Enhancing laboratory report contents to improve outpatient management of test results

In today''s environment, providers are extremely time-constrained. Assembling relevant contextual data to make decisions on laboratory results can take a significant amount of time from the day. The Regenstrief Institute has created a system which leverages data within Indiana Health Information Exchange''s (IHIE''s) repository, the Indiana Network for Patient Care (INPC), to provide well-organized and contextual information on returning laboratory results to outpatient providers. The system described here uses data extracted from INPC to add historical test results, medication-dispensing events, visit information, and clinical reminders to traditional laboratory result reports. These “Enhanced Laboratory Reports” (ELRs) are seamlessly delivered to outpatient practices connected through IHIE via the DOCS4DOCS clinical messaging service. All practices, including those without electronic medical record systems, can receive ELRs. In this paper, the design and implementation issues in creating this system are discussed, and generally favorable preliminary results of attitudes by providers towards ELRs are reported.     

青少年心理健康素质状况及影响因素的研究

目的 探讨青少年心理健康素质的差异和影响因素,为心理健康教育和素质教育的开展提供理论和实践依据.方法 采用青少年心理健康素质调查表对338名大中学生的心理健康素质状况进行调查研究.结果 ①除自我维度外,大、中学生[适应(64.17±7.12)分,(68.27±5.86)分;人际(58.70±7.13)分,(64.78±5.25)分;个性(127.72±14.41)分,(135.72±10.52)分;动力系统(109.34±11.76)分,(129.79±10.12)分;认知风格(61.19±5.35)分,(71.57±5.84)分;归因风格(43.76±4.24)分,(49.86±4.70);应付方式(106.14±10.33)分,(124.77±9.80)分]、男女生、城市学生和农村学生、不同家庭收入水平、不同父母受教育水平学生的心理健康素质各维度及其子维度均存在显著差异.②相关和回归分析表明,心理健康素质的形成和发展受多种因素影响.结论 青少年心理健康素质状况良好;各类学生心理健康素质的发展模式不同.     

Integrating Nursing Care into Systems of Care for Children with Emotional and Behavioral Disorders

PROBLEM: Recent developments in providing care to children with emotional and behavioral disorders, especially those with serious emotional disturbance, have included the establishment of systems of care. Guided by a set of principles and values, these systems of care have organized and delivered services to children and families with complex needs. To date, nurses have not had a salient role in systems of care. RESULTS: It is estimated that 20% of American children and adolescents have an emotional or mental disorder. As many as two thirds of these children are not receiving services. Systems of care have been funded to provide services for these children, particularly for the most severely affected. To date, nursing has not had a prominent role in these systems of care. CONCLUSIONS: Based on their knowledge, skills, and holistic approach to care, nurses could better integrate nursing care into systems of care. Possible roles as case managers, primary therapists, in-home interventionists, and in educational programs are suggested.     

When work strain transcends psychological boundaries: an inquiry into the relationship between time pressure,irritation, work–family conflict and psychosomatic complaints

Against the theoretical background of the effort–recovery model and the action regulation theory, the author presents a cross‐sectional questionnaire study testing hypotheses about the relationship between work‐related time pressure, cognitive and emotional irritation, work–family conflict and psychosomatic complaints. Subjects were 576 female home care nurses. Results of a path analysis show that the relation of time pressure and psychosomatic complaints is partially mediated by experiencing a work–family conflict; also the relation of time pressure and work–family conflict is partially mediated by cognitive and emotional irritation. It is argued that cognitive and emotional irritation are fruitful concepts for a more comprehensive understanding of the relationship between work stressors and the development of strain‐based work–family conflict. Implications for the prevention of work–family conflict are outlined. Copyright © 2008 John Wiley & Sons, Ltd.     

Acute encephalopathy associated with influenza and other viral infections

Acute encephalopathy is the most serious complication of pediatric viral infections, such as influenza and exanthem subitum. It occurs worldwide, but is most prevalent in East Asia, and every year several hundreds of Japanese children are affected by influenza-associated encephalopathy. Mortality has recently declined, but is still high. Many survivors are left with motor and intellectual disabilities, and some with epilepsy. This article reviews various syndromes of acute encephalopathy by classifying them into three major categories. The first group caused by metabolic derangement consists of various inherited metabolic disorders and the classical Reye syndrome. Salicylate is a risk factor of the latter condition. The second group, characterized by a systemic cytokine storm and vasogenic brain edema, includes Reye-like syndrome, hemorrhagic shock and encephalopathy syndrome, and acute necrotizing encephalopathy. Non-steroidal anti-inflammatory drugs, such as diclofenac sodium and mephenamic acid, may aggravate these syndromes. Severe cases are complicated by multiple organ failure and disseminated intravascular coagulation. Mortality is high, although methylprednisolone pulse therapy may be beneficial in some cases. The third group, characterized by localized edema of the cerebral cortex, has recently been termed acute encephalopathy with febrile convulsive status epilepticus, and includes hemiconvulsion-hemiplegia syndrome and acute infantile encephalopathy predominantly affecting the frontal lobes. Theophylline is a risk factor of these syndromes. The pathogenesis is yet to be clarified, but an increasing body of evidence points to excitotoxicity and delayed neuronal death.     

大学新生心理健康状况的调查研究

目的　了解大学新生的心理健康状况 ,探讨提高其心理健康水平的措施。方法　采用大学生人格问卷(UPI) ,以班级为单位 ,在新生正式上课两周以后进行测试。结果　学生一类筛选率 9.2 4 %。UPI关键题选择中 ,以常常失眠占的比例最高 ,想轻生的比例最低 (P <0 .0 5 )。UPI附加题选择中 ,以自身健康方面有问题及有健康或心理卫生方面想要咨询的问题较多 (P <0 .0 5 )。选择“想轻生”的男生的比例略高于女生 ,选择“常常失眠”的女生的比例却明显高于男生 (P <0 .0 5 ) ;选择“常常失眠”、“对任何事情都不感兴趣”和“感觉自己的过去及家庭不幸”的农村学生的比例都高于城市学生 (P <0 .0 5 )。选择“想轻生”和“对任何事情都不感兴趣”的独生子女的比例明显高于非独生子女 ,而选择“自己的过去和家庭是不行的”和“常常失眠”的非独生子女的比例又明显高于独生子女 (P <0 .0 5 )。结论　单亲家庭学生、残疾学生、家庭经济困难学生、独生子女学生是心理问题高危人群