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Results for “Medical Records, Problem-Oriented”

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At least 73 records · Page 4Linked to original sources
PubMed1977

[An information retrieval system for CT-scan data (author's transl)].

A computer program for the current statistical documentation and evaluation of CT diagnostic results is presented. A diagnostic key for the purposes of CT results has been developed. Special emphasis has been given to fast and simple applicability.

Central Nervous System Diseases↗
PubMed1977

A computerized prenatal record.

An entirely computerized ambulatory medical record system is operational in a large health maintenance organization. A unique subsystem was designed for use in prenatal care, in which the provider's completion of a single encounter form at the time of visit meets all the information requirements of care delivery, administration, and quality assurance. Instead of using a conventional paper chart, computer-generated summaries and flow charts are automatically provided for scheduled visits and for use as a hospital preadmission record, significantly reducing the provider effort expended on record keeping. On-line inquiry function is also available using terminals at the ambulatory center and the hospital. The computer data base has been used for quality assurance studies in prenatal care. The system is well accepted by providers, is reliable, and is cost effective.

Computers↗
PubMed1977

Occupational therapy sequential client care recording system: a comparative study.

The client care record is a key document for determining standards of care in occupational therapy. The purpose of this study was to determine the effectiveness of a client care recording system for occupational therapy that combined the theoretical framework of the Developmental Analysis, Evaluation and Intervention Schedule, and the scientific method of the Problem Oriented Medical Record. The research form of the client care record was compared to a traditional client care record in current use in an occupational therapy clinic. An interdisciplinary panel of health professionals rated both the original and proposed form of the record on the variables of completeness, organization, understandability, and usefulness. The findings show statistically significant differences between the client care record based on the combined Developmental Analysis, Evaluation and Intervention Schedule and the Problem Oriented Medical Record and the currently used record system.

Child↗
PubMed1977

A record keeping system addressing future needs.

Important long-range decisions regarding the provision of dental care and the education of dentists and dental para-professionals will be made by the government and third parties. The quality and interpretation of the data to be used depend on who gathers it. If the dental profession is not in the position to gather the data, others certainly will be. There is a wealth of statistical data in the records of every practice. The record keeping system described provides an organized way to get such information out, with a minimum of additional effort. Rather than making it a series of separate tasks to generate a statistical description of the practice population, the incidence of problems, or the progression of treatments, this record keeping system provides a single comprehensive method. This method grows with a practice, whether individual, group, or clinic. By doing this, it provides a long-range continuous monitor of the practice population and the problems incident to it. The installation of such a methodology in clinics and dental school faculty practices will rapidly contribute to our knowledge regarding dental health care. Adoption in whole or in part by private practioners will provide them with new tools for the delivery of better dental care and practice management.

Dental Care↗
PubMed1977

The SOAP revolution.

Explore the source record for details and available documents.

Medical Records, Problem-Oriented↗