The legal acknowledgement of the electronic signature: a key for a secure direct access of patients to their computerised medical record.
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Computer Security↗
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Results for “HANDWRITING”
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The impact of nurses and mothers signing the discharge letter on maternal knowledge and satisfaction after discharge from a neonatal unit: a before and after study.
OBJECTIVE: To assess the maternal recall of the neonatal discharge letter instructions with and without nurse and mother signing the document in addition to the physician signature. METHODS: Maternal recall of the discharge letter instructions was assessed by telephone interviews conducted 2-3 weeks following discharge. One hundred and nine mothers who signed the discharge letter following a change of information delivery policy at discharge were compared with 110 mothers who gave birth when their signature was not yet required. The impact of the discharge form on maternal recall was evaluated by stepwise regression analysis adjusted for obstetric, perinatal and demographic variables. RESULTS: Recall of specific instructions verified by the discharge notes and satisfactory understanding of the discharge letter as graded by the mother were higher among 109 mothers who signed the discharge letter (82% and 88%, respectively) than among 110 mothers who did not add their signature (58% and 73%, respectively), the differences being statistically significant (p=0.002 and 0.022, respectively). The statistical difference was maintained also following adjustment with independent variables. CONCLUSION: Signing the neonatal discharge letter by both nurse and mother may improve maternal comprehension and recall of the delivered information. A prospective controlled study is necessary to validate this hypothesis.
Adult↗
Avoiding medical errors: JCAHO documentation requirements.
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Abbreviations as Topic↗
Computerized physician order entry from a chief information officer perspective.
Designing and implementing a computerized physician order entry system in the critical care units of a large urban hospital system is an enormous undertaking. With their significant potential to improve health care and significantly reduce errors, the time for computerized physician order entry or physician order management systems is past due. Careful integrated planning is the key to success, requiring multidisciplinary teams at all levels of clinical and administrative management to work together. Articulated from the viewpoint of the Chief Information Officer of Lifespan, a not-for-profit hospital system in Rhode Island, the vision and strategy preceding the information technology plan, understanding the system's current state, the gap analysis between current and future state, and finally, building and implementing the information technology plan are described.
Administrative Personnel↗
Translation and interpretation: the hidden processes and problems revealed by computerized physician order entry systems.
Even the most basic computerized physician order entry systems can reduce medication error rates, improve the quality, and decrease the costs of medical care. Routine tasks such as decryption, triage, transcription, and transmission are eliminated or streamlined, reducing the source and likelihood of human errors. Translation of physician intent into actual orders requires more advanced computer systems with sophisticated algorithms built-in. Further, adding an interpretative function to understand and transmit orders that could have subtly different meanings will be challenging. Extensive analysis and the cooperative efforts of multidisciplinary teams will be required to add incremental value to computerized physician order entry systems.
Algorithms↗
Acute and reversible micrographia in a patient possibly due to cerebral ischaemia.
We report a patient who developed acute and reversible micrographia, presumably due to cerebral ischaemia, on a background of mutism following a pharyngo-laryngectomy 10 years earlier. Magnetic resonance (MR) imaging showed chronic small vessel disease without evidence of an acute ischaemic lesion on diffusion-weighted sequences. Our patient's micrographia improved significantly within 12 days of symptom onset. The MR imaging was performed within 5 days of symptom onset, suggesting that the lesion was either too small for detection or had resolved on diffusion-weighted sequences.
Aged↗
Primary writing tremor: motor cortex reorganisation and disinhibition.
BACKGROUND: Primary writing tremor (PWT) is a task-specific tremor of uncertain origin. There has been debate as to whether PWT represents a variant of essential tremor or a tremulous form of focal dystonia related to writer's cramp. In writer's cramp there is evidence of changes in intracortical inhibition (ICI), as well as cortical motor reorganisation. OBJECTIVE: To study corticomotor organisation and short-latency ICI in a patient with typical task-specific PWT. METHODS: Transcranial magnetic stimulation mapping of the corticomotor representation of the hand and studies of ICI using paired-pulse stimulation were performed in a 47-year-old right-handed woman with a pure task-specific writing tremor. RESULTS: The motor maps for the hand were displaced posteriorly on both sides and reverted to a normal position after treatment with botulinum toxin. Short-latency ICI was reduced for the dominant hand. CONCLUSION: The findings indicate reorganisation and disinhibition of the corticomotor projection to the hand and point to the participation of cortical centres in the origin of PWT.
Botulinum Toxins, Type A↗
Oscillatory coupling in writing and writer's cramp.
Writing is a highly skilled and overlearned movement. In patients suffering from writer's cramp, a focal task-induced dystonia, writing is impaired or even impossible due to involuntary muscle contractions and abnormal posture, which occur as soon as the person picks up a pen or within writing a few words. The underlying pathophysiological mechanisms of this movement disorder are not fully understood up to now. The aim of the present study was to unravel the oscillatory network underlying physiological writing in healthy subjects and dystonic writing in writer's cramp patients. Using whole-head magnetoencephalography (MEG) and the analysis tool dynamic imaging of coherent sources (DICS) we studied oscillatory neural coupling during writing in eleven healthy subjects and eight patients suffering from writer's cramp. Simultaneous recording of brain activity with MEG and activity of forearm and hand muscles with surface electromyography (EMG) was performed while subjects were writing for five minutes with their dominant right hand. Applying DICS sources of strongest cerebro-muscular coherence and cerebro-cerebral coherence during writing were identified, which consistently included six brain areas in both, the control subjects and the patients: contralateral and ipsilateral sensorimotor cortex, ipsilateral cerebellum, contralateral thalamus, contralateral premotor and posterior parietal cortex. Coherence between cortical sources and muscles appeared primarily in the frequency of writing movements (3-7 Hz) while coherence between cerebral sources occurred primarily around 10 Hz (8-13 Hz). Interestingly, consistent coupling between both sensorimotor cortices was observed in patients only, whereas coupling between ipsilateral cerebellum and the contralateral posterior parietal cortex was found in control subjects only. These results are consistent with the often described bilateral pathophysiology and impaired sensorimotor integration in writer's cramp patients.
Adult↗
Regional cerebral blood flow correlates of the severity of writer's cramp symptoms.
UNLABELLED: Writer's cramp is a type of idiopathic focal dystonia with incompletely understood pathophysiology. Recent studies provide evidence that one element might be a sensory processing defect. We performed a PET study with O(15) H(2)O to find out in which brain areas activity correlates with the severity of writer's cramp symptoms. METHODS: We studied 10 patients with writer's cramp and 10 age- and gender-matched control subjects. There were seven conditions, each repeated twice: rest, writing, tapping with index finger for 2, 3, 4, and 5 min. For each scan, we obtained EMG recordings from the flexor digitorum superficialis (FDS), extensor indicis proprius (EIP) muscles, and a subjective score of severity of dystonia. Scans were realigned, normalized, smoothed, and analyzed using SPM99. Analysis included both intra- and intergroup comparisons and a correlation analysis where we used EMG recordings and subjective dystonia score as covariates. RESULTS: Random effect analysis of the writing task showed overactivity of the primary sensory cortex and no significant underactivity. Correlation analysis of dystonia patients showed activation of SI when we used the subjective dystonia score as a covariate, and activation of both the SI and primary motor cortex when the normalized EMG score of FDS was used. CONCLUSION: While some overactivity of MI is not surprising, overactivity of SI is more dramatic and suggests a primary deficit in processing sensory feedback. Writer's cramp may arise in part as a dysfunction of sensory circuits, which causes defective sensorimotor integration resulting in co-contractions of muscles and overflow phenomena.
Adult↗
Interindividual uniformity and variety of the "Writing center": a functional MRI study.
Our aim is to investigate the neural substrates for writing using fMRI (twenty right-handed subjects). We assumed that common areas involved in both writing with right and left hands are crucial to the central process of writing. We employed Japanese phonograms (Kana), in which phoneme-grapheme conversion would be extremely simple. Brain activation was examined under three conditions: (1) written naming with the right hand (WR), (2) written naming with the left hand (WL), and (3) naming silently (NA). While the comparison of WR to NA (WR>NA) exhibited activation only in the left frontoparietal area, the WL>NA comparison exhibited broader activation than the WR>NA comparison, i.e., the left frontoparietal area except the motor and sensory areas and the right frontoparietal area. A conjunction analysis in SPM2 revealed common areas of activation across the WR>NA and WL>NA comparisons, which are assumed to be crucial to writing. In the group analysis, three areas were found to be activated: the posterior end of the left superior frontal gyrus, which is superior and posterior to Exner's center; the anterior part of the left superior parietal lobule; and the lower part of the anterior limb of the left supramarginal gyrus. In the single-subject analysis, whereas the first two of the above three areas were found to be crucial for writing in all individuals, an interindividual inconsistency of involvement with writing was observed in three areas: the lower part of the anterior limb of the left supramarginal gyrus (60% involved); the right frontal region (47%); and the right intraparietal sulcus (47%).
Adolescent↗
Evaluating factors that can influence spirography ratings in patients with essential tremor.
Spirograph drawings are used in most comprehensive assessments of essential tremor (ET). Nevertheless, several different paradigms are used and no effort has been made to compare these. We used two different cohorts to assess different aspects of spiral rating. In the first, we had subjects simulate different levels of effort by writing (1) 'normally', (2) 'slowly and carefully', (3) 'softly', and (4) 'rapidly' using both their dominant and non-dominant hands. In the second, subjects (1) drew in between the lines of two drawn spirals, (2) traced a previously drawn spirograph, and (3) drew freehand. Subjects drew each with both 'supported' (regular writing) and 'unsupported' writing. The spirals were coded, randomized and blindly rated on a 0-9 scale. Unsupported drawings were consistently rated as worse than supported spirals, and the dominant hand was generally better than the non-dominant hand. Spiral drawn freehand spirals were consistently rated with the lowest scores. Inter-rater and intra-rater reliability were also best for unsupported drawings and tended to be best for 'freehand'. 'Effort' had little effect on ratings. Based on our results, we recommend that assessment of ET include unsupported, freehand spirals.
Aged↗
Micrographia on free writing versus copying tasks in idiopathic Parkinson's disease.
BACKGROUND: Only a few studies have reported on the frequency of micrographia in idiopathic Parkinson's disease (IPD), and the definition of micrographia in these studies was based simply on the visual inspection of the patients' free writing. OBJECTIVES: We investigated the frequency of consistent (CM) and progressive (PM) micrographia by quantifying the patients' copying of a target letter or figure. METHODS: Seventy-five IPD patients and 30 sex/age matched healthy controls were assigned the tasks of free writing and letter/figure copying. CM was defined by the average size of the letter or figure written or copied by the patients below the controls' mean-2SD. PM was defined by the slope of reduction in size as a function of the serial positioning of the letters/figures below the mean-2SD of the controls. RESULTS: In the free writing, of 75 patients, only one met the criteria for the definition of CM and two met the criteria for the definition of PM definition. In contrast, letter/figure copying tasks identified 33 (44%) patients with CM and 19 (25%) with PM. CONCLUSION: Our study suggests that the prior definition of CM or PM by visual inspection in free writing task is less valid, and that the definition of CM and PM, based on the letter/figure copying tasks rather than free writing tests, could be more objective.
Aged↗
Rate of force production and relaxation is impaired in patients with focal hand dystonia.
One factor, which may contribute to slowed movement in dystonia, is impairment in controlling the voluntary rate of motor output. This study examined the ability of patients with focal hand dystonia to rapidly turn force on and off at the wrist and elbow joints. Dystonic patients were slower than controls in rapidly turning on force from rest at both joints, passively relaxing force and rapidly reversing force output from a steady-state flexion contraction. Adding a preload did not improve the ability of dystonic subjects to rapidly turn on force. These results support the idea that dystonia is a disorder of impaired motor cortical activation, possibly due to basal ganglia dysfunction.
Adult↗
Schizotypy is increased in mixed-handers, especially right-handed writers who use the left hand for primary actions.
Associations between schizotypy and handedness were examined in 733 undergraduates for the Sta and Unex scales of the O-LIFE inventory and several measures derived from the Annett hand preference questionnaire. Higher schizotypy scores were found for mixed-handers defined in various ways, including inconsistent preference for any item of the questionnaire and also the presence of either hand responses. There was a marked elevation of schizotypy scores (p<.001) for right-handed writers who prefer the left hand for other 'primary' actions (throwing, racket, match, hammer, toothbrush and scissors). This observation was replicated in 182 students assessed on the Rust Scale of Schizotypal Cognitions. Several findings agree that inconsistent hand preference is associated with a raised probability of schizotypal thinking.
Adolescent↗
Best practices for abbreviation use.
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Abbreviations as Topic↗
Masked form priming in writing words from pictures: evidence for direct retrieval of orthographic codes.
Three experiments used the masked priming paradigm to investigate the role of orthographic and phonological information in written picture naming. In all the experiments, participants had to write the names of pictures as quickly as possible under three different priming conditions. Nonword primes could be: (1) phonologically and orthographically related to the picture name; (2) orthographically related as in (1) but phonologically related to a lesser degree than in (1); (3) orthographically and phonologically unrelated except for the first consonant (or consonant cluster). Orthographic priming effects were observed with a prime exposure duration of 34 ms (Experiments 1 and 2) and of 51 ms (Experiment 3). In none of the experiments, did homophony between primes and picture names yield an additional advantage. Taken together, these findings support the view of the direct retrieval of orthographic information through lexical access in written picture naming, and thus argue against the traditional view that the retrieval of orthographic codes of obligatorily mediated by phonology.
Adult↗
Exploitation of elasticity in copying geometrical patterns: the role of age, movement amplitude, and limb-segment involvement.
An experiment is reported in which 12 adults and 12 10-year-old children copied three-segment geometrical patterns under various size and limb-segment involvement instructions. Next to an assessment of movement pauses, analyses of pen-tip displacements focused on: (1) the accuracy of size reproduction, (2) movement time, and (3) ratio of peak-over-mean velocity. A low value of the latter measure was considered to reflect the adoption of a cyclical movement regime facilitating the exploitation of elastic properties of muscles and tendons during execution. Subjects generally produced size overshoots which, particularly for the children, were most pronounced for small patterns. These effects were accompanied by prolonged movement times. Peak-over-mean velocity ratios were smallest in adults, in large patterns, and when the arm instead of the hand was required as effector. Although adults paused more frequently than children, pause durations were similar in both groups. It is suggested that fast movements with low peak-over-mean velocity ratios reflect successful attempts by subjects to exploit the elasticity of muscles and tendons. These attempts are accompanied in the present task, however, by an increased risk of having to pause between subsequent segments of a movement sequence, possibly for energy-dissipation reasons.
Adult↗
Functional properties of graphic workspace: assessment by means of a 3D geometric arm model.
Computer simulations aimed at assessing functional characteristics of the graphic workspace are presented. The simulations involve a 10-df kinematic model of the distal part of the writing arm, and yield the effective workspace of the pen tip under two types of kinematic constraints. The first constraint involves fixing the forearm under various pronation angles, the second governs the protrusion of the pen tip from the finger tips. The effective workspace is analyzed in terms of the effort required to reach the various locations in it, where effort is defined in terms of the joint angles adopted by the wrist and fingers to reach each location. The simulation results show agreements between the distribution of required effort over the workspace and known stroke-direction preferences in drawing. Furthermore, they predict shifts in the biases that are thought to lead to these preferences as a function of both hand pronation and pen protrusion.
Biomechanical Phenomena↗