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PubMed2005

Comparing self-reported communication skills of medical students in traditional and integrated curricula: a nationwide study.

OBJECTIVES: To investigate medical students' self-assessments of their communication skills through medical school related to background factors, curriculum design and perceived medical school stress. METHODS: Medical students at all year levels attending Norwegian universities in the spring of 2003 were mailed the Oslo Inventory of Self-reported Communication Skills (OSISCS) developed by the authors. Of the total number of students (N=3055), 60% responded. One school had a traditional curriculum, the other three ran integrated models. RESULTS: Students assessed their instrumental communication skills to increase linearly year by year, while the relational skills showed a curve-linear trajectory reaching the optimum level half-way into the curriculum. Students attending the traditional school reported lower levels of instrumental skills compared to the students from the integrated schools. In relational skills, a similar difference was maintained half-way into the curriculum, but disappeared towards the end. Perceived medical school stress correlated to the self-reported end point levels of the two types of communication skills. DISCUSSION: The trajectories of self-reported instrumental and relational skills indicate significant variations in facilitating mechanisms between curricula, cognitive processing and perceived medical school stress. CONCLUSIONS: Self-reported instrumental and relational communication skills develop differently in medical students over the years according to the type of curriculum. PRACTICE IMPLICATIONS: Curricula should be evaluated for improvement implementations.

Adolescent↗
PubMedDate not supplied

Reduction of the call-response interval with ambulance base paging.

OBJECTIVE: To determine whether the call-response interval for an emergency medical services (EMS) system would be decreased through the introduction of ambulance base paging. METHODS: The study community included a mixture of urban and rural areas with a total population of approximately 400,000. The EMS system is composed of two ambulance services and one central ambulance communication center with computer-aided dispatching capabilities. Approximately 30,000 calls are responded to yearly by the combined ambulance services. A before-and-after study design was used. In a retrospective review of one ambulance service, there were 224 calls collected in the period before base paging and 200 calls collected in the period after base paging was introduced. In the other ambulance service, there were 571 calls captured in the period before base paging and 515 calls captured in the period after base paging. RESULTS: The call-receipt-to-crew-notified interval was reduced from the before period to the after period in both ambulance services: Cambridge--61.8 to 49.8 seconds (p < 0.0001); Kitchener--66.6 to 46.2 seconds (p < 0.0001). The crew-notified-to-vehicle-mobile interval was reduced from the before period to the after period in both ambulance services: Cambridge--91.8 to 73.2 seconds (p < 0.0001); Kitchener-80.4 to 66.0 seconds (p < 0.0001). CONCLUSIONS: The introduction of ambulance base paging reduced components of the call-response interval in this EMS system. Overall, the reduction in time was approximately 30 seconds, which was found to be statistically significant.

Ambulances↗
PubMed1978

Speech rehabilitation of a laryngectomized-glossectomized patient.

A 58-year-old English speaking female, who underwent total laryngectomy and glossectomy and subsequently learned to communicate verbally via various phonatory and articulatory compensations, is described in this report. Radiologic study and empirical observation showed her to be using the inhalation method to achieve esophageal air charge. Her articulatory compensations were typical of those used by other glossectomized pateints. The extent of her recovery of verbal communication skills through alaryngeal speech suggests that glossectomized-laryngectomized patients with similar impairment might benefit from speech rehabilitation where prognosis and general health permit.

Female↗
PubMed2006

Use of microbial risk assessment to inform the national estimate of acute gastrointestinal illness attributable to microbes in drinking water.

Microbial risk assessment (MRA) evaluates the likelihood of adverse human health effects that occur following exposure to pathogenic microorganisms. This paper focuses on the potential use of MRA to provide insight to the national estimate of acute gastrointestinal illness (AGI) in the United States among persons served by public water systems. This article defines MRA, describes how MRA is implemented, provides an overview of the field of MRA and discusses how MRA may be useful for characterizing the national estimate. Communities served by drinking water systems with relatively contaminated source waters, sub-standard treatment facilities, and/or contamination problems in their distribution systems are subject to higher risks than communities where such issues are less of a concern. Further, the risk of illness attributable to pathogens in drinking water in each community can be thought of as the sum of the risk from the treated drinking water and the risk from the distribution system. Pathogen-specific MRAS could be developed to characterize the risk associated with each of these components; however, these assessments are likely to under-estimate the total risk from all pathogens attributable to drinking water. Potential methods for developing such MRAs are discussed along with their associated limitations.

Communicable Diseases↗
PubMed2001

[Surgical treatment for pediatric intractable epilepsy--focusing on modified functional hemispherectomy in infants].

Our experience with modified functional hemispherectomy in 14 infants are presented. The etiology of intractable epilepsy was cortical dysgenesis in all of the cases. We applied our new surgical method, transopercular hemispherotomy, in which the frontal operculum was resected en bloc including the upper half of the insula. The corpus callosum was totally sectioned through the lateral ventricle. The resection cavity was communicated to the inferior ventricle, and the medial temporal structures were resected. Finally, the horizontal fibers emerging from the frontal lobe were sectioned along the posterior edge of the ala minor ossis sphenoidalis. There was no mortality or morbidity during and immediately after operation. In 12 cases with more than 1 year follow-up, remarkable seizure reduction was obtained in 75% of the cases and worthwhile improvement in the remaining 25%. No major complications were encountered, except for hydrocephalus in 3 cases and incomplete section of the callosum in 3. In cases showing catch-up of psychomotor development after surgery, swelling of the unaffected hemisphere was observed.

Brain↗
PubMed2005

The vending and à la carte policy intervention in Maine public high schools.

BACKGROUND: A healthy school nutrition environment may be important for decreasing childhood overweight. This article describes a project to make healthier snacks and beverages available in vending machines and à la carte programs in Maine public high schools. CONTEXT: Seven public high schools in Maine volunteered to participate in this project. Four schools made changes to the nutrition environment, and three schools that served as controls did not. The nutrition guidelines were to offer only low-fat (not more than 30% of total calories from fat) and low-sugar (not more than 35% by weight of sugar) items in vending machines and à la carte programs. METHODS: Strategies to implement the project included early communications with school officials, monetary stipends for participation, identification of a school liaison, and a committee at each school to promote the healthy changes. Baseline nutrient content and sales of all competitive foods and beverages were assessed to develop the guidelines for changes in the four schools. Student volunteers at all seven schools were measured for height, weight, diet quality, and physical activity level to assess the impact of the change to the nutrition environment. Baseline measures were taken in the spring semester of 2004. Nutrition changes were made to the à la carte programs and vending machines in the four intervention schools at the start of the fall semester of 2004. Follow-up nutrition assessment and student data collection occurred in the spring semester of 2005. CONSEQUENCES: Healthy changes in vending machines were more easily achieved than those made in the à la carte programs. Technical assistance and ongoing support were essential for successful implementation of this intervention. INTERPRETATION: It is possible to improve the nutrition environment of Maine public high schools. Stakeholder support is essential to sustain healthy changes.

Adolescent↗
PubMed1993

Endoscopic stenting of nasofrontal communication in frontal sinus disease.

The volume of literature on frontal sinus surgery suggests that the success of surgery to cure frontal sinus pathology is inversely proportional to the total number of techniques described. In an attempt to develop an effective means of treating acute and chronic frontal sinusitis, including iatrogenic naso frontal communication obstruction, an endoscopic stenting procedure has evolved. This method might be contemplated, in selected patients, as the preferred surgery or a useful low morbidity alternative, to more invasive traditional frontal sinus surgery. A high degree of technical difficulty is associated with endoscopic frontal sinus procedures, and they are definitely not recommended for the novice or occasional sinus surgeon. Several years of follow up are required to evaluate the validity of any frontal sinus procedure. More observation of these subjects' clinical progress is necessary before endoscopic stenting of the nasofrontal communication passes the test of time.

Acute Disease↗
PubMedDate not supplied

Informing the TB suspect for sputum sample collection and communicating laboratory results in Nicaragua: a neglected process in tuberculosis case finding.

OBJECTIVE: To assess the patient information process before sputum sample collection, the quality of sputum sample and transmission of acid-fast bacilli (AFB) examination results to TB suspects, in three local areas of Nicaragua. METHODS: (a) directed interviews of consecutive series of TB suspects whose sputum had been examined for AFB; (b) directed interview of health personnel; and (c) assessment of the sputum sample quality. RESULTS: A total of 115 TB suspects and 33 health personnel were interviewed and 625 sputum samples were assessed. Results show multiple weaknesses in the process of information to the patient during sputum collections, as well as in the communication of results. CONCLUSIONS: This study unveiled an aspect usually overlooked of case finding, that is, the information process during sputum production, sputum sample quality, and the communication of results to the TB suspects. The results illustrate the need for routine assessment of the whole diagnostic process.

Adolescent↗
PubMed2006

Telepathy: maximizing resident exposure to surgical pathology decision making.

BACKGROUND: General surgery residents are often not present for the critical intraoperative discussion between surgeon and pathologist regarding surgical pathology findings. METHODS: A prospective pilot study analyzed general surgery resident exposure to surgical pathology. Thereafter, an operating room was equipped to view frozen section images in real time and verbally communicate with the pathologist (TelePATHy). Total operative cases, cases using frozen sections, and use of TelePATHy were recorded. RESULTS: Most residents (78%) reported they were exposed to frozen-section surgical pathology < or =10% of the time. Overall, 202 operations were performed over the 123-day period. Forty-four cases had frozen-section specimens. General surgery residents were present for 40 cases. TelePATHy was successfully used in 32 cases (80%). CONCLUSIONS: General surgery resident exposure to intraoperative pathology findings increased from a reported < or =10% to an observed 80%. TelePATHy is a novel intraoperative tool capable of maximizing the intraoperative experience of the surgical resident.

Decision Making↗
PubMed2004

Botulinum toxin improves quality of life in hemifacial spasm: validation of a questionnaire (HFS-30).

BACKGROUND: Hemifacial spasm (HFS) can be disabling and affect quality of life. There is a lack of a validated scale for evaluating botulinum toxin (BTX) response in HFS. OBJECTIVE: We examined the validity and reliability of a self-rating health-related quality of life (HRQOL) questionnaire (HFS-30) in HFS and investigated the correlation of this questionnaire with the neurologists' assessment of severity of HFS and response to botulinum toxin (BTX) treatment. METHODS: HFS patients were asked to answer a total of 30 self-rating questions divided into seven subscales: Mobility; Activities of Daily Living (ADL); Emotional Well-being; Stigma; Social support; Cognition; and Communication. All of the items were scored on a 5-point scales ranging from 0 ("never") to 4 ("always"). They were also asked to assess their response to the BTX treatment based on a similar questionnaire at 6-8 weeks after BTX. The validity, reliability and sensitivity of the questionnaire were analyzed statistically. RESULTS: There were 80 HFS patients with mean age of 56.3+/-11.1 (S.D.) years (range 35 to 81), consisting of 54 (67.5%) females, 26 (32.5%) males. The intraclass correlation coefficient (ICC) and Cronbach's alpha were more than 0.7 for the majority of the items and subscales, respectively. There was a good positive correlation of severity of HFS with the subscale scores. Regression analysis of physicians' assessment of response to BTX on change in scores from baseline as rated by patients demonstrated a significant correlation. CONCLUSIONS: We demonstrated validity, reliability and sensitivity of the HFS-30 questionnaire. BTX improves quality of life in HFS.

Adult↗
PubMed2000

Induction of gap junctional intercellular communication, connexin43 expression, and subsequent differentiation in human fetal neuronal cells by stimulation of the cyclic AMP pathway.

Expression of gap junction proteins and cell-cell communication was studied in the human neural-glial cell line, SVG, as a first step in defining whether the SVG cells could be used as a model system to study the role of gap junctions in neuronal precursor cells. SVG cells were found to express connexin43 protein that co-migrated with WB-F344 rat liver connexin43 and that reacted with connexin43-specific antibodies on Western blots. However, fluorescence recovery after photobleaching analysis of 5,6-carboxyfluorescein-loaded cells failed to show significant dye coupling. Agents that stimulate the adenylyl cyclase/cAMP pathway were used to induce gap junctional intercellular communication in the SVG cultures. A 24-48 h treatment of SVG cells with 5 microM forskolin or 5 microM forskolin + 200 microM 3-isobutyl-1-methylxanthine increased the percentage of dye-coupled cells from 5-65%, using the fluorescent recovery after photobleaching method. The increase in dye coupling induced by forskolin or forskolin + 3-isobutyl-1-methylxanthine was inhibited by octanol, which is known to block gap junction-mediated cell communication. Western blot analysis of total protein extracts revealed the appearance of a higher molecular weight connexin43 protein band after treatment of SVG cells with forskolin or forskolin + 3-isobutyl-1-methylxanthine, that was not observed in vehicle-treated controls. Alkaline phosphatase treatment of total protein extracts from forskolin or forskolin + 3-isobutyl-1-methylxanthine-treated cells reduced the higher molecular weight band to approximately 41,000 the same as observed in the control extracts. The alkaline phosphatase treatment demonstrates that the higher molecular weight band was due to a phosphorylation event stimulated by forskolin or the forskolin + 3-isobutyl-1-methylxanthine combination. In addition, treatment of the SVG cells with the forskolin or forskolin + 3-isobutyl-l-methylxanthine stimulated outgrowth of neurite-like processes from the cell body which immunostained positive for the connexin43 protein as well as protein markers for neurons and oligodendrocytes. We hypothesize that the SVG cells may represent a neuronal progenitor cell population that has the ability to differentiate when exposed to the appropriate signals.

1-Methyl-3-isobutylxanthine↗
PubMed1999

Familial factors influence level of functioning in pervasive developmental disorder.

OBJECTIVE: To determine whether siblings with pervasive developmental disorders (PDD) tend to have the same type and number of PDD symptoms or a similar level of functioning. METHOD: The familial correlations for PDD subtype, symptom totals, adaptive behaviors, and nonverbal IQ were calculated for 94 children with PDD from 46 families. RESULTS: On variables measuring PDD symptoms, only impairments in nonverbal communication and verbal/nonverbal status tended to run true within families. There was no familial aggregation of PDD subtype. In contrast, measures of nonverbal IQ and adaptive behaviors in socialization and communication showed a moderate degree of familial resemblance. The degree of familial resemblance did not change if the analysis was restricted only to those families in which both affected children met criteria for autism. CONCLUSION: Insofar as the familial resemblance seen in PDD is due to genetic factors, these data provide some evidence that higher- and lower-functioning PDD children may arise from separate genetic mechanisms. Current gene-mapping studies of PDD may need to take this evidence of genetic heterogeneity into account.

Activities of Daily Living↗
PubMed1995

A comparative study of family functioning among Vietnamese and Cambodian refugees.

This study was designed to determine the extent of family problems among a clinic population of Cambodian and Vietnamese refugees, and to identify similarities and differences between the two groups. All 107 patients with adolescent children from a total clinic population of 298 were interviewed using a semistructured questionnaire, results were tabulated, and statistical methods were applied. The types of problems with children described by parents were classified into the dimensions of communication, personal behaviors, school performance, social behaviors, and antisocial behaviors. There were significantly more problems described by Vietnamese parents as compared with Cambodian parents. Vietnamese parents reported significantly more dissatisfaction with life in the United States. For both ethnic groups, parents' relationships with their adolescent children were a major source of concern and had a major impact on parents' perceptions of their own health. Yet, there were important ethnic differences between these refugee groups in how patients perceived their problems.

Acculturation↗
PubMed1995

Post-prandial serum bile acid concentrations and ammonia tolerance in Maltese dogs with and without hepatic vascular anomalies.

Post-prandial serum bile acid concentrations were measured in 200 Maltese dogs in an attempt to identify those with subclinical portosystemic shunts. Five of these were later shown to have hepatic pathology or abnormal liver function. In the other 195 Maltese, bile acid concentrations ranged from 1 to 362 mumol.L-1 (mean +/- SD, 70 +/- 50 mumol.L-1; median, 65.0 mumol.L-1). Of these, 79% were above the reference range (0 to 31 mumol.L-1) established from 23 mixed-breed control dogs. It was therefore not possible to determine the prevalence of subclinical portosystemic shunts on the basis of bile acid determinations. Further investigation of liver function was performed to investigate why bile acid concentrations were increased in these dogs. Rectal ammonia tolerance tests were normal in 102 of 106 Maltese tested and liver samples (11 dogs) and plasma biochemistry profiles (9 dogs) demonstrated no significant hepatic disease or dysfunction. Of 2 Maltese with hyperammonaemia after administration of ammonium chloride, one had a large congenital portosystemic shunt that was confirmed at surgery. In the other there were no macroscopic portosystemic communications, but a liver biopsy showed histological changes consistent with microscopic portovascular dysplasia. Total serum bile acid concentrations were consistently lower when assessed by high-performance liquid chromatography than by an enzymatic spectrophotometric method. This discrepancy was substantially larger in Maltese than in control dogs, suggesting the presence of an additional reacting substance in the serum of Maltese dogs.

Ammonia↗
PubMed1983

Bicompartmental analysis of cerebrospinal fluid circulation. Theory and clinical applications.

A new model for cerebrospinal fluid (CSF) circulation is proposed. Specific activity/time curves for CSF kinetics determined after intraventricular injection of a radiotracer were produced by fitting a biexponential function to data points and developing a two-compartmental model. Calculation of kinetic parameters of the model provides quantitative data about CSF dynamics. The study of each compartment separately and of the intercompartmental relationship is possible with this model. Sequential scan images and graphic plots of the variations of radioactivity in both compartments, derived from this model, add supplementary information in the evaluation of patients. Ventriculography was performed in 80 patients, who fell into four groups: those with normal CSF circulation, hydrocephalus, infantile hydrocephalus, and functioning ventricular shunts. Normal and hydrocephalic patients showed significant differences between the two groups in the means of some numerical parameters calculated from the new model. An increase of intraventricular radioactivity at 24 hours (p less than 10(-4)) and of the volume of Compartment 1 (p less than 0.01) with decreased volume of Compartment 2 (p less than 10(-4)) and total flow outside the system (p less than 10(-3)) were found in patients with hydrocephalus. The limiting values for normal patients were also estimated. Communicating and obstructive hydrocephalus could be differentiated by this method; however, no differences in mean values were found relating to the etiology or clinical course of the hydrocephalus. Normal-pressure hydrocephalus and cerebral atrophy produced significantly different mean values for the volume of Compartment 2 (p less than 0.01), flow out of the system (p less than 0.01), and intercompartmental flow (p less than 0.01).

Cerebral Ventriculography↗
PubMed2006

[Fatigue, anxiety and depression and their management].

Sickness behaviors such as fatigue, anxiety and depression play an important role in the body's defense mechanism. However, once these symptoms become chronic, they are harmful to patients with cancer by decreasing the immune reaction or exacerbating pain and other symptoms. It should be recalled that both medical and surgical interventions profoundly influence fatigue, anxiety and depression of cancer patients. Since latent fatigue, anxiety and depression may be overlooked behind somatic symptoms, communication skills are necessary to understand the suffering of patients. Routine assessment of these symptoms are essential for early intervention in the care of cancer patients. Communication skills such as careful listening and counselling are also useful methods in caring for patients with these symptoms. Although non-medical intervention is usually effective for these symptoms of fatigue, anxiety and depression, approximately 10 to 15% of patients require specific treatment by a psychiatrist. Above all, fatigue, anxiety and depression should be treated as part of the total pain experienced by cancer patients.

Anxiety↗
PubMedDate not supplied

[Infective risks blamed on hospital waste. Epidemiologic reality or sanitary fiction?].

This revision is a reflection on the infectious risks of the hospital waste. According to Center for Disease Control there is no epidemiologic or microbiologic evidence to suggest that most waste from hospitals is any more infective than residential waste. There is no documented epidemiologic evidence that current health care related waste disposal practices have ever caused disease in the community. Only sharps and microbiological cultures are potentially infectious, but they constitute a small part of the total hospital waste and they must be autoclaved. Incineration is not a safe method for the sterilization of the hospital potential infectious waste.

Brazil↗