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PubMed2003

The effect of communication on nursing student outcomes in a Web-based course.

This study compared the effectiveness of different instructional communication methods in a Web-based course on students' cognitive learning, satisfaction, and motivation to complete the course. A total of 174 undergraduate nursing students were selected randomly and assigned to experimental or control groups. Instruments included a demographic data form, two examinations on course material, a course satisfaction scale, and calculation of completion rates. All students received identical didactic Web-based instructional materials. However, type of communication varied among groups. No significant group differences were found for cognitive learning or motivation to complete the course. A significant group difference was found for student satisfaction with the course, indicating carefully planned communication strategies can improve satisfaction. A need for technical support also was evident. More research is needed to determine the best strategies to enhance student learning outcomes and decrease student attrition in Web-based courses.

Adult↗

PubMed1999

Speech perception results in children with cochlear implants: contributing factors.

Speech perception test results were obtained from a group of 40 pediatric cochlear implant users. Half of the children participated in oral-only habilitation programs, which included both traditional oral and auditory-verbal approaches, and half participated in programs that used a combination of oral and manual communication referred to as total communication (TC). Analysis of the scores showed that children enrolled in oral-only habilitation programs scored significantly higher on the speech perception measures than did children who were enrolled in total communication based programs. These results were inconsistent with those of other reports, which suggested that communication methods had little effect on implant outcomes. To further examine the reasons for the differences in performance, we analyzed 7 additional factors, including length of implant use, age at surgery, device type, socioeconomic status, bilingualism, school setting, and participation in private therapy, which may affect implant performance. Multiple-regression analysis again showed communication mode to be the factor most highly correlated with speech perception abilities among this group of children.

Adolescent↗

PubMed1985

Synthesis and turnover of protein-bound Nt-methylhistidine in cultured vascular smooth muscle cells.

Rabbit aortic smooth muscle cells cultured for 14 days in second passage produce significant amounts of protein-bound radioactive Nt-methylhistidine when pulsed with radiolabelled histidine. Much of the radioactive Nt-methylhistidine is located in the actin synthesized by these cells. Pulse chase data also suggest this newly synthesized Nt-methylhistidine disappears from the cell layer at two distinctly different rates: one with a half-life of 2.4 days, and the other with a half-life of approximately 17 days. Radioactive Nt-methylhistidine to histidine ratio reaches a maximum approximately 8 days following the 1-day [14C]histidine pulse. During the initial 15-day chase period, there is a substantial net accumulation of total Nt-methylhistidine in the culture flasks. The data presented in this communication indicate that methods to evaluate Nt-methylhistidine synthesis and disappearance in cultures are feasible when radiolabelled histidine is employed.

Actins↗

PubMed2006

[Partial or total replacement of the aortic arch. Experience in 23 patients].

BACKGROUND: Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body. AIM: To communicate our experience in the first 23 total or partial replacements of aortic arch. MATERIAL AND METHODS: Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998. RESULTS: Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction. CONCLUSIONS: There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative risk.

Aortic Dissection↗

PubMed1993

Use of transputers for real time dose calculation and presentation for three-dimensional radiation treatment planning.

PURPOSE: Real-time 3-dimensional dose calculation will allow display of isodose contours and other metrics for a planner to assess plan effectiveness during plan development, facilitating optimization. METHODS AND MATERIALS: Parallel processing provides an effective means to calculate 3-dimensional dose distribution in real-time while plan parameters are being chosen and adjusted. An array of 20 transputers and a high performance graphics workstation have demonstrated the feasibility of real-time 3-dimensional beam parameter specification, dose calculation, and dose-distribution presentation for evaluation. A mesh connected set of processors using surface processors to generate and terminate rays, and ray processors to calculate ray attenuation and dose distribution has been developed to efficiently utilize large numbers of processors and provide good load sharing, even for small beams that intersect only a small part of the volume. RESULTS: Our feasibility study has calculated dose distribution by the Effective Path Length method in about one second per beam for a treatment volume of 56,400 voxels. We expect to reduce the total time for computation, communication, and display, with even larger volumes, to less than one second. The number of processors can easily be increased for larger treatment volumes or more accurate and computation-intensive dose-calculation algorithms. Transputers provide an elegant and economical method for harnessing up to hundreds of powerful general-purpose processors for computational tasks including dose calculation and isodose contour generation. The same distributed-memory parallel-processing configuration is also suitable for calculation of isodose contours and dose-volume histograms for plan evaluation, automatic calculation of apertures and filters as beam parameters are manipulated, and more accurate dose calculation algorithms that incorporate the effects of scatter. CONCLUSION: Parallel processors can efficiently provide real-time calculation of the information necessary to evaluate treatment plans as they are developed allowing the planner to optimize the plan based on dose distribution and its effects on tumor control and complications.

Humans↗

PubMed1993

[Three levels of communication of people with senile dementia. An attempt to understand the 'life world' structured by people with senile dementia].

The aim of this paper is to study the communication of people with senile dementia for understanding the life-world structured by them. This research was conducted in special ward for senile dementia patients in the Aomori Prefectual Hospital, using the method of participant observation. The investigation period extended from September 1990 to August 1991 for a total of 62 days. First, the life-world of patients with senile dementia is described as follows: Patient' backgrounds, an outline of their everyday life in the institution. These patients have a serious intelligence disorder, therefore they have to live in a closed ward. However, the care system in the ward is very flexible so they are not restricted in their movements. An individual's ability to deal with the demands of everyday life is quite variable. And the quality of an individual's life is not limited to the sum total of his or her abilities. Second, the patients' communication processes are described. The procedure was as follows: The first step was to classify an individual's character and methods which they used to facilitate communication into five types. The second step was to illustrate their communication processes. There are many types of communication processes. But when we take notice of the essential qualities of their communications they fall into three basic patterns as follows: 1. Patients engaged in interactive connections in which the form, or the social fact of the interactions was valued over its narrative content. 2. During most communications each patient will inevitably experience a lack of comprehension. When this occurs they respond by introducing a new subject for discussion, or in other ways attempt to manipulate the interaction back to an area they understand. 3. Most interactions provoke intense interest among the other patient, who often gather to watch and comment among each other. In discussion, some common features that support humans' communication were studied through to compare the communication of people with senile dementia and normal people. In conclusion, the feature of their communication as exposure of the form not the content were explained.

Aged↗

PubMed2002

Characterizing the functional improvement after total shoulder arthroplasty for osteoarthritis.

BACKGROUND: Both shoulder surgeons and patients who are considering total shoulder arthroplasty are interested in the anticipated improvement in shoulder comfort and function after the procedure. The purpose of the present study was to characterize shoulder-specific functional gains in relation to preoperative shoulder function and to present this information in a way that can be easily communicated to patients who are considering this surgery. METHODS: We analyzed the preoperative and follow-up shoulder function in patients managed with total shoulder arthroplasty for the treatment of primary glenohumeral osteoarthritis. Functional self-assessments were available for 102 (80%) of 128 shoulders after thirty to sixty months of follow-up. Outcome was assessed with respect to the change in the number of shoulder functions that were performable, the change in shoulder function as a percentage of the preoperative functional deficit, and the change in the ability to perform specific shoulder functions. RESULTS: The average number of shoulder functions that were performable improved from four of twelve preoperatively to nine of twelve postoperatively (p < 0.01). Function improved in ninety-six shoulders (94%). The number of functions that were performable at the time of follow-up was positively associated with preoperative shoulder function (p < 0.05): the better the preoperative function, the better the follow-up function. The improvement in function was greatest for shoulders with less preoperative function (p < 0.01). On the average, patients regained approximately two-thirds of the functions that had been absent preoperatively. Significant improvement was noted in eleven of the twelve shoulder functions that were examined (p < 0.01). The chance of regaining a function that had been absent before surgery was 73%, whereas the chance of losing a function that had been present before surgery was 6%. Older men tended to have greater functional improvement than younger men. CONCLUSION: Total shoulder arthroplasty for the treatment of primary glenohumeral osteoarthritis significantly improves shoulder function. Postoperative function is related to preoperative function. The improvement that was observed in this clinical series can be conveyed to patients most simply by stating that, after surgery, shoulders typically regained approximately two-thirds of the functions that had been absent preoperatively.

Adult↗

PubMed2001

Validation of the doctor-patient communication component of the Educational Commission for Foreign Medical Graduates Clinical Skills Assessment.

BACKGROUND: The pivotal role of doctor-patient communication in effective health care delivery led the Educational Commission for Foreign Medical Graduates (ECFMG) to incorporate the assessment of interpersonal skills and spoken English proficiency into its Clinical Skills Assessment (CSA). Furthermore, it was decided that to pass the CSA, a candidate would need to meet or surpass defined performance standards for doctor-patient communication as a discrete component. This requirement, among others, is designed to ensure the readiness of graduates of foreign medical schools (FMGs) to enter postgraduate medical education programmes in the United States. OBJECTIVE: The primary focus of this study was to determine the extent to which performance in a simulated testing environment is related to performance in the clinical setting. METHOD: Nurses were trained to rate the communication skills of residents from the patient's perspective. A total of 43 first-year residents were evaluated. The survey ratings (n=225) were compared with the residents' CSA communication scores. RESULTS: Corrected correlations between CSA ratings and those obtained from nurses ranged from 0.61 to 0.73. CONCLUSION: This study provides evidence for the validity of the communication ratings provided by standardized patients. The reasonably strong associations between ratings obtained during testing and those obtained through observation of 'real' patient interactions suggest that external observers can provide accurate evaluations of doctor-patient communication.

Clinical Competence↗

PubMed2003

Migraine disability assessment (MIDAS) score: relation to headache frequency, pain intensity, and headache symptoms.

OBJECTIVE: To determine the extent to which variation in the Migraine Disability Assessment (MIDAS) score is associated with headache frequency, pain intensity, headache symptoms, gender, and employment status. BACKGROUND: The MIDAS questionnaire is a 7-item questionnaire (with 5 scored items) designed to measure headache-related disability, to improve physician-patient communication, and to identify patients with high treatment needs. METHODS: Data from 3 population-based studies (total sample, n = 397) conducted in the United States and the United Kingdom were used to evaluate the relationship between headache features (attack frequency, pain intensity, pain quality, and associated symptoms) and MIDAS score. Data on headache features were collected by telephone using a standardized interview. The MIDAS questionnaire was completed shortly after the telephone interview. General linear models were used to determine the extent to which population variation in the MIDAS score was explained by headache features. RESULTS: Using linear regression, variables for all headache features (ie, headache frequency, pain intensity, pain quality, and associated symptoms) and demographic characteristics explained only 22% of the variation in MIDAS scores. Almost all (19.9%) the explained variance was accounted for by average pain intensity (12.0%), number of headache days (6.1%), and exacerbation of pain with movement (1.8%). When pain intensity and headache frequency were included in the model, no statistically significant differences in MIDAS scores were observed by gender or employment status. Although explaining only 2.1% of the variance, age was significantly associated with MIDAS scores, with those under 25 years demonstrating higher MIDAS scores than other age groups. No other variables (ie, frequency of occurrence of associated symptoms and other measures of quality of pain) were associated with MIDAS scores. CONCLUSIONS: Challenges to the utility of the MIDAS as a measure include whether headache-related disability is largely a function of other routine headache features and whether MIDAS is inherently biased based on work status and gender. While the MIDAS score was associated with headache frequency and average pain score, these two headache features explain only a modest proportion of the variation in MIDAS scores. Additionally, gender and work status were not related to MIDAS scores. These findings suggest that the MIDAS score captures information about disability that is not inherent to other headache features and is independent of gender and work status.

Adult↗

PubMedDate not supplied

Recreational music-making: a cost-effective group interdisciplinary strategy for reducing burnout and improving mood states in long-term care workers.

OBJECTIVES: This controlled, prospective, randomized study examined the clinical and potential economic impact of a 6-session Recreational Music-making (RMM) protocol on burnout and mood dimensions, as well as on Total Mood Disturbance (TMD) in an interdisciplinary group of long-term care workers. METHODS: A total of 112 employees participated in a 6-session RMM protocol focusing on building support, communication, and interdisciplinary respect utilizing group drumming and keyboard accompaniment. Changes in burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively. Cost savings were projected by an independent consulting firm, which developed an economic impact model. RESULTS: Statistically-significant reductions of multiple burnout and mood dimensions, as well as TMD scores, were noted. Economic-impact analysis projected cost savings of $89,100 for a single typical 100-bed facility, with total annual potential savings to the long-term care industry of $1.46 billion. CONCLUSIONS: A cost-effective, 6-session RMM protocol reduces burnout and mood dimensions, as well as TMD, in long-term care workers.

Adult↗

PubMed1976

Elective experiences in family medicine for medical students.

The place of elective experiences in the predoctoral educational program of the Department of Family and Community Medicine of the College of Medicine of The Pennsylvania State University is described. General educational objectives and brief descriptions of courses are presented, and the educational approach is discussed. An overview of the comprehensive educational program is provided, including the methods used and relationship to the total medical school curriculum.

Communication↗

PubMed2006

Daily polyphenol intake in France from fruit and vegetables.

The objective of this study was to create a French database on the polyphenol content of fruit and vegetables as uncooked fruits and vegetables and then to evaluate polyphenol intake through fruit and vegetable consumption in France. To achieve this, we used the Folin-Ciocalteu method adapted to fruit and vegetable polyphenol quantitation (1). Vegetables with the highest polyphenol concentration were artichokes, parsley, and brussels sprouts [>250 mg of gallic acid equivalent (GAE)/100 g fresh edible portion (FEP)]; fruits with the highest concentrations were strawberries, lychees, and grapes (>180 mg of GAE/100 g FEP). Conversely, melons (Cantaloupe cv.) and avocados had the lowest polyphenol concentration for fruits and vegetables, respectively. Based on fruit consumption data, apples and strawberries are the main sources of polyphenols in the French diet, whereas potatoes, lettuces, and onions are the most important vegetable sources. Total polyphenol intake from fruit is about 3 times higher than from vegetables, due to the lower polyphenol concentration in vegetables. The calculation of polyphenol intake, based on both assessment methods used [(Société d'Etudes de la Communication, Distribution et Publicité (SECODIP) and Supplémentation en Vitamines et Minéraux Antioxydants (SUVIMAX)], showed that apples and potatoes provide approximatively half of the total polyphenol intake from fruit and vegetables in the French diet.

Allium↗

PubMed2005

Design, conduct and evaluation of a communication course for oncology fellows.

BACKGROUND: Training in the communication components of cancer care is necessary for the practice of oncology. We conducted a communication course for oncology fellows. METHODS: Teaching methods included lectures, role playing and simulated patient interviews. We used self-reports, knowledge questionnaires and course/faculty evaluations. RESULTS: A total of 17 fellows participated. Skills in dealing with bad news, denial and end-of-life issues improved. We obtained information on communication tasks commonly performed during patient interactions, various aspects of the course and faculty performance. CONCLUSIONS: Fellows' knowledge and self-efficacy improved postcourse. Information on challenges faced by trainees and their feedback may help focus the design of future courses.

Adult↗

PubMed1998

The views of therapists on the use of a patient-held record in the care of stroke patients.

OBJECTIVE: To explore the views of therapists working with stroke patients on the use of a patient-held record (PHR) for stroke patients. A PHR was developed in the form of a pocket-sized booklet (21 cm x 14.5 cm) in which staff recorded information relating to the patient's management. The aim of the PHR was to facilitate communication and involve patients more directly in their care. METHODS: Six semi-structured group interviews were conducted with therapists (25 in total) from one inner city hospital. RESULTS: The following themes emerged from the content analysis: (1) Therapists were supportive of plans for a PHR, citing the benefits of greater patient involvement. (2) However, they questioned its feasibility, in particular the issue of patient responsibility and its use with the cognitively impaired. (3) They also questioned its ability to facilitate communication among health professionals because of existing differences in perspectives. (4) These therapists revealed concerns about the effect that information may have on patients. (5) They also raised practical issues about finding the time to make entries, wording and content of entries in the PHR. CONCLUSION: Responsibility for the PHR may enhance patients' understanding and involvement in their care, yet ownership alone does not guarantee the confidence needed to encourage dialogue between patients and care providers. Furthermore, it is doubtful whether a PHR can hope to overcome the fundamental differences in the philosophies of care which the therapists reported.

Aged↗

PubMed2006

Relationship of resident characteristics, attitudes, prior training and clinical knowledge to communication skills performance.

PURPOSE: A substantial body of literature demonstrates that communication skills in medicine can be taught and retained through teaching and practice. Considerable evidence also reveals that characteristics such as gender, age, language and attitudes affect communication skills performance. Our study examined the characteristics, attitudes and prior communication skills training of residents to determine the relationship of each to patient-doctor communication. The relationship between communication skills proficiency and clinical knowledge application (biomedical and ethical) was also examined through the use of doctor-developed clinical content checklists, as very little research has been conducted in this area. METHODS: A total of 78 first- and second-year residents across all departments at Dalhousie Medical School participated in a videotaped 4-station objective structured clinical examination presenting a range of communication and clinical knowledge challenges. A variety of instruments were used to gather information and assess performance. Two expert raters evaluated the videotapes. RESULTS: Significant relationships were observed between resident characteristics, prior communication skills training, clinical knowledge and communication skills performance. Females, younger residents and residents with English as first language scored significantly higher, as did residents with prior communication skills training. A significant positive relationship was found between the clinical content checklist and communication performance. Gender was the only characteristic related significantly to attitudes. CONCLUSIONS: Gender, age, language and prior communication skills training are related to communication skills performance and have implications for resident education. The positive relationship between communication skills proficiency and clinical knowledge application is important and should be explored further.

Age Factors↗

PubMed2005

Burnout contagion among intensive care nurses.

AIM: This paper reports a study investigating whether burnout is contagious. BACKGROUND: Burnout has been recognized as a problem in intensive care units for a long time. Previous research has focused primarily on its organizational antecedents, such as excessive workload or high patient care demands, time pressure and intensive use of sophisticated technology. The present study took a totally different perspective by hypothesizing that--in intensive care units--burnout is communicated from one nurse to another. METHODS: A questionnaire on work and well-being was completed by 1849 intensive care unit nurses working in one of 80 intensive care units in 12 different European countries in 1994. The results are being reported now because they formed part of a larger study that was only finally analysed recently. The questionnaire was translated from English to the language of each of these countries, and then back-translated to English. Respondents indicated the prevalence of burnout among their colleagues, and completed scales to assess working conditions and job burnout. RESULTS: Analysis of variance indicated that the between-unit variance on a measure of perceived burnout complaints among colleagues was statistically significant and substantially larger than the within-unit variance. This implies that there is considerable agreement (consensus) within intensive care units regarding the prevalence of burnout. In addition, the results of multilevel analyses showed that burnout complaints among colleagues in intensive care units made a statistically significant and unique contribution to explaining variance in individual nurses' and whole units' experiences of burnout, i.e. emotional exhaustion, depersonalization and reduced personal accomplishment. Moreover, for both emotional exhaustion and depersonalization, perceived burnout complaints among colleagues was the most important predictor of burnout at the individual and unit levels, even after controlling for the impact of well-known organizational stressors as conceptualized in the demand-control model. CONCLUSION: Burnout is contagious: it may cross over from one nurse to another.

Adult↗

PubMed1969

Direct cord reading agar in routine mycobacteriology.

A group of 2,081 sputum specimens were planted on Direct Cord Reading Agar. A total of 330 (16%) of these specimens produced positive cultures, 312 strains of Mycobacterium tuberculosis and 18 strains of atypical mycobacteria. The strains of M. tuberculosis showed visible cords on plates in 283 (90.8%) of the isolates and no atypical mycobacteria showed cording. The specimens from the newly admitted patients yielded, in 12 days, 59% of their total positives; 97.6% of these strains, identified as M. tuberculosis with the standard methods recommended by the National Communicable Diseases Center, exhibited cording visible directly on the agar. It is suggested that, for practical purposes, a colony exhibiting cording could be tentatively reported as "M. tuberculosis to be confirmed."

Agar↗

PubMed2004

Communication about the ending of anticancer treatment and transition to palliative care.

BACKGROUND: Communication about the ending of anticancer treatment and transition to palliative care is a difficult task for oncologists. The primary aims of this study were to clarify family-reported degree of emotional distress and the necessity for improvement in communication methods when communicating about the ending of anticancer treatment, and to identify factors contributing to the levels of emotional distress and the necessity for improvement. METHODS: A multi-center questionnaire survey was conducted on 630 bereaved family members of cancer patents who received specialized palliative care in Japan. A total of 318 responses were analyzed (effective response rate, 62%). RESULTS: Thirty-nine percent of the bereaved family members reported that they were 'very distressed' in receiving information about the ending of anticancer treatment, and 19% reported 'considerable' or 'much' improvement was necessary in the communication methods. High-level emotional distress was significantly associated with younger patient age, female family gender, the experience of the physician stating she/he could do nothing for the patient, the physician's unwillingness to explore their feelings, and prognostic disclosure of definite survival periods without probabilities or ranges. High levels of perceived necessity for improvement in the communication methods were significantly associated with the experience of the physician stating she/he could do nothing for the patient, physicians not explaining treatment goals in specific terms, physicians not pacing the explanation with the state of family preparation, physicians not being knowledgeable about the most advanced treatments, and the atmosphere not being relaxing enough to ask questions. CONCLUSIONS: In receiving the information about ending anticancer treatment, a considerable number of families experienced high levels of emotional distress and felt a need for improvement of the communication methods. The strategies to alleviate family distress could include: (i) assuring that physicians will do their best to achieve specific goals, without saying that they can do nothing for the patient; (ii) providing information, including estimated prognosis, in careful consideration of families' preparation and the uncertainty for each patient; (iii) exploring families' emotions and providing emotional support; (iv) acquiring knowledge about advanced treatments; and (v) making the atmosphere relaxing enough to allow families to ask questions.

Aged↗