Using eCoaching to Support Mothers' Pretend Play Interactions at Home.

A unique component of early childhood involves understanding how caregivers and educators promote children's developmental outcomes, with play opportunities being a key avenue for enhancing these skills. Targeted coaching is one type of support that can tap into active family engagement during playful learning. This collective case study examined how remote-based eCoaching could support family-centered practices related to the facilitation of pretend play in caregivers of preschool children in the home setting. Four mother-child dyads of preschool children, with and without a disability, participated in eCoaching focusing on pretend play behaviors. During the implementation of eCoaching, three primary findings emerged related to knowledge acquisition, mothers' facilitation of play with their children, and changes in children's pretend play behaviors. In general, both mothers and children benefited from the eCoaching experience. In addition, mothers' perceptions of eCoaching as a means of family-based support were positive, and all deemed eCoaching easy to engage in and beneficial.

Mexican immigrant mothers' perceptions of their children's communication disabilities, emergent literacy development, and speech-language therapy program.

PURPOSE: This qualitative study explored mothers' perceptions of their children's communication disabilities, emergent literacy development, and speech-language therapy programs. METHOD: Participants were 14 Mexican immigrant mothers and their children (age 17-47 months) who were receiving center-based services from an early childhood intervention program, located in a large urban city in the Midwestern United States. Mother interviews composed the primary source of data. A secondary source of data included children's therapy files and log notes. Following the analysis of interviews through the constant comparative method, grounded theory was generated. RESULTS: The majority of mothers perceived their children as exhibiting a communication delay. Causal attributions were diverse and generally medical in nature (i.e., ear infections, seizures) or due to familial factors (i.e., family history and heredity, lack of extended family). Overall, mothers seemed more focused on their children's speech intelligibility and/or expressive language in comparison to emergent literacy abilities. CONCLUSIONS: To promote culturally responsive intervention, mothers recommended that professionals speak Spanish, provide information about the therapy process, and use existing techniques with Mexican immigrant families.

Outcomes of discretionary laboratory requesting of serum protein electrophoresis.

BACKGROUND: Discretionary laboratory requesting of serum protein electrophoresis (SPE) is widespread throughout the UK despite limited evidence to support clinical usefulness. We aimed to examine the clinical usefulness of discretionary SPE requesting on serum samples with globulins>45 g/L by documenting the number of discretionary tests performed and the number of paraproteins identified in an audit period, by determining if such findings led to further investigation/specialty referral, and by identifying the final diagnosis and subsequent management of these patients. METHODS: A retrospective one-year audit from July 2002 to June 2003 was carried out using information from biochemistry databases and review of medical records. RESULTS: Of 1332 discretionary SPEs performed in one year, 72 paraproteins were identified (5.4%). Further clinical information could be obtained in 66 cases. Appropriate follow-up occurred in 84% of cases. The most common diagnosis was monoclonal gammopathy of undetermined significance (56%). Eighteen percent of patients with an identified paraprotein were diagnosed with B-cell malignancies that warranted treatment. A further 6% progressed to requiring treatment during follow-up. CONCLUSION: Using screening criteria of serum globulins>45 g/L, one in 20 discretionary laboratory requests resulted in a clinically relevant finding. These results suggest such requesting is worthwhile and should aid future debate on the appropriateness of this practice.

The use of Pentacam in the assessment of true exfoliation of the lens capsule.

PURPOSE: To highlight the use of Pentacam in the identification of true exfoliation of the lens capsule. METHODS: A 72-year-old woman presented for assessment of bilateral cataracts. An unusual appearance was noted in the right eye. A scrolled membrane was seen floating in the anterior chamber. RESULTS: Imaging with Pentacam showed its origin to be from the anterior lens capsule, suggesting the diagnosis of true exfoliation of the lens capsule. The patient went on to have uncomplicated cataract surgery and the lens capsule was sent for histopathology. CONCLUSIONS: This case highlights the use of anterior segment imaging, the classic histopathology findings, and the management of cataract surgery in these rare cases.

Primary bladder lymphoma: management and outcome of 12 patients with a review of the literature.

Primary bladder non-Hodgkin's lymphoma (NHL) is rare. Optimal management remains controversial. Using the Scotland and Newcastle lymphoma group database, 12 patients with primary bladder lymphoma were identified between 1980 and 2001, the largest single group of patients available to date. Histology and immunocytochemistry was reviewed in 9 of the 12 cases. Six cases were low-grade extranodal marginal zone lymphoma, 4 diffuse large B-cell lymphoma, one an ALK 1 positive anaplastic large cell lymphoma (ALKoma) and one a low-grade lymphoma unspecified. Two patients (low-grade NHL) were treated with oral antibiotics (n=1) or diathermy (n=1) alone with complete resolution of disease. One patient with high-grade NHL gained complete remission without conventional therapy. Nine patients were treated with single or combined modality surgery, chemotherapy and/or radiotherapy. Overall survival was 75%, mean follow up of 4.8 (range 1-10) years. A review of 88 additional cases in the literature support the findings that primary bladder lymphoma is associated with a good prognosis. Patients with low-grade extranodal marginal zone lymphoma may respond well to simple therapies. Patients with diffuse large B-cell lymphoma respond well to first-line chemotherapy regimens. Ureteric obstruction and acute renal failure are serious complications. Repeat cystoscopy is mandatory for follow-up.