Predictors of long-term neurological outcomes in non-accidental head injury.

BackgroundNon-accidental head injury (NAI) is an inflicted injury usually on a child, often resulting in long-term neurological impairment and occasionally death. This study aimed to investigate the predictive values of acute findings, especially ocular, for long-term neurological outcomes.MethodsMedical records including retinal images of all children who attended the local Children's hospital with a diagnosis of NAI from over a period of 5 years were reviewed and data collected via the electronic patient record system. Patient demographics, injuries sustained, wide-field digital retinal images, visual acuity and sequalae, neurological function, and global function was noted. IBM SPSS software program was used for statistical analysis.ResultsOf the 38 patients (24 males, 14 females), 12 children died acutely from the head injury with the remaining 26 children available for long-term follow-up. A younger age of injury (P=0.004) was the only statistically significant predictor of good neurological outcome as compared with absence of macular retinoschisis, unilateral retinal haemorrhage, and unilateral subdural haemorrhage. Of the 38 children, 17 children had retinoschisis; 9 children with macular retinoschisis died acutely while 4 suffered a degree of developmental delay and only 4 were developmentally normal at the last follow-up. Long-term visual acuity data was available for 18 of the 26 survivors (range: NPL to Snellen 6/5). A statistical significance was noted between retinoschisis and worsened visual acuity (P<0.05).ConclusionsBilateral macular retinoschisis on acute presentation of NAI is associated with a seven-fold and unilateral with a four-fold increase in the development of a poor neurological outcome and eventual death. Conflicting to other studies, younger children presented better neurological outcomes.

Evaluating IAIMS at Yale: information access.

OBJECTIVE: To evaluate use of information resources during the first year of IAIMS implementation at the Yale-New Haven Medical Center. The evaluation asked: (1) Which information resources are being used? (2) Who uses information resources? (3) Where are information resources used? (4) Are multiple sources of information being integrated? DESIGN: Measures included monthly usage data for resources delivered network-wide, in the Medical Library, and in the Hospital; online surveys of library workstation users; an annual survey of a random, stratified sample of Medical Center faculty, postdoctoral trainees, students, nurses, residents, and managerial and professional staff; and user comments. RESULTS: Eighty-three percent of the Medical Center community use networked information resources, and use of resources is increasing. Both status (faculty, student, nurse, etc.) and mission (teaching, research, patient care) affect use of individual resources. Eighty-eight percent of people use computers in more than one location, and increases in usage of traditional library resources such as MEDLINE are due to increased access from outside the Library. Both survey and usage data suggest that people are using multiple resources during the same information seeking session. CONCLUSIONS: Almost all of the Medical Center community is using networked information resources in more settings. It is necessary to support increased demand for information access from remote locations and to specific populations, such as nurses. People are integrating information from multiple sources, but true integration within information systems is just beginning. Other institutions are advised to incorporate pragmatic evaluation into their IAIMS activities and to share evaluation results with decision-makers.

The IAIMS--an essential infrastructure for increasing the competitiveness of health care practices.

The eighth annual workshop of the IAIMS Consortium was devoted to exploring how information technology might provide the tools to allow health care practices to compete in the new health care environment while maintaining independence. The options that were discussed included: optimizing care of the patient in the local setting; reducing practice overhead by improving efficiency and effectiveness; and finding innovative strategies for providing health care and new products.

Using a network menu and the UMLS Information Sources Map to facilitate access to online reference materials.

As computer technology advances, clinicians and biomedical researchers are becoming more dependent upon information from online databases and information systems. By using specially configured computer workstations and high-speed computer networks, it is now possible to access this information in a rapid and straightforward manner. To empower users by providing these capabilities, the authors are assembling a variety of network workstations to be located throughout Yale-New Haven Medical Center. At the heart of the workstation is NetMenu, a program designed to help users connect to a number of important online information systems, including a hospital order entry and results reporting system, a drug reference, bibliographic retrieval systems, and educational programs. In addition, as part of the National Library of Medicine's Unified Medical Language System (UMLS) project, the authors have developed a local prototype of the UMLS Information Sources Map (ISM) and a companion query assistant program to complement the NetMenu in helping users select and connect automatically to information services relevant to a particular question. The ISM query assistant draws from a listing of many online information sources accessible via local and international networks.

NetMenu: experience in the implementation of an institutional menu of information sources.

NetMenu is a program, developed at Yale, which enables straightforward access to online information systems. NetMenu has been deployed in several diverse settings within our medical center. In the hospital, NetMenu is functioning as a front-end for our clinical workstation providing access to the hospital information system, the clinical laboratory computer, a drug database and several bibliographic databases. The medical libraries are utilizing NetMenu for both medical education workstations and for scholarly information workstations. This paper describes our initial experience in the implementation, support, and maintenance of NetMenu as an institutional menu of information sources.

Prototyping an institutional IAIMS/UMLS information environment for an academic medical center.

The paper describes a prototype information environment designed to link network-based information resources in an integrated fashion and thus enhance the information capabilities of an academic medical center. The prototype was implemented on a single Macintosh computer to permit exploration of the overall "information architecture" and to demonstrate the various desired capabilities prior to full-scale network-based implementation. At the heart of the prototype are two components: a diverse set of information resources available over an institutional computer network and an information sources map designed to assist users in finding and accessing information resources relevant to their needs. The paper describes these and other components of the prototype and presents a scenario illustrating its use. The prototype illustrates the link between the goals of two National Library of Medicine initiatives, the Integrated Academic Information Management System (IAIMS) and the Unified Medical Language System (UMLS).

Online bibliographic information: integration into an emerging IAIMS environment.

The Medical Library at Yale University has developed an online free-text database containing Current Contents citations. The database was designed to be integrated into an emerging campus-wide information environment. To this end Current Contents at Yale was designed with a user interface familiar to the Yale community, an alerting service based on electronic mail, and search expansion using the National Library of Medicine's Meta-1 metathesaurus.

Cells born in adult canary forebrain are local interneurons.

Thymidine autoradiography and retrograde transport of horseradish peroxidase (HRP) were combined to determine the connectivity of neurons born in adult canary forebrain. Adult male and female canaries were pretreated with [3H]thymidine to label cells undergoing DNA synthesis prior to mitosis. Thirty or 60 days later, neurons in a forebrain nucleus, hyperstriatium ventralis, pars caudalis (HVc), were labeled by retrograde transport of HRP injected into the only two nuclei known to receive a projection from HVc: robustus archistriatalis (RA) and area X of lobus parolfactorius. The birds were then killed and brain sections were treated to visualize cells containing HRP; these sections were processed for autoradiography to detect [3H]thymidine-labeled cells in the same tissue. More than 9% of all neurons in HVc were thymidine labeled; but of the almost 20,000 HRP-labeled projection neurons examined, fewer than 20 (0.1%) were labeled by the thymidine treatment. Furthermore, the median cell body size for area X-projecting cells was significantly larger than that of thymidine-labeled cells, and the median size of thymidine-labeled cells was significantly larger than that of RA-projecting cells. The simplest interpretation of these results is that the new neurons incorporated into nucleus HVc in adult canary brain are local interneurons, intermediate in size between neurons projecting to RA and area X.

Neurons generated in the adult brain are recruited into functional circuits.

Adult canaries, Serinus canarius, received injections of 3H-labeled thymidine, a marker of DNA synthesis. Thirty days after the last injection, intracellular potentials were recorded from neurons in the nucleus hyperstriatum ventralis pars caudalis, a vocal control nucleus in the telencephalon; these same cells were then injected with horseradish peroxidase. Of the 74 neurons labeled with horseradish peroxidase that were recovered, the nuclei of seven were radioactively labeled. Four of these seven neurons had responded to auditory stimuli. These double-labeled neurons were apparently generated during or after the 3H-labeled thymidine treatment (during adulthood) and subsequently incorporated into functional neural circuits.

Connections of vocal control nuclei in the canary telencephalon.

Connections of two telencephalic vocal control nuclei, the hyperstriatum ventrale, pars caudale (HVc), and robust nucleus of the archistriatum (RA), were investigated in adult canaries. Methods used were transport of horseradish peroxidase and 3H-adenosine and silver staining of degenerating axons. Three nuclei project to HVc: medial nucleus magnocellularis of the anterior neostriatum (MAN), nucleus interfacialis (NIf) of midneostriatum, and nucleus uvaeformis (Uva) of the diecephalon. Uva also projects to NIf. NIf and Uva have not been described previously. HVc projects to area X of lobus parolfactorius, to RA, and to field Avalanche of hyperstriatum ventrale. Nucleus RA receives projections from HVc and from lateral MAN. All these projections are ipsilateral. No gross male/female differences were apparent in the projections to and from HVc. Uptake of HRP by cell somata in HVc following localized injections of this substance into RA or HVc suggests that HVc is composed of rostrocaudally organized clusters of cells, with little lateral communication between them.