Trichotillomania in an Autistic Spectum Disroder: Single Case Intervention

The following work addresses trichotillomania and dermatillomania, both symptoms of the impulses control, in a 11 years old girl, who courses the sixth grade in a private elementary school and with a diagnose of first degree autism spectrum disorder and Attention Deficit Hyperactivity Disorder (ADHD) as a comorbidity. The objective was to reduce the frequency of tearing her hair and the skin imperfections in the school context throughout an intervention based on cognitive behavioral techniques. Within the used methodology to analyze the case an exhaustive evaluation of the patient has been performed using grade observation records, before and during the intervention period in order to systematize the whole process. The intervention techniques used where Token Economy and self-instruction. The results show a progressive improvement of the symptoms, reflected in the diminish of frequency of the behaviors registered that were conducted. In spite of the limited time for the intervention for these kinds of behaviors and the base line phase, it was possible to get to know the girl well and establish bonds with her, in spite of her condition, which can be noted in a better adaptation on her school context. This work seeks to favor the increase of research on this disorder since there is information related on the etiological factors, but it still is not enough, likewise, the related information on these disorders and its possible comorbidities is useful to continue with the advance on the treatments in this area.

Minimally invasive endoscopic approach to perform complete coccygectomy in patients with chronic refractory coccydynia: illustrative case

BACKGROUND Coccydynia refers to debilitating pain in the coccygeal region of the spine. Treatment strategies range from conservative measures (e.g., ergonomic adaptations, physical therapy, nerve block injections) to partial or complete removal of the coccyx (coccygectomy). Because the surgical intervention is situated in a high-pressure location close to the anus, a possible complication is the formation of sacral pressure ulcers and infection at the incision site. OBSERVATIONS In this case report, the authors presented a minimally invasive, fully endoscopic approach to safely perform complete coccygectomy for treatment of refractory posttraumatic coccydynia. LESSONS Although this is a single case report, the authors hope that this novel endoscopic approach may achieve improved wound healing, reduced infection rates, and lower risk of penetration injury to retroperitoneal organs in patients requiring coccygectomy.

Management of Comminuited Intra/Juxta Articular Fracture of Distal Radius Using Bridging External Fixator

Background: Distal radius fractures are the third most common osteoporotic fractures and are frequently treated in emergency department. They have a trimodal peak of occurrence and there has been a significant increase in incidence of involvement in elderly females and young males. Management of these fractures comes with lots of treatment options and challenges to provide good functional outcome. This prospective study was done for the management of communited intra/juxta articular fractures of distal end radius using a bridging external fixator on 25 patients. The principle of ligamentotaxis was used for alignment of fracture fragments and wrist spanning external fixator was used to maintain the fracture reduction.Methods:25 patients of either sex with age group 16 to 80 years were taken from the orthopedic department. After proper primary care, cases were classified using Fernandez classification, and posted for surgery as soon as investigations and fitness were taken.Results:Patients involved in the study were in range of 16 to 78 years with 16 patients having dominant side with road traffic accident as leading cause.Radiological union was seen at an average of 7.3 weeks, 4 patients had superficial pin tract infection, 3 patients had stiffnes and a single case had malunion. Conclusions:Modified clinical scoring system of Green and O’Brien was used to evaluate the overall functional results which showed excellent to good results in 84% of cases. Hence, properly planned and executed bridging external fixator is an easy, cost-effective and reliable treatment modality through the “Principle of Ligamentotaxis”.

A parent-led intervention to reduce anxiety in autistic children with a severe to profound intellectual disability: protocol for the LADDERS pilot feasibility trial

Background There is a need for evidence-based approaches to reduce anxiety experienced by autistic children with severe to profound intellectual disability (ID). Avoidance of anxiety triggers, as a response to pronounced anxiety, occurs irrespective of age, background and neurodiversity. When avoidance is unhelpful, evidence-based anxiety reduction approaches aim to reduce it gradually (graded exposure), subsequently reducing anxiety. Combining graded exposure with emotional regulation techniques may be effective and acceptable for autistic children with severe to profound ID, if sensitive to needs and characteristics of autistic children. We have developed a 16-week, parent-led intervention (LADDERS) to reduce anxiety in this population of autistic children. LADDERS consists of psychoeducation, graded exposure-based tasks, and skills building, delivered utilising a person-centred approach. This study aims to assess whether LADDERS 1) reduces anxiety and 2) whether autistic children and parents find it acceptable and feasible. Method A single-site, multiple baseline, single case experimental study will be conducted. Participants will be parents of autistic children aged between 4-15 years. A minimum of 8 participants will be recruited through a research participant database, the Autistica Discover Network and social media. Once eligibility is confirmed, participants will be assessed at baseline, during the intervention and at a 2-month follow-up (week 24). The primary outcome measure will be a daily diary that assesses child anxiety. Discussion The study will provide preliminary evidence of whether LADDERS reduces anxiety in autistic children with severe to profound ID. Qualitative data from parents and child engagement will provide data on acceptability and feasibility.

Combining vLAPS and Nudging Data Assimilation

The combination of techniques that incorporate observational data may improve numerical weather prediction forecasts; thus, in this study, the methodology and potential value of one such combination were investigated. A series of experiments on a single case day was used to explore a 3DVAR-based technique (the variational version of the Local Analysis and Prediction System; vLAPS) in combination with Newtonian relaxation (observation and analysis nudging) for simulating moist convection in the Advanced Research version of the Weather Research and Forecasting model. Experiments were carried out with various combinations of vLAPS and nudging for a series of forecast start times. A limited subjective analysis of reflectivity suggested all experiments generally performed similarly in reproducing the overall convective structures. Objective verification indicated that applying vLAPS analyses without nudging performs best during the 0–2 h forecast in terms of placement of moist convection but worst in the 3–5 h forecast and quickly develops the most substantial overforecast bias. The analyses used for analysis nudging were at much finer temporal and spatial scales than usually used in pre-forecast analysis nudging, and the results suggest that further research is needed on how to best apply analysis nudging of analyses at these scales.

Behavior analytic based virtual reality interventions to teach adaptive and functional skills for individuals diagnosed with autism: A systematic review

Virtual reality technologies hold promise for the therapy based on the science of applied behavior analysis as they can replicate real life environments and allow the user to role-play in a simulated environments. This literature review synthesizes the research base evaluating the effects of behavior analytic interventions delivered via virtual reality (VR) technology to teach adaptive and functional skills for individuals with autism. Method: We conducted a systematic search in four databases followed by a reference search for those articles by the systematic database search. We also conducted a quality review using the Evaluative Method for Evaluating and Determining Evidence-Based Practices in Autism (Reichow, 2008). Results: We identified 24 studies with a majority of the studies (n = 18; 75%) utilizing group experimental or quasi-experiment research design, and the remaining (n = 6; 25%) utilizing single-case research design. Of those studies, ten targeted vocational related skills, seven targeted functional behaviors (e.g., problem behavior treatment, hypersensitivity, phobias), four targeted safety skills (e.g., driving, airplane travel, pedestrian safety), two studies targeted general functional skills, and one targeted exercise engagement. Of the 24 studies, 12 met the quality criteria to be classified as “strong” or “adequate” and can offer evidence on the integration of VR technology into the practice of behavior analysis for teaching adaptive or functional skills. Discussion: Taken as a whole, the three studies (Cox et al., 2017; Hu & Han, 2019; Wade et al., 2013) identified as “strong” quality studies were conducted by three different research teams, at three different locations, with 74 different participants and meet the qualifications to be considered a promising practice.

Merger and post-merger integration at Oxford University Hospitals: mixed-methods evaluation and lessons learned

Purpose Hospital mergers are common in the United Kingdom and internationally. However, mergers rarely achieve their intended benefits and are often damaging. This study builds on existing literature by presenting a case study evaluating a merger of two hospitals in Oxford, United Kingdom with three distinct characteristics: merger between two university hospitals, merger between a generalist and specialist hospital and merger between two hospitals of differing size. In doing so, the study draws practical lessons for other healthcare organisations.Design/methodology/approach Mixed-methods single-case evaluation. Qualitative data from 19 individual interviews and three focus groups were analysed thematically, using constant comparison to synthesise and interpret findings. Qualitative data were triangulated with quantitative clinical and financial data. To maximise research value, the study was co-created with practitioners.Findings The merger was a relative success with mixed improvement in clinical performance and strong improvement in financial and organisational performance. The merged organisation received an improved inspection rating, became debt-free and achieved Foundation Trust status. The study draws six lessons relating to the contingencies that can make mergers a success: (1) Develop a strong clinical rationale, (2) Communicate the change strategy widely and early, (3) Increase engagement and collaboration at all levels, (4) Be transparent and realistic about the costs and benefits, (5) Be sensitive to the feelings of the other organisation and (6) Integrate different organizational cultures effectively.Originality/value This case study provides empirical evidence on the outcome of merger in a university hospital setting. Despite the relatively positive outcome, there is no strong evidence that the benefits could not have been achieved without merger. Given that mergers remain prevalent worldwide, the practical lessons might be useful for other healthcare organisations considering merger.