The evolving clinical chart. How it reflects and influences psychiatric and medical practice and the quality of care.

The clinical chart constitutes an evolving patient care document. This article compares charts from the turn of the century with those of today. It has changed from a simple user-friendly personal note record to a major medical-legal documentation system. With this evolution have come shifts in clinicians' attitudes toward the chart, a more active role in influencing care for the record, a much more public position of it, and a more homogenized record. It concludes with methods for the practitioners to incorporate the evolving chart into their work so as to further improve their documentation and care.

Rapid confirmatory identification of Mycobacterium bovis using a dot blotting immunodetection technique.

A safe, cost effective and accurate immunodetection technique for the rapid identification of Mycobacterium bovis colonies is described. One hundred and thirteen M. bovis isolates were differentiated from other species of mycobacteria using a M. bovis specific monoclonal antibody, with nitrocellulose membrane as the solid support. The technique confirms M. bovis identification in only 4 h compared to 3 weeks for conventional antibiotic sensitivity tests.

The surgical management of urinary incontinence in myelodysplastic children.

Over a 4-year period, 69 patients with intractable urinary incontinence secondary to myelodysplasia have undergone surgical therapy to try to achieve continence. Preoperative evaluation used uroradiological and urodynamic studies, including measurement of leak point pressure and leak point volume. Twenty-one patients had a procedure to increase outlet resistance, 30 patients had bladder augmentation, and 18 patients had both procedures performed. Fifty-seven of the 69 patients have achieved total continence for a success rate of 83%.

Use of a urethral splent in one-stage hypospadias repair.

Over a 9-month period, 28 patients with distal penile or more proximal hypospadias underwent one-stage surgical repair. Bladder drainage was achieved in the traditional fashion with either an indwelling Foley catheter or suprapubic catheter or by using a modified urethral silicone stent ("splent"). Twenty-two patients had repair with a perimeatal skin flap, and the remaining six patients had major urethral reconstruction with a vascularized preputial island flap. Use of the urethral splent was associated with shorter postoperative hospitalization and minimal short-term complications. The authors' experience has shown that use of a urethral splent for urinary drainage is efficient and effective in postoperative management after hypospadias repair.

Long-term followup of pediatric dismembered pyeloplasty: how long is long enough?

PURPOSE: We determined followup for pediatric patients after pyeloplasty based on the risk of late complications and the likelihood of return if discharged early from followup. MATERIALS AND METHODS: We retrospectively reviewed the charts of all patients who underwent dismembered pyeloplasty at a single center between 1986 and 1996. Data regarding recurrent ureteropelvic junction obstruction and symptoms suggesting possibly recurrent obstruction were assessed. RESULTS: During the select period 123 pyeloplasties were performed. A total of 77 renal units were followed greater than 5 years. At 1 year postoperatively diuretic renograms showed normal drainage in 87% of the cases and prolonged or incomplete drainage in 13%. Obstruction recurred 8 years postoperatively in only 1 renal unit (0.8% overall, 1.3% of those followed greater than 5 years). Symptoms suggestive of recurrent obstruction developed in 18% of the patients but represented true recurrence in only 1. If one were to consider early followup discharge for these patients, the probability of repeat referral due to such symptoms was significantly higher in year 1 than in year 3. Most symptoms were initially assessed with ultrasound. CONCLUSIONS: Recurrent ureteropelvic junction obstruction is unlikely after unobstructed postoperative diuretic renogram and does not warrant long term followup. Ideal followup would extend to 2 years, covering the period when an initial symptom of recurrence is most likely to present and enabling baseline unobstructed renal ultrasound to be performed.