Drowning in Data: Workflow Changes Improve the Collection of Clinically Relevant and Actionable Data.

Background: The implantable loop recorder (ILR) is valuable for recording and evaluating clinically relevant arrhythmias. Devices with wireless capabilities are programmed to automatically transmit data to a secure website for retrieval by cardiology staff. However, increased data review time, memory saturation, and overwriting of true arrhythmia episodes can result unless alerts are programmed to appropriately detect meaningful (or actionable) cardiac data. Patients are instructed to manually activate the ILR to initiate simultaneous recording of rhythms as part of routine, scheduled assessments or during symptomatic events. However, patients may feel overwhelmed or intimidated when attempting to generate their own cardiac data because of the large volume of new information and unfamiliar equipment instructions. Objective: To determine if workflow changes and enhanced patient education improve the collection of more meaningful data from the ILR. Methods: A retrospective chart review was conducted of rhythm data from patients with implantable Medtronic Reveal Linq cardiac monitors. Cardiac rhythm data were gathered three months before and after workflow changes to compare quality and quantity of remote transmissions. Results: Significant improvements were noted following workflow changes and enhanced patient education. Scheduled transmissions increased, unscheduled transmissions decreased, and missed transmissions decreased per patient each month. Conclusion: Workflow changes improved the quality of transmissions and decreased the quantity of transmissions. The capacity to provide high-quality care also improved, as evidenced by the ability to obtain more clinically relevant and actionable data.

Obsessional slowness: a case study.

BACKGROUND: Obsessional slowness is a rare psychiatric disorder with few treatment options and limited research to date. Some suggest that targeted behavioural interventions may reduce the time taken for functional daily activities. PURPOSE: To examine whether a behavioural intervention would reduce the amount of time taken for an adolescent with obsessional slowness to walk to class. METHODS: A single-subject A-B-A withdrawal design was incorporated into this case study. The treatment involved one-to-one pacing and prompting during the subject's walk to gym class. Walking times to gym class were measured during a baseline phase, during a one-month treatment phase, and during a post-treatment follow-up phase. FINDINGS: The subject's walking times decreased during the treatment phase. Post-treatment walking times suggested a carry-over effect. IMPLICATIONS: This study adds to the sparse evidence on treatments for obsessional slowness and suggests occupation-based treatment options.

Predictive accuracy of the Miller assessment for preschoolers in children with prenatal drug exposure.

The Miller Assessment for Preschoolers (MAP) is a standardized test purported to identify preschool-aged children at risk for later learning difficulties. We evaluated the predictive validity of the MAP Total Score, relative to later cognitive performance and across a range of possible cut-points, in 37 preschool-aged children with prenatal drug exposure. Criterion measures were the Wechsler Preschool & Primary Scale of Intelligence-Revised (WPPSI-R), Test of Early Reading Ability-2, Peabody Picture Vocabulary Test-Revised, and Developmental Test of Visual Motor Integration. The highest predictive accuracy was demonstrated when the WPPSI-R was the criterion measure. The 14th percentile cutoff point demonstrated the highest predictive accuracy across all measures.