Preschool speech and language screening: further validation of the sentence repetition screening test.

A recent review indicated that only one speech and language screening test (the Sentence Repetition Screening Test; SRST) designed for preschoolers has been successfully validated in a representative population. This study sought to replicate the SRST validation study using a somewhat younger age group and to compare predictive indices to typical measures of parent concern and teacher judgment. A sample of (N = 343) prekindergarten children (ages 54 to 66 months) attending school registration in the spring before kindergarten entry was tested with the SRST. A stratified sample of 76 returned for criteria testing within 2 months. Teacher ratings were obtained 5 months later. Outcome measures were standard language (Bankson and Illinois Test of Psycholinguistic Abilities) and speech articulation (Arizona) tests. With a prevalence of 11%, SRST prediction of language outcomes resulted in the following indices: sensitivity, .62; specificity, .91; predictive validity, .44; overreferral, 8.4%; and underreferral, 4%. Prediction of the articulation outcome with a prevalence of 11% resulted in indices as follows: sensitivity, .57; specificity, .95; predictive validity, .75; overreferral, 3.7%; and underreferral, 8.3%. Teacher ratings and a parent questionnaire (Speech and Language Screening Questionnaire) approached the same rate of prediction of articulation but with a higher overreferral rate. The predictive indices from the SRST exceeded the comparison measures for language outcomes.

The NEECHAM Confusion Scale: construction, validation, and clinical testing.

This article reports the development of the NEECHAM Confusion Scale for rapid and unobtrusive assessment and monitoring of acute confusion. The scale was tested in two samples (N = 168 and 258, respectively) of elderly patients hospitalized for acute medical illness. Internal consistency and interrater reliability of the instrument were found to be high. The NEECHAM correlated well with the Mini-Mental State Examination and the sum of DSM-III-R positive items. Factor analyses identified and confirmed cognitive/behavioral and physiological domains. The NEECHAM provides a valid and reliable bedside assessment of acute confusion, particularly at its onset and in patients with "quiet" manifestations.

Sources of support reported by mothers and fathers of infants hospitalized in a neonatal intensive care unit.

Over the past two decades, awareness of the importance of social support for individuals faced with a major life transition or a stressful event has increased. The purpose of this study was to identify the perceptions of mothers and fathers of critically ill infants about the helpfulness of support provided to them by family, health care professionals, and other when their infants were in a neonatal intensive care unit (NICU). Social support in this study is conceptualized as the interpersonal transactions that parents of preterm infants perceive as helpful in reducing their stress and coping with their child's illness. Data were collected using the Illness Support Scale, on which subjects rated the helpfulness of support from individuals across their network. Findings indicate that these parents experienced a moderately high level of support and perceived NICU nurses as very helpful. Nurses need to continue to develop their role in helping families by identifying specific supportive interventions.

Barriers and facilitators of research utilization. An integrative review.

For over 20 years, nursing literature has discussed the gap between the conduct of research and the use of its findings to improve practice. Factors relating to the nurse, the setting, the research, and the way research is presented have been identified as barriers to research utilization. A combined approach that includes specialty organizations that take the lead in knowledge synthesis and dissemination, the creation of national on-line databases, and enhanced institutional supports and educational efforts is recommended.

Research utilization: reconnecting research and practice.

Barriers to the use of research in practice include problems with the availability of research, the manner in which it is presented, and the use of the research. They also include barriers in the setting and "shortcomings" of individual nurses. Most approaches to increasing research utilization have focused on the "shortcomings" of clinicians. A more useful approach is to make changes in both education and practice to rejoin researchers and clinicians and to reconnect the conduct and use of research.

Cancer and the partner relationship: what is its meaning?

When cancer occurs, it is an illness that has meaning for the lives of all members of the family. This article focuses on the meaning and significance of the illness for the partner relationship, both the individuals within the relationship and the dyad. Results of two studies are presented: one study is based on in-depth interviews with 50 individuals who were newly diagnosed with cancer and their partners, and the other study used questionnaires from 412 patients and 175 partners to obtain statistical data. Findings pointed to the importance of meaning in the adjustment of individuals, as well as the dyad. Interview data indicated that patients and their partners searched for meaning in the illness that would decrease its threat, and statistical analyses showed the significance of meaning as it applies to specific aspects of adjustment. The importance of considering meaning in care that is directed toward the prevention of problems within the dyad, which can occur as a result of coping with the stress of cancer are emphasized, and some specific recommendations are made.

Simultaneous Technique for Acuity and Readiness Testing (START): further concurrent validation of an aid for developmental surveillance.

STUDY OBJECTIVE: A brief (8-minute) procedure, now called Simultaneous Technique for Acuity and Readiness Testing or START, has been shown to be efficacious for predicting developmental outcomes and a cost-effective screen for visual acuity. The objective of the two studies reported here was to examine the ability of this procedure to predict concurrent development outcome by using a new simplified scoring system. DESIGN: A prospective design was used. Subjects were screened using START, and then samples were stratified on the basis of developmental screening results (START in study 1 and the revised Denver Developmental Screening Test and a shortened version of the Minnesota Child Development Inventory in study 2) into subsamples (n = 118 and 120) which were administered the standard criterion test (McCarthy Scales of Children's Abilities in one cohort and the Stanford-Binet in the other). SETTING: Prekindergarten registration for a rural school system in North Carolina. SUBJECTS: Two county-wide cohorts of preschool children (n = 352 and 362). MEASUREMENTS AND MAIN RESULTS: Results for prediction of the McCarthy outcomes were as follows: sensitivity, 0.76; specificity, 0.99; predictive value, 0.81; underreferral, 1.3%; overreferral, 1.0%; and percent agreement, 98%. Prediction of Stanford-Binet results was as follows: sensitivity, 0.94; specificity, 0.83; predictive value, 0.22; underreferral, 0.3%; overreferral, 16%; and percent agreement, 84%. Most of the overreferrals for the Stanford-Binet were in the clinically important borderline category. CONCLUSION: These results provide further support for the concurrent validity of START: The results illustrate how routine health procedures can be restructured to obtain clinically useful data on specific child developmental functioning.

The Fluharty Preschool Speech and Language Screening Test: a population-based validation study using sample-independent decision rules.

Two cohorts of 4- and 5-year-old children (N = 700) were screened with the Fluharty Preschool Speech and Language Screening Test. Two stratified samples (n = 51 cohort 1; n = 147 cohort 2), based on speech/language screening results, were administered criterion tests for articulation (AAPS-R or Templin-Darley) and language (TOLD or TALC-R). Clinical validation indices for combined speech or language outcome in the two cohorts were as follows: sensitivity, .43 and .31 respectively; specificity, .82 and .93; predictive value, .43 and .54; overreferral, 14% and 5%; underreferral, 14% in both cohorts, and percent agreement, 72% and 80%. The measure of sensitivities for language outcomes was lower than the above, whereas sensitivities for articulation was higher. These results suggest that the Fluharty is too insensitive to be relied on for screening programs aimed at identifying preschool children with language disorders, although it appears to have promise for the identification of children with articulation impairments.

Elicited imitation: its effectiveness for speech and language screening.

The authors explored the clinical usefulness of a brief sentence-repetition screening task (SRST), by screening 382 kindergarten children and performing follow-up tests on a stratified sample of 78. Results indicate that an elicited-imitation task can predict the combined outcome of receptive and expressive language problems, as well as articulation problems. Replication, cross-validation and assessment of children with selective receptive impairments are recommended. Nevertheless, the present study demonstrates that the use of sentence-repetition screening tasks could be a very efficient strategy for screening for both language and articulation problems in kindergarten children.

Parental Stressor Scale: neonatal intensive care unit.

This article is a report of the development of the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU), which is designed to measure parental perception of stressors arising from the physical and psychosocial environment of the neonatal intensive care unit. Stress theory, literature reviews, expert consultation, and parent interviews guided instrument development and refinement and established the content validity of the instrument. Construct validity is supported by links with theory, correlation with anxiety measures, and factor analytic results. Alpha coefficients support the tool's internal consistency. Three scales were identified: Parental Role Alterations, Sights and Sounds of the Unit, and Infant Behavior and Appearance. Available metrics allow scoring for stress occurrence levels, overall stress levels, and number of stressors experienced. The PSS:NICU can serve as a research or clinical measure to evaluate stressors experienced by parents with infants in a NICU.

Impact of a parent's cancer on adult children: role and relationship issues.

The diagnosis and initial treatment of a parent for cancer is a highly stressful process that generates a variety of concerns for adult children. This study describes the initial effect of a parent's cancer on adult children. Adult children's concerns about role and relationship issues emerged as major themes in the content analysis of their interviews.

The stress response of mothers and fathers of preterm infants.

Differences in neonatal intensive care unit (NICU) environmental stress, uncertainty, and anxiety of 23 mothers and fathers (couples) whose premature infants were hospitalized in an NICU were explored. Alterations in the parental role were found to be stressful for both mothers and fathers, with mothers reporting significantly greater stress in this area than did fathers. Stress and uncertainty decreased significantly over time. Mothers and fathers did not differ in level of anxiety. Findings suggest that both mothers and fathers are distressed by the admission of a premature to an NICU; however, mothers may be more distressed by certain aspects of the experience.

The neonatal intensive care unit environment: sources of stress for parents.

Many aspects of neonatal intensive care units (NICUs) are stressful to parents, including prolonged hospitalization, alterations in parenting, exposure to a technical environment, and the appearance of their small, fragile infant. To identify potential NICU stressors for parents, levels of stress these experiences engender, and their relationship to anxiety, parents of infants hospitalized in three NICUs were interviewed using the Parental Stressor Scale: NICU and the State-Trait Anxiety Inventory. Alterations in parental role caused by the infant's illness generated the greatest stress. The second highest areas of stress were the infant's appearance and behavior. State anxiety levels were higher than normative means and significantly related to stress scores.

How to write a research grant proposal.

Good writing will not of itself produce a good research grant proposal. Nevertheless, a well-organized, well-written proposal can help you get funded, so it's worth some effort. This article provides guidelines for writing all the standard parts of a proposal.