Change processes during intensive day programme treatment for adolescent anorexia nervosa: a dyadic interview analysis of adolescent and parent views.

Background: Day programmes for adolescent anorexia nervosa (AN) can function as an alternative to inpatient admissions and/or an increase in outpatient treatment intensity. Processes of change during treatment for AN are currently poorly understood. This study aimed to explore how adolescents with AN and their parents understood the helpful and unhelpful factors and processes that impacted them during day programme treatment. Method: A critical realist paradigm was used to qualitatively explore the views of 16 participants. Participants were recruited from the Intensive Treatment Programme (ITP) at the Maudsley Center for Child and Adolescent Eating Disorders (MCCAED) at the end of treatment. Dyadic Interview Analysis (DIA) was used to compare and contrast the narratives of the seven adolescent-parent pairs after two inductive reflexive thematic analyses were conducted for the group of eight adolescents and the group of eight parents separately. Results: Eight subthemes across three themes were identified: 1) "Like me she didn't feel so alone anymore"-families connect with staff, peers, and each other; 2) "You have to eat because ITP say so"-the programme provides families with containment through its structure and authority; and 3) "I found that I was using the skills I learnt there like in multiple aspects of my life, not just around food"-families take in new ideas and generalize these into their lives. These interconnected themes generated hope and change. However, helpful elements individually could be unhelpful if one or more of the other factors were missing. For example, staff firmness, which participants often found helpful (theme two), could be experienced as harshness when adolescents did not feel related to as individuals (theme one). Conclusion: The findings can be conceptualized within recent descriptions regarding the therapeutic change, including epistemic trust and mentalization. Treatment characteristics, such as intensity and containment, as well as illness-specific factors and processes, such as control and collaboration, the role of peer support, and the potential for family members to experience the impact of the adolescent's AN and treatment non-response as traumatic, are equally important to consider.

Attention levels in young children who stutter.

The purpose of this study was to determine whether children who stutter (CWS) and children who do not stutter (CWNS) differ in terms of attentional ability. Participants were 40 age- and gender-matched CWS and CWNS (aged between 72 and 120 months). Attentional ability was assessed using the Test of Everyday Attention for Children (TEA-Ch), a clinical assessment battery comprising 13 attentional measures, assessing three areas of attention: selective attention, sustained attention, and attentional switching. A low score on the assessment indicates attentional difficulty. There was an overall tendency for CWS to score lower than CWNS on all 13 TEA-Ch measures and all three attentional abilities. This difference reached statistical significance for the sustained attentional component. The present study provides support for the hypothesis that there are some differences between CWS and CWNS in terms of attentional ability. The findings are interpreted within existing models of attention with regard to previous studies of attention in CWS.

Comparing the performance of people who stutter and people who do not stutter on the Test of Everyday Attention.

INTRODUCTION: Compelling findings into the relationship between stuttering and attentional ability have started to emerge, with some child and adult studies indicating poorer attentional ability among people who stutter (PWS). The purpose of the present research was to provide a more complete picture of the attentional abilities of PWS, as well as to gather insights into their individual attentional performance. METHOD: We compared the attentional ability of PWS to that of people who do not stutter (PWNS) by using the Test of Everyday Attention (TEA). TEA is a clinical assessment battery with a very good validity and reliability comprising 8 subtests that pose differential demands on sustained attention, selective attention, attentional switching, and divided attention. Fifty age- and gender-matched PWS and PWNS (aged 19-77 years) took part in the study. Importantly, we also examined stuttering severity in the PWS group. RESULTS: PWS performed significantly worse on tasks tapping into visual selective and divided attentional resources. Furthermore despite failing to reach statistical significance, the results also revealed an interesting trend for stuttering to be associated with poorer performance on two subtests measuring attentional switching and one tapping into auditory selective attention. Moreover, as hypothesized, there was also a negative association between stuttering severity and performance on two TEA subtests measuring visual selective attention. Finally, the type of TEA test variant produced no significant effect on performance. CONCLUSIONS: We interpret these results as indicative of stuttering being associated with poorer performance on tasks measuring certain attentional abilities. These tie in well with theoretical models identifying speech production as particularly attention-demanding in stuttering or approaches placing attentional dysfunction at the heart of the condition. The present research also has practical implications for the use of attentional training to improve fluency.

The preparedness of newly qualified doctors - Views of Foundation doctors and supervisors.

BACKGROUND: There is evidence that newly qualified doctors do not feel prepared to start work. AIM: This study examined the views of first year Foundation doctors (F1) and supervisors regarding how prepared they felt newly qualified doctors were for the early weeks of work. METHODS: Fifty-two F1s took part in a focus group or individual interview during their first year of Foundation training. Twenty-two supervisors took part in an individual interview. RESULTS: The F1s struggled with new responsibilities, decision-making, time management, prioritizing tasks and the large administrative component to their role. They felt unprepared for making diagnoses, prescribing and acting in an emergency. Supervisors felt F1s were generally well prepared to start work, with skills improving through experience. However, F1s needed more practical experience with real patients and more opportunities to take responsibility, make decisions and perform some clinical skills. Supervisors did not feel that F1s accessed senior support appropriately. F1s indicated they preferred to go to peers for assistance in the first instance, and felt unsupported by seniors, particularly at weekends and on night shifts. CONCLUSIONS: Specific areas of unpreparedness were identified by both F1s and supervisors; leading to recommendations to enhance effective transition from medical student to F1.

Scores on Riley's stuttering severity instrument versions three and four for samples of different length and for different types of speech material.

Riley stated that the minimum speech sample length necessary to compute his stuttering severity estimates was 200 syllables. This was investigated. Procedures supplied for the assessment of readers and non-readers were examined to see whether they give equivalent scores. Recordings of spontaneous speech samples from 23 young children (aged between 2 years 8 months and 6 years 3 months) and 31 older children (aged between 10 years 0 months and 14 years 7 months) were made. Riley's severity estimates were scored on extracts of different lengths. The older children provided spontaneous and read samples, which were scored for severity according to reader and non-reader procedures. Analysis of variance supported the use of 200-syllable-long samples as the minimum necessary for obtaining severity scores. There was no significant difference in SSI-3 scores for the older children when the reader and non-reader procedures were used. Samples that are 200-syllables long are the minimum that is appropriate for obtaining stable Riley's severity scores. The procedural variants provide similar severity scores.

Communication and self-esteem in adults with Down syndrome.

BACKGROUND: It is estimated that around 50-90% of people with learning disabilities experience difficulties in communicating. Previous research has linked communication difficulties and self-esteem in other populations, yet this relationship has not previously been investigated for people with Down syndrome. AIMS: To explore the relationship between communication and self-esteem in adults with Down syndrome. This research also aimed to offer an empowering and inclusive opportunity for adults with learning disabilities to be involved in research. METHODS & PROCEDURES: Recruitment took place via a charity established for people with Down syndrome. Twelve adults with Down syndrome and an adult they nominated were approached. A qualitative methodology was selected to explore communication and self-esteem. A thematic analysis focused on the qualitative data collected via semi-structured interviews. OUTCOMES & RESULTS: Major themes within the data revealed that a relationship between communication and self-esteem may exist for adults with Down syndrome. CONCLUSIONS & IMPLICATION: This study demonstrated that people with Down syndrome may experience low self-esteem that may be linked to communication. The clinical implications of this are considered and areas for future research are identified.

Collaborative project to co-ordinate care for patients with dementia.

Health leaders from across Suffolk joined together in a collaborative action-learning project to identify ways of offering more productive and personalised care for patients with dementia and their carers. The project revealed a range of factors necessary for success, notably professional collaboration and effective facilitation. The outcome was a range of evidenced-based recommendations to improve care and efficiency, as well as ensuring that the quality, innovation, productivity and prevention (QIPP) agenda was met. The lessons can be applied not just in dementia care, but to other long-term and complex care situations.