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Implications of changes in healthcare for biomedical communications.
Payment for medical services on the basis of DRGs and other innovations in medical care are restricting the income of major medical institutions. This has resulted in decreased demand for biomedical communication services (and more cost awareness) in support of traditional educational and patient care programs and an increased demand for services to support institutional public relations and marketing programs. Biomedical communications will need to respond to this fluid environment by broadening its institutional role and adopting new information technologies.
Digital photography: enhancing communication between burn therapists and nurses.
Burn rehabilitation therapists rely on nursing staff to follow through with the positioning and splinting programs. To communicate more effectively, a communication tool that consisted of digital photos and written instructions was created. Microsoft Word and Nikon View software were used to design the communication tool. The purpose of the study was to assess the perceived effectiveness of a communication tool between burn therapists and burn nurses for splinting and positioning. Thirty-two surveys were distributed to burn nursing staff to assess their perception of the communication tool (digital photographs with written instructions) compared with previous methods of instructions (without digital photographs). Seventy-three percent of nurses felt the communication tool with verbal instructions were the best methods of communicating splinting and positioning needs. All respondents felt that the rehabilitation staff should continue to use the communication tool.
Interpersonal communication skills of deaf adolescents and their relationship to communication history.
As part of a longitudinal study, the conversational skills of 67 deaf adolescents were assessed in spoken English, simultaneous communication (SimCom) and American Sign Language (ASL). Two groups of students were identified on the basis of the communication used in their current educational program: a small group of 16 students in programs using spoken English (oral) and a larger group of 51 students in programs using sign communication (bimodal). Students in spoken English programs had good spoken English skills and limited ASL skills, whereas the reverse was true for students in bimodal programs. Most students demonstrated sufficient skill in one or more systems to meet basic interpersonal communications needs, but not those required for advanced academic discourse. In neither group was spoken English related to ASL skill. SimCom skills were strongly related to spoken English in the oral program group and to ASL in the bimodal program group. Spoken English in adolescence was highly predictable from spoken English in early childhood. Within the bimodal program group, students with deaf parents had better SimCom and ASL skills than those with hearing parents. Among bimodal program students with hearing parents, better SimCom skills (but not ASL skills) were associated with earlier introduction to sign communication in school and to mothers' use of sign communication.
Communicating health care options and cost management programs.
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Hearing Status, Language Modality, and Young Children's Communicative and Linguistic Behavior.
This study examined early pragmatic skill development in a group of 38 children with severe or profound hearing loss between 1 and 4 years of age who were enrolled in a simultaneous communication (SC) approach to language learning. Both their use of intentionally communicative acts and their use of language were studied in an analysis of 30-min play sessions between a child and the primary caregiver. Results were compared with previously published data from two age-matched groups: 38 deaf children who were enrolled in oral communication (OC) programs and 84 normally hearing (NH) children. All groups showed a significant improvement with age in the communicative behaviors measured; therefore, the overall trend was toward growth-in all age groups-even when the rates of growth differed. By age 3 years, a pattern of communicative function use had emerged in all three groups. Patterns exhibited by deaf children in the SC and OC groups were similar to each other and to younger NH children but dissimilar to NH age mates. Although the use of signed input by normally hearing parents and teachers did not serve to ameliorate the profound effects of hearing loss on communication development in SC children, it did provide some early advantages. The children in SC groups did not exhibit an advantage over children in OC groups in their overall frequency of communication or the breadth of their vocabulary but they began using words earlier and used mature communicative functions significantly more often. Although children in the OC groups did not exhibit a significant advantage in the overall amount of speech used, they showed an advantage in the breadth of their spoken vocabulary in a conversational setting. Implications for early intervention programming are discussed.
Emergent models of implementation and communication: the Critical Care Family Assistance Program.
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Can public campaigns effectively change psychological determinants of safer sex? An evaluation of three Dutch campaigns.
This study evaluated the 1994, 1995 and 1996 Dutch safer sex campaigns as to their effectiveness in terms of improved attitudes, perceived social norms, self-efficacy and intentions regarding safer sex. The hypotheses were tested that variables become more positive when campaigns are conducted and less positive when campaigns are discontinued. A comprehensive design, including a baseline-post-test/post-test-only group design and a longitudinal or multiple assessment group design, was employed to exclude testing effects, history effects, cultural changes and sample differences as alternative explanations. The results show that despite high baseline levels, the campaigns positively affected all variables. Importantly, levels of all variables decreased when no campaign was conducted. It is concluded that campaigns are needed to maintain high levels of determinants of safer sex and that future campaign goals should be formulated in terms of stabilization instead of growth.
In-office infertility support group.
The office health care team is often concerned about the emotional aspects of infertility patient management. Is it adequately addressed? Patients often lack the proper means of ventilating their feelings and providing physicians with feedback regarding their frustrations in infertility treatment. A method of addressing the emotional aspects of infertility patient management using office personnel is described. Specifically, our office nurse conducts evening sessions allowing conversation, questions, voicing of complaints, and a vehicle for feedback from physicians to patients. A feeling of trust in the program and improved relationships with office personnel have resulted, as well as better patient-physician communication. This program can be incorporated easily into an infertility practice.
Patient-physician communication as organizational innovation in the managed care setting.
Despite changes in the healthcare system, the relationship between patients and physicians remains fundamental to high-quality care. Managed care rules and restrictions, such as constraints on choice of providers, review processes, and decreasing length of visits, are creating potential conflicts between patients and their physicians. To strengthen the patient-physician relationship, some managed care organizations are implementing communication skills training for physicians. This article provides case studies describing how 2 large managed care organizations successfully incorporated communication skills training into their environments. An organizational perspective is used to delineate the 3 stages--adoption, implementation, and institutionalization--that managed care organizations generally traverse in incorporating communication skills programs and making them an integral part of their organizational culture. Specific suggestions are provided for physician leaders and administrators who are considering similar programs in their settings.
Communicating with the elderly consumer: the growing health care challenge.
By the year 2010, one quarter of the U.S. population will be at least 55 years old. Government and private programs help some elderly persons receive adequate health care, but more are needed. The programs offered must be communicated effectively to this burgeoning population segment. The authors examine research results of gerontologists and experimental psychologists that shed light on perceptual, learning, and memory changes that occur with aging. The effects of these age-related changes are discussed within the theoretical context of persuasive communications. Implications for communication programs targeted at older consumers are presented.
Educational program for physicians to reduce use of non-steroidal anti-inflammatory drugs among community-dwelling elderly persons: a randomized controlled trial.
CONTEXT: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs for patients 65 years of age or older, primarily for musculoskeletal symptoms of osteoarthritis. Because NSAIDs frequently cause serious gastrointestinal (GI) and other complications among elderly patients, expert guidelines for osteoarthritis recommend acetaminophen-based regimens, which are safer and often as effective as NSAIDs. OBJECTIVE: Evaluate a physician education program that communicated guidelines for management of osteoarthritis in elderly patients that emphasized avoidance of NSAIDs when possible. The program reviewed NSAID risks and benefits and recommended: re-evaluating continuous NSAID users, considering substitution of up to 4 g/d of acetaminophen for the NSAID, and trying topical agents and nonpharmacologic measures. DESIGN AND SETTING: Randomized controlled trial among community-dwelling Tennessee Medicaid enrollees. SUBJECTS: Study physicians had 5 or more patients who: were community-dwelling Medicaid enrollees 65 years of age or older; had used NSAIDs regularly for at least 180 days; had had no medical care encounters during this period suggesting an indication other than osteoarthritis; and had 1 year of baseline and follow-up data. The study thus included 209 physicians (103 intervention/106 control) with 1,566 qualifying regular NSAID users (768/798). INTERVENTIONS: Face-to-face visit to study physicians by another physician, and reminder placements in the charts of patients eligible to have NSAID use reevaluated. OUTCOMES: Change between baseline and follow-up years in: days of prescribed NSAIDs, acetaminophen, other drugs for musculoskeletal disorders, and GI drugs; outpatient visits and inpatient days of stay; SF36 measures of general health, physical function, and bodily pain (from 40% random patient sample); and over-the-counter NSAIDs (from the sample). RESULTS: Intervention-attributable reduction of 7% (95% CI, 3% to 11%) in days of prescribed NSAIDs use with concomitant increase in acetaminophen use. No significant changes in other study endpoints. The intervention effect was greater among 75 physicians with a completed study visit, whose 564 patients had a 10% (95% CI, 6% to 14%) attributable reduction in NSAID use. CONCLUSIONS: The educational program modestly reduced NSAID exposure in community-dwelling elderly patients without undesirable substitution of other medications or detectable worsening of musculoskeletal symptoms.
Gap junction-mediated transfer of left-right patterning signals in the early chick blastoderm is upstream of Shh asymmetry in the node.
Invariant patterning of left-right asymmetry during embryogenesis depends upon a cascade of inductive and repressive interactions between asymmetrically expressed genes. Different cascades of asymmetric genes distinguish the left and right sides of the embryo and are maintained by a midline barrier. As such, the left and right sides of an embryo can be viewed as distinct and autonomous fields. Here we describe a series of experiments that indicate that the initiation of these programs requires communication between the two sides of the blastoderm. When deprived of either the left or the right lateral halves of the blastoderm, embryos are incapable of patterning normal left-right gene expression at Hensen's node. Not only are both flanks required, suggesting that there is no single signaling source for LR pattern, but the blastoderm must be intact. These results are consistent with our previously proposed model in which the orientation of LR asymmetry in the frog, Xenopus laevis, depends on large-scale partitioning of LR determinants through intercellular gap junction channels (M. Levin and M. Mercola (1998) Developmental Biology 203, 90-105). Here we evaluate whether gap junctional communication is required for the LR asymmetry in the chick, where it is possible to order early events relative to the well-characterized left and right hierarchies of gene expression. Treatment of cultured chick embryos with lindane, which diminishes gap junctional communication, frequently unbiased normal LR asymmetry of Shh and Nodal gene expression, causing the normally left-sided program to be recapitulated symmetrically on the right side of the embryo. A survey of early expression of connexin mRNAs revealed that Cx43 is present throughout the blastoderm at Hamburger-Hamilton stage 2-3, prior to known asymmetric gene expression. Application of antisense oligodeoxynucleotides or blocking antibody to cultured embryos also resulted in bilateral expression of Shh and Nodal transcripts. Importantly, the node and primitive streak at these stages lack Cx43 mRNA. This result, together with the requirement for an intact blastoderm, suggests that the path of communication through gap junction channels circumvents the node and streak. We propose that left-right information is transferred unidirectionally throughout the epiblast by gap junction channels in order to pattern left-sided Shh expression at Hensen's node.
Oral home telecare tutorials for the community-dwelling elderly.
The objectives of this empirical study were to evaluate the quantitative and qualitative alterations experienced by community-dwelling elderly and their families when employing oral home telecare (a care service system based on interactive motion-picture transmission between households and healthcare providers). The subjects were four community-dwelling elderly in Kuriyama-cho, Hokkaido. The tutorial programs were designed to provide health information and education, as well as to enhance life skills related to exercise and communication. The programs were provided to the elderly through a new oral healthcare interactive learning system disseminated via an ISDN-based network. Quantitative and qualitative observation data on oral home telecare were collected by videophone and subsequently discussed. Functional independence in daily activities, communication skills, and social cognition, independence in oral care, and oral hygiene status all improved. Clients and their families were able to acquire broader knowledge relating to oral and general health, practical oral homecare skills, and social life skills. The use of this home telecare system as a "preventive home visit" and as a "living environmental tool" incorporating broad social supports could help improve the quality of life of clients and become part of a community oral healthcare service.
The meaning of communication to a group of deaf college students: a multidimensional perspective.
The purpose of this study was to investigate the meaning of communication to deaf college students and to explore with them the range of skills and conditions that they consider important for communication. Ethnographic interviews with 23 first-year students at the National Technical Institute for the Deaf at Rochester Institute of Technology (NTID at RIT) were used to gather information about communication. Analysis of the interviews led to the organization of informants' comments into four dimensions of communication, including language-modality, affective, situational, and sociopolitical. These dimensions were then used to develop a multidimensional perspective on communication. The paper concludes with a discussion of the implications of a multidimensional perspective on communication for the development of comprehensive communication training programs for deaf people.
[Television could be effective in the family planning program in Rwanda].
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An alumni-based evaluation of graduate training in health communication: results of a survey on careers, salaries, competencies, and emerging trends.
Published information about career options and the core competencies necessary for health communication professionals (HCPs) is limited. Although the number of graduate programs in health communication continues to grow, no formal assessment of the success of this type of training has been conducted. The current study presents the results of an evaluation of the Master's Program in Health Communication offered collaboratively by Emerson College and the Tufts University School of Medicine. The program was one of the first of its kind and has graduated more health communication students than any other in the United States. To conduct the assessment of the program, the two schools collaborated on the development of an on-line survey for the alumni. Of the 131 graduates eligible to participate, 106 completed the survey. The survey yielded detailed information on the following: (1) career options for individuals with master's degrees in health communication; (2) value of graduate coursework for developing competencies in health communication; (3) salary expectations for individuals with graduate degrees in health communication; and (4) emerging trends in the field. These findings have important implications for the development of new programs and the refinement of existing ones in health communication.
Computer-aided-instruction in the emergency department.
The Massachusetts General Hospital Laboratory of Computer Science created a library of computer-aided-instruction (CAI) programs in 1972. An experimental network of Cai programs, made possible by National Library of Medicine (NLM) support, was set up in July 1972, operating over commercial communication lines. Programs developed by Massachusetts General, Ohio State University and the University of Illinois Medical College were made available to users with terminals in about 36 cities through a local telephone number. During the first two years of the program over 80 institutions participated. A trial of the Massachusetts General programs, in conjunction with the Continuing Education Committee of the American College of Emergency Physicians, was conducted in five representative community hospitals. The hospitals put up the cost of the terminals and the telephone charges. Results of the study showed that 12 of the 40 (30%) emergency physicians in the target population took 10 or more programs. They gave the programs a favorable overall rating--1.6 on a scale of 1 (strongly positive) to 5 (strongly negative).