Improving phonological awareness with Talking Tables in at-risk kindergarten readers.

BACKGROUND: For young children experiencing phonological awareness (PA) difficulties, the need for early and targeted intervention to prevent reading disability is unequivocal. There are very few studies, however, on the efficacy of PA interventions delivered at school. AIMS: This study examined the impact of an early PA intervention embedded within an oral language program designed for at-risk kindergartners. METHODS: Using a quasi-experimental pretest/posttest design, at-risk readers from four schools received either the 10-week intervention in small groups, three times a week for 30 min as a supplement to the regular classroom curriculum or served as controls not participating in the intervention and receiving the usual classroom instruction. RESULTS: Children in the intervention group demonstrated a greater use of phonological awareness at posttest on overall composites of phonological processing, and on several individual accuracy and fluency measures targeting skills at the phoneme level. CONCLUSIONS: The results add to accumulating evidence on the efficacy and effectiveness of teacher-delivered school-based early literacy interventions.

Does CBM maze assess reading comprehension in 8-9-year olds at-risk for dyslexia?

Recent research has reported the word-level, code-related focus of curriculum-based measures (CBM) of reading comprehension such as Maze (Muijselaar et al., 2017) with typically developing readers, but research has yet to examine whether this finding also applies to children at-risk for dyslexia. We administered a collection of cognitive, linguistic, CBM, and norm-referenced measures to children whose word reading and decoding fluency fell below the 25th percentile and were, therefore, considered at-risk readers. We found that language comprehension contributed additional variance beyond decoding (fluency and accuracy measures) to reading comprehension as assessed by the WIAT-III, but that decoding explained the most variance in children's performance on the CBM Maze task (vis à vis the simple view of reading). The findings have practical implications to the use of CBM Maze as a formative assessment with children at-risk for dyslexia and elucidate the need for additional or alternative assessments to capture the reading comprehension construct.

Instrucciones de Alta por Video: Effectiveness of Video Discharge Instructions for Spanish-Speaking Caregivers in the Pediatric Emergency Department.

INTRODUCTION: Although evidence supports the addition of video discharge instructions to improve caregiver knowledge among English-speaking caregivers of children in the pediatric emergency department, there is no evidence about the effectiveness of videos for Spanish-speaking caregivers. The purpose of this study was to test whether Spanish video discharge instructions added to standard written and oral discharge instructions would result in improved knowledge and satisfaction among caregivers compared with written and oral instructions alone. METHODS: Spanish videos were created for fever, gastroenteritis, and bronchiolitis. A quasi-experimental, consecutive-sample, pre-post-test design was used with an audio computer-assisted survey platform to provide surveys in Spanish. The intervention group received written and oral instructions + video, whereas the comparison group received written and oral instructions alone. RESULTS: Data were collected from 150 caregivers. Caregivers who were given written and oral instructions + video showed significant knowledge improvement regarding their child's diagnosis and treatment (+19.3% and +23.6%, respectively, among standard participants; P < 0.001). Moreover, videos did not significantly improve caregivers' knowledge regarding illness duration and when to seek further care. Regardless of the discharge instruction format, no significant difference was observed in the helpfulness of the instructions (-1%; pre vs post, 84% vs 80%; χ2 = 0.35; P = 0.58). DISCUSSION: Study results demonstrate that when tailored to reflect diagnosis-specific education, video discharge instructions can improve Spanish-speaking caregiver knowledge about discharge education compared with written and oral instructions alone. Videos can be integrated to standardize the ED discharge process as an adjunct to nurse-provided written and oral instructions with an interpreter for Spanish-speaking families.

Endometriosis: A Malignant Fingerprint.

BACKGROUND: Endometriosis is complex, but identifying the novel biomarkers, inflammatory molecules, and genetic links holds the key to the enhanced detection, prediction and treatment of both endometriosis and endometriosis related malignant neoplasia. Here we review the literature relating to the specific molecular mechanism(s) mediating tumorigenesis arising within endometriosis. METHODS: Guidance (e.g. Cochrane) and published studies were identified. The Published studies were identified through PubMed using the systematic review methods filter, and the authors' topic knowledge. These data were reviewed to identify key and relevant articles to create a comprehensive review article to explore the molecular fingerprint associated with in endometriosis-driven tumorigenesis. RESULTS: An important focus is the link between C3aR1, PGR, ER1, SOX-17 and other relevant gene expression profiles and endometriosis-driven tumorigenesis. Further studies should also focus on the combined use of CA-125 with HE-4, and the role for OVA1/MIA as clinically relevant diagnostic biomarkers in the prediction of endometriosis-driven tumorigenesis. CONCLUSIONS: Elucidating endometriosis' molecular fingerprint is to understand the molecular mechanisms that drive the endometriosis-associated malignant phenotype. A better understanding of the predictive roles of these genes and the value of the biomarker proteins will allow for the derivation of unique molecular treatment algorithms to better serve our patients.

White matter capillaries in vascular and neurodegenerative dementias.

Previous studies suggest white matter (WM) integrity is vulnerable to chronic hypoperfusion during brain ageing. We assessed ~ 0.7 million capillary profiles in the frontal lobe WM across several dementias comprising Alzheimer's disease, dementia with Lewy bodies, Parkinson's disease with dementia, vascular dementia, mixed dementias, post-stroke dementia as well as post-stroke no dementia and similar age ageing and young controls without significant brain pathology. Standard histopathological methods were used to determine microvascular pathology and capillary width and densities in 153 subjects using markers of the basement membrane (collagen IV; COL4) and endothelium (glucose transporter-1; GLUT-1). Variable microvascular pathology including coiled, tortuous, collapsed and degenerated capillaries as well as occasional microaneurysms was present in all dementias. As expected, WM microvascular densities were 20-49% lower than in the overlying cortex. This differential in density between WM and cortex was clearly demonstrated by COL4, which was highly correlated with GLUT-1 densities (Spearman's rho = 0.79, P = 0.000). WM COL4 immunopositive microvascular densities were decreased by ~ 18% across the neurodegenerative dementias. However, we found WM COL4 densities were increased by ~ 57% in post-stroke dementia versus ageing and young controls and other dementias. Using three different methods to measure capillary diameters, we found WM capillaries to be significantly wider by 19-45% compared to those in overlying neocortex apparent with both COL4 and GLUT-1. Remarkably, WM capillary widths were increased by ~ 20% across all dementias compared to ageing and young controls (P < 0.01). We also noted mean WM pathology scores incorporating myelin loss, arteriolosclerosis and perivascular spacing were correlated with COL4 immunopositive capillary widths (Pearson's r = 0.71, P = 0.032). Our key finding indicates that WM capillaries are wider compared to those in the overlying neocortex in controls but they dilate further during dementia pathogenesis. We suggest capillaries undergo restructuring in the deep WM in different dementias. This reflects compensatory changes to retain WM perfusion and integrity during hypoperfusive states in ageing-related dementias.

Creating a Sensory-Friendly Pediatric Emergency Department.

INTRODUCTION: For children with autism spectrum disorder (ASD) and sensory-processing disorder (SPD), an unexpected visit to the emergency department can be an overwhelming experience that creates intensifying behaviors and an unsafe clinical interaction for the child, nurses, and providers. Although resources exist to help nurses work with this specialized group, there are limited examples of the challenges and opportunities of modifying an emergency department to be a place where nurses can provide sensory-informed care. METHODS: Guided by Watson's Theory of Caring, nurses and child life specialists in our pediatric emergency department initiated a practice improvement (PI) project to create a sensory-friendly emergency department. The nurses (1) engaged with community members and families, (2) examined current practices, (3) modified the patient care environment, (4) collaborated in an interprofessional educational session, and (5) created a shared vision for the modified patient-care environment. RESULTS: This article describes the nurse-initiated PI process and the journey to create an evidence-based sensory-friendly pediatric emergency department. A model is presented so that other facilities can embark on their own initiative, and case studies are used to evaluate project outcomes. DISCUSSION: Integrating current evidence, staff suggestions, community input, and expert advice allowed us to find creative solutions to the unique sensory needs of children who visit our emergency department. Modifying both the patient-care environment and the patient-flow process to accommodate for the needs of children with ASD/SPD created a more peaceful and healing environment for children and their families and gave nurses the support they needed to provide sensory-informed care.

Evidence-Based Practice: Video-Discharge Instructions in the Pediatric Emergency Department.

PROBLEM: While a high quality discharge from a Pediatric Emergency Department helps caregivers feel informed and prepared to care for their sick child at home, poor adherence to discharge instructions leads to unnecessary return visits, negative health outcomes, and decreased patient satisfaction. Nurses at the Inova Loudoun Pediatric ED utilized the Johns Hopkins Model of Evidence Based Practice to answer the following question: Among caregivers who have children discharged from the ED, does the addition of video discharge instructions (VDI) to standard written/verbal discharge instructions (SDI) result in improved knowledge about the child's diagnosis, treatment, illness duration, and when to seek further medical care? METHODS: A multidisciplinary team reviewed available evidence and created VDI for three common pediatric diagnoses: gastroenteritis, bronchiolitis, and fever. Knowledge assessments were collected before and after delivery of discharge instructions to caregivers for both the SDI and VDI groups. RESULTS: Analysis found that the VDI group achieved significantly higher scores on the post test survey (P < .001) than the SDI group, particularly regarding treatment and when to seek further medical care. After integrating the best evidence with clinical expertise and an effective VDI intervention, the team incorporated VDI into the discharge process. IMPLICATIONS FOR PRACTICE: VDI offer nurses an efficient, standardized method of providing enhanced discharge instructions in the ED. Future projects will examine whether VDI are effective for additional diagnoses and among caregivers for whom English is not the primary language.

Neuropsychological Profiles of Written Expression Learning Disabilities Determined by Concordance-Discordance Model Criteria.

Children with specific learning disabilities (SLD) have disparate neuropsychological processing deficits that interfere with academic achievement in spelling, writing fluency, and/or written expression (WE). Although there are multiple potential causes of WE SLD, there is a paucity of research exploring this critical academic skill from a neuropsychological perspective. This study examined the neuropsychological profiles of WE SLD subtypes defined using the concordance-discordance model (C-DM) of SLD identification. Participants were drawn from a sample of 283 children (194 boys, 89 girls) aged 6 years to 16 years old (M(age) = 9.58 years, SD = 2.29 years) referred for comprehensive neuropsychological evaluations in school settings and subsequently selected based on C-DM determined spelling, writing fluency, and WE SLD. WE SLD subtypes differed on several psychomotor, memory, and executive function measures (F range = 2.48-5.07, p range = .049 to <.001), suggesting that these children exhibit distinct patterns of neuropsychological processing strengths and weaknesses. Findings have relevance for differential diagnosis of WE subtypes, discriminating WE SLD subtypes from low WE achievement, and developing differentiated evidence-based instruction and intervention for children with WE SLD. Limitations and future research will be addressed.

Psychosocial and Adaptive Deficits Associated With Learning Disability Subtypes.

Children with specific learning disabilities (SLD) have deficits in the basic psychological processes that interfere with learning and academic achievement, and for some SLD subtypes, these deficits can also lead to emotional and/or behavior problems. This study examined psychosocial functioning in 123 students, aged 6 to 11, who underwent comprehensive evaluations for learning and/or behavior problems in two Pacific Northwest school districts. Using concordance-discordance model (C-DM) processing strengths and weaknesses SLD identification criteria, results revealed working memory SLD (n = 20), processing speed SLD (n = 30), executive SLD (n = 32), and no disability groups (n = 41). Of the SLD subtypes, repeated measures MANOVA results revealed the processing speed SLD subtype exhibited the greatest psychosocial and adaptive impairment according to teacher behavior ratings. Findings suggest processing speed deficits may be behind the cognitive and psychosocial disturbances found in what has been termed "nonverbal" SLD. Limitations, implications, and future research needs are addressed.

A literature review of interprofessional working and intermediate care in the UK.

AIMS AND OBJECTIVES: This systematic literature review aimed at addressing two questions: first, what evidence exists regarding intermediate care in the UK; and what interventions have been used to develop interprofessional working in intermediate care in the UK? A systematic review of the literature from 2000-2006 resulted in a total of 104 full-text articles describing research into intermediate care in the UK. BACKGROUND: The review was the first stage of a large, national project evaluating and developing interprofessional working among health and social care staff, particularly in relation to the intermediate care of older people. DESIGN: Systematic literature review. METHODS: All the literature was reviewed by one reviewer, and a second review was carried out by a team of reviewers to ensure each article was reviewed twice, independently. One article was reviewed by all the reviewers to ensure inter-rater reliability; finally, all the reviews were amalgamated, which resulted in one summary per article. RESULTS: The main findings drawn from this systematic literature review are that research carried out on intermediate care in the UK has a diverse set of aims, for example economic evaluations, delivery of intermediate care and exploring the views and perceptions of those involved in intermediate care. CONCLUSIONS: Although several articles include discussions about the importance of interprofessional working in intermediate care, no article specifically focused on the interprofessional focus of intermediate care, and there was no research about interventions used to develop interprofessional working. RELEVANCE TO CLINICAL PRACTICE: Intermediate care as a policy has been interpreted very differently across the four countries of the UK; there is no one preferred or consistent interpretation to its delivery.

A comparison of the quality of blood specimens drawn in the field by EMS versus specimens obtained in the emergency department.

INTRODUCTION: Emergency Department (ED) acceptance of blood specimens drawn by Emergency Medical Services (EMS) staff is not a consistent standard of practice across hospitals. The literature does not address acceptance of pre-hospital phlebotomy specimens drawn by EMS staff. The purpose of this study was to compare specimen redraw rates and ED throughput times for specimens drawn by EMS versus ED staff. METHODS: Data was collected on 400 patients regarding phlebotomist type, intravenous (i.v.) site, i.v. angiocatheter size, number of i.v. attempts producing blood specimens, redraw reason, undue blood exposure to phlebotomist, diagnosis, and length of stay. RESULTS: In this study of 400 patients (EMS=200; ED=200), the redraw rate was higher for the ED group (11.5%) than the EMS group (9.5%). The primary reason for redraw in the EMS group was insufficient quantity (52.6%; ED=8.7%, p<.05). The primary reason for redraw in the ED group was hemolysis (52.2%; EMS=31.6%). Median ED throughput time was 17 minutes less for the EMS group (163 minutes) than for ED group (180 minutes). There were no incidences of undue blood exposure in either group. DISCUSSION: Based on no statistically significant differences between the two study groups in redraw rates, a decreased ED patient throughput time, and no undue blood exposure incidences, pre-hospital phlebotomy by EMS in the field and subsequent ED acceptance of samples is a standard of practice that can be implemented.