Objective: To synthesise and summarise existing literature investigating whether and how psychological distress as a consequence of perinatal loss and associated coping impact upon maternal–fetal relationships subsequent to miscarriage and stillbirth. Background: Although now widely accepted that the relationship between mother and child developsin utero, little is known about how a previous miscarriage or stillbirth impacts upon these processes in a subsequent pregnancy. Methods: An integrative review methodology was chosen for the review. Results: Fifteen empirical and theoretical articles were reviewed and summated into two topic areas: psychological distress following perinatal loss and the subsequent maternal–fetal relationship, and coping following perinatal loss and the subsequent maternal–fetal relationship. Conclusions: Studies show that perinatal loss can cause psychological distress in subsequent pregnancy. It is not clear whether and how such distress impacts on maternal–fetal relationships because studies have yielded mixed findings. Mothers employ a complex self-protective mechanism to cope with this distress, and use strategies to reassure themselves and to maintain hope that the pregnancy will result in a live birth. It is not clear whether the use of this mechanism impacts upon the development of the mother–fetus relationship in subsequent pregnancy. Further research is now required to determine how these strategies are employed, the impact of these strategies on pregnancy-specific anxiety, maternal–fetal relationships and the postnatal attachment relationship. Health professionals working with parents in these circumstances should acknowledge that anxiety and associated coping behaviours are common, and support be provided when parents show signs of considerable psychological distress.

This abstract from the Diabetes UK Professional Conference 2020 evaluates the real-world impact of attending the DESMOND (Diabetes Education for Self-Management of Ongoing and Newly Diagnosed) programme on HbA1c and lipid profile in Warwickshire.

Neurorehabilitation is often thought of as a stand-alone process occurring in a defined unit. However, patients with neurological conditions make up a large proportion of general medical admissions and general practitioner consultations. They often present with an upper motor neurone syndrome that requires careful management of their weakness, disordered motor control, spasticity and bladder/bowel dysfunction. Spasticity management can be particularly challenging, but is rewarding if physical and pharmacological measures are used appropriately and in a timely manner. This review attempts to explain the process of rehabilitation and how it can improve the care of neurological patients in all settings. Through the basic principles of rehabilitation – assessment, goal-setting, intervention and evaluation – function can be optimized while preventing complications and minimizing distress to patients, families and carers.

The Sensory Tool to Assess Responsiveness (STAR) is an interdisciplinary neurobehavioural diagnostic tool for individuals with prolonged disorders of consciousness. It utilises current diagnostic criteria and is intended to improve upon the high misdiagnosis rate in this population. This study assesses the inter-rater reliability of the STAR and its diagnostic validity in comparison with the Coma Recovery Scale-Revised (CRS-R) and the Wessex Head Injury Matrix (WHIM). Participants were patients with severe acquired brain injury resulting in a disorder of consciousness, who were admitted to the Royal Leamington Spa Rehabilitation Hospital between 1999 and 2009. Patients underwent sensory stimulation sessions during their period of admission, which were recorded on video. Using this footage, patients were re-assessed for this study using the STAR, WHIM and CRS-R criteria. The STAR demonstrated "moderate" inter-rater reliability, "substantial" diagnostic agreement with the CRS-R, and "moderate" agreement with the WHIM. There were no significant differences between diagnoses assigned by the different assessments. The STAR demonstrated a good degree of inter-rater reliability in identification of diagnoses for patients with disorders of consciousness. The diagnostic outcomes of the STAR agreed at a good level with the CRS-R, moderately with the WHIM, and did not significantly differ from either. This demonstrates the reliability and validity of the STAR, showing its appropriateness for clinical use. Future longitudinal studies and research into the STAR's applicability in long-stay rehabilitation are indicated. Keywords: Behavioural assessment; brain injury; disorders of consciousness; minimally conscious state; vegetative state.

Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments.

Purpose: The national Hip Sprint audit highlighted poor mobility outcomes following neck-of-femur fractures (NOF#) with up to 60% failing to return to pre-fracture mobility level. The standard community rehabilitation provided by our Trust included long waits and basic levels of rehabilitation provision. Our elective arthroplasty pathway incorporates a specialist orthopaedic home-support-team (HST) whom visit patients in their homes after in-patient discharge to provide rehabilitation and joint management. COVID-19 placed unprecedented demands on inpatient bed capacity and community service provision with the need to prevent long length of stay. Whilst elective orthopaedics ceased during the second wave, our aim was to determine if early specialist community intervention following NOF# results in low length of stay and provides clinically significant improvements in patient outcomes. Methods: We performed a two-month pilot study (December–January 2020/21) for all NOF# cases at an NHS district general hospital. The inclusion criteria for specialist HST involvement were the capacity to follow commands, absence of complex social-care needs and the ability to step-round transfer with/without equipment. Outcome measures were time to first contact, number of contacts, Berg Balance score, mobility status, ongoing referral requirement and patient subjective feedback (iWantGreatCare: questions 7,81,97,98). Results: There were 73 NOF# cases occurring across the 2-month study period with 23 (32%) cases meeting the inclusion criteria for specialist HST. Eight patients (11%) passed away during the pilot period, one was seen by the HST. One case seen by the HST ultimately required revision-surgery. The mean age of cases seen by the HST was 78 years (range 51–96). Surgical management comprised of hemi-arthroplasty (8), intramedullary-nail (6), total hip arthroplasty (6), and dynamic hip screw (3). The mean length of inpatient stay was 8 days (range 1–33) with all patients returning to their usual place of residence. All patients’ received telephone contact within 24-hours and the medium time to first community contact was 4 days, with patients receiving on average 3 visits (range 1–8) over a mean 21 days. Over 80% (17/21) of patient improved their mobility status from inpatient discharge to HST discharge (mean 20 days). Within 3-months of surgery, 15 cases returned to their pre-fracture level of mobility, including 8 who are mobilising independently. The Berg Balance score was completed in 14 patients with 11 achieving a clinically significant change (>6.5). Thirteen patients did not require any further healthcare input and four were able to be managed in an out-patient setting. Patient reported outcomes showed 100% patients scored 5/5 on all questions. Conclusion(s): A third of NOF# cases were eligible for the HST service. We have demonstrated specialist HST involvement achieves significant improvements in balance and mobility with high levels of patient satisfaction. In one case, a patient who sustained a NOF# a year previous and a second during this pilot managed to return to primary pre-injury mobility with the assistance of the HST, despite failing to achieve this after their first injury. Impact: Utilising a specialist orthopaedic HST may reduce the strain of inpatient capacity and traditional community rehabilitation services however further investigation is required.