Teaching caregivers to implement an augmentative and alternative communication intervention to an adult with ASD

Many researchers have investigated the effectiveness of augmentative and alternative communication (AAC) systems on improving communication skills of children with autism spectrum disorder (ASD) and communication complex needs (CCN); however, few studies included adults with ASD. Also, there is a lack of research on primary caregiver implemented interventions with high treatment fidelity although primary caregiver-implemented interventions have been used effectively with adults with ASD and their families. This study investigated the accuracy of primary caregivers’ implementation of a tablet-computer based AAC system while they were providing instruction to an adult with ASD. Also, independent use of AAC system of the participant was examined. We implemented a multiple probe design across three instructional coaching steps to examine the accuracy of the caregivers’ AAC implementation. One adult with autism and CCN and his four primary caregivers participated in this study, twice a week for seven weeks. Both visual and statistical analyses were utilized. Results indicated that, with instructional coaching, all of the caregivers were able to implement the procedures of the AAC mode with the participant accurately, as demonstrated via visual inspection and statistical analyses. Nevertheless, there was little improvement in the participant's independent use of the AAC mode. Limitations and suggestions for future researchers are discussed.     

Psychiatric outcomes amongst adult survivors of childhood burns

Background

Research on the adult psychiatric outcomes of childhood burns is limited.

Aims

To examine the rates of DSM-IV psychiatric disorder amongst adult survivors of paediatric burns, and to explore factors likely to contribute to variation in outcomes. In line with Meyer and colleagues [1], it was expected that high levels of psychopathology would be found.

Method

Participants were 272 adults hospitalised for burns during childhood between the years 1980 and 1990. Structured interviews and self-report questionnaires were used to assess psychiatric symptoms.

Results

Lifetime prevalence of any DSM-IV disorder was 42%, 30% for depressive disorders, and 28% for anxiety disorders. Eleven percent had made a suicide attempt. Female gender, single relationship status, higher level of disfigurement, longer hospital stays and higher number of burn-related surgeries were associated with adverse psychiatric outcomes.

Conclusions

High rates of suicidality and depression were concerning in adults with a history of childhood burns. Factors found to predict psychiatric outcomes could be used to direct interventions and further research is needed to establish how this could best be done.     

An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: A confirmatory factor analysis and a resulting continuous severity score

Objective

The metabolic syndrome (MetS) is typically diagnosed based on abnormalities in specific clustered clinical measures that are associated with increased risk for coronary heart disease (CHD) and Type 2 diabetes mellitus (T2DM). However, current MetS criteria result in racial/ethnic discrepancies. Our goals were to use confirmatory factor analysis (CFA) to delineate differential contributions to MetS by sub-group, and if contributions were discovered, develop sex and racial/ethnic-specific equations to calculate MetS severity.

Research Design and Methods

Using data on adults from the National Health and Nutrition Examination Survey 1999–2010, we performed a CFA of a single MetS factor that allowed differential loadings across groups, resulting in a sex and race/ethnicity-specific continuous MetS severity score.

Results

Loadings to the single MetS factor differed by sub-group for each MetS component (p < 0.001), with lower factor loadings among non-Hispanic-blacks for triglycerides and among Hispanics for waist circumference. Systolic blood pressure exhibited low factor loadings among all groups. MetS severity scores were correlated with biomarkers of future disease (high-sensitivity C-reactive-protein, uric acid, insulin resistance). Non-Hispanic-black-males with diabetics had a low prevalence of MetS but high MetS severity scores that were not significantly different from other racial/ethnic groups.

Conclusions

This analysis among adults uniquely demonstrated differences between sexes and racial/ethnic groups regarding contributions of traditional MetS components to an assumed single factor. The resulting equations provide a clinically-accessible and interpretable continuous measure of MetS for potential use in identifying adults at higher risk for MetS-related diseases and following changes within individuals over time. These equations hold potential to be a powerful new outcome for use in MetS-focused research and interventions.     

牙周-正畸联合治疗成人牙周炎效果观察

目的：探讨牙周-正畸联合治疗成人牙周炎患者的方法及临床疗效。方法回顾性分析2008年3月～2010年4月我院经牙周-正畸联合治疗的37例成人牙周炎患者临床资料,并观察正畸治疗后23～48个月远期疗效。结果正畸治疗后37例患者咬合关系正常,前牙覆覆盖正常,牙齿排列整齐,邻接关系恢复,尖窝接触关系良好,牙齿松动明显好转,牙龈探诊未见出血,X线片检查显示牙槽骨吸收停止或有增生影像。随访23～48个月,37例患者基本做到半年复查一次,其中无复发29例（78.4%）,轻度复发8例（21.6%）,无明显复发者。结论牙周-正畸联合治疗牙周炎能有效控制炎症,消除咬合创伤,排齐牙列,利于牙周组织痊愈及患牙固定,恢复患牙咀嚼和美观功能,保持长期稳定的治疗效果。     

成人血小板增多症临床诊断及治疗

目的：总结成人血小板增多症的诊断要点,探讨血小板去除术在成人血小板患者中的应用价值。方法收集我院收治的50例成人血小板增多症患者,按随机双盲法分组,单纯采用羟基脲治疗对照组患者,为观察组患者行血小板去除术,比较两组临床疗效。结果观察组临床治疗效果为缓解、进步、无效的病例分别为15例、8例、2例,临床有效率为92.0%,显著高于对照组的76.0%（x2=3.059,P ＜0.05）。结论血小板去除术可缓解乏力、烦热、气短、失眠等临床症状,提高生存质量,值得在血小板增多症患者中推广。     

不对称经椎弓根截骨矫治成人先天性脊柱侧后凸畸形

【摘要】 目的：分析应用不对称经椎弓根截骨技术矫治成人先天性脊柱侧后凸畸形的临床疗效。方法：2009年9月~2013年10月采用不对称经椎弓根截骨矫治成人先天性脊柱侧后凸畸形患者16例,男9例,女7例。年龄18～42岁,平均23.6岁。均有腰背痛,无神经受压症状。16例患者脊柱侧凸Cobb角43°~97°,后凸Cobb角15°~70°。侧凸畸形和后凸畸形顶椎均位于同一节段,其中顶椎位于胸椎10例、腰椎6例。于术前、术后及末次随访时在X线片上测量脊柱冠状面主弯Cobb角、矢状面后凸角、冠状面平衡及矢状面平衡,比较术前、术后及末次随访时影像学参数评估手术矫形效果。于术前、末次随访时填写SRS-22问卷量表,评估患者术后的生活质量变化。结果：手术融合节段5~12个,平均7.23个节段。手术时间3~7h,平均4.26h。术中出血量700～2500ml,平均1265ml。1例L1部位截骨患者术后出现双下肢痛觉过敏,急诊手术探查发现截骨部位硬脊膜皱褶,脊髓受压,对截骨部位椎板切开减压,术后症状明显好转,术后3个月随访神经症状消失。2例患者术后出现一侧胸腔积血,紧急行胸腔闭式引流术,1周后拔除引流管。15例患者获得6～48个月（平均13.4个月）随访。获得随访的15例患者冠状位主弯Cobb角术前为58.67°±20.36°（43°～97°）,术后为20.32°±8.76°（8°～37°）,末次随访时为21.76°±8.34°（10°～41°）,术后与术前比较差异有统计学意义（P<0.01）,矫正率为50.76%~82.36%,平均为65.36%,末次随访时与术后比较丢失率为2.45%。术前矢状位后凸角度为45.62°±16.26°（15°～70°）,术后为16.35°±16.87°（-20°～40°）,末次随访时为18.27°±13.92°（-15°～40°）,术后与术前比较差异有统计学意义（P<0.01）,矫正率为50.97%~79.32%,平均为64.16%,末次随访时与术后比较丢失率为4.2%。15例患者中,6例术前存在冠状面失平衡,术后均恢复平衡;4例术前存在矢状面失平衡,术后3例恢复平衡,1例仍为失平衡。SRS-22问卷量表总得分由术前66.47±12.35分（49～79分）提高至末次随访时的84.13±6.42分（76～92分）（P<0.01）。15例患者均获得骨性融合,无假关节形成或内固定断裂。结论：应用不对称经椎弓根截骨技术矫治先天性脊柱侧后凸畸形,可获得较好的矫形效果,显著改善患者躯体外观及躯体平衡,同时明显改善患者的生活质量。     

Low positive end-expiratory pressure does not exacerbate nebulized-acid lung injury in dogs

It is not clear if low end-expiratory pressures contribute to ventilator-induced lung injury in large animals. We sought to determine whether ventilation with a low level of positive end-expiratory pressure (PEEP) worsens preexisting permeability lung injury in dogs. Lung injury was initiated in 20 mongrel dogs by ventilating with nebulized 3N hydrochloric acid until a lower inflection point (LIP) appeared on the respiratory system pressure-volume loop. One group of 10 dogs was then ventilated for 4 hours with PEEP set below the LIP (low PEEP), whereas the remaining group of dogs was ventilated for the same time period with similar tidal volumes but with PEEP set above the LIP (high PEEP). We found histologic evidence of reduced alveolar volumes in the low-PEEP animals. However, there were no differences in neutrophil infiltration, lung lobe weights, pulmonary capillary hemorrhage or congestion, or arterial endothelin-1 concentration between the 2 protocol groups. In conclusion, we were unable to demonstrate that ventilation with PEEP set below the LIP exacerbates hydrochloric acid-induced lung injury in dogs.     

Can use of an administrative database improve accuracy of hospital-reported readmission rates?

Objectives

Readmission rates after cardiac surgery are being used as a quality indicator; they are also being collected by Medicare and are tied to reimbursement. Accurate knowledge of readmission rates may be difficult to achieve because patients may be readmitted to different hospitals. In our area, 81 hospitals share administrative claims data; 28 of these hospitals (from 5 different hospital systems) do cardiac surgery and share Society of Thoracic Surgeons (STS) clinical data. We used these 2 sources to compare the readmissions data for accuracy.