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[Fatal craniocerebral trauma in a young child. I: Forensic documentation, model generation and geometric impact conditions].

The aim of forensic biomechanics is the reconstruction of traumatic events based on the pathological findings in the victim's morphology and on the traces and shapes of the traumatizing tools. The introduction of Streifenlichttopometrie into forensic science enables 3-dimensional and proportionally accurate documentation of the victim's body and injuring agent with submillimeter precision. The advantages of this method of documentation are the possibilities of producing animated models which correspond exactly to the body's shape and injury topography, and of ascertaining the physical parameters (centers of mass, moments of inertia) of the various body parts and the geometrical impact conditions for the reconstruction of the injury dynamics. This way of proceeding thus enables more precise models than hitherto possible for kinetic and dynamic reconstruction. In the case of an infant who was fatally injured by a wooden sculpture the generation and application of computer aided 3-dimensional reconstruction models are shown.

Accidents↗

Document on illegal marriages, 1987.

In December 1987, the State Family Planning Commission of China issued a document calling for government at all levels to take resolute measures to educate people about the Marriage Law and stop violations. The Document also provides that local governments should insist on legal registration and, after education with the help of associations of women, workers, and youths, punish Marriage Law violators. It stresses that local officials should abide by the law and stipulates that they will be severely punished for dereliction of duty or taking bribes.

Asia↗

Project document drafted to revitalize population education.

In the pipeline is the recently developed draft project document aimed at revitalizing and strengthening the population education in the country. It is now under review and approval. To reactivate the population education program, the project calls for the issuance of an Executive Order by the Department of Education, Culture and Sports to create a national Population Education Center and the establishment of 15 Regional Population Education Offices and 133 population education desks at the divisional level. This institutional network will ensure the nationwide implementation of population education program. It will also update and revise some existing curricula and develop new teaching/learning materials for kindergarten, elementary and university level as well as packages for learners and fieldworkers of nonformal education. The first baseline activities to accomplish this are to review the existing curricula for population education messages from kindergarten to grade 11 and university level as well as a survey to determine population learning needs of pupils and teachers from kindergarten to university level. The project will also go into training and re-training of project staff, trainers at national and regional levels, 2000 new teachers and 1000 formerly trained teachers and 17 documentation/library assistants. Strengthening of its Documentation Center and setting up to an information network will also be undertaken. Thus, by the end of the project, it is envisaged that about half a million students and 2500 educators would have increased their knowledge and developed positive attitudes towards population-related concepts.

Asia↗

Moving forward with document imaging and never looking back to paper.

Many healthcare facilities are exploring document imaging solutions and enjoying the benefits of increased accessibility and faster workflows. The transition requires significant planning, however. In this article, learn how several healthcare organizations implemented document imaging systems and how their facilities have changed as a result.

Efficiency, Organizational↗

Angiographic documentation of a persistent otic artery.

The persistent otic artery is a rare remnant of early fetal development that, to our knowledge, has been convincingly documented only once before with angiography. Other persistent vessels such as the trigeminal, hypoglossal, and proatlantal intersegmental arteries have been found to be associated with a variety of vascular anomalies. We believe we present the second case of a persistent otic artery documented by means of angiography and the first such case associated with multiple intracranial aneurysms.

Aged↗

Testing for GHB in hair by GC/MS/MS after a single exposure. Application to document sexual assault.

Gamma-hydroxybutyric acid, or GHB, is a substance naturally present within mammal species. Properties of neurotransmitter or neuromodulator are generally given to this substance. GHB is therapeutically used as an anesthetic, but can be used for criminal offenses (date-rape drug). It appears that the window of detection of GHB is very short in both blood and urine, and therefore its presence is very difficult to prove after a rape case. In order to document single exposure, we investigated the use of hair. Hair was collected one month after the allegated event in order to sample the corresponding period after regular growing. After rapid (2 min) decontamination with dichloromethane, the hair shaft was cut into 3-mm segments. They were overnight incubated in 0.01 N NaOH in the presence of GHB-d6, followed by neutralization and extraction in ethyl acetate under acidic conditions. GHB (precursor ion m/z 233, product ions m/z 147 and 148) was tested by GC/MS/MS (Finnigan TSQ 700) after derivatization with BSTFA + 1% TMCS. Physiological concentrations (n = 24) were in the range 0.5 to 12.0 ng/mg, with no influence due to hair color. No variation of concentrations was observed along the hair shaft in controlled subjects, except for the proximal segment, due to an incorporation through sweat. This demonstrates that endogenous levels for each single subject are constant during hair growth. A controlled human administration of 25 mg/kg to a volunteer demonstrated that a single exposure to GHB is detectable in hair after segmentation. In a case of rape under influence, a clear increase of the corresponding segment (about 2.4 ng/mg) in time was observed, in comparison with the other segments (0.6 to 0.8 ng/mg). This study demonstrates that a single exposure to GHB in a case of sexual assault can be documented by hair analysis when collected about one month after the crime.

Adult↗

Oral care interventions in critical care: frequency and documentation.

BACKGROUND: No data have been collected to describe the products, methods, and frequency of oral care needed to reduce dental plaque, oral colonization, and ventilator-associated pneumonia in critically ill patients. OBJECTIVES: To describe the frequency of use of oral care interventions reported by nurses in several intensive care units in a large southeastern medical center. METHODS: Staff members completed a written survey describing their oral care practices, and oral care interventions were recorded from the unit's flow sheet for the previous 24 hours for all patients at 5 randomly selected times during 1 month. RESULTS: Most respondents (75%) reported providing oral care 2 or 3 times daily for nonintubated patients, and 72% reported providing care 5 times daily or more for intubated patients. However, oral care was documented on the unit's flow sheet a mean of 1.2 times per patient. Reported use of toothpaste and a toothbrush was significantly greater in nonintubated patients (P < .001), and use of a sponge toothette was significantly greater in intubated patients (P < .001). Nurses' mean rating of oral care priority was 53.9 on a 100-point scale. CONCLUSIONS: Despite evidence that they are ineffective for plaque removal, sponge toothettes remain the primary tool for oral care, especially in intubated patients in intensive care units. Nurses report frequent oral care interventions, but few are documented. Education and focus on good oral care strategies are required; nursing research to delineate the best procedure for all patients in intensive care units is needed.

Critical Care↗

[A document by the late Prof. Saburo Matubara, a medico-historical material written in Yiddish].

The late Prof. Saburo Matubara was professor of psychiatry at Kanazawa Medical Academy and later at Kanazawa Medical College (now Kanazawa University Medical School). Among the articles he left, the authors found a document written in Yiddish, which turned out to be a publicity material on prevention and cure of tuberculosis issued in 1907 by the Department of Health, City of New York for Jewish emigrants. As the authors believe this is the first medico-historical material written in Yiddish and found in Japan, its content and its medical, linguistic and historical backgrounds are reviewed. The document suggests the importance of linguistic study on medico-historical materials in multicultural and multilingual society.

Emigration and Immigration↗

Salvage therapy with abacavir in HIV-1-infected patients with previously documented M184V mutation: a possibility of NRTI recycling.

We evaluated in an open-label, randomized, controlled, pilot trial if the re-emergence of previously selected resistant strains, harbouring M184V mutation, could be modulated by the use of different drug associations as components of the new antiretroviral regimens. In addition, we assessed the clinical relevance of this mutation on the management of heavily pretreated HIV-infected patients. The primary end-point of the study was the reselection of M184V mutation. Secondary end-points were the variation over time of HIV RNA plasma levels and CD4 cell counts and the progression of HIV disease. The primary population for efficacy analysis was the intention-to-treat exposed population. After a run-in phase consisting in a new treatment regimen excluding either lamivudine (3TC) or abacavir (ABC) so as to clear the previously documented M184V mutation, 18 patients with an HIV RNA plasma level greater than 10000 copies/ml were randomized to receive an antiretroviral drug regimen (at least three drugs) including either ABC or the association of ABC+3TC. All patients were naive to ABC. The M184V mutation reappeared in 1/9 patients in the ABC group and in 8/9 patients in the ABC+3TC group (P<0.003, 95% CI: 0.5-1). In the ABC group we observed a rapid decrement of viral load that was maintained throughout all the study period (P<0.05). On the contrary, in the ABC+3TC group, after a transient decrement at 2 months, a progressive increment towards baseline values was observed. The proportion of patients with a viral load reduction of at least 0.5 logs at 12 months was significantly higher in the ABC group: 8/9 patients vs 3/9 (P=0.05, 95% CI: 0.2-0.92). Similarly, from an immunological point-of-view, the increase at all time points (since randomization) in CD4 cell count was statistically significant in the ABC group (P<0.01), while no difference was observed in the ABC+3TC group. The possibility of a successful use of ABC in salvage regimens opens alternative therapeutic options for heavily pretreated patients with previously documented M184V mutation. Further studies should clarify whether this is true for other drugs of the nucleoside analogues class.

Adult↗

[Document of wishes stated in advance: attitudes of primary care patients].

OBJECTIVE: To find the attitude of health centre patients to the Document of Wishes stated in Advance (DWA).Design. Descriptive cross-sectional study using a specially designed questionnaire. Setting. Urban health centre in Palma de Mallorca. PARTICIPANTS: 132 users of a primary care clinic in Palma de Mallorca, seen between 21/6/2002 and 15/7/2002. Criteria for exclusion: <40 years old, first visit, major physical or psychological disease at time of visit and advanced neoplasia. MAIN MEASUREMENTS: Patients received written information on the DWA along with the self-administered questionnaire that consisted of five closed questions and free comment. RESULTS: 107 questionnaires were received back (81%). 57.6% were women; and mean age was 55 (40-87). 97% thought the DWA was interesting. 39.3% said they would formalise a DWA and a further 39.3% thought it possible they would. If they did so, 88.8% wanted to discuss it with family members and 73.8% with their family doctor. 32.1% had already talked "clearly" with their family members about terminal care, and 31.1% had talked "in general terms". 36.8% said they had not talked about it. 86% found it "not at all uncomfortable" to read the document. 38 respondents wrote comments about a dignified death, freedom to decide, the relevance of the DWA, the importance of being informed and euthanasia. CONCLUSIONS: Participants were clearly in favour of the DWA and many fully intended to formalise it. They wanted to discuss the question with family members and their doctors. Thinking about it did not make them uncomfortable. The recent legalisation of the DWA may help patients and doctors to talk openly about care at the end of life.

Adult↗

British Society of Paediatric Dentistry: a policy document on oral health care in preschool children.

This policy document was prepared by Janet Rayner, Ruth Holt, Fiona Blinkhorn and Karen Duncan. Policy documents produced by BSPD represent a majority view, based on a consideration of currently available evidence. They are produced to provide guidance, with the clear intention that the policy be regularly reviewed and updated to take account of changing views and developments.

Cariostatic Agents↗

Asthma in light of patient documents. A factor analytic study.

INTRODUCTION: The aims of the study were to elucidate the disease spectrum of asthma in clinical practice, the interplay of symptoms, tests and background factors in the diagnosis of asthma and the applicability of exploratory factor analysis in analysing patient documents. MATERIALS AND METHODS: The data in this retrospective cross-sectional study included 195 suspect asthma patients from a systematic sample of 2877 outpatients examined in the Pulmonary Clinic of the Tampere University Hospital from 1983 to 1993 and some statistics on the place of residence and place of birth of the patients. The materials on 73 variables were reduced to 9 factors explaining 40% of the variance in a rotated principal component analysis. CONCLUSIONS: The factorial description of the patient documents revealed four types of asthma: "allergic", "seasonal", "nasal" and "obstructive" asthma. These phenotypes became more dominant in this order with increasing age. Skin prick reactions to pollen diminished, whereas reactions to epithelia and house dust mite increased from allergic to obstructive asthma. Some slight differences in the patient characteristics were also found with respect to place of residence and place of birth. The use of factor analysis in clinical practice and organisation was demonstrated.

Adult↗

[Some documents on the education in the Ottoman Medical School].

After the foundation of the Ottoman Medical School in 1838 in Galatasaray in Istanbul, we have examined in the Ottoman archives some documents about the physician and professors who are in charge of the Ottoman Medical School. We have learned with these documents that the chief physician Abdülhâk Molla was honored with a mension and an ordonnance was given by the sultan for the publication of his book, and in the chemical laboratory of the medical school all of the examinations are done without payment. In 1867 when it was an epidemic of cholera in Istanbul, Mr. Georges Ralli was charged in the Hospital of Humbarahane. The directory of the Medical School ordered cupboards for the School. When the typhoid fever epidemic appeared in 1865 in Istanbul a physician was attended in the Medical School. An order was given by the sultan for the pick up of the medical opium in the mounth Uludağ for the pharmacy of the medical school and for the exercise of the lessons of obstetrics in the Medical School, a lady was invited from Austria. Many professors in the Medical School received different compensations.

History, 19th Century↗

Documented monitoring: an alarming turn of events.

Event recording of transthoracic impedance and electrocardiogram (documented monitoring) has recently become available to the clinician. Through its use, investigators have documented a remarkably low incidence of true alarms for apnea and bradycardia among monitored infants and children and an even lower incidence of clinically significant alarms. This technique has allowed clinicians to improve monitor management and to discontinue monitoring sooner. Coupled with recording of hemoglobin saturation and pulse waveform, this technology will serve to enhance our understanding of the pathophysiology of events that accompany apparent life-threatening events and that precede sudden infant death syndrome.

Apnea↗

Knowledge representation in digital medical documents for efficient information access and retrieval.

Information access and retrieval are essential to serve the delivery and application of evidence-based medicine. The literature provides evidence for the effectiveness of computerization of medical knowledge for increasing compliance with current standards and improving patient outcomes. But all efforts in implementing knowledge-based functions remain limited in respect of either the prolonged exposure to live clinical use, the complexity of knowledge content supported, the dependencies on a technology platform and host system, or the proof of use and content sharing across multiple and varying environments. We have to face currently an information overload, especially in medicine. As a result, efficient ways of implementation of evidence-based care become more and more important. Most of the medical knowledge contained in textbooks, guidelines, journals as well as online resources is text-based. In order to present problem-specific information at the point of care the outlined concept relies on a document-based solution with the eXtensible Markup Language (XML). The adoption of XML as a standard for the publication and interchange of documents creates a great opportunity for better information retrieval. On the basis of structured data we are able to improve the search quality for clinical information which forms a crucial pre-requisite for the implementation of evidence-based care.

Diffusion of Innovation↗

Clinical documents: attribute-values entity representation,context, page layout and communication.

This paper presents how acquisition, storage and communication of clinical documents is implemented at the University Hospitals of Geneva. Careful attention has been given to user-interfaces, in order to support complex layouts, spell checking, and templates management with automatic prefilling. A dual architecture has been developed for storage using an entity-attribute-value unified database and a consolidated, patient-centered, layout-respectful file-based storage, providing both representation power and speed of access. This architecture allows a great flexibility for storing a continuum of data types, ranging from simple typed values to complex clinical reports. Finally, communication is entirely based on HTTP-XML internally, and a HL-7 CDA interface V2 is currently studied for external communication. Some of the problems encountered, mostly related to the typology of documents and the ontology of clinical attributes are evoked.

Computer Systems↗

Application of an XML-based document framework to knowledge content authoring and clinical information system development.

The role of XML in health care is evolving rapidly. Coupled with other W3C standards, informaticists can design systems that may be used not only for storage and retrieval of structured knowledge, but also for quick transformation of such knowledge into many different usable formats. At Intermountain Health Care, we are currently developing an XML-based document framework to accommodate both the capture of structured knowledge as well as its transformation into several usable formats. Our objective relies upon the premise that information systems can be implemented using workflows based on structured documents.

Artificial Intelligence↗

Utilizing the nursing process in the ophthalmic operating room documentation.

Nursing documentation has always been regarded not only as time consuming but a nursing activity that is problematic when it comes to compliance. Somehow nurses must find the balance between documentation of significant events and observations versus duplication or repetition of routine patient activities. This paper describes how these problems were met by one institution.

Humans↗