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Throughout her career, Audrey Holland advocated for persons with aphasia, urging clinicians and others to view each person in the context of their needs and desires in navigating daily life. In this article, we acknowledge her ideas about functional treatment, and consider their influence on contemporary, activity-focused aphasia treatment. Three criteria define activity-focused treatment: (1) activity-specific goals, (2) personally relevant targets, and (3) near-real-life practice settings. Elements of treatment design, activities, and outcome measurement described here exemplify Audrey's beliefs in person-centered clinical aphasiology. Operationalizing treatment elements and designing a context as close to real life as possible are clinical actions that support these beliefs. Activity-focused treatment and other life participation approaches have often been relegated to the last phase of treatment; following Audrey's example, we advocate beginning with activity-focused treatment based on a client's communication needs and desires. Activity-focused treatment benefits persons with aphasia, their families, clinicians, and other stakeholders by presenting outcomes that reflect communication change in a real-life context and that are individually relevant. Such outcomes foster an individual's inclusion in their communication environments, respect the WHO platform of functional treatment, and prepare a clinician to present outcome data relevant to that individual.
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BACKGROUND: Evidence-based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia-ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well-being and patient-reported satisfaction/impact of treatment, were identified through three international consensus studies. Constructs were paired with outcome measurement instruments (OMIs) during an international consensus meeting (ROMA-1). Before the current study (ROMA-2), agreement had not been reached on OMIs for the constructs of communication or patient-reported satisfaction/impact of treatment. AIM: To establish consensus on a communication OMI for inclusion in the ROMA COS. METHODS & PROCEDURES: Research methods were based on recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Participants with expertise in design and conduct of aphasia trials, measurement instrument development/testing and/or communication outcome measurement were recruited through an open call. Before the consensus meeting, participants agreed on a definition of communication, identified appropriate OMIs, extracted their measurement properties and established criteria for their quality assessment. During the consensus meeting they short-listed OMIs and participants without conflicts of interest voted on the two most highly ranked instruments. Consensus was defined a priori as agreement by ≥ 70% of participants. OUTCOMES & RESULTS: In total, 40 researchers from nine countries participated in ROMA-2 (including four facilitators and three-panel members who participated in pre-meeting activities only). A total of 20 OMIs were identified and evaluated. Eight short-listed communication measures were further evaluated for their measurement properties and ranked. Participants in the consensus meeting (n = 33) who did not have conflicts of interest (n = 29) voted on the top two ranked OMIs: The Scenario Test (TST) and the Communication Activities of Daily Living-3 (CADL-3). TST received 72% (n = 21) of 'yes' votes and the CADL-3 received 28% (n = 8) of 'yes' votes. CONCLUSIONS & IMPLICATIONS: Consensus was achieved that TST was the preferred communication OMI for inclusion in the ROMA COS. It is currently available in the original Dutch version and has been adapted into English, German and Greek. Further consideration must be given to the best way to measure communication in people with mild aphasia. Development of a patient-reported measure for satisfaction with/impact of treatment and multilingual versions of all OMIs of the COS is still required. Implementation of the ROMA COS would improve research outcome measurement and the quality, relevance, transparency, replicability and efficiency of aphasia treatment research. WHAT THIS PAPER ADDS: What is already known on this subject International consensus has been reached on five core constructs to be routinely measured in aphasia treatment studies. International consensus has also been established for OMIs for the three constructs of language, quality of life and emotional well-being. Before this study, OMIs for the constructs of communication and patient-reported satisfaction/impact of treatment were not established. What this paper adds to existing knowledge We gained international consensus on an OMI for the construct of communication. TST is recommended for inclusion in the ROMA COS for routine use in aphasia treatment research. What are the potential or actual clinical implications of this work? The ROMA COS recommends OMIs for a minimum set of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment research. Although not intended for clinical use, clinicians may employ the instruments of the ROMA COS, considering the quality of their measurement properties. The systematic inclusion of a measure of communication, such as TST, in clinical practice could ultimately support the implementation of research evidence and best practices.
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Afasia , Comunicação , Qualidade de Vida , Adulto , Humanos , Atividades Cotidianas , Afasia/diagnóstico , Afasia/terapia , Técnica Delphi , Idioma , Avaliação de Resultados em Cuidados de Saúde/métodos , Projetos de Pesquisa , Resultado do TratamentoRESUMO
Multitasking assessments based on everyday scenarios are useful assessment tools that can reveal the consequences of language and cognitive impairments on functioning. Unfortunately, many existing multitasking assessments require a high degree of linguistic processing that may preclude their use with adults with aphasia. The purposes of this paper are to (1) describe the development of a multitasking assessment relevant to everyday activities, the Catalog Ordering Task (COT), specifically designed for aphasia, (2) investigate differences between the performances of adults without aphasia and adults with aphasia on the COT, and (3) explore the relationships between language and cognitive performances and the COT to facilitate clinical utility. Seventy-four participants, 40 adults with aphasia and 34 people without aphasia, completed the multitasking assessment in single and dual task conditions. The secondary task in the dual task condition was a tone detection task requiring a foot-pedal press. Participants with aphasia also completed additional language and cognitive assessments. We systematically developed the Catalog Ordering Test (COT) with considerations for semantics, syntax, and ecological validity. Criterion validity with acceptable levels of inter-rater and test-retest reliability were observed. Adults with aphasia performed with about half the accuracy and twice as slowly as people without aphasia. Adults with all severity levels of aphasia were able to complete the COT. Multitasking performance on the COT was related to impairment-level measures of language and cognition. The COT is a potentially clinically useful assessment of multitasking, specially designed for aphasia.
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PURPOSE: Generalization has been defined and instantiated in a variety of ways over the last half-century, and this lack of consistency has created challenges for speech-language pathologists to plan for, implement, and measure generalization in aphasia treatment protocols. This tutorial provides an overview of generalization with a focus on how it relates to aphasia intervention, including a synthesis of existing principles of generalization and examples of how these can be embedded in approaches to aphasia treatment in clinical and research settings. METHOD: Three articles collectively listing 20 principles of generalization formed the foundation for this tutorial. The seminal work of Stokes and Baer (1977) focused attention on generalization in behavioral change following treatment. Two aphasia-specific resources identified principles of generalization in relation to aphasia treatment (Coppens & Patterson, 2018; Thompson, 1989). A selective literature review was conducted to identify evidence-based examples of each of these 20 principles from the extant literature. RESULTS: Five principles of generalization were synthesized from the original list of 20. Each principle was supported by studies drawn from the aphasia treatment literature to exemplify its application. CONCLUSIONS: Generalization is an essential aspect of meaningful aphasia intervention. Successful generalization requires the same dedication to strategic planning and outcome measurement as the direct training aspect of intervention. Although not all people with aphasia are likely to benefit equally from each of the principles reviewed herein, our synthesis provides information to consider for maximizing generalization of aphasia treatment outcomes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24714399.
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Afasia , Fala , Humanos , Patologistas , Afasia/diagnóstico , Afasia/terapia , Generalização Psicológica , Resultado do TratamentoRESUMO
INTRODUCTION: Clinicians caring for adults with borderline personality disorder (BPD) in acute settings such as the emergency department (ED) have little evidence/guidance to base decisions on. Specific/detailed guidance for managing BPD in the ED is needed given the morbidity and mortality risks, high service utilisation, unique challenges and risk of iatrogenic interventions. The primary objective of this study is to use a consensus method to develop a guideline for managing adults with BPD in the ED. This protocol and the key questions for the guideline were developed with the advice of people with BPD and their family members/support persons. METHODS AND ANALYSIS: We will perform a four-phase Delphi study of an expert panel of clinicians, researchers, adults with BPD and their family members/support persons. Various disciplines (psychiatry, psychology, emergency medicine, nursing, social work) and treatment approaches will be included in the expert panel. An online questionnaire will be developed from systematic reviews, qualitative assessments of pivotal literature, and opinions suggested by the panel (phase 1). The panel will rate their agreement on opinions for each key question covering areas of emergency care of adults with BPD using two rounds of this questionnaire (phases 2 and 3). Opinions meeting predefined thresholds for consensus will be brought to consensus meetings moderated by an independent chair (phase 4). The purpose of these meetings is to finalise the set and phrasing of the opinions for each area of emergency care. These final opinions will be the recommendations in the guideline. If there are significant differences of opinion, the guideline will present both recommendations alongside one another. ETHICS AND DISSEMINATION: This study has received ethics approval by the Hamilton Integrated Research Ethics Board in Hamilton, Ontario, Canada. The results of this study will be disseminated through peer-reviewed publications, conferences and national professional and patient/family/support associations.
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Transtorno da Personalidade Borderline , Humanos , Adulto , Técnica Delphi , Transtorno da Personalidade Borderline/terapia , Projetos de Pesquisa , Serviço Hospitalar de Emergência , OntárioRESUMO
PURPOSE: A systematic review (SR) represents a rigorous process of identifying and summarizing current research to answer specific clinical questions. Not all SRs present high-quality information, because they do not adhere to established standards of conduct or reporting. This tutorial aims to (a) describe two tools developed in epidemiology for reporting (PRISMA 2020; Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and appraising (AMSTAR 2; A MeaSurement Tool to Assess Systematic Reviews) SRs and (b) exemplify the use of AMSTAR 2. First, we describe the intents of PRISMA 2020 and AMSTAR 2 and compare the items on each checklist. Next, we apply the AMSTAR 2 list of domains to critically appraise methodological quality in two randomly selected SRs, which describe aphasia treatment. Appraisal results are reported, including the AMSTAR 2 ratings for overall confidence in the results of each review. For each SR, the overall rating was critically low, indicating that within the seven critical domains of AMSTAR 2, the SR had more than one critical weakness. CONCLUSIONS: While PRISMA 2020 is a tool to guide preparation of SRs, to examine SR quality, the AMSTAR 2 is the tool of choice. Applied to two current aphasia treatment SRs, the AMSTAR 2 demonstrates that although both SRs were thorough, thoughtful summaries of a body of aphasia treatment literature, they did not achieve high ratings for methodological quality. Clinicians reading SRs are advised to familiarize themselves with quality assessment tools to assure that an SR meets expected criteria to document internal and external validity of the SR process, so resulting findings can be confidently applied for patients with aphasia.
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Afasia , Relatório de Pesquisa , Humanos , Lista de Checagem/métodos , Afasia/diagnóstico , Afasia/terapiaRESUMO
PURPOSE: In the aphasia literature, motivation has been described as potentially influencing rehabilitation outcomes, and there are reports that researchers and clinicians have acted to promote it. However, studies directly investigating the range of beliefs and practices surrounding motivation do not exist currently. The purpose of this scoping review is to develop themes related to the beliefs and practices appearing in the recent aphasia literature. METHOD: Four databases (CINAHL, PsycINFO, PubMed, and Google Scholar) were searched using keywords aphasia and motivation (including derivatives such as motiv*) for articles published between 2009 and 2020. Searches returned 19,731 articles; after deleting duplicates and applying inclusionary criteria, 365 articles remained. In each article, text surrounding the term motivation was highlighted and thematic analysis was applied to these quotations. RESULTS: Sixteen themes were developed through thematic analysis and placed into two groups. The first group contained five themes suggesting that researchers believed that motivation should be studied and recognized the value of motivation in person(s) with aphasia when participating in research or clinical activities. The second group contained 11 themes reporting diverse beliefs and practices in how motivation is incorporated in research and clinical activities. CONCLUSIONS: Results from this scoping review suggest that aphasia researchers, clinicians, and persons with aphasia hold beliefs about motivation that can influence clinical and research decisions. In general, beliefs and decisions related to motivation appeared to be guided by intuition rather than theories of motivation. These themes are discussed within the context of three psychological needs proposed by self-determination theory: competency, autonomy, and relatedness. Applying theories of motivation to future study in aphasia rehabilitation will guide work that can provide empirical support for these beliefs.
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Afasia , Motivação , Humanos , Afasia/reabilitação , Autonomia PessoalRESUMO
PURPOSE: This scoping review examined studies reporting restorative treatments designed to improve auditory comprehension in people with aphasia. METHOD: We searched eight databases using keywords aphasia, auditory comprehension, treatment, intervention, and rehabilitation, for studies published between 1970 and 2020. Searches returned 170 records, and after applying exclusionary criteria, 28 articles remained. For each article, two authors independently extracted data on study design parameters, participant characteristics, treatment protocol, and treatment outcomes, including generalization. RESULTS: Studies were categorized by treatment focus: direct auditory (n = 7), mixed auditory (n = 13), or indirect (n = 8). Study designs were group (n = 12), single-subject experimental design (n = 11), or case study (n = 5). Fifteen studies had a control condition and/or a control group. Thirteen studies included two to 10 participants. Aphasia severity and auditory comprehension severity were infrequently reported, and most participants were greater than 1-year poststroke. Treatment targets and tasks varied. Sessions ranged from 8 to 240 min, once or more per week, for eight to 60 total sessions over 2-20 weeks. Impairment-based outcome measures were typically used. Improvement and generalization were regularly reported; however, authors frequently did not report statistical significance. CONCLUSIONS: A variety of treatments have addressed auditory comprehension deficits in people with aphasia, with many reporting improvements in auditory comprehension for some people. However, the variability in treatment tasks and delivery and outcome measurements preclude confidently offering specific clinical recommendations for implementing auditory comprehension treatments. Gaps identified by the current study may guide the development and exploration of transparent, repeatable, patient-centered treatments. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21291345.
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Afasia , Compreensão , Humanos , Afasia/terapia , Afasia/reabilitação , Resultado do TratamentoRESUMO
Determining the optimal amount and intensity of treatment is essential to the design and implementation of any treatment program for aphasia. A growing body of evidence, both behavioral and biological, suggests that intensive therapy positively impacts outcomes. We update a systematic review of treatment studies that directly compares conditions of higher and lower intensity treatment for aphasia. We identify five studies published since 2006, review them for methodologic quality, and synthesize their findings with previous ones. For both acute and chronic aphasia, results at the language impairment and communication activity/participation levels tend to be more equivocal than previously demonstrated, with no clear differences between intensive and nonintensive treatment emerging across studies. Future research directions are discussed including research design, definitions of treatment intensity, and behavioral and biological measurement of short- and long-term changes following implementation of an intensive treatment.
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Afasia/terapia , Afasia/psicologia , Comportamento , Ensaios Clínicos como Assunto , Comunicação , Humanos , Aprendizagem , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/psicologia , Doenças do Sistema Nervoso/terapia , Qualidade da Assistência à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
Purpose Early identification is a key element for accessing appropriate services for preschool children with language impairment. However, there is a high risk of misidentifying typically developing dual language learners as having language impairment if inappropriate tools designed for monolingual children are used. In this study of children with bilingual exposure, we explored performance on brief dynamic assessment (DA) language tasks using graduated prompting because this approach has potential applications for screening. We asked if children's performance on DA language tasks earlier in the year was related to their performance on a year-end language achievement measure. Method Twenty 4-year-old children from Spanish-speaking homes attending Head Start preschools in the southwestern United States completed three DA graduated prompting language tasks 3-6 months prior to the Head Start preschools' year-end achievement testing. The DA tasks, Novel Adjective Learning, Similarities in Function, and Prediction, were administered in Spanish, but correct responses in English or Spanish were accepted. The year-end achievement measure, the Learning Accomplishment Profile-Third Edition (LAP3), was administered by the children's Head Start teachers, who also credited correct responses in either language. Results Children's performance on two of the three DA language tasks was significantly and positively related to year-end LAP3 language scores, and there was a moderate and significant relationship for one of the DA tasks, even when controlling for age and initial LAP3 scores. Conclusions Although the relationship of performance on DA with year-end performance varies across tasks, the findings indicate potential for using a graduated prompting approach to language screening with young dual language learners. Further research is needed to select the best tasks for administration in a graduated prompting framework and determine accuracy of identification of language impairment.
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Multilinguismo , Aptidão , Linguagem Infantil , Pré-Escolar , Humanos , Idioma , Testes de LinguagemRESUMO
BACKGROUND: A core outcome set (COS; an agreed, minimum set of outcomes) was needed to address the heterogeneous measurement of outcomes in aphasia treatment research and to facilitate the production of transparent, meaningful, and efficient outcome data. OBJECTIVE: The Research Outcome Measurement in Aphasia (ROMA) consensus statement provides evidence-based recommendations for the measurement of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment studies. METHODS: This statement was informed by a four-year program of research, which comprised investigation of stakeholder-important outcomes using consensus processes, a scoping review of aphasia outcome measurement instruments, and an international consensus meeting. This paper provides an overview of this process and presents the results and recommendations arising from the international consensus meeting. RESULTS: Five essential outcome constructs were identified: Language, communication, patient-reported satisfaction with treatment and impact of treatment, emotional wellbeing, and quality of life. Consensus was reached for the following measurement instruments: Language: The Western Aphasia Battery Revised (WAB-R) (74% consensus); emotional wellbeing: General Health Questionnaire (GHQ)-12 (83% consensus); quality of life: Stroke and Aphasia Quality of Life Scale (SAQOL-39) (96% consensus). Consensus was unable to be reached for measures of communication (where multiple measures exist) or patient-reported satisfaction with treatment or impact of treatment (where no measures exist). DISCUSSION: Harmonization of the ROMA COS with other core outcome initiatives in stroke rehabilitation is discussed. Ongoing research and consensus processes are outlined. CONCLUSION: The WAB-R, GHQ-12, and SAQOL-39 are recommended to be routinely included within phases I-IV aphasia treatment studies. This consensus statement has been endorsed by the Collaboration of Aphasia Trialists, the British Aphasiology Society, the German Society for Aphasia Research and Therapy, and the Royal College of Speech Language Therapists.
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Afasia/terapia , Consenso , Avaliação de Resultados em Cuidados de Saúde , Acidente Vascular Cerebral/terapia , Afasia/diagnóstico , Emoções , Humanos , Idioma , Guias de Prática Clínica como Assunto , Qualidade de Vida , Acidente Vascular Cerebral/diagnóstico , Inquéritos e QuestionáriosRESUMO
PURPOSE: This systematic review summarizes evidence for intensity of treatment and constraint-induced language therapy (CILT) on measures of language impairment and communication activity/participation in individuals with stroke-induced aphasia. METHOD: A systematic search of the aphasia literature using 15 electronic databases (e.g., PubMed, CINAHL) identified 10 studies meeting inclusion/exclusion criteria. A review panel evaluated studies for methodological quality. Studies were characterized by research stage (i.e., discovery, efficacy, effectiveness, cost-benefit/public policy research), and effect sizes (ESs) were calculated wherever possible. RESULTS: In chronic aphasia, studies provided modest evidence for more intensive treatment and the positive effects of CILT. In acute aphasia, 1 study evaluated high-intensity treatment positively; no studies examined CILT. Four studies reported discovery research, with quality scores ranging from 3 to 6 of 8 possible markers. Five treatment efficacy studies had quality scores ranging from 5 to 7 of 9 possible markers. One study of treatment effectiveness received a score of 4 of 8 possible markers. CONCLUSION: Although modest evidence exists for more intensive treatment and CILT for individuals with stroke-induced aphasia, the results of this review should be considered preliminary and, when making treatment decisions, should be used in conjunction with clinical expertise and the client's individual values.
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Afasia/reabilitação , Afasia/terapia , Medicina Baseada em Evidências , Terapia da Linguagem , Reabilitação do Acidente Vascular Cerebral , Afasia/etiologia , Humanos , Acidente Vascular Cerebral/complicaçõesRESUMO
Percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction (STEMI) decreases morbidity and mortality if performed within the first 2 hours of symptom onset. However, the American College of Cardiology/American Heart Association guideline for percutaneous coronary intervention door-to-balloon time (<90 minutes) in patients with STEMI is a infrequently accomplished goal. This study enrolled 277 patients with STEMI who were self-transported or transported by emergency medical services to NorthEast Medical Center for primary percutaneous coronary intervention. This study tested the hypothesis that prehospital wireless transmission of an electrocardiogram to a cardiologist's hand-held device results in shorter emergency department door-to-reperfusion time. A comparison was made between patients whose electrocardiogram was successfully transmitted during the intervention phase with (1) patients transported by the emergency medical services in the preintervention, (2) patients self-transported in the intervention phase, and (3) patients whose wireless transmission failed in the intervention phase. During the preintervention phase (2001 to 2003), 48 patients were enrolled. During the intervention phase (2003 to 2005), the following patients were enrolled: 101 self-transported patients, 24 patients with successful electrocardiographic transmission, and 19 patients for whom transmission failed. The median door-to-reperfusion time for patients with successful electrocardiographic transmission was 50 minutes, which was significantly shorter than a preintervention time of 101 minutes (p <0.0001), an intervention phase self-transport time of 96 minutes (p <0.0001), and a failed transmission time of 78 minutes (p <0.0001). In conclusion, prehospital wireless electrocardiographic transmission to a cardiologist's hand-held device significantly decreased emergency department door-to-reperfusion time, thus achieving the American College of Cardiology/American Heart Association guideline for patients with STEMI.
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Cardiologia , Computadores de Mão , Eletrocardiografia , Sistemas de Comunicação entre Serviços de Emergência , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Idoso , Angioplastia Coronária com Balão , Inteligência Artificial , Estenose Coronária/diagnóstico , Estenose Coronária/terapia , Determinação de Ponto Final , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica , North Carolina , Projetos Piloto , Estudos Prospectivos , Processamento de Sinais Assistido por Computador , Fatores de Tempo , Transporte de Pacientes , Resultado do TratamentoRESUMO
Purpose: In aphasia treatment literature, scarce attention is paid to factors that may reduce a study's validity, including adherence to assessment and treatment procedures (i.e., fidelity). Although guidelines have been established for evaluating and reporting treatment fidelity, none exist for assessment fidelity. Method: We reviewed treatment fidelity guidelines and related literature to identify assessment fidelity components. We then examined 88 aphasia treatment studies published between 2010 and 2015 and report the frequency with which researchers provide information regarding the following assessment fidelity components: assessment instruments, assessor qualifications, assessor or rater training, assessment delivery, assessor or rater reliability, and assessor blinding. Results: We found that 4.5% of studies reported information regarding assessment instruments, 35.2% reported information regarding assessor qualifications, 6.85% reported information regarding assessor or rater training, 37.5% reported information regarding assessor or rater reliability, 27.3% reported on assessor blinding, and no studies reported information regarding assessment delivery. Conclusions: There is a paucity of assessment fidelity information reported in aphasia treatment research. The authors propose a set of guidelines to ensure readers will be able to evaluate assessment fidelity, and thus study validity.
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Afasia , Pesquisa/tendências , Humanos , Reprodutibilidade dos TestesRESUMO
Personal health budgets (PHBs) were piloted in the National Health Service (NHS) in England between 2009 and 2012 and were found to have greater positive effects on quality of life and psychological well-being for those with mental health problems than commissioned service, as well as reducing their use of unplanned care. The government intends to extend PHBs in England for long-term conditions, including mental health, from April 2015. Given the importance of engaging clinicians in the next phase of PHB development, we provide an overview of the approach, synthesise the evidence from the national pilot and debate some of the opportunities and challenges. Balancing individual choice and recovery with concerns for risk, equity and the sustainability of existing community services is the central tension underpinning this innovation in mental health service delivery.
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BACKGROUND/PURPOSE: Coronary stent deployment outcomes can be negatively impacted by inaccurate lesion measurement and inappropriate stent length selection (SLS). We compared visual estimate of these parameters to those provided by the CorPath 200® Robotic PCI System. METHODS: Sixty consecutive patients who underwent coronary stent placement utilizing the CorPath System were evaluated. The treating physician assessed orthogonal images and provided visual estimates of lesion length and SLS. The robotic system was then used for the same measures. SLS was considered to be accurate when visual estimate and robotic measures were in agreement. Visual estimate SLSs were considered to be "short" or "long" if they were below or above the robotic-selected stents, respectively. RESULTS: Only 35% (21/60) of visually estimated lesions resulted in accurate SLS, whereas 33% (20/60) and 32% (19/60) of the visually estimated SLSs were long and short, respectively. In 5 cases (8.3%), 1 less stent was placed based on the robotic lesion measurement being shorter than the visual estimate. CONCLUSIONS: Visual estimate assessment of lesion length and SLS is highly variable with 65% of the cases being inaccurately measured when compared to objective measures obtained from the robotic system. The 32% of the cases where lesions were visually estimated to be short represents cases that often require the use of extra stents after the full lesion is not covered by 1 stent [longitudinal geographic miss (LGM)]. Further, these data showed that the use of the robotic system prevented the use of extra stents in 8.3% of the cases. Measurement of lesions with robotic PCI may reduce measurement errors, need for extra stents, and LGM.
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Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Robótica , Stents , Reestenose Coronária/prevenção & controle , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Resultado do TratamentoRESUMO
A framework for a workshop on grant writing to be presented to allied health professionals who seek to develop or improve their grant writing skills is described. The proposed framework contains eight sections that describe preparation for a grant application. The sections discuss activities that occur before, during, and after completing the application. The framework is flexible in its delivery format. The flexibility of this framework creates unique opportunities to present information to allied health professionals and to encourage them to seek funding for research and clinical projects.
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Pessoal Técnico de Saúde/educação , Organização do Financiamento , Redação , Educação/métodos , Humanos , Estados UnidosRESUMO
PURPOSE: The purpose of this study was to determine whether typically developing preschool children with bilingual experience show evidence of learning within brief dynamic assessment language tasks administered in a graduated prompting framework. Dynamic assessment has shown promise for accurate identification of language impairment in bilingual children, and a graduated prompting approach may be well-suited to screening for language impairment. METHOD: Three dynamic language tasks with graduated prompting were presented to 32 typically developing 4-year-olds in the language to which the child had the most exposure (16 Spanish, 16 English). The tasks were a novel word learning task, a semantic task, and a phonological awareness task. RESULTS: Children's performance was significantly higher on the last 2 items compared with the first 2 items for the semantic and the novel word learning tasks among children who required a prompt on the 1st item. There was no significant difference between the 1st and last items on the phonological awareness task. CONCLUSIONS: Within-task improvements in children's performance for some tasks administered within a brief, graduated prompting framework were observed. Thus, children's responses to graduated prompting may be an indicator of modifiability, depending on the task type and level of difficulty.
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Linguagem Infantil , Hispânico ou Latino , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Desenvolvimento da Linguagem , Multilinguismo , Aprendizagem Verbal , Desenvolvimento Infantil , Pré-Escolar , Feminino , Humanos , Testes de Linguagem , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Fonética , Valores de Referência , SemânticaRESUMO
Febrile seizures are the most common form of childhood seizures, affecting 2% to 5% of children. They are considered benign and self-limiting; however, a febrile seizure is a terrifying event for most parents, and is one of the most common causes of trips to the emergency room. A febrile seizure is "an event in infancy or childhood, usually occurring between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause." This definition excludes seizures with fever in children who have had a prior afebrile seizure. In 2011, The American Academy of Pediatrics (AAP) published a clinical practice guideline defining a febrile seizure as "a seizure accompanied by fever (temperature ≥ 100.4°F or 38°C by any method), without central nervous system infection, that occurs in infants and children 6 through 60 months of age." Febrile seizures are further classified as simple or complex. This article reviews the evaluation, management, and prognosis of simple and complex seizures, including febrile status epilepticus.
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Convulsões Febris , Pré-Escolar , Saúde Global , Humanos , Incidência , Lactente , Prognóstico , Recidiva , Fatores de Risco , Convulsões Febris/complicações , Convulsões Febris/diagnóstico , Convulsões Febris/epidemiologia , Convulsões Febris/terapia , Estado Epiléptico/diagnóstico , Estado Epiléptico/etiologia , Estado Epiléptico/terapiaRESUMO
A number of recent studies utilizing both functional neuroimaging and lesion analysis techniques in neurologic patients have produced conflicting results with respect to the neural correlates of picture naming. Picture naming involves a number of cognitive processes, from visual perception/recognition to lexical-semantic retrieval to articulation. This middle process, the ability to retrieve a name associated with an object, has been attributed in some cases to posterior portions of the left lateral temporal lobe and in other cases, to anterior temporal cortex. In the current study, we used voxel-based lesion symptom mapping (VLSM) to identify neural correlates of picture naming in a large sample of well-characterized left hemisphere (LH) patients suffering from a range of naming deficits. We tested patients on the Boston Naming Test (BNT), a clinical, standardized measure of picture naming that is widely used in both clinical and research settings. We found that overall performance on the BNT was associated with a network of LH regions that included significant portions of the left anterior to posterior middle temporal gyrus (MTG) and superior temporal gyrus (STG) and underlying white matter, and extended into left inferior parietal cortex. However, when we added covariates to this analysis that controlled for deficits in visual recognition and motor speech in order to isolate brain regions specific to lexical-semantic retrieval, the significant regions that remained were confined almost exclusively to the left mid-posterior MTG and underlying white matter. These findings support the notion that a large network in left peri-Sylvian cortex supports picture naming, but that the left mid-posterior MTG and underlying white matter play a critical role in the core ability to retrieve a name associated with an object or picture.