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Despite advances in delirium knowledge and the publication of best practice guidelines, uncertainties exist regarding assessment of Delirium Superimposed on Dementia (DSD). An international survey of delirium specialists was undertaken to evaluate current practice.
Invitations to participate in an online survey were distributed by email among members of four international delirium associations with additional publication on their websites. The survey covered the assessment and diagnosis of DSD in clinical practice and research studies. Questions were structured around current practice and attitudes.
The 205 responders were mostly confident that they could detect DSD with 60% rating their confidence at 7 or above on a likert scale of 0 (none) to 10 (excellent). Seventy-six percent felt that Dementia with Lewy Bodies (DLB) was the most challenging dementia subtype in which to diagnose DSD. Several scales were used to assess for the presence of DSD including the Confusion Assessment Method (CAM) (54%), DSM-5 criteria (25%) and CAM-ICU (15%). Responders stated that attention (71%), fluctuation in cognitive status (65%), and arousability (41%) were the most clinically useful features to assess when diagnosing DSD. Motor fluctuations were also deemed important but 61% had no specific test to monitor these.
The largest survey of DSD practice to date demonstrates that despite good levels of confidence in recognizing DSD, there exists a lack of consensus concerning assessment and diagnosis globally. These findings suggest the need for the development of more research leading to precise diagnostic criteria and comprehensive guidelines regarding the assessment and diagnosis of DSD.
English learners face challenges that are compounded by the fact that they enter schools at every grade level and at various times during the academic year with varying levels of language and literacy proficiency in both their native language and English. This chapter describes four randomized, controlled trials (RCTs) including long-term follow-ups designed to evaluate the efficacy of an English and Spanish supplemental intervention for bilingual (Spanish/English) first graders with reading difficulties. It presents an overview of the English and then Spanish interventions. This is followed by a summary of four studies, which were implemented in successive years in Houston, Austin, and Brownsville. Students were randomly assigned to treatment or comparison conditions. At the end of first grade, all four experimental studies reported improved outcomes for intervention students on phonological awareness, word-reading fluency, reading comprehension, and spelling, and these findings were maintained through fourth grade for treatment students.