Infants' growth charts for southern Iran

Currently there are no growth charts based on local norms available for infants in Iran, and their growth is assessed by the National Centre for Health Statistics (NCHS) reference data, which is misleading. Growth charts for a cohort of 317 infants (164 girls and 153 boys) born in Shiraz (Southern Iran) in 1996 and followed for 2 years from birth are presented. All the centiles of length and weight charts are slightly above those of the NCHS charts under the age of 6 months and fall substantially below those over the age of 6 months. However, the spread is similar, so there is no suggestion that the difference is due to the prevalence of gross malnutrition. The difference shows that the use of locally based growth charts are essential for assessing the growth of children in Iran. The representativeness of our data leads us to conclude that the charts presented here are likely to be applied to the urban infant population of Iran.

Gegenwärtig stehen im Iran für Kleinkinder keine auf lokalen Normdaten basierende Wachstumsdiagramme zur Verfügung. Das Wachstum dieser Kinder wird anhand der Referenzdaten des Nationalen Zentrums für Gesundheitsstatistik (NCHS) eingeschätzt, was zu Fehleinschätzungen führt. Es werden Wachstumsdiagramme für eine Kohorte von 317 Kleinkindern (164 Mädchen und 153 Jungen) vorgestellt, die 1996 in Shiraz (Südiran) geboren wurden und nach ihrer Geburt 2 Jahre lang untersucht wurden. Alle Längen- und Gewichtszentilen liegen bis zu einem Alter von unter 6 Monaten leicht über denjenigen der NCHS-Diagramme und fallen ab einem Alter von 6 Monaten beträchtlich unterhalb diese. Allerdings ist die Spannweite ähnlich und daher gibt es kein Anzeichen dafür, dass der Unterschied auf das Vorliegen einer schweren Unterernährung zurückzuführen ist. Die Unterschiede zeigen, dass die Verwendung von lokalen Wachstumsdiagrammen für die Einschätzung des Wachstums von Kindern im Iran notwendig ist. Die Tatsache, dass unsere Daten als repräsentativ anzusehen sind, veranlasst uns zu der Schlussfolgerung, dass die hier vorgestellten Charts wahrscheinlich für die städtische Kleinkinderpopulation im Iran anwendbar sind.

On ne dispose pas actuellement en Iran de tables normatives de la croissance établies sur des données locales, si bien que la croissance des enfants iraniens est inadéquatement observéeen référence aux données du National Centre for Health Statistics (NCHS). On présente ici des courbes de croissance établies à partir d'une cohorte de 317 enfants (164 filles et 153 garçons) nés à Shiraz (Iran méridional) en 1996 et suivis pendant leurs deux premières années. Tous les centiles de taille et de poids sont légèrement supérieurs à ceux des tables NCHS avant l'âge de six mois, puis leurs deviennent nettement inférieurs par la suite. L'évolution des courbes étant similaire, il n'y a donc pas raison de suspecter que la différence est due à de la malnutrition. Cet écart entre les deux tables montre que l'utilisation de courbes fondées sur des données locales est essentielle pour le suivi de la croissance des enfants en Iran. La représentativité de nos données nous conduit à estimer que les tables présentées dans ce travail sont applicables à la population infantile urbaine en Iran.     

A Novel Similarity Learning Method via Relative Comparison for Content-Based Medical Image Retrieval

Nowadays, the huge volume of medical images represents an enormous challenge towards health-care organizations, as it is often hard for clinicians and researchers to manage, access, and share the image database easily. Content-based medical image retrieval (CBMIR) techniques are employed to facilitate the above process. It is known that a few concrete factors, including visual attributes extracted from images, measures encoding the similarity between images, user interaction, etc. play important roles in determining the retrieval performance. This paper concentrates on the similarity learning problem of CBMIR. A novel similarity learning paradigm is proposed via relative comparison, and a large database composed of 5,000 images is utilized to evaluate the retrieval performance. Extensive experimental results and comprehensive statistical analysis demonstrate the superiority of adopting the newly introduced learning paradigm, compared with several conventional supervised and semi-supervised similarity learning methods, in the presented CBMIR application.     

Healthcare technology co-operatives: Innovative about innovation

Abstract

The paper provides an introduction to the National Institute for Health Research Devices for Dignity Healthcare Technology Co-operative. Embedded within the NHS, Devices for Dignity identifies areas of unmet clinical need and translates these into research and development projects to develop new medical technologies. It addresses the needs of people living with long-term conditions, helping them to live more dignified and independent lives. Through partnerships with patients, universities, the NHS and industry, Devices for Dignity has developed an innovation methodology for successful medical technology innovation.     

Unmet needs: relevance to medical technology innovation?

Abstract

This paper describes and discusses the role of unmet needs in the innovation of new medical technologies using the National Institute for Health Research Devices for Dignity (D4D) Healthcare Technology Co-operative as a case study. It defines an unmet need, providing a spectrum of classification and discusses the benefits and the challenges of identifying unmet need and its influence on the innovation process. The process by which D4D has captured and utilized unmet needs to drive technology innovation is discussed and examples given. It concludes by arguing that, despite the challenges, defining and reviewing unmet need is a fundamental factor in the success of medical technology innovation.     

Attitudes of Jewish and Bedouin responders toward family physicians’ use of electronic medical records during the medical encounter

Objective

Culture is known to impact expectations from medical treatments. The effects of cultural differences on attitudes toward Electronic Medical Records (EMR) have not been investigated. We compared the attitudes of Jewish and Bedouin responders toward EMR's use by family physicians during the medical encounter, and examined the contribution of background variables to these attitudes.

Methods

86 Jewish and 89 Bedouin visitors of patients in a regional Israeli University Medical Center responded to a self-reporting questionnaire with Hebrew and Arabic versions.

Results

T-tests and a linear regression analysis found that culture did not predict attitudes. Respondents’ self-reported health status, Internet and e-mail use, and estimates of their physician's typing speed explained a total of 18.6% of the variance in attitudes (p < 0.001).

Conclusion

Bedouins respondents’ attitudes toward EMR use were better than expected and similar to those of their Jewish counterparts. The most significant factor influencing respondents’ attitudes was the physician's typing speed.

Practice implications

(1) Further studies should consider the possible impact of cultural differences between the family physician and the healthcare client on attitudes. (2) Interventions to improve physicians’ skill in operating EMRs and typing will potentially have a positive impact on patients’ satisfaction with physicians’ EMR use.     

Integrating clinical communication with clinical reasoning and the broader medical curriculum

Objective

The objectives of this paper are to discuss the results of a workshop conducted at EACH 2012. Specifically, we will (1) examine the link between communication, clinical reasoning, and medical problem solving, (2) explore strategies for (a) integrating clinical reasoning, medical problem solving, and content from the broader curriculum into clinical communication teaching and (b) integrating communication into the broader curriculum, and (3) discuss benefits gained from such integration.

Methods

Salient features from the workshop were recorded and will be presented here, as well as a case example to illustrate important connections between clinical communication and clinical reasoning.

Results

Potential links between clinical communication, clinical reasoning, and medical problem solving as well as strategies to integrate clinical communication teaching and the broader curricula in human and veterinary medicine are enumerated.

Conclusion

Participants expressed enthusiasm and keen interest in integration of clinical communication teaching and clinical reasoning during this workshop, came to the idea of the interdependence of these skills easily, and embraced the rationale immediately.

Practice implications

Valuing the importance of communication as clinical skill and embracing the interdependence between communication and thought processes related to clinical reasoning and medical problem solving will be beneficial in teaching programs.     

Web-based self-management support training for health professionals: A pilot study

Objective

To evaluate a web-based self-management training for health professionals. Patients spend 99% of their time outside the healthcare system. Thus self-management support from health professionals is central to optimal care. Our objective was to teach health professionals the skills to provide this support.

Methods

Primary care residents and practicing providers enrolled in six groups. Each group received four web-based interactive training sessions derived from self-efficacy theory. Retrospective-pre/post assessed changes in self-management beliefs and confidence. Wilcoxon signed-rank tests with Bonferroni correction compared responses. Focus groups solicited qualitative feedback.

Results

Fifty-seven residents and providers across the United States enrolled. Residents demonstrated positive changes on all belief questions (P 0.001–0.012). Practicing providers had a non-significant positive change on one and significant changes on the remainder (P 0.001–0.018). Both types of participants demonstrated significant increases on confidence questions regarding their ability to support self-management (P < 0.01 for all). Participants described learned techniques as being useful, reducing burnout, and increasing acceptance of patient involvement in care planning.

Conclusion

The web-based self-management support training for health professionals was feasible and changed beliefs and confidence.

Practice implications

The program may maximize patient self-management by increasing provider self-efficacy and skill for self-management support.