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Ten morphological awareness intervention studies, conducted in English with students in kindergarten through 12th grade between 2008 and 2020, were synthesized in this article. Research in the studies focused on the effects of morphological awareness intervention on literacy outcomes of students who struggle with reading and writing—including students with disabilities. The 10 studies included a total of 411 participants ranging from kindergarten to 12th grade. All 10 studies used an experimental pre/post-test design to determine growth in morphological awareness as well as assessed areas in word identification, spelling, reading comprehension, vocabulary, and written composition. The assessments across the studies varied and included standardized and nonstandardized measures. Effect sizes for standardized measures ranged from 0.0 to 0.97. Effect sizes for nonstandardized measures ranged from −0.03 to 2.96. Results indicate that morphological instruction, including short-term interventions, is beneficial to students at risk of future reading difficulties.

A study was carried out among healthcare workers and new mothers to determine their opinions on using the Edinburgh Postnatal Depression Scale screening tool to detect postnatal depression (PND). Results revealed that in most cases the problem was not reported by mothers, highlighting the need to encourage new mothers to reveal their symptoms of postnatal depression.

Linda Mason created the looks on these pages from her shop, Art of Beauty, 26 Grand St., nr. Sixth Ave. (212-625-0490). Her book Eye Candy will be published in April [...]

Abstract The writing difficulties of students with disabilities, including those with behavior disorders are well documented (Harris & Graham, 1999). These students not only face challenges in composing, but may [...]

Byline: SAREER BADSHAH, LINDA MASON, KEN MCKELVIE, ROGER PAYNE AND PAULO J.G. LISBOA Abstract The adverse effect of extreme maternal ages on pregnancy outcomes is well-known, however, factors associated with [...]

Many students who have experienced complex trauma receive special education services related to emotional and behavioral disorders at residential treatment facilities (RTFs) as they undergo therapy. One academic skill in which students with emotional and behavioral disorders often struggle is writing. The current multi-probe, multiple-baseline, across-groups-of-students study involved a science teacher in an RTF delivering whole-class persuasive writing instruction using the self-regulated strategy development model with 11 secondary students experiencing complex trauma. Results suggested large effects for persuasive parts (overall Tau-U= .97), word count (overall Tau-U= .96), and holistic quality (overall Tau-U= .97), as well as high social validity among participants. Implications for providing instruction to students in RTF settings and future directions for this population are included.

ABSTRACTBackgroundResearch on menstrual health is required to understand menstrual needs and generate solutions to improve health, wellbeing, and productivity. The identification of research priorities will help inform where to invest efforts and resources.ObjectivesTo identify research priorities for menstrual health across the life-course, in consultation with a range of stakeholder groups from a variety of geographic regions, and to identify if menstrual health research priorities varied by expertise.MethodsA modified version of the Child Health and Nutrition Research Initiative approach was utilized to reach consensus on a set of research priorities. Multisector stakeholders with menstrual health expertise, identified through networks and the literature, were invited to submit research questions through an online survey. Responses were consolidated, and individuals were invited to rank these questions based on novelty, potential for intervention, and importance/impact. Research priority scores were calculated and evaluated by participants’ characteristics.ResultsEighty-two participants proposed 1135 research questions, which were consolidated into 94 unique research questions. The mean number of questions did not differ between low- and middle-income country (LMIC) and high-income country (HIC) participants, but significantly more questions were raised by participants with expertise in mental health and WASH. Sixty-six participants then ranked these questions. The top ten-ranked research questions included four on ‘understanding the problem’, four on ‘designing and implementing interventions’, one on ‘integrating and scaling up’, and one on ‘measurement’. Indicators for the measurement of adequate menstrual health over time was ranked the highest priority by all stakeholders. Top ten-ranked research questions differed between academics and non-academics, and between participants from HICs and LMICs, reflecting differences in needs and knowledge gaps.ConclusionsA list of ranked research priorities was generated through a consultative process with stakeholders across LMICs and HICs which can inform where to invest efforts and resources.

Several letters to the editor are presented in response to articles in previous issues, including "The New Debate Over Working Moms," in the September 18, 2000 issue, "Too Much Corporate Power," in the September 11, 2000 issue and "There Is not Enough Gas Around," in the September 18, 2000 issue.

Despite millions of dollars spent to help control asthma, the rates of emergency department (ED) visits due to asthma symptoms increased by about 18% for children aged 5 to 17 [...]

A workshop with virtual consultation practice-based professional development model for self-regulated strategy development persuasive writing instruction was evaluated in a randomized controlled trial. Nineteen general education teachers and 564 Grade 5 and 6 students in 16 low-wealth rural schools participated. Following training, teachers provided instruction in their inclusive classrooms. Results indicated that students receiving instruction improved in the number of persuasive elements and words written when compared with students in the control group. Differences in element type were evaluated with largest effects noted for reasons and explanations. Student group differences were noted with nonstruggling students having greater gains than struggling students.

There are tremendous growth opportunities for electrical contractors. Lenders who want to capitalize on this growth will be interested in this article in which the authors outline what you need to know to make profitable loans to these borrowers. (Reprinted by permission of the publisher.)

The article focuses on the concept of computer dating. Computer dating began five years ago at Harvard University, when two undergraduates founded "Operation Match," the prototype of the modern electronic matchmaking systems. Nine months later, some 90,000 college students had spent time with their computer selected "perfect" dates. The 3 dollar fee seemed a token payment for a minimum of five people with whom to have fun. A few firms still match for fees of 5 dollars to 10 dollars, but on the whole computer dating is becoming a big money operation. Compatibility charges 395 dollars and 495 dollars for its programs.

In humans and rodent models, commensal gut bacteria contribute to post-stroke infection. Experimental stroke in rodents causes gut barrier dysfunction and permeability, enabling translocation and dissemination of host gut microbiota.

The profile for high technology continues to grow on the Suncoast, both in terms of employees and new products and services. Florida's high-tech corridor--once characterized as making a sharp, east [...]

Self-regulated strategy development (SRSD) is an evidence-based intervention for use with students with emotional and behavioral disorders (EBD). To date, there are nine studies investigating SRSD in alternative education settings, including self-contained day and residential schools, with 113 students with EBD in grades 3 through 12. A brief synthesis of this body of SRSD research is presented, which represents SRSD implementation in individualized, small-group, and class-wide formats using group and single-case research design methodology. Lessons learned from this research are presented to inform both practitioners and researchers, including guidelines for overcoming the unique barriers to SRSD implementation that students with EBD in alternative education settings may present. Lessons learned include the need for (a) developing strategies for increasing students’ academic engagement, (b) further addressing behavioral and academic needs, (c) overcoming issues of truancy and transience, (d) promoting maintenance and generalization, and (e) increasing teacher buy-in. Future directions for this line of research are also outlined.

A multiple baseline alternating treatment (A-B-C-D) design was used to evaluate the effectiveness of a writing and peer revision intervention. Eight middle school students enrolled in an alternative program for students with emotional and behavioral disorders received Self-Regulated Strategy Development (SRSD) for 10-minute quick writing and revision during planning. Assessment occurred across baseline, writing, and revision phases, and the last phase alternated between individual and peer revision. Measures included quality; number of traits and words; the ability of participants to identify, evaluate, and make revisions during planning; and the degree to which participants incorporated revision recommendations. Positive effects for writing and promise for peer revision were indicated. Implications for future research practice are discussed.

Two experiments were conducted with developmental education students to investigate the impact of a contextualized intervention focusing on written summarization and other reading and writing skills. In experiment 1 (n = 322), greater gain was found for intervention than comparison participants on three summarization measures: proportion of main ideas from the source text, accuracy, and word count (ES = 0.26–0.42). In experiment 2 (n = 246), results were replicated for several summarization measures (ES = 0.36–0.70), but it was also found that intervention participants copied more from the source text at posttest than did the comparison group. Further, intervention participants using science text outperformed students receiving generic text on two summarization measures (ES = 0.32–0.33), providing moderate support for contextualization.

Clinical studies and new guidelines are frequently being published in the area of preoperative fasting. A growing population of patients with obstructive sleep apnea is being referred for outpatient procedures including adenotonsillectomy.

A multiprobe multiple baseline design was used to evaluate the effectiveness of strategy instruction in persuasive quick writing with 5 seventh- and eighth-grade students who attended a county alternative placement school for students with severe emotional and behavioral disabilities. Students were taught to plan and write a 10-minute persuasive response using the Self-Regulated Strategy Development instructional model. Instruction was conducted over five 30-minute sessions plus three 10-minute sessions. Positive effects were noted for all students on the primary measure, quality of written responses. The effect of the intervention was maintained over time. All students reported that the instruction benefited performance.

Students' academic achievement across content areas is often dependent on their ability to express knowledge through written expression. Many adolescent students lack the skills to write efficiently and effectively. These low‐achieving writers can benefit from instruction in self‐regulating the writing process. One approach, Self‐Regulated Strategy Development (SRSD) instruction, has proven effective in improving the writing performance of struggling adolescent learners. In this article, SRSD instruction for teaching adolescents to respond to a quick write prompt will be described. يعتمد إنجاز الطلاب الدراسي عبر مجالات المحتوى غالباً على قدرتهم على التعبير عن معرفتهم بواسطة الكتابة. وكثير من المراهقين يفتقرون المهارات الضرورية ليكتبوا بشكل فعال وكفء. وقد يستفيد هؤلاء الكتّاب ذوو الإنجازات المنخفضة من التعليم في توجيه عملية الكتابة الذاتي. لقد ثبتت هذه الطريقة فعاليتها وهي تأتي بالاسم تعليم التنمية الإستراتيجية ذات التوجيه الذاتي في تحسين الأداء التحريري لدى الدارسين المراهقين الذين يواجهون صعوبات في الكتابة. لذا تمت في هذه المقالة وصفة لتعليم التنمية الإستراتيجية ذات التوجيه الذاتي لتعليم المراهقين الإجابة على سؤال يطلب منهم الكتابة بسرعة. 学生在各学科范畴的学业成绩，经常取决于他们能否以书面方式表达自己的学识。许多青少年学生就是缺乏了那些让他们有效率与有效果地书写的技能。这些书写成绩差的学生，可从自我调整写作过程的教学中获益。「自我调整策略发展」这教学法，已被证实能有效地改善有书写困难的青少年学习者的书写表现。本文描述在「自我调整策略发展」的教学中，如何教导青少年回应一项快速写作的提示。 La réussite académique des élèves dans les disciplines dépend souvent de leur capacité à exprimer leurs connaissances par écrit. Beaucoup d'adolescents scolarisés ne savent pas écrire effectivement de façon efficace. Ces scripteurs peu performants peuvent tirer bénéfice d'un enseignement pour autoréguler le processus d'écriture. Une méthode, le Self‐Regulated Strategy Development (SRSD), s'est révélée efficace pour améliorer les performances en écriture des adolescents en difficulté à l'école. Dans cet article, on décrit l'enseignement par le SRSD pour enseigner à des adolescents un moyen rapide d'écrire rapidement. Академические успехи учащихся в любых предметных областях часто зависят от их способности выразить знание в письменной форме. Однако многие подростки не обладают эффективными навыками письма. Таким школьникам было бы полезно научиться “саморегулированию процесса письма”. Один из подобных подходов – SRSD – оказался эффективным для повышения качества письма подростков, испытывающих трудности в учебе. В статье описывается обучение подростков с применением SRSD для написания быстрых ответов на проверочные вопросы. Los logros académicos de los estudiantes a través de áreas de contenido dependen a menudo de su capacidad para la expresión escrita. Muchos estudiantes adolescentes no tienen las destrezas necesarias para escribir eficiente y eficazmente. Estos escritores pueden sacar beneficio de instrucción sobre cómo ellos mismos pueden regular el proceso de escribir. Un acercamiento, la enseñanza de Desarrollo de Estrategia de Autoregulación (SRSD por sus siglas en inglés), ha mejorado la escritura de aprendices adolescentes con dificultades. En este artículo se describe la instrucción de SRSD para enseñarles a los estudiantes adolescentes a responder a una señal de escribir rápido.

Understanding and writing about expository material is difficult for many students. Content classroom activities and assessment tasks, however, are often structured within a framework of student reading followed by extended written response. This multiple probe design across subjects study examined the expository comprehension and informative writing performance of 9 fourth-grade low-achieving students, 4 with disabilities and 5 without disabilities, following Self-Regulated Strategy Development (SRSD) instruction for TWA (Think before reading, think While reading, think After reading) and PLANS (Pick goals, List ways to meet goals, And, make Notes and Sequence notes). Student performance, as measured by oral and written retells, improved and was maintained following instruction. Students also liked the strategies as well as instruction, and believed that TWA + PLANS improved their reading and writing.

Practice placements have been identified as a primary factor influencing new graduates' selection of specialty preference. The purpose of this phenomenological study was to gain an understanding of the experiences and issues for occupational therapists when providing practice placements for students in mental health. This research was prompted by continuing difficulties in the recruitment and retention of occupational therapists within mental health services in Queensland, Australia, along with a declining number of offers for student practice placements.In-depth interviews with eight participants extrapolated four key elements in the experiences of educating students, which were time, energy, skills and mental health provider issues. The participants also identified determinants that influenced the decision to educate students, including professional responsibility, personal rewards and demands, and support needs. The inherent complexities of contemporary mental health practice, such as emotional and role demands, added pressure when educating students. The need for appropriate support and practice placement educator training programmes that deal effectively with mental health issues was highlighted.

The objective of this study was to investigate menís awareness of sexually transmitted infections (STIs) and sexual health services, together with the best ways of providing information about them.Information was collated via a self-administered questionnaire, which was answered by 429 men, giving a response rate of 31%.Men aged 16+ living in two primary care trusts (PCTs) in the north-west of England were accessed through a range of different sources, including social, educational, health, work and religious facilities.Despite the high rates of STIs in the north-west, approximately one in five men had not heard of herpes, syphilis or chlamydia. One in ten had not heard of gonorrhoea. The majority of men were unaware that many STIs could be asymptomatic. Only 13% knew where their local genitourinary medicine (GUM) clinic was. The main deterrents to accessing the clinic were embarrassment and not knowing where it was.Menís knowledge of STIs is limited, particularly in relation to the symptoms. The best way of providing information, according to the respondents, was through their general practitioner (GP). However, in practice this might be difficult, as men are reluctant users of GP services in general. Knowledge of the whereabouts of the local GUM clinics is also limited. Although most men thought that they would visit their GP if they thought they might have an STI, this may result from them not knowing the alternatives, rather than having a real choice. More information, targeted wisely, is thus necessary in order to educate men about STIs and service provision.

Against a background of decreasing age at sexual debut, local Brook staff voiced concerns about the increase in clinic attenders under the age of 14 years, who appeared to engage in risky behaviours. This exploratory study, carried out with service providers in a young persons sexual health clinic, aimed to discover what issues staff felt were important to 11–14 year-old girls, in order that a future study be conducted with the young girls themselves. Service providers from two Brook Advisory Centres were interviewed. The interviews were semi-structured and analysed using content analysis. Many of the issues that staff identified as important to young girls mirrored current research findings with older adolescents. These were: alcohol consumption, peer pressure, low self-esteem and confidence, and a lack of knowledge around sexually transmitted infections. However, a new issue to emerge was the high proportion of young girls attending the clinic for the emergency contraceptive pill despite not knowing whether they had had intercourse or not. The study also found that staff perceived the need to understand issues from the perspective of the young girls themselves.Staff identified a necessity for improved sex education and education around peer pressure and assertiveness, whilst topics for future research which emerged from the study findings included issues of self-esteem, dynamics of peermedia pressure and why young girls feel that they need to have sex.

Focuses on the difficulty of several mothers in returning to work after a maternity leave. Importance of enthusiasm and commitment in regaining interest in the job; Significance of setting up priorities; Extension of parental care through the father.

While many women suffer from stress incontinence during pregnancy or following delivery, a recent study showed that the instruction women received in pelvic floor exercise varied enormously. Some women received no information at all. In order to determine current policy and practice in pelvic floor instruction, enquiries were made of the UKCC and the Chartered Society of Physiotherapists. Neither body produced routine guidelines for their members on this subject. This may stem from the lack of conclusive research evidence regarding the efficacy of pelvic floor exercise at this time, which means that professional bodies are unable to provide clear directives to their members. This article argues for the need to establish the relationship between antenatal and postpartum exercises and stress incontinence, and in light of any conclusions drawn, for professional bodies to provide clear guidelines to their members so that women receive standardised treatment and care, if deemed necessary.

Objective:to identify whether women were made aware of stress incontinence around the time of childbirth, whether symptomatic women sought help from professionals caring for them at this time, to look at what help they receive in the first instance and to understand why some of those experiencing it chose not to seek help.

Objectives: to examine the instruction in pelvic floor exercises given to women during pregnancy or following delivery, to assess the quality of any instruction provided, and to consider these in light of the women's views about the service. Design: a postal questionnaire was sent to a sample of women when they reached 34 weeks of pregnancy and a second at 8 weeks postpartum. A sub-sample of women who reported symptoms of stress incontinence at 8 weeks postpartum were interviewed about the instruction in pelvic floor exercises that they received during their pregnancy, or in the puerperium. Participants: of the 918 women who were sent the first questionnaire, 717 returned it completed (78%). Five-hundred-and-seventy-two of 894 women (64%) completed the second questionnaire. Forty-two of 179 symptomatic women (23%) took part in an interview. Findings: 55% of women received some form of instruction in pelvic floor exercises by 34 weeks of pregnancy. Eighty-six per cent received instruction following birth. The way the information was given varied, ranging from a brief reminder, to exercising in a class with an instructor. The information was provided by a range of health professionals, and no single profession appeared to undertake responsibility for the service. As a result, the views of the service varied. A few women reported that they had received good quality instruction, others were critical of it, and a small number reported that they had received no instruction at all. The widespread practice of leaving a leaflet by the women's beds during their stay in hospital, was criticised by a large proportion of the women. Key conclusion: the instruction in pelvic floor exercises by health service professionals was provided on an ad hoc basis. In many instances, the programme of instruction did not meet recommendations made in the literature. It is likely that the success of randomised controlled trials reported in the literature would not be repeated in the ‘real world’. Implications for practice: there is a need for the service to be reorganised so that all women receive high-quality instruction during pregnancy, with a reminder to exercise following birth. This could help to prevent, or relieve, the symptoms of stress incontinence that frequently occur at these times. Copyright 2000 Harcourt Publishers Ltd.

Cardiac transplantation has become a widely accepted ther apy for a variety of end-stage cardiac diseases in pediatric patients. From November 1985 to November 1999, 347 pe diatric cardiac transplantations were performed at Loma Linda University Medical Center (LLUMC), including 235 in children younger than 6 months of age. It is essential to be familiar with the physiologic and anatomic characteristics of the recipient. Hypoplastic left heart syndrome is the most frequent congenital disorder leading to transplant in neo nates at LLUMC, with diseases presenting with left ventric ular failure accounting for the majority of the remainder of patients. We have assessed many variables for a possible relationship to intraoperative or postoperative compli cations, including anesthetic induction and maintenance agents, pH and base excess, as determined by arterial blood gas analysis before cardiopulmonary bypass (CPB), and he modynamic changes requiring treatment before CPB. Al though we have noticed an association between low patient temperature or mechanical stimulation at the time of ster notomy, and hemodynamic complications before CPB, in our experience no single anesthetic technique or intraoper ative event, including ventricular fibrillation, predicts early mortality. We believe anesthetic management of pediatric cardiac transplant recipients should be tailored to fit the pathophysiology present.

Pediatric cardiac transplantation has been performed with increasing frequency to treat hypoplastic left heart syn drome and other types of congenital heart disease. A large number of these patients will require anesthesia posttrans plantation for noncardiac surgery. A review of our series of 92 anesthetics in 46 patients has better defined periopera tive risk factors, anesthetic management, common surgical procedures, and complications associated with noncardiac surgery in posttransplantation patients. Anesthetic manage ment concerns include allograft coronary artery disease, graft rejection, denervation, cardiac dysrhythmias, immuno suppression, cyclosporine-induced hypertension, drug inter actions, renal dysfunction, and intravenous access prob lems. Preoperative evaluation must include the possibility and definition of these problems. Medically stable patients undergoing noncardiac/nonthoracic surgery after cardiac transplantation undergo the same surgical procedures as similarly aged nontransplantation patients. Similar induc tion techniques can be used as in nontransplantation pa tients. These patients may also be scheduled for same-day surgery if other significant medical problems are not present and the difficulty of the surgery is compatible with an out patient setting. Patients with more complex medical prob lems, including chronic rejection, significant coronary artery disease, or a history of congestive failure may need over night monitoring in a hospital setting despite that only a minor surgical procedure is being performed.

Accurate assessments and appropriate management of dyspnea are essential to provide improved quality of life for hospice patients. This study describes methods of assessing dyspnea and interventions used to manage dyspnea in 72 hospice patients with end-stage lung disease or lung cancer. The mean age of the sample was 72.46 years old and the majority was white (80 percent) and male (62 percent). Paired t-tests were used to compare mean scores on admission and near death for dyspnea severity, Karnofsky functional status, pain, and Mini-Mental Status scores. Results showed significant decline in functional and cognitive status, but no significant changes in dyspnea severity and pain. Dyspnea was often assessed subjectively with observational methods only. Use of inhalants, oxygen, positioning, steroids, and oral opioids were the most frequent therapies for dyspnea. Relaxation, guided imagery, and other complementary therapies were rarely used (five percent or less). Measurement of dyspnea needs to be done frequently by using standardized instruments to assess severity and degree of symptom distress as well as the effects of treatment. Clinical trials are needed to determine which dyspnea interventions are most effective in terminally ill patients. Guidelines such as those developed for pain management are needed for effectively managing dyspnea.

A survey of 512 staff working in UK services for people with intellectual disabilities was conducted. Descriptive findings regarding staff characteristics, working conditions and a range of staff outcomes are reported. The majority of staff were in their thirties, female, and married or living as married, and almost half of staff had dependants. Almost all the staff in this survey were white. On average, staff had spent approximately eight and a half years working in services for people with intellectual disabilities, and approximately three and a half years working in their current work location. Approximately one‐sixth of staff were working on a fixed‐term contract. Almost two‐thirds of staff were contracted to work full‐time, although nearly two‐fifths of staff reported working longer than their contracted hours.

The purpose of this study was to identify effective strategies for supervising small groups of second‐year students in an occupational therapy fieldwork programme based on a collaborative group model. Contemporary models for fieldwork education over the past decade have involved more placements for students working in peer groups, to address the shortage of fieldwork placements and to create opportunities for students to work in a team environment. Discussion about these fieldwork options has focused on the perceived value of the programmes rather than on the processes used for supervising students in groups. The research methodology chosen for this study was cooperative inquiry because of its congruence with the qualitative nature of group supervision and the collaborative model on which the fieldwork programme was based. Thirteen of a total of 18 occupational therapy supervisors volunteered to participate in the study. Data about supervision skills that would enhance student learning were generated through a series of experiential action cycles in the fieldwork setting, interspersed with regular peer reflection meetings. The results highlighted a range of supervision strategies such as student orientation, the facilitation of peer discussion and reflection on practice, and encouragement by the supervisor for students to use resources in the fieldwork environment and to take responsibility for their own learning. The depth of data gained from the study may have been limited owing to time constraints and other commitments of research participants. A social culture of mutual learning and support was established through the cooperative inquiry process, with potential for building ongoing relationships and participant awareness of educational innovations. Copyright © 1999 Whurr Publishers Ltd.

Despite an appropriate screening process, the potential for a misdiagnosed multiple personality to be included in a group is much higher than most therapists realize. The author describes one long-term group's experience with the emergence of two multiple personalities.

Recent studies on how anesthetic agents and manipulation of physiologic parameters, in both normal and injured brains, affect cerebral blood flow and oxygen delivery to the brain are reviewed. In addition, advances in monitoring cerebral blood flow and oxygen delivery to the brain are updated.

Subjects were asked to move their eyes as far as possible to the left and to the right (n= 40). The right movement was significantly greater in extent. The extent of lateral eye movement correlated positively with scores on the rod-and-frame test and negatively with those on the WAIS Block Design and Similarities. Maximum extent of lateral eye movement may be a simple and useful index of cognitive style.

Provides suggestions and makeup directions on achieving the `natural look'. Choosing and correct application of makeup; Makeup colors.

Background Patients with glioma are at increased risk for tumor-related and treatment-related complications. Few guidelines exist to manage complications through supportive care. Our prior work suggests that a clinical care pathway can improve the care of patients with glioma. Methods We designed a quality improvement (QI) project to address the acute care needs of patients with gliomas. We formed a multidisciplinary team and selected 20 best-practice measures from the literature. Using a plan-do-study-act framework, we brainstormed and implemented various improvement strategies starting in October 2013. Statistical process control charts were used to assess progress. Results Retrospective data were available for 12 best practice measures. The baseline population consisted of 98 patients with glioma. Record review suggested wide variation in performance, with compliance ranging from 30% to 100%. The team hypothesized that lack of process standardization may contribute to less-than-ideal performance. After implementing improvement strategies, we reviewed the records of 63 consecutive patients with glioma. The proportion of patients meeting criteria for 12 practice measures modestly improved (65% pre-QI; 76% post-QI, P > .1). Unexpectedly, a higher proportion of patients were readmitted within 30 days of hospital discharge (pre-QI: 10%; post-QI: 17%, P > .1). Barriers to pathway development included difficulties with transforming manual measures into electronic data sets. Conclusions Creating evidence-based clinical care pathways for addressing the acute care needs of patients with glioma is feasible and important. There are many challenges, however, to developing sustainable systems for measuring and reporting performance outcomes overtime.

The article reports on the new toolkit called Strategic Highway Research Program used by Chris Williams, a senior project manager for Vermont Department of Transportation, in the construction of a new bridge in Vermont.