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PubMed2004

Survival-determining factors in patients with neurologic impairments who received home health care in Japan.

BACKGROUND: The Japanese have become the longest-lived nation population in the world, and numbers of elderly who require medical and nursing care are increasing. The capacity of nursing homes and nursing institutions is sharply limited in Japan; further, as a group, elderly Japanese patients prefer home care to institutional care. For these reasons, the home health care system in Japan has been increasingly important. OBJECTIVE: We sought to identify factors determining long-term survival in Japanese patients receiving home health care for neurologic disorders. PATIENTS AND METHODS: We retrospectively evaluated 180 patients with neurologic disease, who received home health care conducted by our hospital between 1992 and 2001. Factors considered were age; gender; illnesses; prognosis; follow-up period; activities of daily living (ADL); behavioral, cognitive, and communicative functions; swallowing function; feeding method; serum nutritional values (total protein, albumin, and total cholesterol); hemoglobin concentration; and social care services provided at home. RESULTS: Variables affecting long-term survival in 180 patients with neurologic disease were age (P<0.0002) and severity of dysphagia (P<0.04) by Cox's proportional hazard test. CONCLUSION: Maintenance of swallowing function and adequate nutrition through a variety of feeding methods that can be provided by a home health care program are important for long-term survival of patients with stroke and also that of patients with other neurologic diseases.

Activities of Daily Living↗
PubMed2005

Barriers to communication regarding end-of-life care: perspectives of care providers.

OBJECTIVE: Communication regarding end-of-life care is frequently perceived as suboptimal, despite the intent of both health care providers and patients. We interviewed health care providers to determine their perspective regarding these barriers to communication. MATERIALS AND METHODS: Eleven focus groups with a total of 10 attending physicians, 24 residents, and 33 nurses were convened to explore barriers to end-of-life discussions on the Internal Medicine service at a 600-bed tertiary care hospital in Toronto, Canada. An interview schedule was designed to elicit information regarding the process of end-of-life discussions, barriers to these discussions, and possible interventions for limiting such barriers. Transcripts were qualitatively analyzed by 6 raters who independently identified "themes." Themes were refined using the Delphi technique and classified under broader "categories." RESULTS: Four main categories of barriers emerged, relating to (1) patients, (2) the health care system, (3) health care providers, and (4) the nature of this dialogue. Attending physicians and residents most frequently identified patient-related factors as barriers to discussions, followed by system, dialogue, and provider barriers (43%, 39%, 10%, and 8%, respectively, for attending physicians; 40%, 34%, 13%, and 13%, respectively, for residents). Nurses similarly identified patient-related and system barriers most frequently, but provider barriers were discussed more often than dialogue barriers (46%, 28%, 22%, and 4%, respectively). CONCLUSIONS: Attending physicians, residents, and nurses perceive the recipients of their care, and the system within which they provide this care, to be the major source of barriers to communication regarding end-of-life care. This finding may impact on the effectiveness of quality-improvement initiatives in end-of-life care.

Adult↗
PubMed2003

Communication in general practice: differences between European countries.

BACKGROUND: Based on differences in national health care system characteristics such as the gatekeeping role of GPs (at the macrolevel) and on diverging GP and patient characteristics (at the microlevel), communication may differ between countries. Knowledge of the influence of these characteristics on doctor-patient communication will be important for setting European health care policies. OBJECTIVES: Our objectives were (i) to compare doctor-patient communication in general practice between European countries; and (ii) to investigate the influence of the gatekeeping system and GP and patient characteristics on doctor-patient communication in general practice. METHODS: Fifteen patients per GP (in total 2825 patients) of 190 GPs in six European countries were included. Participating countries were The Netherlands, Spain, the UK (gatekeeping countries), Belgium, Germany and Switzerland (non-gatekeeping countries). Data were collected by means of patient and GP questionnaires and observation of videotaped consultations, and analysed by one-way and multilevel, multivariate analysis. RESULTS: Differences in communication between countries were found in: affective and instrumental behaviour; biomedical and psychosocial talk; GPs' patient-directed gaze; and consultation length. The study showed that GPs' gatekeeping role (with registered patients) was less important for doctor-patient communication than was expected. Patient characteristics such as gender, age, having psychosocial problems, and familiarity between the doctor and the patient were the most important in explaining differences in communication. CONCLUSION: The gatekeeping role of GPs is hardly important in explaining doctor-patient communication. The relationship is more complex than expected. Patient and GP characteristics are more important. Cultural factors should be included in future studies.

Adult↗
PubMed2005

Effect of communication disability on satisfaction with health care: a survey of medicare beneficiaries.

PURPOSE: To examine the prevalence and characteristics of community-dwelling Medicare beneficiaries reporting a communication disability and the relationship between that disability and dissatisfaction with medical care. METHOD: A total of 12,769 Medicare Current Beneficiary Survey respondents age 65 and older in 2001 were categorized by level of communication disability. Sampling weights were used to make inferences about the entire Medicare population. RESULTS: Over 16 million beneficiaries reported a communication disability. Hearing problems were most commonly reported (41.99%). The association between dissatisfaction and communication disability was statistically significant (p <or= .05) for 8 of 10 items. CONCLUSIONS: Prevalence of dissatisfaction among those with a communication disability varied, ranging from 3.43% to 19.34%. Respondents with a communication disability reported much more dissatisfaction when compared with those respondents without a communication disability.

Aged↗
PubMed2005

Enhancing patient-physician communication: a community and culturally based approach.

BACKGROUND: African American women are more likely to be diagnosed at later stages of breast cancer. METHODS: A total of 15 residents participated in a program to increase their self-efficacy in communication skills relevant to understanding and responding to African American cultural issues associated with mammography screening. RESULTS: Physicians reported increasing confidence in their ability to elicit barriers to mammography; assess cultural beliefs and norms; assess perceived health benefits and emotional adjustment; engage in emotional talk; motivate; and negotiate and build partnerships with patients. CONCLUSIONS: A brief program can increase physician communication skills to meet the needs of a diverse population.

Adult↗
PubMed2004

Communication training for health professionals who care for patients with cancer: a systematic review of training methods.

BACKGROUND: Effective communication is increasingly recognised as a core clinical skill. Many health and social care professionals, however, do not feel adequately trained in communicating and in handling interpersonal issues that arise in the care of patients with cancer. AIM: The aim of this paper was to assess the effectiveness of different training methods used in communication training courses for health professionals. METHOD: We searched six computerised databases and augmented this with follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and training methods were extracted and compared in tabular format. RESULTS: A total of 47 studies potentially assessing communication training were identified. Sixteen papers were included evaluating 13 interventions. Four were randomised controlled trials (RCTs) (grade a); the others were grade III. Eleven interventions trained health professionals; two trained medical students. Interventions for training in communication skills were characterised by the variety of communication approaches used and a diversity of methods. They were applied to health professionals with very different roles, served different purposes and evaluated a variety of outcome measures: behavioural assessments, patient outcomes and professionals' self-report. CONCLUSIONS: The best results are to be expected from a training programme that is carried out over a longer period of time. Learner-centred programmes using several methods combining a didactic component focusing on theoretical knowledge with practical rehearsal and constructive feedback from peers and skilled facilitators proved to be very effective. Small groups encouraged more intensive participation. Training in communication for both medical or nursing students and senior health professionals is advisable.

Communication↗
PubMed2005

Helminthiasis in selected children seen at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria.

OBJECTIVES: Illiteracy, poverty with associated poor environmental sanitation practices have been implicated in the heavy burden of helminthiasis among children. The objective of this cross-sectional survey is to determine the impact of parents' level of education on the intestinal helminthic status of children. PATIENTS, MATERIALS AND METHODS: All patients, 0-15 years totaling 1030 who visited the communicable disease clinic of the University of Benin Teaching Hospital, Benin City, from October, 2001 to March 2002 were included in this study. However, only 207 of the enlisted patients submitted faecal samples for examination and constituted the study population. Tool for data collection was structured questionnaire that was researcher administered to mother/caregivers after informed consent was obtained. Information sought in the questionnaire included sex and age of the subjects and level of education of their parents. Formol ether concentration method was used for stool examination while intensity was estimated using McMaster counting chamber technique. RESULTS: Of the 207 faecal samples examined 46(22.2% ) had ova of helminths while 161(77.85% ) had none. More school children, 40(19.3% ), than pre-school children, 6(2.9% ) had helminth ova in their faecal samples and the difference was found to be statistically significant (P < 0.05). More females, 28(13.5% ) than males, 18(8.7% ) were infected but the difference was however not statistically significant (P > 0.05). Intestinal helminth ova seen in order of prevalence include A. lumbricoides, 23(11.1% ); hookworm, 12(5.8% ); T. trichiuria, 8(3.8% ); Schistosoma mansoni, 2(1.0% ); Strongyloides stercoralis, 1(0.5% ) while multiple infection was recorded in 11(5.3% ) patients. Intensity of infection was low. The difference between the means for A. lumbricoides, T. trichiuria and multiple infection by age were found to be statistically significant P < 0.001; P < 0.05; P < 0.001, respectively. Mother's level of education more than father's level of education seemed to influence the pattern of intestinal helminthiasis among the children but the association was not found to be statistically significant (P > 0.05). CONCLUSION: Prevalence and intensity of infection was low probably due to periodic antihelminthic treatment offered by the health authorities. Improvement in mother's level of education brought about decrease in prevalence of intestinal helminthiasis among the children. Therefore, improvement in female education should be encouraged to reduce the incidence of communicable disease in the family.

Adolescent↗
PubMed2005

Communication skills in a Lebanese medical school: from movie theaters to medical classrooms.

BACKGROUND: Communication skills are widely taught in US medical schools, but in Lebanon, such teaching is in its infancy. METHODS: At the American University of Beirut, we piloted a communication skills teaching package using video scenarios in Arabic. A total of 150 second-year medical students addressed eight communication issues in a 3-hour multi-method workshop that included watching and discussing video clips and role-playing. RESULTS: Students evaluated the sessions positively for relevancy, quality of video clips, teaching methods, and usefulness for future practice. CONCLUSIONS: This interactive, role-playing workshop proved highly acceptable to Arab students and has been permanently incorporated into the curriculum.

Communication↗
PubMed2005

Post-traumatic eye observations.

Retrobulbar haemorrhage after facial trauma or surgery is an uncommon but well-documented complication. The assessment and management of this condition is variable. We asked 288 maxillofacial surgeons in the UK about the signs and symptoms, incidence, and management of retrobulbar haemorrhage. We also enquired about the regimen that they used for eye observations, the patients who, in their opinion, required observation, and the method of communication of instructions to the nursing staff. A total of 185 responded (64%). Each surgeon had seen a mean of 1.3 cases of retrobulbar haemorrhage, of which most, n=190 (91%) were treated by surgery. There were 96 different eye observations regimens documented. There was a general consensus about the signs and symptoms, and 82 (44%) of respondents used a proforma for recording eye observations. On the basis of this study we recommend a standard regimen for eye observations, and have a designed a facial injury advice sheet to be given to patients who attend the accident and emergency department and are to be discharged home and followed up at a later date.

Clinical Protocols↗
PubMedDate not supplied

[Capture-recapture methodology: an option for surveillance of non-communicable diseases in the elderly].

Capture-recapture methodology is used in Ecology to estimate the total size of wild animal populations. This method can be used in Epidemiology to estimate the incidence and prevalence of communicable and non-communicable diseases in a relatively inexpensive and quick way. Surveillance systems based on the use of this methodology are a potential alternative for monitoring non-communicable diseases in Brazil. This paper presents a brief review of fundamental capture-recapture methodology and its applications to Epidemiology. We also present a theoretical model for implementation of a diabetes mellitus surveillance system in the elderly using publicly available morbidity and mortality data sources and the capture-recapture methodology.

Aged↗
PubMed2001

Stopping long-term drug therapy in general practice. How well do physicians and patients agree?.

BACKGROUND: GPs have a particular responsibility to limit the occurrence of polypharmacy and adverse drug reactions, and to discontinue unnecessary drug therapy. OBJECTIVE: The aim of the present study was to measure the extent to which patients and physicians agree upon information communicated in a consultation when a drug is withdrawn. METHODS: A total of 272 Norwegian GPs and 272 patients filled in questionnaires after a consultation in which a long-term drug therapy had been discontinued. Their answers were compared and the agreement measured by kappa statistics. RESULTS: There was 100% concordance between physicians and patients as to what drug had been discontinued. Most of the drugs (72%) were cardiovascular. There was fair agreement as to whether the drug was to be stopped abruptly or gradually withdrawn (kappa 0.61) and whether a follow-up appointment had been scheduled (kappa 0.41). Physicians were not able to judge patients' satisfaction accurately (kappa 0.20). Most patients (73%) were satisfied or very satisfied with the decision to withdraw the drug, and many commented that good communication and close follow-up is a prerequisite for successful withdrawal of long-term drug treatment. CONCLUSIONS: Discontinuation of drug treatment was welcomed by most patients. Physicians and patients agreed completely as to what drug was to be discontinued, and fairly well about other factual aspects, but physicians were not able to judge patients' satisfaction accurately.

Adult↗
PubMed2006

A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD.

PURPOSE: This randomized group experiment compared the efficacy of 2 communication interventions (Responsive Education and Prelinguistic Milieu Teaching [RPMT] and the Picture Exchange Communication System [PECS]) on spoken communication in 36 preschoolers with autism spectrum disorders (ASD). METHOD: Each treatment was delivered to children for a maximum total of 24 hr over a 6-month period. Spoken communication was assessed in a rigorous test of generalization at pretreatment, posttreatment, and 6-month follow-up periods. RESULTS: PECS was more successful than RPMT in increasing the number of nonimitative spoken communication acts and the number of different nonimitative words used at the posttreatment period. Considering growth over all 3 measurement periods, an exploratory analysis showed that growth rate of the number of different nonimitative words was faster in the PECS group than in the RPMT group for children who began treatment with relatively high object exploration. In contrast, analogous slopes were steeper in the RPMT group than in the PECS group for children who began treatment with relatively low object exploration.

Autistic Disorder↗
PubMed2004

Evaluation of a communication skills seminar for students in a Japanese medical school: a non-randomized controlled study.

BACKGROUND: Little data exist for the effectiveness of communication skills teaching for medical students in non-English speaking countries. We conducted a non-randomized controlled study to examine if a short intensive seminar for Japanese medical students had any impact on communication skills with patients. METHODS: Throughout the academic year 2001-2002, a total of 105 fifth-year students (18 groups of 5 to 7 students) participated, one group at a time, in a two-day, small group seminar on medical interviewing. Half way through the year, a five-station objective structured clinical examination (OSCE) was conducted for all fifth-year students. We videotaped all the students' interaction with a standardized patient in one OSCE station that was focused on communication skills. Two independent observers rated the videotapes of 50 students who had attended the seminar and 47 who had not. Sixteen core communication skills were measured. Disagreements between raters were resolved by a third observer's rating. RESULTS: There was a statistically significant difference in proportions of students who were judged as 'acceptable' in one particular skill related to understanding patient's perspectives: asking how the illness or problems affected the patient's life, (53% in the experimental group and 30% in the control group, p = .02). No differences were observed in the other 15 core communication skills, although there was a trend for improvement in the skill for asking the patient's ideas about the illness or problems (60% vs. 40%, p = .054) and one of the relationship building skills; being attentive and empathic nonverbally (87% vs. 72%, p = .064). CONCLUSION: The results of this study suggest that a short, intensive small group seminar for Japanese medical students may have had a short-term impact on specific communication skills, pertaining to understanding patient's perspectives.

Adult↗
PubMed1999

Relationship between clinical competence and interpersonal and communication skills in standardized-patient assessment.

PURPOSE: To evaluate the relationship between clinical competence and interpersonal and communication skills, in an attempt to clarify current thinking about these two dimensions as measured with standardized-patient (SP) examinations. METHOD: Simple Pearson correlations were computed between total examination scores for clinical competence and interpersonal and communication skills. Three sets of different types of data involving 15 separate examinations were used to explore the generality of the findings. To control for a within-case halo effect and measurement error, corrected cross-half correlations and corrected cross-case correlations were also computed. RESULTS: The simple correlations and the corrected cross-half and cross-case correlations showed moderate and above relationships between these two dimensions in the clinical context. The simple correlations centered around .50, and the corrected cross-half and cross-case correlations were slightly higher, centering around .65 and .70, respectively. CONCLUSION: The authors' thinking is that the moderate relationship between clinical competence and interpersonal and communication skills is not due to a flaw in the measurement of clinical competence, as has been suggested, but rather is a natural consequence of the clinical encounter, which exacts an interdependence of these two dimensions. At least, this possibility must be seriously considered so medical educators can think and act appropriately in the assessment of clinical performance.

Adult↗
PubMed2005

Patient communication following head and neck cancer surgery: a pilot study using electronic speech-generating devices.

PURPOSE/OBJECTIVES: To describe the communication of patients who received electronic speech-generating devices (SGDs) following surgical procedures for head or neck cancer. DESIGN: Exploratory, complementary mixed methods. SETTING: Otolaryngology surgical inpatient unit of an urban teaching hospital. SAMPLE: 10 purposively selected patients with a mean age of 57.1 years (SD = 12.8 years) and moderately severe illness (Acute Physiology and Chronic Health Evaluation III score mean = 27.1 + 13.2) who had SGDs in their hospital rooms for 9.1 + 6.2 days. METHODS: Observation, interviews, questionnaires, and clinical record review. MAIN RESEARCH VARIABLES: Communication methods, communication content, SGD use, communication quality (i.e., ease and user satisfaction), barriers to SGD use, and patient clinical characteristics. FINDINGS: SGDs were used in message construction in 8 (17%) out of 48 total observed communication events. Writing (31%) and nonverbal communication (46%) were the most frequently observed primary methods of communication used by patients with head and neck cancer postoperatively. Five patients demonstrated occasional SGD use with or without cuing, and one used the SGD as the dominant communication method. Ease of Communication Scale scores showed only slightly less difficulty with communication when compared to a historic control group. Patients initiated communications more often when SGDs were used in message construction. Poor device positioning, staff unfamiliarity with SGDs, and patient preference and ability for writing were barriers to SGD use. CONCLUSIONS: Although writing and making gestures were the most common communication methods, SGDs were used successfully by selected patients and may be particularly beneficial for constructing complex messages during conversation. IMPLICATIONS FOR NURSING: SGDs may be an appropriate assistive communication strategy for postoperative patients with head and neck cancer. Nurses can facilitate effective patient communication with SGDs by cuing patients on device options and positioning SGDs within easy reach.

Aged↗
PubMed1989

Immuno-isolation and culture of biliary epithelial cells from normal human liver.

Biliary epithelial cells (BEC) lining the intra-hepatic biliary ducts are the site of damage in several immunologically mediated liver diseases. BEC are difficult to isolate since they represent only 5% of the total cell number in normal liver. In this communication, a novel method for their isolation from normal liver is presented using a monoclonal antibody (HEA125) with specificity for an epithelial cell surface glyco-protein reported to be expressed in liver only by biliary epithelium. By combining differential density centrifugation and immuno-magnetic separation using HEA125 pure BEC (10(5) cells/g fresh tissue) were prepared routinely. These cells were maintained in culture for up to 4 weeks with significant increases in cell numbers. The ability to prepare BEC from human liver offers an opportunity to develop In Vitro models to investigate the aetiology of diseases of intra-hepatic biliary epithelium.

Antibodies, Monoclonal↗
PubMed2004

[Simulator-based modular human factor training in anesthesiology. Concept and results of the module "Communication and Team Cooperation"].

BACKGROUND: Human factors (HF) play a major role in crisis development and management and simulator training can help to train HF aspects. We developed a modular training concept with psychological intensive briefing. The aim of the study was to see whether learning and transfer in the treatment group (TG) with the module "communication and team-cooperation" differed from that in the control group (CG) without psychological briefing ("anaesthesia crisis resource management type course"). METHODS: A total of 34 residents (TG: n=20, CG: n=14) managed 1 out of 3 scenarios and communication patterns and management were evaluated using video recordings. A questionnaire was answered at the end of the course and 2 months later participants were asked for lessons learnt and behavioral changes. RESULTS: Good communication and medical management showed a significant correlation (r=0.57, p=0.001). The TG showed greater initiative ( p=0.001) and came more often in conflict with the surgeon ( p=0.06). The TG also reported more behavioral changes than the CG 2 months later. The reported benefit of the simulation was training for rare events in the CG, whereas in the TG it was issues of communication and cooperation ( p=0.001). CONCLUSIONS: A training concept with psychological intensive briefing may enhance the transfer of HF aspects more than classical ACRM.

Anesthesia↗