[USING INFORMATION FROM COMPUTERIZED MEDICAL FILES TO DETERMINE THE RISK OF POOR OUTCOME IN EXTREMELY PRETERM INFANTS].

INTRODUCTION: During the last two decades preterm deliveries have been rising with increasing numbers of survivors at risk of abnormal outcomes. Characterization of risk factors for abnormal outcome is important for caregivers and patients' families. We hypothesized that it is possible to evaluate significant risk factors from computerized files early in life. OBJECTIVES: To evaluate data from computerized files that could help identify children born preterm at increased risk of abnormal outcomes without a neurodevelopmental exam. METHODS: This is a retrospective cohort study including children born at less than 29 weeks gestation and/or less than 1000 grams. The long term outcome was defined using data from the local child developmental center. Risk factors were retrieved from computerized files from birth until 3 years of age and assessed using univariate and multivariate analysis. RESULTS: A total of 74 children were included in the study; 30 with abnormal outcomes. The following parameters: Bedouin origin (p = 0.033), low 1 minute Apgar score (p = 0.044), late sepsis (p = 0.017), exposure to x-rays (p = 0.033), hospital based specialist visits (p = 0.017) and hospitalization (p = 0.035) were more common in the abnormal outcome group or increased its risk in univariate analysis. Bedouin origin (OR = 3.81-5.11), late sepsis (OR = 4.07-4.94) and hospital based specialist visits (OR = 4.67, 95% CI = 1.11-19.55) increased more than fourfold the risk of abnormal outcomes in multivariate analysis. CONCLUSIONS: This study has important implications as Bedouin origin and llate sepsis can be determined before discharge. Furthermore, follow-up of high risk children should be locally accessible. Prevention of late sepsis is of upmost importance, as well as awareness of specialists to the follow-up status of children born preterm.

Predictive value of amplitude-integrated electroencephalography pattern and voltage in asphyxiated term infants.

The aim of this study was to correlate amplitude-integrated electroencephalography soon after birth with neurodevelopmental outcome in children who suffered from hypoxic-ischemic encephalopathy. Near term infants with hypoxic-ischemic encephalopathy and amplitude-integrated electroencephalography recording before 6 hours of age were included. Neurologic and cognitive outcome were assessed at 30 months of age and over. Outcome was correlated with either the pattern or voltage of the tracing. Thirty-nine infants were included. Eight died in the immediate neonatal period. At the age of 3 and 6 hours, sensitivity of low voltage to poor outcome was 33% and 42% respectively and of burst suppression pattern to poor outcome was 83% and 75% respectively. Association of voltage to outcome was significant only at 6 hours of age (P = 0.025). Association of pattern to outcome was significant both at 3 and 6 hours of age (P = 0.003, 0.008). These data on amplitude-integrated electroencephalography predictive value early in life were similar to previous studies. Burst suppression pattern, as early as 3 hours of age, is associated with poor outcome. At the age of 6 hours, both low voltage and burst suppression are associated with poor outcome. Pattern seems more sensitive than voltage.

Physician-parent communication as predictor of parent satisfaction with child development services.

The purpose of this study was to assess the level of parental satisfaction with services of a child development center and to evaluate the physician-parent dimensions of communication. A total of 90 parents to children with disability ranging in age from 6 months to 6 years participated in the study (84% response rate). Attitudes regarding parental communication with physicians were evaluated by 15 items clustered into three factors, which expressed different dimensions of communication: caring, collaboration and interest. Parents ranked their general satisfaction with the center's services relatively high as well as their evaluations of physician behavior of caring, collaboration and interest. Positive and statistically significant correlations were found between the studied communication dimensions and general satisfaction. However, collaboration was the only dimension that explained the variability on general satisfaction in a multivariate analysis. The collaboration of the physician with the parents was a key factor to explain parental general satisfaction with child rehabilitative services. Collaboration, which is associated with processes such as mutual decision making and sharing of responsibility, should be nurtured, in order to increase parents' general satisfaction with the services given.

Parent-therapist communication and satisfaction with the services of a child development center: a comparison between Israeli parents-Jews and Bedouins.

This study evaluates the level of general satisfaction with the services of a child development center in 2 groups of Israeli parents, Jews and Bedouins. It also assesses which 3 dimensions of therapist-parent communication significantly explain general satisfaction with the center's services. A total of 193 parents of children ranging from 6 months to 6 years of age participated in the study (84% response rate). Parents' attitudes regarding their communication with the center's therapists were evaluated by 15 items that were clustered into 3 dimensions of communication: caring, collaboration, and interest. General satisfaction with the center's services was high in both groups. Relatively high average scores were also given to the studied dimensions of communication. Jews were more satisfied with the center's services than were Bedouins and ranked caring and collaboration significantly higher than did Bedouins. Caring and collaboration best explained the variability in general satisfaction in a multivariate analysis. Being a Jew or a Bedouin parent was not found to be a significant explanatory variable of general satisfaction with the center's services. Therapists' expressions of care and collaboration with parents seem to be key factors in explaining parents' general satisfaction with rehabilitation services in the 2 different cultural groups. These factors should therefore be nurtured in order to ensure parents' satisfaction and participation in the ongoing and demanding process of child rehabilitation. The question of whether this finding is applicable to other populations has to be further studied.

Therapists' communication styles and parents' global trust in the therapists: a comparison between Jewish and Bedouin parents.

PURPOSE: This study was designed to examine the level of global trust in therapists for two groups of Israeli parents, Jews and Bedouin, and to assess which of three interpersonal communication styles significantly explain global trust in the therapists. METHODS: A total of 193 parents of children ranging from six months to six years of age participated in this study. Parents' perceptions regarding their communication with the center's therapists were measured by 15 items clustered into three dimensions of communication: caring, collaboration, and interest. RESULTS: Parents of both cultural groups expressed high levels of global trust in the center's therapists. Jewish parents trusted their children's therapists significantly more than their Bedouin counterparts and ranked the therapists' caring and collaboration more highly. The communication style of caring was found to be the sole contributor to the variability in global trust. CONCLUSIONS: Effort should be undertaken to develop effective communication styles for the dimension of caring to increase therapists' ability to promote global trust in their patients' parents.