Knowledge and perceptions of newly graduated medical practitioners in Malaysia of their role in medical care of people with developmental disabilities

Improving content and consistency on developmental disabilities in undergraduate medical curricula has been recommended as a means of improving health outcomes for people with developmental disabilities. Although often the subject of studies in Western countries, little is known about content on developmental disabilities in undergraduate curricula in developing countries. A study was undertaken to: (1) explore content and experience with developmental disabilities received in undergraduate training by medical practitioners in Malaysia; and (2) explore perceptions of their role in the identification and management of developmental disabilities in practice. Comparisons were made according to location of training. Data were collected using a 107-item questionnaire that was administered to 230 newly graduated house officers on their first rotations in seven public hospitals in Peninsula Malaysia. Deficits and inconsistencies were indicated in both content and experience of developmental disabilities during training. Uncertainty about their role in the identification and management of developmental disabilities was evident. Greater inconsistencies and deficits were evident for respondents trained in Eastern and Middle Eastern countries compared with those trained in Malaysia and Western countries. Results suggest a need for increased content, consistency, and intentional exposure in relation to developmental disabilities during undergraduate training across all training settings.

Iniatives to reduce the use of seclusion and restraints on people with developmental disabilities: a systematic review and quantitative synthesis

Contrary to the expectations articulated in public policy, restrictive interventions are commonly used in support services for people with developmental disabilities. This systematic review and quantitative synthesis was undertaken to investigate whether the use of seclusion and restraints on people with developmental disabilities can be reduced. Searches of the Academic Search Complete, CINAHL, MEDLINE, and PsycINFO electronic databases returned 7226 records, of which 11 met the inclusion criteria for this review. A further 3 papers were obtained through scanning the reference lists of those articles included from the initial literature search. All 14 studies were single-subject designs focusing on initiatives to reduce physical or mechanical restraint. Between the baseline and intervention phases, there were mean reductions in the frequency and duration of restraint use of 79% (SD = 21%, n = 13 subjects from 7 studies) and 45% (SD = 58%, n = 10 subjects from 6 studies), respectively. For studies in which restraint use to manage agitation and aggression was targeted, there was a 79% (SD = 21%, n = 13 subjects from 7 studies) decrease in the frequency and a 28% (SD = 67%, n = 6 subjects from 3 studies) reduction in the duration of restraint. With respect to studies in which restraint use to prevent self-harm was targeted, there was a 71% (SD = 34%, n = 4 subjects from 3 studies) reduction in restraint use. Effect sizes were calculable, using non-overlap approaches, for 9 of the 14 studies. The magnitudes of the effect sizes suggest that, on average, the interventions were effective in reducing the use of restraints. The effects generated in studies where restraint use for self-harm was targeted were typically more pronounced than those in which restraint use for agitation and aggression was addressed. There were broad variations, however, in the percentage reductions in restraint use and in the magnitudes of the effect sizes. Although the findings of this review are encouraging, more research is needed, in which greater attention must be paid to rigorous research design, application, and analysis.

Mixed-initiative decision support for care planning based on clinical practice guidelines

Care Plan On-Line (CPOL) is an intranet based system that supports a “Coordinated Care” model for chronic/complex disease management. CPOL combines provision of solicited and unsolicited advice features based on integration of the electronic medical record (EMR) with its decision support logic. The objective is to support General Practitioners (GPs) in formulating a 12-month care plan of services such that: (a) the plan is proactive and patient-centered; (b) the GP is kept in awareness of project- and diseasespecific clinical practice guidelines; and (c) the support integrates with GP workflow in a natural fashion. A key feature of our approach is to blur the distinction of EMR and decision support by presenting guidelines in layers with the top-most being a problem-oriented presentation of patient status, progressing on through to patient-independent supporting evidence. In conjunction with a degree of automated inclusion of care planning services, the system demonstrates mixed user and software initiative. We describe the CPOL deployment setting, the challenges of guideline-based clinical decision support, our approach to guideline delivery, and the CPOL architecture.

An ecobehavioural analysis of interactive engagement of children with developmental disabilities with their peers in inclusive preschools

Ecobehavioural analysis procedures were used to examine the interactive engagement of children with developmental disabilities due to Down syndrome who attended inclusive preschools for 2 years. Compared with typical children, the children with disabilities displayed infrequent interactions with peers for the duration of the study. For the children with disabilities, interactive engagement was largely unrelated to the characteristics of class activities, while typical children responded positively to activities expected to promote peer interaction. The results are discussed in terms of the inadequacy of informal strategies commonly applied in inclusive preschool settings to promote interactive engagement in children with disabilities.

The impact of enterprise resource planning systems on management accounting : an Australian study

Information technology is significantly changing the operating practices of an increasing number of companies globally. These developments have important implications for the accounting profession and in particular accounting practices in the twenty-first century. This study examines the development of enterprise resource planning (ERP) systems as a means of illustrating how changes in information technology allows all systems in a company to be linked to manage operations holistically.

The study investigates the change in accounting systems using a sample of Australian companies with emphasis on the adoption of ERP systems including the potential impact of ERP on capital budgeting processes. The results show that ERP systems are changing management accounting practices, although at this stage, the impact on capital budgeting techniques appears to be limited. The findings contribute to the emerging body of literature on the development of ERP systems and its impact on management accounting teaching and research.

Parents' perception of the quality of life of preschool children at risk or having developmental disabilities.

Despite increased concern for the health related quality of life (HRQOL) of people with disabilities, little is known about the HRQOL of children with developmental disabilities. The present study aimed to explore the HRQOL of children who were at risk or having developmental disabilities in Hong Kong. Using the parent-reported Chinese Pediatric Quality of Life Inventory (PedsQL), the HRQOL of 173 children (2–4 years) with signs of delays in development was contrasted with that of 132 children with typical development. We found that those who exhibited high risk of developing a developmental disability had significantly lower overall well-being (76.3 ± 13.7 vs. 84.2 ± 11.3; p<0.001) and psychosocial health (71.3 ± 15.6 vs. 82.5 ± 12.9; p<0.001) but not necessarily physical health. The findings are consistent with previous findings in children with different disabilities and chronic illnesses. They suggest children at risk or having DDs need help in restoring their quality of life up to the standard experienced by their healthy peers, particular in psychosocial aspects such as social functioning, emotion functioning, and school functioning.

The effect of planning design on thermal comfort in outdoor spaces

Urban outdoor spaces are considered essential elements of cities, where the greatest amount of human contact and interaction takes place. That is the reason why there is increasing public interest in the quality of open urban spaces as they can contribute to the quality of life within cities, or contrarily increase isolation and social exclusion. There are a lot of factors influencing the success of the outdoor spaces; one of the principal factors is the microclimatic comfort. In the hot areas, the outdoor thermal comfort conditions during the daytime are often far above acceptable comfort standards due to intense solar radiation and high solar elevations. The variation of the urban spaces' configuration can generate significant modifications of the microclimatic parameters. Design decisions such as street and sidewalk widths, shading structures, materials, landscaping, building heights, and inducing air flow have a significant impact on the pedestrian thermal comfort and subsequently on the use of the urban environment. Although it has been established that the vegetation elements should be considered as one of the main tools that can be used in improving the thermal comfort in outdoor spaces, the integration of the climate dimension in the planting design process in urban spaces is lacking because of insufficient interdisciplinary work between urban climatology, urban design and landscape architecture. The primary aim of this research is to study the influence of some of the design decision for the plantation elements in outdoor spaces on the thermal comfort of its users. This will provide landscape designers and decision makers with the appropriate tools for effectively assessing the development of urban environment while considering the microclimate of outdoor spaces. A special emphasis is put on summertime conditions in Egypt. Findings of this research will contribute to sustainable urban design of outdoor spaces.

Gendered service delivery : a masculine and feminine perspective on staff gender

Despite acknowledgement that paid caregivers have a significant impact on the lives of people with intellectual disability, the subjective experience of staff gender is rarely considered in research. Qualitative data from a study on the sexual health needs of men and boys with intellectual disability is presented. We designed this study to determine what impact staff gender has on the sexual health needs of men and boys with intellectual disability. Findings suggest that although staff traverse the same geographies of care, they do it in uniquely gendered ways. Staff gender is an important consideration when dealing with sexual health matters and can enhance the type and quality of relationships between people with intellectual disability.

Impact of the Learn to Play program on play, social competence and language for children aged 5 - 8 years who attend a specialist school

Introduction
The aim of this study was to investigate the change in the relationship between play, language and social skills of children aged 5–8 years pre and post participation in the ‘Learn to Play’ program. The Learn to Play program is a child led play based intervention aimed at developing self-initiated pretend play skills in children.

Methods
All 19 participants attended a specialist school, with 10 of the 19 children having a diagnosis of autism. The play, language and social skills of the children were assessed at baseline and at follow up. Children were assessed using the Child-Initiated Pretend Play Assessment, the Preschool Language Scale and the Penn Interactive Peer Play Scale. Follow up data collection occurred after the children had been participating in the Learn to Play program for 1 hour twice a week for 6 months.

Results
After 6 months in the program, typical indicators of play accounted for an increase of 47.3% in shared variance with social interaction and an increase of 36% in shared variance for social connection. For language, object substitution ability accounted for 50% of the shared variance, which was an increase of 27% from baseline.

Conclusion
The ‘Learn to Play’ program was associated with increases in children's language and social skills over a 6-month period within a special school setting, indicating the Learn to Play program is an effective intervention for children with developmental disabilities. This paper presents an example of how the Learn to Play program can be adapted into a classroom setting.

Tweet reach : a research protocol for using Twitter to increase information exchange in people with communication disabilities

Objective: To (a) outline the background to research evaluating Twitter use by people with severe physical and communication disabilities participating actively in online communication forums for increasing information exchange and (b) illustrate a range of potential methods that might be applied in furthering research on the use of social media by people with developmental and acquired communication disabilities. Methods: The literature on communication disabilities, augmentative and alternative communication, and social media research informed the rationale for and design of three studies investigating the use of Twitter by people with communication disabilities. Results: To date, there is little information in the literature about how people with a range of communication disabilities might use Twitter to increase their access to information and help them to feel knowledgeable and in control of their own lives. In this paper, three studies are proposed to investigate the use of Twitter by people with communication disabilities.

Development of play profiles : influence of disability on children's play

Occupational therapists value play as a significant occupation in a child’s life and use play both as a means and as an end in itself to support development. This thesis explores the nature of play in children with developmental disabilities, seeking to determine whether there are consistent patterns of play specific to different disability categories. An extensive literature review of play and disability was completed, and Cooper’s (2000) model of play is used to organize the literature findings. This study investigated differences in play behaviour in 50 children diagnosed with Autistic Spectrum Disorder, Down syndrome, Developmental Delay and Physical impairments, aged 4 to 6 years 6 months who attended educational facilities in a regional centre in South East Queensland. Quantitative and qualitative play behaviour was assessed using two measures, Revised Knox Preschool Play Scale (Knox, 2008) and the Child Initiated Pretend Play Assessment (Stagnitti, 2007) with the Australian Developmental Screening Test (Burdon, 1993) used to determine developmental age to eliminate this as a potential confounding variable when statistically analyzing the results.
Cognitive, language and fine motor abilities were found to have a statistically significant impact on play ability rather than the different disability groupings. Children with Down syndrome had significantly more imitative play actions than any other disability grouping. Cooper’s (2000) model was found to be a useful tool to analyze differing play characteristics according to different disability groupings. Modifications to Cooper’s original model of play to more accurately depict play characteristics are proposed.