Assessment of abnormal growth curves.

An important part of well-child care is the assessment of a child's growth. While growth in the vast majority of children falls within normal percentile ranges on standard growth curves, an occasional child demonstrates worrisome deviations in weight, height or head size. A single growth percentile value at any particular point in a child's life is only of limited usefulness to the physician. More important is the child's rate of growth. Children whose growth parameters are at the extremes of the growth curve but whose growth rates are normal are likely to be healthy. Conversely, accelerated or slowed growth rates are rarely normal and warrant further evaluation. This article addresses the initial steps to be taken when evaluating children with suspected growth abnormalities, the guiding principles that apply to all growth problems, and the most common growth curve deviations and approaches to their management.

Health informatics.

This article addresses health informatics and some of the technology advancements and issues facing health care organizations today. As the ability to communicate and share data with other institutions is rapidly advancing, so is the need for industry coding standardization and data protection.

Computerized student testing as a learning tool in a family practice clerkship.

BACKGROUND: The purpose of this paper is to describe and evaluate a computerized multiple choice testing system developed to teach family medicine core content in a junior clerkship. METHODS: Students were tested in a minimum of 10 content areas based upon a pretest, and answered sets of 10 randomly generated questions in each area. Students received immediate feedback on scores and correct answers. RESULTS: A total of 192 students took 10,184 computerized tests. Mean student scores rose significantly with successive tests. Scores on the written final clerkship examination correlated with computerized testing scores. Students accepted the computerized testing system well. CONCLUSIONS: The computerized testing system led to immediate learning, but its effects on long-term learning were less clear.

Patients' reactions to physician use of a computerized medical record system during clinical encounters.

BACKGROUND: As physicians begin to use computer technology in front of patients during clinical encounters, concern has been raised that such computer use may exert a dehumanizing effect on the physician-patient relationship. To investigate this concern, we measured patient reactions to physician use of a computerized medical record system during clinical encounters. METHODS: Adult patients who presented for clinical care were randomized into three groups. With the first group, the physician used a standard paper-and-pencil charting system during the encounter. With the second group, the physician used a computerized medical record system with keyboard input. With the third group, the physician used the computerized medical record system with voice input. Patient reactions were measured with a questionnaire that the patients completed after the clinical encounter. RESULTS: For most components of the physician-patient relationship studied in this report, questionnaire scores did not differ significantly among the three study groups. Patients in the voice input group rated physician explanations of patient problems significantly higher than patients in the other two groups. There was a trend for patient confidence in the physician to be higher in the keyboard input group. Although measured encounter durations were significantly shorter in the computer groups, there were no differences in patient satisfaction with encounter duration among the three groups. CONCLUSIONS: Physician use of computers during clinical encounters was not associated with a decline in the perceived quality of the physician-patient relationship.

An approach to difficult management problems in otitis media in children.

BACKGROUND: Otitis media is one of the most common pediatric diseases encountered by family physicians. While isolated, acute episodes pose little clinical difficulty, recurrent infections and persistent middle ear effusions can be perplexing problems. METHODS: This review presents a clinical approach to the management of recurrent and persistent middle ear disease. RESULTS AND CONCLUSIONS: Recurrent infections can be treated with a trial of daily prophylactic antibiotics to decrease the rate of recurrence. Should infections continue to recur despite the daily prophylaxis, polyethylene tube placement is warranted to drain surgically the middle ear effusions that give rise to the recurrent infections. Acute episodes of otitis media are commonly followed by prolonged, asymptomatic periods of middle ear effusion. Patients with this disease have decreased hearing leading to potential deficits in their speech and academic development. If such effusions do not spontaneously resolve within 2 months, repeated courses of antibiotics with the possible addition of a course of oral steroids are warranted to speed resolution of the effusion before proceeding to placement of polyethylene tubes.

Physicians' accuracy in manual computation.

Parenteral alimentation fluids are now part of routine nutritional support in the neonatal intensive care unit, and a number of software products are available to help physicians with the formulations. Use of these products is based on the assumption that an appreciable amount of error occurs during manual computation, but few attempts to measure this error have been reported. I performed a retrospective analysis of the accuracy of physicians' calculations of the formulas for parenteral alimentation fluid. In addition, I assessed the ability of our institution's computer-based parenteral alimentation program to correct the deficiencies identified. The study showed no significant differences between physicians' calculations as a whole and their paired ideal values. Individual errors did occur, however, and were large enough to have potential clinical importance. Use of the parenteral alimentation program was found to correct these errors.

Obstetrician: a protocol system for a family practice clinic.

Physicians often base their medical practices on bodies of rote medical knowledge. Proper use of this type of knowledge requires thorough and consistent application of large sets of memorized facts--a mental function that is often difficult for the unaided human intellect. Programs such as OBSTETRICIAN can assume this function. Incorporating these programs into medical record systems offers the best hope that busy practitioners will use them.