Parental involvement in neonatal critical care decision-making

The paper analyses the decision-making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed. Two distinct communicative approaches to decision-making were used by doctors: ‘making recommendations’ and ‘providing options.’ Different trajectories for parental involvement in decision-making were afforded by each design, as well as differences in terms of the alignments, or conflicts, between doctors and parents. ‘Making recommendations’ led to misalignment and reduced opportunities for questions and collaboration; ‘providing options’ led to an aligned approach with opportunities for questions and fuller participation in the decision-making process. The findings are discussed in the context of clinical uncertainty, moral responsibility and the implications for medical communication training and guidanc

Mathematics difficulties in children born very preterm: current research and future directions

Children born very preterm have poorer attainment in all school subjects, and a markedly greater reliance on special educational support than their term-born peers. In particular, difficulties with mathematics are especially common and account for the vast majority of learning difficulties in this population. In this paper, we review research relating to the causes of mathematics learning difficulties in typically developing children, and the impact of very preterm birth on attainment in mathematics. Research is needed to understand the specific nature and origins of mathematics difficulties in very preterm children to target the development of effective intervention strategies

Universal gestational age effects on cognitive and basic mathematic processing

Prematurity has adverse effects on basic mathematic processing following birth at all gestations <36 weeks and on IQ and mathematic attainment <34 weeks GA. The ability to predict IQ and mathematic processing scores from one cohort to another among children cared for in different eras and countries indicates that universal neurodevelopmental factors explain the effects of gestation at birth. In contrast, mathematic attainment may be improved by schooling

Learning disabilities among extremely preterm children without neurosensory impairment: Comorbidity, neuropsychological profiles and scholastic outcomes

Background: Children born extremely preterm are at high risk for intellectual impairment, learning disabilities, executive dysfunction and special educational needs, but little is understood about the comorbidity of intellectual and learning disorders in this population. Aims: This study explored comorbidity in intellectual disability (ID) and learning disabilities (LD) in children born extremely preterm (EP; <26+0 weeks’ gestation). Subjects and study design: A UK national cohort of 161 EP children and 153 term-born controls without neurosensory impairments was assessed at 11 years of age (the EPICure Study). Outcome measures: IQ, mathematics and reading attainment, executive function, visuospatial processing and sensorimotor skills were assessed using standardised tests, and curriculum-based attainment and special educational needs (SEN) using teacher reports. Results: Overall, 75 (47%) EP children and 7 (4.6%) controls had ID or LD (RR 10.12; 95% CI 4.81, 21.27). Comorbidity in ID/LD was more common among EP children than controls (24% vs. 0%). EP children with comorbid ID/LD had significantly poorer neuropsychological abilities and curriculum-based attainment than EP children with isolated or no disabilities. LD were associated with a 3 times increased risk for SEN. However, EP children with ID alone had poorer neuropsychological abilities and curriculum-based attainment than children with no disabilities, yet there was no increase in SEN provision among this group. Conclusions: EP children are at high risk for comorbid intellectual and learning disabilities. Education professionals should be aware of the complex nature of EP children’s difficulties and the need for multi-domain assessments to guide intervention

Charting the survival, health and development of extremely preterm infants: EPICure and beyond

Major technological advances and improvements in neonatal medicine in the 1970s and 1980s resulted in significant reductions in mortality rates for babies born at extremely low gestations. In 1992, the gestational age for defining stillbirth in the UK was reduced from 28 weeks to 24 weeks reflecting the marked increase in survival for extremely preterm births. However, as the ‘limits of viability’ were pushed back ever further, there was increasing recognition of the high risk for residual disability amongst extremely preterm survivors. By the mid-1990s, clinicians were aware that the landscape had changed considerably for extremely preterm infants, but wide variation in survival rates between single centres and a lack of standardized developmental follow-up meant that it was difficult to gauge the impact of extremely preterm birth on a national level and to counsel parents as to the likely outcomes for their child. So in 1995, a team of neonatologists in the UK undertook the challenge of carrying out the first national epidemiological study of survival and outcomes following extremely preterm birth, and from that the EPICure Studies were born. Over the last 20 years these and other national cohort studies have helped shape neonatal care and advance our understanding of the life course consequences of extreme prematurity. Here we provide an overview of the key findings from the EPICure Studies and discuss the future challenges faced by clinicians and academics in tackling the causes, consequences and care of extremely preterm births

Early and long-term outcome of infants born extremely preterm

There is no question that birth at extremely low gestational ages presents a significant threat to an infant's survival, health and development. Growing evidence suggests that gestational age may be conceptualised as a continuum in which births before 28 weeks of gestation (extremely preterm: EP) represent the severe end of a spectrum of health and developmental adversity. Although comprising just 1%-2% of all births, EP deliveries pose the greatest challenge to neonatal medicine and to health, education and social services for the provision of ongoing support for survivors with additional needs. Studying the outcomes of these infants remains critical for evaluating and enhancing clinical care, planning long-term support and for advancing our understanding of the life-course consequences of immaturity at birth. Here we review literature relating to early and long-term neurodevelopmental, cognitive, behavioural and educational outcomes following EP birth focusing on key themes and considering implications for intervention

The extremely preterm young adult - State of the art.

Recently several studies have reported adult outcomes for individuals born at extremely low gestations, although they tend to be included as part of slightly more mature populations. The growth in collaborative studies allows greater confidence in the identification of persisting risk and allows us to have confidence in the likely outcomes in more contemporary cohorts. This review shows the persistence of adverse outcomes through to adult life and includes a range of outcomes including all body systems evaluated. Nonetheless adult outcomes demonstrate that most survivors appear to be free of major disabling conditions and demonstrate good participation in society. Several studies have reported outcomes in the third decade, but subsequent ageing trajectories have not yet been defined. The stability of many of the outcomes evaluated over childhood into adult life and the lack of improvement in prevalence of childhood impairments found in contemporary cohorts indicates persisting levels of risk

Impaired Pulmonary Function Mediates Inattention in Young Adults Born Extremely Preterm

Aim To test whether poor childhood pulmonary function explains the relationship between extremely preterm (EP) birth and attention-deficit/hyperactivity disorder (ADHD) symptoms in young adulthood. Methods EPICure birth cohort participants include children born Results Ninety EP and 47 term-born participants had pulmonary function testing at 11 and 19 years. Inattention z-scores were higher in the EP group (mean difference 0.55 [95% CI 0.11, 0.99]) but not hyperactivity. Compared to term-born peers, EP participants had lower FEV1 z-scores at 11 (mean difference−1.35 [95% CI −1.72, −0.98]) and 19 (mean difference−1.29 [95% CI −1.65, −0.92]). Path models revealed that childhood pulmonary function explained the relationship between EP birth and inattention. Conclusions Extremely preterm young adults have increased risk for inattention compared to term-born peers. Poor pulmonary function appears to underlie this risk. The mechanisms responsible remain unclear and warrant further study.</p

VCL Components for Vector Graphics in the Instruction of Chemistry

Předmětem práce je zhodnocení problematiky vzorců ve výuce organické chemie na střední škole, zhodnocení současného stavu softwaru pro kreslení chemických struktur a vývoj VCL komponent pro chemické kreslení. V současnosti dostupný software je na vysoké odborné úrovni a v chemické praxi má široké použití, nehodí se však pro použití ve výuce na druhém a třetím stupni. Výsledkem práce jsou komponenty pro vytváření, zobrazení a manipulaci s chemickými vzorci jednoduchých organických látek v souladu s požadavky střední školy Součástí práce je také aplikace ukazující základní vlastnosti vyvinutých komponent. Kom- ponenty i aplikace jsou vytvořeny v prostředí Borland Delphi 2005. CD s elektronickou verzí textu, zdrojovými kódy komponent i aplikace a spustitelnou verzí aplikace je přiloženo

Reduced health-related quality of life in children born extremely preterm in 2006 compared with 1995: The EPICure studies

Objective: To compare health-related quality of life (HRQL) in childhood for extremely preterm (EP) births before 26 weeks of gestation in England in two eras: 1995 and 2006.Design: Prospective cohort studies.Setting: School or home-based assessments at 11 years of age.Participants: Available data for 88 EP children born before 26 weeks of gestation in 2006 (EPICure2) were compared with those of 140 born in England during 1995 (EPICure). To account for social secular trends, the comparison between eras was also made for term-born controls as reference.Main outcome measures: HRQL was measured using the parent-completed Health Utilities Index (HUI) questionnaire with utility scores calculated using the HUI3 classification system. Eight attributes were assessed: vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain.Results: At 11 years, mean utility scores were significantly lower in EPICure2 (2006) than in EPICure (1995; Δ -0.12, 95% CI -0.20 to -0.04). The difference increased (Δ -0.27, 95% CI -0.41 to -0.12) after adjusting for significant perinatal and demographic differences between cohorts. Rates of suboptimal function were increased in EPICure2 for all eight attributes, but statistically significant differences were only found in speech (p=0.004) and dexterity (p=0.020). After excluding children with severe neurodevelopmental impairment, the adjusted difference between cohorts remained significant but attenuated (-0.14 (-0.26 to -0.01)). Mean utility scores for controls were similar between cohorts (Δ -0.01 (-0.04 to 0.02)).Conclusions: Using parent report, there was a clinically significant decline in HRQL ratings for EP children over time. Areas contributing the most to the decline were speech and dexterity.</div