[Ocular lesions in melanodermia patients with chronic renal failure]

AIM

To describe the and the factors that influence their occurrence.

MATERIAL AND METHODS

A prospective study was performed over a year in the Ophthalmology clinic of Aristide le DANTEC Hospital, including 112 eyes of chronic renal failure patients followed up in the internal medicine unit of the same hospital. For each patient data of his follow up in the nephrology ward were recorded, even as the ophthalmological clinical examination which included colour test and angiography. All the lesions found were recorded on a questionnaire, seeking for any influence as far as age, sex, duration of signs, dialysis, and general complications were concerned. The analysis was performed using the 2005 Epi-info 6.0 software.

RESULTS

Sex ratio was 1.54. 70% were above 40 years old. Blindness was found on 44.6% of the eyes. There were 20.5% cases of eye lids oedema, 15.8% conjunctival calcifications, 26.8% cataracts, 3 cases of ocular hypertension, 7.1% corneal lesions. Hypertensive retinopathy was found on 75.9% of the cases, amongst 14.3% classified stage 3, and retinal oedema signs associated on 13.8%, arteriosclerosis on 14.3% of the cases. 88.1% had confirmed signs of dyschromatopsia. On angiography, there was evidence of chorioretinal lesions due to high blood pressure, including decrease of the choroidal blood flow, choroidal ischemic areas, and halo peripapillary oedema. Age was a risk factor for eye lid oedema. Corneal and conjunctival lesions, even as eye lid oedema and hypertensive retinopathy were more frequent on patients, sick for less than a year. High blood pressure was a risk factor for papillary lesions, hypertensive retinopathy, and dyschromatopsia. Corneal and conjunctival calcifications were found mostly on patients on dialysis, whereas they had less eye lid oedema, hypertensive retinopathy, and maculopathy.

CONCLUSION

Retinal lesion, especially due to high blood pressure is the most described. It permits to establish the prognostic of the disease. Patients on dialysis show a decrease of that retinopathy, but some sequels might persist which are invalidating, irreversible and may lead to blindness. This can be prevented by early screening of high blood pressure and an adequate treatment of chronic renal failure. Ophthalmologic examination remains a cheap and simple method to prevent the complications.

Spirometry centile charts for young Caucasian children: the Asthma UK Collaborative Initiative

RATIONALE

Advances in spirometry measurement techniques have made it possible to obtain measurements in children as young as 3 years of age; however, in practice, application remains limited by the lack of appropriate reference data for young children, which are often based on limited population-specific samples.

OBJECTIVES

We aimed to build on previous models by collating existing reference data in young children (aged 3-7 yr), to produce updated prediction equations that span the preschool years and that are also linked to established reference equations for older children and adults.

METHODS

The Asthma UK Collaborative Initiative was established to collate lung function data from healthy young children aged 3 to 7 years. Collaborators included researchers with access to pulmonary function test data in healthy preschool children. Spirometry centiles were created using the LMS (lambda, micro, sigma) method and extend previously published equations down to 3 years of age.

MEASUREMENTS AND MAIN RESULTS

The Asthma UK centile charts for spirometry are based on the largest sample of healthy young Caucasian children aged 3-7 years (n = 3,777) from 15 centers across 11 countries and provide a continuous reference with a smooth transition into adolescence and adulthood. These equations improve existing pediatric equations by considering the between-subject variability to define a more appropriate age-dependent lower limit of normal. The collated data set reflects a variety of equipment, measurement protocols, and population characteristics and may be generalizable across different populations.

CONCLUSIONS

We present prediction equations for spirometry for preschool children and provide a foundation that will facilitate continued updating.

Changing trends in antiepileptic drug prescribing in girls of child-bearing potential

OBJECTIVE

To characterize trends in prescribing carbamazepine (CBZ), sodium valproate (VPA) and lamotrigine (LTG) in adolescent females in the UK and to examine possible reasons for changing trends.

DESIGN

Population-based observational study.

SETTING

UK General Practice Research Database between 1 January 1993 and 31 December 2006.

PATIENTS

12-18-year-old subjects who were issued >or=1 CBZ, VPA or LTG prescription.

MAIN OUTCOME MEASURES

Prescribing prevalences stratified by age, gender and antiepileptic drug.

RESULTS

5417 patients (47.6% females) were prescribed 147 111 prescriptions for CBZ (34.5%), VPA (38.6%) or LTG (26.9%). The prevalence of LTG prescribing in females increased from 0.08 (95% CI 0.04 to 0.12) to 0.80 (95% CI 0.70 to 0.89) per 1000 female population. Conversely, the prevalence in females of CBZ and VPA prescribing significantly decreased from 1.00 (95% CI 0.85 to 1.15) to 0.51 (95% CI 0.44 to 0.58) and from 0.94 (95% CI 0.80 to 1.09) to 0.63 (95% CI 0.55 to 0.72), respectively. This 10-fold rise in LTG prescribing in females is much higher than the fivefold rise in males from 0.09 (95% CI 0.05 to 0.14) to 0.47 (95% CI 0.40 to 0.54) per 1000 male population.

CONCLUSION

The practice of prescribing antiepileptic drugs in adolescents has changed gradually over the last decade. More females aged 12-18 years are prescribed LTG than CBZ or VPA and the increase is much greater than for males. The increase in LTG prescribing mirrors a corresponding decrease in both VPA and CBZ. Concerns about potential problems to offspring appear to be affecting prescription trends in adolescent females of child-bearing potential.

Association of prematurity, lung disease and body size with lung volume and ventilation inhomogeneity in unsedated neonates: a multicentre study

BACKGROUND

Previous studies have suggested that preterm birth with or without subsequent chronic lung disease is associated with reduced functional residual capacity (FRC) and increased ventilation inhomogeneity in the neonatal period. We aimed to establish whether such findings are associated with the degree of prematurity, neonatal respiratory illness and disproportionate somatic growth.

METHODS

Multiple breath washout measurements using an ultrasonic flowmeter were obtained from 219 infants on 306 test occasions during the first few months of life, at three neonatal units in the UK and Australia. Tests were performed during unsedated sleep in clinically stable infants (assigned to four exclusive diagnostic categories: term controls, preterm controls, respiratory distress syndrome and chronic lung disease). The determinants of neonatal lung function were assessed using multivariable, multilevel modelling.

RESULTS

After adjustment for age and body proportions, the factors gestation, intrauterine growth restriction and days of supplemental oxygen were all significantly associated with a reduced FRC. In contrast, increased ventilation inhomogeneity (elevated lung clearance index) was only significantly associated with duration of supplemental oxygen. After adjusting for continuous variables, diagnostic category made no further contribution to the models. Despite using identical techniques, unexpected inter-centre differences occurred, associated with the equipment used; these did not alter the negative association of preterm delivery and disease severity with lung function outcomes.

CONCLUSION

Reduction in FRC is independently associated with prematurity, intrauterine growth restriction and severity of neonatal lung disease. Determinants of lung function shortly after birth are highly complex in different disease groups.

Socioeconomic deprivation independent of ethnicity increases status epilepticus risk

BACKGROUND

A higher incidence of convulsive status epilepticus (CSE) has been reported in nonwhite compared to white populations. Socioeconomic factors can be intricately involved in observed ethnic "effects," and the importance of socioeconomic status on health conditions is widely recognized. Understanding the effect of socioeconomic factors on CSE would provide insights into etiology and management, leading to the development of novel prevention strategies.

METHODS

From a population-based UK study on childhood CSE, we tested the hypothesis that socioeconomic deprivation independent of ethnicity increases the risk of childhood CSE. Home postal codes were used to measure the socioeconomic status of the neighborhood in which patients lived relative to that of the borough in which the neighborhood was located. The child's ethnicity was reported by parent(s). Relationships between socioeconomic status, ethnicity, and incidence were investigated using Poisson regression analysis.

RESULTS

A total of 176 children were enrolled. The incidence of CSE in nonwhite children [18.5, 95% confidence interval (CI) 13.7-23.3/100,000/year] was 1.8 (95% CI 1.3-2.4) times greater than for white children (10.5, 95% CI 7.9-13.1/100,000/year) (p < 0.0005). Socioeconomic deprivation and Asian ethnicity were independently associated with increased incidence. For each point increase in Index of Multiple Deprivation (IMD) 2004, there was a 1.03 cumulative increased relative risk (95% CI 1.01-1.06, p = 0.007). Asian children were 5.7 times (95% CI 1.7-18.9) more likely than white children to have a first-ever episode of CSE (p = 0.004). Socioeconomic and ethnicity effects were related to etiology of CSE.

INTERPRETATION

Ethnic and socioeconomic factors independently affect risk for prolonged febrile seizures and acute symptomatic CSE, but not for other types of childhood CSE.

Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study

BACKGROUND

Episodes of childhood convulsive status epilepticus (CSE) commonly start in the community. Treatment of CSE aims to minimise the length of seizures, treat the causes, and reduce adverse outcomes; however, there is a paucity of data on the treatment of childhood CSE. We report the findings from a systematic, population-based study on the treatment of community-onset childhood CSE.

METHODS

We collected data prospectively on children in north London, UK, who had episodes of CSE (ascertainment 62-84%). The factors associated with seizure termination after first-line and second-line therapies, episodes of CSE lasting for longer than 60 min, and respiratory depression were analysed with logistic regression. Analysis was per protocol, and adjustment was made for repeat episodes in individuals.

RESULTS

182 children of median age 3.24 years (range 0.16-15.98 years) were included in the North London Convulsive Status Epilepticus in Childhood Surveillance Study (NLSTEPSS) between May, 2002, and April, 2004. 61% (147) of 240 episodes were treated prehospital, of which 32 (22%) episodes were terminated. Analysis with multivariable models showed that treatment with intravenous lorazepam (n=107) in the accident and emergency department was associated with a 3.7 times (95% CI 1.7-7.9) greater likelihood of seizure termination than was treatment with rectal diazepam (n=80). Treatment with intravenous phenytoin (n=32) as a second-line therapy was associated with a 9 times (95% CI 3-27) greater likelihood of seizure termination than was treatment with rectal paraldehyde (n=42). No treatment prehospital (odds ratio [OR] 2.4, 95% CI 1.2-4.5) and more than two doses of benzodiazepines (OR 3.6, 1.9-6.7) were associated with episodes that lasted for more than 60 min. Treatment with more than two doses of benzodiazepines was associated with respiratory depression (OR 2.9, 1.4-6.1). Children with intermittent CSE arrived at the accident and emergency department later after seizure onset than children with continuous CSE did (median 45 min [range 11-514 min] vs 30 min [5-90 min]; p<0.0001, Mann-Whitney U test); for each minute delay from onset of CSE to arrival at the accident and emergency department there was a 5% cumulative increase in the risk of the episode lasting more than 60 min.

INTERPRETATION

These data add to the debate on optimum emergency treatment of childhood CSE and suggest that the current guidelines could be updated.

[Prevention of the acute tolerence with fentanyl by ketamine]

INTRODUCTION

The objective of this study is to evaluate in under developed country where post operative pain management inadequate the efficiency of the prevention of this acute tolerance with opioids by the ketamine.

MATERIALS AND METHODS

We did a prospective study on months period (January 2004 to June 2004). The setting was the HPD surgical unit recovery room. The patients of more than 15 years and less than 60 years who underwent painful or fairly painful surgical operation under general anaesthesia were included. The patients intubés,ventilated and sedated in the recovery room were excluded from the study .The patients were divided into two groups: in group 1 the patients were given 100 microg/kg of ketamine 15 mn before induction. In group 2 the patients where given a placebo 15 mn before induction. The fentanyl was used systematically during induction at the dosage of 5 microg/kg. The quality of per-operative analgesia was evaluated by the appreciation of the heart rate and the blood pressure. The DPO was evaluated by the analogical visual scale (EV A) at the entrance and the exit of the recovery room, and at the 4th, 8th, 12th and 24th hour after the surgery.

RESULTS

Hundred and thirteen (113) patient were included in the study (groupel with ketamine: 56 patients, groupe 2 without ketamine: 57). The average age was 30 years with extremes from 16 to 60 years. In group 1 and preoperatively 5.9% of the patients receided additional fentanyl ranging from 50 to 100 microg/kg against 47.7% in group 2. In the post-operative period, the morphine consumption was 22.02% for the Group 1 and 43.37% for Group 2. The difference between the two groups is statistically significant. A case of restlessness was noted in group 1.

CONCLUSION

The low dose ketamine seems to be effective for the prevention of the postoperative severe pain induced by the fentanyl. It allows also an improvement of the quality of per-operational analgesia.

[Clinical and angiographical findings of age-related macular degeneration in Senegal. Preliminary results]

INTRODUCTION

Principal cause of legal blindness in industrialized countries, age-related macular degeneration (ARMD) have never been studied in West Africa. We report and analyse the clinical and angiographical characteristics of macular degeneration in our patients older than 50 years.

MATERIAL AND METHODS

In this prospective study, we recruited during 13 months all patients presenting ARMD signs from our consultation department. Various clinic and angiography parameters were collected. The follow up varied between 6 and 20 months.

RESULTS

The prevalence of this pathology was of 6.5 per 1000. Sex ratio was 0.36 and mean age 61.6 years (53 to 80 years). No familial history of ARMD was found. Three patients were more exposed to sun because of their profession, 9 had high blood pressure, 6 were hyperopes and 1 was smoking. A drop of visual acuity was noted in all cases but no metamorphopsies. Signs founded were miliar drusen (20 eyes), serous drusen (4 eyes), association of those two kinds (4 eyes) and retinal pigmented epithelium abnormalities (PE) (8 eyes) alone or associated with drusen. These signs were significant of age-related maculopathy (ARM). The fluorescein angiography confirmed the type of lesions and showed no signs of neovascularization. An aggravation of the pigment migration was noted in one case after 20 months.

CONCLUSION

Age related macular degeneration doesn't seem frequent in our population of patients and shows essentially under its initial form of ARM even though facilitating factors seemed identical, excepted tobacco addiction, sun exposition and systemic hypertension. This study which short terms results we are presenting would need to be continue to give more precisions on those data.

Reference ranges for spirometry across all ages: a new approach

RATIONALE

The Third National Health and Nutrition Examination Survey (NHANES III) reference is currently recommended for interpreting spirometry results, but it is limited by the lack of subjects younger than 8 years and does not continuously model spirometry across all ages.

OBJECTIVES

By collating pediatric data from other large-population surveys, we have investigated ways of developing reference ranges that more accurately describe the relationship between spirometric lung function and height and age within the pediatric age range, and allow a seamless transition to adulthood.

METHODS

Data were obtained from four surveys and included 3,598 subjects aged 4-80 years. The original analyses were sex specific and limited to non-Hispanic white subjects. An extension of the LMS (lambda, mu, sigma) method, widely used to construct growth reference charts, was applied.

MEASUREMENTS AND MAIN RESULTS

The extended models have four important advantages over the original NHANES III analysis as follows: (1) they extend the reference data down to 4 years of age, (2) they incorporate the relationship between height and age in a way that is biologically plausible, (3) they provide smoothly changing curves to describe the transition between childhood and adulthood, and (4) they highlight the fact that the range of normal values is highly dependent on age.

CONCLUSIONS

The modeling technique provides an elegant solution to a complex and longstanding problem. Furthermore, it provides a biologically plausible and statistically robust means of developing continuous reference ranges from early childhood to old age. These dynamic models provide a platform from which future studies can be developed to continue to improve the accuracy of reference data for pulmonary function tests.

Health-related quality of life (HRQOL) among patients with Generalised Anxiety Disorder: evaluation conducted alongside an escitalopram relapse prevention trial

BACKGROUND

Improving health-related quality of life (HRQoL) should be a treatment goal for patients with Generalised Anxiety Disorder (GAD).

OBJECTIVES

To assess the impact of treatment with escitalopram on HRQoL as well as the effect of relapse on HRQoL and work productivity.

METHODS

This study was conducted alongside a double-blind, placebo-controlled, relapse prevention multinational clinical trial. Relapse was defined as a Hamilton Anxiety Scale (HAMA) >or= 15. Treatment responders (HAMA <or= 10) after 12 weeks of open-label treatment (10 mg/day escitalopram for Week 1 followed by 20 mg/day thereafter) were included. The study dataset comprised patients (n = 329) from French, Canadian, German and Swedish centres. HRQoL was assessed using the SF-36 scale, and data on sick leave and on-the-job productivity as measured by the Work Limitation Questionnaire and the work efficacy and work satisfaction visual analogue scales (VAS) scales were collected at baseline, randomization (Week 12), Weeks 36, 60 and at last assessment. For future health economic analysis, quality adjusted life years were calculated from the SF-36 results.

RESULTS

At baseline, GAD patients reported significantly impaired quality of life compared with the general population. During the 12-week open-label treatment period, treatment responders reported significant improvements in HRQoL on all dimensions of the SF-36 (p < 0.001) and on-the-job productivity (p < 0.001), whereas sick leave decreased but did not reach statistical significance. After randomization, relapsed patients reported significantly lower QoL than non-relapsed patients on all 4 SF-36 mental health dimensions (p < 0.001). Relapsed patients reported slightly lower on-the-job productivity than non-relapsed patients and scored lower on the work efficacy and work satisfaction VAS scales.

CONCLUSION

GAD adversely affects patient functioning and daily life. Short-term treatment with escitalopram reverses this impairment to population norms. GAD relapse is associated with a deterioration of HRQoL and work productivity.

Reference equations for pulmonary function tests in preschool children: a review

Recent developments in pulmonary function tests (PFTs) in preschool children (2-5 years of age) have meant that objective assessments of respiratory function are now possible for this age group. However, the application and interpretation of these tests may be limited by the relative paucity of appropriate reference equations. This review summarizes available preschool reference equations, identifies the current gaps and limitations in the methodologies and statistics used and proposes future directions for improving reference data. A PubMed search which included the MeSH terms (preschool [2-5years]), (respiratory function test), and (reference value) yielded 214 publications which were screened to identify 34 publications presenting 36 reference equations for seven techniques. There were considerable differences with respect to population characteristics, recruitment strategies, equipment and methodologies and reported parameters both within and between each measurement technique. Despite an increasing number of reference equations for PFT for preschool children, the extent to which these can be generalized to other populations may be limited in some cases by inclusion of relatively few children less than 5 years of age, a lack of details regarding the sample populations and measurement techniques and/or inappropriate statistical analysis. A fresh approach based on large sample sizes, clearly documented population characteristics, equipment and protocols, and more rigorous modern statistical methods both for developing reference equations and interpreting results could enhance clinical application of these tests. This in turn would maximize the tremendous opportunities to detect early lung disease offered by the recent surge in developing suitable tests for preschool children.

Vesicostomy vs primary ablation for posterior urethral valves: always a difference in outcome?

OBJECTIVE

A vesicostomy is believed to have a detrimental effect in boys with posterior urethral valves compared to primary valve ablation. We compared the outcomes of boys managed by initial vesicostomy with those undergoing primary fulguration.

MATERIALS AND METHODS

The outcomes of 54 boys (23 vesicostomy, 31 primary valve fulguration) over 1 year of age who had not undergone renal transplant were considered. Outcome parameters identified were ultrasound findings, continence status, glomerular filtration rate (GFR) and 1-year creatinine. Dryness was defined as completely dry both day and night with no need to wear pads. Results are presented with 95% confidence intervals.

RESULTS

Ultrasound examinations were normal in 9/19 (47.4%) of the vesicostomy group and 11/24 (45.8%) of the fulguration group. Graded ultrasound results were not significantly different (p=0.24). The vesicostomy patients were more often dry (79% vs 64%, p=0.43). The vesicostomy group had on average higher GFR (95.26 vs 85.79) and lower 1-year creatinine (49.58 vs 52.46) values. After accounting for age differences between groups, there was no significant difference in the GFR and 1-year creatinine values (p=0.16 and p=0.87, respectively).

CONCLUSIONS

There was a tendency for the major outcomes to be more favourable in the vesicostomy group. Although trends were non-significant, confidence intervals were wide and potential differences of clinical importance could not be discounted.

A comparative study of the efficacy of acute and continuation treatment with escitalopram versus duloxetine in patients with major depressive disorder

OBJECTIVE

This study evaluated the efficacy and tolerability of escitalopram and duloxetine in the treatment of major depressive disorder (MDD).

RESEARCH DESIGN AND METHODS

Patients were randomised to 24 weeks of double-blind treatment with fixed doses of escitalopram (20 mg) (n = 143) or duloxetine (60 mg) (n = 151). The primary analysis of efficacy was an analysis of covariance (ANCOVA) of change from baseline to endpoint (week 24) in MADRS total score (last observation carried forward). MAIN OUTCOME MEASURES;

RESULTS

At week 8, the mean change from baseline in total MADRS score was -19.5 for patients treated with escitalopram (n = 141) and -17.4 for patients treated with duloxetine (n = 146), a difference of 2.1 points (p < 0.05). At week 8, the proportion of responders (> or = 50% decrease in MADRS) was 69% (escitalopram) and 58% (duloxetine) (p < 0.05) and remission (MADRS < or = 12) rates were 56% (escitalopram) and 48% (duloxetine) (NS). For the primary endpoint, the mean change from baseline in total MADRS score at week 24 was -23.4 for patients treated with escitalopram and -21.7 for patients treated with duloxetine, a difference of 1.7 points (p = 0.055, one-sided). The difference in mean change from baseline in MADRS total score favoured escitalopram at weeks 1, 2, 4, 8, 12 and 16 (p < 0.05). The overall withdrawal rates were 22% (escitalopram) and 25% (duloxetine) (NS). The withdrawal rate due to adverse events was lower for escitalopram (9%) compared to duloxetine (17%) (p < 0.05) and significantly more patients treated with duloxetine reported insomnia (12.6% vs. 4.9%) and constipation (8.6% vs. 2.8%).

CONCLUSION

Escitalopram was superior to duloxetine in acute treatment and at least as efficacious and better tolerated in long-term treatment of MDD.

The nature of feeding in infants with unrepaired cleft lip and/or palate compared with healthy noncleft infants

OBJECTIVE

Feeding difficulties are reported widely in infants with cleft lip and/ or palate. There is, however, a paucity of objective information about the feeding patterns of these infants. This study compared patterns of feeding in infants with unrepaired cleft lip and palate with healthy noncleft infants of a similar age.

SETTING

North Thames Regional Cleft Centre. The noncleft cohort was recruited from West Middlesex University Hospital, a general hospital with similar demographics.

PARTICIPANTS

Fifty newborn infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate who were referred to the North Thames Regional Cleft Centre participated. Parents of 20 randomly selected, noncleft infants agreed to participate.

MAIN OUTCOME MEASURES

Feeding patterns were rated using the Neonatal Oral Motor Assessment Scale. Additional objective information was collected using the Great Ormond Street Measurement of Infant Feeding (Masarei et al., 2001; Masarei, 2003).

RESULTS

Infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate had less efficient sucking patterns than their noncleft peers had. They used shorter sucks (mean difference, 0.30 second; p < .0005), a faster rate of sucking (mean difference, 34.20 sucks/second; p < .0005), higher suck-swallow ratios (mean difference, 1.87 sucks/swallow; p < .0005), and a greater proportion of intraoral positive pressure generation (mean difference, 45.97% positive pressure; p < .0005).

CONCLUSIONS

This study demonstrated that the sucking patterns of infants with nonsyndromic complete unilateral cleft lip and palate or a cleft of the soft and at least two thirds of the hard palate differ from those of their noncleft peers.

The effectiveness of Picture Exchange Communication System (PECS) training for teachers of children with autism: a pragmatic, group randomised controlled trial

OBJECTIVE

To assess the effectiveness of expert training and consultancy for teachers of children with autism spectrum disorder in the use of the Picture Exchange Communication System (PECS).

DESIGN

Group randomised, controlled trial (3 groups: immediate treatment, delayed treatment, no treatment).

PARTICIPANTS

84 elementary school children, mean age 6.8 years.

TREATMENT

A 2-day PECS workshop for teachers plus 6 half-day, school-based training sessions with expert consultants over 5 months.

OUTCOME MEASURES

Rates of: communicative initiations, use of PECS, and speech in the classroom; Autism Diagnostic Observation Schedule-Generic (ADOS-G) domain scores for Communication and Reciprocal Social Interaction; scores on formal language tests.

RESULTS

Controlling for baseline age, developmental quotient (DQ) and language; rates of initiations and PECS usage increased significantly immediately post-treatment (Odds Ratio (OR) of being in a higher ordinal rate category 2.72, 95% confidence interval 1.22-6.09, p < .05 and OR 3.90 (95%CI 1.75-8.68), p < .001, respectively). There were no increases in frequency of speech, or improvements in ADOS-G ratings or language test scores.

CONCLUSIONS

The results indicate modest effectiveness of PECS teacher training/consultancy. Rates of pupils' initiations and use of symbols in the classroom increased, although there was no evidence of improvement in other areas of communication. TREATMENT effects were not maintained once active intervention ceased.