BackgroundGlobally, people with intellectual disabilities and/or autism experience health inequalities. Death occurs at a younger age and the prevalence of long-term morbidities is higher than in the general population. Despite this, their primary healthcare access rates are lower than the general population, their health needs are often unmet, and their views and experiences are frequently overlooked in research, policy, and practice.AimTo investigate the barriers and facilitators reported by individuals with intellectual disabilities, autism, or both, and/or their carers, to accessing and utilising primary health care for their physical and mental health needs.Design & settingAn integrative review was undertaken, which used systematic review methodology.MethodElectronic databases MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane were searched for relevant studies (all languages) using a search strategy. Two researchers independently screened the results and assessed the quality of the studies.ResultsSixty-three international studies were identified. Six main themes relating to barriers and facilitators emerged from an analysis of these studies. The main themes were: training; knowledge and awareness; communication; fear and embarrassment; involvement in healthcare decision-making; and time. All the themes were underpinned by the need for greater care, dignity, respect, collaborative relationships, and reasonable adjustments. Opposing barriers and facilitators were identified within each of the main themes.ConclusionAdolescents and adults with intellectual disabilities and/or autism experience several barriers to accessing and utilising primary health care. The findings highlight the reasonable adjustments and facilitators that can be implemented to ensure that these individuals are not excluded from primary health care.

ObjectiveTo assess five physical signs to see whether they can assist in the screening of patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and potentially lead to quicker treatment.MethodsThis was a diagnostic accuracy study with inter-rater agreement assessment. Participants recruited from two National Health Service hospitals, local CFS/ME support groups and the community were examined by three practitioners on the same day in a randomised order. Two allied health professionals (AHPs) performed independent examinations of physical signs including: postural/mechanical disturbances of the thoracic spine, breast varicosities, tender Perrin’s point, tender coeliac plexus and dampened cranial flow. A physician conducted a standard clinical neurological and rheumatological assessment while looking for patterns of illness behaviour. Each examination lasted approximately 20 min.ResultsNinety-four participants were assessed, 52 patients with CFS/ME and 42 non-CFS/ME controls, aged 18–60. Cohen’s kappa revealed that agreement between the AHPs was substantial for presence of the tender coeliac plexus (κ=0.65, p<0.001) and moderate for postural/mechanical disturbance of the thoracic spine (κ=0.57, p<0.001) and Perrin’s point (κ=0.56, p<0.001). A McNemar’s test found no statistically significant bias in the diagnosis by the experienced AHP relative to actual diagnosis (p=1.0) and a marginally non-significant bias by the newly trained AHP (p=0.052). There was, however, a significant bias in the diagnosis made by the physician relative to actual diagnosis (p<0.001), indicating poor diagnostic utility of the clinical neurological and rheumatological assessment.ConclusionsUsing the physical signs appears to improve the accuracy of identifying people with CFS/ME and shows agreement with current diagnostic techniques. However, the present study concludes that only two of these may be needed. Examining for physical signs is both quick and simple for the AHP and may be used as an efficient screening tool for CFS/ME. This is a small single-centre study, and therefore, further validation in other centres and larger populations is needed.

Trusted evidence. Informed decisions. Better health.

Introduction: Clinical practice guidelines (CPGs) are expected to make evidence-based recommendations, thus guiding practice and reducing unwarranted variation. CPGs are particularly helpful in guiding complex procedures such as the Videofluoroscopic Swallowing Study (VFSS) for the assessment of dysphagia, but there is a suspected high level of variability among them. To explore the extent of this variation, this study aimed to systematically identify and appraise all VFSS CPGs available worldwide. Methods: A systematic search of 3 academic databases and other sources was conducted to identify relevant CPGs; independent reviews of each CPG were undertaken by a Speech and Language Therapist and a Radiographer. Both reviewers completed a predetermined checklist of expected professional content for each CPG. CPGs were then assessed for quality using the Appraisal of Guidance for Research & Evaluation II (AGREE II) instrument. Findings from the professional content review and the methodological quality review were synthesised to inform an assessment of suitability of each CPG to inform clinical practice. Results: Seven VFSS CPGs were identified worldwide, none of which were co-designed by radiographers or aimed at a radiographer audience. Each differs in their professional content, recommendations, underpinning evidence base and professional focus. Average AGREE ll scores across the quality domains vary considerably, ranging from 93-22%. No CPGs scored highly on all six AGREE II domains. Conclusion: There is no standardisation between VFSS guidelines. Six CPGs are not recommended for clinical use; only one of the seven identified CPGs is recommended for use following significant modification. Implications for practice: The lack of a comprehensive, evidence-based guideline encourages unwarranted variation in clinical practice which potentially compromises clinical care. Further research is needed to define VFSS best practice.

Introduction More people are surviving major trauma, often with life changing injuries. Alongside physical injury, many survivors of major trauma experience psychological and psychosocial impacts. Presently, there is little guidance at the UK national level for psychological and psychosocial aspects of major trauma care. Set in the context of the regional model of major trauma care implemented in the UK in 2012, the purpose of this review was to identify and bring together primary research about psychological and psychosocial aspects of major trauma care in the UK to produce an overview of the field to date, identify knowledge gaps and set research priorities. Methods A scoping review was undertaken. Seven electronic databases (MEDLINE, Cochrane Library, CINAHL, Embase, PsycINFO, SocINDEX with Full Text and PROSPERO) were searched alongside a targeted grey literature search. Data from included studies were extracted using a predefined extraction form and underwent bibliometric analysis. Included studies were then grouped by type of research, summarised, and synthesised to produce a descriptive summary and overview of the field. Results The searches identified 5,975 articles. Following screening, 43 primary research studies were included in the scoping review. The scoping review, along with previous research, illustrates that psychological and psychosocial impacts are to be expected following major trauma. However, it also found that these aspects of care are commonly underserved and that there are inherent inequities across major trauma care pathways in the UK. Conclusion Though the scoping review identified a growing body of research investigating psychological and psychosocial aspects of major trauma care pathways in the UK, significant gaps in the evidence base remain. Research is needed to establish clinically effective psychological and psychosocial assessment tools, corresponding interventions, and patient-centred outcome measures so that survivors of major trauma (and family members or carers) receive the most appropriate care and intervention.