Endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy without the use of radiation.

BACKGROUND: Biliary disease in pregnancy is a relatively uncommon condition; the diagnosis of this condition is not standardized. Furthermore, the use of radiographic imaging studies and therapeutic approaches in pregnancy is limited because of the possibility of fetal exposure. STUDY DESIGN: During a 2-year interval of 2001 to 2002, we successfully performed endoscopic retrograde cholangiopancreatography (ERCP) studies in 6 pregnant women between 6 and 30 weeks of gestation with symptomatic acute cholangitis or pancreatitis without irradiation exposure or major maternal complications. Five of the women had classic symptoms of severe right upper quadrant abdominal pain, gallbladder stones, jaundice, and dilated bile ducts on ultrasonic evaluation. One woman had severe recurrent pancreatitis during early pregnancy 4 years after a cholecystectomy. The cases are compiled to provide a descriptive review of ERCP without the use of radiation imaging treatment for these conditions. RESULTS: Maternal outcome: After ERCP, jaundice resolved in all cases. No further episodes of pancreatitis occurred during the 1 affected pregnancy. No post-ERCP complications occurred during this series. Two patients required cholecystectomy later, one in the postpartum period and the other 5 weeks post-ERCP. Fetal outcome: Two infants were born at term without complications. Two infants were born prematurely at 35 weeks, 1 with significant growth retardation and pulmonary complications and 1 without developmental problems or complications. Two mothers were lost to follow-up; the outcomes of their pregnancies are unknown. CONCLUSION: The use of ERCP in pregnancy is limited because of the undesirable effects of radiation exposure to the fetus.

The predictive power of narrative data in occupational therapy evaluation.

OBJECTIVE: This study examined whether adding the Canadian Occupational Performance Measure (COPM) to existing occupational therapy evaluation measures used in a subacute skilled nursing facility unit enhanced the accuracy of therapists' predictions of the functional status of clients at discharge. METHOD: This study utilized a prospective comparison design. Two independent predictive variables were developed using the standard Functional Independent Measure (FIM), and an enhanced FIM that included narrative information from the Canadian Occupational Performance Measure (FIM/COPM). These variables were subsequently compared with the actual FIM discharge (DFIM) scores for 31 clients. The primary author (D.S.) gathered data from chart review and conducted the statistical analysis. The data were analyzed using descriptive correlations (Pearson r) and comparison statistics (Wilcoxon signed rank test). RESULTS: Comparison statistics (Wilcoxon signed rank test) revealed a statistically significant difference between the standard FIM predictive score and the discharge FIM score. No statistically significant difference was found between the FIM/COPM predictive score and the discharge FIM score. These findings suggest that predictive scores based solely on information attained from the standard FIM resulted in less accuracy in outcome predictions. Correlational analyses further supported these conclusions. CONCLUSION: The findings support the study hypothesis that use of the COPM in combination with the FIM enhances accuracy in prediction of outcomes for rehabilitative services for persons in adult physical disabilities settings.

Schools as host environments: toward a schoolwide reading improvement model.

Despite vast differences among school districts across the country, all students must learn how to read in a complex "host-environment" called a school. A challenge in beginning reading, therefore, is to transcend these differences and focus, instead, on the essential task of teaching reading in schools. Teaching reading involves attending to what we know about beginning reading and the alphabetic writing system, the difficulties of reading, and the challenges associated with dyslexia. Teaching reading in a school requires that interventions be tailored to the unique needs of an individual school and implemented and sustained at the school building level. In this article, we outline the Schoolwide Reading Improvement Model (SRIM). This model is characterized by the strategic integration of research-based practices in assessment, instructional design, and beginning reading instruction. Additionally, the SRIM acknowledges the specific needs of individual schools and is customized to provide the best fit with each unique "host-environment." First we provide a description of each major stage of the SRIM and then an example of its application in a school district in western Oregon.

Instructional and curricular requisites of mainstreamed students with learning disabilities.

The successful integration of students with learning disabilities into mainstream reading classes may require teachers to adapt instruction and curricula in major ways. In this article, we discuss the relation between the instruction prescribed by standardized commercial curricula and the reading achievement of mainstreamed students with learning disabilities and other low-performing nonhandicapped students. An instructional template designed to complement commercially published reading lessons is described and its effects on the reading achievement of mainstreamed students with learning disabilities examined. Next, the limitations of generic instructional procedures to rectify the deficiencies of mainstream curricular programs for students with greater-than-average instructional needs are reviewed. We conclude with a discussion of the complexity of educating instructively needy learners in mainstream settings and the significance of well-designed instruction.

The effect of task alternatives on vocabulary knowledge: a comparison of students with and without learning disabilities.

This study used a two-part task format to (a) describe the vocabulary knowledge of 10- and 12-year-old students with learning disabilities and (b) assess the effect of task alternatives on their vocabulary knowledge. We addressed these research objectives by comparing the performance of 24 students with learning disabilities to an equal number of their normally achieving peers. Vocabulary knowledge was first assessed through a production task. In the even the student's response was inaccurate or incomplete, an identification task assessing the same vocabulary term was presented. Results revealed that, compared to normally achieving students, students with learning disabilities are (a) significantly less able to construct fully specified responses to production tasks, (b) comparable in their ability to use pictorial responses to demonstrate vocabulary knowledge not accessible in production tasks, and, (c) when equated in reading achievement, only 10-year-olds are significantly poorer in composite vocabulary knowledge.