Lessons From Research for Implementing An Instructional Accommodations Model in Secondary Inclusion

Inclusion teachers at the secondary level need research-based guidance on how to support students with disabilities using accommodations in the classroom. A team of general education and special education teachers developed a model for planning, implementing, and monitoring instructional accommodations. The model calls for students’ active engagement. Findings from two studies on students with high incidence disabilities learning a strategy for “self-accommodating” inform on how general educators and special educators can implement the Secondary Classroom Accommodations Model with active student involvement.

Using Telemedicine to Reduce Suicide Ideation and Behavior: A Systematic Literature Review

Objective: To review the published research for reported effectiveness of telemedicine in reducing suicide ideation and behavior in patients already diagnosed with a psychiatric disorder. Design: A thorough literature search on the PubMed, Web of Science, PsycInfo, Cochrane Library, and TRIP (Turning Research Into Practice) Medical Database was conducted. Phrases such as “telemedicine,” “telehealth,” “remote consultation,” “mobile health,” “psychiatric disorders,” “suicide,” “suicide, attempted or ideation,” and “telepsychiatry” were employed in a variety of combinations. The primary inclusion criteria encompassed peer-reviewed articles published in the past 5 years. Secondary inclusion criteria comprised: (1) the diagnosis of any psychiatric disorder for all patients included in the study, (2) the absence or presence of use of telepsychiatry to offer consultation and communication, and (3) reported outcomes involving suicide rates or attempted suicide rates. The research publications passing inclusion criteria were assessed, and all their corresponding outcome measures were included in a meta-analysis. Results: A total of 705 studies were identified by applying the initial search strategy to the electronic databases described. Of these, 205 passed the primary inclusion criteria. After excluding duplicates and non-English articles, 105 articles were screened using the secondary inclusion criteria. Nine articles remained, including three systematic reviews that were excluded. Finally, a total of six independent, non-overlapping studies were included in this meta-analysis, encompassing data for 576 participants. The 18 outcome measures in this meta-analysis included five “positive” measures: perceived ability to cope with suicidal ideation, optimism, gratitude, positive affect, and the Mini Mental State Exam. The “negative” measures included: suicidal ideation intensity, hopelessness, depression, suicidality, HAMD (Hamilton Depression Rating Scale) score, HAMD score without suicide item, medical admissions, number of days of medical hospitalizations, number of psychiatric hospitalizations, number of emergency room visits, suicide ideation questionnaire (SIQ) from baseline to posttreatment, and SIQ from baseline to follow-up. Overall, this review found support for the hypothesis that telemedicine can reduce suicide ideation and behavior. There was a moderate effect size for the 18 measures analyzed. Based on the four different forest plots presented in this analysis, all average effect sizes calculated showed that the intervention of telemedicine has a small-to-moderate effect on the measures studied, which translates loosely to a small-to-moderate effect on the patient’s suicide ideation and behavior. Conclusions: Telemedicine appears to be a promising way to reduce suicidal ideation, although how this translates into reductions in self-harm and/or suicide attempts is unclear from this review alone.

Pharmacokinetics during therapeutic hypothermia for neonatal hypoxic ischaemic encephalopathy: a literature review

BackgroundNeonatal hypoxic ischaemic encephalopathy due to perinatal asphyxia, can result in severe neurodevelopmental disability or mortality. Hypothermia is at present the only proven neuroprotective intervention. During hypothermia, the neonate may need a variety of drugs with their specific pharmacokinetic profile. The aim of this paper is to determine the effect that hypothermia for neonates suffering from hypoxic ischaemic encephalopathy has on the pharmacokinetics and to what extent dosing regimens need adjustments.MethodA systematic search was performed on PubMed, Embase and Cochrane Library of literature (2000–2020) using a combination of the following search terms: therapeutic hypothermia, neonate, hypoxic ischemic encephalopathy and pharmacokinetics. Titles and abstracts were screened, and inclusion/exclusion criteria were applied. Finally, relevant full texts were read, and secondary inclusion was applied on the identified articles.ResultsA total of 380 articles were retrieved, and 34 articles included after application of inclusion/exclusion criteria and duplicate removal, two additional papers were included as suggested by the reviewers. Twelve out of 36 studies on 15 compounds demonstrated a significant decrease in clearance, be it that the extent differs between routes of elimination and compounds, most pronounced for renal elimination (phenobarbital no difference, midazolam metabolite −21%, lidocaine −24%; morphine −21% to −47%, gentamicin −25% to −35%, amikacin −40%) during hypothermia. The data as retrieved in literature were subsequent compared with the dosing regimen as stated in the Dutch paediatric formulary.ConclusionDepending on the drug-specific disposition characteristics, therapeutic hypothermia in neonates with hypoxic ischaemic encephalopathy affects pharmacokinetics.