initiatives have on long-term maintenance of PA remains under-researched. This study sought to explore the experiences of participants in order to characterise those who have and have not successfully sustained increases in PA following participation in a PA intervention after a diagnosis of gastrointestinal (GI) cancer, and identify barriers and facilitators of this behaviour. DESIGN: Cross-sectional qualitative study. Semi-structured interviews with participants who had previously taken part in a PA programme in the UK, explored current and past PA behaviour and factors that promoted or inhibited regular PA participation. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Themes and subthemes were identified. Differences between individuals were recognised and a typology of PA engagement was developed. PARTICIPANTS: Twenty-seven individuals (n=15 male, mean age=66.3 years) with a diagnosis of GI cancer who had participated in one of four interventions designed to encourage PA participation. SETTING: UK. RESULTS: Seven themes were identified: disease processes, the role of ageing, emotion and psychological well-being, incorporating PA into everyday life, social interaction, support and self-monitoring and competing demands. A typology with three types describing long-term PA engagement was generated: (1) maintained PA, (2) intermittent PA, (3) low activity. Findings indicate that identifying an enjoyable activity that is appropriate to an individual's level of physical functioning and is highly valued is key to supporting long-term PA engagement. CONCLUSION: The typology described here can be used to guide stratified and personalised intervention development and support sustained PA engagement by people LWBC

Prevalence of serum N-methyl-D-aspartate receptor autoantibodies in refractory psychosis

N-methyl-d-aspartate receptor (NMDA-R) autoantibodies have been reported in people with acute psychosis. We hypothesised that their presence may be implicated in the aetiology of treatment-refractory psychosis. We sought to ascertain the point prevalence of NMDA-R antibody positivity in patients referred to services for treatment-refractory psychosis. We found that 3 (7.0%) of 43 individuals had low positive NMDA-R antibody titres. This suggests that NMDA-R autoantibodies are unlikely to account for a large proportion of treatment-refractory psychosis

Brain-relevant antibodies in first-episode psychosis:a matched case–control study

BACKGROUND: There has been much recent excitement about the possibility that some cases of psychosis may be wholly due to brain-reactive antibodies, with antibodies to N-methyl-D-aspartate receptor (NMDAR) and the voltage-gated potassium channel (VGKC)-complex reported in a few patients with first-episode psychosis (FEP). METHODS: Participants were recruited from psychiatric services in South London, UK, from 2009 to 2011 as part of the Genetics and Psychosis study. We conducted a case-control study to examine NMDAR and VGKC-complex antibody levels and rates of antibody positivity in 96 patients presenting with FEP and 98 controls matched for age and sex. Leucine-rich glioma inactiviated-1 (LGI1) and contactin-associated protein (CASPR) antibodies were also measured. Notably, patients with suspicion of organic disease were excluded. RESULTS: VGKC-complex antibodies were found in both cases (n = 3) and controls (n = 2). NMDAR antibody positivity was seen in one case and one control. Either LGI1-Abs or CASPR2-Abs were found in three cases and three controls. Neuronal antibody staining, consistent with the above results or indicating potential novel antigens, was overall positive in four patients but also in six controls. Overall, antibody positivity was at low levels only and not higher in cases than in controls. CONCLUSIONS: This case-control study of the prevalence of antibodies in FEP does not provide evidence to support the hypothesis that FEP is associated with an immune-mediated process in a subgroup of patients. Nevertheless, as other bio-clinical factors may influence the effect of such antibodies in a given individual, and patients with organic neurological disease may be misdiagnosed as FEP, the field requires more research to put these findings in context.</p

Exploring maintenance of physical activity behaviour change among people living with and beyond gastrointestinal cancer: a cross-sectional qualitative study and typology

Objectives: in the last decade there has been a rapid expansion of physical activity (PA) promotion programmes and interventions targeting people living with and beyond cancer. The impact that these initiatives have on long-term maintenance of PA remains under-researched. This study sought to explore the experiences of participants in order to characterise those who have and have not successfully sustained increases in PA following participation in a PA intervention after a diagnosis of gastrointestinal cancer, and identify barriers and facilitators of this behaviour. Design: cross-sectional qualitative study. Semi-structured interviews with participants who had previously taken part in a physical activity program in the UK explored current and past PA behaviour and factors that promoted or inhibited regular PA participation. Interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Themes and sub-themes were identified. Differences between individuals were recognised and a typology of PA engagement was developed.Participants: twenty-seven individuals (N = 15 male, mean age = 66.3 years) with a diagnosis of GI cancer who had participated in one of four interventions designed to encourage PA participation. Setting: United Kingdom.Results: seven themes were identified: disease processes, the role of ageing, emotion and psychological well-being, incorporating PA into everyday life, social interaction, support and self-monitoring and competing demands. A typology with three types describing long-term PA engagement was generated 1) maintained PA, 2) intermittent PA, 3) low activity. Findings indicate that identifying an enjoyable activity that is appropriate to an individual’s level of physical functioning and is highly valued is key to supporting long-term PA engagement. Conclusion: the typology described here can be used to guide stratified and personalised intervention development and support sustained PA engagement by people living with and beyond cancer. <br/