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PubMed2005

Handedness: differential specializations for control of trajectory and position.

Handedness is often portrayed as a nonfunctional artifact of cerebral asymmetry. Our data, however, indicate that handedness reflects cerebral specialization for specific control processes. Each hemisphere/limb system is specialized for different but complementary functions: the dominant system for controlling limb trajectory dynamics, and the nondominant system for controlling limb position.

Biomechanical Phenomena↗

PubMed1997

Strengthening partnerships between state programs for children with special health care needs and managed care organizations.

The roles and responsibilities of state Title V Programs for Children with Special Health Care Needs (CSHCN) are changing with the rapid expansion of managed care. The authors surveyed Title V CSHCN programs to learn about critical issues and examples of collaboration with managed care organizations in the following areas: (1) defining and identifying children with special health care needs, (2) enrollment assistance and family participation, (3) pediatric provider and service requirements, (4) education and training, (5) quality of care, and (6) pediatric risk-adjusted capitation mechanisms. This article also includes recommendations developed by the federal Maternal and Child Health Bureau's Work Group on Managed Care.

Capitation Fee↗

PubMed1990

Special issues in child custody evaluations.

The child and adolescent psychiatrist who performs child custody evaluations assumes an extraordinary responsibility. Operating at the interface of psychiatry and the law, this forensic psychiatrist is often confronted by special factors that can make a normally complicated process even more intricate. This paper examines the forensic psychiatrist's role in dealing with a number of special issues which often arise during child custody evaluations. These issues are: the mentally ill parent, the homosexual parent, stepparents, grandparents' rights, and parental kidnapping. Case vignettes are presented, and guidance for the clinician is provided.

Adolescent↗

PubMedDate not supplied

Children with sensorimotor deficits: a special risk group.

Children with spina bifida, cerebral palsy, mental retardation, developmental delays, and seizure states are handicapped with sensorimotor deficits, including gait or coordination instability, temperature insensitivity, and mental simplicity. These handicaps make this distinct and unpretentious population more susceptible to lethal burns. A 30-year review was conducted in a pediatric burn center to examine the relationships between pediatric sensorimotor deficit and burn injury. Of the 4874 acute burn admissions, 66 children were identified with preexisting sensorimotor deficits. Data indicate that children with sensorimotor deficit are more prone to burn injury from both their physical impairment and poorly supervised environments. In addition to extended hospitalizations, these children bear significantly higher mortality risks. Had the special supervisions and protection required by such handicapped children been provided, 80% of the burn injuries could have been prevented. Results emphasize that the future of these special children with sensorimotor deficits relies on health care providers playing a greater role in educating parents and caregivers.

Burns↗

PubMed1992

Acute gastrointestinal bleeding. Experience of a specialized management team.

The initial experience of a specialized management team organized to provide expedient care for all acute major gastrointestinal bleeding in protocolized fashion at a large referral center is presented. Of the 417 patients, 56% developed bleeding while hospitalized. Upper gastrointestinal bleeding accounted for 82%. The five most common etiologies included gastric ulcers (83 patients), duodenal ulcers (67 patients), erosions (41 patients), varices (35 patients), and diverticulosis (29 patients). Nonsteroidal anti-inflammatory drugs were implicated in 53% of gastroduodenal ulcers. The incidence of nonbleeding visible vessels was 42% in gastric and 54% in duodenal ulcers. The rates of rebleeding were 24% (20 patients) in gastric ulcers and 28% (19 patients) in duodenal ulcers. Predictive factors for rebleeding included copious bright red blood, active arterial streaming, spurting, or a densely adherent clot. The rebleeding rate for esophagogastric varices was 57%. The mortality rate overall was 6% (27 patients), with rates varying from 3% (five patients) for gastroduodenal ulcers to 40% (14 patients) for esophagogastric varices. The morbidity rate for the entire patient population was 18% (77 patients), dominated by myocardial events (34 patients). The average length of hospitalization for gastroduodenal ulcers was 5 days, for diverticulosis 8 days, and for varices 10 days. The major efforts of a specialized Gastrointestinal Bleeding Team would be best directed at both reducing the morbidity associated with acute bleeding and reducing the overall cost of care.

Adolescent↗

PubMed1999

The administrative support team: specialized support.

Specialization has enabled one person to develop a high level of expertise in one management function. The entire department of nursing, not just one unit, shares the benefits of this expertise. The result is efficient and effective use of resources. The lateral relationship between the administrative support team and clinical manager teams has promoted communication flow and exchange while keeping the decision-making power at the clinical level. The implementation of the administrative support team has provided the right solution to the problem: specialized support.

Alberta↗

PubMed1982

Utilization of specialized ambulatory care by the elderly. A study of a clinic.

Specialized ambulatory geriatric care remains an understudied topic. This article analyzes the organization of one special clinic that was established in an apartment block of elderly housing. The findings indicated that as the number of nurse practitioners and case workers' visits rose steadily during the first four years of the clinic's existence, visits to the clinic physicians declined by approximately one visit per client per year. The clinic population utilized less inpatient hospital care than other nonusing residents, and less than other residents of similar age in Connecticut. There was reduced usage of intermediate nursing home care (as opposed to skilled nursing care). Hence, how geriatric ambulatory care is delivered affects institutionalization. In the interests of general well-being and economy, more attention should be paid to this extramural phase of medical care of the elderly.U

Activities of Daily Living↗

PubMed1993

Health insurance and utilization of medical care for children with special health care needs.

Based on analyses of the 1988 National Center for Health Statistics, National Health Interview Survey, Child Health Supplement, this study examines the insurance coverage and utilization of physicians, hospitals, and prescribed medicine among the 9.6 million U.S. children with special health care needs, defined as children who had one or more selected chronic conditions that caused them to experience pain, discomfort, or being upset often or all of the time in the last year, or who were limited in their major childhood activities (playing or going to school) as a result of these or other impairments or health problems. The findings confirmed that substantial variation in access to routine medical care exists among these children. Though health status is an important predictor of which children use services in general, poor, minority children who lived with their mother or someone other than their parents, or those without insurance or an identifiable regular medical provider were most likely to experience financial barriers to access or were less apt to seek care than other children with comparable needs. Access to routine medical care remains particularly problematic for these subsets of children with special health care needs.

Adolescent↗

PubMed1993

New procedures for evaluating vision functions of special populations.

Research over the last few decades has demonstrated the rapid development of vision function that occurs in infancy with near-adult levels reached before the age of 1 year. This period of rapid development coincides with the period of maximum sensitivity to insult. These facts emphasize the importance of effective screening techniques for visual disorders. Off-axis photorefraction is described as a new and effective screening technique for detection of refractive errors, media opacities, and strabismus. Separate from screening, a significant need exists for optometric vision evaluations in special populations. Normal infants, developmentally delayed or multi-handicapped children and adults, and cognitively impaired adults are examples of special populations who are difficult to examine with standard optometric techniques. New procedures for measuring visual acuity, contrast sensitivity, color vision, and stereopsis using behavioral or electrophysiological measures are described. Advantages and disadvantages of the different techniques are discussed.

Color Perception↗

PubMed2002

Do specially designed visual display unit lenses create increased postural load compared with single-vision lenses during visual display unit work?

Three different types of spectacle lenses, specially designed for visual display unit (VDU) work, were compared with single-vision lenses regarding postural load. The different corrections effect on postural load was measured by using electromyography. Muscle loads were recorded from the trapezius muscle and the infraspinatus muscle. Continuous measurements of body posture were measured by using three dual axis inclinometers attached to the head, back, and upper arm. No significant differences were found between the single-vision lenses and the specially designed VDU lenses regarding muscle load. Small differences were found regarding the head angle. The study concludes that these new lens designs create interesting opportunities for the optometrist to optimize the visual conditions for VDU workers.

Arm↗

PubMedDate not supplied

Developing a special needs restraint loaner program for transporting medically fragile children.

Pediatric orthopaedic patients require special consideration for their transportation needs. A hospital-based program to fulfill these needs promotes patient safety and allows accessibility of needed devices to elective and nonelective patients. Nurses can be an integral part of this process. This article presents the process of establishing a special needs restraint program including the legalities, acquisition of equipment, and training of appropriate personnel.

Child↗

PubMed2004

Discrepancy between opinion and attitude on the practice of ECT by psychiatrists specializing in old age in the Netherlands.

BACKGROUND: Current guidelines consider electroconvulsive therapy (ECT) in the Netherlands a treatment of choice for a depressive disorder with psychotic features, severe suicidal behavior, severe physical exhaustion, or resistance to treatment with antidepressants (consecutively SSRIs, TCAs, lithium, MAO inhibitors). It is advised to use ECT early on in the treatment of depressed elderly patients. In practice, ECT is applied to only a minority of depressed elderly patients in the Netherlands. This situation dates back to the 1970s, in which strong aversive opinions toward ECT grew in the Netherlands, largely as a reaction to the malpractice of ECT in that time and influenced by social-cultural opinions toward psychiatry. Negative attitudes among professionals and lack of knowledge may contribute to the under use in depressed elderly patients. METHODS: A postal questionnaire was sent to 152 psychiatrists who specialize in old age to assess their opinions and attitudes toward ECT. RESULTS: Only a small minority thought ECT was a treatment of choice in a depressive disorder with psychotic features (4%), severe suicidal risk (2%), or physical exhaustion (5%). The majority of the psychiatrists had strongly reserved opinions in considering ECT as a treatment of first, second or third choice in depressed elderly patients, even in treatment-resistant depressive disorders. CONCLUSIONS: Many psychiatrists who specialize in old age in the Netherlands divert from the current guidelines and are reluctant toward using ECT as a treatment of choice in a number of specific, clinical situations. This might be a major contributing factor to the present and past underuse of ECT in depressed elderly patients in the Netherlands.

Aged↗

PubMedDate not supplied

Low molecular weight heparins in special populations.

Low molecular weight heparins (LMWH) are replacing unfractionated heparin (UH) as safe and effective agents for the prevention and treatment of thromboembolism. Although LMWH offer many advantages over UH, usage is less clearly defined in certain special populations, including renal dysfunction, obesity and pregnancy. This article will briefly review the pharmacology of LMWH and discuss usage in these special populations.

Anticoagulants↗

PubMed2002

Substance use-related outpatient consultations in specialized health care: an underestimated entity.

BACKGROUND: To study the occurrence and documentation of substance use related outpatient visits in specialized health care. METHODS: The diagnosis recorded in retrospective discharge data in Tampere University Hospital for 6 years was compared with the prospective data gathered from separately completed forms added during an 8-week period to every outpatient's discharge data. In this form, the relation of substance use and the actual reason for the consultation were specifically elicited. RESULTS: On the basis of diagnoses, retrospectively, 0.4% (6,666 of 1,555,898) of outpatient visits were caused by substance use. In the prospective part of the study, 5.6% of visits (1,401/25,014) were related to substance use. Retrospective study demonstrated 2% prevalence of substance use, whereas prospective study showed 36% substance use-related visits at the emergency room. According to the retrospective discharge data, alcohol-related organ damages were the major reason for substance use-related outpatient visits. In the prospective study, the proportion of acute traumas was most prevalent. CONCLUSIONS: Our study indicates that substance use-related visits often remain undetected in specialized health care. Substance use-related visits were underdocumented/undetected in the emergency room. Using a simple separate form could dramatically increase the detection of substance use-related visits.

Ambulatory Care↗

PubMed2006

Outcome in neurocritical care: advances in monitoring and treatment and effect of a specialized neurocritical care team.

OBJECTIVE: To review current advances in the treatment of critically ill neurologic patients, including specialized care by neurointensivists. DESIGN: Review article. MAIN DISCUSSION AND CONCLUSIONS: Significant developments in the fields of neurology and neurosurgery have led to improved treatments for the critically ill neurologic patient. The major areas reviewed include neuromonitoring, disease-specific treatments, and specialized neurocritical care units and team. The current trend is for the application of the so-called multimodality neuromonitoring, which includes the use of several monitoring techniques, including intracranial pressure, brain electrophysiology, brain metabolism and oxygenation, and cerebral blood flow, among others. Many new therapies that have been introduced are discussed, including thrombolytic therapy for acute ischemic stroke, induced hypothermia for comatose survivors of cardiac arrest, and endovascular coiling for ruptured cerebral aneurysms. Lastly, the introduction of neurointensivists and neurocritical care units has been associated with reduced hospital mortality and resource utilization without changes in readmission rates or long-term mortality rates.

Critical Care↗

PubMedDate not supplied

First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055.

OBJECTIVE: To investigate endometrial safety by assessment of endometrial biopsy samples and the tolerability and efficacy of the special Actaea or Cimicifuga racemosa extract (CR BNO 1055). DESIGN: Four hundred postmenopausal women with symptoms related to estrogen deficiency were enrolled into a prospective, open-label, multinational, multicenter study. Treatment duration (daily dose corresponds to 40 mg of herbal drug) was 52 weeks. To determine the probability of endometrial hyperplasia and more serious adverse endometrial outcome, the point estimator and upper limit of 95% CI were calculated. Descriptive statistics was used to assess the secondary endpoints. RESULTS: Endometrial safety has been proven because no case of hyperplasia or more serious adverse endometrial outcome occurred (point estimate: 0.0; upper limit of 95% CI: 0.011). Endometrial thickness, which was measured by endovaginal ultrasonography, did not show an increase. The number and intensity of hot flushes were markedly decreased. The dropout rate was less than 10%. The overall tolerability was good. CONCLUSIONS: The lack of endometrial proliferation and improvement of climacteric complaints as well as only few gynecologic organ-related adverse events are reported for the first time after a treatment period of 1 year. Due to the improved benefit:risk ratio, it must be assumed that the Cimicifuga racemosa special extract BNO 1055 is a safe alternative for treatment of climacteric complaints.

Administration, Oral↗

PubMed2005

Effects of a specially designed fermented milk product containing probiotic Lactobacillus casei DN-114 001 and the eradication of H. pylori in children: a prospective randomized double-blind study.

GOALS: To determine the efficacy of triple therapy supplemented with a specially designed fermented milk product containing specific probiotic Lactobacillus casei (L. casei) DN-114 001 strain on Helicobacter pylori eradication in children. BACKGROUND: Lactobacillus species possess in vitro activity against H. pylori. There are no consistent data on the impact of eradication therapy supplemented with probiotics on H. pylori cure rates in childhood in vivo. STUDY: Multicenter, prospective, randomized, double-blind controlled study. Eighty-six symptomatic H. pylori-positive children were randomized either to receive the control treatment of omeprazole, amoxicillin, and clarithromycin (OAC) for 7 days or the test treatment of omeprazole, amoxicillin, and clarithromycin for 7 days supplemented with fermented milk (Actimel) containing L. casei DN-114 001 (OAC-LC), for 14 days. H. pylori status was assessed at 4 weeks following therapy using two noninvasive tests. RESULTS: Intention-to-treat (ITT) based eradication rates for the OAC-LC group were 84.6% (95% CI, 71.2%-95.5%), and 91.6% (95% CI, 76.9%-98.2%) by per-protocol (PP) analysis. Eradication in the OAC group was 57.5% (95% CI, 42.2%-72.3%) in the ITT set and 61.3% (95% CI, 44.4%-75.0%) in the PP group. Eradication success was higher in the OAC-LC group compared with the OAC group in both ITT (P=0.0045) and PP analysis (P=0.0019). Primary resistance for clarithromycin could be determined in 21.2%. Side effects were infrequent. Drug compliance was good throughout the study. CONCLUSION: Supplementation with fermented milk, containing live special probiotic L. casei DN-114 001, confers an enhanced therapeutic benefit on H. pylori eradication in children with gastritis on triple therapy.

Antigens, Bacterial↗

PubMedDate not supplied

Surveillance program for early detection of hepatocellular carcinoma in Japan: results of specialized department of liver disease.

OBJECTIVE: Surveillance of cirrhotic patients enables early detection of hepatocellular carcinoma (HCC) and possibly prolongs survival. The aim of this study was to explore whether early-stage HCC can be detected earlier at a specialized department of liver disease than in other institutions. METHODS: The study subjects were 574 patients with HCC. Patients were subdivided into 3 groups according to the manner of HCC detection: group A, HCC was detected in 91 patients during periodic examination at Kurume University School of Medicine; group B, HCC was detected in 301 patients during periodic examination at other institutions; group C, HCC was detected incidentally or because of symptoms in 182 patients. RESULTS: The HCC detected in group A was significantly of smaller size (20.4 mm) compared with groups B (27.1 mm, P<0.0001) and C (57.8 mm, P<0.0001). The frequency of receiving treatment (surgery or local ablation therapy) was significantly higher in group A (73%) than in groups B (52%, P=0.002) and C (26%, P<0.0001). The 5-year survival rates were 52% for group A, 40% for group B, and 23% for group C, respectively. The survival of group A was significantly better than that of groups B (P=0.0157) and C (P<0.0001). CONCLUSIONS: Surveillance for HCC at specialized Department of Liver Disease can detect early-stage HCC, resulting in a higher chance of receiving promising treatment.

Aged↗