Adaptation of Parents Raising a Child with ASD: The Role of Positive Perceptions, Coping, Self-efficacy, and Social Support.

This study explored the adaptation of parents raising a child with an Autism Spectrum Disorder (ASD) specifically the contributory role of positive perceptions, coping, self-efficacy, and social support. One hundred and thirty-six parents of children with a diagnosis of ASD completed a battery of self-report questionnaires via an online survey. Using multiple regression analyses positive perceptions, adaptive coping, self-efficacy, and social support were each a significant contributor to one or more positive adaptation outcomes. Multiple moderated regression analysis found no evidence that these factors were significant moderators between behavioural problems and parental adaptation. The implications of these findings in supporting parents raising a child with ASD are outlined.

'Possible shunt malfunction' pathway for paediatric hydrocephalus-a study of clinical outcomes and cost implications.

BACKGROUND: Shunt insertion for hydrocephalus is a common paediatric neurosurgery procedure. Shunt complications are frequent with an estimated 20-40% failure rate within the first year, and 4.5% per year subsequently. We have an open-door 'possible shunt malfunction' pathway for children treated with a shunt or endoscopic third ventriculostomy, providing direct ward access to ensure rapid assessment and timely management of children. OBJECTIVE: To audit the 'possible shunt malfunction' pathway in terms of clinical outcomes (percentage-confirmed shunt dysfunction and number of re-attendances) and costs. METHODS: Clinical data for patients attending the triage service were prospectively recorded over 7 months-including the number of attendances, previous shunt revisions, shunt type, investigations performed (CT, x-rays), and outcome. Costings (e.g. costs of physician, inpatient stay, investigations) were obtained from the hospital's procurement department. RESULTS: In the study period, there were 81 attendances by 62 patients and only 16% of attendances resulted in surgical management (either shunt revision or ETV). Approximately 17% of patients re-attended at least once. The average cost per attendance in our pathway was £765.57 ($969.63; €858.73). The total expenditure for the pathway over 7 months was £62,011.03 ($78,540.07; €69,556.81), with inpatient stay making up the biggest percentage of cost (49.2%). CONCLUSION: Only 16% (13 attendances) of those attending through our pathway required neurosurgical intervention. Investigations for possible blocked shunt come at significant health, social, and financial cost. High rates of shunt failure, re-attendance, investigations, and inpatient stays incur a sizable financial burden to the healthcare system.

Outcomes of rapid identification for gram-positive bacteremia in combination with antibiotic stewardship at a community-based hospital system.

BACKGROUND: Rapid diagnostics for bloodstream infections have been shown to improve outcomes. Most studies have focused on rapid diagnostics for a single pathogen and have been conducted in academic medical centers. The Verigene Gram-Positive Blood Culture Test (BC-GP) identifies 12 gram-positive organisms and 3 genetic markers of antibiotic resistance from positive blood culture media in 2.5 hours. This study evaluates implementation of the Verigene BC-GP panel in combination with real-time support from the Antibiotic Stewardship Team (AST) in a community hospital system. METHODS: This multicenter, pre-post, quasi-experimental study was conducted at the five hospitals that compose Scripps Healthcare. Rapid diagnostic testing was performed at a central laboratory from 7 a.m.-7 p.m. Pharmacists notified physicians of results and assisted with antibiotic modifications. The primary outcomes were average time to targeted antibiotic therapy and difference in antibiotic duration for contaminants. Secondary end points included hospital length of stay, mortality, pharmacy costs, and overall hospitalization costs. Adult patients with a gram-positive bacteremia admitted in 2011 (pre-rapid testing) were compared with those admitted in 2014 (post-rapid testing). RESULTS: There were 103 patients in the preintervention group and 64 patients in the intervention group. The optimized identification process, combined with AST intervention, improved mean time to targeted antibiotic therapy (61.1 vs 35.4 hrs, p<0.001) and decreased mean duration of antibiotic therapy for blood culture contaminants (42.3 vs 24.5 hrs, p=0.03). Median length of stay (9.1 vs 7.2 days, p=0.04) and overall median hospitalization costs ($17,530 vs $10,290, p=0.04) were lower in the intervention group. Mortality was similar between groups (9.1% vs 9.2%, p=0.98). CONCLUSION: Rapid identification of gram-positive blood cultures with AST intervention decreased time to targeted antibiotic therapy, length of unnecessary antibiotic therapy for blood culture contaminants, length of stay, and overall hospital costs.

Split-thickness skin graft donor site management: a randomized controlled trial comparing polyurethane with calcium alginate dressings.

Split-thickness skin grafting (SSG) is a common reconstructive technique for the treatment of patients with deep burns and other traumatic injuries. The management of the donor site after harvesting an SSG remains controversial because of a variety of dressings available for use. The aim of this randomized controlled trial was to compare the effectiveness of a polyurethane dressing, Allevyn™, to a calcium alginate, Kaltostat®. From August 2009 to April 2010, 36 patients were randomized to Allevyn™ or Kaltostat® for donor site management following split skin graft surgery. Pain intensity and adverse events were the primary outcomes assessed. Secondary outcome measures included time for wound healing, ease of application and removal and overall patient satisfaction. Time to first dressing change was earlier in those randomized to Allevyn™ compared with Kaltostat® (5·5 days versus 8·11 days, P = 0·014). In patients randomized to Allevyn™, excessive exudate lead to a significantly increased number of dressing changes before day 10 (14 days versus 7 days, P = 0·018). The total number of dressing changes applied was also greater in those with Allevyn™ compared with Kaltstat® (P = 0·007). There were no significant differences between the two treatment groups with respect to time to wound healing, level of pain intensity, length of stay, staff and patient satisfaction levels. This trial showed Allevyn™ to be associated with increase demands on nursing time, increased cost of dressing products, medical consumables and wastes. Kaltostat® remains the dressing of choice for initial donor site dressing in this burns unit.

Gender, social background and sexual attitudes among Chinese students.

Chinese society is changing rapidly. As a result of the political and economic reforms of the 'socialist market economy', for example, people have more choices than before. To examine current attitudes to sexual behaviour and marriage, 1100 university students from different parts of China were asked to talk about their views on marriage and choosing a marriage partner, and to describe their own sexual behaviours. Views about 'male superiority' in marriage, for age, education and height persisted, especially for women. Overall, attitudes to sexual behaviours were less open then in the West. However, young people from the cities with educated/professional parents showed more liberal attitudes than those from rural backgrounds. While some attitudes are changing, evidence concerning behaviour change is not so clear. There are important implications for the HIV/AIDS awareness programmes and sex education.

Mental health nurses' experiences of schizophrenia rehabilitation in China and India: a preliminary study.

Nursing methods based on Western models may not be culturally relevant to patients from ethnic minority groups or other countries. In order to meet the needs of all patients, more research is needed to understand the cultural and social factors that influence nursing approaches. This paper reports preliminary open-ended discussions with mental health nurses in China and India in order to gain insights into the cultural and social issues that surround social rehabilitation of patients with schizophrenia. Rehabilitation methods included cognitive behavioural therapy, psychosocial methods, and employment/vocational training. Several cultural and social issues drive the rehabilitation process in both countries, including the use of traditional medicine and healers, emphasis on family involvement, stigma, gender inequality, and lack of resources. Participants in both countries were working hard to tackle some of these issues, but also expressed need for improved resources. The study provides an insight into the cultural and social factors that shape schizophrenia rehabilitation in China and India, and serves as a baseline for further research about nursing across cultures. The study also highlights the marked differences in attitudes, values, and behaviours across cultural groups that need to be considered by nursing professionals to ensure that services are culturally competent.

The influence of environmental enrichment on Chinese visitor behavior.

Welfare improvements for nonhuman animals should aim to satisfy the needs of visitors as well as those of the animals. Little research has been conducted, however, and existing work is confined to zoos in developed countries. This article reports the behavioral responses of Chinese visitors to environmental enrichment improvements in a zoo enclosure. Visit, viewing, and stopping behaviors significantly increased at the transformed exhibit, indicating that it provoked greater visitor interest. Furthermore, increased intragroup behaviors suggested that the exhibit probably motivated visitors to interact socially. The positive impact of the exhibit changes supports the enrichment efforts taking place in zoos around the world. The changes also provide encouragement for zoos in developing countries such as China because greater visitor interest provides a strong argument and an incentive for improving welfare standards.

Cultural effects on the expression of some fears by Chinese and British female students.

To compare the culturally acquired aspects of fears in two different cultures, the author gave an augmented version of the I. M. Marks and A. M. Mathews Fear Scale (1979) to 50 female students in China and 49 female students in England. When the rank ordering of the fears measured in both groups was compared, the author found a high positive correlation, suggesting cross-cultural consistencies in the ranking of fearful objects. Both groups most feared social criticism and appraisal by others, followed by fears of blood, pain, and injury. The students feared least aspects related to agoraphobia. When the expressed levels of fear were compared, the Chinese students had significantly lower fear scores for many items. The reasons for those scores are discussed in terms of lower actual fear levels, moderating response sets, or socialization practices. The fears that showed no cultural differences were the ones that had early biologically relevance, such as fear of the dark and of high places. Only the socially learned fears showed cultural differences.

An introduction to Chinese psychology--its historical roots until the present day.

In this article the authors review the historical development of Chinese psychology. China's long history as a country immersed in the study of psychological issues is well known and has had an influence on developments in the field of psychology around the world. Modern Chinese psychology, however, was imported from the West and the Soviet Union and has been closely linked with China's social environment and changes of national policy. Today Chinese psychology is still in a preliminary stage. Despite difficulties that may impede its future development, the importance of psychology in the modernization of China has been widely recognized.