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Lisa Sowle Cahill takes up the methodological issue of how substantive religious perspectives can be communicated in a pluralistic society. Cahill sees public discourse about bioethics as embodying a commitment to dialogue among traditions, religious and nonreligious, that have common concerns.
In this study, we applied the methodology grounded in human-centered distributed cognition principles to the information flow analysis of a highly intensive, distributed and complex environment--the Biomedical Engineer (BME) console system at NASA Johnson Space Center. This system contains disparate human and artificial agents and artifacts. Users and tasks of this system were analyzed. An ethnographic study and a detailed communication pattern analysis were conducted to gain deeper insight and better understanding of the information flow patterns and the organizational memory of the current BME console system. From this study, we identified some major problems and offered recommendations to improve the efficiency and effectiveness of this system. We believe that this analysis methodology can be used in other distributed information systems, such as a healthcare environment.
BACKGROUND: Legionnaires' disease, most often a serious condition, is a relatively rare disease in Norway although in recent years it has been on the increase. Because of clinical and microbiological diagnostic difficulties, one can assume that the number of new cases reported is significantly too low. MATERIAL AND METHOD: A multidisciplinary team established in the City of Trondheim has two main functions; first, to trace sources of contagion when outbreaks of the disease and detected; second, to carry out routine inspections in order to trace potential environmental sources. RESULTS: Over a four-year period (2001 - 2004), 19 cases of Legionnaires' disease were diagnosed; 17 of these are presumed to have originated locally. This is an incidence rate five times greater than the national average. Legionella pneumophila was discovered in the patients' local environment in 6 cases. Environmental investigations showed that the bacterium was present in three water-cooling towers, one Jacuzzi, one swimming pool, a shower in a factory, and in the hot-water system of a building complex. Most of the discoveries were made in the summer or autumn in several different locations in the city. Legionella pneumophila was found more often with low rather than high bacterial count, contrary to the information given in the Norwegian Legionnaires' disease prevention handbook. INTERPRETATION: Legionella pneumophila is in all likelihood a naturally occurring bacterium in many of the water sources and water supply plants in Trondheim. This requires continual awareness and readiness to tackle the disease. We have seen that a multidisciplinary team is well suited to evaluating high-risk environments, tracing outbreaks and carrying out information tasks targeted both at professionals and the public at large.
BACKGROUND: Refugees are likely to suffer from complex medical conditions due to persecution and exile. The symptoms may persist several years after the individual has fled his or her homeland. Knowledge of refugees' health condition in their receptive countries is insufficient. MATERIAL AND METHOD: Qualitative interviews with 12 general practitioners (GPs) in and around Oslo. A narrative approach was chosen for the analysis. RESULTS: The GPs' consultations with refugee patients seem to be characterised by uncertainty on the relevance of their refugee experience to their health condition. The GPs were reluctant to invite the patient to talk about traumatic experiences connected to their homelands, the escape and the exile. Rather, they express that unfamiliar culture and foreign language act as barriers to good communication between doctor and patient. Specialised health services seem neither to be accessible to the patients nor to be providers of clinical supervision for the GPs. INTERPRETATION: Cultural status seems to cover up experiences related to escape and exile. A lack of specialised health services seems to place the GP as a single actor in the medical service to refugee patients. The interviews revealed a need for instruction material adapted to the GPs' situation.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
The following care study aims to explore the effects of wound-related pain on a patient with leg ulceration. The study illustrates current deficits within the author's clinical area, a day hospital for elderly people, in relation to how both a patient's pain and quality of life are measured. It suggests means by which this could be overcome, e.g. by the use of appropriate pain and quality of life pain measurement scales. The case study also highlights the hospital-community divide, with reference to communication and the exchange of information relating to a patient's pain. It advocates optimizing interdisciplinary team communication and discusses how developing closer working relationships and improving education can play a part in enhancing communication. While this case study is concerned with an individual patient, it aims to demonstrate that the problems identified and the resulting indications for clinical practice will promote an increasingly holistic view of the patient and benefit all future patients with leg ulceration.
Discussion forums on the Internet allow doctors to discuss issues of interest in a rapid, convenient and educational manner. In March 2002, the department of dermatology at the St George Hospital in Sydney launched a national Website with an online discussion forum for dermatologists. Features of the Website forum include the ability to moderate the discussion boards, a choice of public or private discussions and receipt of automatic email notifications. Over three months, three dermatologists posted a total of 13 messages on three different topics. The low rate of participation by dermatologists may have been due to lack of time or familiarity with the technology. Increased promotion to and education of dermatologists who are most likely to use the discussion forum may improve utilization of this means of communication.
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OBJECTIVE: To identify evidence on the role of assertiveness and teamwork and the application of aviation industry techniques to improve patient safety for inpatient obstetric care. DATA SOURCES: Studies limited to research with humans in English language retrieved from CINAHL, PubMed, Social Science Abstracts, and Social Sciences Citation Index, and references from reviewed articles. STUDY SELECTION: A total of 13 studies were reviewed, including 5 studies of teamwork, communication, and safety attitudes in aviation; 2 studies comparing these factors in aviation and health care; and 6 studies of assertive behavior and decision making by nurses. Studies lacking methodological rigor or focusing on medication errors and deviant behavior were excluded. DATA SYNTHESIS: Pilot attitudes regarding interpersonal interaction on the flight deck predicted effective performance and were amenable to behavior-based training to improve team performance. Nursing knowledge was inconsistently accessed in decision making. Findings regarding nurse assertiveness were mixed. CONCLUSIONS: Adaptation of training concepts and safety methods from other fields will have limited impact on perinatal safety without an examination of the contextual experiences of nurses and other health care providers in working to prevent patient harm.
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We describe the teaching programme in ethics, law and communication skills for clinical medical students which is being developed as part of the Oxford Practice Skills Project. These three elements of practice are approached in an integrated teaching programme which aims to address everyday clinical practice. The role of a central value of patient-centred health care in guiding the teaching is described. Although the final aim of the teaching is to improve actual practice, we have found three 'sub-aims' helpful in the development of the programme. These sub-aims are: increasing students' awareness of ethical issues; enhancing their analytical thinking skills, and teaching specific knowledge.
Although collaboration in child abuse investigations has been emphasized since 1974, barriers, including role conflicts and organizational differences, have often been reported. This study describes the process of collaboration based on the perceptions of investigators working with a Child Advocacy Center. Telephone interviews were conducted with 290 child protective service workers and law enforcement officers from 28 child advocacy centers in 20 different states. Respondents identified barriers to the process of collaboration such as conflicts over case control and facilitators including co-housing and cross-training. Conditions that should contribute to successful collaboration are discussed.
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The need for enhanced biologic surveillance has led to the search for new sources of data. Beginning in September 2001, Emergency Medical Associates (EMA) of New Jersey, an emergency physician group practice, undertook a series of surveillance projects in collaboration with state and federal agencies. This paper examines EMA's motivations and concerns and discusses the collaborative opportunities available to data suppliers for syndromic surveillance. Motivations for supplying data included altruism and public service, previous involvement in terrorism and disaster preparedness, academic research interests, and the opportunity to find added value in the group's existing information systems. Concerns and barriers included cost, maintaining patient confidentiality, and challenges in interacting with the public health community. The extensive and carefully maintained electronic medical record enabled EMA to conduct multiple studies in collaboration with state and federal agencies. The electronic medical record provides useful data that might be more sensitive and specific in detecting outbreaks than the patient-chief-complaint data more commonly used for surveillance. EMA's experience also indicates that opportunities exist for the public health community to work with emergency physicians and emergency physician groups as suppliers of data. Such collaborations not only are useful for syndromic surveillance systems but also can help build relations that might facilitate a response to an actual biologic attack.
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