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Objective: Despite evidence that excessive screen use may contribute to negative health, developmental, emotional, and behavioral outcomes, more children are engaging in increasing amounts of screen-related activities. For children with neurodevelopmental conditions, increased screen use could exacerbate emotional/behavioral difficulties (EBDs) by interfering with sleep quantity and quality., Aims: This study examined the possible mediating role of sleep in the relationship between screen use and EBDs in preschool children with neurodevelopmental disorders (NDDs) clinically referred to a child development center in Singapore., Methods: A screen use questionnaire developed for the purposes of the present study, the Children's Sleep Habits Questionnaire, and the Strengths and Difficulties Questionnaire were completed by 367 caregivers of 2- to 5-year-old children with NDDs (39.5% autism spectrum disorder; 36.8% speech-language disorders; 23.7% others)., Results: Average daily screen use duration was 3.98 hours, with 93.9% exceeding 1 hour of screen time daily. 57.7% of children had screen devices in their bedrooms, while 52% commenced screen use at the age of 18 months or earlier. Sleep problems fully mediated the relationship between the number of bedroom screen devices and children's EBDs, as well as between the age of first screen use and EBDs, but not between hours of screen use and EBDs. Controlling for age, developmental level, and family income, children who started using screens earlier than 18 months and who had screen devices in their bedrooms had significantly more sleep problems and EBDs than those without., Conclusion: Children with neurodevelopmental conditions may have more difficulties disengaging from screen devices in their bedrooms, and an earlier age of screen exposure may contribute to more chronic disruption of sleep.

Background: Bolus nasogastric tube feeding is common. Unsafe practices such as failure to confirm tube placement can result in death. It is vital to ensure that nurses are adopting safe practices., Objective: To evaluate nurses' practices on bolus nasogastric feeding relating to verification of tube placement, management of gastric residual volume, and response to complications during feeding., Design: Cross-sectional, self-administered survey using clinical scenarios., Setting and Participants: All nurses who worked in the general wards in a tertiary hospital in August 2008., Methods: We developed six clinical scenarios to describe common clinical situations in nurses' daily practices. Participants were instructed to choose the responses that best reflected their practices, and to return the completed questionnaires to the study member present., Results: The survey participation rate was 99.5% (1203 nurses). Seventy-six percent would choose two or more methods to verify placement when they were in doubt. Percentage of hydrogen (pH) testing was the most common first method of checking tube placement. The second and third self-reported methods were auscultation and the bubble test. Few chose radiography to confirm tube placement. When the aspirate was pH 7, and in the presence of positive auscultation, most participants would take further steps to confirm placement. There were variations in the nurses' responses on managing the gastric residual volume, with 78.1% indicating that they would return the aspirate. Most nurses lacked the knowledge to effectively manage patients' distress during tube feeding., Conclusions: The findings showed that the majority of participants reported that they would exercise due caution by taking additional measures to check tube placement when in doubt. The practice gaps identified in the study highlighted a need to realign our care to best practices. Following the study, we revised the institution's guideline, reinforced specific safety precautions on nasogastric feeding, and incorporated clinical scenarios in our training., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Introduction: Functional magnetic resonance imaging (fMRI) is a neuroradiological technique for the localisation of cortical function. FMRI made its debut in cognitive neuroscience and then eventually to other clinical applications. We report our experience with pre-surgical fMRI on a high field scanner, based purely on a clinical platform., Materials and Methods: The protocols included motor, auditory, visual and language fMRI. The choice of protocols was dependant on clinical request and lesion locale., Results: Retrospective analysis and audit of the fi rst 30 consecutive patients over a 12-month period revealed that about 85% of patients had a successful examination. In a pictorial essay, we demonstrate that patients with weakness in performing a motor task showed abnormal activations of the pre-motor and supplementary motor areas., Conclusion: FMRI data greatly enhances the pre-surgical planning process and the conduct of surgery when it is incorporated into the surgical navigation system in the operating theatre.

Introduction: In line with other established protocols, our unit has instituted a standardised protocol for the management of moderate and severe traumatic brain injury since 1996 in our neurointensive care unit., Materials and Methods: We reviewed the outcomes, at 6 months' post-injury, in an elderly group aged > or = 64 years (73.86 +/- 8.0 years) and compared them to a younger group aged 20 to 40 years (29.2 +/- 5.7 years) in a cohort of 324 patients. Outcome was dichotomised as favourable (mild and moderate disability but independent; Glasgow Outcome Score [GOS] 4 and 5), unfavourable (severe disability and persistent vegetative state; GOS 2 and 3) and death (GOS 1)., Results: In the elderly group, the mortality (55.4%) was slightly more than double that of the younger group (20.9%); 21.5% had an unfavourable outcome (14.2% in the younger group) and only 23% had a favourable outcome (compared to 64.9% in the younger group). The final outcomes were significantly worse in all levels in the elderly group. This was in spite of data showing that the mechanism of injury was of a higher impact in the younger group, with a higher incidence of polytrauma and cervical spine injury. On admission, the mean Glasgow Coma Score (GCS) was 8.3 +/- 3.91 for the elderly group and 8.59 +/- 4.05 for the younger group (P = 0.763). Computed tomography scan showed that the elderly had a higher incidence of mass lesions (extradural haematoma and subdural haematoma) and traumatic subarachnoid haemorrhage. A subgroup (29.2%) of elderly patients had no surgical intervention based on poor clinical/neurological status, premorbid functional status and pre-existing medical conditions, with their family's consent. The GCS of < or = 8, on admission, was significant (P <0.001) in predicting mortality in the elderly. In the elderly group, the female gender had a higher mortality rate (70.4%) than the males (44.7%) (P = 0.19)., Conclusion: Age must be considered an independent factor in outcome prediction in the elderly with moderate and severe traumatic brain injury. A more conservative approach in the management of an elderly patient with severe head injury may be reasonable given its dismal outcomes after careful dialogue with the relatives.