Use of telehealth technology to extend child protection team services.

OBJECTIVE: In response to increased referrals to Florida's Child Protection Teams and concern regarding statewide availability of medical expertise in the area of child abuse and neglect, Children's Medical Services of the Florida Department of Health established a telemedicine project to facilitate immediate expert medical evaluations of alleged child abuse or neglect. This article describes a baseline examination of the project, including the technique of concept mapping, to examine how larger systematic factors influence the adaptation of telemedicine technology in child abuse examination settings. METHODS: This study included interviews of key staff plus the incorporation of concept mapping, which takes qualitative data (individual statements and opinions) and quantifies them (sorts and ranks them by order of group importance). RESULTS: Findings from interviews revealed that the frequency of use of telehealth services varies across the state as a result of several factors, including space limitations and staff training. Patients, however, seem to be comfortable with the use of the new technology. The concept mapping exercise displayed a progression of issues that are perceived to have an impact on the use of this technology. CONCLUSIONS: Technology use is affected by unforeseen variables, such as physical space limitations and examination room availability. Family concerns about patient privacy issues were rare and were resolved quickly by the health care practitioner. Although using this equipment is not difficult, the search for user-friendliness should be continued. Staff engagement early in the process likely will result in a greater likelihood of use of the technology.telehealth, telemedicine, child protection, child abuse and neglect, concept mapping.

A computerized medical record for clinical management of children with cerebral palsy.

Computerization has numerous applications in the administrative, business, and personal arenas. Applications in the medical field have produced a myriad of programs with varying degrees of impact on direct patient care. A recent Institute of Medicine report states that a computer-based medical record should become the standard for medical records.

Computers in medicine: enhancing medical care for children with developmental disabilities.

Caring for children with developmental disabilities and their families requires the close monitoring and management of a multitude of complex medical and psychosocial issues. The need for an interdisciplinary team approach to address these concerns presents special logistical problems on how to organize and present the information obtained during a clinic visit, and how to expedite the dissemination of this information to the team members. I am currently utilizing a computerized medical record database in the Developmental Disabilities Clinic at Children's Hospital-Columbus, Ohio and at The Nisonger Center a university affiliated program (UAP). The hardware required for the operation of this system includes a Macintosh PowerBook 170 and FilemakerPro software by Claris. The flexibility of use and the potential future applications of this program provides a practical clinical approach to caring for children with developmental disabilities.

Rasmussen encephalitis: epilepsia partialis continua secondary to chronic encephalitis.

Rasmussen encephalitis is a disease consisting of chronic encephalitis with progressive neurologic deficits and focal intractable seizure activity. The etiology is unknown, but pathologic specimens revealed changes consistent with viral encephalitis. Even though neuro-imaging techniques, such as positron emission tomography and magnetic resonance imaging, offer the prospect of specific, presurgical diagnostic criteria, the initial diagnosis usually is made on a clinical basis. Treatment modalities, including a wide variety of antiepileptic drug therapies and surgical interventions, may result in significant physical and mental impairments. We summarize the clinical presentation, diagnostic considerations, and different treatment protocols in a patient with this rare and debilitating disorder.

Superficial compartment syndrome of the foot after infiltration of intravenous fluid.

The infiltration of intravenous fluids is common in pediatric practice, but complications are unusual. This is a report of a four-year-old boy with a spinal cord injury resulting in paraplegia who developed a compartment syndrome of the foot due to intravenous fluid extravasation. The patient required surgical decompression and subsequent skin grafting. This case report demonstrates that the normal warning signs indicative of intravenous fluid infiltration such as pain or perception of pressure are not applicable in patients with spinal cord injuries and that equipment warning systems may not be a reliable means for monitoring infiltrations. Intravenous lines placed in the affected limb of these patients must be frequently visualized and evaluated.

Visual telephone for pediatric rehabilitation inpatients.

Prolonged pediatric rehabilitation inpatient hospitalizations can cause numerous psychologic problems. A four-year-old patient with spinal cord injury required intensive prolonged rehabilitation and demonstrated maladaptive behaviors secondary to the family situation and the length of the hospitalization. Use of a visual telephone display unit eliminated several of the behavior problems and helped expedite his eventual discharge.

Computers in medicine. Augmenting medical care in pediatric patients with chronic illnesses.

The use of computers to aid care for chronically ill pediatric patients is a relatively new concept. We are currently using Filemaker II software and a Macintosh Plus computer to augment overall patient care in children with chronic diseases, such as spina bifida, cerebral palsy, neuromuscular diseases, head injury, and spinal cord injury. This is a computerized medical record with a clinical database for dissemination of information to multidisciplinary team members, generating letters to private health care providers, displaying telephone messages, and assisting inpatient care. Advances in computer technology will provide future applications to aid health care providers in caring for patients with chronic illnesses.