Developmental disabilities: improving competence in care using virtual patients

Nurse practitioners (NPs) have an increasingly important role in health care provision in the United States. However, most nurses report that they receive little or no clinical training in the area of developmental disabilities. A core development team consisting of NP faculty members from three universities, one physician assistant faculty member, the parents of children with developmental disabilities, and educational specialists developed two multimedia interactive pediatric instructional modules in CD-ROM format: one involving a child with Down syndrome and the other, an infant born at 26 weeks gestation. Participants were required to make decisions about proper clinical interaction throughout the cases. The modules on CD were piloted with NP students at three universities. Effectiveness study results demonstrated significant gains in both knowledge and comfort level regarding the care of patients with developmental disabilities.

Caring for children with intellectual and developmental disabilities: virtual patient instruction improves students' knowledge and comfort level

Nurses play a vital role in providing health care to children with developmental disability (DD) throughout the United States. Unfortunately, most nurses continue to report that they receive little or no clinical education in the area of DDs. In response to this need, a core development team consisting of nurse practitioners and nursing faculty from three universities, one physician assistant faculty, parents of children with DD, and educational specialists developed two multimedia (virtual patient) pediatric instructional modules in CD-ROM format--one involving a child with Down syndrome, and the other involving an infant born at 26 weeks' gestation. Participants were required to make clinical decisions throughout the cases. The modules on CD were piloted with nursing students from three universities. Results of the effectiveness study demonstrated significant gains in knowledge and comfort level regarding the care of children with DD.

Palivizumab prophylaxis of respiratory syncytial virus disease in 2000-2001: results from The Palivizumab Outcomes Registry

The objective of the Registry was to characterize the population of infants receiving prophylaxis for respiratory syncytial virus (RSV) disease by describing the patterns and scope of usage of palivizumab in a cross section of US infants. RSV hospitalization outcomes were also described. The Palivizumab (Synagis, MedImmune, Inc., 25 West Watkins Mill Road, Gaithersburg, MD 20878) Outcomes Registry was a prospective multicenter survey conducted at 63 sites. Demographics, injection history, and RSV hospitalization outcomes were collected on 2,116 infants receiving palivizumab. Infants were enrolled in the Registry between September 1, 2000-March 1, 2001, at the time of their first injection. Infants born at less than 32 weeks of gestation accounted for 47% of infants enrolled, and those between 32-35 weeks accounted for 45%; approximately 8% were greater than 35 weeks of gestation. Lower RSV hospitalization rates were observed in infants who had greater adherence to regularly scheduled injections. Nearly one-half of all hospitalizations occurred within the first and second injection intervals, suggesting the importance of early RSV protection. The confirmed RSV hospitalization rate of all infants in the Registry was 2.9%; the rate was 5.8% in infants with chronic lung disease of infancy, and 2.1% in premature infants without chronic lung disease. In conclusion, these data support the continued effectiveness of palivizumab prophylaxis for severe RSV lower respiratory tract disease in a large cohort of high-risk infants from geographically diverse pediatric offices and clinics. The Palivizumab Outcomes Registry provides an opportunity to assess palivizumab utilization and clinical effectiveness in the US.

Case report: hemiballismus with unusual MRI findings

A 90-year-old male experienced the abrupt onset of hemiballismus. He had an unusual MRI picture with bright signal in the right basal ganglia on T1-weighted imaging with no significant signal abnormality identified on T2-weighted imaging. This appearance has been described in diabetic patients who sustain ischemia in the basal ganglia region and prior cases are cited.

Laterality effects for tactile patterns

A series of studies was carried out to investigate laterality effects in the discrimination of tactile patterns presented to the fingertips of right-handed subjects. When both hands were stimulated simultaneously, a small right-hand advantage (RHA) was observed for a sequential task and a small left-hand advantage (LHA) was found for a spatial task, but only in women and only when there was a delay or mask between presentation and response. This may indicate different attentional strategies for men and women, or better shielding against interhemispheric interference in women. When only one hand was stimulated at a time (unimanual tasks), no laterality effects were found with sequential tasks, but a substantial RHA for a spatial task was observed. Because the unimanual spatial task involves more possible alternatives than the unimanual sequential ones, this RHA may be a consequence of increased information load rather than a the spatial/sequential distinction. While laterality effects in tactile laterality studies are relatively inconsistent, there are clear differences between bimanual and unimanual presentation. Effects related to hemispheric specialization are much more evident with bilateral presentation.

Assessing extracranial carotid stenosis: magnetic resonance angiography, duplex scanning, and digital angiography

Recent data have demonstrated the efficacy of carotid endarterectomy in patients with severe, symptomatic carotid stenosis. In this context, our study analyzes the role of carotid testing with magnetic resonance angiography and carotid duplex scanning, as compared to arterial digital subtraction angiography.

Handedness effects in the detection of dichotically-presented words and emotions

Left-handed and right-handed subjects were given two dichotic listening tasks using identical material. In one task, they were asked to determine whether or not a specific target word was present (verbal task). In the other task, subjects were asked to indicate whether or not one of the dichotically-competing words was spoken in a particular affective tone (emotion task). Overall, a right-ear advantage (REA) was found with the verbal task and a left-ear advantage (LEA) with the emotion task. Left-handers showed a slightly smaller REA than right-handers on the verbal task, but a slightly larger LEA on the emotion task. This finding suggests that left- and right-hemispheric functions are not related in a complementary fashion and that handedness effects for nonverbal tasks are different from those seen with verbal tasks. The emotional LEA was much larger for angry stimuli than for happy, sad, or neutral stimuli. Rather than providing evidence for a hemisphere by affective valence interaction, such results suggest a stimulus-specific effect.