North-American Lidcombe Program file audit: replication and meta-analysis

Thousands of North American clinicians have trained for the Lidcombe Program of Early Stuttering Intervention, yet there are no benchmark data for that continent. This retrospective file audit includes logistical regression of variables from files of 134 children younger than 6 years who completed Stage 1 of the Lidcombe Program. Benchmarking data for clinic visits to Stage 2 is available for these files. Meta-analysis supplements worldwide Lidcombe Program benchmark data. The median number of clinic visits to Stage 2 was 11. High pre-treatment stuttering severity predicted more clinic visits than low severity. A trend toward statistical significance was found for the frequency of clinic visits. Frequent attendance of mean less than 11 days was associated with longer treatment times than infrequent attendance of mean 11 days or more. Results for North America were consistent with benchmark data from the UK and Australia. The mean attendance trend is clinically important and requires further investigation because of its potential clinical significance.     

Frontotemporal dementia: a different kind of dementia

Frontotemporal dementia (FTD) is an umbrella term for a number of uncommon illnesses, including Pick's disease, which affect the frontal and/or temporal lobes of the brain and produce a dementia syndrome that is quite characteristic but unfamiliar to most clinicians. It is the third most common cause of cortical dementia. An overview of clinical manifestations, diagnosis, and management of FTD is provided with some specific information in relation to Pick's disease and a case example. Caregivers, in particular, need the education and support that could be provided by informed nurses.     

Attitudes towards euthanasia.

There are an infinite variety of attitudes to euthanasia, each individual response to the concept being influenced by many factors. Consequently there is a literature on the subject ranging from the popular article to papers in specialized journals. This study, however, has taken a well defined sample of people, inviting them to answer a questionnaire which was designed to elicit their attitudes to euthanasia in a way which could be analysed statistically. Nor surprisingly attitudes appeared to 'harden' as those answering the questionnaire grew more experienced in dealing with patients and also more professionally established. Thus it was found that of the seven groups questioned practising physicians showed more positive attitudes to euthanasia and their responses did not differ significantly from those of senior medical students. It is these groups which actually or potentially have to resolve the clinical dilemma posed by the dying patient.     

Physician contribution to a cesarean delivery risk model

OBJECTIVE: The purpose of this study was to assess the contribution of physician management to the probability of cesarean delivery. STUDY DESIGN: A prospective cohort study was performed of all live births who weighed > or =500 g for a 2-year period (1999-2000) at a large metropolitan hospital (n = 10,027 births). Factors that were associated significantly with cesarean delivery at one time excluded cases in which cesarean delivery was a necessary or probable outcome. In the planned vaginal delivery sample (n = 7940 births), a risk-adjusted logistic regression model was used to assess the prediction of cesarean delivery. To test for the effect of physician-management physician, we used the subset of physicians with > or =45 deliveries in the 2-year time period (n = 6563 deliveries). RESULTS: When physician-management physician data were added to the use of forward stepwise regression, entry order was abnormal position, nulliparity, birth weight of >4000 g, and physician. The model's predictive ability improved from 43.8% to 50.2%. CONCLUSION: Physician management adds a significant independent effect to the cesarean delivery risk model.