OBJECTIVE:To compare the performance of formal prognostic instruments vs subjective clinical judgment with regards to predicting functional outcome in patients with spontaneous intracerebral ...hemorrhage (ICH).
METHODS:This prospective observational study enrolled 121 ICH patients hospitalized at 5 US tertiary care centers. Within 24 hours of each patientʼs admission to the hospital, one physician and one nurse on each patientʼs clinical team were each asked to predict the patientʼs modified Rankin Scale (mRS) score at 3 months and to indicate whether he or she would recommend comfort measures. The admission ICH score and FUNC score, 2 prognostic scales selected for their common use in neurologic practice, were calculated for each patient. Spearman rank correlation coefficients (r) with respect to patientsʼ actual 3-month mRS for the physician and nursing predictions were compared against the same correlation coefficients for the ICH score and FUNC score.
RESULTS:The absolute value of the correlation coefficient for physician predictions with respect to actual outcome (0.75) was higher than that of either the ICH score (0.62, p = 0.057) or the FUNC score (0.56, p = 0.01). The nursing predictions of outcome (r = 0.72) also trended towards an accuracy advantage over the ICH score (p = 0.09) and FUNC score (p = 0.03). In an analysis that excluded patients for whom comfort care was recommended, the 65 available attending physician predictions retained greater accuracy (r = 0.73) than either the ICH score (r = 0.50, p = 0.02) or the FUNC score (r = 0.42, p = 0.004).
CONCLUSIONS:Early subjective clinical judgment of physicians correlates more closely with 3-month outcome after ICH than prognostic scales.
Epidemiological studies of intracerebral hemorrhage (ICH) have consistently demonstrated variation in incidence, location, age at presentation, and outcomes among non-Hispanic white, black, and ...Hispanic populations. We report here the design and methods for this large, prospective, multi-center case-control study of ICH.
The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multi-center, prospective case-control study of ICH. Cases are identified by hot-pursuit and enrolled using standard phenotype and risk factor information and include neuroimaging and blood sample collection. Controls are centrally identified by random digit dialing to match cases by age (±5 years), race, ethnicity, sex, and metropolitan region.
As of March 22, 2013, 1655 cases of ICH had been recruited into the study, which is 101.5% of the target for that date, and 851 controls had been recruited, which is 67.2% of the target for that date (1267 controls) for a total of 2506 subjects, which is 86.5% of the target for that date (2897 subjects). Of the 1655 cases enrolled, 1640 cases had the case interview entered into the database, of which 628 (38%) were non-Hispanic black, 458 (28%) were non-Hispanic white, and 554 (34%) were Hispanic. Of the 1197 cases with imaging submitted, 876 (73.2%) had a 24 hour follow-up CT available. In addition to CT imaging, 607 cases have had MRI evaluation.
The ERICH study is a large, case-control study of ICH with particular emphasis on recruitment of minority populations for the identification of genetic and epidemiological risk factors for ICH and outcomes after ICH.
The risk for impaired vitamin B
12
status increases with age, as does the use of proton pump inhibitors (PPI). Long-term use of PPIs is associated with several nutritional deficiencies including B
12
.... Currently, there are no recommendations for B
12
screening among patients taking PPIs. Data were abstracted on B
12
concentrations, B
12
-containing supplement use, medications, and select hematological values from a retrospective chart review of 658 adults, 391 with serum B
12
concentrations, admitted to 6 different medical units at 2 regional hospitals in Southwestern Ontario between 2010 and 2012. We found no difference between PPI users and nonusers and serum B
12
concentrations (404 ± 224 vs 369 ± 213 pmol/L; P = 0.0690). This may be due to use of B
12
containing multivitamins in 41% of PPI users. Regression modelling found that aging increases the odds of having an impaired B
12
status (<220 pmol/L) by 1.4 times and those using B
12
supplements are almost 4 times more likely to have an impaired status. Mean corpuscular volume was not related to B
12
status. In this population, older PPI users are more likely to be using multivitamins, which may delay nutritional deficiencies. However, the lower B
12
concentrations of PPI users taking only B
12
supplements is a concern and requires further research. Finally, physicians need to be aware that mean corpuscular volume is no longer recommended as an effective biomarker for B
12
screening and updated screening protocols need to be used to reduce the possibility of adverse neurological effects from impaired B
12
status.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Evidence suggests that installing a classroom management system known as the Color Wheel reduced inappropriate behaviors and increased on-task behavior in second- and fourth-grade classrooms; ...however, no systematic studies of the Color Wheel had been disseminated targeting pre-school or kindergarten participants. To enhance our understanding of the Color Wheel System (CWS) as a prevention system, a multiple-baseline design was used to evaluate the effects of the Color Wheel on inappropriate vocalizations (IVs) in three general education kindergarten classrooms. Partial-interval time-sampling was used to record classwide IVs, which were operationally defined as any comment or vocal noise that was not solicited by the teacher. Time series graphs and effect size calculations suggest that the CWS caused immediate, large, and sustained decreases in IVs across the three classrooms. Teacher acceptability and interview data also supported the CWS. Implications related to prevention are discussed and directions for future research are provided.
Background
The early subjective clinical judgment of clinicians outperforms formal prognostic scales for accurate determination of outcome after intracerebral hemorrhage (ICH), with the judgment of ...physicians and nurses having equivalent accuracy. This study assessed specific decisional factors that physicians and nurses incorporate into early predictions of functional outcome.
Methods
This prospective observational study enrolled 121 ICH patients at five US centers. Within 24 h of each patient’s admission, one physician and one nurse on the clinical team were each surveyed to predict the patient’s modified Rankin Scale (mRS) at 3 months and to list up to 10 subjective factors used in prognostication. Factors were coded and compared between (1) physician and nurse and (2) accurate and inaccurate surveys, with accuracy defined as an exact prediction of mRS.
Results
Aside from factors that are components of the ICH or FUNC scores, surveys reported pre-existing comorbidities (40.0%), other clinical or radiographic factors not in clinical scales (43.0%), and non-clinical/radiographic factors (21.9%) as important. Compared to physicians, nurses more frequently listed neurologic examination components (Glasgow Coma Scale motor, 27.3 vs. 5.8%,
p
< 0.0001; GCS verbal, 12.4 vs. 0.0%,
p
< 0.0001) and non-clinical/radiographic factors (31.4 vs. 12.4%,
p
= 0.0005). Physicians more frequently listed neuroimaging factors (ICH location, 33.9 vs. 7.4%,
p
< 0.0001; intraventricular hemorrhage, 13.2 vs. 2.5%,
p
= 0.003). There was no difference in listed factors between accurate versus inaccurate surveys.
Conclusions
Clinicians frequently utilize factors outside of the components of clinical scales for prognostication, with physician and nurses focusing on different factors despite having similar accuracy.
Student engagement is a critical feature to the teaching and learning dynamic that takes place in the classroom. Technology is often used as a means for increasing student engagement, and Student ...Response Technology (SRT), where students use handheld clickers to respond during classroom instruction, is one form of technology used to do this. The current study examined the effect of SRT on student engagement in elementary classrooms for students with disabilities. A multiple baseline across participants design was used to measure student engagement across several areas, including rate of participation and on-task behavior. Both visual and statistical analysis yielded a relationship between use of SRT and two areas of engagement: student’s participation and on-task behavior.
Paediatric Multisystem Inflammatory Syndrome (PIMS-TS) is a rare life-threatening complication that typically occurs several weeks after SARS-CoV-2 infection in children and young people (CYP). We ...used national and regional-level data from the COVID-19 pandemic waves in England to develop a model to predict PIMS-TS cases.
SARS-CoV-2 infections in CYP aged 0-15 years in England were estimated using the PHE-Cambridge real-time model. PIMS-TS cases were identified through the British Paediatric Surveillance Unit during (March-June 2020) and through Secondary Uses Services (SUS) from November 2020. A predictive model was developed to estimate PIMS-TS risk and lag times after SARS-CoV-2 infections.
During the Alpha wave, the model accurately predicted PIMS-TS cases (506 vs. 502 observed cases), with a median estimated risk of 0.038% (IQR, 0.037-0.041%) of paediatric SARS-CoV-2 infections. For the Delta wave, the median risk of PIMS-TS was significantly lower at 0.026% (IQR, 0.025-0.029%), with 212 observed PIMS-TS cases compared to 450 predicted by the model.
The model accurately predicted national and regional PIMS-TS cases in CYP during the Alpha wave. PIMS-TS cases were 53% lower than predicted during the Delta wave. Further studies are needed to understand the mechanisms of the observed lower risk with the Delta variant.
The study we report here examined parental, pre-course, and in-course predictors of students’ probability of retaining (
n
= 136) or losing the HOPE scholarship (
n
= 41). The study was conducted in ...a multi-section, entry-level course (
n
= 203) for the Teacher-Education Program at a large state university in the southeastern U.S. Logistic regression that included a special computation of standardized beta weights was used in determining the predictive strength of selected variables and groups of variables. The variables with the strongest standardized beta weights included class attendance, critical thinking ability, and high school GPA. Of the various sub-groups of variables, pre-course and in-course variables generated the strongest prediction models. All models did much better in predicting retention than loss of HOPE scholarships.
The study examined the effects of unstructured laptop use on levels of class participation and exam performance in 7 sections of a highly structured entry-level educational psychology course. We ...permitted students to have their laptops available only during specified course units, but they could use their laptops to any extent and in any way desired in the designated units. We collected survey data at the conclusion of the laptop units to determine students' self-reported laptop use for various in-class purposes. Self-reported participation showed that students participated more in class discussion when allowed to use their laptops. In contrast to its effect on class participation, laptop availability did not significantly affect exam performance. Although most students preferred not to use their laptops during class, preferred users mainly reported using their laptop for taking notes and accessing course content. Most students claimed not to be distracted from the class discussion by using their own laptops or observing others' use of laptops.
Two behavioural strategies for reducing learned fear are extinction and counter-conditioning, and in this study we compared the relative effectiveness of the two procedures at diminishing fear in ...children. Seventy-three children aged 7–12 years old (M = 9.30, SD = 1.62) were exposed to pictures of two novel animals on a computer screen during the fear acquisition phase. One of these animals was paired with a picture of a scared human face (CS+) while the other was not (CS-). The children were then randomly assigned to one of three conditions: counter-conditioning (animal paired with a happy face), extinction (animal without scared face), or control (no fear reduction procedure). Changes in fear beliefs and behavioural avoidance of the animal were measured. Counter-conditioning was more effective at reducing fear to the CS + than extinction. The findings are discussed in terms of implications for behavioural treatments of childhood anxiety disorders.
•Counter-conditioning was more effective than extinction at reducing fear in children.•Most children learned on one of the measures but only a few learned on both.•Including non-learners in fear reduction studies could mask results.•Counter-conditioning may be more appealing to anxious children than extinction.
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