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PubMed1984

Medical and legal problems in psychiatric coding under the DSM and ICD systems.

The various diagnostic systems in psychiatry have differed in their terminology and associated numerical codes. Lack of attention to coding variations in the DSM and ICD systems during the review of patient records can lead to misinterpretation and confusion; reliance on historical or statistical studies that use differing systems may be questionable. Two cases illustrate the problems caused by lack of awareness of these factors. Specification by the psychiatrist of both the diagnostic system used and the appropriate revision or edition can lessen communication error or misunderstanding.

Confidentiality↗
PubMed2002

Fast drops: a high-throughput approach for setting up protein crystal screens.

There is significant demand to rapidly obtain protein structure information for both structural genomics and drug discovery applications. To meet this demand, all steps in the process of determining protein structure by X-ray crystallography need to be optimized and streamlined with high-throughput methodologies. This communication describes a method that brings high-throughput technology to protein crystallization in both manual and automated modes, suitable for virtually every crystallography laboratory.

Crystallization↗
PubMedDate not supplied

[HIV, HBV, or HCV transmission from infected health care workers to patients].

BACKGROUND: The report of transmission of viruses, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), from health care workers (HCWs) to patient has alarmed public opinion with potential repercussions on health organisation. OBJECTIVES: To review available information on cases of transmission of HIV, HBV and HCV from HCW to patient reported worldwide. METHODS: A literature review was conducted with a Medline search of English language full papers, using the following key terms: HIV, HBV, HCV; healthcare workers, occupational and hospital transmission, outbreak, look back investigation. The Medline search was supplemented by a manual search using reference lists of published studies and proceedings of meetings, including some personal communications already reported in a previous review. RESULTS: Since 1972, 50 outbreaks have been reported in which 48 HBV infected HCWs (39 surgeons) transmitted the infection to approximately 500 persons. To date, 3 cases of transmission of HIV and 8 confirmed cases of transmission of HCV (to a total of 18 patients) from infected healthcare workers to patients have been reported. The factors influencing the transmissibility of infection include: type of procedures performed, surgical techniques used, compliance with infection control precautions, the clinical status and viral burden of the infected HCW and susceptibility of the patient to infection. The risk of transmission of HIV, HBV and HCV from HCWs to patients is associated primarily with certain types of surgical specialties (obstetrics and gynaecology, orthopaedics, cardiothoracic surgery) and surgical procedures that can expose the patient to the blood of the HCW: exposure-prone procedures. Since the early 90's industrialized countries have issued recommendations for preventing transmission of blood-borne pathogens to patients during "exposure prone" invasive procedures. With regard to HBV there is common consent to restricting or excluding HCWs tested HbeAg positive or HBV DNA-positive from performing exposure-prone procedures, while there are still some discrepancies in the different countries for dealing with HCV-infected personnel and in some cases also for those with HIV infection. CONCLUSIONS: Efforts to prevent surgeon-to-patient transmission of blood-borne infections should focus not only on ascertaining the infection status of the HCW but principally on eliminating the cause of blood-borne exposures, for example by the use of blunt suture needles, improved instruments, reinforced gloves, changes in surgical technique and the use of less invasive alternative procedures. These measures should be implemented in order to minimize the risk of blood exposure and consequently of virus transmission both to and from HCW to patients.

HIV Infections↗
PubMed1991

[Nutritional assessment of women working in the textile industry in Lodz from 1986 to 1989].

This communication was designed to determine the intake of food products and nutrients in randomly selected manual workers (women) of the textile industry, as well as to quantitatively evaluate the deficiency or excess of nutrients in their average diet. Daily nutrition was evaluated in 300 females, manual workers aged 35-44 years. Rheir nutrition was assessed by the method of a questionnaire concerning food intake during 24 h prior to the inquiry. As a result, the kind of nutrition was determined. Moreover, the nutritive value of the daily food rations, as well as the intake of the different groups of food products were calculated and compared with the recommended food standard B. The results indicate that: the observed unbalanced nutrition involving deficiencies of milk, vegetables, fruits and cereals may lead to e.g. disturbances in the acid-base equilibrium and to hypovitaminoses; the deficiency of magnesium and calcium creates the risk at the accelerating sclerotic changes; deficiencies of iron, zinc and cooper in the diet of women of reproductive age may result in the occurrence of anemia and exert an adverse effect on the offspring; on account of work in two or three shifts, it is indispensable to organize taking of meals during working hours.

Adult↗
PubMed2002

Documenting diabetes care: the diabetes nurse specialists' perspective.

Diabetes Nurse Specialists (DNSs) are often the hub of the communications network for the entire diabetes multiprofessional health care team, patients and their families. Frequently they liaise between primary and secondary care and have a key role in the provision of a 'seamless service'. To work effectively and efficiently they need a foolproof system of documentation and communication. The aim of the study was to investigate the means by which DNSs document patient care in order to provide baseline information about ongoing record-keeping practices. The study comprised a cross-sectional survey in which data were obtained by questionnaire. All DNSs in the UK registered with the British Diabetic Association were invited to participate in the study. A 70.3% response rate was achieved (n = 545). The results indicated that manual profession-specific records were used by 65.3% of DNSs, 21.1% used shared/integrated records, 12.8% used computerized records and only 0.7% made use of patient-held records. Whilst almost all DNSs felt that a good record-keeping system was essential in providing 'seamless care' to patients, not all felt their system was efficient. Of those using a computerized system 65.7% rated it as efficient, compared with only 28.1% of those using a profession-specific system and 26.1% of those using a manual shared system. A high percentage of DNSs (65.9%) felt that the provision of 'seamless care' was hindered by communication problems with members of other professional groups. The findings from this study indicate that computers alone cannot bridge the gap between primary and secondary care, but 'seamless care' may become more of a reality with computerized record-keeping systems and participation by all members of the multidisciplinary team.

Attitude of Health Personnel↗
PubMed2006

PECS and VOCAs to enable students with developmental disabilities to make requests: an overview of the literature.

This paper provides an overview of the literature dealing with the use of the Picture Exchange Communication System (PECS) and voice output communication aids (VOCAs) for promoting the performance of requests by students with developmental disabilities. Computerized and manual searches were carried out to identify the studies published during the last 15 years (i.e., the period between 1992 and 2006 during which PECS and VOCA approaches became popular). Thirty-seven studies were identified and then divided into three groups concerning the use of the PECS or equivalents, the use of VOCAs or equivalents, and the comparison of both these approaches, respectively. Of the 173 students involved in studies using the PECS or equivalents only three could be considered failures, while a fourth one did not progress in the program due to illness. Similarly, of the 39 students who used VOCAs or equivalents only three could be considered failures, while one was partly successful. Finally, of the 11 students involved in the comparisons between PECS and VOCAs none could be classified as a failure. The results are very encouraging but methodological concerns and the relatively limited use of the systems in terms of request items and request opportunities suggest caution. Caution may also be needed in interpreting the reported similarities between the two systems in usability and effectiveness.

Adolescent↗
PubMed1998

Evaluating therapist competency and adherence to behavioral family management with bipolar patients.

The present study assessed fidelity to the behavioral family management (BFM) model for treating bipolar disorder patients and their families. The BFM Therapist Competency/Adherence Scale (BFM-TCAS) was developed to evaluate clinicians' competency and adherence to BFM, as outlined by Miklowitz' (1989) BFM Manual for use with bipolar patients. Therapist competency and treatment adherence was also evaluated with regard to two family characteristics: overall level of family difficulty and family expressed emotion (EE) status. The BFM-TCAS was used to code 78 videotaped sessions of 26 families with a bipolar member, selected from a larger treatment study of bipolar disorder patients. The findings suggest that, overall, clinicians adhered closely to the BFM manual. Specific areas in which there was high competency and treatment adherence were (a) skill in conveying factual information about bipolar illness, (b) establishment of a therapeutic environment, and (c) ability to take command of therapy sessions. The one area in which there was less competency and relatively weak adherence to the manual was the use of between-session homework assignments to assist families in mastering the BFM exercises. Results of this study also suggest that, for the most part, therapist competency and adherence ratings were not related to overall level of difficulty or to family EE status.

Adolescent↗
PubMed1998

Allegations of sexual abuse by nonverbal autistic people via facilitated communication: testing of validity.

OBJECTIVE: The aim of the paper is to offer a comprehensive approach to establishing the validity of allegations of sexual abuse by nonverbal autistic children and adults produced through facilitated communication (FC). This approach is offered as an alternative to existing methodology that relies exclusively on the "message passing" task, and has been used to advantage in the courts. METHOD: Three components to the battery are included: (a) specialized psychometric testing; (b) a variant of the message passing task; and (c) systematic analysis of the allegations themselves. Through the juxtaposition of the data from the different sources, conclusions can be reached as to the allegations' authorship. RESULTS: The results of a series of studies addressing the issue of validity of FC in general are briefly presented. Then a case presentation is offered to demonstrate how the technique can be employed to clarify allegations of sexual abuse. Elements of two other cases are also briefly discussed. CONCLUSIONS: Facilitated communication has been heralded as a breakthrough, allowing nonverbal people with autism to express themselves. It relies on manual guidance by a facilitator. Its proponents' resistance to allowing the technique's validation relying on the paradigm of normal science has resulted in its broad dissemination without support. In the case of sexual abuse allegations thus far the "message passing" task has been used to assess their verity. The present methodology is offered as a more comprehensive alternative to "message passing," with relevance to other populations of nonverbal individuals.

Adult↗
PubMed1994

Computer program for connection and data management of an automated coagulation system: the KC 10.

In Europe, the KC 10, manufactured by Amelung Germany, is one of the instruments most commonly found in coagulation laboratories. For facilitating the work of technical validation, we wrote a software adapted to any IBM or compatible PC running under MS-DOS, to manage the analyser performance. Data are automatically collected via the BCD interface from the analyser or keyed in for the other techniques. The software deals with 64 different analyses entirely 'user defined'. An 'electronic worksheet' presents the results, by page of ten patients. This enables the laboratory technician to assess the coherence of the various data and to perform verifications or complementary tests if necessary. As an option, a blinking asterisk can signal all results outside predetermined range. By moving the cursor through the table, a test result can be deleted, modified or added. A function displays the patient's previous files in a window because the data are recorded in long-term archives at the end of the day. This long-term recording allows a search of previous files to decide additional tests if the patient is unknown. A daily archive function classifies and prints the whole day's work in alphabetical order. A protocol of communication allows connection to a mainframe Bayer-Technicon computer. This program and the user's manual are free, available on request from address above.

Blood Coagulation Tests↗
PubMed2007

How to make an autonomous robot as a partner with humans: design approach versus emergent approach.

In this paper, we discuss what factors are important to realize an autonomous robot as a partner with humans. We believe that it is important to interact with people without boring them, using verbal and non-verbal communication channels. We have already developed autonomous robots such as AIBO and QRIO, whose behaviours are manually programmed and designed. We realized, however, that this design approach has limitations; therefore we propose a new approach, intelligence dynamics, where interacting in a real-world environment using embodiment is considered very important. There are pioneering works related to this approach from brain science, cognitive science, robotics and artificial intelligence. We assert that it is important to study the emergence of entire sets of autonomous behaviours and present our approach towards this goal.

Artificial Intelligence↗
PubMed1999

Efficacy and safety of rivastigmine in patients with Alzheimer's disease: international randomised controlled trial.

OBJECTIVES: To assess the effects of rivastigmine on the core domains of Alzheimer's disease. DESIGN: Prospective, randomised, multicentre, double blind, placebo controlled, parallel group trial. Patients received either placebo, 1-4 mg/day (lower dose) rivastigmine, or 6-12 mg/day (higher dose) rivastigmine. Doses were increased in one of two fixed dose ranges (1-4 mg/day or 6-12 mg/day) over the first 12 weeks with a subsequent assessment period of 14 weeks. SETTING: 45 centres in Europe and North America. PARTICIPANTS: 725 patients with mild to moderately severe probable Alzheimer's disease diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, and the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. OUTCOME MEASURES: Cognitive subscale of the Alzheimer's disease assessment scale, rating on the clinician interview based impression of change incorporating caregiver information scale, and the progressive deterioration scale. RESULTS: At the end of the study cognitive function had deteriorated among those in the placebo group. Scores on the Alzheimer's disease assessment scale improved in patients in the higher dose group when compared with patients taking placebo (P<0.05). Significantly more patients in the higher dose group had improved by 4 points or more than had improved in the placebo group (24% (57/242) v 16% (39/238)). Global function as rated by the clinician interview scale had significantly improved among those in the higher dose group compared with those taking placebo (P<0.001), and significantly more patients in the higher dose group showed improvement than did in the placebo group (37% (80/219) v 20% (46/230)). Mean scores on the progressive deterioration scale improved from baseline in patients in the higher dose group but fell in the placebo group. Adverse events were predominantly gastrointestinal, of mild to moderate severity, transient, and occurred mainly during escalation of the dose. 23% (55/242) of those in the higher dose group, 7% (18/242) of those in the lower dose group, and 7% (16/239) of those in the placebo group discontinued treatment because of adverse events. CONCLUSIONS: Rivastigmine is well tolerated and effective. It improves cognition, participation in activities of daily living, and global evaluation ratings in patients with mild to moderately severe Alzheimer's disease. This is the first treatment to show compelling evidence of efficacy in a predominantly European population.

Activities of Daily Living↗
PubMed2006

What is manipulative behavior, anyway?

One of the most common ways of characterizing patients diagnosed with borderline personality disorder is that they are manipulative. Clinical usage of the term varies widely but clearly carries a pejorative meaning. Furthermore, behaviors that look similar to those called manipulative in clinical contexts are not called manipulative in broader society. It is crucial to become clear on what manipulation is, because studies show that carers routinely perceive BPD patients as manipulative and so have less empathy for them. In this paper the concept of manipulativity is clarified and its scope narrowed by distinguishing it from a number of related concepts, and a number of reasons why manipulating others is morally objectionable are suggested. I argue that, while some BPD patients may be manipulative, much of their behavior can and should be understood in a different light. Moral and clinical values are conflated in carers' judgments of manipulativity, and clinicians and researchers need to clarify when and why manipulative behavior is dysfunctional, and when it is merely morally wrong. Separating these two domains will enable carers to be more empathetic and less blaming of their patients' behavior.

Behavior Control↗
PubMed2004

Hispanic ethnicity, language, and depression: physician-patient communication and patient use of alternative treatments.

OBJECTIVE: To examine the relationship between Hispanic ethnicity and language spoken with physician communication about depression and patient use of alternative treatments for depression. METHOD: This is a secondary data analysis from a trial of depression screening conducted in four primary care clinics. Patients with Hispanic or non-Hispanic White ethnic backgrounds and those meeting DSM-III-R criteria for current major depression, minor depression, dysthymia as well as those that screened positive on a depression screening instrument (n = 141) are included in this analysis. We labeled those who screened positive for depression but did not meet DSM-IIIR criteria for a current depressive disorder as "distressed." Clinicians' use of counseling and patient use of alternative treatments were based on patient self-report. RESULTS: Forty-two percent (n = 59) of the sample stated that their physician had either told them that they had depression, treated them for depression, or recommended that they seek help for depression. Over 40% of patients spent time talking with their physicians at their current visit about what was making them depressed and 34% received counseling about depression. Hispanic ethnicity and language were not significantly related to physician communication with patients about how to overcome depression. Thirty-six percent of patients reported talking with a minister or other religious person about feelings of depression or sadness. Seventeen percent of patients had used herbal remedies or non-prescription medications and 5% had seen a curandero for feelings of depression or sadness. Hispanic ethnicity and language were not significantly related to patient use of alternative treatments for depression. CONCLUSIONS: Hispanic ethnicity and language were not significantly related to physician-patient communication about depression or patient use of alternative treatments for depression. Physicians should make sure to ask patients about all of the types of things they are doing to help overcome their depression.

Choice Behavior↗
PubMed1993

Education literature for Hispanic patients.

A patient tells his home health nurse through an interpreter that he does not understand the treatment consent form. The form is printed in English. The patient understands only Spanish. A young woman learned her child's home antibiotic therapy through a demonstration given in Spanish. She now wants to review the procedure to program the pump that controls the intravenous dose. The manual is printed in English. The young mother understands only Spanish. These examples reflect the growing communication problems facing home care workers who work in Hispanic communities.

Hispanic or Latino↗
PubMed1998

The lung scan in patient selection for lung volume reduction surgery.

UNLABELLED: The lung scan is one of the most important diagnostic tests used for selecting candidates for lung volume reduction surgery (LVRS) and for determining the actual percentage of lung to be resected during the surgery (McKenna R, personal communication, 1997). This article describes the anatomical quantitation of the lungs. METHODS: We used automatic and manual regions of interest in the posterior, and both posterior obliques of lung perfusion images to calculate the percent function in each individual lung lobe. RESULTS: We evaluated 172 patients with this technique. Subsequently 136 of these patients had LVRS. CONCLUSION: The anatomical placement of regions of interest in the lung perfusion image aids the thoracic surgeon in selecting LVRS candidates and in determining the amount of lung to be resected during surgery.

Aged↗