Early coronary angiography in NSTEMI: a regional Victorian perspective.

BACKGROUND: Current guidelines highlight a paucity of evidence guiding optimal timing for non-ST-elevation myocardial infarction (NSTEMI) in high-risk and non-high-risk cases. AIM: We assessed long-term major adverse cardiovascular events (MACEs) in NSTEMI patients undergoing early (<24 h) versus delayed (>24 h) coronary angiography at 6 years. Secondary end-points included all-cause mortality and cumulative MACE outcomes. METHODS: Baseline characteristics and clinical outcomes were assessed among 355 patients presenting to a tertiary regional hospital between 2017 and 2018. Cox proportional hazard models were generated for MACE and all-cause mortality outcomes, adjusting for the Global Registry of Acute Coronary Events (GRACE) score, patient demographics, biomarkers and comorbidities. RESULTS: Two hundred and seventy patients were included; 147 (54.4%) and 123 (45.6%) underwent early and delayed coronary angiography respectively. Median time to coronary angiography was 13.3 and 45.4 h respectively. At 6 years, 103 patients (38.1%) experienced MACE; 41 in the early group and 62 in the delayed group (hazard ratio (HR) = 2.23; 95% confidence interval (CI) = 1.50-3.31). After multivariable adjustment, the delayed group had higher rates of MACE (HR = 1.79; 95% CI = 1.19-2.70), all-cause mortality (HR = 2.76; 95% CI = 1.36-5.63) and cumulative MACE (incidence rate ratio = 1.54; 95% CI = 1.12-2.11). Subgroup analysis of MACE outcomes in rural and weekend NSTEMI presentations was not significant between early and delayed coronary angiography (HR = 1.49; 95% CI = 0.83-2.62). CONCLUSION: Higher MACE rates in the delayed intervention group suggest further investigation is needed. Randomised control trials would be well suited to assess the role of early invasive intervention across all NSTEMI risk groups.

Using the ADDIE Model of Instructional Design to Create Programming for Comprehensive ABA Treatment.

ABA research abounds with articles on increasing or decreasing a small set of behaviors. These articles fit nicely within the framework of Focused ABA Treatment in which the goal of treatment centers on only a few behaviors. However, many behavioral practitioners spend most of their time developing Comprehensive ABA Treatment in which a large number of behaviors are systematically changed across multiple developmental domains. Few resources are available to help in designing and implementing such programming. This article presents a model from the field of instructional design for the development of comprehensive programming. Applying the ADDIE model-Analyze, Design, Develop, Implement, Evaluate-the article identifies a consistent process to follow, critical actions to take, and helpful resources to use when developing comprehensive programming for individuals with autism.

Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder.

Aims: To map studies assessing both clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) in clinical samples, focusing on clinical/research/preventive paradigms and proposing informed research recommendations. Methods: We conducted a PRISMA-ScR/JBI-compliant scoping review (protocol: https://osf.io/8mz7a) of primary research studies (cross-sectional/longitudinal designs) using valid measures/criteria to assess CHR-P and BPD (threshold/subthreshold) in clinical samples, reporting on CHR-P/psychotic symptoms and personality disorder(s) in the title/abstract/keywords, identified in Web of Science/PubMed/(EBSCO)PsycINFO until 23/08/2023. Results: 33 studies were included and categorized into four themes reflecting their respective clinical/research/preventive paradigm: (i) BPD as a comorbidity in CHR-P youth (k = 20), emphasizing early detection and intervention in psychosis; (ii) attenuated psychosis syndrome (APS) as a comorbidity among BPD inpatients (k = 2), with a focus on hospitalized adolescents/young adults admitted for non-psychotic mental disorders; (iii) mixed samples (k = 7), including descriptions of early intervention services and referral pathways; (iv) transdiagnostic approaches (k = 4) highlighting "clinical high at risk mental state" (CHARMS) criteria to identify a pluripotent risk state for severe mental disorders. Conclusion: The scoping review reveals diverse approaches to clinical care for CHR-P and BPD, with no unified treatment strategies. Recommendations for future research should focus on: (i) exploring referral pathways across early intervention clinics to promote timely intervention; (ii) enhancing early detection strategies in innovative settings such as emergency departments; (iii) improving mental health literacy to facilitate help-seeking behaviors; (iv) analysing comorbid disorders as complex systems to better understand and target early psychopathology; (v) investigating prospective risk for BPD; (vi) developing transdiagnostic interventions; (vii) engaging youth with lived experience of comorbidity to gain insight on their subjective experience; (viii) understanding caregiver burden to craft family-focused interventions; (ix) expanding research in underrepresented regions such as Africa and Asia, and; (x) evaluating the cost-effectiveness of early interventions to determine scalability across different countries. Systematic Review Registration: https://osf.io/8mz7a.

How "global" is research in early intervention for psychosis? A bibliometric analysis.

INTRODUCTION: Unlike high-income countries (HICs), there are few early intervention services for psychosis in low-and middle-income countries (LAMICs). In HICs, research spurred the growth of such services. Little is known about the state of EIP research in LAMICs, which we address by examining their research output and collaborations vis-à-vis that of HICs. METHODS: We conducted a search in Scopus database for early psychosis publications in scientific journals since 1980. Data from each record, including title, author affiliation, and date, were downloaded. For HIC-LAMIC collaborations, data on first, corresponding and last authors' affiliations, and funding were manually extracted. Descriptive statistics and social network analysis were conducted. RESULTS: Globally, early psychosis publications increased from 24 in 1980 to 1297 in 2022. Of 16,942 included publications, 16.1 % had LAMIC authors. 71.3 % involved authors from a single country (regardless of income level). 21.9 % were collaborations between HICs, 6.6 % between HICs and LAMICs, and 0.2 % among LAMICs. For research conducted in LAMICs and involving HIC-LAMIC collaborations, the first, last, and corresponding authors were LAMIC-based in 71.8 %, 60.7 %, and 63.0 %, respectively. These positions were dominated (80 %) by authors from four LAMICs. 29.4 % of the HIC-LAMIC subset was funded solely by LAMIC funders, predominantly two LAMICs. CONCLUSIONS: LAMICs are starkly underrepresented in the otherwise flourishing body of early psychosis research. They have far fewer collaborations and less funding than HICs. Closing these gaps in LAMICs where most of the world's youth live is imperative to generate the local knowledge needed to strengthen early psychosis services that are known to improve outcomes.

Implementing a Uniform Outcome Measurement Approach for Early Interventions of Autism Spectrum Disorders.

OBJECTIVE: Naturalistic developmental behavioral interventions (NDBI) for children with autism spectrum disorder (ASD) show evidence for effectiveness for specific social communication targets such as joint attention or engagement. However, combining evidence from different studies and comparing intervention effects across those studies have not been feasible due to lack of a standardized outcome measure of broader social communication skills that can be applied uniformly across trials. This investigation examines the usefulness of the Brief Observation of Social Communication Change (BOSCC) as a common outcome measure of general social communication skills based on secondary analyses of data obtained from previously conducted randomized control trials (RCTs) of three intervention models, the Early Social Intervention (ESI), Early Start Denver Model (ESDM) and Joint Attention Symbolic Play Engagement and Regulation (JASPER). METHOD: The subset of datasets from the three RCTs was created to examine differences in the BOSCC scores between intervention and control groups over the course of the interventions. RESULTS: Based on 582 videos from 207 caregiver-child dyads, the BOSCC noted significant differences between intervention vs. control groups in broad social communication skills within two of the three intervention models which were longer in duration and focused on a broad range of developmental skills. CONCLUSION: The BOSCC offers the potential to take a uniform measurement approach across different intervention models to capture the effect of intervention on general social communication skills but may not pick up the effects of some brief interventions targeting proximal outcomes.

The Role of Adverse Childhood Experience in the Relationship Between Autism Severity and Early Intervention and Special Education Plan.

The purpose of this study is to examine the association between autism spectrum disorder (ASD) severity and having a special education or early intervention plan and the impact of adverse childhood experiences (ACEs) on this association. This study used the 2020-2021 National Survey of Children's Health (NSCH) and included 2,537 children aged 3-17 years old who currently have ASD. Multivariable logistic regression, controlling for demographic and family characteristics and health status, was used to explore the association between autism severity and having an early intervention plan. The analysis was stratified by the number of ACEs to explore their role in the association. Children with moderate or severe ASD were more likely to have a special education or early intervention plan than those with mild ASD in the crude and adjusted models. This association continued to be true for children who experienced 1 ACE (aOR: 2.28, 95%CI: 1.09-4.77) but not true for those who experienced no ACEs (aOR: 1.16, 95%CI: 0.70-1.94) and 2 or more ACEs (aOR: 1.84, 95%CI: 0.92-3.69). Results demonstrate that children with moderate or severe autism were more likely to receive early intervention or special education. This association changed depending on the number of ACEs experiences.

Exploring the needs of healthcare workers receiving psychological first aid during the COVID19 pandemic.

BACKGROUND: Healthcare workers (HCW; e.g., nurses, social workers) work in stressful conditions, a situation that has been further exacerbated by the COVID-19 pandemic. A review of the supportive role of Psychological first aid (PFA) suggested that it can protect HCW from psychological distress. Despite the growing interest of PFA among public health organizations, there is a dearth of literature on its potential impact for the psychological well-being of HCW and its implementation within organizations. OBJECTIVE: This study aimed to evaluate whether PFA met the psychological needs of HCW in Montreal, Quebec. METHODS: A sample of 15 HCW who received PFA by a peer within their organization were recruited to participate in semi-structured interviews. Qualitative research using thematic analysis was conducted. RESULTS: Five themes were identified: 1) PFA satisfied participants' psychosocial needs; 2) PFA provided by peers allowed participants to feel understood and supported; 3) High availability and multiple modalities facilitated PFA access; 4) Occupational and organizational cultures hindered PFA access; and 5) Recommendations to promote the use of the PFA service. CONCLUSION: Results describe four psychosocial needs met by the PFA intervention: to have resources/strategies, to be validated, to obtain a better understanding of the psychological reactions they were experiencing, and to be guided and supported in their difficulties at work. Overall, these findings illustrate how PFA goes beyond the reduction of distress symptoms in the aftermath of a potentially traumatic event. The relevance to further the assessment of PFA's positive effects on psychological adaptation and/or recovery is also highlighted.

Client and family experiences with telehealth-delivered early psychosis services.

OBJECTIVE: The COVID-19 pandemic prompted a significant shift to delivering early psychosis services using telehealth. Little is known about the experience of using telehealth in early psychosis services. This quality improvement qualitative project investigated the experiences of program participants and family members with telehealth services in OnTrackNY, an early intervention program for psychosis in New York State during the COVID-19 pandemic. METHODS: The project team conducted individual interviews and focus groups. Data analyses used a matrix approach. RESULTS: Nineteen OnTrackNY program participants and nine family members participated in five focus groups and nine individual interviews. Data were organized into five themes (a) accessibility: most individuals had a device and internet access and challenges were related to connectivity, such as image freezing and sound breaking; (b) convenience/flexibility: benefits included the reduced commute and costs; (c) levels of comfort/privacy with telehealth: program participants felt less judged and less anxiety leading up to in-person appointments while also expressing privacy concerns; (d) sense of connectedness: in-person social connections were deemed important and not replaceable by telehealth; and (e) suggestions: program participants expressed a preference for in-person group activities and suggested hybrid options, highlighting the importance of in-person visits to establish rapport at the beginning of treatment before transitioning to telehealth. CONCLUSIONS: Telehealth services were generally well accepted. Suggestions for future service delivery include offering a combination of telehealth and in-person services based on program participants' preferences and prioritizing in-person services during the early phase of treatment.

Transcranial alternating current stimulation (tACS) at gamma frequency: an up-and-coming tool to modify the progression of Alzheimer's Disease.

The last decades have witnessed huge efforts devoted to deciphering the pathological mechanisms underlying Alzheimer's Disease (AD) and to testing new drugs, with the recent FDA approval of two anti-amyloid monoclonal antibodies for AD treatment. Beyond these drug-based experimentations, a number of pre-clinical and clinical trials are exploring the benefits of alternative treatments, such as non-invasive stimulation techniques on AD neuropathology and symptoms. Among the different non-invasive brain stimulation approaches, transcranial alternating current stimulation (tACS) is gaining particular attention due to its ability to externally control gamma oscillations. Here, we outline the current knowledge concerning the clinical efficacy, safety, ease-of-use and cost-effectiveness of tACS on early and advanced AD, applied specifically at 40 Hz frequency, and also summarise pre-clinical results on validated models of AD and ongoing patient-centred trials.

Barking Up the Wrong Tree-Motor-Sensory Elements as Prodrome in Autism.

Autism spectrum disorder (ASD) has been intensely investigated since the term was first used over 80 years ago. The prevalence of ASD is constantly rising, and, currently, 1:36 children are diagnosed with this disorder. Despite the intense interest in ASD, the origins of this disorder remain obscure. This article explores motor issues and proprioceptive interoception difficulties as the prodrome of ASD. The importance of early intervention in the prognosis of ASD is common knowledge. Yet, since the communicational and social behaviors typical of ASD are observable only after the age of 18 months, diagnosis and early intervention are delayed. Therefore, the quest into the involvement of sensory-motor difficulties as a source of ASD traits, or at least as a potential early indicator, is warranted, with the intention of enabling early diagnosis and early intervention. This article examines the justification for this new avenue of early diagnosis and intervention and may open up a completely different way of viewing ASD. This new point of view may suggest an original path of assessment and intervention in infancy with this group of clients, possibly leading to improved prognosis for children and their families.

Knowledge translation strategies used to promote evidence-based interventions for children with cerebral palsy: a scoping review.

BACKGROUND: Cerebral palsy (CP) is the most common childhood physical disability, imposing substantial costs on individuals and society. Early interventions that promote brain optimization and reorganization are vital for children with CP. Integrating early evidence-based practice (EBP) remains challenging but enhances functional outcomes. METHODS: Following a scoping review methodology, databases were searched to identify studies examining the impact of knowledge translation (KT) strategies for pediatric CP interventions. Extraction included study characteristics, methodology, KT strategies, barriers, and facilitators. Numerical and inductive content analysis identified themes among KT strategies. A final stakeholder consultation to discuss the results was conducted. RESULTS: This review included seventeen articles. Common outcomes included participant change in EBP knowledge and behaviour. Common barriers included a need for more resources, protected time, and funding. Most studies followed a multifaceted KT approach. Various KT strategies were used, primarily mentoring, workshops, case studies, and online tools. INTERPRETATION: Results underscored the need for tailored KT strategies for implementing EBP for children with CP. Additionally, user-friendly KT tools and involving mentors to facilitate the intervention can haste EBP uptake. Successful adoption depends on challenges in healthcare settings. This study provides insights into current KT strategies for advancing best practices for children with CP.

Employing multifaceted knowledge translation strategies in a pediatric rehabilitation setting can support the adoption of evidence-based practices for children with cerebral palsy.It is important to identify and address common barriers hindering the use of evidence-based practices in cerebral palsy rehabilitation in a specific context to tailor a knowledge translation strategy.Having qualified rehabilitation professionals act as evidence-based practice leaders in a healthcare setting is crucial for promoting evidence-based practices among other professionals.

Disorganization in individuals at clinical high risk for psychosis: psychopathology and treatment response.

Disorganization is a nuclear dimension of psychosis, especially in schizophrenia. Despite its relevant association with poor prognosis and negative outcomes, it is still under-investigated compared to positive and negative symptoms, in particular at the onset of illness. This study explored disorganization in youth at Clinical High Risk for Psychosis (CHR-P) over a 2-year period. A sample of 180 CHR-P participants (50% males; 51.1% with baseline second-generation antipsychotic medication) recruited within a specialized CHR-P service completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Across the follow-up, we examined key associations of disorganization with other domains of psychopathology, functioning, and treatment response using Spearman's rank correlation coefficients and linear regression analyses. Our results showed a significant longitudinal reduction in disorganization severity levels across the follow-up. This decrease was significantly associated with improvements in negative symptoms and daily functioning, with a shorter duration of untreated psychiatric symptoms, and with baseline equivalent dose of antipsychotic medication. No significant longitudinal associations with other treatment component of the PARMS program were found. Our findings suggest a longitudinal improvement in disorganization dimension in CHR-P individuals, especially in the context of early interventions targeting reduction in the duration of untreated psychiatric symptoms and favoring a prompt antipsychotic therapy.

A remote parent-led early intervention protocol to promote motor development in infants with congenital heart disease: a feasibility pilot study of a randomized clinical trial.

This study evaluated the feasibility of a parent-led, home-based early intervention for motor development in infants with Congenital Heart Disease (CHD), part of a larger multicenter, single-blind randomized controlled trial (ClinicalTrials.gov NCT05907109). Parents, supported by remote specialists weekly, engaged in multidomain stimulation activities five days a week, for six months. Feasibility was assessed via parental questionnaires, adherence rates, and infant motor development assessments. Despite high dropout and mortality rates, results showed 80% adherence, 91% parental satisfaction, 75% availability, and 60% self-efficacy. No significant motor skill differences were noted between the intervention (IG; n = 19) and control groups (CG; n = 11) at six months, but the higher baseline risk in IG suggests promotion of motor skills in the intervention group. Future studies in Brazil might extend the study duration to address high dropout and mortality rates.

A qualitative analysis of the usefulness, risks, and challenges of incorporating functionality and body compassion into the prevention and treatment of eating disorders.

Functionality appreciation and body compassion are empirically supported concepts that can help one to view their body in different and compassionate ways. However, they have yet to be applied to eating disorder (ED) samples and therefore it is important to explore the perceived benefit, risk, and nuance in this population. Semi-structured interviews (N = 25) were conducted with treatment providers, those with a lived experience of an ED, or history of body image distress. Usefulness, applicability, potential risks, benefits, and desired delivery format were probed. Thematic analysis was used. Participants reported that compassion and functionality approaches were useful, complement existing treatment approaches, and important for early intervention. Although considered safe, caveats were noted for ED samples, including introducing content at the right time (e.g., when medically stable), and when having the cognitive flexibility to think about one's body in different ways. For example, functionality appreciation could trigger thoughts about what one's body cannot do while compassion may allow for normalising negative thoughts. Both concepts were viewed as useful and safe to support positive body image at a community level and can be used with ED samples with additional support. This insight from potential users helps with co-design of appropriate content.

Timing of surgical intervention in peripheral nerve injuries from gunshot wounds: Management and review of the literature.

Background: Gunshot wounds (GSWs) can result in various peripheral nerve injuries (PNIs), ranging from direct nerve transection to neuropraxia caused by the ballistic shockwave mechanism. PNIs from GSWs can be treated with either early or delayed intervention, with the literature supporting both approaches and sparking a debate between early and delayed intervention for PNIs from GSWs. Here, we present a case that underwent delayed exploration of the right common peroneal nerve after GSW and a literature review comparing early versus delayed intervention for PNIs from GSWs. Case Description: A 29-year-old male underwent right common peroneal nerve exploration 2 months after he sustained a GSW to the right lower extremity at the level of the fibular head tracking to the lateral malleolus. Initially, after the injury, he was offered supportive care. On evaluation, 1 month later, he reported a right-sided foot drop and paresthesias in the right lower extremity. A partial-thickness injury of the right peroneal nerve was seen on ultrasound, and a bullet fragment in the distal right lower extremity was revealed on computed tomography. The surgical intervention consisted of the right common peroneal nerve decompression proximally to distally and removal of the bullet fragment. Postoperatively, the patient did well with improvements in his right ankle dorsiflexion and plantar flexion seen at his 1.5-month follow-up visit. Conclusion: Many factors must be considered when treating PNIs from GSWs. For each case, clinical judgment, injury mechanism, and risk-benefit analysis must be evaluated to determine each patient's optimal treatment strategy.

Parents' experiences of participating in the Small Step early intervention program for infants at high risk of cerebral palsy: essential components and potential dilemmas.

MATERIALS AND METHODS: Thirteen parents (eight mothers and five fathers) of ten children participated in this qualitative study through individual in-depth interviews. Transcripts were analysed using reflexive thematic analysis. RESULTS: The parents emphasized the advantage of having the intervention provided at home with coaching and flexible support from the interprofessional team of therapists. This assured the families and enhanced their capacity to provide the child with playful and enriched learning opportunities integrated in everyday life. However, identification of achievable goals and intervention delivery could be emotionally taxing for parents, especially in the early stages and if treatment effects were below hopes and expectations. CONCLUSIONS: Our findings provide insights into what kind of support parents prefer and dilemmas professionals should be aware of when providing early intervention to families of infants at high risk of CP. Parents appreciated being involved as equal partners and receiving home-based guidance. Acknowledging grief and sorrow as natural reactions and fostering open discussions about expectations seem essential in addressing families' individual needs.

Guidance on how to integrate playful training in everyday life at home is crucial in reducing family stress and empower parents.In collaborative goalsetting, therapists should explore parents' hopes and expectations and provide guidance on possible realistic short-term goals.Therapists should be aware that participating in early intervention can be emotionally challenging and acknowledge grief and sorrow as natural reactions.

Cognitive, behavioral and socio-communication skills as predictors of response to Early Start Denver Model: a prospective study in 32 young children with Autism Spectrum Disorder.

Introduction: The effectiveness of early interventions in young autistic children is well established, but there is great interindividual variability in treatment response. Predictors of response to naturalistic developmental behavioral interventions (NDBI), like the Early Start Denver Model (ESDM), are needed. Methods: We conducted an exploratory study to prospectively seek predictors of response in 32 young children treated with ESDM after receiving an ASD diagnosis. All children were less than 39 months old (mean age: 29.7 mo), and received individualized ESDM for nine months. Tests were administered at the beginning, after 4 months, and at the end of treatment. Results: Four children (12.5%) were "strong responders", 8 children (25.0%) were "moderate responders", and 20 children (62.5%) were "poor responders". A more favorable response to ESDM was significantly predicted by higher PEP-3 Expressive Language, Receptive Language, Cognitive Verbal/Preverbal, Visuo-Motor Imitation scores, higher GMDS-ER Personal/Social, and VABS-II Communication scores, by lower ADI-R C restricted/stereotypic behaviors, and by joint attention level. Discussion: Most predictors showed a linear association with increasing response to ESDM, but GMDS-ER Personal-Social and joint attention level predicted strong response, while PEP-3 receptive language equally predicted moderate or strong response. Although larger samples will be necessary to reach definitive conclusions, in conjunction with prior reports our findings begin providing information able to assist clinicians in choosing the most appropriate treatment program for young autistic children.

Early, Intensive and Persistent Lipid-Lowering Therapy for Secondary Prevention of Acute Coronary Syndrome.

AIM: Early and intensive low-density lipoprotein (LDL-C)-lowering therapy plays important roles in secondary prevention of acute coronary syndrome (ACS), but the treatment period for further clinical benefit remains undefined. This single-center, retrospective study explored LDL-C trajectory after ACS and its associations with subsequent cardiovascular events (CVE). METHODS: In 831 patients with ACS, we evaluated LDL-C reduction during the first 2 months post-ACS as an index of early intervention and the area over the curve for LDL-C using 70 mg/dl as the threshold in the next 6 months (AOC-70) as a persistent intensity index. Patients were followed for a median of 3.0 (1.1-5.2) years for CVE, defined as the composite of cardiovascular death, non-fatal myocardial infarction, angina pectoris requiring revascularization, cerebral infarction, and coronary bypass grafting. RESULTS: LDL-C decreased from baseline to 2 months post-ACS (107±38 mg/dl to 78±25 mg/dl, p＜0.001) through high-intensity statin prescription (91.8%), while achieving rates of LDL-C ＜70 mg/dl at 2 months remained only 40.2% with no significant changes thereafter. During the follow-up period, CVE occurred in 200 patients. LDL-C reduction during the first 2 months and AOC-70 in the next 6 months were both associated with subsequent CVE risk (sub-HR [hazard ratio] [95% confidence interval]: 1.48 [1.16-1.89] and 1.22 [1.05-1.44]). Furthermore, early intervention followed by persistently intensive LDL-C-lowering therapy resulted in further CVE risk reduction. CONCLUSIONS: The present study observed that achieving early and intensive LDL-C reduction within the first two months after ACS and maintaining it for the next six months suppressed subsequent CVE risk, suggesting the importance of early, intensive, and persistent LDL-C-lowering therapy in the secondary prevention of ACS.

Giant vascular malformations invading the skull: A case report.

BACKGROUND: Vascular malformations (VMs) arise as a result of errors in the process of angiogenesis and are usually present at birth, but may not become apparent until after birth. However, giant VMs of the head and face are uncommon, with few reported cases, and the prognosis for their surgical intervention is unclear. CASE SUMMARY: A 12-year-old girl was admitted to the hospital with findings of an enlarged right temporal scalp. After admission, computed tomography (CT) angiography of cerebral ateries showed a right occlusal gap and a right temporal artery venous malformation. Furthermore, cerebral angiography showed a right temporal lobe VM with multiple vessels supplying blood. The patient underwent surgery to remove the malformed vessels and the eroded skull. Two hours after the surgery, the patient's right pupil was dilated, and an urgent CT scan of the skull showed a right subdural haematoma under the incision, which was urgently removed by a second operation. After surgery, we gave continuous antibiotic anti-infection treatment, and the patient recovered well and was discharged two weeks later. CONCLUSION: Surgical removal of giant haemangiomas is risky and adequate preoperative (including interventional embolisation) and intraoperative preparations should be made.

Interventions and their efficacy in supporting language development among preterm children aged 0-3 years - A systematic review.

BACKGROUND: Preterm children have a higher risk for linguistic delays than full-term infants but are rarely provided with language intervention at an early age. Knowledge on early language interventions targeted to preterm children is scarce, and efficacy of the interventions is rarely reported. AIM: This systematic review aims to identify interventions for preterm children aged 0-3 years with at least one language outcome. Efficacy of the interventions and quality of the study reports were evaluated. STUDY DESIGN: The article search was carried out in six databases: EBSCOhost, Scopus, ERIC, LLBA, Ovid, and Web of Science. Effect sizes (Hedges' g) were calculated for language outcomes. Quality of the study reports was assessed using the levels of evidence system by the American Speech-Language-Hearing Association. RESULTS: The 28 studies identified were divided into three groups: interventions at Neonatal Intensive Care Unit, interventions during the first year, and interventions during the second and/or third years. Most of the interventions focused on supporting child-care and general development. Of the interventions, 61 % were efficacious in supporting language development of preterm children. The most promising results regarding efficacy were interventions conducted during the second and/or third years (80 %). Quality of the reports varied from high/good (89 %) to low (11 %). CONCLUSION: The 28 existing studies provide limited evidence of the efficacy of very early interventions promoting language development of preterm children. However, especially the results for interventions conducted during the second and/or third years show promise. More studies, particularly language-focused interventions with longer follow-ups, are needed.