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"Larkin, Maria"
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Nutrition Counseling in the Treatment of Eating Disorders
Marcia Herrin and Maria Larkin have collaborated on the second edition of Nutrition Counseling in the Treatment of Eating Disorders, infusing research-based approaches and their own clinically-refined tools for managing food and weight-related issues. New to this edition is a section on nutrition counseling interventions derived from cognitive behavioral therapy-enhanced, dialectical behavioral therapy, family-based treatment, and motivational interviewing techniques. Readers will appreciate the state of the art nutrition and weight assessment guidelines, the practical clinical techniques for managing bingeing, purging, excessive exercise, and weight restoration as well as the unique food planning approach developed by the authors. As a comprehensive overview of food and weight-related treatments, this book is an indispensible resource for nutrition counselors, psychotherapists, psychiatrists, physicians, and primary care providers.
eBook
176 Development of a novel frailty trigger for use at triage in the emergency department
BackgroundFrailty is not routinely identified at Emergency Department (ED) triage. The introduction of a frailty modifier has been recommended in international ED triage guidelines but is yet to be widely adopted. We developed a short Frailty Trigger for use at triage.MethodsThe Frailty Trigger was developed following a systematic review examining ED frailty screening instruments. A two-round electronic Delphi followed to determine the core components of ED frailty screening. The 3 highest scoring statements relating to components were edited to create the questions. A diagnostic test accuracy study was undertaken among consecutive adults aged ≥70 years, who attended one ED between December 2021 and February 2022, comparing the Trigger against three, validated frailty screening instruments; the Clinical frailty Scale (CFS), Variable indicative of Placement (VIP) and PRISMA-7. An independent comprehensive geriatric assessment (CGA) determined each patient’s frailty status.Results313 adults aged ≥70 years were available, median age 78±9 years. Excellent accuracy for frailty demonstrated, (AUC) 0.822 (95% CI:0.780-0.865). Mean administrative time 25.5 seconds (SD ±10.9s). It had similar accuracy to VIP (AUC 0.820, p=0.937), lower than PRISMA-7 (AUC 0.896, p<0.001) and CFS (AUC 0.946, p<0.001). A positive score was independently associated with longer ED stays (mean 32.5 versus 26.7 hours) and hospital stays (mean 10 versus 4 days, p<0.001).ConclusionThe Frailty Trigger showed excellent diagnostic accuracy for frailty versus three longer, validated screens and was quicker to use. It predicted ED and hospital length of stay. Larger studies in ED are required to examine accuracy and effect on triage pathways.Abstract #176 Figure 1ROC curves comparing the Frailty Trigger and CFS[Figure omitted. See PDF]
Journal Article
Using Extended Vocabulary Instruction to Support Students’ Expressive Vocabulary
The purpose of this study was to examine the effects of extended vocabulary instruction on the expressive vocabulary of two third-grade students with vocabulary deficits. According to the Common Core State Standards Initiative (n.d.), students in third grade should be able to determine the meaning of unknown and multiple-meaning words and phrases based on grade-level material, demonstrate an understanding of word relationships, make real-life connections with words and how they are used, and recognize shades of meaning among similar words. There is a relationship between vocabulary and comprehension (Ouellette, 2006). Furthermore, making inferences is also important for comprehension (Hall & Barnes, 2017). This study demonstrated the effectiveness of extended vocabulary instruction for supporting participants’ target word knowledge and inferencing skills through a single-case multiple probe across word sets design. Two participants enrolled in third grade demonstrated increases in target word knowledge and inferencing skills. Implications for practice are discussed.
Dissertation
Educators’ Perceptions of the Effects of the Blended Learning Program on the Language Acquisition, Academics, and Social Emotional Learning and Development of English Language Learners
The purpose of this case study was to examine the efficacy of blended learning and educators’ perceptions of the blended learning program on addressing the overarching components of every student having equitable access, being globally competitive, ensuring effective digital learning, and developing proficiency among the English language learner (ELL) population. When one school district in Maryland made a seismic shift toward the blended learning program and Schoology, a learning management system, its influences were greater than traditional instructional practices alone, especially among ELLs. Using purposefully select sampling of secondary schools within a site district, 11 participants consisting of teachers, school-based administrators, and central office staff were interviewed and submitted supporting documents sharing their instructional practices in how they perceived the effectiveness of the blended learning program and Schoology in providing inclusive education, equitable access to close the gap, disrupt the inequities, decrease dropout rates, and increase graduation rates among ELLs. The district saw a decrease within its dropout rates, an increase in its graduation rates, and an upsurge of ELLs reaching proficiency levels in language acquisition, academics, and social emotional learning and development when implementing the blended learning program and Schoology. This research will discuss implications of these findings for interpretations in identifying innovative instructional strategies for personalized learning to help ELLs meet success and make curriculum decisions and education reform for sustainable change.
Dissertation
Assessing Weight
In this chapter we outline how to estimate a patient's biologically appropriate weight (BAW), how to talk about weight issues, how to use body mass index (BMI) categories, and how to appropriately monitor weights throughout treatment. This information provides a framework for the following chapters on restoring weight, managing weight and managing bingeing, purging, and exercise behaviors. Although all team members address weight issues, usually it is the nutrition counselor's responsibility to assess and monitor weights and to educate patients about the biological facts that influence body weight. Weight monitoring is a helpful gauge of the adequacy of a particular food plan and it can reassure patients who worry that improving eating patterns will cause undesired changes in weight.
Book Chapter
Treating Binge Eating
Binge eating is defined as eating unusually large amounts of food while experiencing a lack of control over eating. Loss of control is assessed by asking, \"Did you have a sense of loss of control at the time?\" \"Could you have stopped eating once you had started?\" \"Could you have prevented the episode from occurring?\" (Wolfe, Baker, Smith, and Kelly-Weeder, 2009). Patients who binge eat may have a diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED). Some are overweight or obese and some not. Entrenched AN, especially if the body mass index (BMI) is less than 17.5, almost always includes bouts of binge eating (Lowe et al., 2011). It is important to note that binge eating is found in over 60% of AN patients and is known to delay or inhibit full recovery in AN (Tenconi, Lunardi, Zanetti, Santonastaso, & Favaro, 2006).
Book Chapter
Managing Purging
Purging, especially self-induced vomiting, is a difficult behavior to extinguish. Patients usually agree when we say that purging is the eating-disorder (ED) behavior that is most addicting. We respectfully acknowledge that purging may seem like a logical solution to a number of problems. Besides an ersatz weight-management tool, purging provides short-term relief of anxiety, resulting in relaxation, exhilaration, and even a sense of \"purity.\" To be effective with patients who purge, we find that we must be sympathetic, tolerant, and understanding of each patient's difficulties, particularly his or her embarrassment about purging. We keep in mind that correcting purging behaviors takes much effort on the patient's part and constant encouragement and help with problem-solving on our part. In this chapter, we define and describe purging behaviors (see Chapter 1: Clinical Features of Eating Disorders, pp. 3-31) and then devote the rest of the chapter to describing approaches we use to help patients become free of the compulsion to purge.
Book Chapter
Clinical Features of Eating Disorders
Eating disorders (EDs) are biologically-based mental disorders classified and defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 2000). This chapter relies on the DSM-IV and the soon to be published next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). We conclude this chapter with a discussion of the most significant of the proposed DSM-5 criteria for EDs.
Book Chapter