Follow-Up Decision Support Tool for Public Healthcare: A Design Research Perspective / 대한의료정보학회지

OBJECTIVES: Mobile health (m-Health) technologies may provide an appropriate follow-up support service for patient groups with post-treatment conditions. While previous studies have introduced m-Health methods for patient care, a smart system that may provide follow-up communication and decision support remains limited to the management of a few specific types of diseases. This paper introduces an m-Health solution in the current climate of increased demand for electronic information exchange. METHODS: Adopting a novel design science research approach, we developed an innovative solution model for post-treatment follow-up decision support interaction for use by patients and physicians and then evaluated it by using convergent interviewing and focus group methods. RESULTS: The cloud-based solution was positively evaluated as supporting physicians and service providers in providing post-treatment follow-up services. Our framework provides a model as an artifact for extending care service systems to inform better follow-up interaction and decision-making. CONCLUSIONS: The study confirmed the perceived value and utility of the proposed Clinical Decision Support artifact indicating that it is promising and has potential to contribute and facilitate appropriate interactions and support for healthcare professionals for future follow-up operationalization. While the prototype was developed and tested in a developing country context, where the availability of doctors is limited for public healthcare, it was anticipated that the prototype would be user-friendly, easy to use, and suitable for post-treatment follow-up through mobility in remote locations.

Hypertensive encephalopathy: a rare presentation of Williams-Beuren syndrome

A male child of four years is reported with Williams-Beuren Syndrome [WBS]. It was not recognized initially when he presented with odd facies and developmental delay since early infancy. The diagnosis was established later when he developed hypertensive encephalopathy secondary to bilateral renal artery stenosis, a congenital anomaly that must be looked for in such patients. No echographic evidence of congenital heart disease was found. Blood pressure estimation on routine physical examination of every child is emphasized. The diagnosis is mainly clinical as the definitive chromosomal studies are presently not available in Pakistan

Hepatitis A - frequency in children with non-specific abdominal symptoms

To study the frequency of subclinical hepatitis 'A' in children having non-specific abdominal symptoms. Design: A descriptive study. Place and Duration of Study: This study was conducted at Combined Military Hospital [CMH], Peshawar from June to December 2000. Subjects and Three hundred and sixty children of either gender, < 12 years of age, presenting with vague abdominal symptoms and no jaundice were evaluated for hepatitis. Eighty eight [24.4%] children meeting the inclusion criteria of elevated serum alanine aminotransferase [ALT], twice the upper limits of normal [90 IU/L], and normal serum bilirubin were labelled as subclinical hepatitis. A total of 360 children were evaluated for vague abdominal symptoms and 96 [26.7%] of them had hepatitis on laboratory profile. Eight patients developed early jaundice and were excluded from the study. Out of 88 [24.4%] cases of subclinical hepatitis, 82 [93.2%] had hepatitis-A, 03 [3.4%] had hepatitis-B, while no causative agent was found in 03 [3.4%] children. The common presenting symptoms were abdominal pain/discomfort, loss of appetite, nausea, vomiting, malaise, fatigue and fever. Hepatomegaly and splenomegaly was documented in 56% and 43% cases respectively. A history of exposure to a patient with hepatitis was present in 14/88 [15.9%] cases whereas no child was vaccinated against HAV. Serum ALT level declined to normal limits within 4 weeks for 77/88 [87.5%] cases and within 6 weeks for 84/88 [95.4%]. All cases recovered spontaneously with out any complication. Hepatitis-A was rampant in children presenting with vague abdominal symptoms in our series

Abdominal epilepsy

Abdominal epilepsy [AE] is a rather uncommon clinical entity in children that might create diagnostic confusion especially when it lacks the typical manifestations of an epileptic seizure. We report the case of a young boy having apparently unexplained episodes of paroxysmal abdominal symptoms with no other suggestion of an underlying epileptic disorder. The case also explains how the clinical presentation can be misleading unless a high index of suspicion is maintained to reach the ultimate diagnosis