Aims. The National High Secure Deaf Service at Rampton Hospital provides inpatient assessment, treatment and rehabilitation for D/deafz* males living with a range of difficulties including complex responses to trauma, mental health difficulties and/or learning disabilities. In 2011, the Deaf Prison In-Reach Service was established in conjunction with Yorkshire Specialist Commissioning Group and Nottinghamshire NHS Trust aiming to provide specialist support to D/deaf prisoners. * 'D' = Deafness as a culture, 'd' = deafness as a medical disability. Methods. The team evaluated the service to raise awareness of the specific needs of D/deaf prisoners by identifying and describing characteristics, demographics, trends and patterns within existing data as well as highlighting the nature of offences, prevalence of trauma and length of time over tariff. A secondary aim was to identify areas for development to adequately meet the needs of D/deaf prisoners. Results. After reviewing data for 29 prisoners (female = 3, male = 26), the most common source of support offered by the DPRIS was signposting (over 50%), followed by direct individual work (with nursing or psychology), assessment and consultancy. Since 2011, the DPRIS has assessed 30 individuals and completed over 717 prison visits for assessments and interventions. Whilst this has been acknowledged as a small number, it has been attributed to the difficulties locating D/deaf prisoners and lack of awareness regarding the DPRIS. Currently, referrals to the DPRIS come from prison healthcare staff, but this fails to address the wider specialist needs of this population: basic communication needs, occupational needs and risk reduction work. It also excludes individuals unknown to healthcare. Direct engagement with the DPRIS included: focused risk reduction work, anger management, mental health monitoring, and 1:1 psychology work. Prior to involvement from the DPRIS, five individuals declined to engage in prison therapy. With support from the DPRIS, two were transferred to more appropriate placements, one was recommended for transfer (not transferred) and one received mental health monitoring (nursing). One continued to decline which could be attributed to potential (lack of) motivation/readiness. This evaluation supports the need for specialist interventions to ensure equitable access to recovery and rehabilitation. Conclusion. What Next? It is hoped that the unique needs of this population will be communicated amongst professionals and steps will be made to address these as previously recommended in reports from the BDA (2016) and the Howard League.

no abstract available

Outcome measures used in dysphagia rehabilitation should be validated and clinically meaningful. The Dysphagia Severity Rating Scale (DSRS) is a clinician-rated scale of oral intake, with three ordinal subscales (fluids, diet, and supervision). This research describes validation of the DSRS and establishes the Minimal Clinically Important Difference (MCID) of this scale.

Dementia and hearing loss are both common among older people. The co-occurrence of the two conditions increases complexities in all aspects of an individual's care and management plan. There has been increasing research interest in the relationship between dementia and hearing loss in recent years. In this review we discuss the relationship between hearing loss and dementia, including hearing loss as a risk factor for dementia; the effects of dementia with hearing loss on affected persons' quality of life and the care they receive; screening and available interventions; and opportunities for prevention. We also discuss dementia and hearing loss in the care home setting, as the majority of residents have either, or indeed both, dementia and/or hearing loss. Several mechanisms have been suggested for how hearing loss and dementia may be related but the evidence for how these may operate together is still unclear. Similarly, although it is to be hoped that the active identification and management of hearing problems may help to reduce the future development of cognitive impairment, evidence for this is still lacking. Copyright © 2019 Elsevier B.V.

Objectives: The aim of this study was to determine which components of psychological therapies are most important and appropriate to inform audiologists' usual care for people with tinnitus.Design: A 39-member panel of patients, audiologists, hearing therapists, and psychologists completed a three-round Delphi survey to reach consensus on essential components of audiologist-delivered psychologically informed care for tinnitus.Results: Consensus (≥80% agreement) was reached on including 76 of 160 components. No components reached consensus for exclusion. The components reaching consensus were predominantly common therapeutic skills such as Socratic questioning and active listening, rather than specific techniques, for example, graded exposure therapy or cognitive restructuring. Consensus on educational components to include largely concerned psychological models of tinnitus rather than neurophysiological information.Conclusions: The results of this Delphi survey provide a tool to develop audiologists' usual tinnitus care using components that both patients and clinicians agree are important and appropriate to be delivered by an audiologist for adults with tinnitus-related distress. Research is now necessary to test the added effects of these components when delivered by audiologists.

There are approximately 10 million deaf and hard of hearing people in the United Kingdom, of whom 3.7 million are of working age.1 Deafness is more than an audiological measurement that defines an individual’s degree of hearing loss. Deaf people form a heterogeneous group, and the age of onset of their deafness and degree of hearing impairment have a significant effect upon the individual’s communication preference and cultural identity.2 Those who become deaf in early childhood, before the development of full spoken language (prelingual deafness), are more likely to use sign language such as British Sign Language (BSL), and belong to the Deaf * community and share its associated values and belief system. They are proud to be Deaf and share a unique set of defining life experiences with other members of the Deaf community. In the United Kingdom, 800,000 people are either severely or profoundly deaf, of which approximately 70,000 are BSL users.1 These individuals are probably most likely to refer to themselves as being Deaf.

A review of the literature relating to the psychological treatment needs of deaf mentally disordered offenders residing in high secure settings was conducted. Four literature searches were conducted relating to offending, mental illness, assessment and treatment with the deaf. The literature regarding these areas was found to be highly limited. Despite this, evidence suggests that deaf people are over represented in high secure facilities. It is also suggested that deaf offenders show higher levels of violent and sexual offences than their hearing counterparts. Most theories accounting for this difference in offending relate to the insufficient acquirement of social understanding however the finding may be an artefact of biases in the criminal justice system. Overall deaf people appear to experience similar levels of mental illness but greater levels of learning disability than hearing people. There are numerous sources of error when conducting assessments with deaf people. Similarly there are a number of challenges when delivering interventions with deaf people. These issues are discussed in terms of their implications for the psychological treatment needs of deaf mentally disordered offenders. Suggestions for future research include making use of systematic case studies to avoid some of the methodological challenges of researching this population. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Objectives: To determine whether the traditional assessment of adaptive behaviour is valid with deaf people who use sign language. Some Deaf people with a mild intellectual disability often struggle to gain fluency in sign language and hence experience high levels of exclusion from both hearing and deaf communities and support services. They can struggle to find ways of solving many of the difficulties of modern life and can struggle to develop some adaptive behaviours. Without an appreciation of the linguistic and cultural context of a Deaf person, assessment is difficult. There is a question whether comparisons should be made with Deaf people without ID or to hearing people with and without an ID. Methods: A small sample of deaf people with an intellectual disability was assessed about their adaptive behaviour in their first language of British Sign Language using the ABAS-III. This was triangulated with the views of their support staff who were also deaf and sign language users. Each participant and their adaptive behaviour were discussed in BSL. Results: For each participant, the responses to each item of the ABAS-III was systematically analysed for construct validity and discussed with Deaf support workers. Items which were difficult to adapt or appeared inappropriate or inaccurate were identified. Comparisons to the age norms were made. Conclusions: Findings suggests that formal assessment of adaptive behaviour of Deaf people with ID should be used with caution. Recommendations for a valid assessment of adaptive behaviour are made based on the findings of this study.

Background: Recent studies indicate an increased incidence of pertussis disease in recent years. The aim of this study was to evaluate the efficacy of the acellular vaccine for children (as a replacement of current whole cell vaccine in the Expanded Program on Immunization) and for high-risk adults in Iran through updating current best available evidence. Methods: We performed a systematic literature review in relevant databases we focused on previously published systematic reviews to select those that address our questions. The AMSTAR (assessing the methodological quality of systematic reviews) tool was used for screening available reviews. Then search in databases was done until Feb 2014 to update the evidence. We pooled results using meta-analysis methods by Stata statistical package. Results: Eleven systematic review articles were included in the initial evaluation. In the end, two systematic reviews on acellular vaccine booster doses and the acellular vaccine in children were selected as the baseline evidence. In the update phase, new clinical trials were screened, and the results were updated. Overall pooled estimate of relative efficacy of acellular to whole cell was 0.68 (95% CI, 0.55-0.81) for children immunization Pooled estimates for the efficacy of acellular versus placebo were 0.70 (95% CI, 0.60-0.80). Overall pooled estimate of efficacy of booster dose of acellular was 0.87(95% CI, 0.85-0.88) compared to placebo. In addition pooled estimate of acellular vaccine efficacy based on response to antigen was 0.78(95% CI, 0.64-0.93) in highrisk group. Conclusion: The results show higher performance and safety of the acellular vaccine in the prevention of pertussis in children versus the whole cell vaccine. Moreover, the efficacy of the acellular vaccine in high-risk adult groups is acceptable. This study provides evidence in favor of the introduction of an acellular vaccine to the national program of immunization. Studies on cost effectiveness and aspects of policy analysis are recommended.

Hypocalcaemia due to hypoparathyroidism following thyroidectomy is a relatively common occurrence. Standard treatment is with oral calcium and vitamin D replacement therapy; lack of response to oral therapy is rare. Herein we describe a case of hypoparathyroidism following thyroidectomy unresponsive to oral therapy in a patient with a complex medical history. We consider the potential causes in the context of calcium metabolism including: poor adherence, hungry bone syndrome, malabsorption, vitamin D resistance, bisphosphonate use and functional hypoparathyroidism secondary to magnesium deficiency. Malabsorption due to intestinal hurry was likely to be a contributory factor in this case and very large doses of oral therapy were required to avoid symptomatic hypocalcaemia.;