Repeated readings using audiotaped material enhances oral reading in children with reading difficulties

The method of repeated readings using audiotaped material was implemented in the present study by having poor readers aged 9-13 years listen to and read audiotaped stories until the passages could be read fluently without the tape. A same-age control group with similar reading difficulties was given an alternative reading program that was similar to that received by the experimental group (with respect to creative writing, spelling, phonics, and vocabulary development), but which differed in terms of passage reading exercises (controls read from basal readers, whereas the experimental group did repeated readings of audiotaped material). Only students in the repeated readings of audiotaped material group showed a significant effect of treatment on oral reading, whereas controls showed significantly larger gains in word attack skills. There were no between-group differences in silent reading, a close comprehension test, or isolated word recognition. The pattern of findings suggested that repeated readings of audiotaped material enhances oral reading ability of students with reading difficulties, but the effects of treatment do not generalize to a wide range of reading measures.     

Reading and comprehension: phoniatric assessment in students with reading difficulties

IntroductionReading is a highly refined skill that encompasses two main components: decoding graphic symbols and understanding the written message. These aspects generally develop together, but reading comprehension is a much more complex process, sustained not only by the identification of written words and vocabulary but also by language systems, such as syntax and general knowledge. Although there is a well-established technique for performing the phoniatric assessment, there is no common use of tests that assess reading comprehension or the association of this information with other assessment data.ObjectiveThe objective of this study is, in the context of the phoniatric consultation, to evaluate the reading and retelling in children with relevant reading difficulties and to correlate the decoding and comprehension problems with the alterations observed in auditory and visual perceptual tests, pointing out the evidence that best contributed to the differential diagnosis of these subjects.MethodsStarting from a population of 301 children enrolled in the 4th and 5th grades of elementary school, 13 children with evident reading and writing difficulties were evaluated regarding the reading and retelling tasks and separated into groups according to the problem of decoding, fluency, and comprehension. Reading performance was correlated with the performance in visual and auditory perceptual tests and based on the similarity analysis, the tests considered to be the most relevant in the diagnosis process of these children were identified.ResultThe results suggest that the tasks: naming of figures, repetition of numbers in reverse order, figure copying, syllabic synthesis, phonemic synthesis, rhyme, and phonemic manipulation altogether contribute to diagnosis and multidisciplinary intervention aspects.ConclusionSome tasks are more relevant to the diagnostic process of children with complaints of learning difficulties in reading.     

Mandibular bone tumors. Diagnostic difficulties

A session of the "Société de Stomatologie et de Chirurgie maxillo-faciale de France" was devoted to a discussion of diagnostic difficulties in cases of mandibular bone tumors. Several case-reports were presented as a basis for comments on clinical and radiologic criteria of the benign or malignant nature of bone tumors, these being the foundation on which to establish the most effective surgical approach to adopt. Pre-operative biopsy is not considered essential when confirmation of diagnostic has been obtained.     

Cost-effective diagnosis of ingested foreign bodies

OBJECTIVES: To compare the cost effectiveness of plain film radiography, computed tomography (CT), and endoscopy as initial diagnostic modalities in adult patients complaining of retained ingested foreign bodies. DESIGN: A systematic literature review was conducted to determine key statistics for the analysis, such as prevalence of disease, prevalence of complications, and the sensitivity and specificity of each diagnostic modality. Costs were estimated using 2006 Medicare reimbursement for hospital and professional fees. A deterministic cost-effectiveness analysis was then conducted using decision analysis software and a decision tree model to evaluate the various diagnostic strategies. After identifying initial results, we also performed sensitivity and threshold analysis to assess the strength of the recommendations. RESULTS: We reviewed 316 abstracts, identified 16 pertinent studies that included a total of 7,088 patients with possible foreign bodies, and extracted key statistics from those papers. Decision analysis showed that CT scanning as an initial diagnostic strategy proved more cost effective than plain film or operative endoscopy. The incremental cost of immediate endoscopy for every additional correctly diagnosed patient was $5,238. Plain radiography was more costly and less effective, even with the addition of confirmatory CT scanning after a negative plain film. Sensitivity and threshold analyses demonstrated that these results are robust. CONCLUSIONS: Patients presenting with a complaint of a retained ingested foreign body are most cost-effectively managed with CT scan, after history and physical. Immediate endoscopy may be considered if CT is not available, although it adds significant cost. Plain films are dominated by these two diagnostic strategies.     

Cost-effective management of low-risk papillary thyroid carcinoma

OBJECTIVE: To compare the 20-year cost-effectiveness of initial hemithyroidectomy vs total thyroidectomy in the management of small papillary thyroid cancer in the low-risk patient. DESIGN: Pooled data from the published literature were used to determine key statistics for decision analysis such as rates of recurrence, rates of complications for all interventions undertaken, and rates of death. The 2005 costs were obtained from the US Department of Health and Human Services, as well as from Medicare reimbursement schedules. Future costs were discounted at 6%. SETTING: Decision analysis study. PATIENTS: Data from the published literature. MAIN OUTCOME MEASURES: A state-transition (Markov) decision model was constructed based on the most recent American Thyroid Association recommendations. A cost-effectiveness analysis was performed using fixed probability estimates and Monte Carlo microsimulation, with effectiveness defined as cause-specific mortality or recurrence-free survival. After identifying initial results, sensitivity and threshold analyses were performed to assess the strength of the recommendations. RESULTS: Initial probability estimates were determined from a review of 940 abstracts and 31 relevant studies examining outcomes in patients with low-risk thyroid cancer undergoing thyroidectomy or neck dissection. During 20 years, cost estimates (including initial surgery, follow-up, and treatment of recurrence) were between $13,896.81 and $14,241.24 for total thyroidectomy and between $15,037.58 and $15,063.75 for hemithyroidectomy. Cause-specific mortality was similar for both treatment strategies, but recurrence-free survival was higher in the total thyroidectomy group. Sensitivity and threshold analyses demonstrated that these results were sensitive to rates of recurrence and cost of follow-up but remained robust when compared with willingness to pay. CONCLUSIONS: Total thyroidectomy dominates over hemithyroidectomy as initial treatment for low-risk papillary thyroid cancer. However, in sensitivity analyses, these results varied by institution because of heterogeneity in long-term treatment outcomes. With changing protocols of management, it is possible that hemithyroidectomy will emerge as being more cost-effective. Long-term prospective trials are necessary to validate our findings.     

Cost-effective dental protection during rigid endoscopy

We describe a simple method to create a reusable and customizable dental guard using readily available materials. Our method does not require an extra patient visit and does not add operative time. Furthermore, our guard is rigid, which allows force to be distributed over adjacent teeth, unlike soft mouth guards.     

Giant-cell lesions of the maxilla. The diagnostic difficulties

A 30 year old woman with a giant cell tumor of maxilla developed recurrence of tumor two years after initial surgical resection. The place of this benign but relapsing tumor among giant cell lesions (called "myeloplaxic tumors" in the past) is discussed and the differential diagnosis of these lesions outlined.     

Treatment of otogenic intracranial complications. Therapeutic and diagnostic difficulties

The article presents the results of clinical, laboratory, CT and MRT examination and treatment of patients with otogenic intracranial complications (OIC) hospitalized to ENT clinics for the last 10 years. The statistics show that the number of OIC patients tends to decrease for the last 40 years. This may be explained by perfection of specialized ENT service in backcountry rural districts. It is emphasized that use of antibiotics and other anti-inflammatory drugs before hospitalization changes a clinical OIC picture and complicates early diagnosis especially the diagnosis of cerebral and cerebellar abscesses.     

Neurobiological studies of reading and reading disability

Evidence from neuroimaging studies, including our own, suggest that skilled word identification in reading is related to the functional integrity of two consolidated left hemisphere (LH) posterior systems: a dorsal (temporo-parietal) circuit and a ventral (occipito-temporal) circuit. This posterior system appears to be functionally disrupted in developmental dyslexia. Relative to nonimpaired readers, reading-disabled individuals demonstrate heightened reliance on both inferior frontal and right hemisphere posterior regions, presumably in compensation for the LH posterior difficulties. We propose a neurobiological account suggesting that for normally developing readers, the dorsal circuit predominates at first, and in conjunction with premotor systems, is associated with analytic processing necessary for learning to integrate orthographic with phonological and lexical–semantic features of printed words. The ventral circuit constitutes a fast, late-developing, word form system, which underlies fluency in word recognition. Learning outcomes: As a result of this activity, (1) the participant will learn about a model of lexical processing involving specific cortical regions. (2) The participant will learn about evidence which supports the theory that two dorsal LH systems may be disrupted in developmental dyslexia. (3) The participant will learn that individuals with reading impairment may rely on other regions of the brain to compensate for the disruption of posterior function.     

Cost-effective diagnostic nasal endoscopy with a modified otoscope

We present 'Mishra's rhinoscope', a novel, cost-effective technique of zero-degree rigid nasoendoscopy with a modified otoscope, the results of which are comparable with the fibreoptic sinoscope. This is particularly suited for the developing world where financial constraints restrict the diagnosis of an occult nasal pathology.     

Children's naming and word-finding difficulties: descriptions and explanations.

PURPOSE: There is a substantial minority of children for whom lexical retrieval problems impede the normal pattern of language development and use. These problems include accurately producing the correct word even when the word's meaning is understood. Such problems are often referred to as word-finding difficulties (WFDs). This article examines the nature of naming and lexical retrieval difficulties in these and other groups of children. METHOD: A review of the relevant literature on lexical access difficulties in children with word-finding difficulties was conducted. Studies were examined in the terms of population parameters and comparison groups included in the study. RESULTS AND CONCLUSIONS: Most discussions of the cognitive processes causing lexical retrieval difficulties refer to semantics, phonology, and processing speed. The authors propose that understanding of these topics will be further advanced by the use of appropriate methodology to test developmental models. In this way it will be possible to identify the processes that contribute to successful lexical retrieval and the processes that result in retrieval difficulties.