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Biomedical subjects

C U Lehmann

Publications and source records attributed to C U Lehmann.

16 recordsLinked to original sources
PubMed2006

Computer based medication error reporting: insights and implications.

BACKGROUND: Despite the growing use of error reporting tools, the healthcare industry is inexperienced in receiving, understanding, and analyzing these reports. OBJECTIVE: To assess the accuracy and define the epidemiology of medication error reports. DESIGN, SETTING, AND PATIENTS: A retrospective cohort study of 581 error reports containing 1010 medication errors reported between July 2001 and January 2003 at a large academic children's institution. MAIN OUTCOME MEASURES: Correct classification and types of medication errors. RESULTS: Of the 1010 medication errors reviewed, 298 (30%) were prescribing errors, 245 (24%) were dispensing errors, 410 (41%) were administration errors, and 57 (6%) involved medication administration records (MAR). Following expert review, 208 errors (21%) were deleted because they had been inappropriately coded as errors and 97 (10%) were added as they were not initially coded despite having occurred. In addition, 352 medication error reports needed to have the subtype of error reclassified; 207 (59%) of these involved the reporter choosing the non-descript "other" category on the reporting tool (such as "Prescribing other") which was able to be reclassified by expert review. The overall distribution of error type categories did not change significantly with expert review, although only MAR errors were underreported by the reporters. The most common medications were anti-infectives (17%), pain/sedative agents (15%), nutritional agents (11%), gastrointestinal agents (8%), and cardiovascular agents (7%). CONCLUSIONS: Despite clear imperfections in the data captured, medication error reporting tools are effective as a means of collecting reliable information on errors rapidly and in real time. Our data suggest that administration errors are at least as common as prescribing errors in children. Further research is needed, not only in the area of computerized physician order entry (CPOE) for children, but also on ways to make the dispensing and administration of medications safer.

Academic Medical Centers↗
PubMed2006

Confirmation of communication between deep venous drainage and the vein of galen after treatment of a vein of Galen aneurysmal malformation in an infant presenting with severe pulmonary hypertension.

Vein of Galen aneurysmal malformations (VGAM) are characterized by multiple arteriovenous connections draining into a markedly enlarged median draining vein. This ectatic vein is not the vein of Galen, but its embryonic precursor, the median prosencephalic vein of Markowski. During normal development, the posterior portion of the median prosencephalic vein persists as the vein of Galen, while its anterior portion regresses in parallel with the formation of the internal cerebral veins (ICV). It has been traditionally thought that, in children with a VGAM, the deep venous system does not connect to and, a fortiori, does not drain into the ectatic median prosencephalic vein/vein of Galen. This report describes a case of successfully treated VGAM in which the drainage of an ICV into the vein of Galen was only demonstrated by follow-up MR imaging and venography. The potential implications of this finding for the management of VGAMs are discussed.

Cerebral Angiography↗
PubMed2004

Application of a Medical Text Indexer to an online dermatology atlas.

Clinical dermatology cases are presented as images and semi-structured text describing skin lesions and their relationships to disease. Metadata assignment to such cases is hampered by lack of a standardized dermatology vocabulary and facilitated methods for indexing legacy collections. In this pilot study descriptive clinical text from Dermatlas, a Web-based repository of dermatology cases, was indexed to Medical Subject Heading (MeSH) terms using the National Library of Medicine's Medical Text Indexer (MTI). The MTI is an automated text processing system that derives ranked lists of MeSH terms to describe the content of medical journal citations using knowledge from the Unified Medical Language System (UMLS) and from MEDLINE. For a representative, random sample of 50 Dermatlas cases, the MTI frequently derived MeSH indexing terms that matched expert-assigned terms for Diagnoses (88%), Lesion Types (72%), and Patient Characteristics (Gender and Age Groups, 62% and 84% respectively). This pilot demonstrates the potential for extending the MTI to automate indexing of clinical case presentations and for using MeSH to describe aspects of clinical dermatology.

Abstracting and Indexing↗
PubMed2000

Reducing the paper load: computer-based patient records.

Physicians burdened with increasing paper work may find relief in computer-based patient records (CPR). CPRs may aid clinicians in the areas of billing, documentation, reporting, and data retrieval. Value-added features like decision support and event monitoring facilitate patient outcome, decrease health care costs and allow improved administration. The authors discuss obstacles in the use of computers in patient care with a focus on security, confidentiality, and Y2K.

Computer Security↗
PubMed1999

Restricted natural language processing for case simulation tools.

For Interactive Patient II, a multimedia case simulation designed to improve history-taking skills, we created a new natural language interface called GRASP (General Recognition and Analysis of Sentences and Phrases) that allows students to interact with the program at a higher level of realism. Requirements included the ability to handle ambiguous word senses and to match user questions/queries to unique Canonical Phrases, which are used to identify case findings in our knowledge database. In a simulation of fifty user queries, some of which contained ambiguous words, this tool was 96% accurate in identifying concepts.

Computer Simulation↗
PubMed1999

Active Learning Centre: utilization patterns of an interactive educational World Wide Web site.

The advent of the World Wide Web (WWW) provides unique opportunities to transform medical education. Interactive computer assisted instruction has shown promising results but its growth has been impeded by logistical barriers. We designed an interactive WWW site--Active Learning Centre (ALC)--that offers a novel approach to these problems, combining remotely authored databases with computer-generated self-assessment tests. This study analyzes utilization and user assessment of the site. The site was found to be patronized mostly by students and health professionals from English-speaking countries. Users have been pleased with their experience and suggest further expansion of the ALC. Our data have also tentatively shown that their knowledge improved with repeated visits to the site.

Attitude to Computers↗
PubMed1998

Development and health care needs of lesbians.

Lesbians have complained about the lack of awareness and sensitivity of their health care providers, resulting in unnecessary examinations and inappropriate focus on reproductive issues. This study attempted to identify psychosocial and health care needs of lesbians, to assess relationships with primary care providers and disclosure of sexual orientation, and to describe the chronologic features of a sexual identity and lifestyle. An anonymous, self-administered written questionnaire was distributed through a campus lesbian organization. Fifty-three women (median age 23 years) completed the questionnaire. Whereas 60% had disclosed their sexual orientation to their parents, only 31% had "come out" to their health care provider. Of participants who had disclosed their sexual preference to a provider, 27% reported a negative effect on their health care, 57% of participants who never had penile intercourse had annual Papanicolaou smears, and 16% felt pressured in the past to accept birth control from a physician. Lesbian sexuality was associated with several risk factors, such as childhood abuse (20%), alcohol or drug problems (39%), suicide attempts (27%), depression (49%), and physical or verbal abuse at school (34%). Average age of awareness of sexual orientation was 15 years, and average age of first homosexual activity was 17 years. Lesbians are at risk for depression, substance abuse, and suicide attempts. Although most would like to confide in their physician, few do because of fears of negative reactions. Communication must be improved to better address their specific health care needs.

Adult↗
PubMed1995

Keep the change, doc!: coins in the upper GI tract of children.

Many children are brought to the Emergency Room each year because they have swallowed foreign bodies (FBs), particularly coins. Whether to remove these foreign bodies or let them pass through naturally is a constant dilemma for ER physicians. This article reviews our experiences in treating pediatric patients who underwent FB retrieval for coins, food particles and toy parts, and discusses their clinical and endoscopic findings. The vast majority (82%) of the swallowed FBs were lodged in the esophagus. A review of the literature and a suggested medical protocol to manage patients who have swallowed coins are also discussed in this article.

Adolescent↗
PubMed1994

Emergency department utilization by adolescents.

PURPOSE: To review adolescents' utilization of a hospital emergency department (ED) in a rural area, to identify their characteristics, and to explore their motivation to seek health care in this setting. METHODS: A retrospective chart survey of all 4932 adolescent visits (ages 12-18 years, 55.5% females) to the ED in a small town with a population of 55,000 serving a rural area was conducted for the calendar year 1989. Chief complaints and diagnoses were retrospectively categorized according to six groups: injury, pulmonary problems, Ob/Gyn, infection, nonspecific pain (complaint)/no diagnosis (diagnoses), and "other." RESULTS: There was an increasing number of visits with increasing age. Adolescents with private insurance, who accounted for 50% of patients, were more likely than self-paying adolescents (14%) and adolescents on Medicaid (36%) to have a primary care source and to have access to a telephone. Injury was the most common diagnosis with motor vehicle accidents (MVA) accounting for 15% of all injuries. Self-paying adolescents and those on Medicaid were more likely to be diagnosed with an infection or an Ob/Gyn problem than adolescents with health insurance. Only 5.9% of adolescents were admitted to the hospital service. 8.5% of adolescents were discharged from the ED without a diagnosis. 78% of these had complained about nonspecific pain. CONCLUSIONS: Many adolescents in this rural area were found not to have an identified primary care source and to seek health care in EDs. Illnesses that could have been prevented or treated in a more cost-effective setting thus become "emergencies." Primary care sources are needed that are accessible and acceptable to adolescents.

Adolescent↗
PubMedDate not supplied

Active Learning Centre: design and evaluation of an educational World Wide Web site.

OBJECTIVE: A new medium--World Wide Web (WWW)--has grown rapidly over the last few years. It provides opportunities for development of new educational tools and facilitates learning through interactivity, self-paced study and easy access. The aim of this project was to devise all educational WWW site (Active Learning Centre) that would take advantage of the capabilities of the new medium and assess its utilization by users. METHODS: Active Learning Centre provides customizable computer-generated feedback tests, searchable databases (currently Microbiology, Pharmacology, Vaccines, and Spanish-language Cardiovascular Medications), remote WWW-based database authoring, and multilingual support. Its modular architecture allows easy expansion into new areas of knowledge. To evaluate the Active Learning Centre we conducted a study evaluating utilization of the site and user feedback. RESULTS: The site is being used by thousands of patrons from around the world, the majority of whom are health professionals/health profession students from English-speaking countries. Customizable interactive tests are the most popular feature of the site. Most users give the site high ratings and would like it to expand further. CONCLUSION: The paradigm of combining interactive feedback tests with searchable % reference databases has been successful. Further expansion of the site to incorporate other areas of knowledge is planned.

Computer-Assisted Instruction↗
PubMedDate not supplied

Utilization of a paediatric link collection by health professionals and laypersons.

The Internet is an evolving resource for health-care information. However little information exists on providers' and other web patrons' usage of the 'medical' Internet. This study aims to characterize the users of a large paediatric link collection, describe their objectives and track their use of the information provided by the site. We utilized a paediatric link collection called the Pediatric Points of Interest (POI) and a combination of a questionnaire, unique user identifier and link-tracking system to collect data about POI patrons' demographics and Internet resource utilization. During a five week period, 5216 individuals visited the POI and requested 36,187 links. The majority of users had less than one year of Internet experience and were first-time visitors to the POI. More than 83% of users were from North America. Medical professionals were more likely to return to the POI during the study period and reported visiting the POI mainly for 'medical education', 'research', 'resource identification', and 'disease specific information'; they proceeded primarily to the resource categories 'Medical Institutions and Agencies' (32%) and 'Professional Education and Resources' (28%). Laypersons expressed the greatest interest in 'disease specific information' and 'patient education' and most frequently visited the category. 'Patient Education' (42%). On average, users were able to identify resources related to their stated goals within one level of searching. Health care providers and other web patrons are actively utilizing Internet sites to seek medical information and are able to identify resources with a minimum of searching.

Adolescent↗
PubMedDate not supplied

The interactive patient: a multimedia interactive educational tool on the World Wide Web.

To develop a physician-friendly continuing medical education tool for use on the World Wide Web, and to improve physicians' clinical and history taking skills, developers at Marshall University designed a multimedia interactive patient encounter for a Web server. Any physician with access to the Internet can use this program to take a history, perform a physical examination, order laboratory and radiologic studies, and submit a diagnosis and treatment plan. The system evaluates the user's performance electronically and delivers CME credits by mail. The Interactive Patient has been embraced by the medical community, with many institutions providing links to this new tool and hundreds of physicians using it. The enthusiasm of most users demonstrates that combining education with fun enhances the learning experience.

Attitude to Computers↗
PubMedDate not supplied

Juvenile polyps and their distribution in pediatric patients with gastrointestinal bleeding.

Juvenile polyps (JPs) are the most common colonic tumor in childhood. The total number and anatomical distribution have changed significantly since the introduction of flexible colonoscopy. This article reviews our experiences treating 29 pediatric patients with JPs, and evaluates the 66 polyps we removed and their distribution in the colon. Thirteen patients (45%) had multiple polyps and 35% of all polyps were found proximal to the sigmoid colon. In the 14 patients who underwent a complete colonoscopy, eight had multiple polyps and 55% of these polyps were found proximal to the sigmoid colon. As a result, we conclude that there is a trend toward more polyps per patient and a more distal colonic distribution in children with JPs than previously reported. We recommend that a complete colonoscopy and possible polypectomy be performed on all children with unexplained rectal bleeding.

Age Factors↗