Adolescent inpatient psychiatric treatment was evaluated from the multiple perspectives of clinicians, young people and parents using standardised measures and goal-based outcomes (GBOs). The sample included cases ( N = 128) discharged from a London adolescent unit between April 2009 and December 2015. Measures were completed at admission and discharge, and change in ratings was analysed to assess treatment outcomes. Ratings of clinicians and young people on the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) were compared. Adolescents demonstrated significant improvement across all measures from admission to discharge. Correlation between clinicians' and adolescents' HoNOSCA ratings was weak at admission ( r = .25) but stronger at discharge ( r = .63). Standardised effect sizes were larger for GBOs ( d = 1.73 and 3.16 for adolescent and clinician-rated goals, respectively) compared to all standardised measures ( d = 0.31-0.93). Improvement was observed across all measures of functioning and symptoms following inpatient treatment. Clinicians and young people developed better shared understanding of the problems from admission to discharge. GBOs are more sensitive to change compared to standardised measures and may be meaningfully adopted by inpatient units for routine outcome monitoring.
Gorham syndrome is a rare disease that presents as progressive osteolysis, and may affect any part of the skeleton. The pathologic process involves the replacement of normal bone by aggressively expanding but non-neoplastic vascular tissue, resulting in massive osteolysis of the adjacent bone. If the spine and ribs are affected, the subsequent kyphosis and chest wall deformity may cause severe restrictive ventilatory impairment. We report a 34-year-old male with Gorham syndrome presenting as progressive kyphosis, severe back pain, unstable gait, and exertional dyspnea. Pulmonary function testing revealed severe restrictive ventilatory impairment. He underwent spinal surgery but could not be extubated after surgery. Postoperative left lower lung pneumonia and respiratory failure required prolonged mechanical ventilation. After a weaning program of pressure support ventilation and T-piece spontaneous breathing trials, he was successfully weaned from mechanical ventilation.
PurposeThis study explored in-service educators' experience of using the Wisconsin Assistive Technology Initiative (WATI) for assistive technology (AT) decision-making within Singapore schools.Design/methodology/approachThe study adopted a qualitative design. Eight educators across both mainstream and special education schools were introduced to the WATI framework which they subsequently employed as a trial experience for a student under their care. Written feedback gathered from participants was analysed to identify common issues and themes regarding the use of the WATI framework for AT decision-making.FindingsThe comprehensive consideration of a broad scope of different factors, provision of a structured process for AT decision-making, as well as a common language for use by different stakeholders emerged as key benefits of implementing the WATI. Challenges encountered include administrative struggles in gathering different stakeholders together, time and resource constraints and difficulties in loaning AT devices for trial use.Practical implicationsBased on educators' feedback, recommendations to facilitate the adoption of the WATI for AT decision-making within Singapore schools are discussed and considered. This study also highlights the need for greater AT instruction within both preservice and in-service teacher preparation programmes in Singapore.Originality/valueSchools in Singapore currently rarely adopt any frameworks in place to guide educators through a systematic process of AT consideration. It is anticipated that this study will spearhead and drive the adoption of systematic frameworks such as the WATI for better AT decision-making within Singapore schools.Peer reviewThe peer review history for this article is available at: https://publons.com/publon 10.1108/JET-03-2021-0015
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