Subject(s)
Ambulatory Care , Attitude of Health Personnel , Education, Medical, Undergraduate/methods , Faculty, Medical/standards , Internal Medicine/education , Preceptorship/methods , Students, Medical/psychology , Teaching/methods , Adult , Boston , Connecticut , Curriculum , Female , Focus Groups , Humans , MaleABSTRACT
OBJECTIVE: To evaluate clinicians' satisfaction and frustrations with the use of a handheld computer system that implements a guideline for management of childhood asthma exacerbations. SETTING: Nine primary-care pediatric practices. DESIGN: Survey component of a randomized, prospective before-after trial. INTERVENTION: Newton MessagePad outfitted with custom software (called "AsthMonitor") that assists in documentation of clinical findings and provides guideline-based recommendations. RESULTS: Overall, 3 users gave strongly positive global ratings while 6 users were neutral. The majority used the documentation functions concurrently with care. Except for recommendations to administer oxygen (which were unsupported by evidence), users found the recommendations appropriate and appreciated the reminders. Seven of 9 participants believed it took more time to document with AsthMonitor. CONCLUSIONS: Handheld computers are acceptable to some office-based practitioners to provide guideline-based advice within the context of the clinical encounter.
Subject(s)
Asthma/therapy , Attitude to Computers , Consumer Behavior , Microcomputers , Practice Guidelines as Topic , Child , Data Collection , Guideline Adherence , Humans , Medical Records Systems, Computerized , Randomized Controlled Trials as Topic , Surveys and Questionnaires , User-Computer Interface , WritingABSTRACT
The sleep/wake states of newborn infants were investigated as as a function of vaginal and C-section delivery. The subjects were 51 normal full-term infants: 26 vaginally delivered, 12 delivered by emergency C-section, and 13 delivered by elective C-section. Their sleep states and wakefulness were continuously recorded from the time of birth throughout their stay in the hospital, that is, the first 2 postnatal days for the vaginally delivered infants and 5 days for the C-section infants. Sleep was recorded using the automated Motility Monitoring System, which permits 24-hr recordings without instrumentation of the subject. During the 1st postnatal day, both C-section groups showed state patterns that differed significantly from those of the vaginally delivered infants. Analyses for single states indicated that both C-section groups had significantly less active sleep, and the elective group had more wake and more sleep--wake transition than the vaginal group. The two C-section groups did not differ significantly on any measure. Only the vaginally delivered infants showed significant day/night differences during the first 2 days, with more wakefulness, shorter mean sleep periods and shorter longest-sleep periods during the daytime on both days. The results of this study indicate that the earliest postnatal sleep patterns differ and the diurnal sleep rhythm is disrupted as a result of surgical delivery.
Subject(s)
Delivery, Obstetric , Infant, Newborn/physiology , Sleep/physiology , Analysis of Variance , Cesarean Section/classification , Circadian Rhythm/physiology , Elective Surgical Procedures , Emergencies , Female , Humans , Male , Pregnancy , Sleep Stages/physiologyABSTRACT
OBJECTIVE: The purpose of this study was to describe the sleep of newborns throughout the first 48 postnatal hours and to relate their earliest sleep characteristics to developmental status at 6 months. METHODS: The sleep of 36 healthy newborns was recorded continuously throughout the first two postnatal days, starting immediately after birth, using an automated Motility Monitoring System. The Motility Monitoring System consists of a pressure-sensitive mattress pad connected to an amplifier and a small 24-hour analog recorder. A single channel of analog signals produced by the newborn's respiration and motility is continuously recorded onto a 60-minute cassette tape. The signals are digitized and scored, in 30-second epochs, for Active Sleep, Quiet Sleep, Active-Quiet Transition, Sleep-Wake Transition, and Wake. In addition to the percent of time spent in each state, the Mean Bout Length of Active Sleep, Mean Bout Length of Quiet Sleep, Mean Sleep Period, Longest Sleep Period, and Arousals in Quiet Sleep were also measured. RESULTS: On postnatal day 1, four measures were significantly related to 6-month Bayley mental scores: Mean Sleep Period, Longest Sleep Period, Sleep-Wake Transition, and Arousals in Quiet Sleep; and two measures were significantly related to Bayley motor scores: Mean Sleep Period and Sleep-Wake Transition. On postnatal day 2, none of the measures were related to mental scores, while two measures were related to the motor scores: Quiet Sleep and Mean Bout Length of Quiet Sleep. CONCLUSIONS: The results suggest that the newborn's sleep characteristics during the first postnatal day provide uniquely sensitive indices of later neurobehavioral function.
