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PubMed1984

The relationship of the level of training and area of medical specialization with registrant performance in an advanced trauma life-support course.

Approved advanced trauma life-support (ATLS) programs were given to 160 residents and practitioners of various specialties, utilizing a standardized 50-item, multiple-choice posttest. Level of training (practitioner v resident) and area of medical specialization with registrant performance on total score and in specific subcontent areas of ATLS were evaluated by subjecting total and subcontent percent scores to a two-way analysis of variance and Newman-Keuls pairwise comparisons. Practitioners outperformed the residents in the subcontent area of abdominal injuries, P less than .05. In specialization, emergency medicine outperformed internal medicine specialists, P less than .05. Pairwise differences among specialists were not statistically significant. In airway problems, surgeons and internists were outperformed by emergency medicine, whereas in burns, emergency medicine and family practitioners significantly outperformed the surgeons. Emergency medicine outperformed internal medicine, P less than .05, in subcontent area of extremity injuries. We conclude that registrants are likely to benefit from an ATLS course, but preliminary evidence would seem to justify some "tailoring" of the ATLS curriculum for different registrant specialty groups.

Curriculum↗
PubMedDate not supplied

Relationship of preschool special education outcomes to instructional practices and parent-child interaction.

Developmental outcomes attained by children receiving preschool special education services in relationship to both the general instructional approach used by their teachers and their parents' style of interaction were examined. The sample included 70 children from 41 Early Childhood Special Education (ECSE) classrooms. The type of instructional model children received was determined by dividing the sample into three clusters based upon six global ratings of children's classroom environment: Choice; Cognitive Problem-Solving; Child-Initiated Learning; Developmental Match; Child-Centered Routines; and Rewards and Discipline Strategies. Based on this analysis, 27 children were classified as receiving developmental instruction; 15 didactic instruction; and 28 naturalistic instruction. Observations of parent-child interaction collected at the beginning and end of the year were classified along four dimensions using the Maternal Behavior Rating Scale: Responsiveness, Affect, Achievement Orientation and Directiveness. Results indicated that the kinds of experiences that children received varied significantly across the three instructional models. However, there were no significant differences in the impact of these instructional models on children's rate of development. Regression analyses indicated that children's rate of development at the end of intervention was significantly related to their parents' style of interaction but was unrelated to the type of instructional model they received.

Autistic Disorder↗
PubMed2001

Nursing inputs to special schools in N. Ireland.

Children attending special schools often have healthcare needs that require ongoing medical and nursing care. Two postal surveys were undertaken of 47 special schools in N. Ireland to determine the type of contact they had with nurses and the functions they fulfilled. Responses were received from 42 school principals and from the 11 Health and Social Service Trusts responsible for nursing services. It was found that nurses were based in nine of 42 schools while the remaining schools depended on a range of different visiting nurses. The nurses were involved in 'hands-on' tasks as well as giving advice and training to school personnel. Further research needs to define more closely the nursing needs of these pupils as well as evaluating the differential benefits of various nursing services to schools and how their inputs can be coordinated with those of other health professionals.

Attitude to Health↗
PubMed1991

Risk factors for major neurodevelopmental impairments and need for special education resources in extremely premature infants.

The purpose of this cohort study was to determine the incidence of and risk factors for major neurodevelopmental impairments among survivors of extreme prematurity. The study cohort comprised 100 infants born between 24 and 28 weeks of gestational age at one tertiary center from 1983 to 1984. Twenty-five infants (25%) died; 75 (75%) survived until follow-up (mean, 60 months). Standardized neurodevelopmental and psychometric assessments were performed in blind fashion on 68 of the 75 surviving children (91% follow-up). Informal assessments (parent, teacher, and physician reports) were obtained instead for seven (9%) children who had relocated outside of the area. Overall, 19 children (25%) had one or more major impairments: mental retardation, 9; cerebral palsy, 4; multiple impairments, 5; and blindness, 1. Despite a high prevalence of impairments, 95% of children (n = 71) were functionally independent [corrected]. Special educational resources were definitely necessary for seven (9%) and possibly needed for 36 (48%) additional children. Univariate analyses revealed four significant risk factors for cerebral palsy: hydrocephalus (relative risk = 12.2), grades III and IV intraventricular hemorrhage (relative risk = 5.8), 5-minute Apgar score lower than 7 (relative risk = 5.7), and bronchopulmonary dysplasia (relative risk = 5.5). Hydrocephalus was the only significant risk factor observed for mental retardation (relative risk = 5.4). Risk factors predicting a need for special education resources included sepsis (relative risk = 24.9), low socioeconomic status (relative risk = 16.3), and nonwhite race (relative risk = 3.0). Thus our data suggest that biomedical factors appear to confer the greatest risk of major impairments; sociodemographic factors appear to have a significant impact on educational risk in extremely premature infants who do not die. Continued follow-up with biomedical and developmental-social interventions appears warranted to decrease the risk of educational underachievement in this population.

Birth Weight↗
PubMed2001

Medically unexplained symptoms: an epidemiological study in seven specialities.

OBJECTIVES: This study aimed to estimate the prevalence and risk factors for medically unexplained symptoms across a variety of specialities. METHODS: A cross-sectional survey was conducted at two general hospitals in southeast London between 1995 and 1997. Eight hundred and ninety consecutive new patients from seven outpatient clinics were included. Demographic and clinical characteristic variables were assessed. RESULTS: Five hundred eighty-two (65%) of the subjects surveyed returned completed questionnaires. A final diagnosis was available in 550 (62%). Two hundred twenty-eight (52%) fulfilled criteria for medically unexplained symptoms. The highest prevalence was in the gynecology clinic (66%). After adjustment for confounders, medically unexplained symptoms were associated with being female, younger, and currently employed. Psychiatric morbidity per se was not associated with the presence of medically unexplained symptoms, but was more likely in those complaining of multiple symptoms. Those with medically unexplained symptoms were less disabled, but more likely to use alternative treatment in comparison with those whose symptoms were medically explained. Patients with medically unexplained symptoms were more likely to attribute their illness to physical causes as opposed to lifestyle factors. CONCLUSIONS: Medically unexplained symptoms are common across general/internal medicine and represent the most common diagnosis in some specialities. Medical behavior, training, and management need to take this into account.

Adolescent↗
PubMed1996

Early recognition of children with special educational needs: report from a district.

Health professionals involved in the pre-school child health surveillance programme need to identify those children who are likely to require a formal statement of special educational needs. Such children should be identified as early as possible, preferably by their fourth birthday. Each district needs to examine their programme and thereby identify factors associated with late recognition of such children. We report on our own practice and findings over a three-year period, including the factors associated with late recognition of special needs and efforts to improve the rate of early recognition.

Child, Preschool↗
PubMed2000

Accuracy of clinical diagnosis of lung cancer in Budapest in an institute specializing in chest diseases.

Among 250 consecutive autopsies (170 males and 80 females) performed at the Institute of Pulmonology in Budapest in 1996/7, there were 132 deaths in which cancer of the lung/bronchus was deemed to be the underlying cause of death. At autopsy, six cases previously thought to be dying from lung cancer were found to have died from other diseases (false positive rate = 5%). Twelve lung cancer deaths were also found to have been missed, a false negative rate of 9%, which was similar for adenocarcinoma, squamous carcinoma, and small cell carcinoma cases. Our findings confirmed the expectation expressed earlier that death certification of lung cancer would be more accurate in an institute specializing in chest diseases, to which patients had to be fit enough to be transferred, than in two general hospitals in Budapest. Nevertheless, since most cases certified as dying from lung cancer die without the benefits available in the specialized institute, the estimated false negative and positive rates for lung cancer death certification in Hungary remain high, at an estimated 56% and 30%, respectively. The much lower autopsy rates in most other countries than in Hungary points to there being considerable inaccuracy in lung cancer mortality rates internationally.

Adult↗
PubMed2004

Special education in residential treatment.

Special education programs in residential treatment settings face significant challenges that include issues of family dynamics, the increasingly troubled student population, public school collaboration, and the ever-changing climate of special education governance.Successful programs must build in flexibility and collaboration to deliver prescriptive services to the identified needs of their students.

Adolescent↗
PubMed2005

Special education needs of children with newly diagnosed epilepsy.

Children with epilepsy often experience poor social and educational outcomes. This study aimed to determine the timing of services with respect to the onset of seizures. It also aimed to identify the aspects of childhood epilepsy (type of epilepsy, etiology, seizure control, and treatment) that are associated with the use of special education services. As part of a prospective community-based study, 613 children were recruited when first diagnosed with epilepsy. Mean age at first seizure was 5 years 11 months (SD 4, range 1mo to 15y 8mo). Parents were interviewed 5 years after children were first diagnosed with epilepsy (n=542; 276 [51%] males). Children's mean age at time of interview was 11 years 10 months (SD 4y 1mo, range 5y 8mo to 21y 8mo). Etiology was classified as idiopathic (n=181, 33.4%), cryptogenic (n=261, 48.2%), and remote symptomatic (n=100, 18.5%). Service use was reported in 315 (58%) children. Compared with neurologically intact children (i.e. cryptogenic and idiopathic etiology; n=415, 77%), children with a remote symptomatic etiology and/or an epileptic encephalopathy (n=127, 23%) received services more frequently (88% vs 49%, p<0.001). In the former group, services were initiated for 66 (15%) children before their first seizure; according to age at onset, services were initiated before the first seizures in 12/164 (7.3%) if <5 years, 34/171 (19.9%) if 5-9 years, and 20/80 (25%) if >10 years. A large proportion of children with epilepsy, even if neurologically otherwise normal, receive special education services. Initiation of services often precedes onset of seizures even in neurologically intact children. This suggests that behavioral and cognitive abnormalities may predate the onset of epilepsy and are not necessarily the direct consequences of epilepsy.

Adolescent↗
PubMed1992

Wisdom-related knowledge in a life review task: age differences and the role of professional specialization.

The study adopts life review as an avenue to access wisdom-related knowledge and examines the contribution of age and type of professional specialization to individual differences in wisdom-related knowledge. Women from 2 age groups/cohorts (young, M = 32 years; old, M = 71 years) and different professional specializations (human services vs. nonhuman services) were asked to think aloud about the life review of a fictitious woman who was either young or old. Verbal protocols were scored on 5 wisdom-related criteria: factual and procedural knowledge about life, life-span contextualism, relativism of values, recognition, and management of uncertainty. Three major findings emerged. First, human-services professionals outperformed the control group. Second, old adults performed as well as young adults. Third, for older adults wisdom-related performance was enhanced by the match between their own age and the age of the fictitious character.

Adaptation, Psychological↗
PubMed1999

An exploration of the application of social role valorization in special hospitals.

The set of ideas known as 'social role valorization' (SRV) has been highly influential in services for some client groups, but has rarely been applied in contexts of security. A framework of questions was designed to assist the application of the theory and principles of SRV in work with patients in special hospitals. Small-scale exercises in its use were introduced to explore the relevance and usefulness of SRV ideas in special hospital work. Evaluation indicated potential usefulness in a variety of contexts, especially when allied to consideration of values issues. No attempt was made in these exercises to incorporate SRV in the operational structures of the hospitals, a task that would require much more thought and work at an organizational level.

Hospitals, Special↗
PubMed1999

The prevalence of optometric anomalies and symptoms in children receiving special tuition.

A case-control study was performed where 9 pupils receiving special tuition (ST-group) were compared with 36 controls. Six (66.7%) of the pupils in the ST-group were diagnosed as dyslexic. No significant correlation was revealed between receiving special tuition and having reduced visual function, nor between reduced visual function and number of visually related symptoms. Although the number of symptoms was not significantly greater in the ST-group, some of the symptoms were significantly more common in the ST-group, and none were significantly more common in the control group.

Adolescent↗
PubMed2004

Evaluating rural nursing home environments: dementia special care units versus integrated facilities.

Although one in four seniors currently lives in a rural area, little is known about the capacity of rural nursing homes to provide specialized dementia services. The physical and social environments are increasingly recognized as important factors in the quality of life and functional ability of persons with dementia. This study compared eight rural nursing homes (those located in centres with populations < or =15,000) that had created dementia Special Care Units (SCUs) to eight same-sized rural nursing homes that did not have SCUs. Outcomes were assessed in relation to residents, staff, family members, and the environment. In this paper we describe the overall study design and findings from the environmental assessment. Analysis of variance (ANOVA) was used to compare the SCU versus non-SCU environments on the nine dimensions of the Physical Environmental Assessment Protocol (PEAP), which was used to assess the physical environment. The SCUs were more supportive on six dimensions: maximizing awareness and orientation, maximizing safety and security, regulation of stimulation, quality of stimulation, opportunities for personal control, and continuity of the self. Analysis of variance was also used to compare the groups on the six subscales of the Nursing Unit Rating Scale (NURS), which assesses the social environment of dementia care settings. The SCUs were more supportive on the Separation and Stimulation subscales, indicating that SCUs had greater separation of residents with dementia from other residents for activities of daily living and programming, and better control of non-meaningful stimulation.

Aged↗
PubMedDate not supplied

Visually impaired (VI) education in Romania and the United Kingdom: special education in Romania since 1990 for blind and partially sighted children and young people, with comparisons drawn from similar experiences of legislative and educational changes in England and Wales since 1981.

This article reviews the educational facilities available in the last decades of the 20th century for blind and partially sighted children and young people in Romania and the UK. A turning point in England and Wales came with the Education (Special Educational Needs) Act 1981. For Romania, the turning point came in 1990 with the overthrow of the Ceaucescu regime in late 1989. Romania is seeking entry to the European Union in 2007. This has provided an incentive to bring special educational philosophy and facilities quickly into line with other countries in the European Union. Similar problems regarding inclusion are encountered in both countries. Differentiating features are their different demographic characteristics and the educational resources and assets available at the time of the major changes. Finally, there is a brief review of the number of people with sight loss in paid employment as the next logical focal point for a national inclusion strategy. The UK has been able to develop and advance further than Romania in this sphere, but the legal framework is in place in Romania. The generic terms visually impaired (VI) and sight loss are both used throughout when referring to blind and partially sighted people.

Blindness↗
PubMed2002

A health intervention programme for children with albinism at a special school in South Africa.

The genetic condition albinism has a high frequency among the Sotho people of northern South Africa. Affected children have pale hair, eyes and skin-a dramatic contrast to the normal dark pigmentation. Their visual performance is poor and many attend special schools for the visually impaired. Children with albinism experience problems that are, on the one hand, physiological, and, on the other, social-psychological and educational in nature. In this self-report study 38 children at a rural special school described their eye and skin problems, a direct result of their lack of pigmentation, as well as strategies they adopted to manage their condition. A further section of the study deals with the social adaptation difficulties experienced by these children. The questionnaire tested for local belief systems about albinism and how these impact on the socialization of children with albinism. The intervention strategy proposed in this study is based on the assumption that any attempt to address both the health and social problems should be of a holistic, interactionist nature, and be based on the values and belief systems of the local community. In addressing the physical problems, the proposed intervention programme focuses on sensible sun protection habits from a young age and the active participation of the children. To alleviate the social problems a team (interactionist) approach including children, teachers, parents, health officials and the wider community is recommended.

Adolescent↗
PubMedDate not supplied

Treatment and prevention of pediatric heat-related illnesses at mass gatherings and special events.

Pediatric heat-related illnesses are likely to occur during mass gatherings and special events. Because critical care nurses may be called upon to provide care during such events, education in the recognition, treatment, and prevention of these illnesses is essential. This article describes the pathophysiology of heat-related illnesses and their recognition and treatment at mass gatherings and special events. Interventions to prevent heat-related illnesses at these events are discussed.

Air Conditioning↗
PubMed1983

Changing approaches to methodology of research in special education.

The author discusses the methodology applied in research in special education in Poland in the past and proposes new approaches in this respect. In the past the researchers concentrated rather on observation of disabled children with the same kind of disability; quantitative measurements were rarely applied. Objective data on personality traits and behaviour of disabled persons can be obtained by comparative studies of disabled with nondisabled people, using scientific methods. Such studies were conducted in 1976-1980 at Warsaw University, covering such problems like life goods, self evaluation, methods of teaching, outside-class activities, upbringing in disabled families, social activity and organization of special education. It appears from this approach that there are far more common than so called "specific" problems between the disabled and nondisabled. The identification of "common denominators" is the basis for decategorization of our perception of the disabled, for the development of adequate services for these people, and for their integration and normalization within society.

Behavior↗
PubMed1993

Political and legislative conditions for the successful education of children with special educational needs.

The last 10 years have seen a much higher profile given to the education of children with special educational needs in the whole range of schools and learning environments available in different countries and different communities. At the same time, the world recession and the continued high rate of debt and spending on armaments combine to lower the opportunities for deprived and vulnerable children in our societies. Because children with special needs, their families and their teachers are particularly vulnerable, they need to join forces to ensure that their combined concerns are heard by the world community.

Child↗