Clinical spectrum of previously undiagnosed pediatric cardiac disease.

Previously undiagnosed pediatric cardiac disease represents a clinical challenge for the emergency physician. The clinical presentation of these disorders can mimic other conditions of the respiratory, gastrointestinal and neurologic systems at a time when the need for early identification and treatment is at a premium. A high index of suspicion and superb clinical acumen is required to make a timely diagnosis and initiate optimal care. METHODS: A retrospective chart review using explicit criteria and a structured data collection process was performed on all children presenting with previously undiagnosed cardiac disease over a five and half year period. RESULTS: Thirty-six patients were identified over a five and a half year period representing one patient per 4838 pediatric ED presentations. A diverse set of chief complaints, triage categories, clinical presentations and diagnoses were identified. Undiagnosed congenital lesions, acquired cardiac disease, dysrhythmias and infectious diseases of the heart were represented. The need for surgical intervention (22%) and mortality (6%) was substantial. CONCLUSION: In the aggregate, these conditions occur at an important rate and represent a high risk subset of pediatric patients presenting to the emergency department. Individually, the conditions occur infrequently and 'pattern recognition' may not aid the clinician. Early diagnosis and prompt intervention is important in this population.

Computerized content analysis of writings of Mahatma Gandhi.

Three brief excerpts from the autobiographical writings of Mohandas K. Gandhi were analyzed for neuropsychobiological content using the PCAD 2000 computer program. The computer software produces scores on 13 scales such as anxiety, hostility, cognitive impairment, and depression; compares the assigned scores with norms derived from 5-minute speech samples taken from normal, medically and psychiatrically healthy adults and children; and suggests DSM-IV diagnostic categories for consideration. The results demonstrate an objective, repeatable method for achieving insight into the mental states and traits of historic figures based on their writings.

Computerized content analysis of speech plus speech recognition in the measurement of neuropsychiatric dimensions.

The Psychiatric Content Analysis and Diagnosis (PCAD) program performs automated content analysis of machine-readable transcriptions of speech samples to measure the magnitude of neuropsychiatric states and traits. Technological advances provided by computerized speech recognition may offer a possible alternative to labor-intensive manual transcription for preparation of samples for PCAD processing. To test this hypothesis, 25 digitally recorded verbal samples were transcribed both manually and by a commercially available speech recognition software package, and the transcriptions scored by PCAD. The inter-correlations between scores derived from the two different methods of transcriptions offer mixed results, with values ranging from a high of 0.920 to a low of -0.119.

Computerized neuropsychiatric assessment of geriatric subjects by content analysis of brief samples of their speech.

The life expectancy of people living in the United States is increasing. Are very elderly individuals compromised mentally and physically in comparison to much younger persons? The purpose of this study was to test the efficacy of a computerized program applicable to the content analysis of 5-minute speech samples obtained from a group of individuals 90 years of age and older and to compare the results with those previously obtained in younger people with respect to their mental capacities in terms of a set of diverse neuropsychiatric dimensions. After obtaining informed consent from 26 elderly people, recorded verbal samples were elicited from each individual in response to purposely ambiguous instructions to talk for 5 minutes about any interesting or dramatic personal life experiences. The transcripts of their speech samples were digitized on a computer diskette and processed on the computer program. The computer program compared the scores obtained on each verbal sample with norms obtained on 15 previously validated content-analysis scales from individuals ranging in age from 5 to 80. The norms on these content-analysis scales are different for children (aged 5-10) and adults (aged 11-80). The computerized content-analysis scores obtained from this elderly cohort reveal plausible deviations from the norms for younger people.

Computerized content analysis of conversational interactions.

The emotional impact of illness sustained by patients, their families, and friends is increasingly recognized as an important dimension of clinical evaluation and intervention. This study first attempted to extend a computerized technique of measuring the magnitude of mental events from a content analysis of speech initially designed for use on single verbal samples or verbal texts to the analysis of conversational interactions. The study then applied this method of extended measurement to conversations concerning seriously ill surgical patients. The authors' objective was to develop a graphic method that illustrates the neuropsychological interchanges occurring in these conversations. Speech samples were recorded during discussions among nurses, surgeons, intensivists, and family members involved in the care and treatment of seriously ill patients hospitalized in the surgical intensive care unit at Barnes-Jewish Hospitals associated with Washington University School of Medicine, St. Louis, Missouri. These samples then were transcribed into computer-readable text files and divided into utterances: uninterrupted speech by a single individual. The utterances were assigned numeric scores by a computer program on each of 14 validated content analysis scales measuring various neuropsychological dimensions. The scores are presented graphically in chronological sequence to illustrate the emotional interactions in these conversations. The graphic representations depicting sequences of computerized content analysis-derived scores for the mental reactions of the speakers in such conversations provide insights into the psychodynamics occurring in such stressful situations.

Computer detection of cognitive impairment and associated neuropsychiatric dimensions from the content analysis of verbal samples.

This is a report of a study testing the capacity of a computerized measure of the content analysis of five minute verbal samples to detect and measure cognitive impairment and comorbid neuropsychiatric dimensions in 117 drug-abusing inpatients. The cognitive impairment scores obtained from the computerized procedure correlated significantly with independent scores from the Trails B and Stroop Color and Word test as well as with ANAM (Automated Neuropsychiatric Assessment Metric) neuropsychological tests, including the Matching to Sample Efficiency and Accuracy, the Code Substitution Efficiency, the Continuous Performance Task Efficiency and Accuracy, the Code Substitution Delayed Recall Accuracy, and the Simple Reaction Time Efficiency. When the computerized verbal-content-analysis-derived cognitive impairment scores were combined with scores of selected other ANAM measures, more and higher intercorrelations occurred with Trails A, Trails B, the Stroop Color and Word test, and the Wisconsin Card Sort test. In addition, validated measures of a broad range of associated neuropsychiatric dimensions can be obtained simultaneously from the same five minute verbal samples providing the cognitive impairment scores. No significant effects were found on the cognitive impairment scores of age, education, gender, race, and duration of drug-abuse abstinence.

Computerized content analysis of some adolescent writings of Napoleon Bonaparte: a test of the validity of the method.

The aim of this study was to test the validity of a computer software program previously demonstrated to be capable of making DSM-IV neuropsychiatric diagnoses from the content analysis of speech or verbal texts. In this report, the computer program was applied to three personal writings of Napoleon Bonaparte when he was 12 to 16 years of age. The accuracy of the neuropsychiatric evaluations derived from the computerized content analysis of these writings of Napoleon was independently corroborated by two biographers who have described pertinent details concerning his life situations, moods, and other emotional reactions during this adolescent period of his life. The relevance of this type of computer technology to psychohistorical research and clinical psychiatry is suggested.