Updating clinical dietetics: terminology.
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Abstracting and Indexing↗
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Information systems integration in radiology.
Advances in information systems and technology in conjunction with outside forces requiring improved reporting are driving sweeping changes in the practice of radiology. In most academic radiology departments, there can be at least five separate information systems in daily use, a clinical picture archiving and communication system (PACS), a hospital information system (HIS), a radiology information system (RIS), a voice-recognition dictation system, and an electronic teaching/research file system. A PACS will have incomplete, incorrect, and inconsistent data if manual data entry is used. Correct routing of studies for diagnostic reporting and clinical review requires accurate information about the study type and the referring physician or service, often not easily entered manually. An HIS is a hospital-wide information system used to access patient information, reports from various services, and billing information. The RIS is typically a system specifically designed to place radiology orders, to receive interpretations, and to prepare bills for patients. Voice-recognition systems automatically transcribe the radiologist's dictation, eliminating transcription delays. Another system that is needed in a teaching hospital holds images and data for research and education. Integration of diverse systems must be performed to provide the functionality required by an electronic radiology department and the services it supports. Health Level 7 (HL7) and Digital Imaging and Communications in Medicine (DICOM) have enabled sharing of data among systems and can be used as the building blocks for truly integrated systems, but the user community and manufacturers need to specify the types of functionality needed to build clinically useful systems. Although technology development has produced the tools for interoperability for clinical and research/educational use, more work needs to be done to define the types of interaction that needs to be performed to realize the potential of these systems.
Computer Communication Networks↗
Manual activity during speaking. I. Right-handers.
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Auditory Perception↗
A study of potential roles of supersonic transport crews and some implications for the flight deck. Volume II. Feasible automated and manual implementation concepts for SST activities and functions. NASA CR-562.
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Automation↗
[Training in preventing assaultive behaviors for psychiatric professionals].
Dangerous behaviors in psychiatric institutions constitute major clinical and administrative problems. Staff competency in dealing with assaultive patients is an important factor in reducing institutional violence. One of the training programs for mental health staff working with dangerous patients is called Professional Assault Response Training (PART). PART is a product of several years of experience accumulated by the group of California authors in their efforts at designing a safe and effective approach in responding to various dangerous behaviors. PART principles guide staff in 1) de-escalating dangerous incidents through verbal crisis interventions; 2) avoiding or minimizing the risk of minor physical injury through evasion; 3) preventing serious bodily harm through the use of manual restraint. The importance of maintaining self-control by staff is reinforced throughout the entire course as a crucial professional skill. Other PART principles include identifying realistic treatment expectations for assaultive patients, proper physical mobility and emotional balance of staff, recognizing warning signals of impeding danger, using reasonable force to match response to the level of dangerousness. The PART training explores various theoretical explanations of violence (legal model, stress model, environmental model, communication model, developmental model, basic needs model and common-sense model). Verbal interventions which are a cornerstone of the PART approach are matching specific motives of threatening behavior--fear, frustration, manipulation and intimidation. Physical interventions taught in the course (evasion and manual restraint) include only techniques which can be used safely and which are not pain inducing. Finally, the PART training also assists staff in properly documenting assaultive incidents.
Aggression↗
National rural health mission--opportunity for Indian Public Health Association.
Indian Public Health Association (IPHA) welcomes the release of National Rural Health Mission (NRHM) documents. It suggests that manpower requirements of the Community Health Centre (CHC) should be rationally determined on the basis of work and patient load of the CHC. Importance should be given on availability of simple & life saving equipment, female staff when male staff is not available. Safe drinking water, an adequate sanitation and excreta disposal facility through Panchayet Raj Institution (PRI) or privatization was proposed. Accredited Social Health Activist (ASHA) has been accepted more streamlining based on the community was suggested. Capacity building or training should be CHC based for grass-root level functionaries with incentive to Medical officer (MO). IPHA proposes to extend support in capacity building, development of manual for ASHA & other categories of health professional as well as Program Implementation Plan (PIP).
Communication↗
Professional standards and public accountability.
In a rapidly evolving healthcare environment, nurse anesthetists will experience increased pressure to deliver value based anesthesia care. Activities of the professional association must be dedicated to advancing patient safety and excellence in anesthesia. To best serve the public and the profession, the nurse anesthetist profession must continue to be accountable for quality of care to patients, committed to continuing competency for professional practice, and promote sustained communication and dissemination of research-based standards development.
Certification↗
Coordinating shared care using electronic data interchange.
Shared care is the situation in which physicians jointly treat the same patient. Shared care may occur with elderly patients suffering from several health problems, patients with chronic disorders such as diabetes, mellitus, obstructive pulmonary diseases, or cardiological disorders. For a number of health problems, including diabetes, shared care protocols have been developed involving division of tasks between health care providers from different disciplines [1]. Optimal communication is considered to be a vital aspect of shared care, both from medical and cost-effectiveness points of view, but at the same time communication forms the bottleneck as physicians often lack time to comply with the protocol [2]. At present, new technologies are emerging that hold the promise of improving communication between health care providers. One such technology is Electronic Data Interchange (EDI), defined as "the replacement of paper documents by standard electronic messages conveyed from one computer to another without manual intervention" [3]. In Europe, the ISO syntax standard EDIFACT has been adopted as the standard for defining EDI-messages [4]. In The Netherlands, coordination of the standardization of health care messages is performed by a national organization. At present, several standardized messages are available for a variety of purposes. One is a message for data exchange between physicians; in this message, however, only physician-patient- and hospital-identifying data are structured, and all medical data is transferred as free text. Consequently, using this message, the receiving system is unable to integrate the data into the computer-based patient record. In order to support shared care, a message is needed that can also transfer the structure of the data in a computer-based record in order to allow integration of records from multiple sources. Therefore, we developed a new message, called MEDEUR, that is designed for integrated patient data exchange between computer-based patient records. The message can contain both administrative and medical data and can be used for transmission of a complete medical record, or sections of it. Our departments are working on a project in which general practitioners and specialists use their own electronic medical record system for storing data of jointly treated patients. In addition, the participating physicians use the MEDEUR message standard in communicating about these patients. The use of EDI enables physicians to transmit patient data electronically to another physician's computer system. The receiving physician can store the data automatically in his electronic medical record without having to re-type the data. We will demonstrate the electronic data interchange functionality of the general practitioner's information system, ELIAS, and the integrated composing and storing of electronic messages. We will also discuss several system design issues.
Computer Communication Networks↗
Effects of early manual instruction on the oral-language development of two deaf children.
The speech and language training provided to deaf children at our clinic is done by the Kanazawa Method, which consists of reception and expression training in sign communication and auditory/oral language, as well as written-language training. In our investigation, we analyzed the acquisition of passive and active vocabulary in sign and oral language. The subjects were two children congenitally deaf at the 105 dB level or greater. Recorded-language samples through the age of 54 months were analyzed. Acquisition of sign occurred more quickly than oral-language acquisition. The children's production of active nouns, function words, and "wh-" question words in sign was equivalent to that of hearing peers, and later this proficiency transferred to oral language. These results suggest that early presentation of sign is effective in the acquisition of function words and interrogative sentences, both of which are especially challenging for the Deaf.
Child Development↗
Reciprocal peer teaching: students teaching students in the gross anatomy laboratory.
Three common instructional strategies used to teach gross anatomy are lecture, discovery or inquiry-based learning, and cooperative learning. One form of cooperative learning, called reciprocal peer teaching (RPT), illustrates circumstances where students alternate roles as teacher and student. By assuming the responsibility of teaching their peers, students not only improve their understanding of course content, but also develop communication skills, teamwork, leadership, confidence and respect for peers that are vital to developing professionalism early in their medical careers. Traditionally in our Anatomy department, students dissect the entire body using a standard dissection manual. More non-traditionally, however, we have increased cooperative learning in the dissection laboratory by involving students in a series of supplementary RPT activities. During these exercises, 10% of the class practiced their demonstration with course instructors until the students felt prepared to demonstrate the exercise to their classmates. We designed one peer demonstration emphasizing three to six teaching objectives for most of the 40 dissection units. This resulted in a compendium of peer demonstrations for implementation throughout the course. The multitude of diverse exercises permitted each student many opportunities to teach their peers. A debriefing questionnaire was administered at the end of the course demonstrating that 100% of students agreed the RPT experience increased their understanding of the topics they taught and 97% agreed it increased their retention of information they taught to their peers. In addition, 92% agreed that RPT improved their communication skills, which can be applied beyond anatomy to their careers as future physicians.
Anatomy↗
Extended Network Generalized Entanglement Theory: therapeutic mechanisms, empirical predictions, and investigations.
Extended Network Generalized Entanglement Theory (Entanglement Theory for short) combines two earlier theories based on complexity theory and quantum mechanics. The theory's assumptions are: the body is a complex, self-organizing system (the extended network) that self-organizes so as to achieve genetically defined patterns (where patterns include morphologic as well as lifestyle patterns). These pattern-specifying genes require feedback that is provided by generalized quantum entanglement. Additionally, generalized entanglement has evolved as a form of communication between people (and animals) and can be used in healing. Entanglement Theory suggests that several processes are involved in complementary and alternative medicine (CAM). Direct subtle therapy creates network change either through lifestyle management, some manual therapies, and psychologically mediated effects of therapy. Indirect subtle therapy is a process of entanglement with other people or physical entities (e.g., remedies, healing sites). Both types of subtle therapy create two kinds of information within the network--either that the network is more disregulated than it is and the network then compensates for this error, or as a guide for network change leading to healing. Most CAM therapies involve a combination of indirect and direct therapies, making empirical evaluation complex. Empirical predictions from this theory are contrasted with those from two other possible mechanisms of healing: (1) psychologic processes and (2) mechanisms involving electromagnetic influence between people (biofield/energy medicine). Topics for empirical study include a hyperfast communication system, the phenomenology of entanglement, predictors of outcome in naturally occurring clinical settings, and the importance of therapist and patient characteristics to outcome.
Attitude to Health↗
[A quantitative and qualitative study on effective information flow for infectious disease control in welfare facilities for the elderly].
OBJECTIVES: To clarify factors associated with effective information tranges among staff of welfare facilities for the elderly, and to propose measures for an appropriate information flow system in welfare facilities and public health centers, communication channels and methods, and encouraging factors and barriers were investigated in terms of a printed medium on the control and management of scabies infections. METHODS: A self-administered questionnaire survey and an interview survey were conducted with the staff of welfare facilities for the elderly where "Control and management manual of scabies infection" had been distributed by the Tama-Tachikawa Public Health Center in Tokyo. A self-administered questionnaire was sent to managers and chief practitioners of 66 facilities. Respondents were obtained from 66 managers and chief practitioners (response rate: 84.8%), and 831 practitioners (response rate: 53.1%). The questionnaire consisted of 20 items for managers and 18 items for chief practitioners, including experience of scabies epidemics in facilities, training experience for the use of "Control and management manual of scabies infection," measures for information gathering, and current information flow within the facility. A semi-structured interview survey was conducted with the manager and/or chief practitioner and practitioners in five facilities. The number of respondents was 10. The interview questions included job description, scabies control measures, dissemination of the manual to the staff, use of the manual, flows of health-related information, and factors associated with information flows. Summarized codes were extracted from the transcriptions from tape recording and were categorized repeatedly according to similarity. RESULTS: In the questionnaire survey, differences of Community information flow by types of facilities and professional backgrounds were found. Variation was detected in measures for information gathering and focuses in information management between managers/chief practitioners and practitioners. Practitioners wanted opportunities for information exchange while managers/chief practitioners mainly focused on prioritization of information collected. In addition, many respondents felt that information networks outside the facilities were poorly organized. From the interview survey, three major categories were extracted, that is, 'Information flow system,' 'Personal qualification,' and 'Factors related to the information flow system.' As factors related to the information flow system, the following 7 subcategories were extracted. 1. Interest in information; 2. Working style and workload; 3. Information networks outside the facility; 4. Information management in the facility; 5. Environment for information sharing; 6. Budget for the information system; and 7. Interpersonal communication. CONCLUSIONS: For an effective information system, welfare facilities for the elderly should work on staff training, building their own information flow systems and improving the environment for information sharing and networking with specialized agencies, such as public health centers. At the same time, public health centers should support networking, interpersonal two-way communication and training of welfare-facility workers.
Aged↗
Cognitive retraining for organizational impairment in obsessive-compulsive disorder.
Individuals with obsessive-compulsive disorder (OCD) have difficulties in organizing information during encoding associated with subsequent memory impairments. This study was designed to investigate whether impairments in organization in individuals with OCD can be alleviated with cognitive training. Thirty-five OCD subjects and 36 controls copied and recalled the Rey-Osterrieth Complex Figure Test (RCFT) [Osterrieth, P.A., 1944. Le test de copie d'une figure complexe: Contribution a l'étude de la perception et de la memoire (The test of copying a complex figure: A contribution to the study of perception and memory). Archive de Psychologie 30, 286-350.] before being randomly assigned to a training or non-training condition. The training condition was designed to improve the ability to organize complex visuospatial information in a meaningful way. The intervention phase was followed by another copy and recall trial of the RCFT. Both OCD and control subjects who underwent training improved more in organization and memory than subjects who did not receive organizational training, providing evidence that the training procedure was effective. OCD subjects improved more in organizational during encoding than control subjects, irrespective of whether or not they had received training. This suggests that organization impairment in OCD affects primarily the ability to spontaneously utilize strategies when faced with complex, ambiguous information but that the ability to implement such strategies when provided with additional trials is preserved. These findings support a distinction in OCD between failure to utilize a strategy and incapacity to implement a strategy.
Adult↗
Characteristics of non-verbal memory impairment in bipolar disorder: the role of encoding strategies.
BACKGROUND: There is evidence that individuals with bipolar disorder exhibit neuropsychological impairments not only during episodes of depression or mania but also when they are euthymic. One of the most consistently reported cognitive problems in euthymic individuals with bipolar disorder is impairment in episodic memory. Learning and memory depend on individuals' ability to organize information during learning. A recent study by our group showed that verbal episodic memory impairments in euthymic patients with bipolar I disorder (BP-I) are mediated by difficulties in organizing verbal information appropriately during learning. The purpose of the present study was to determine whether memory impairments in euthymic individuals with BP-I extend to non-verbal memory and whether non-verbal memory impairments are mediated by difficulties in organizing non-verbal information during encoding. METHOD: Study participants were 25 euthymic, remitted individuals with BP-I and 25 age, gender and education matched control participants. Participants completed the Rey-Osterrieth Complex Figure Test (RCFT), a well-established measure of non-verbal memory that enables assessment of organization during learning. RESULTS: Compared to control participants, BP-I participants showed impaired performance on the RCFT immediate recall. They also relied less on organizational strategies during encoding. Multiple regression modeling indicated that group differences between control and BP-I participants in long-delayed free recall did not remain statistically significant when effects of lower organization were partialled out. CONCLUSIONS: Non-verbal memory problems in individuals with bipolar disorder, while euthymic, are mediated by poor use of non-verbal organization strategies during encoding, but do not appear to reflect deficits in retention of information.
Adult↗
Teaching Rwandan families to care for people with AIDS at home.
AIDS causes disabling symptoms during its chronic and terminal phases. Families throughout the world, whether related to the patient by blood or affection, provide most of the personal care for him or her at home during these phases. Whether the family has access to advanced medical care or not, they can be taught simple comfort measures and nursing care skills that will improve the well-being of the patient. In Rwanda, a small country in east-central Africa, Red Cross volunteers were trained to teach these skills. The volunteers then returned to their villages to help local families. Six months later, 24 of these families were interviewed about the impact of the volunteers' visits. Families indicated they had benefited from being taught the caregiving skills. They also appreciated the emotional support attendant to the volunteers' visits. In summary, the training course enabled volunteers both to enhance family nursing care skills and to provide emotional support to families caring for people with AIDS at home. This training can also be used by volunteers to assist families caring for members ill with other endemic chronic infectious diseases.
Acquired Immunodeficiency Syndrome↗
University of Rochester Child and Family Study: risk research in progress.
The University of Rochester Child and Family Study (URCAFS) is a risk research program concerned with cross-sectional and developmental relationships among three areas: parental psychopathology and health, family system functioning and dysfunctioning, and child psychopathology and health. The preliminary findings indicate that both parental psychopathology and family variables predict significantly to independent measures of school functioning of index sons during their childhood and early adolescence. Although the offspring have not yet reached the age of major risk for schizophrenia, 52 percent of the families have one or more offspring either in psychiatric treatment or for whom treatment had been recommended.
Adolescent↗
Post-traumatic stress disorder in young people with intellectual disability.
BACKGROUND: Post-traumatic stress disorder (PTSD) is common and treatable. There is extensive research on people of average intelligence yet little on individuals with developmental disabilities. METHODS: We report two people with intellectual disability (ID) who experienced PTSD. The relevance of their developmental difficulties, social and communication profiles, attentional skills, and causes of these, to their presentations is discussed. RESULTS: Both individuals have fragile X syndrome and severe ID. One has Diagnostic and Statistical Manual - 4th Edition (DSM-IV) autistic disorder; the other DSM-IV attention deficit-hyperactivity disorder. They experienced developmental and psychological regressions, new challenging behaviours and exacerbations of existing ones coincident with emotional trauma. PTSD symptoms and phenomena were identifiable despite intellectual and communicatory impairments. CONCLUSION: Presentation of PTSD is influenced by degree and cause of ID, social circumstances, social and communicatory skills, nature and timing of traumatic experience and subsequent management. The paucity of literature suggests it is missed frequently in individuals with ID who risk having problems misattributed to other causes with potential for inappropriate interventions.
Adolescent↗
American Indian sign: a gestural communication system for the speechless.
American Indian sign, used as a gestural communication system for the speechless, served the daily life needs of patients with a variety of deficits, many with unfavorable prognosis for oral speech rehabilitation. The project included total glassectomees, laryngectomees, dysphonics, dysarthrics and apraxics. Many of the last named were hemiplegics. The sign was effectively interpreted by hospital personnel, patients and visitors, none of whom had received any instruction in interpreting the sign. This system may be a desirable new tool from an old culture for the professional repertoire of the speech clinician. An illustrated manual and instructional videotapes are in preparation.
Apraxias↗