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A developmental framework for memory rehabilitation in children.

Memory difficulties in adults with acquired brain injuries have been reported in the literature for some time. In recent years, the consequences of memory difficulties from acquired and neurodevelopmental disorders in children have also been investigated. Initial studies have suggested that, like adults, children can experience severe and specific memory deficits. However, there are important developmental differences, both in terms of the nature of cognitive difficulties experienced, and the subsequent consequences for learning, educational attainment and everyday living. Despite the advances made in developmental memory studies, as yet, there appears to be scant literature to guide effective rehabilitation specifically targeted at children. As a starting point, it may be appropriate to consider adaptation of adult rehabilitation strategies to address memory problems in children. This paper describes some of the common principles and practices of adult rehabilitation strategies and then considers the validity of such strategies against developmental models of the memory system and child's learning environment. In particular, four important areas are highlighted: the development of normal memory functions in children, the range of cognitive deficits that can occur in a developing brain, the interaction of memory deficits with other immature cognitive skills and the context of the psycho-social environment in which rehabilitation may take place.

Awareness↗

Evaluation of a labeling system to indicate the presence of an advance directive in a hospital medical record.

OBJECTIVE: To investigate the accuracy of one hospital's system to indicate whether an advance directive exists within a patient's medical record. DESIGN: Medical record review while patients were hospitalized. SETTING: Internal medicine residency program within a tertiary care hospital. STUDY PARTICIPANTS: Patients admitted to four internal medicine services between 25 October 2000 and 6 December 2000. MAIN OUTCOME MEASURES: Presence of an advance directive and a label in medical records were recorded, along with patient demographics, and sensitivity, specificity, and accuracy were calculated. RESULTS: Four of 125 medical records (3%) contained advance directives. Sensitivity of a label for an advance directive was 25% [95% confidence interval (CI) 1-81%], specificity was 62% (95% CI 53-71%), and accuracy was 61% (95% CI 52-69%). CONCLUSIONS: Use of the hospital's labeling system to indicate the presence of advance directives was found to be highly inaccurate. Failure to correctly follow or understand the intended labeling procedure was the most likely source of error. Hospitals should include plans to check the accuracy of protocols when they are adopted to ensure that they are performing as intended.

Adult↗

An interactive voice response system to enhance antidepressant medication compliance.

Advances in technology can have direct and indirect benefits to clinical practice. The challenge that clinicians face is to properly match resources and outcomes, along with patient preferences. This article explores the use of an innovative interactive voice response system to increase patient compliance with antidepressant medication prescribed in primary care settings. The development of the interactive voice response system, its implementation, and clinical outcomes are described. The findings underscore the need to carefully match intervention strategies with the needs of specific patient populations, and the importance of human dialog in the context of healing.

Adult↗

Using talking lights to assist brain-injured patients with daily inpatient therapeutic schedule.

OBJECTIVES: To test the ability of patients with brain injury to use a patient locator and minder (PLAM) system to assist in their adherence to therapy schedules. PARTICIPANTS: Five patients with acquired brain injury who were inpatients on an acute rehabilitation floor of a rehabilitation hospital. MEASURES: The number of human prompts necessary to direct a patient to, and ensure arrival at, a scheduled therapy destination and the proportion of therapy sessions requiring no prompting was measured both before and after the introduction of the PLAM system. RESULTS: With the PLAM system, the average number of human prompts dropped by more than 50%, and the number of sessions requiring no prompting increased from 7% to 44%. CONCLUSION: The PLAM system described in this article seems feasible and useful for patients with acquired brain injury in assisting them with arrival at their therapy destinations without the assistance of staff.

Adult↗

An email alert system for internal medicine physicians.

This study evaluated the effectiveness of an email-based alerting system for internal medicine house staff and faculty in geographically dispersed locales. Responses to a test alert email message were used to quantify the rapidity by which physicians read the message, and to define subgroups in which this communication modality proved most successful. The results of this study are being used to improve our preparedness for emergencies.

Academic Medical Centers↗

A patient-focused pathway for ambulatory anticoagulation care.

Careful monitoring of ambulatory patients on anticoagulation medication is essential to prevent serious complications such as hemorrhages or blood clots. Nurse-run clinics developed in the 1980s provided some of the assistance necessary for chronic maintenance. These clinics had systems problems, however, that were frustrating for both the nurse and the patient. The article describes how multidisciplinary involvement at one medical center helped develop an anticoagulation pathway that improved service to patients and clarified and strengthened the nurse's role in the pathway.

Anticoagulants↗

Oral lichen planus and malignant transformation: is a recall of patients justified?

There has been a continuous debate regarding the possible malignant potential of oral lichen planus (OLP). Based on the results from follow-up studies, OLP is regarded by several authors as a pre-malignant condition, and patients with OLP have been recommended to have their lesions monitored two to four times annually. This recommendation needs reconsideration, because a recall system of all patients with OLP requires substantial economic resources. In a reality where such resources are limited, a recall system must be weighed against other benefits and the fact that the malignant potential of OLP is most likely very low. The present review focuses on the diagnostic criteria for OLP, the pre-malignant potential of OLP, and the extent to which the available information can be used to reduce morbidity and mortality of oral cancer related to OLP.

Cell Transformation, Neoplastic↗

Promoting functional activity engagement at appropriate times with people with multiple disabilities.

This study was aimed at teaching three persons with multiple disabilities to carry out functional activities at appropriate times independently. To this end, an electronic time system that produced vibratory alarms at preset times and a board with object-cues (instructions for the activities) were used. Data indicated that all three persons learned to perform the scheduled activities at the preset times independent of prompts from staff. Implications of the data and the combination of these activities with structured occupational periods were discussed.

Activities of Daily Living↗

MEDLINE SDI services: how do they compare?

INTRODUCTION: Selective dissemination of information (SDI) services regularly alert users to new information on their chosen topics. This type of service can increase a user's ability to keep current and may have a positive impact on efficiency and productivity. Currently, there are many venues available where users can establish, store, and automatically run MEDLINE searches. PURPOSE: To describe, evaluate, and compare SDI services for MEDLINE. RESOURCES: The following SDI services were selected for this study: PubMed Cubby, BioMail, JADE, PubCrawler, OVID, and ScienceDirect. METHODOLOGY: Identical searches were established in four of the six selected SDI services and were run on a weekly basis over a period of two months. Eight search strategies were used in each system to test performance under various search conditions. The PubMed Cubby system was used as the baseline against which the other systems were compared. Other aspects were evaluated in all six services and include ease of use, frequency of results, ability to use MeSH, ability to access and edit existing search strategies, and ability to download to a bibliographic management program. RESULTS: Not all MEDLINE SDI services retrieve identical results, even when identical search strategies are used. This study also showed that the services vary in terms of features and functions offered.

Equipment Design↗

The reduction of broken appointment rates through an automated appointment confirmation system.

Broken appointments continue to be an important productivity, quality assurance, and access gauge for private dental practices and academic dental centers. In November 2001, the University of Rochester Eastman Dental Center, an urban academic dental center, installed an automated confirmation system to address a high incidence of broken appointments. Following the installation of the system, the Eastman Dental Center experienced a marked decrease in the broken appointment rate. Over a twelve-month period, the center's overall broken rate declined from 23.42 percent to 19.17 percent. The general dentistry rate declined from 23.67 percent to 19.77 percent, and the pediatric dentistry rate declined from 29.42 percent to 25.25 percent.

Analysis of Variance↗

High rate of non-compliance with anti-tuberculosis treatment despite a retrieval system: a call for implementation of directly observed therapy in Saudi Arabia.

SETTING: Taif Chest Hospital, Taif, Saudi Arabia. OBJECTIVES: Non-compliance with anti-tuberculosis drug therapy is recognised as a major cause of treatment failure, drug resistance and relapse. In Saudi Arabia, the problem of non-compliance is frequent and has serious implications which need urgent attention from the health-care authority. The objectives of this study were to define factors that affect compliance rate and to determine the appropriate methods to modify these factors. DESIGN: We designed and tested a retrieval system to improve patient return for follow-up and drug collection after an initial hospital admission period in a large chest hospital in the western region of the country. RESULTS: Of 628 patients, 358 (57%) did not attend the first out-patient clinic visit. The retrieval system was successful in bringing back only 83 patients, reducing the default rate by only 13.2%. Various factors that may affect compliance were analysed in the remaining 275 (43.8%) non-compliant patients. CONCLUSION: Because many of these factors are difficult to change, we strongly support implementation of the WHO-recommended directly observed treatment (DOT) strategy in Saudi Arabia and other countries facing similar problems with tuberculosis control.

Adult↗

Improving cervical screening in a remote aboriginal community.

Improved cervical screening has been identified as a priority in reducing the incidence of cervical cancer among Aboriginal women. This paper discusses the cervical screening recommendations of a women's health project developed by Nganampa Health Council (NHC), the Aboriginal-controlled medical service meeting the health needs of the people of the Anangu Pitjantjatjara (AP) Lands. A community participation public health model was used in program development. A process including community and staff consultation, literature review and prioritisation informed the program development, ensuring strategies thereby derived were culturally acceptable as well as practical and scientifically valid. The epidemiology of cervical cancer and screening in this community is discussed. Strategies aimed at maximising patient participation, improving patient satisfaction, running an effective call and recall system, improving quality of cervical smears, improving management of women with abnormal smears and evaluating the program are suggested. The involvement of the community in a scientifically sound, public health approach may increase the likelihood that the strategies suggested will be effective in this community. Both the model of program development and the cervical screening strategies derived are likely to be of relevance for other Aboriginal communities.

Community Participation↗

Smoking status identification: two managed care organizations' experiences with a pilot project to implement identification systems in independent practice associations.

OBJECTIVE: To determine whether managed care organizations (MCOs) can effectively promote the sustained use of smoking status identification systems among independent practice associations. STUDY DESIGN: Quasi-experimental design measuring smoking status documentation before and after an intervention. METHODS: A chart review of the MCOs' patients at 4 participating primary care clinics determined the baseline for smoking status documentation before intervention. Baseline data were unavailable from a fifth participating clinic. Two quality improvement personnel were sent by the MCOs to help the clinics chose and implement a system for identifying smoking status. All of the clinics chose a sticker system. The change in smoking status documentation was assessed by chart reviews of patients enrolled in the MCOs who were seen during the period between 3 and 16 months after implementation of the system. RESULTS: Following the intervention, a significant increase in smoking status documentation was noted among participating clinics. The proportion of patients whose smoking status was identified and documented by any method increased from 50% to 87% (P < .01) at the 4 clinics with baseline data. By clinic, the increase varied from 6% to 60%. The sticker system was the method by which most patients' smoking status was documented (77%). There were no controls, so the influence of outside factors, including a regional smoking cessation campaign that coincided with this study, cannot be quantified. CONCLUSIONS: Managed care organizations may be an effective change agent for implementing the guidelines for tobacco use and dependence treatment.

Blue Cross Blue Shield Insurance Plans↗

Effectiveness of a call/recall system in improving compliance with cervical cancer screening: a randomized controlled trial.

OBJECTIVE: To determine the effectiveness of a simple call/recall system in improving compliance with cervical cancer screening among women not screened in the previous 3 years. DESIGN: Prospective randomized controlled study. SETTING: Two family medicine clinics (1 urban, 1 rural) affiliated with Memorial University of Newfoundland, St. John's. PARTICIPANTS: A sample of women aged 18-69 years who were listed as patients of the clinics but who had not had a Papanicolaou test (Pap test) within the 3 years before the start of the study. Of 9071 women listed as patients 1360 (15.0%) had not undergone screening in the previous 3 years. A random sample of 650 were selected, 209 of whom were excluded because they had had a hysterectomy, had had a recent Pap test, had moved or had records containing clerical errors. This left 441 women for the study. INTERVENTION: The 221 women in the intervention group were sent a letter asking them to seek a Pap test and a reminder letter 4 weeks later. The 220 in the control group were sent no letters. MAIN OUTCOME MEASURES: Number of women who had a Pap test within 2 months and 6 months after the first letter was sent. RESULTS: Within 2 months, more women in the intervention group than in the control group had been screened (2.8% [5/178] and 1.9% (4/208] respectively). There was also a difference between the overall proportions at 6 months (10.7% [19/178] and 6.3% [13/208] respectively). None of the differences was statistically significant. CONCLUSION: A letter of invitation is not sufficient to encourage women who have never or have infrequently undergone a Pap test to come in for cervical cancer screening. The effectiveness of added recruitment methods such as opportunistic screening by physicians, follow-up by telephone and the offer of a specific appointment should be evaluated.

Adolescent↗

External cueing systems in the rehabilitation of executive impairments of action.

The use of a mnemonic cueing system (NeuroPage) and a paper and pencil checklist in the rehabilitation of executive problems in a 50-year-old woman are described. Following a CVA 7 years earlier, the patient, despite intact general intellectual and memory functioning, had specific executive impairments of attention, planning, realizing intended actions, and also exhibited behavioral routines similar in form to obsessive-compulsive rituals. In a series of ABAB single-case experimental designs, the efficacy of 2 external cueing systems in prompting appropriately timed action is demonstrated. It is argued that the combination of external control and increased sustained attention to action were critical to the success of NeuroPage with this patient. Furthermore it is hypothesized that the checklist was effective in facilitating the patient's ability to foresee and recognize the consequences of her actions, which in turn had an impact on the probability of her changing those same actions.

Attention↗

Women's views of the cervical smear test: implications for nursing practice--women who have not had a smear test.

This is the first of two papers reporting the findings of a study on the views of women with regards to the cervical smear test. In this first paper the views of those who have not had a smear test are analysed. The implications of those views for nursing practice in primary health care are identified and explored. Conducted in 1989-1990, the ESRC-funded study was located in the north-east of England and drew respondents from two age groups living in working-class localities. Focusing upon the views of women who have not had a smear test, a number of conclusions were evident: (a) that the call, recall system did not invite all women in the screening target group for a smear test; (b) that beliefs and attitudes, rather than practical problems, were cited as major factors in non-attendance; and (c) that women hold strong views on aspects of service delivery they would like to see in place. Thus the organization and delivery of the service might be reviewed. However, the barriers posed by beliefs and attitudes must be further explored through community-based work encompassing all community-based health professionals.

Adult↗

The use of computer vision in an intelligent environment to support aging-in-place, safety, and independence in the home.

This paper discusses the use of computer vision in pervasive healthcare systems, specifically in the design of a sensing agent for an intelligent environment that assists older adults with dementia during an activity of daily living. An overview of the techniques applied in this particular example is provided, along with results from preliminary trials completed using the new sensing agent. A discussion of the results obtained to date is presented, including technical and social issues that remain for the advancement and acceptance of this type of technology within pervasive healthcare.

Activities of Daily Living↗

The Fitzroy Valley Pap Smear Register. Cervical screening in a population of Australian aboriginal women.

OBJECTIVE: To describe the operation of the Fitzroy Valley Pap Smear Register, a population-based call and recall system for cervical screening for Aboriginal women, and the prevalence of cervical abnormalities in the women screened. DESIGN: Descriptive study. SETTING: An Aboriginal community in the far north-west of Western Australia. PARTICIPANTS: Aboriginal women aged 15 to 69 years, living in the Fitzroy Valley, Kimberley region. MAIN OUTCOME MEASURES: Proportion of eligible women on the Register; age distribution of women screened; prevalence of squamous cell abnormalities. RESULTS: In December 1990, there were 507 Aboriginal women on the Register, being 86.9% of the Aboriginal women in the Fitzroy Valley aged 15-69 years. During 1990, 53.6% of the target population were screened; 369 Pap smears were taken from 312 Aboriginal women. Seventy-six (24.3%) had never previously been screened. Considering only the first smear for each woman in the study period, 10.6% showed minor abnormalities, and 1.6% (95% confidence interval [CI], 0.2%-3.0%) had cervical intraepithelial neoplasia (CIN I, II or III); 2.6% has smears showing definite evidence of human papillomavirus (HPV) infection. For 15-19 year olds the prevalence of CIN was 4.7% (95% CI, 1.0%-13.3%). CONCLUSIONS: The study shows how an inexpensive call and recall system can ensure good coverage of cervical screening in a group of women who would otherwise be under-screened. The overall prevalence of CIN in Aboriginal women in the Fitzroy Valley was lower than the figure for all Victorian women (3.6%--data from the Victorian Cytology Service). Although the numbers are small, the relatively high prevalence of CIN in young women is of some concern, and emphasises the importance of regular screening in this group.

Adolescent↗