Adaptive behavior in autism: Minimal clinically important differences on the Vineland-II.

Autism Spectrum Disorder (ASD) is associated with persistent impairments in adaptive abilities across multiple domains. These social, personal, and communicative impairments become increasingly pronounced with development, and are present regardless of IQ. The Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) is the most commonly used instrument for quantifying these impairments, but minimal clinically important differences (MCIDs) on Vineland-II scores have not been rigorously established in ASD. We pooled data from several consortia/registries (EU-AIMS LEAP study, ABIDE-I, ABIDE-II, INFOR, Simons Simplex Collection and Autism Treatment Network [ATN]) and clinical investigations and trials (Stanford, Yale, Roche) resulting in a data set of over 9,000 individuals with ASD. Two approaches were used to estimate MCIDs: distribution-based methods and anchor-based methods. Distribution-based MCID [d-MCID] estimates included the standard error of the measurement, as well as one-fifth and one-half of the covariate-adjusted standard deviation (both cross-sectionally and longitudinally). Anchor-based MCID [a-MCID] estimates include the slope of linear regression of clinician ratings of severity on the Vineland-II score, the slope of linear regression of clinician ratings of longitudinal improvement category on Vineland-II change, the Vineland-II change score maximally differentiating clinical impressions of minimal versus no improvement, and equipercentile equating. Across strata, the Vineland-II Adaptive Behavior Composite standardized score MCID estimates range from 2.01 to 3.2 for distribution-based methods, and from 2.42 to 3.75 for sample-size-weighted anchor-based methods. Lower Vineland-II standardized score MCID estimates were observed for younger and more cognitively impaired populations. These MCID estimates enable users of Vineland-II to assess both the statistical and clinical significance of any observed change. Autism Res 2018, 11: 270-283. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The Vineland Adaptive Behavior Scales (2nd edition; Vineland-II) is the most widely used scale for assessing day-to-day "adaptive" skills. Yet, it is unknown how much Vineland-II scores must change for those changes to be regarded as clinically significant. We pooled data from over 9,000 individuals with ASD to show that changes of 2-3.75 points on the Vineland-II Composite score represent the "minimal clinically-important difference." These estimates will help evaluate the benefits of potential new treatments for ASD.

The introduction of digital dental technology into BDS curricula.

The aim of this study was to determine the degree to which digital dental technologies have been introduced into the curricula of UK dental schools. A survey was carried out of all the UK dental schools that teach undergraduate dental students. The survey contained six questions and was designed to determine if digital dental technology techniques or systems were being taught in the curricula, what these techniques were, and whether the school dental laboratories supported these techniques. Sixteen schools were surveyed and 11 replied: a response rate of 69%. Forty-five percent of the schools that replied did not teach digital dental technology in their curriculum. Of the 55% of schools who did teach digital dental technology, 50% gave lectures or demonstrations while the other 50% allowed practical involvement by the student. Two thirds of these stated that not all the students participated in practical usage. Seventy-three percent of the schools that replied had dental laboratories using some, but not all the digital dental technology techniques listed. Eighty percent of the schools that were not teaching digital dental technology said it was because it was not included in the curriculum, and 20% stated it was due to a lack of technical expertise or support.

Nurses' knowledge of pain assessment, pharmacologic and nonpharmacologic interventions.

This study compared differences in knowledge of pain assessment and pharmacologic and nonpharmacologic pain management strategies among 232 L.P.N.s and R.N.s from three hospitals. Twenty-three adult medical, surgical, and special care units were represented. The "Knowledge of Pain Management" tool measured knowledge of pain assessment, drug and nondrug strategies, and was based on AHCPR guidelines. Scores ranged from 24% to 92%. There were significant differences in scores across hospitals and between R.N.s and L.P.N.s. The mean score was 72% for L.P.N.s and 75% for R.N.s. There was a significant difference in pharmacologic scores between L.P.N.s versus A.D./A.A.-R.N.s, B.S.N-R.N.s, and M.S.N.-M.S.-R.N.s but not between L.P.N.s and diploma-R.N.s. There were significant differences in overall knowledge scores between L.P.N.s versus B.S.N.-R.N.s but not A.D./A.A.-R.N.s, diploma-R.N.s, and M.S.N./M.S-R.N.s. Finding suggest the need for aggressive nursing education programs offered in academic and clinical settings to assist nurses in effectively managing the universal phenomenon of pain.