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Biomedical subjects

M S Houston

Publications and source records attributed to M S Houston.

9 recordsLinked to original sources
PubMed2000

Assessment of the accuracy of low-cost store-and-forward teledermatology consultation.

BACKGROUND: Telemedicine has the potential to revolutionize the delivery of dermatologic care to underserved areas. OBJECTIVE: Our purpose was to compare diagnoses from two types of dermatology consultations: telemedicine using store-and-forward (SAF) technology, and traditional face-to-face (FTF) office visits. METHODS: Skin conditions were imaged with a consumer-grade digital camera. A standardized template was used to collect historical data. Information was stored in a secured database for access by 2 or 3 board-certified dermatologists. Results from the FTF visit were used to assess the accuracy of the SAF diagnoses. RESULTS: A total of 106 dermatologic conditions in 92 patients were included. Concordance between FTF and SAF diagnoses was high, ranging from 81% to 89% for all 3 dermatologists. Clinically relevant disagreement occurred in only 4% to 8% of cases. Remaining disagreements did not affect patient care. Diagnostic confidence and image quality affected agreement. When cases of high confidence were analyzed separately, agreement increased to 88% to 100%. This increase was substantiated by means of a chi-square test between the high confidence and low confidence groups, which demonstrated statistical significance (P <. 005) for all dermatologists. Similarly, when cases of above average image quality were considered, agreement increased to 84% to 98%. Again this difference was substantiated by means of a chi-square test between adequate and poor images, with statistical significance for two dermatologists (P <.001). Accuracy was comparable between disease types with the exception of benign neoplasms, which demonstrated agreement of 22% to 46%. CONCLUSION: These data support the use of existing digital technology to construct an accurate SAF teledermatology system. The inexpensive camera and widely available computer equipment make this an extremely affordable system. Furthermore, participating dermatologists appear well aware of system limitations, as reflected in the increased agreement for high confidence cases. Additional investigation of the accuracy of teledermatology for benign neoplasms is warranted.

Adolescent↗
PubMed1999

Population-based screening for postpartum depression.

OBJECTIVE: To estimate the community prevalence in Olmsted County, Minnesota of elevated scores on the Edinburgh Postnatal Depression Scale, a self-report screening tool for postpartum depression. METHODS: At the 6-week postpartum visit, the Edinburgh Postnatal Depression Scale was administered to women who gave birth in Olmsted County between July 28, 1997 and March 28, 1998. Study sites included all ambulatory clinics that provide pregnancy care in the county, and women who missed postpartum visits were contacted by mail. A threshold of 12 or more points on the scale was selected for clinical use; data for scores of ten and above were also examined. RESULTS: Of the 909 Olmsted County women studied (response rate 83.2%), 11.4% (n = 104) had scores of 12 or greater, with a 95% confidence interval (CI) of 9.4%, 13.5%. The percentage of women with a positive screen increased to 19.8% (n = 180; 95% CI 17.2%, 22.4%) when scores of 10 or higher were included, as has been recommended for screening in primary care settings. Forty-eight or 5.3% of the subjects (95% CI 3.8%, 6.7%) indicated experiencing suicidal ideation during the previous week. CONCLUSION: More than 11% of women had elevated scores on the Edinburgh Postnatal Depression Scale, indicating a high likelihood of postpartum depression and the need for further assessment. The screening process required little extra time and was acceptable to the subjects and clinicians. Screening for postpartum depression is appropriate and feasible for clinical practice and increases the identification of women suffering from this serious, common, and highly treatable disorder.

Adult↗
PubMed1999

Clinical consultations using store-and-forward telemedicine technology.

OBJECTIVE: To investigate the potential role of a store-and-forward (SAF) telemedicine system in specialty consultations initiated by primary care physicians. MATERIALS AND METHODS: In this pilot telemedicine study, patients needing consultations in cardiology, dermatology, endocrinology, and orthopedics had both standard face-to-face (FTF) consultations and SAF consultations. RESULTS: Fifteen patients had both FTF and SAF consultations, 4 had echocardiograms transmitted for an SAF consultation only, and 1 had an SAF consultation but no FTF appointment. Of 19 diagnoses made, all were essentially the same in both types of consultations; 14 of 15 FTF consultations and 15 of 19 SAF consultations resulted in additional treatment recommendations. CONCLUSIONS: While it was possible to develop a desktop system for SAF consultations, the equipment was not adequately integrated. Without total digital input, including electronic patient medical records, packaging of information is laborious and impractical. Seamlessly adapting to existing clinical practice is vital. Issues such as increasing work for the physicians or office staff, gathering adequate patient information, and designing a referral process were more difficult than we had anticipated. Patient acceptance was high, but the clinical pilot had very small numbers.

Female↗
PubMed1997

Risk factors for 30-day mortality in elderly patients with lower respiratory tract infection. Community-based study.

BACKGROUND: Pneumonia is a major cause of death in the elderly, but there are few studies of risk factors for death that include both ambulatory and nursing home patients. OBJECTIVE: To assess factors associated with 30-day mortality in a population-based study of older adults with lower respiratory tract infection. METHODS: Identification of (1) a previously identified retrospective cohort of all residents of Rochester, Minn, aged 65 years or older who experienced a first episode of pneumonia or bronchitis during a calendar year and (2) the risk factors associated with 30-day mortality through review of complete inpatient and ambulatory medical records. Logistic regression was used to identify significant independent risk factors for 30-day mortality. RESULTS: A total of 413 adults aged 65 years or older were identified. The independent factors for 30-day mortality were atypical symptoms (odds ratio [OR], 4.98; 95% confidence interval [CI], 2.14-11.60), neurologic illness (OR, 3.92; 95% CI, 1.47-6.59), current diagnosis of cancer (OR, 6.2; 95% CI, 2.40-15.99), and recent or current use of antibiotics (OR, 3.13; 95% CI, 1.45-6.77). CONCLUSIONS: Malignancy and neurologic disease are well-recognized conditions that identify patients with lower respiratory tract infections who have a high risk of death within 30 days. An atypical presentation with confusion, lethargy, poor eating, or recent or current antibiotic use also identifies patients, with a high risk of 30-day mortality.

Aged↗
PubMed1990

Practical management of hyperthyroidism.

There are several causes of hyperthyroidism, and correct diagnosis is essential for management. Graves' disease is most commonly managed with radioactive iodine therapy (131I), antithyroid drugs or surgery. Toxic adenomas (single or multiple) may be treated with 131I or surgery. Most types of thyroiditis are managed expectantly. Pregnant women, children and the elderly deserve special consideration. Follow-up is vital to identify the later development of hypothyroidism.

Antithyroid Agents↗
PubMedDate not supplied

The process of developing a computer-assisted instruction program.

The author describes the process of developing a computer-assisted instruction program with limited funds and resources. Development of the content of the program was done by the author. Grant funds were obtained to pay a programmer and purchase hardware and software. The author shares her personal experiences in this process and some of the challenges and pitfalls that were encountered.

Bed Rest↗
PubMedDate not supplied

Care of the school-aged child in 90/90 traction.

Children in the school-aged period are those most likely to sustain a fractured femur. One method of treatment for this age group is immobilization of the fracture in 90/90 traction. Specific needs of these children are discussed, and related nursing problems are identified. The physiologic and psychosocial aspects of nursing care are also addressed. Emphasis is placed on the developmental tasks inherent in this age group. Mastery of illness and hospitalization are central issues for the school-aged child and can be facilitated through the efforts of nursing and hospital staff. A therapeutic play program is also a beneficial adjunct to treatment and nursing care.

Child↗
PubMedDate not supplied

Community-acquired lower respiratory tract infection in the elderly: a community-based study of incidence and outcome.

BACKGROUND: We studied the incidence, characteristics, and survival of elderly patients from a defined community who had pneumonia or bronchitis (lower respiratory tract infection). METHODS: This study was a population-based retrospective cohort study of residents of Rochester, Minnesota, aged 65 years or older with a first episode of pneumonia or bronchitis during the calendar year 1987. RESULTS: Overall age- and sex-adjusted incidence rates for an initial episode in a calendar year were 5452 per 100,000: 2420 per 100,000 (95 percent confidence interval, 2056 to 2783 per 100,000) for bronchitis and 3032 per 100,000 (95 percent confidence interval, 2639 to 3425 per 100,000) for pneumonia. After exclusion of eight cases diagnosed at autopsy, the overall 30-day mortality was 10.7 percent. Patients with pneumonia had lower survival than expected for the Minnesota white population (log-rank statistic = 117.38, P < 0.0001). The observed survival of patients with bronchitis was also significantly less than expected (log-rank statistic = 6.25, P = 0.012). CONCLUSION: Lower respiratory tract infections are common in the elderly. Most patients in this study were not hospitalized, and atypical presentations were not observed. Early mortality (30 days) was high. Among elderly patients with either pneumonia or bronchitis, the survival was lower than expected. This study confirmed the need for population-based studies, because more than two-thirds of patients would have been missed if only hospitalized patients were included.

Aged↗