Nurse acceptance of a computerized arrhythmia monitoring system.

Implementation of a sophisticated computerized arrhythmia monitoring system in our institution initially met with negative attitudes from the critical care nurses in the ICCU and IMCU. This negative response can be attributed to several factors: (1) reliability of a computer monitoring system, (2) requirement of extensive education and training in the operational aspects of the system, and (3) time-consuming interface to the system. The nurses' responsibility to direct patient care did not allow enough time to properly adjust program parameters and react to the system. However, the comparative study performed by Zencka and colleagues overwhelmingly supported the effectiveness of the use of this system in the clinical setting. The introduction of the Arrhythmia Monitoring Technician obviated these problems. The technicians are responsible for the total operation of the monitoring system. Interface to the system occurs on two levels: (1) technician interface to the system by the adjustment of parameters and the verification of detected abnormalities and (2) technician interface to the nurses by notification of detected arrhythmias via remote transmission. In a recent survey, a majority of the nurses in the ICCU and IMCU indicated their positive support of the effectiveness of this computerized arrhythmia monitoring system. Critical care nurses in our institution consider computerized arrhythmia monitoring an essential component in the provision of quality patient care.

[Attention and hyperactivity disorder in children. Early detection--preventing social consequences]. / Aufmerksamkeits- und Aktivitätsstörung bei Kindern. Früh erkennen--soziales Abrutschen verhindern.

Attention deficit and activity disorder is characterized by impaired concentration, increased impulsiveness and motor restlessness. In a high percentage of cases, the symptoms persist into adulthood. Untreated victims have an increased risk of: failing to realize their full potential with regard to school-leaving performance, of developing substance dependence, of dissocial development, and of becoming more prone to accidents during leisure activity, in traffic and at work. The treatment strategies recommended in guidelines issued by the German societies of child and adolescent psychiatry are evidence-based and reliably effective.

[Drug treatment of 7- to 14-year-old children. Results of a parent survey]. / Arzneimittelverbrauch bei 7- bis 14jährigen Kindern. Ergebnisse einer Elternbefragung.

In comparison to other European countries, Germany has by far the highest availability of drugs. Consequently the fear is often expressed that drugs may be over-prescribed even for children and that educational measures or home remedies would often be equally effective. In particular, the issue of inappropriate prescribing of psychotropic drugs for children is often raised, even though epidemiological studies have failed to document such a practice. In a study conducted to obtain comprehensive data about the use of drugs by children, questionnaires were given to parents of children at four schools in Bavaria (2 industrial towns, 2 university towns). This anonymous inquiry was supported by the Ministry of Education and Cultural Affairs. Of the 1750 questionnaires distributed 1189 were evaluated (67.9% response rate). On an average, each child took 3.17 drugs per year, mainly for respiratory infections, fever, pain and gastrointestinal symptoms. Analgesics, nasal preparations, cough medicine, gastrointestinal medications and antibiotics were used frequently and psychotropic drugs only rarely (rank 20). For psychiatric conditions, only one child in 170 was given psychotropic drugs and only one in 108 used sedatives. Overall, drugs and home remedies were used with almost equal frequency (1.23:1). For psychiatric problems, home remedies were used three times more frequently, whereas for other problems drugs predominated. Of the parents who responded were 79.3% satisfied with the prescribed drugs; 9.1% stated that they changed the dosage of the prescribed drugs.

[Self-assessment of prescribing behavior of psychotropic drugs for children and adolescence. Results of a survey of established physicians]. / Selbsteinschätzung des Verordnungsverhaltens bei Psychopharmaka an Kindern und Jugendlichen. Ergebnisse einer Befragung von niedergelassenen Arzten.

All registered general practitioners, pediatricians, and neuropsychiatrists of lower franconia were asked to fill out a questionnaire regarding the ratio of 0-20 year old patients with psychiatric symptoms and their prescribing methods of psychopharmaca. Neuropsychiatrists treated less children and adolescents with psychiatric symptoms than pediatricians or general practitioners. Approximately 50% of the patients with psychiatric symptoms received psychopharmaca. The most frequently prescribed psychopharmaca were neuroleptics and antidepressants, followed by phytopharmaca with various ingredients, which were most frequently prescribed by general practitioners. The average duration of a psychopharmacotherapy was 9 weeks. A great deal of uncertainty regarding the prescription of psychopharmaca to children and adolescents has become evident. Despite the fact that an enuresis can not be diagnosed before the end of the 5th year, it was one of the most frequently treated symptom of the 2-5 year old children. On the other hand, approximately one third of all physicians principally do not treat children and adolescents with psychopharmaca.

Comparison of total and regional body composition in adolescent patients with anorexia nervosa and pair-matched controls.

Body composition in 31 adolescent girls suffering from anorexia nervosa (AN) was measured at the time of hospitalization in order to assess the muscle/bone relationship as a potential source of the development of osteopenia. Differences in lean tissue, fat and bone mass in total body, weight bearing and non weight bearing limbs were estimated in AN and pair-matched controls aged 14.2 +/- 1.8 years (range: 9-17 years). Further, it was investigated if bone mineral density (BMD) better reflects the muscle/bone relationship than bone mineral content (BMC). At the distal radius parameters measured by peripheral quantitative computed tomography (pQCT) were used to estimate the association of volumetric bone density to bone strength and lean body mass. The correspondence to the same and different body regions was assessed. Total lean mass in the controls was closely related to total body bone mineral content (TBBMC), as was lean tissue and bone mass of the limb subregions (r = 0.82 to 0.93). In contrast, the correlation was significantly lower in AN (r = 0.33 to 0.77). In the controls, the pQCT-derived bone strength was correlated with muscle mass of the forearm (r = 0.78, p < 0.001), but only moderately in AN (r = 0.47, n.s.). Regional lean tissue was 11-20% and fat mass was 56-66% lower in AN (p < 0.01). After adjustment for height, TBBMC was different at p = 0.01. Within the limbs subregions, BMC (but not BMD) was different in both groups only in the upper arm and the thigh. BMC reflected the bone/muscle relationship better than BMD. Intra- and between group regressions gave no significant differences between weight bearing and non weight bearing limbs. In conclusion, the assessment of musculoskeletal factors may be a useful tool to develop individual preventive measures for therapy after recovery of our patients.

A study of cranial computer tomograms in very early and early onset schizophrenia.

The cranial computer-assisted tomograms of 19 patients suffering from schizophrenic psychoses with onset by age of 14 were examined. The emphasis was on the extent of the inner liquor spaces. Compared to healthy controls, at the beginning of illness a significant enlargement was revealed only in the patient group with very early onset schizophrenia (VEOS, onset prior to the age of 12), whereas children with early onset (EOS, 12 to 14 years of age) showed no significant brain pathology. As a second result, an increase in the extent of the inner liquor spaces seems to correlate with the duration of illness. It is therefore concluded that psychoses interfere with neurodevelopmental processes and cause more severe brain pathology in very young children, already detectable at the onset of the illness. EOS, on the other hand, induces progressive morphological abnormalities over the course of the illness.