Getting to grips with the heterogeneity of developmental dyslexia.

The aim of this study was to better understand the heterogeneity of developmental dyslexia by identifying the most common deficits in the reading systems of children with dyslexia with different poor word reading profiles. We classified the word reading profiles of 138 children with developmental dyslexia using nonword and irregular-word reading tests and then used independent experimental tests to explore the cognitive deficits within their word reading systems. The most common deficit associated with primary sublexical impairment (i.e., poor nonword reading) was poor grapheme-phoneme conversion (GPC) knowledge. The most common deficits associated with primary lexical impairment (i.e., poor irregular-word reading) were an impaired orthographic lexicon plus impaired links between this lexicon and the phonological lexicon and semantic knowledge. Finally, the most common deficits associated with mixed reading impairment (i.e., poor nonword reading and poor irregular-word reading) were poor GPC knowledge, an impaired orthographic lexicon, poor links between this lexicon and the phonological lexicon and semantic knowledge, and poor phonological output. We discuss the implications of these findings for theories of reading and for the diagnosis and treatment of dyslexia.

Choice Architecture in Opioid Safety Alerting.

The need for effective and efficient clinical decision support (CDS) embedded in electronic health record (EHR) processes is growing. Using choice architecture design strategies may increase effectiveness of CDS solutions. The authors describe implementation of an opioid risk alert and subsequent revisions of that alert to increase effectiveness and reduce alert volumes. The first version of the alert used an opt-in choice architecture when recommending naloxone and the second version used an active choice design. The percentage of opioid prescriptions ordered with naloxone prescribed within the last 12 months increased significantly after implementation of the first version of the alert and then further increased significantly after implementation of the second version. Alert volumes decreased over the same timeframe. An education campaign was also implemented during the timeframe studied and likely also contributed to the naloxone outcomes seen.

Phonics training for English-speaking poor readers.

BACKGROUND: Around 5% of English speakers have a significant problem with learning to read words. Poor word readers are often trained to use letter-sound rules to improve their reading skills. This training is commonly called phonics. Well over 100 studies have administered some form of phonics training to poor word readers. However, there are surprisingly few systematic reviews or meta-analyses of these studies. The most well-known review was done by the National Reading Panel (Ehri 2001) 12 years ago and needs updating. The most recent review (Suggate 2010) focused solely on children and did not include unpublished studies. OBJECTIVES: The primary aim of this review was to measure the effect that phonics training has on the literacy skills of English-speaking children, adolescents, and adults whose reading was at least one standard deviation (SD), one year, or one grade below the expected level, despite no reported problems that could explain their impaired ability to learn to read. A secondary objective was to explore the impact of various factors, such as length of training or training group size, that might moderate the effect of phonics training on poor word reading skills. SEARCH METHODS: We searched the following databases in July 2012: CENTRAL 2012 (Issue 6), MEDLINE 1948 to June week 3 2012, EMBASE 1980 to 2012 week 26, DARE 2013 (Issue 6), ERIC (1966 to current), PsycINFO (1806 to current), CINAHL (1938 to current), Science Citation Index (1970 to 29 June 2012), Social Science Citation Index (1970 to 29 June 2012), Conference Proceedings Citation Index - Science (1990 to 29 June 2012), Conference Proceedings Citation Index - Social Science & Humanities (1990 to 29 June 2012), ZETOC, Index to Theses-UK and Ireland, ClinicalTrials.gov, ICTRP, the metaRegister of Controlled Trials, ProQuest Dissertations and Theses, DART Europe E-theses Portal, Australasian Digital Theses Program, Education Research Theses, Electronic Theses Online System, Networked Digital Library of Theses and Dissertations. Theses Canada portal, www.dissertation.com, and www.thesisabstracts.com. We also contacted experts and examined the reference lists of published studies. SELECTION CRITERIA: We included studies that use randomisation, quasi-randomisation, or minimisation to allocate participants to either a phonics intervention group (phonics alone, phonics and phoneme awareness training, or phonics and irregular word reading training) or a control group (no training or alternative training, such as maths). Participants were English-speaking children, adolescents, or adults whose word reading was below the level expected for their age for no known reason (that is, they had adequate attention and no known physical, neurological, or psychological problems). DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias, and extracted data. MAIN RESULTS: We found 11 studies that met the criteria for this review. They involved 736 participants. We measured the effect of phonics training on eight outcomes. The amount of evidence for each outcome varied considerably, ranging from 10 studies for word reading accuracy to one study for nonword reading fluency. The effect sizes for the outcomes were: word reading accuracy standardised mean difference (SMD) 0.47 (95% confidence interval (CI) 0.06 to 0.88; 10 studies), nonword reading accuracy SMD 0.76 (95% CI 0.25 to 1.27; eight studies), word reading fluency SMD -0.51 (95% CI -1.14 to 0.13; two studies), reading comprehension SMD 0.14 (95% CI -0.46 to 0.74; three studies), spelling SMD 0.36 (95% CI -0.27 to 1.00; two studies), letter-sound knowledge SMD 0.35 (95% CI 0.04 to 0.65; three studies), and phonological output SMD 0.38 (95% -0.04 to 0.80; four studies). There was one result in a negative direction for nonword reading fluency SMD 0.38 (95% CI -0.55 to 1.32; one study), though this was not statistically significant.We did five subgroup analyses on two outcomes that had sufficient data (word reading accuracy and nonword reading accuracy). The efficacy of phonics training was not moderated significantly by training type (phonics alone versus phonics and phoneme awareness versus phonics and irregular word training), training intensity (less than two hours per week versus at least two hours per week), training duration (less than three months versus at least three months), training group size (one-on-one versus small group training), or training administrator (human administration versus computer administration). AUTHORS' CONCLUSIONS: Phonics training appears to be effective for improving some reading skills. Specifically, statistically significant effects were found for nonword reading accuracy (large effect), word reading accuracy (moderate effect), and letter-sound knowledge (small-to-moderate effect). For several other outcomes, there were small or moderate effect sizes that did not reach statistical significance but may be meaningful: word reading fluency, spelling, phonological output, and reading comprehension. The effect for nonword reading fluency, which was measured in only one study, was in a negative direction, but this was not statistically significant.Future studies of phonics training need to improve the reporting of procedures used for random sequence generation, allocation concealment, and blinding of participants, personnel, and outcome assessment.

Sight Word and Phonics Training in Children With Dyslexia.

The aims of this study were to (a) compare sight word training and phonics training in children with dyslexia, and (b) determine if different orders of sight word and phonics training have different effects on the reading skills of children with dyslexia. One group of children (n = 36) did 8 weeks of phonics training (reading via grapheme-phoneme correspondence rules) and then 8 weeks of sight word training (reading irregular words as a whole), one group did the reverse (n = 36), and one group did phonics and sight word training simultaneously for two 8-week periods (n = 32). We measured the effects of phonics and sight word training on sight word reading (trained irregular word reading accuracy, untrained irregular word reading accuracy), phonics reading (nonword reading accuracy, nonword reading fluency), and general reading (word reading fluency, reading comprehension). Sight word training led to significant gains in sight word reading measures that were larger than gains made from phonics training, phonics training led to statistically significant gains in a phonics reading measure that were larger than gains made from sight word training, and both types of training led to significant gains in general reading that were similar in size. Training phonics before sight words had a slight advantage over the reverse order. We discuss the clinical implications of these findings for improving the treatment and assessment of children with dyslexia.