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PubMed1997

Evaluation of the Abbott Cell Dyn 4000 automated fluorescent reticulocyte measurements: comparison with manual, FACScan and Sysmex R1000 methods.

The Abbott Cell Dyn 4000 (CD4000) is the first haematology analyser in which fully-automated reticulocyte measurements can be routinely determined by fluorescence as part of the full blood count. This communication reports the first evaluation of this method which was undertaken by three independent reference laboratories in Belgium, Germany and Italy. A total of 695 different samples was entered into the study which was designed to compare CD4000 reticulocyte information (enumeration and qualitative maturational data) with results determined in parallel with the existing manual (supravital staining) reference procedure, and two semi-automated fluorescent assays (Becton Dickinson FACScan and Sysmex R1000 instruments). These studies revealed good agreement between the CD4000 and the manual procedure, with no inter-method bias. Comparison of CD4000 and FACScan reticulocyte measurements, however, indicated a distinct tendency for the FACScan to give higher reticulocyte estimates than the CD4000. Finally, the comparison of the CD4000 with the Sysmex R1000 showed excellent agreement in the range 0-6% reticulocytes, although there was some inter-method bias in the higher range (> 15%). Analysis of agreement levels between the methods using specific 'clinical decision points' confirmed the tendency for overestimation by the FACScan, in that 58% of the samples with a reticulocytopenia of < 0.5% as defined by the CD4000 gave FACScan results within the normal range (0.5-1.8%). In contrast, there was absolute agreement between the CD4000 and the Sysmex R1000 for all reticulocytopenias. Comparison (195 samples) of instrument fluorescent reticulocyte maturation profiles demonstrated an exponential relationship (r = 0.78) between CD4000 IRF and R1000 HFR (highly fluorescent reticulocyte fraction) values. The suggestion that the CD4000 IRF values includes some of the MFR as well the HFR reticulocyte fraction was confirmed as the correlation between the CD4000 IRF and the Sysmex R1000 MFR plus HFR percentages was linear (r = 0.82). This study confirms a high performance level for the CD4000 automated fluorescent reticulocyte method.

Autoanalysis↗
PubMed1993

Three-dimensional echocardiography.

Lack of spatial registration of imaging transducers is a major technical limitation of two-dimensional (2-D) echocardiography. Volume scanning of the heart, or three-dimensional (3-D) echocardiography, is achieved by using a 3-D spatial registration device with a conventional 2-D scanner, or by using a high speed, phased-array real-time scanner. Three-dimensional spatial coordinate systems may be external or internal systems with respect to the scanning transducer. With external systems data acquired from several cardiac windows may be integrated and reconstructed. An external coordinate system allows creation of a "line of intersection" display to guide image positioning in the nonvisualized dimension orthogonal to the real-time image. Use of this display has shown a significant, threefold improvement in the accuracy of image positioning and the reproducibility of chamber measurements. Three-dimensional echocardiography using polyhedral surface reconstruction also yields more accurate measurement of ventricular volume and new measurements of total endocardial surface area and infarct surface area. Computer modeling and 3-D computergraphic displays hold promise of valuable new methods of communication, data analysis, and surgical planning.

Cardiac Volume↗
PubMed2002

[Mechanism of esophageal speech after total laryngectomy].

OBJECTIVE: To evaluate the characteristics of esophageal speech after total laryngectomy. METHODS: Esophageal speech evaluation of 40 cases of esophageal phonation included acoustic parameters, intraesophageal pressures during phonation, speech intelligibility, fluency, communication, respiratory sound and cognate distinctions between voiced and voiceless sounds. RESULTS: In 8 poor speakers, the neoglottis was spasmodic and difficult to vibrate during phonation. In 32 good speakers, the neoglottis was relaxed and easy to vibrate during phonation. The training age, speech intelligibility, fluency, communication, respiratory sound, cognate distinctions between voiced and voiceless sounds and intraesophageal pressures during phonation were significantly different between good and poor esophageal speakers. Vocal characteristics of good speakers differed significantly from those in the normal (P < 0.05 or P < 0.01). The upper intraesphageal pressure during esophageal phonation was higher than that of the normal, especially for poor esophageal phonation. The middle to lower intraesphageal pressures was highest during poor esophageal phonation. CONCLUSIONS: Esophageal phonation was completely alaryngeal, and its activators also differ completely, so phonation could not maintain much longer. Patients with poor esophageal phonation could not drive the air through the neoglottis freely.

Adult↗
PubMed1990

Pain experiences of intensive care unit patients.

The purpose of this study was to describe various dimensions of the pain experiences of intensive care unit (ICU) patients. A purposive, primarily surgical sample of 24 ICU patients from two hospitals was interviewed after transfer from ICU. All but one patient remembered their ICU stay. Although this and six other patients had no recall of pain, 63% of the sample rated their pain as being moderate to severe in intensity. In a subgroup of nine patients having cardiac surgery, mean morphine sulfate administration during the first three postoperative days was 14 mg/day. This group of patients reported a lack of total pain relief from analgesics. Patients also described various sources of their pain, difficulties they had in communicating their pain, and nonpharmacologic methods that helped relieve their pain. Results of this study clearly indicate that not only pain but its communication and treatment were significant problems for a substantial portion of this ICU sample. Further descriptive and experimental research of pain characteristics and treatment practices for ICU patients is urgently needed. Improvements in nursing practice that result from such research may make a substantial difference in the comfort and well-being of critically ill patients.

Adult↗
PubMed2005

Tailoring communication in cancer genetic counseling through individual video-supported feedback: a controlled pretest-posttest design.

OBJECTIVES: To assess the influence of a 1-day individual video-feedback training for cancer genetic counselors on the interaction during initial visits. Feedback was intended to help counselors make counselees' needs more explicit and increase counselors' sensitivity to these. METHODS: In total 158 counselees, mainly referred for breast or colon cancer and visiting 1 of 10 counselors, received a pre- and post-visit questionnaire assessing needs (fulfillment). Visits were videotaped, counselor eye gaze was assessed, and verbal communication was analyzed by Roter Interaction Analysis System (RIAS) adapted to the genetic setting. Halfway the study, five counselors were trained. RESULTS: Trained counselors provided more psychosocial information, and with trained counselors emotional consequences of DNA-testing was more often discussed. Counselees seen by a trained counselor considered their need for explanations on (emotional) consequences of counseling as better fulfilled. Unexpectedly, counselees' contribution to the interaction was smaller with trained counselors. CONCLUSION: Feedback appeared to result in greater emphasis on psychosocial issues, without lengthening the visit. However, counselors did not become more verbally supportive in other ways than by providing information. PRACTICE IMPLICATIONS: A 1 day individual training appears effective to some extend; increased opportunities for watching and practicing behavioral alternatives and arranging consolidating sessions may improve training results.

Adult↗
PubMed1993

Quality improvement: analysis and modeling based on survey results.

This paper describes the results of the survey conducted in the manufacturing, distribution, and service organizations regarding total quality management (TQM) implementation. These results proved that an effective TQM program should contain consistent training of all employees and managers in TQM issues, significant improvement in communication methods between departments implementing TQM, development of the standards to measure and control the cost of quality, and reliable information about the results of TQM implementation. Based on the survey results, the quantitative relationships between quality improvement characteristics and different internal factors are presented. Statistical models described in the paper revealed leading predictors of a successful TQM implementation.

Humans↗
PubMed1993

Recovery of patients after four months or more in the persistent vegetative state.

A retrospective review was made of the case notes of 43 consecutive patients admitted to a unit specialising in the rehabilitation of people in the persistent vegetative state. Eleven of these patients regained awareness four months or more after suffering brain damage. The time to the first reported incidence of eye tracking was between four months and three years, and the time to the first response to command was between four and 12 months. Only one patient was eventually unable to communicate, six could use non-verbal methods of indicating at least a yes or no response, and four were able to speak. Six patients remained totally dependent while two became independent in daily activities. Four patients became independent in feeding, three required help, and four remained on gastrostomy feeding. Thus some patients can regain awareness after more than four months in a vegetative state, and, although few reach full independence, most can achieve an improved quality of life within the limitations of their disabilities. The recovery period is prolonged and may continue for several years. Even patients with profound brain damage should be offered the opportunity of a specialist rehabilitation programme.

Activities of Daily Living↗
PubMedDate not supplied

Long-term results of voice rehabilitation after total laryngectomy using primary tracheoesophageal puncture in Chinese patients.

PURPOSE: Prosthetic voice restoration is an increasingly popular method of postlaryngectomy voice rehabilitation. Despite its success in non-tonal languages, the efficacy of tracheoesophageal speech in tonal languages was largely unknown. The aim of the present study was to evaluate the long-term results of voice rehabilitation using a Blom-Singer valve (BSV) in the tonal language of Cantonese. PATIENTS AND METHODS: The records of 159 patients who underwent total laryngectomy and primary tracheoesophageal puncture (TEP) between May 1985 and December 1994 were retrospectively reviewed. Tracheoesophageal speech was regarded as functional if effective communication could be made during face-to-face conversation and telephone conversation. Any TEP-related complications were noted. Perioperative factors that might contribute to nonfunctional speech were subjected to statistical analysis. RESULTS: Six hospital mortalities were excluded from speech analysis. Of the remaining 153 patients, the median follow-up was 25 months, ranging from 3 to 113 months. Seventy-three patients had closure of tracheosophageal fistulae (TEF), and the main causes were ineffective voice production, dislodgment, and tracheostomal stenosis. Only 15 of them acquired functional speech before closure. The other 80 patients used a BSV as the chief modality of voice rehabilitation, with functional results achieved in 64 patients. None of the perioperative factors were found to be statistically significant in relation to nonfunctional speech. CONCLUSION: Primary TEP is an established method of voice rehabilitation after total laryngectomy. In our series, 52% patients achieved functional tracheoesophageal speech using a BSV.

Esophagus↗
PubMed1975

[Experimental xenogenic immune pancreatitis. 1. Histological findings in the mouse exocrine pancreas after treatment with anti-mouse pancreas rabbit serum (author's transl)].

QUESTION: In the pathogenesis of some forms of chronic pancreatitis an immunological influence has been discussed. Therefore, experimental studies of the exocrine pancreas after immunological damage should be done. In this communication histological findings on the mouse exocrine pancreas are presented after treatment with anti-mouse pancreas rabbit serum. MATERIAL AND METHODS: a total of 71 adult male white mice was divided into 4 groups treated in the following way: 1. 35 animals with anti-mouse pancreas rabbit serum 2. 14 animals with normal rabbit serum 3. 16 animals with physiological saline 4. 6 animals remained untreated. The sera under study and the saline were, without exception, administered intraperitoneally with single doses of 0.3 ml once, resp. twice daily for 0 up to 16 days. Constantly, 3 hours before sacrifice, the animals received the last injection. For histological examination, the fresh pancreas was fixed in formaline. After embedding in paraffin, sections were stained by the following methods: hematoxyline-eosin, trichrome according to Goldner, Giemsa staining, PAS-reaction, and tryptophane demonstration according to ADAMS (1957).

Animals↗
PubMed2005

[Teaching empathy in medical education].

OBJECTIVES: To determine whether there is any difference in empathic tendencies and attitudes towards communication in medical practice among the first-year students of Adnan Menderes University Medical School, and to determine the effect of education and the relation between these two features. METHOD: The Empathic Tendency Scale and Attitudes Towards Communication in Medical Practice Questionnaire were used to collect data from 36 (55.3 % of the total) students (65.7 % female; mean age: 18.3). RESULTS: Students are clustered into two groups for both scales using K-means analysis, which was used to see whether the students were homogeneous regarding empathy and communication attitudes at the beginning of the teaching period. According to the Empathic Tendency Scale results 25% of students have a high empathic tendency (HET) and 75% have a low empathic tendency (LET) and the results of the Attitudes Towards Communication in Medical Practice Questionnaire indicated that 56% have positive and 44% have negative attitudes towards communication. However, the difference between the pre-and post-teaching results of either group seems to show a tendency towards change (p< 0.10). The change has a negative and a positive tendency in the HET and LET groups, respectively. CONCLUSION: Our results seem to verify the predicted differences among the students in their empathic tendencies and attitudes towards communication in medical practice. It seems that empathic tendency is more likely to be changed by an appropriate teaching technique when change within the groups is concerned.

Adolescent↗
PubMed1987

An investigation of verbal interaction, knowledge of sexual behavior and self-concept in adolescent mothers.

Variables commonly considered to be major factors in contributing to the incidence of adolescent pregnancy may be only part of the total pattern. This study sought to examine the adolescent mothers' communication with significant others and their knowledge about sex, pregnancy, and birth control methods. Self-concepts of the adolescent mothers were compared with those of the published norms of the Tennessee Self-Concept Scale. The study included 23 adolescent mothers between the ages of 13 and 19 who were gravida 1 as indicated by their medical records. They were given a questionnaire constructed from previous research. They also completed a communication scale and the Tennessee Self-Concept Scale. The findings of the present study indicated that most adolescent mothers considered their communication with their parent mothers to be one of mutual understanding. However, it appears that most adolescent mothers obtain much of their information about sex, pregnancy, and birth control methods from significant others. The self-concepts of these adolescent mothers were lower in comparison to the norm. The results indicate a need for further research in the area of adolescent sexual development, sex education in the school, and increased involvement of parents in the communication of sexual mores.

Adolescent↗
PubMed1977

How aging affects the ear.

With aging, a different variety of ear diseases becomes more common. External ear disease is often a local reflection of generalized skin problems aggravated by retained water or local manipulation. Hearing loss may be the result of long-standing middle ear disease rather than aging. In this situation, the inconveniences and possible dangers of a chronically infected ear may be resolved with surgical intervention. Nasopharyngeal or lymphomatous disease must be suspected in any geriatric patient manifesting middle ear disease for the first time. Like presbyopia, presbycusis is a normal consequence of aging. It may be severe, but it does not lead to total deafness and equally involves both ears. Early discovery of the condition and institution of hearing rehabilitation methods will minimize the individual's communicative handicap and tendency to withdraw from society. Unilateral or asymmetric sensorineural hearing loss should be thoroughly evaluated for the purpose of identifying a curable and potentially life-threatening disease.

Aged↗
PubMed2005

Diagnostic features of pelvic osteolysis on computed tomography: the importance of communication pathways.

BACKGROUND: Progressive periacetabular osteolysis following total hip arthroplasty may require revision surgery. The purpose of this study was to use computed tomography scans of hemipelves retrieved at autopsy from patients who had had a total hip arthroplasty, to define the radiographic characteristics that differentiate clinically important osteolytic lesions from osteoarthritic bone cysts. METHODS: We analyzed forty-four hemipelves that had been retrieved at autopsy at a mean of eight years after a total hip arthroplasty with an uncemented acetabular component. Computed tomography images were analyzed to identify the location, volume, and presence of cortical erosion and/or communication pathways with the joint space for all periacetabular bone defects. Lesions that were not present on preoperative or immediate postoperative plain radiographs were defined as new lesions. These new lesions were compared with those that were present on preoperative or immediate postoperative plain radiographs, which were defined as preexisting lesions. RESULTS: Forty-six lesions were identified on computed tomography, and sixteen of them were preexisting lesions. The mean volume of the preexisting lesions was 1.5 +/- 1.5 cm(3), which was significantly smaller than the mean volume of 5.6 +/- 11.4 cm(3) of the thirty new lesions (p = 0.034). Twenty-eight of the thirty new lesions had a clear communication pathway with the joint space, while thirteen of the sixteen preexisting lesions demonstrated no communication pathway. New lesions were significantly more likely to communicate with the joint space than were preexisting lesions (p < 0.001). Cortical erosion was seen in sixteen of the thirty new lesions; none of the sixteen preexisting lesions exhibited cortical erosion (p < 0.001). CONCLUSIONS: The most important difference between osteolytic lesions and preexisting bone defects was the presence of a communication pathway to the joint space. Lesions that did not have an identifiable communication to the joint space were smaller and were not associated with cortical erosion. Lesions with communication to the joint through multiple pathways or through a central dome hole were larger and more likely to be associated with cortical erosion.

Adult↗
PubMed2006

A regional medical operations center improves disaster response and inter-hospital trauma transfers.

BACKGROUND: Delays in both inter-hospital trauma transfers and disaster response are common. We hypothesized patient flow could be improved by formal adoption of systems that improve cooperation and communication. METHODS: The regional trauma database of the Southwest Texas Regional Advisory Council for Trauma and the Regional Medical Operations Center (RMOC) database were queried to test the hypothesis. RESULTS: A total of 9507 trauma patients were transferred. Medcom resulted in decreased transfer process times. The RMOC was activated during Hurricanes Katrina and Rita. During two 24-hour periods, the RMOC coordinated the inter-hospital transfer of 781 patients and the movement of thousands of evacuees and special needs patients. CONCLUSIONS: Medcom, an organized system combining a communications center with formal trauma center cooperation, improves patient flow and reduces trauma transfer times. The RMOC, based on the same principles of cooperation and communication, allows for rapid transfer of hospitalized and special needs patients during disaster/mass casualty situations.

Databases as Topic↗
PubMed2006

Exploring knowledge work and leadership in online midwifery communication.

AIM: This paper reports a study to answer the following question: if given a user-friendly online system, that enabled communication across the practice community, would midwives function as knowledge workers? BACKGROUND: Globally, the demand for quality-led and innovative service delivery requires that nurses and midwives shift from being 'information workers', or passive receivers of managerial and organizational decisions, to become 'knowledge workers' who are able to create, lead and communicate service innovation and practice development. New communication technologies may offer a means for healthcare professionals to interact as knowledge workers and develop supportive communities of practice. METHODS: An online discussion forum was implemented as a low-cost technological intervention, deploying existing hardware and a standard hospital intranet. The evaluation of the forum was constructed as case-study organizational research. The totality of online communication, both traffic and content, was analysed over a 3-month period (193 messages downloaded 2003/2004), and 15 in-depth interviews were undertaken with forum users. FINDINGS: Given simple, facilitative, innovative technology, supported by a positive working culture and guided by effective leadership, midwives could function as 'knowledge workers', critically reflecting upon their practice and translating knowledge into action designed to achieve change in practice. Participation occurred across all staff grades, and midwives were predominantly supportive and facilitative towards the contributions made by colleagues. CONCLUSION; Midwives may be well placed to exemplify the 'ideal' characteristics of the knowledge worker being demanded of modern healthcare professionals. The deployment of online interactive technologies as part of strategic vision to enhance knowledge work among healthcare professionals should be given attention within health systems.

Attitude of Health Personnel↗
PubMedDate not supplied

Family as a member of the trauma rounds: a strategy for maximized communication.

INTRODUCTIONS: In many hospital settings, the process of providing information to families of critically ill and injured patients can be frustrating for all concerned. Communication failure is the root of much dysfunction in health care and improvement would be well received. The Trauma Team chose to include family members in daily work rounds, allowing total access to team deliberations. METHODS: For the past two years, families have been informed at the time of admission of the patient that daily patient rounds provide an optimal venue for information exchange and that the team expected family participation. A written 25 question survey was sent to selected family participants to obtain their retrospective opinions about the process. Additionally the ICU nursing staff completed an abbreviated survey to document their perceptions as to how family rounds facilitated care. RESULTS: Rounds with families have occurred daily, resulting in much improved relationships as reported by the team. Stress seems functionally diminished, hostility reduced and system dysfunction is less frequent. A total of 34 family questionnaires were available for evaluation. Parents were the most frequent participants (68%). Respondents reported having limited clinical knowledge about their family member prior to rounds but obtaining vital information from rounds which allowed them to understand the patient's condition and plans for care. No areas of dissatisfaction were documented. Sixteen respondents wrote comments which were positive in nature. Respondents from the nurse questionnaire indicated satisfaction with communication by the team and resultant facilitation of relations with the families. CONCLUSIONS: Despite misgivings by some team members, the presence of family on rounds has been a success as judged by the participants. There have been no adverse events. This method of family interaction is worthy of utilization in other institutions to provide enhancement of communications with families.

Attitude of Health Personnel↗
PubMed1997

First early patient contact for medical students in Prague.

BACKGROUND: Undergraduate medical education in the Czech Republic is currently undergoing extensive changes. OBJECTIVES: Since the very beginning of the study we have aimed to introduce mandatory education in general practice at the Second Medical School of Charles University in Prague. METHODS: A total of 106 medical students were divided into pairs; three pairs of students were assigned to one GP (trainer) who chose suitable families for them to visit after lectures in communication skills. The students met their trainers again after the visits, and 1 week of family placement was concluded by seminars that involved small groups of students led by assistant lecturers of the Institute of General Practice of the Postgraduate Medical School. RESULTS AND CONCLUSIONS: Early patient contact for medical students proved to be a good method of starting training in communication skills and for helping to understand the patient as a human being. Students evaluated highly their lecture notes and seminars for small groups as ways of preparing them for their future tasks. The attention that the medical students gave to their new subject, and their interest in continuing the seminars and visits of 'their' families, showed that the Family Placement project had a positive response.

Curriculum↗
PubMed2004

Interprofessional training in the context of clinical practice: goals and students' perceptions on clinical education wards.

AIMS: This paper describes the context of interprofessional training on clinical education wards (CEWs) and reports students' perceptions of this type of interprofessional and professional training. CONTEXT: A 2-week interprofessional clinical course was designed for medical students in their surgical eighth term, and nursing, occupational therapy and physiotherapy students, all in their sixth term. Clinical tutors were responsible for the patients and also supervised the students. The goals for the students included: to provide the patients with good medical care, nursing and rehabilitation; to develop their own professional roles; to enhance their level of understanding of the other professions; to stress the importance of good communication for teamwork and for patient care; to enhance understanding of the role of the patient, and to become more aware of ethical aspects of health care. MATERIAL AND METHODS: A questionnaire developed by teachers from the 4 educational departments was used. A total of 962 students responded (78%). RESULTS: The CEWs provided the students with good clinical practice in terms of training in their own professions as well in learning more about the other professions. The importance of good communication for teamwork and for patient care was recognised. The quality of supervision and students' perception of their own professional roles were important factors regarding satisfaction with the CEW course. CONCLUSIONS: The CEW course seemed to provide the students with an opportunity to develop their own professional roles and their functions as team members.

Attitude of Health Personnel↗