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Children with school problems--an expanding role for the paediatrician.

Children with school problems comprise a significant part of the new paediatric morbidity. There is confusion in terminology and it is suggested that instead of attempting to make a diagnosis of doubtful validity and limited clinical utility, paediatricians focus instead on generating an accurate description of the strengths and weaknesses of these children. When placed in the context of a transactional model of aetiology and function, such an individual difference, nondiagnostic, nonlabelling approach facilitates the development of appropriate intervention strategies, as well as creating a suitable framework for interdisciplinary communication. It is suggested that such a broad based approach to the assessment and management of children with school problems allows the paediatrician to play an important role in enabling these children to fulfil their potential.

Child↗

Theory and methods for research on ethical issues in dementia care.

Swedish research on ethical issues in dementia care is almost exclusively done by nursing scientists. Many of these studies are rightfully acclaimed as exemplary research. But the strong focusing on the nurse and her relation to the patient tends to bias the ethical issues--the attitudes of other persons involved or affected are also in need of investigation. Further, there is a predilection for content analysis at the expense of causal analysis. In this paper an eclectic approach to the study of ethical issues in dementia care is advocated. More interdisciplinary communication and co-operation is also needed--especially between nursing scientists and moral philosophers. To facilitate such communication and co-operation a model for analysis of ethical issues is presented and discussed. To illustrate my ideas I use three articles by researchers from the department of advanced nursing in Umeå: Ekman & Norberg (1988), Norberg & Asplund (1990) and Akerlund & Norberg (1989-90).

Behavioral Research↗

Enhancing the role public health nurses play in serving children with special health needs: an interactive videoconference on Public Law 99-457 Part H.

Public Law 99-457 Part H supports the development of systems to identify infants and toddlers with special health needs and provide these children the comprehensive care they need. Although public health nurses traditionally provide many of the mandated services. Part H, with its roots in education, presents new terminology, conceptual models, and challenges to public health nurses. An interactive videoconference entitled "Public Health Nurses and Part H: Putting the Pieces Together" was broadcast to 525 public health nurses in 11 states. The program goals were to increase knowledge of Part H among public health nurses and to enhance their role in its implementation. An evaluation was conducted to assess knowledge change and satisfaction with the program format. Results revealed a high degree of satisfaction with distance learning and no difference across sites in knowledge acquisition or participant satisfaction. A need identified through this project is increased interdisciplinary communication among those who serve infants and toddlers with special needs. In an era when financial resources are dwindling, interactive videoconferencing is an innovative and cost-effective method for decreasing the isolation of many public health nurses by offering opportunities for education and networking from their local communities.

Child Health Services↗

A new symbolic language for diagramming pacemaker/heart interaction.

A new symbolic language is presented that can be used to diagram pacemaker/heart interactions. The language symbolically indicates "normally" conducted and ectopic events; pacemaker stimuli; pacemaker capture of the chamber; triggered pacemaker stimuli by "normal" or ectopic events; as well as such anomalous pacemaker/heart interactions as failure to sense; "crosstalk" between electrodes; and "normal," ectopic, or paced events in one chamber sensed by the electrode in the other chamber. In addition, symbols are provided to represent antegrade and retrograde accessory pathway conduction, and electronic and physiological refractory intervals. A common baseline is used to separate symbols for atrial activity, above the baseline, from those for ventricular activity, below the baseline. Parallel baselines are used to plot refractory intervals. Thus, even complex dual-chamber pacemaker operating modes can be represented with intrinsic and stimulated cardiac response to pacemaker operation. The language can be sketched out informally for description of general concepts or drafted on millimeter grid paper to make precise timing notations. It is especially useful for interdisciplinary communication of ideas about complex pacemaker/heart interactions.

Atrial Function↗

Stimulant drugs for hyperactivity: some additional disturbing questions.

Continued professional recognition and concern are urged in regard to increased use of stimulant drugs for treatment of hyperactivity, unaccompanied by 1) adequate interdisciplinary communication about specific behaviors leading to referral and treatment, or 2) adequate assessment of the behavioral and educational consequences of the medication. Some pertinent questions are posed.

Attention↗

Fetal autopsy: the most important contribution of pathology in a center for perinatal medicine.

OBJECTIVE: The aim of the current paper is to analyze the significant changes in fetal autopsy made by pathologists in a center for perinatal medicine in response to the recent rapid developments in prenatal medicine. METHODS: We use our technical equipment (interdisciplinary databank, Intranet, fine instruments, imaging techniques) for prenatal diagnostics and fetal pathology in the Center for Perinatal Medicine at the Charité University Medical Center in Berlin, Germany. RESULTS: Our technical setup has made it possible for us to plan autopsies in such a way that rare malformations in special cases can be documented in sectional planes corresponding to the prenatal sonographic images. Before the postmortem examination the pathologist receives all the prenatal findings obtained for the fetus and is able to examine the prenatal images on a monitor. The final diagnosis in the postmortem report includes the results of modern molecular pathology, clinical-genetic examination of the fetus, cytogenetic and molecular-cytogenetic findings and postmortem x-rays. CONCLUSIONS: To be able to incorporate these various results into a final report in routine work the use of an interdisciplinary database is essential. Such a database also ensures faster and more productive interdisciplinary communication in a center of perinatal medicine.

Adult↗

Audit of maternal serum screening: strategies to augment counselling in response to women's views.

Women's opinion on the maternal serum screening programme offered at one maternity unit in East Northumberland (1991-1992) was evaluated. The responses from 1,774/2,633 women showed a general acceptance of the test but 722/1,774 (40%) wanted more information and a third, more explanation. Recommendations, which included a 'gold standard' protocol, a video to complement revised patient information literature and a coordinator to facilitate interdisciplinary communication and training with support for midwives, were introduced. The audit cycle was completed by a repeat questionnaire survey of 2,489 women from the postnatal ward (1992-1994) with a 67.3% response. An overall improvement in levels of satisfaction with reduction in, but not eradication of, the need for more information and explanation had occurred. These findings have relevance to the current controversy surrounding the counselling implications of maternal serum screening and have led to the formation of a network of professionals to develop the programme in our region.

Down Syndrome↗

Linking human and veterinary health: trends, directions and initiatives.

The objective of this brief article is to provide an overview of some of the important harmonization efforts that are currently under way within the animal health community. Topics include: scientific networks and interdisciplinary communication; organizations that address animal-related public health concerns; the role of the veterinary pharmaceutical scientist within human health-oriented professional organizations; recent publications pertaining to veterinary pharmacology, pharmaceutics and therapeutics; and the role of global networking in veterinary product research and development.

Agriculture↗

Biomarkers in epidemiology: scientific issues and ethical implications.

The current generation of biologic markers have three characteristics that differentiate them from previous ones. These include the ability to detect xenobiotics at concentrations at the cellular and molecular level, to detect earlier biologic changes presumptive of disease or disease risk, and to identify a detailed continuum of events between an exposure and resultant disease. If biomarkers are to enhance cancer epidemiology, they must be valid, reliable, and practical. When these characteristics have not been previously demonstrated, pilot studies should be conducted prior to the primary study. Interdisciplinary communication and collaboration is required so that useful markers are selected and that collection and handling, assay, and interpretation are appropriate. The status of many biomarkers is that they have been developed in the laboratory but lack validation for field use. Validation of a marker for use in a population requires attention to issues of background prevalence, sample size, natural history, persistence, variability, confounding factors, and predictive value. Additionally, practical features such as subject preparation, access to specimens, specimen storage aspects, and costs must be clarified. Ultimately, the use of biologic markers in epidemiologic studies will depend on how well the markers increase ability to reduce misclassification, provide for better interpretation of exposure-disease associations, and increase opportunities for prevention. Validation studies and general research using biomarkers also have clinical, ethical, and legal implications. These range from communicating uncertainty about the meaning of a marker to the kinds of societal response that result when groups or individuals are identified as having an "abnormal" marker frequency.

Biomarkers, Tumor↗

Orthodontics and orthognathic surgery: adjuncts to restorative and periodontal therapy.

Orthodontic and orthognathic surgical procedures are important adjuncts to the provision of optimum restorative and periodontal care. Dentoalveolar and skeletal abnormalities of either developmental or acquired origin can be corrected primarily, thus eliminating the necessity for compromise in prosthetic design. Dental relationships that are contributory to irreversible periodontal deterioration can be normalized to facilitate stabilization of the periodontal condition and to increase the longevity of the natural dentition. Maxillofacial surgical treatment is technically complex but is more conservative than many traditionally accepted treatment procedures. It is based on the rationale of conservation of natural structures rather than their radical ablation or their sacrifice to uncontrollable progressive disease processes. Patient participation to establishment of treatment objectives and extensive patient education are essential ingredients in such treatment. Interdisciplinary communication and coordination contribute to a mutual appreciation of treatment possibilities and limitations. Thus, orthodontic and orthognathic surgical options should be considered in planning the solution to a wide variety of periodontal and restorative treatment problems.

Adult↗

The enigma of progress in denitrification research.

Humans have dramatically increased the amount of reactive nitrogen (primarily ammonium, nitrogen oxides, and organically bound N) circulating in the biosphere and atmosphere, creating a wide array of desirable products (e.g., food production) and undesirable consequences (e.g., eutrophication of aquatic ecosystems and air pollution). Only when this reactive N is converted back to the chemically unreactive dinitrogen (N2) form, do these cascading effects of elevated reactive N cease to be of concern. Among the quantitatively most important processes for converting reactive N to N2 gas is the biological process of classical denitrification, in which oxides of nitrogen are used as terminal electron acceptors in anaerobic respiration. This Invited Feature on denitrification includes a series of papers that integrate our current state of knowledge across terrestrial, freshwater, and marine systems on denitrification rates, controlling factors, and methodologies for measuring and modeling denitrification. In this paper, we present an overview of the role of denitrification within the broader N cycle, the environmental and health concerns that have resulted from human alteration of the N cycle, and a brief historical perspective on why denitrification has been so difficult to study. Despite over a century of research on denitrification and numerous recent technological advances, we still lack a comprehensive, quantitative understanding of denitrification rates and controlling factors across ecosystems. Inherent problems of measuring spatially and temporally heterogeneous N2 production under an N2-rich atmosphere account for much of this slow progress, but lack of interdisciplinary communication of research results and methodological developments has also impeded denitrification research. An integrated multidisciplinary approach to denitrification research, from upland terrestrial ecosystems, to small streams, river systems, estuaries, and continental shelf ecosystems, and to the open ocean, may yield new insights into denitrification across landscapes and waterscapes.

Environmental Pollutants↗

Mental health intervention with children and adolescents with end-stage renal disease.

The increasing number of pediatric patients with end-stage renal disease who undergo dialysis and transplantation have necessitated the development of psychological interventions to lessen the emotional impact of these procedures. This report describes the dilemmas involved in mental health interventions and consultation in a treatment program for end-stage renal disease. Case illustrations of a young child's severe anxiety reaction to dialysis, an adolescent's depression, and a family's withdarwal document the varied patterns of adaptation to treatment for renal failure. Psychotherapeutic approaches are presented to illustrate the flexible use of a number of treatment modalities including brief crisis-oriented intervention which emphasized the patient's cognitive mastery of procedures. The development of viable mechanisms of professional collaboration improves the quality of patient adaptation by lessening the fragmentation of care and problems of interdisciplinary communication often associated with the medical care of children and adolescents with end-stage renal failure.

Affective Symptoms↗

Use of a computerized digital camera in podiatric medical practice.

Multimedia technology was once rarely found outside the realm of commercial production studios or in elaborate computer games. However, with the addition of only a few simple accessories, recent advances have made this technology readily available to the podiatric medical practitioner on a desktop office computer. The role that the application of multimedia technology using a computerized digital camera can play in a podiatric medical practice--including in such areas as record keeping, outcome measurement, patient education, interdisciplinary communications, and practice-management tools--is discussed.

Computers↗

Perspectives on artificial joint design.

Due to poor interdisciplinary communication, many artifical joint designs fail to account for some features that normally allow bones to survive for life. In part, these features concern modeling drifts and remodeling basic multicellular units (BMUs), the microdamage thresholds of bone, its load-grain alignment and shear lock properties, load focusing and defocusing, mechanical usage/strain thresholds for controlling the biological mechanisms, and the regional acceleratory phenomenon. This article reviews briefly some major aspects of these features and suggests how implant design might account for them.

Biocompatible Materials↗

CQI project improves discharge process.

At Gibson Rehab Center in Williamsport, PA, a continuous quality improvement project to bolster the institution's discharge planning process has resulted in increased satisfaction and an award for quality. The 15-month project was spearheaded by a multidisciplinary team charged with identifying areas that had a significant impact on customer service and suggesting better ways of delivering that service. Among the changes the group suggested were establishing a weekly discharge planning group for new neuro patients, assigning a discharge coordinator for each treatment team, and creating an interdisciplinary communication sheet for the home health therapy staff.

Health Care Surveys↗

Multidisciplinary full-mouth restoration with porcelain veneers and laboratory-fabricated resin inlays.

Recent advances in dental materials, laboratory technology, and adhesive protocols have significantly expanded the contemporary restorative armamentarium. Utilized in combination with comprehensive treatment planning, these innovations enable clinicians to provide enhanced aesthetic care that achieves the increasing expectations of their patients. Using a detailed case presentation, this article highlights the harmonious integration of modern smile design, material selection, and interdisciplinary communication that must be addressed in order to deliver optimal treatment with porcelain laminate veneer and laboratory-fabricated resin inlay restorations.

Adult↗

[Multi-morbidity as a responsibility: 1,000 illnesses--one health. The physician's image 200].

The prototype physician 2000 A.D. will have to be able to recognise multimorbidity and its individual importance in a general medical and social sense. There will be a specifically challenge in the fields of individual prophylaxis, interdisciplinary communication, integration of all nursing and treating partners and the ethical judgement between individually useful and theoretically possible treatment options. Medical education and social systems will have to provide enough knowledge and skills as well as opportunities to allow this necessary development of our future physicians 2000 A.D.

Austria↗

[Pharmacokinetics--questions of terminology and problems].

Pharmacokinetics have become one indispensable tool in drug evaluation, clinical pharmacology and diagnostics. Therefore the basic principles of pharmacokinetics are outlined and pertinent definitions are given. Some scientific terms in this field are explained in order to facilitate interdisciplinary communication. The theoretical background of some practicable algorithms for obtaining pharmacokinetical parameters is described with the attempt of relying solely on the understanding usually induced by basic courses in biology, medicine and chemistry. It is demonstrated that the evaluation of pharmacokinetical analyses may only be interpreted in a context of any or all of these disciplines. Without this context pharmacokinetical results may remain mere mathematical descriptions of unknown mechanisms.

Animals↗