Internal communications. Growing and merging at a mind-boggling rate, Anthem tries to lay down the graphics law.
Explore the source record for details and available documents.
Blue Cross Blue Shield Insurance Plans↗
SEARCH · Search PubMed
Results for “Manual Communication”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Venlafaxine in children, adolescents, and young adults with autism spectrum disorders: an open retrospective clinical report.
Autism is characterized by social deficits, communication and language impairments, narrow restricted interests, repetitive behaviors, inattention, and hyperactivity. While selective serotonin reuptake inhibitors have demonstrated efficacy in treating core symptoms of autism, norepinephrine reuptake inhibitors have demonstrated efficacy in symptoms of attention-deficit hyperactivity disorder (ADHD). An open, retrospective clinical study with venlafaxine evaluated its effect on core symptoms of autism as well as associated features of ADHD. Ten consecutive subjects meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria for an autism spectrum disorder were treated with venlafaxine, initiated at 12.5 mg per day and adjusted on a flexible basis. Six of 10 completers were judged to be sustained treatment responders, by scoring 1 (very much improved) or 2 (much improved) on the Clinical Global Impressions improvement scale. Venlafaxine was effective in low dosages (mean, 24.37 mg/day; range, 6.25 to 50 mg/day) and was well tolerated. Improvement was noted in repetitive behaviors and restricted interests, social deficits, communication and language function, inattention, and hyperactivity. Controlled treatment trials with venlafaxine are warranted in autism spectrum disorders.
Adult↗
Attention deficit hyperactivity disorder: the scope of the problem.
Throughout the recent past, the evolution of ADHD as a disability label or category has been driven primarily by the development of a series of diagnostic manuals by a professional organization (i.e., American Psychiatric Association). The result has been a diagnostic category consisting of behaviors that form a practical construct of the disability. The evolution of the label and its behavioral construct was driven more by the needs of professional manuals than by theoretical considerations or empirical research. With the development of theoretical models and additional empirical research, however, we appear to be gaining a better understanding of the nature of ADHD. New symptom categories have more educational and communicative significance, and, importantly, these categories appear to have more explanatory value than did previous categories. Further investigation of these emerging symptom categories should advance our understanding of ADHD and how it can be managed more effectively. As clinicians, however, whether we focus on primary symptom categories for clinical/educational purposes or emerging symptom categories for their explanatory power, we need to continue to gain a better understanding of ADHD and its impact on our students. This article has provided a description of the evolution of the ADHD label and noted some of the directions that current research appears to be leading. In doing so, we hope that we have provided practicing speech-language pathologists with a better understanding of the history and scope of this problem.
Attention Deficit Disorder with Hyperactivity↗
Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects.
OBJECTIVE: To extract from the biomedical literature the reported effects of acute hyperglycemia on the major components of the innate immune system and to describe the clinical benefits of strict blood glucose control in certain patients. DATA SOURCE AND SELECTION: A Medline/PubMed search (1966 to July 2004) with manual cross-referencing was conducted, including all relevant articles investigating the effects of acutely elevated glucose levels on innate immunity. All publication types, languages, or subsets were searched. DATA EXTRACTION AND SYNTHESIS: Original and selected review articles, short communications, letters to the editor, and chapters of selected textbooks were extracted. Most recent and relevant clinical trials were reviewed for the introductory section to provide the clinical background to this topic. The selected bench laboratory articles were then divided into three main categories based on the timing of events: a) the early phase of the innate immune reaction; b) the cytokine network; and c) the phagocytic phase. The most obvious findings related to hyperglycemia included reduced neutrophil activity (e.g., chemotaxis, formation of reactive oxygen species, phagocytosis of bacteria), despite accelerated diapedesis of leukocytes into peripheral tissue, as well as specific alterations of cytokine patterns with increased concentrations of the early proinflammatory cytokines tumor necrosis factor-alpha and interleukin-6. Furthermore, a reduction of endothelial nitric oxide formation takes place, thus decreasing microvascular reactivity to dilating agents such as bradykinin, and complement function (e.g., opsonization, chemotaxis) is impaired, despite elevations of certain complement factors. CONCLUSIONS: Acute, short-term hyperglycemia affects all major components of innate immunity and impairs the ability of the host to combat infection, even though certain distinctive proinflammatory alterations of the immune response can be observed under these conditions.
Acute Disease↗
Affective disturbances in Alzheimer's disease.
OBJECTIVE: To evaluate the emotional disturbances in patients with Alzheimer's disease (AD) using both a categorical and a dimensional approach. DESIGN: Prospective study. SETTING: Outpatient clinic in a neurological department from a general University Teaching Hospital. MEASURES: A semi-structured interview was used to fill in the Hamilton Depression Rating Scale, the Retardation Rating Scale for depression, the Tyrer and Covi scales for anxiety, and the Depressive Mood Scale for emotional disturbances. The cognitive status was assessed by the Mini-Mental State Examination and the Mattis Dementia Rating Scale. PATIENTS: One hundred eighteen consecutive AD outpatients fitting the criteria for probable or possible AD, according to the National Institute of Neurological and Communication Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, were compared with 34 community-dwelling healthy older controls and with 20 inpatients meeting the diagnostic criteria for depression according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition-Revised. RESULTS: No AD patient met the criteria for Major Depressive Episode or Generalized Anxiety Disorder, but 10 (8%) met the criteria for Dysthymic Disorder. AD patients scored significantly higher than the control group but lower than the depressed group for depressive and anxious symptomatology. Depressive symptomatology was correlated negatively to the cognitive status and positively to anxious symptomatology. Two main dimensions in emotional disturbances were described using the Depressive Mood Scale: Emotional Deficit (anhedonia, hypoexpressiveness) and Loss of Control (felt irritability, hyperexpressiveness). Emotional Deficit was correlated positively to the depressive symptomatology and correlated negatively to the cognitive status and the Loss of Control dimension. Loss of Control was correlated positively to the severity of the depressive and anxious symptomatology and weakly to cognitive performance. CONCLUSION: Affective changes were found frequently in AD patients, but no major affective disorder was found. The dimensional approach seems to be more appropriate than the categorical approach to describe the emotional disturbances in these patients.
Affect↗
Bi-Bi to MCE?
In the past few years, we have witnessed the introduction of a bilingual-bicultural approach and an increasing skepticism of the value of manually coded English in the education of deaf children. The thrust of bilingual-bicultural programs is emphasis on using American Sign Language as the primary language of instruction. However, merely advocating something (i.e., the use of American Sign Language) in no way guarantees its successful implementation. This paper reviews the research on past usage of manually coded English in the classroom for clues as to some of the concerns that American Sign Language might face in its implementation.
Communication↗
Blood cultures.
Bacteremia and fungemia are encountered commonly and are associated with significant morbidity and mortality. Laboratory detection is therefore of paramount importance. Principles of successful blood culturing, clinically important technical issues, manual and automated detection systems, and interpretation of culture results are reviewed in this article.
Blood↗
Sonographic diagnosis of a small fistulous communication between a subphrenic abscess and a perforated duodenal ulcer.
We report a case of a fistula between a subphrenic abscess and a perforated duodenal ulcer diagnosed by sonography and confirmed by CT. The sonographic findings included a subphrenic fluid collection connected to the anterior aspect of the superior duodenum by a nonpulsatile, anechoic tubular lesion. Manual compression of the upper epigastrium resulted in movement of echogenic debris from the antrum and superior duodenum through the fistulous tract into the abscess.
Aged↗
Data clustering and other archive retrieval strategies for teleradiology and picture archiving and communication systems.
A key advantage in the conversion from film-based to digital radiology is the possibility of a long-term on line electronic archival of patient studies. The popular approach based on optical disk jukeboxes for the long-term archive and magnetic disk storage for data caching is not economically attractive because of the cost of both the jukebox and the medium. Strategies for extending the archival system design with a tape jukebox have been studied. The proposed strategy calls for the use of high-ratio lossy compression together with low-cost tape storage to make long-term on line archiving more affordable. An intelligent prefetching algorithm based on hospital information system and radiologic information system triggers, which in turn are augmented by manual case preparation, can effectively overcome the longer latency of ad hoc retrievals. This longer latency is caused by both system-level bottlenecks and the sequential access constraint of the tape drive. Strategies for image clustering and tape allocation by patient classification also enhance retrieval efficiency. This archival design using image compression, prefetching, and clustering could be implemented in many of the existing teleradiology and picture archiving and communication systems.
Algorithms↗
Health Level Seven (HL7): standard for healthcare electronic data transmissions.
The nursing profession needs computer-formatted data that can be exchanged within and between agencies. The exchange of electronic data, both in the United States and in the international community, requires agreement on the format of the data elements to be exchanged. The Health Level Seven (HL7) standard is a proposed voluntary standard for healthcare applications that addresses the way information is exchanged electronically. This brief article will provide background information regarding the development and status of HL7 and its implications for nursing. From the clinical perspective, nurses follow standards of care developed by professional organizations. These standards facilitate clear communication among nurses, consumers, and members of other disciplines. Similarly, the electronic transmission and exchange of clinical information must have a standard to ensure that messages arrive and are decoded correctly. Many standards for electronic data already exist; financial transactions such as banking are familiar examples. The theme of the 1990 Symposium on Computer Applications in Medical Care (SCAMC), was Standards in Medical Informatics. Many pertinent papers and workshops were presented. However, references to electronic data standards are found primarily in conference proceedings and technical manuals. Thus, although activity is widespread, and events are rapidly moving in the healthcare industry, most of the information is not yet widely available. It seems timely, therefore, to provide background material to nurses in order for them to participate in the process.
Computer Communication Networks↗
Perspectives of people with enduring mental ill health from a community-based qualitative study.
BACKGROUND: The views of people with enduring mental ill health have received limited exploration. Existing work has largely focused on patients in specialist mental health settings, rather than on a wider range of patients in the community. AIM: To explore experiences and perceptions of health care of people with enduring mental ill health. DESIGN OF STUDY: A community-based qualitative study using theoretical sampling, in-depth interviews, and grounded methodology. SETTING: A total of 34 responders registered with four general practices, serving five wards with a mean Townsend Deprivation Score of 7.75. METHOD: Subjects were chosen using a theoretical sampling framework and they participated in one-to-one interviews which were audiotaped. Themes were identified and developed by reading transcripts, then they were further refined and classified manually by open coding into key categories using a grounded approach. RESULTS: The primary goal of the responders was to enhance, sustain, and take control of their mental health. The building of positive therapeutic relationships with professionals based upon effective communication, trust, and continuity were important to achieving this aim. However, the settings in which their health care took place could affect responders' attempts to deal with social stigma. Experiences of social isolation, socioeconomic privation, and stigmatisation were often pervasive. These compromised responders' opportunities and their capacity to enhance their mental health, compounding their illness and marginalisation. CONCLUSIONS: This study shows the potential of health professionals to empower people with enduring mental ill health, by attending to the quality of communication and continuity of care they provide and to where this takes place. It further underlines a need to address the social stigma and exclusion this group experiences.
Adult↗
Standardized exchange of clinical documents--towards a shared care paradigm in glaucoma treatment.
OBJECTIVES: The exchange of medical data from research and clinical routine across institutional borders is essential to establish an integrated healthcare platform. In this project we want to realize the standardized exchange of medical data between different healthcare institutions to implement an integrated and interoperable information system supporting clinical treatment and research of glaucoma. METHODS: The central point of our concept is a standardized communication model based on the Clinical Document Architecture (CDA). Further, a communication concept between different health care institutions applying the developed document model has been defined. RESULTS: With our project we have been able to prove that standardized communication between an Electronic Medical Record (EMR), an Electronic Health Record (EHR) and the Erlanger Glaucoma Register (EGR) based on the established conceptual models, which rely on CDA rel.1 level 1 and SCIPHOX, could be implemented. The HL7-tool-based deduction of a suitable CDA rel.2 compliant schema showed significant differences when compared with the manually created schema. Finally fundamental requirements, which have to be implemented for an integrated health care platform, have been identified. CONCLUSIONS: An interoperable information system can enhance both clinical treatment and research projects. By automatically transferring screening findings from a glaucoma research project to the electronic medical record of our ophthalmology clinic, clinicians could benefit from the availability of a longitudinal patient record. The CDA as a standard for exchanging clinical documents has demonstrated its potential to enhance interoperability within a future shared care paradigm.
Computer Communication Networks↗
Targeting smokers with low readiness to change with tailored and nontailored self-help materials.
BACKGROUND: Few smoking cessation self-help materials are available for smokers who are not planning to quit. However, computer-tailored interventions can be designed specifically for these smokers. METHODS: In a large randomized field trial (N = 843), two different tailored smoking cessation self-help interventions (multiple tailoring and single tailoring) and one standardized smoking cessation self-help guide were compared with a no-information control group and with each other. The contents of the tailored interventions were adapted to individuals' self-reported stage of change, outcome expectations, self-efficacy levels, and smoking behavior. RESULTS: The primary outcome measure was forward stage transition. The standardized self-help guide had no effect. Among smokers who were not planning to quit within the next 5 years the multiple-tailored intervention was more effective than the single-tailored intervention. This pattern was supported by the cognitive changes caused by the interventions. Among smokers who were planning to quit within the next 5 years but not within the next 6 months, none of the self-help materials had any effect. CONCLUSION: The present results show that the self-help material currently available in the Netherlands, the standardized self-help guide, was not effective among smokers with low readiness to change. However, computer-generated tailored interventions seem a promising means of communicating information on smoking and smoking cessation to these smokers.
Adult↗
Psychiatric diagnostic dilemmas in the medical setting.
OBJECTIVE: To review the problems posed for doctors by the failure of existing taxonomies to provide a satisfactory method for deriving diagnoses in cases of physical/psychiatric comorbidity, and of relating diagnoses on multiple axes. METHOD: Review of existing taxonomies and key criticisms. The author was guided in selection by his experience as a member of the working parties involved in the creation of the American Psychiatric Association's DSM-IV. RESULTS: The attempts of the two major taxonomies, the ICD-10 and the American Psychiatric Association's DSM-IV, to address the problem by use of glossaries and multiple axes are described, and found wanting. Novel approaches, including McHugh and Slavey's perspectives of disease, dimensions, behaviour and life story, are described and evaluated. The problem of developing valid and reliable measures of physical/psychiatric comorbidity is addressed, including a discussion of genetic factors, neurobiological variables, target markers and other pathophysiological indicators. Finally, the concept of depression as a systemic illness involving brain, mind and body is raised and the implications of this discussed. CONCLUSIONS: Taxonomies require major revision in order to provide a useful basis for communication and research about one of the most frequent presentations in the community, physical/psychiatric comorbidity.
Comorbidity↗
[Improved medicine lists with multi-dose packaging?].
BACKGROUND: In a part of Oslo, Norway, the community care services use multi-dose packed medicines for some of their clients. We wanted to investigate whether this improved quality as compared to manually dispensed medicines. MATERIAL AND METHODS: We included 20 patients who received multi-dose packaged medicines, and 33 patients in two other districts who received manually dispensed medicines, and recorded disagreements between what daily medicines the general practitioner had prescribed and those that were dispensed by the community care service or the multi-dose packager. RESULTS: The 53 patients received a total of 324 daily medicines. Disagreements were found in 23% of all daily medicines, involving 58% of patients. In addition, deficiencies in the information on medication were found in 6% of all daily doses. For patients who received multi-dose packaged medicines, disagreements were found in relation to 21 % of the drugs. For patients who received manually dispensed medicines, disagreements were found in 17% and 33% of the medicines lists in the two districts. INTERPRETATION: The disagreements found between the medication prescribed by doctors and what was dispensed were unacceptable regardless of dispensing method (manual or automatic). It is important to clarify who should be responsible for maintaining accurate records for patients who receive community care.
Aged↗
[Interrelations between physician, hairdresser and mass media in management of hair loss].
Hair problems are attacked at the levels of information supply, trichological competence and evidence based medical treatment. The alopecias represent a major health care challenge, and the psychological significance of hair loss has only recently found appreciation in the medical community. They may pose a vexing problem for non-specialized physicians, who tend to trivialize such complaints, although the patient's perception of abnormality determines whether or not advice is sought. Perception of a hair problem is subject to sociocultural standards; films and advertisements help determine the threshold for "normality" and what is "healthy" and "beautiful", and the media provide an abundance of undiscriminating information with respect to hair care. Patients with hair problems frequently consult the hairdresser prior to the medical specialist. Thus additional areas of competence should be incorporated into the hairdresser's training qualifications. Besides manual, creative and psychological aptitudes, "trichological competence" relating to the recognition of most important hair disorders, recognition of personal limitations and cooperation with the medical specialist are required. To optimize the interaction between the physician, hairdressers and the media, more effective communication and public activities from the medical profession are desirable, with success depending on full identification of the set goals, qualification and adherence to the standards determined by the medical speciality.
Alopecia↗
A rich lymphatic network exists in the inferior surface of the vocal cord.
Conservation laryngeal surgery is an increasingly available alternative for the treatment of laryngeal cancer. Understanding anatomy of laryngeal lymph drainage is essential for clinicians to diagnose, grade and surgically manage the laryngeal cancer. Although the lymphatic drainage of the larynx has been extensively studied, few studies revealed the relationship of the lymphatic drainage between various parts of the larynx. The distribution of lymphatic vessels in the inferior surface of the vocal cord also remains unclear. The aim of this study was to investigate the communication of the lymphatic networks between the vocal cord, the supraglottic and subglottic parts of the larynx, paying special attention to the lymphatic drainage of the inferior surface of the vocal cord. Eighteen larynx specimens from 18 fresh fetal cadavers were manually injected with prassion blue solution into the mucosal or submucosal layer of the larynx in order to reveal the lymphatic vessels in the inner larynx. We found that a rich lymphatic network is present in the inferior surface of the vocal cord, and the lymphatic networks in the superior and inferior surfaces of the vocal cord appear as two different patterns. These findings provide an anatomical basis for the design of a partial or conservation laryngeal surgery, particularly when considering the precise resection margin.
Cadaver↗
The MEDLARS regional center at UCLA: a progress report.
This paper supplements information given in earlier papers on the UCLA MEDLARS Search Station. Four major machine problem areas in the operation of a decentralized station are identified: adjustments required to run a large information retrieval type program in an academic computing facility serving many users; handicap in running time for COBOL programs; advent of the third generation of computers with attendant preparation; and need for constant current communication among all members of a decentralized network system. Statistics are given for the initial operating period, January-May 1966: 119 search requests received, 109 formulated, and 60 fully processed. Parallel searches with other MEDLARS installations, comparisons of MEDLARS and manual Index Medicus searches, and other search activities are reported.
California↗