ABSTRACT
Developing and deploying informatics solutions which are useful and acceptable to busy physicians are challenging tasks. We describe the design, deployment, and evaluation process by which the delivery of routine clinical laboratory reports is automated using electronic mail. Data from TMR, an operational computer-based patient record (CPR), are presented to providers using an individualized, modern interface. This system is compared to the existing, paper-based system for delivery of data from the same CPR. Differences between the two systems of data delivery are analyzed, with emphases on 1) electronic documentation of data delivery and receipt, 2) electronic and/or paper documentation of clinical action taken as a result of laboratory reports, 3) timeliness of report availability, 4) costs, 5) workflow compatibility, and 6) physician satisfaction. The new delivery system employs inexpensive, commercially available software applications and entails only trivial changes to the proprietary CPR. Built into the new system are features which allow quantitative measurements of its performance for analysis along with survey-based user satisfaction data. The open systems design is deliberately non-proprietary, inexpensive, and generalizable. Accordingly, it offers practical possibilities for settings in which clinical information systems are just being planned, as well as for those in which such systems are already established.
Subject(s)
Clinical Laboratory Information Systems , Computer Communication Networks , Medical Records Systems, Computerized , Documentation , Forms and Records Control/methodsABSTRACT
Functional dysphagia in children has historically been treated using a cognitive behavioral approach. The case of a 7-year-old boy treated using a successful multimodal approach, including behavioral, family, and play therapy with alprazolam augmentation, is reported. The patient showed minimal response to early interventions but rapidly improved with the prescription of alprazolam before meals.
Subject(s)
Alprazolam/therapeutic use , Deglutition Disorders/drug therapy , Deglutition Disorders/therapy , Alprazolam/administration & dosage , Child , Child Abuse, Sexual/psychology , Cognitive Behavioral Therapy , Combined Modality Therapy , Deglutition Disorders/diagnosis , Fluoroscopy , Humans , Male , Relaxation TherapyABSTRACT
Among 170 preadolescent children (138 males, 32 females) admitted to the University of Iowa Psychiatric Hospital between 1970 and 1983, 23 males (17%), had adult prison records at follow-up in 1990. Assaultive behavior in childhood predicted adult imprisonment (odds ratio = 4.96, 95% confidence interval 1.8-13.8, p = 0.002), as did criminality in a biological parent (odds ratio = 4.0, 95% confidence interval 1.3-12.4, p = 0.015). Diagnosis, including conduct disorder, was not correlated with outcome. Among these young children, male gender, violence, and parental criminality identified persons at high risk for adult imprisonment. Psychiatric hospitalization in childhood is a risk for adult disturbance, including sociopathy.
Subject(s)
Crime/statistics & numerical data , Hospitalization , Mental Disorders/diagnosis , Adolescent , Adult , Age Factors , Child , Female , Follow-Up Studies , Humans , Juvenile Delinquency/psychology , Male , Mental Disorders/psychology , Parents/psychology , Personality Disorders/etiology , Personality Disorders/psychology , Prisoners/psychology , Risk FactorsABSTRACT
Conventional theories about stressors severe enough to lead to PTSD have focused on external events. Historically, however, psychosis has been considered one of the most severe stressors to which one can be subjected. The impact of psychosis, in the case of schizophrenia, may be mistaken for the psychosis itself. The possibility of a comorbid, psychosis-induced PTSD should be considered in persons who have experienced a psychotic illness. Recognition of the syndrome may lead to more effective and emphathic clinical treatment of persons with severe mental illness.
Subject(s)
Schizophrenia/complications , Stress Disorders, Post-Traumatic/etiology , Adolescent , Comorbidity , Humans , Male , Schizophrenic Psychology , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychologyABSTRACT
An abduction device is described that allows mobility and continued physical therapy for cerebral palsy patients who are recovering from multilevel lower-extremity surgery. An easy-to-use, removable abduction bar allows ongoing therapy and ambulation in the postoperative casts when the bar is removed and maintenance of hip abduction when the bar is in place. This has aided our patients in achieving maximal benefit of the surgical/therapy program and minimized the regression of presurgical motor skills during the immobilization period.
Subject(s)
Casts, Surgical , Cerebral Palsy/rehabilitation , Early Ambulation/methods , Leg/surgery , Child , HumansABSTRACT
Primitive reflexes and motor development were evaluated in 127 very low birth weight (VLBW) infants (birth weight less than 1501 grams) at four months corrected age. The asymmetrical tonic neck reflex, tonic labyrinth reflex, and Moro reflex were assessed for each child. The ability of each child to reach (obtain a red ring) and roll were observed. The child's performance on the gross motor scale of the Denver Development Screening Test was recorded. Thirty-seven term infants were administered identical evaluations at four months of age. The VLBW infants retained stronger primitive reflexes and exhibited a significantly higher incidence of motor delays than term infants. Significant correlations existed between the strength of the primitive reflexes and early motor development for VLBW infants. This study confirms a high incidence of motor delays among VLBW infants and demonstrates a clear association between retained primitive reflexes and delayed motor development in VLBW infants.
