Examining the impact of a city-wide intensive interaction staff training program for adults with profound and multiple learning disability: a mixed methods evaluation

PURPOSE: Intensive interaction is used to increase communication in people at a pre-verbal stage of communication development. The aim of the study was to evaluate a city-wide implementation of intensive interaction training to care staff by investigating how staff use intensive interaction with adults with profound and multiple learning disability, and their perceived impact of intensive interaction on these service users. METHOD: In phase 1, a survey investigated the outcomes of intensive interaction training on the work practices of staff supporting people with profound and multiple learning disability. In phase 2, individual interviews were conducted with staff to further investigate these experiences and perceptions. Interviews were analyzed using thematic analysis. RESULTS: Almost all of the participants (96%) reported using intensive interaction at work with 76% wanting to use intensive interaction with more people. Factors preventing staff from using Intensive Interaction were highlighted. Three over-arching themes were identified from the interviews; the impact of Intensive Interaction; facilitating the implementation of Intensive Interaction and; the organizational support and barriers to the implementation of Intensive Interaction. CONCLUSIONS: Training in intensive interaction at a city-wide level enables staff to develop their knowledge of the approach and to engage in intensive interaction to promote the social inclusion of adults with profound and multiple learning disability. The barriers preventing staff from engaging in Intensive Interaction with adults with profound and multiple learning disability should be addressed. Implications for Rehabilitation Training care staff in intensive interaction promotes social inclusion for adults with profound and multiple learning disability. Care staff are able to identify changes in the interactive and communicative behaviors of adults with profound and multiple learning disability. Care staff perceive they are able to facilitate changes in the interactive and communicative behaviors of adults with profound and multiple learning disability. Care staff need continued support and training to sustain their use of Intensive Interaction with adults with profound and multiple learning disability. Services need to reduce the barriers of staffing, management and organizational structure to enable care staff to sustain their use of Intensive Interaction for adults with profound and multiple learning disability

Influence of lip closure on alveolar cleft width in patients with cleft lip and palate

<p>Abstract</p> <p>Background</p> <p>The influence of surgery on growth and stability after treatment in patients with cleft lip and palate are topics still under discussion. The aim of the present study was to investigate the influence of early lip closure on the width of the alveolar cleft using dental casts.</p> <p>Methods</p> <p>A total of 44 clefts were investigated using plaster casts, 30 unilateral and 7 bilateral clefts. All infants received a passive molding plate a few days after birth. The age at the time of closure of the lip was 2.1 month in average (range 1-6 months). Plaster casts were obtained at the following stages: shortly after birth, prior to lip closure, prior to soft palate closure. We determined the width of the alveolar cleft before lip closure and prior to soft palate closure measuring the alveolar cleft width from the most lateral point of the premaxilla/anterior segment to the most medial point of the smaller segment.</p> <p>Results</p> <p>After lip closure 15 clefts presented with a width of 0 mm, meaning that the mucosa of the segments was almost touching one another. 19 clefts showed a width of up to 2 mm and 10 clefts were still over 2 mm wide. This means a reduction of 0% in 5 clefts, of 1-50% in 6 clefts, of 51-99% in 19 clefts, and of 100% in 14 clefts.</p> <p>Conclusions</p> <p>Early lip closure reduces alveolar cleft width. In most cases our aim of a remaining cleft width of 2 mm or less can be achieved. These are promising conditions for primary alveolar bone grafting to restore the dental bony arch.</p

Outcome analysis in patients with primary necrotizing fasciitis of the male genitalia.

OBJECTIVES: To characterize patients with primary necrotizing fasciitis of the male genitalia (Fournier\u27s gangrene) and to identify risk factors and prognostic variables of survival. METHODS: Fifty consecutive patients with primary necrotizing fasciitis of the male genitalia treated at our institution during a 15-year period between 1984 and 1998 were retrospectively analyzed. Of these patients, 44 (88.0%) were found to be eligible for analysis of the outcome parameters. Univariate survival analysis was performed using the Kaplan-Meier algorithm followed by multivariate analysis of statistically significant variables. Six patients (12.0%) who were severely immunocompromised were studied separately. RESULTS: Medical comorbidities were prevalent, with diabetes being the most common condition (50%). The overall mortality rate was 20% (10 of 50). Three statistically significant predictors of outcome were identified among the variables analyzed. These were the extent of the infection (P = 0.0262), the depth of the necrotizing infection (P = 0.0107), and treatment with hyperbaric oxygen (P = 0.0115). Multivariate regression analysis of these variables identified the extent of the infection (P = 0.0234) as the only statistically significant, independent predictor of outcome in the presence of other covariables. CONCLUSIONS: The involved body surface area appears to be the most important prognostic variable, with a significant impact on outcome. Given the high mortality of the disease entity and a trend toward the improved survival of patients receiving hyperbaric oxygen, this treatment form appears indicated in more severe cases. Immunocompromised patients, who frequently have an atypical and fulminant clinical course, appear to constitute a separate group with a dismal prognosis