FEES is safe and reliable in assessing laryngeal penetration and tracheal aspiration in NICU infants.

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BackgroundTo determine if the EuroQol Health Related Quality of Life survey produces equivalent results when administered by phone interview or patient-completed forms.MethodsPeople awaiting hip or knee arthroplasty at a major metropolitan hospital participated. They were randomly assigned to receive the EuroQol Health Related Quality of Life survey via telephone, followed by a patient completed form 1 week later, or vice versa. Equivalence was determined using two one-sided tests (TOST) based on minimal clinically-important differences for the visual analogue scale (VAS) and the summary Utility Index. Cohen’s Kappa scores were computed to determine agreement for the individual EuroQoL Likert scale items.ResultsSeventy-six from 90 (84%) participants completed the survey twice. Based on limits set at ±7 and ±0.11 for the VAS and Utility Index, respectively, equivalence was established between the two methods of administration for both the VAS (mean difference 0.05 [90% CI −3.76–3.67]) and the Utility Index (mean difference 0.06 [90% CI 0.02–0.11]). Varying levels of agreement, ranging from slight to substantial (κ = 0.17–0.67), were demonstrated for the individual health domains. The order of telephone and patient-completed survey administration had no significant effect on results.ConclusionsEquivalent results are obtained between telephone and patient-completed administration for the VAS and Utility Index of the EuroQol Survey in people with advanced hip or knee osteoarthritis. The limits of agreement for the individual health domains vary which prevents the accurate interpretation of real change in these items across modes.

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Background: Premature infants may demonstrate feeding difficulties requiring an instrumental swallowing assessment. Fiberoptic endoscopic evaluation of swallowing (FEES) is one assessment that can evaluate bottle feeding and breastfeeding. Purpose: This pilot study investigated the safety and feasibility of FEES for neonatal intensive care unit (NICU) infants during breastfeeding. Methods: The setting for this prospective, descriptive study was an urban level III NICU that provided care for premature and critically ill infants. Participants were 5 infants recruited from a convenience sample who were at least 37 weeks postmenstrual age, demonstrated feeding difficulties during a bedside feeding and swallowing examination, and were breastfeeding. Each participant received a FEES assessment while breastfeeding (FEES-B). Adverse events and vital signs including prefeeding and postfeeding respiratory rate, heart rate, and oxygen saturation level were recorded to assess safety. Visualization of milk, laryngeal penetration, and tracheal aspiration assessed feasibility. Results: Participants had a mean postmenstrual age of 39.8 weeks. No adverse events, including epistaxis or laryngospasm, were reported; there were no instances of autonomic instability; and there were no statistically significant differences between prefeeding and postfeeding respiratory rate, heart rate, or oxygen saturation level. Two infants successfully breastfed during FEES-B. Human milk was observable, and laryngeal penetration was noted with 1 infant. Implication for Practice: FEES-B was found to be safe, with limited data supporting feasibility. Infants demonstrated no physiologic instability during FEES-B, and milk was visualized in the pharynx during breastfeeding with 2 infants. Implication for Research: Further studies are warranted to assess effectiveness of FEES-B in infants.

The debate over whether infants prefer a familiar stimulus over a novel stimulus has persisted for over 30 years, and there is evidence which supports both sides of the question. However, the research which supports the preference for the familiar uses different measures than that which supports the preference for novelty. In the first experiment, the preference for the familiar was tested by making one stimulus more familiar than the others presented. A target of à familiar' face was presented eight times more frequently than the other faces. During the experiment, the infants could choose at which face they looked and for how long. It was found that the infants significantly preferred the familiar face over any one of the novel faces, especially when the familiar face was presented first. Substituting auditory for visual stimuli, the second experiment was a replication of the first experiment. Consonant±vowel syllables were used instead of faces. Overall, 17 stimuli were used: one repeating`familiar' sound, and 16 novel sounds. It was found that the infants significantly preferred the familiar sound over any of the novel sounds. As found in Experiment 1, the infants also had a greater preference for the familiar sound when it was presented first.

In 1993, the American Speech-Language-Hearing Association (ASHA) recommended caseloads of 40 for speech-language pathologists (SLPs) practicing in the public schools, a recommendation that was not feasible for most school districts. In addition, new laws and policies substantially increased the paperwork, responsibilities, and time expenditures required of the school-based SLP. ASHA subsequently instigated extensive reviews of the problem and, in 2002, suggested that schools instead use a “workload analysis approach,” considering all of the required activities from prereferral to dismissal, in order to determine the number of children an SLP could appropriately serve. In our study, we attempted to catalog the status of Texas' efforts in using workload considerations. More than 400 school-based respondents indicated the percentages of time they spent fulfilling each professional responsibility at their school. Responses suggest that variation in caseload numbers corresponds to clinician role (SLP vs. supervising SLP vs. SLP Assistant). Most clinicians indicated that they were fairly satisfied with their job; however, many were employed 5 or fewer years in the schools and the average workweek was 48–49 hours. Although it appears that Texas is using workload considerations to some extent, efforts should continue to optimize the quality of treatment for Texas schoolchildren and retention of SLPs in the schools.

A number of recent studies have shown that newborns prefer to look at mother's face rather than at the face of a stranger. This preference can be seen as the result of familiarity with the mother's face, stemming from a greater number of encounters with mother's face. A schema theory can deal with this kind of recognition. Recent work with verbal stimuli has shown that newborns are sensitive to primacy and recency as well as simple familiarity. A pilot and one complete experiment were carried out to examine whether primacy and recency operated with faces as well. Results indicated that primacy, but not recency, was effective. The results show very rapid learning, learning that may outpace the capacity of any extant model of perceptual learning.