The pica phenomenon, where non-edible substances are repeatedly consumed, has been linked with developmental and behavioural disorders, particularly autism. The clinical presentation of foreign body ingestion in patients with autism is discussed, and recommendations for caregivers are provided based on the available literature. An 18-year-old man with severe autism and behavioural difficulties presented with a vague history of decreased appetite and melaena of eight months duration. Foreign body ingestion commonly occurs in individuals with autism spectrum disorders and should be suspected in patients who present with vague gastrointestinal symptoms. The adverse medical and surgical consequences of foreign body ingestion emphasize the need for early recognition. Surgical intervention for foreign body ingestion can prevent complications. Magnetic substances can cause considerable gastrointestinal morbidity and require urgent endoscopic or surgical removal. Primary prevention is also vital.
Objective This study examined clinicians' views of the roles of two elements of cognitive behavioral therapy (CBT) in explaining treatment outcomes—CBT techniques and the therapeutic alliance. Method Ninety‐eight clinicians who reported delivering CBT for eating disorders completed measures addressing their beliefs about what is effective in CBT, their use of specific techniques, and their own anxiety levels. Results Clinicians substantially overestimated the role of both therapeutic techniques and the alliance in explaining treatment outcomes in CBT. Weak but significant correlations were found between therapist anxiety levels and their beliefs about the value of therapeutic techniques or the alliance. However, these associations were in different directions, with higher levels of clinician anxiety associated with more belief in the effects of the alliance but with less belief in the role of CBT techniques. Belief in the role of the therapeutic alliance was associated with a lower likelihood of encouraging the patient to change their eating pattern, while belief in the role of techniques was linked to greater use of case formulation, cognitive restructuring, behavioral experiments and body image work. Discussion Clinicians overestimate the value of both the alliance and therapy techniques in explaining treatment outcomes in CBT for eating disorders. Their beliefs about the strength of these factors are related to their own anxiety, and to their choice of techniques. Clinicians and supervisors should attend to the evidence regarding the impact of a range of elements of therapy, and work with all of those factors to enhance outcomes.
BackgroundLow back pain (LBP) is the world’s leading cause of disability and yet poorly understood. Cross-national comparisons may motivate hypotheses about outcomes being condition-specific or related to cultural differences and can inform whether observations from one country may be generalised to another. This analysis of data from three cohort studies explored whether characteristics and outcomes differed between LBP patients visiting chiropractors in Sweden, Denmark and the UK.MethodsLBP patients completed a baseline questionnaire and were followed up after 3, 5, 12 and 26 weeks. Outcomes were LBP intensity (0–10 scales) and LBP frequency (0–7 days the previous week). Cohort differences were tested in mixed models accounting for repeated measures. It was investigated if any differences were explained by different baseline characteristics, and interaction terms between baseline factors and nations tested if strength of prognostic factors differed across countries.ResultsThe study sample consisted of 262, 947 and 453 patients from Sweden, Denmark and the UK respectively. Patient characteristics were largely similar across cohorts although some statistically significant differences were observed. The clinical course followed almost identical patterns across nations and small observed differences were not present after adjusting for baseline factors. The associations of LBP intensity and episode duration with outcome differed in strength between countries.ConclusionsChiropractic patients with low back pain had similar characteristics and clinical course across three Northern European countries. It is unlikely that culture have substantially different impacts on the course of LBP in these countries and the results support knowledge transfer between the investigated countries.
Moebius syndrome is a congenital neurological disorder that impacts facial expression, communication and appearance. In this article, the authors will discuss the psychological and social impacts of living with this rare form of facial palsy. Existing research suggests that patients may face challenges in developing psychological wellbeing, positive body image and in communicating effectively with others. Therefore, recommendations for nursing practitioners in how to best support this patient group are discussed.
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