AAC and literacy

Purpose: To review current research on the use of augmentative and alternative communication (AAC) for prompting literacy in children with special educational needs. Method: Research studies relevant to emergent literacy and AAC use are reviewed. Studies focused on acquisition of literacy across various populations of children with special needs are reviewed. Results: Existing literature suggests that AAC may provide strategies and systems to compensate for impairments and disabilities of individuals with severe communication disorders. Conclusion: AAC may support literacy learning in children with special educational needs.     

Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit—Five cases and a review

Purpose

Delirium in the intensive care unit (ICU) is conventionally treated pharmacologically but can progress into a protracted state refractory to medical treatment—a potentially life-threatening condition in itself.

Methods

We treated 5 cases of severe protracted delirium in our ICU with electroconvulsive therapy (ECT) after failure of conventional medical therapy.

Results

The delirious state of long standing agitation, anxiety, and discomfort was controlled in all patients. Electroconvulsive therapy was effective in controlling delirium in 4 patients. The last patient became calm, relieved of stress, and able to cooperate with the ventilator but remained in a state of posttraumatic amnesia after a head trauma.

Conclusion

Although controversial, ECT is nevertheless recognized as an efficient and safe treatment for various psychiatric illnesses including delirium. Considering the significantly increased mortality and severe cognitive decline associated with delirium in the ICU, we find ECT to be a valuable treatment option for this vulnerable patient population. It can be considered when agitation cannot be controlled with medical treatment, when agitation and delirium make weaning impossible, or prolonged deep sedation the only alternative.     

Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammary carcinoma

Between 1978 and 1985, 393 of 2,765 (14%) patients with operable cancer of the breast (clinical stage T0-3N0-2M0) were irradiated after excisional biopsy and staging axillary dissection. Of 77 patients with microscopic axillary metastases, 68 received systemic adjuvant therapy. Treatment failed locally in 26 cases, and there were seven patients with distant metastasis. The three major factors for increased local treatment failure were (a) age below 40 years (P = .003), (b) negative estrogen receptor assay result (P = .03), and (c) failure to deliver a radiation boost dose when tumor was present at the margin of the specimen (P = .002). The size of the tumor, the nodal status, the progesterone receptor assay result, and the presence of ductal carcinoma in situ mixed with infiltrating carcinoma did not show a significant influence on local recurrence. In 274 of 393 (70%) patients, cosmesis was evaluated. The four major factors affecting cosmesis favorably were (a) utilization of a wedge (P less than .0001); (b) treatment of two fields a day (P less than .0001); (c) failure to use a separate treatment port to the regional lymph nodes, so as to avoid field junctions (P = .0003); and (d) small size of specimen (less than 50 cm2) (P = .0171). A second or third cancer was found in 39 of the 393 (10%) patients; contralateral breast cancer was the most common form (n = 23), followed by genitourinary cancer (n = 5). The most frequent complication was arm edema (6%).     

Seasonality trends of Pediculosis capitis and Phthirus pubis in a young adult population: follow-up of 20 years

BACKGROUND: It is not mandatory to report Pediculosis capitis and Phthirus pubis in most countries; therefore, little is known about the seasonality of these infestations. METHODS: We analysed the data based on routine and mandatory reporting of every case of Pediculosis capitis and Phthirus pubis to the Army Health Branch Epidemiology Department, Israel, over the last two decades. RESULTS: The average 20-year incidence of Pediculosis capitis shows a significant rise during the warmer months (R2 = 0.692, P < 0.05) with a parallel significant decrease in the cooler months (R2 = 0.893, P < 0.05). The results for Phthirus pubis show a significantly higher person-time incidence in the winter (P < 0.001). Sensitivity analysis to investigate possible sources of heterogeneity during this time indicated that no single year was an important source of heterogeneity. CONCLUSIONS: Pediculosis capitis is more frequent in the warmer months, whereas Phthirus pubis is more dominant in the cooler months.