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PubMedDate not supplied

[Evaluation of the understanding level of pediatric prescription].

OBJECTIVE: This study intends to establish the relation between the understanding level of pediatric prescription by the mother, or other adult, accompanying the child to a doctors visit and the probable causes of noncompliance with the treatment, in order to improve the quality of pediatric health care. METHODS: We randomly interviewed one hundred adults who accompanied children to the pediatric outpatient clinic of Hospital Universitário. They received medical orientation and/or prescriptions. The interviews were made from April to October 2000 and we used a questionnaire to evaluate social, economic and cultural status. We also evaluated aspects related to the appointment and treatment, and the understanding of doctors handwriting and prescription. RESULTS: Eighty-three percent of them received a prescription and 17% received only orientation; 88% were the mothers and 63% had not finished elementary school. Concerning the appointment, 80% felt satisfied. Seventy-one percent among those who received prescriptions could understand the doctor's handwriting and 29% had some or none understanding of it. Forty-seven percent of the prescriptions had symbols and/or abbreviations that could not be understood by 59% of the adults. Seventy-one percent could remember all the prescribed drugs without looking at the prescription; 15.7% needed to read it in order to remember the drugs; 7.2% could not remember the drugs and said that a pharmacist had to help them and 6% could not remember or read the prescription. CONCLUSION: Aspects related to the poor understanding of pediatric prescriptions are caused by the low social, economic and cultural status of the adult accompanying the child; as well as aspects regarding physicians such as the use of symbols and abbreviations, illegible handwriting and verbal orientation only.

English Abstract↗
PubMedDate not supplied

Prescription errors. Legibility and drug name confusion.

Inadvertent drug substitution occurred in several instances in our practices due to the combination of the physician's illegible handwriting on prescriptions and the pharmacist's misinterpretation of subtle clues, which might have prevented the errors. The literature on the legibility of physician handwriting is reviewed. Our specific recommendations include using preprinted prescription pads, training staff assistants who write prescriptions, printing complete directions on each prescription, and aggressively educating each patient about the name and purpose of all drugs being prescribed. Patients are encouraged to bring their medications to each office visit to identify potential errors.

Handwriting↗
PubMed1997

Parkinsonism reduces coordination of fingers, wrist, and arm in fine motor control.

This experiment investigates movement coordination in Parkinson's disease (PD) subjects. Seventeen PD patients and 12 elderly control subjects performed several handwriting-like tasks on a digitizing writing tablet resting on top of a table in front of the subject. The writing patterns, in increasing order of coordination complexity, were repetitive back-and-forth movements in various orientations, circles and loops in clockwise and counterclockwise directions, and a complex writing pattern. The patterns were analyzed in terms of jerk normalized for duration and size per stroke. In the PD subjects, back-and-forth strokes, involving coordination of fingers and wrist, showed larger normalized jerk than strokes performed using either the wrist or the fingers alone. In the PD patients, wrist flexion (plus radial deviation) showed greater normalized jerk in comparison to wrist extension (plus ulnar deviation). The elderly control subjects showed no such effects as a function of coordination complexity. For both PD and elderly control subjects, looping patterns consisting of circles with a left-to-right forearm movement, did not show a systematic increase of normalized jerk. The same handwriting patterns were then simulated using a biologically inspired neural network model of the basal ganglia thalamocortical relations for a control and a mild PD subject. The network simulation was consistent with the observed experimental results, providing additional support that a reduced capability to coordinate wrist and finger movements may be caused by suboptimal functioning of the basal ganglia in PD. The results suggest that in PD patients fine motor control problems may be caused by a reduced capability to coordinate the fingers and wrist and by reduced control of wrist flexion.

Adult↗
PubMed1997

Dysgraphia in children: lasting psychomotor deficiency or transient developmental delay?

A longitudinal design was applied to differentiate between normal variations of psychomotor development and lasting handwriting deficiency (dysgraphia). Sixteen primary school children were tested with writing tasks that were recorded on a computer-monitored'XY tablet. These tasks represented different modules of the handwriting model of Van Galen (1991). Dependent variables were spatial errors, movement time, movement dysfluencies, trajectory length, stroke curvature, and the degree of neuromotor noise in the movement velocity profiles. The latter variable was measured by means of Power Spectral Density Analysis of the movement velocity signal, which revealed that movements of poor writers were substantially more noisy than those of proficient writers, with a noise peak in the region of neuromotor tremor. At the same time, the poor writers were less accurate. It was concluded that control of spatial accuracy rather than allograph retrieval or size control is the discriminating feature in dysgraphic children. Moreover, poor writers do not catch up with their peers within the 1 year time span tested.

Agraphia↗
PubMed1981

Medication effects in the classroom: three naturalistic indicators.

Hyperactive and comparison boys participated in 5-week summer enrichment programs that included classroom activities and structured assessments of peer interaction patterns. During the 3rd and 4th weeks of these programs, a double-blind, methylphenidate-placebo crossover design was implemented within the hyperactive group. Three heterogeneous indicators of everyday behaviors were obtained: number of negative incidents noted by staff, quality of handwriting, and number of times the teacher called the boys' names aloud in the classroom. Medication effects emerged for each of these indicators. When hyperactive boys were taking placebos, they were involved in more negative incidents, their handwriting was poorer, and their names were called more-frequently than when the boys were taking methylphenidate. Interrelationships among the measures suggest moderate cross-situational generality of medication responsiveness. Discussion focused on the bandwidth of medication effects and the need to examine the social ramifications of child treatments.

Attention Deficit Disorder with Hyperactivity↗
PubMed1994

Deciphering the physician note.

Objective information about legibility of physician handwriting is scant. This retrospective chart review compared handwritten general medicine clinic chart notes from internal medicine faculty and housestaff with their typed counterparts. The written counterparts took 11 seconds (46%) longer to read and 5 seconds (11%) longer to answer comprehension questions. The authors' comprehension measure (developed specifically for ambulatory clinic notes) was only slightly higher for typed notes. The legibility of physician handwriting is not as dismal as assumed; physicians can effectively communicate on paper.

Handwriting↗
PubMed2006

Impact of computerised chemotherapy prescriptions on the prevention of medication errors.

OBJECTIVES: The authors sought to evaluate the impact of computerised chemotherapy prescription on the reduction of medication errors. The purpose of this study was to assess the incidence of errors present in electronic versus manual prescription. MATERIAL AND METHODS: The data gathered from computerised chemotherapy prescription sheets were submitted to a prospective analysis as cases of the intervention groups. The control group was comprised of the handwritten chemotherapy prescription sheets. Chemotherapy prescriptions for consecutive oncology patients were analysed by 2 independent examiners, who investigated errors of omission, commission, interpretation of dates, abbreviations and illegible handwriting. The proportion of treatment prescriptions containing one or more errors and the median of errors were calculated in order in both groups. RESULTS: At least one error was detected in 100% of the manual prescriptions and in 13% of computerised prescriptions (p < 0.001). The median of errors per computerised prescription was 0 (range: 0- 1), whereas in manual prescriptions the median was 5 (range: 1-12) (p < 0.001). Errors of omission were predominant in manual prescriptions. Errors of commission were limited to 1 case of unjustified cytostatic agent infra-dosage in a computerised prescription. This error was present in 3 cases in handwritten prescriptions and, in addition, 1 case of premedication drug substitution was detected. Errors of interpretation of the date, use of abbreviations and illegible handwriting were frequent among manual prescriptions and were absent from computerised prescriptions. CONCLUSIONS: Electronic chemotherapy prescription is a powerful tool. In this study it has been shown to decrease chemotherapy-related medication errors and ensure that safe chemotherapy practices were followed.

Antineoplastic Agents↗
PubMed1984

Multiple component agraphia in a patient with atypical cerebral dominance: an error analysis.

A 52-year-old man with atypical cerebral dominance (left-handed for writing but mixed handedness for other tasks) suffered an extensive right hemisphere stroke, resulting in a combination of deficits that has not been previously reported. There were profound visual constructive and visual perceptual disturbances and a spatial agraphia, which were consistent with a nondominant hemisphere lesion. There was also a severe apraxic agraphia, which is typically associated with a dominant hemisphere lesion, but no other signs of dominant hemisphere dysfunction such as linguistic disturbance or limb-motor apraxia were present. This case serves to highlight the functional and anatomical relationship between handwriting and other forms of praxis; the various sources of error in letter formation; the need to be specific in labeling and describing agraphias ; and the role of a detailed analysis of writing errors in delineating the neuropsychological processes involved in handwriting.

Agraphia↗
PubMed1987

Neuropsychological analysis of a typewriting disturbance following cerebral damage.

Following a left CVA, a skilled professional typist sustained a disturbance of typing disproportionate to her handwriting disturbance. Typing errors were predominantly of the sequencing type, with spatial errors much less frequent, suggesting that the impairment was based on a relatively early (premotor) stage of processing. Depriving the subject of visual feedback during handwriting greatly increased her error rate. Similarly, interfering with auditory feedback during speech substantially reduced her self-correction of speech errors. These findings suggested that impaired ability to utilize somesthetic information--probably caused by the subject's parietal lobe lesion--may have been the basis of the typing disorder.

Aphasia↗
PubMed1984

A review, analysis, and some new data on hand-posture distributions in left-handers.

Different methods have been employed to assess handwriting posture in left-handers, and different dimensions of hand posture have been used for categorization. Within North American samples, there is a remarkable consistency between studies in the distributions when the same assessment method is used, but there are very large and highly significant differences for different methods of assessment. The various methods and dimensions of categorization evidently index different variables, and these are likely to have different relations with neuropsychological factors. It is possible, however, to gather questionnaire data on handwriting posture that closely resemble direct experimenter observation, as a brief report on left-handed males shows.

Female↗
PubMed2004

Limitations of the dual-process-theory regarding the writing of words and non-words to dictation.

It is generally assumed that the lexical and phonological systems are involved in writing to dictation. In an experiment concerned with the writing of words and non-words to dictation, the handwriting of female students was registered using a digitising tablet. The data contradict the assumption that the phonological system represents an alexical process. Both words and non-words which were acoustically presented to the subjects were lexically parsed. The analysis of kinematic data revealed significant differences between the subjects' writing of words and non-words. The findings reveal gross disturbances of handwriting fluency during the writing of non-words. The findings of the experiment cannot be explained by the dual-process-theory.

Adult↗
PubMed2005

Quantification of the shape of handwritten characters: a step to objective discrimination between writers based on the study of the capital character O.

In view of contributing to the scientific validation of the individuality of handwriting, the testing of the two so called fundamental laws of handwriting--1: no two people write exactly alike; 2: no one person writes the same word exactly the same way twice--was approached by analysing the shape of 445 handwritten capital characters O produced by three individuals. A methodology based on classical Fourier descriptors was applied to the characters contours, which were extracted through an automated procedure of image analysis. Precise individual characterization of the shape was possible through Fourier analysis. Within-writer variability of the shape of character O for the writers selected could be shown in an objective and quantitative way through the statistical analysis of the Fourier descriptors. It was demonstrated that this polymorphism differed between the three writers. Differentiation between writers was quantitatively demonstrated by discriminant analysis of the Fourier descriptors, and by the existence of marked morphological distances between the set of characters O of each writer. The degree of dissimilitude of the character O writings could, thus, be assessed. Because of relatively reduced within-writer variability and a pronounced differentiation between the writers, a morphological profile could be established and discrimination between writers could be obtained through the quantification of the shape of one handwritten character.

Discrimination, Psychological↗
PubMed2006

Modified pen grip in the treatment of Writer's Cramp.

Writer's Cramp (WC) is a focal, action-related dystonia, which induces hypertonic co-contractions and severely impairs handwriting. One behavioral treatment approach is the handwriting training developed by Mai and Marquardt (1999), [Mai, N., & Marquardt, C. (1999). Schreibtraining in der neurologischen Rehabilitation. In EKN-Materialien für die Rehabilitation. Dortmund: Borgmann] which includes among various motor exercises the use of a modified pen grip (stabilized between index and middle finger). This pen grip has proven particularly successful in clinical practice. The current study aims at elucidating the immediate effects of the modified pen grip on writing in 23 WC patients and 11 healthy controls. All participants wrote a sentence with their usual and also with the modified pen grip. Movement and pressure were recorded with a digitizing tablet. Pressure, movement time for the whole sentence, script size and writing fluency were analyzed. When writing with their usual pen grip, pressure in the WC patients was elevated, and writing speed was decreased compared to healthy controls. Changing over to the modified pen grip reduced the pressure significantly in WC patients and controls, but left other aspects of their writing unaffected. This shows that the use of the modified pen grip is an effective way to normalize pen pressure in WC patients, thereby providing the best conditions for the training of speed and fluency.

Adult↗
PubMed2005

Premotor activations in response to visually presented single letters depend on the hand used to write: a study on left-handers.

In a previous fMRI study on right-handers (Rhrs), we reported that part of the left ventral premotor cortex (BA6) was activated when alphabetical characters were passively observed and that the same region was also involved in handwriting [Longcamp, M., Anton, J. L., Roth, M., & Velay, J. L. (2003). Visual presentation of single letters activates a premotor area involved in writing. NeuroImage, 19, 1492-1500]. We therefore suggested that letter-viewing may induce automatic involvement of handwriting movements. In the present study, in order to confirm this hypothesis, we carried out a similar fMRI experiment on a group of left-handed subjects (Lhrs). We reasoned that if the above assumption was correct, visual perception of letters by Lhrs might automatically activate cortical motor areas coding for left-handed writing movements, i.e., areas located in the right hemisphere. The visual stimuli used here were either single letters, single pseudoletters, or a control stimulus. The subjects were asked to watch these stimuli attentively, and no response was required. The results showed that a ventral premotor cortical area (BA6) in the right hemisphere was specifically activated when Lhrs looked at letters and not at pseudoletters. This right area was symmetrically located with respect to the left one activated under the same circumstances in Rhrs. This finding supports the hypothesis that visual perception of written language evokes covert motor processes. In addition, a bilateral area, also located in the premotor cortex (BA6), but more ventrally and medially, was found to be activated in response to both letters and pseudoletters. This premotor region, which was not activated correspondingly in Rhrs, might be involved in the processing of graphic stimuli, whatever their degree of familiarity.

Adult↗
PubMed2006

Ablative stereotactic surgery improves manual performance time in Parkinson's disease.

The objective of this study was to determine the influence of stereotactic ablative surgical interventions on the time required for the performance of manual tasks (i.e. performance time) in patients with Parkinson's disease (PD). We studied 28 patients after pallidotomy and pallido-thalamotomy who were evaluated at four time: before the operation, and 2 days, 3 and 6 months postoperatively. The speed of performance of handwriting and drawing were assessed by means of a chronometer using certain parts of an international standard scale (modified by Fahn). The patients were also assessed according to the Unified Parkinson's Disease Rating Scale (UPDRS) part III. The patients were divided into two groups. Those in group A had relief of all main Parkinsonian symptoms after pallidotomy including tremor. The patients in group B had no relief of tremor straight after pallidotomy. For them the pallidotomy was completed with thalamotomy in the same sitting, which had resulted in cessation of tremor. The time of performance of the manual tasks diminished significantly in all cases in both groups (Student's t-test: p<0.0001). No complications developed following pallidotomy. Pallido-thalamotomy caused transient adverse effects in two patients, and one patient developed permanent adverse effects such as dysarthria and dysequilibrium. Significant improvements were observed in the speed of handwriting and drawing in both groups, but pallido-thalamotomy was accompanied with complications.

Globus Pallidus↗
PubMed1998

The stability of pen-joint and interjoint coordination in loop writing.

This study is concerned with pen-joint and interjoint coordination in handwriting. In particular, it focuses on the stability of coordination as a means to find the locus of coordination control in the arm-pen effector system. Twelve subjects generated loop sequences of varying length at various positions on the baseline of writing. Joint excursions and pen-tip displacements were recorded by means of a 3D-motion tracking system. The coordination stability of 15 pairs of 6 mechanical degrees of freedom (d.f.s) of the arm-pen effector system was investigated by means of relative phase analyses. Pen-joint coordination between horizontal pen-tip displacements and wrist excursions was found to be most stable; that between vertical pen-tip displacements and finger excursions was considerably less stable. Interjoint coordination was generally less stable than pen-joint coordination, and most stable between the wrist and the elbow. Sequence length and its position on the line differentially affected the coordination stability of the d.f. combinations. The results are discussed in relation to assumptions about joint coordination in writing as expressed by computational handwriting models.

Adult↗
PubMed1994

Pure dysgraphia with relative sparing of lower-case writing.

We describe the cognitive analysis of a patient with acquired pure dysgraphia. She presented a peculiar dissociation between lower- and upper-case handwriting: lower-case writing was relatively spared and showed a significant superiority of words versus nonwords. Upper-case writing and oral spelling did not show lexical effects, but were affected by item length. In all modalities errors consisted mainly of single graphemic substitutions, deletions, insertions and transpositions, resulting in legal or illegal nonwords, and showed a similar distribution across letter positions. These findings were suggestive of an impairment of the graphemic output buffer, which however revealed itself to different degrees in the two handwriting styles.

Aged↗
PubMed1989

Writing posture in right hemiplegic children.

The handwriting posture of 29 children with congenital right hemiparesis was classified according to standard criteria. All 29 children, who ranged in age from 4 to 14 years, were classified unambiguously as noninverted writers. The prevalence of noninverted writing in this sample differs significantly from that reported for the general population of children. The data thus support the claim that neural factors contribute to handwriting posture.

Adolescent↗