Utilizing in-vivo feedback for caregiver training of pediatric feeding protocols.

Researchers have used multicomponent behavioral skills training packages including written and verbal instructions, modeling, rehearsal, and feedback when teaching caregivers to implement pediatric feeding treatment protocols (e.g., Anderson & McMillan, 2001; Seiverling et al., 2012). Some investigators have shown that fewer behavioral skills training components may be necessary for effective training (e.g., Mueller et al., 2003; Pangborn et al., 2013). We examined the use of in-vivo feedback following written instructions to train caregivers to implement pediatric feeding treatment protocols using a multiple baseline design across 3 caregiver dyads. Correct implementation of the feeding treatment procedures was low during baseline (written instructions only), increased with only the addition of in-vivo feedback, and remained high during follow-up sessions for all caregivers. Results are discussed in terms of clinical implications and caregiver satisfaction.

Noncontingent and differential reinforcement in the treatment of pediatric feeding problems.

We conducted functional analyses of the inappropriate mealtime behavior of 5 children diagnosed with feeding problems. Then, we compared the effects of differential and noncontingent reinforcement, and the relative effects of escape extinction with and without differential or noncontingent reinforcement, when escape extinction appeared necessary. Both reinforcement procedures were effective without escape extinction to treat food refusal for 1 child, but only differential reinforcement was effective without escape extinction to treat the child's liquid refusal. Escape extinction was necessary for 4 of 5 children. The addition of positive reinforcement resulted in beneficial effects (i.e., more stable acceptance, decreased inappropriate mealtime behavior or negative vocalizations) with 3 of 4 children. With escape extinction, differential reinforcement was more effective to treat food refusal for 2 children and noncontingent reinforcement was more effective for 1 child.

Preliminary efficacy of prize-based contingency management to increase activity levels in healthy adults.

An estimated 30% of Americans meet the criteria for obesity. Effective, low-cost interventions to increase physical activity are needed to prevent and treat obesity. In this study, 11 healthy adults wore Fitbit accelerometers for 3 weeks. During the initial baseline, subjects earned prize draws for wearing the Fitbit. During intervention, percentile schedules were used to calculate individual prize-draw criteria. The final week was a return to baseline. Four subjects increased step counts as a result of the intervention. A bout analysis of interresponse times revealed that subjects increased overall step counts by increasing daily minutes active and within-bout response rates and decreasing pauses between bouts of activity. Strategies to improve effectiveness are suggested, such as modification of reinforcement probability and amount and identification of the function of periods of inactivity.

Systematic differences between healthcare professionals and poison information staff in the severity scoring of pesticide exposures.

CONTEXT: Severity scores are used in triage and for data comparison in cases of poisoning. Exposure severity scores have not been generally validated and their utilization by healthcare staff other than specialists in poison information (SPIs) is untested. OBJECTIVE: To compare the poisoning severity grading allocated in pesticide exposure cases by healthcare professional enquirers and poison information staff. METHODS: Pesticide exposures reported to the U.K. National Poisons Information Service (NPIS) systems in a prospective study were graded for severity by healthcare professional enquirers and NPIS SPIs who used established poisons severity-grading algorithms. The scores were compared in children and adults, for the two professional groupings, both overall and for separate pesticides. RESULTS: Overall SPIs graded severity resulting from pesticide exposure at a lower level than the enquirer. For children, enquirer mean severity score was 1.62 (95% confidence interval (CI) 1.57-1.66) and SPIs mean severity score was 1.16 (95% CI 1.13-1.19) (p < 0.001). For adults, enquirer mean severity score was 1.91 (95% CI 1.84-1.97) and SPIs mean severity score was 1.74 (95% CI 1.69-1.79) (p < 0.001). Importantly, the differences in the scores between the two professional groups were greater in children [+0.46 (95% CI 0.41-0.51)] than in adults [+0.17 (95% CI 0.11-0.24)] (p < 0.001). Findings for individual pesticides were less consistent but in general showed similar trends. The exception was glyphosate for which severity grading by poison information staff was higher for children [SPIs 1.68 (95% CI 1.38-1.96) than the enquirers 1.26 (95% CI 1.08-1.44), p < 0.02]. CONCLUSIONS: Our findings suggest inherent differences in the perception of pesticide toxicity between healthcare professionals and SPIs. There was also a difference in the scoring approach depending on the pesticide involved. Additional investigations are required to define the role and accuracy of severity scoring in different types of poisoning and the applicability to different types of severity assessors.