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PubMed2000

[Effect of optimized integrated management on long-term effectiveness of cardiologic rehabilitation].

BACKGROUND AND OBJECTIVE: Long-term risk factor (RF) modification after cardiac rehabilitation (CR) is less than satisfactory. Problems of communication between the CR centre and the practising physician (GP) are one potential source of sub-optimal management. The goal of the PROTECT-study was to evaluate the influence of improved communication between rehabilitation centres and the GP on the quality of RF-modification. PATIENTS AND METHODS: In 50 specialized CR centres 882 patients in the group with intensified communication were compared to 160 patients in the usual care group. All patients underwent a course of residential CR. Intensified communication was attempted by a total of four phone calls to the GP, a RF booklet in which the RF profile, the individual RF treatment goals and the current RF status were delineated. Main treatment goals with respect to RF-modification after 6 months were: Blood pressure < 140/90 mmHg, LDL-Cholesterol < 100 mg/dl or at least 115 mg/dl and a body mass index of < 25 or at least < 30. RESULTS: The percentage of of patients with adequate blood pressure control (< 140/90 mmHg) was 85.1% vs. 85%, with LDL-cholesterol < 100 mg/dl 27.2% vs. 23.9%, with good body-mass index (< 25) 32.4% vs. 28.2% (intensified communication vs. control group; p = ns). The treatment initiated by the CR centres was continued in about 90% of patients. CONCLUSION: The study has shown that improved communication between the CR centres and the GP's after CR had only a marginal effect on the quality of RF-management. One key element of secondary prevention could be to get the patient more strongly involved in reaching the targets of therapy.

Aged↗
PubMed1989

Efficacy of chloroquine in the treatment of malaria in children under five years in Baissa (Gongola State, Nigeria).

The Nigerian Federal Ministry of Health in 1987 instituted a nationwide programme to gather data on the efficacy of chloroquine in treating malaria in children as a basis for the development of a national malaria therapy policy. The programme is part of a comprehensive Combating Childhood Communicable Diseases (CCCD) programme. A simplified WHO in vivo method, involving follow-up observations on day 1 (D1), D2, D7 and D14 following the first day the study began (D0), was used for this study. A total of 769 children were screened, of which 363 (47%) were positive for malaria parasites. Fifty-three children were enrolled for the 14-day follow up, and chloroquine phosphate, 25 mg (base) kg-1, was given in three divided doses on D0, D1 and D2. Parasitological failure occurred in 25% of the children. There were no clinical failures in the study; i.e. no child found with parasitaemia after completing treatment was judged to be clinically ill. Generally the older children had the heavier parasite densities and severer symptoms.

Animals↗
PubMed2002

Timed-event sequential analysis of agitation in nursing home residents during personal care interactions with nursing assistants.

Computer-assisted behavioral observation data were collected from 66 nursing home residents while they received assistance during personal care routines from a certified nursing assistant (CNA). Data were collected both before and after a comprehensive behavior-management and communication-skills training program was delivered to the nursing staff. A total of 30 residents showed 6 or more episodes of disruptive vocalization or other forms of agitation during baseline observations, and timed-event sequential analysis methods were used to test whether certain CNA behaviors either elicited or prevented onsets of agitation in these 30 residents. Simple verbal prompts used by CNAs during personal care routines before staff training were found to elicit agitation onset ( p =.03), whereas positive statements to the resident were found to reduce the likelihood of agitation onset (p =.02). In a previous analysis of the effects of staff training, we found that rates of resident agitation were significantly lower after training compared with baseline and that CNAs increased their rates of positive statements to residents. In the present study, timed-event sequential analyses indicated that the verbal prompts used by CNAs during personal care routines were no longer associated with an increased rate of resident agitation after staff training among the 20 residents who showed 6 or more episodes of agitation both before and after staff training. These findings suggest that the staff training program improved the quality of CNA verbal prompts. The sequential analysis of observational data provides an important method for studying interpersonal interactions, including those of nursing home residents and the nursing staff who care for them.

Activities of Daily Living↗
PubMed1993

Computer hardware and software to assist the visually impaired and blind.

Modern developments in computer hardware and software for the business world have been adapted to allow the partially sighted and blind to participate successfully in computer usage in education, employment and recreation. Adaptations such as the enlargement of the whole screen display, production of enlarged print and voice output of screen contents can assist the partially sighted. Conversion of computer screen information into speech or braille can be used in conjunction with sound boards and touch pads to allow the totally blind access to the exact spatial layout of screen contents. Optical character recognition devices whereby the printed page can be accessed by computer, and recent voice recognition techniques which allow a computer to interpret voiced commands, can also be used to assist the totally blind. Developments in these areas are discussed together with specific examples of equipment now available which make use of the various methods described.

Blindness↗
PubMed2006

Clinical decision making and views about psychiatric advance directives.

OBJECTIVES: Psychiatric advance directives allow competent persons to document advance instructions or designate a health care agent to communicate their preferences for future mental health treatment in the event of an incapacitating crisis. Although laws authorizing psychiatric advance directives have proliferated, little is known about clinicians' understanding and perceptions of these legal tools. METHODS: A total of 597 mental health professionals (psychiatrists, psychologists, and social workers) completed a survey about their attitudes toward psychiatric advance directives and decision making about following such directives. RESULTS: Approximately half the sample (47 percent) agreed that advance instructions would be helpful to consumers with severe mental illnesses, and a majority (57 percent) endorsed health care agents as beneficial. Regardless of profession, clinicians had more positive attitudes about psychiatric advance directives when they correctly recognized that they were not required by state law to follow directives that note the patient' s refusal of appropriate medical treatment. In multivariate analyses, the decision to abide by a patient' s advance refusal of treatment in a hypothetical scenario was predicted by knowing the laws associated with these directives, valuing family opinions about treatment, and respecting patient autonomy. CONCLUSIONS: Clinicians correctly apprised of the state law were more likely to endorse psychiatric advance directives. Thus clinicians may be more willing to use directives if they are educated about the legal parameters of their implementation. The clinicians' profession had only an indirect influence on whether clinicians would follow an advance instruction that noted the patient's refusal of appropriate treatment; rather, clinicians' values and legal knowledge had the greatest effect, highlighting the potentially complex ethical dilemmas faced by mental health professionals who encounter these directives.

Adult↗
PubMed2000

Stereotactic brain biopsies in AIDS patients--early local experience.

AIM: To assess the usefulness of stereotactic brain biopsies in AIDS patients with cerebral lesions in Singapore. METHODS: A total of 10 patients with AIDS and cerebral lesions underwent stereotactic brain biopsies in the Department of Neurosurgery, Tan Tock Seng Hospital (TTSH) between September 1997 and September 1998. The patients were referred from the Communicable Diseases Centre (CDC), TTSH. These patients either failed a trial of therapy for toxoplasmosis encephalitis (TE) or had CT/MRI scans which did not suggest TE. Four were CT-guided and six were MRI-guided stereotactic biopsies. The Radionics Cosman-Robert-Wells (CRW) stereotactic apparatus was used for all cases. RESULTS: The male to female ratio was 9:1. Histological diagnosis from biopsy was lymphoma (5), metastatic adenocarcinoma (1), TE (1), abscess (1), encephalitis (1) and granulomatous tissue (1-presumed tuberculosis). CONCLUSION: The early experience is that stereotactic brain biopsy is useful in patients with AIDS and cerebral lesions. The etiology is confirmed in the majority of cases and impacts on management decisions and prognostication.

Acquired Immunodeficiency Syndrome↗
PubMed2001

[Local groups as a tool for quality assurance of community health services].

BACKGROUND: The aim of this study was to assess the use of local interprofessional or audit groups as a tool of quality enhancement. MATERIAL AND METHODS: Fifty-six doctors, physiotherapists and nurses attended nine local interprofessional groups. The aim was to improve the quality of each professional's practice and to improve communication between the professions. RESULTS: The groups had a total of 62 meetings with each professional attending on average 5.7 meetings. All groups initiated quality enhancement projects. Initially the groups were very active and showed great initiative, but there were few final results. However, many groups reported improved communication and cooperation between the participating professionals. INTERPRETATION: The experience from this project may be summarised as follows: The professionals within one and the same group should have more or less the same background and specialty. We recommend caution with organising interprofessional groups unless their participants work in the same practice. Interprofessional groups should spend adequate time for the members to get to know each other, and they should be guided by an experienced leader.

Communication↗
PubMed1981

A community approach to the prevention of dental disease in the children of developing countries.

Even in developed Western countries the ready availability of sophisticated restorative dentistry has been relatively unsuccessful in reducing the prevalence of dental disease. It is therefore totally wrong to seek to impose a similar structure of dental care in the developing countries with their shortages of wealth, communications and trained personnel. Instead, the emphasis must be on education and the application of preventive methods by relatively simply trained personnel working with the support and under the guidance of a few fully trained dentists. The establishment of a dental service in the developing countries must contain the following three elements. First, the undertaking of a nationwide survey of the prevalence of dental disease. Next the establishment of training schools in each ethnic area where dental surgeons, dental therapists and dental assistants can be recruited and trained. Lastly, the recruitment and training of local instructors in dental health to work in their own schools, villages and districts, concerned with the supervision of oral hygiene, fluoride mouthrinsing and diet. This scheme is based on the principle of self help through locally recruited and trained personnel and the encouragement of community pride in positive dental health.

Child↗
PubMed1994

Oocyte follicle cells association during development of human ovarian follicle. A study by high resolution scanning and transmission electron microscopy.

Morphodynamics of oocyte follicle cells association during the development of human ovarian follicles were studied by transmission electron microscopy and high resolution scanning electron microscopy including the ODO method. For this study primordial, primary, growing preantral and antral follicles were systematically analysed in a total of 20 adult and fetal (3-8 months and at term) ovaries. In early stages of follicle development (primordial and primary stages) the flattened and/or polyhedral cells, closely associated with the growing oocyte, project an increasing number of microvillous processes. These are in apposition with the oolemma, and form bulbous terminals presenting attachment zones such as zonula adherens, desmosomes and communicating junctions (gap junctions). "Focal contacts" between oolemma, and lateral microvillous extensions of follicle cells were also present. Unusual forms of contact between follicle cell microvilli and oocytes in the early stages of growing primordial and primary follicles were also observed. These consist of long, thin extensions penetrating into the oocyte through deep invaginations of the oolemma. The aid of high resolution SEM of specimens subjected to the ODO method clearly reveals their 3-D arrangement within the ooplasm. They appear as long tortuous microvilli coming very close to the nucleus, and in their course are closely associated with a variety of organelles such as Golgi vesicles, endoplasmic reticulum membranes and nascent forms of smooth endoplasmic reticulum. Using integrated observations by TEM and SEM, there may be as many as 3-5 "intraooplasmic processes" even in only one plane of fracture of an oocyte. Therefore, if the total volume of the oocyte and associated cells is considered, their amounts appear to be higher than previously reported. Thus, they have to be considered as normal devices of deep contact between the ooplasm and associated follicle cell extensions. The presence of such structures within the ooplasm in early developing follicles well coincides with the great increase in volume of the oocyte. Although it is commonly believed that the activation of the growing oocyte may depend on the numerous contacts between the oolemma and follicle cells (mostly via gap junctions), the finding of these additional intraoocytic extensions suggests that they may in someway contribute to the initiation of growth in the human. In fact, these microvilli penetrate deep into the ooplasm, much like a sword in its sheath.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1976

[The fecal flora of man. IV. Communication: Comparison of the newly developed method with the old conventional method for the analysis of intestinal flora (author's transl)].

The results of 42 fecal flora analysis of healthy adult men were compared by using a newly developed method and an old conventional method. Statistical estimate indicate, that with the new method the total counts and the counts of bifidobacteria, catenabacteria (eubacteria and anaerobic lactobacilli), peptostreptococci, and clostridia (except Cl. perfringens) as well as the occurences of peptostreptococci and spirillaceae were significant higher than with the use of the old method. On the other hand the counts and occurences of bifidobacteria, veillonellae, Cl. perfringens, Megasphaerae and aerobes were similar with both method. With the new method the total counts of feces of healthy adult men nubmered 1-2 X 10(11) per g wet weight, and fastidious anaerobes, such as bacteroides, catenabacteria and peptostreptococci, were always occurred as predominant flora. The results suggest that the conventional anaerobic jar method is inadequate for the isolation of fastidiuos anaerobes and indicate that the use of modified medium 10 in combination with strict anaerobic technique is necessary for the analysis of fecal flora.

Adult↗
PubMedDate not supplied

Communication problems of hearing-impaired patients.

AIM: The main objective of this national survey was to check the findings of an earlier pilot survey. This had found that patients who had a hearing-impairment and were in hospital were often seriously disadvantaged by their disability. METHOD: The survey was conducted by questionnaire and the sampling frame confined to hearing-impaired patients who had been in hospital during the previous three years. A total of 359 completed and valid questionnaires were returned. RESULTS: The responses confirmed the finding of the pilot survey. They indicated that there were serious shortcomings in the ability of many hospital staff to cope with the problems of hearing-impaired patients. CONCLUSION: Common causes of the problems were identified. The major factor was inadequate training of both nurses and doctors in deaf awareness and the associated communication skills. Other significant factors included patients concealing their disability, pressure of work and poor communication between staff. Appropriate training at all staff levels should eliminate a high proportion of these problems.

Adolescent↗
PubMed1998

Emergency department senior house officers' consultation difficulties: implications for training.

STUDY OBJECTIVE: We investigated the types of patient presentations that cause senior house officers (SHOs) most difficulty during their tenure in emergency departments and report the extent to which such difficulties are related to SHOs' communication problems, stress, or perceived lack of skills or knowledge. METHODS: We conducted a questionnaire survey of 171 newly appointed SHOs employed in 27 EDs in the South Thames region of England. Subjects were asked to describe the presentation that gave them greatest difficulty during three subsequent shifts at the end of the first and fourth months of their ED appointment. RESULTS: A total of 132 (77%) and 110 (64%) respondents returned questionnaires at the end of the first and fourth months, respectively; 61% (105) responded to both questionnaires. The respondents described 537 of a possible total of 726 cases (74%). Communication problems caused difficulty in 406 (76%) cases, SHOs' experience of stress in 352 (66%) cases, and a perceived lack of knowledge or skills in 281 (52%) cases. Communication problems and the experience of stress occurred in 141 (26%) cases. Patients presenting with mental or behavioral disorders and symptoms most frequently gave rise to communication problems, perceived lack of skills, and the experience of stress. The difficulties described at the two time periods were very similar indicating that experience alone had little effect on these problems. CONCLUSION: ED SHOs may benefit from communication skills training, the opportunity to review difficult case presentations, and the alleviation of organizational stress factors.

Adult↗
PubMedDate not supplied

Communication between the dental laboratory technician and dentist: work authorization for fixed partial dentures.

PURPOSE: A questionnaire was sent to laboratory technicians to determine the level of communication between dentists and dental laboratories in specific areas of the work authorization forms for the fabrication of fixed partial dentures. MATERIALS AND METHODS: A select number of dental laboratories were randomly chosen from the National Association of Dental Laboratories (NADL) for each of the 50 states. The questionnaire was mailed to the laboratory directors for a total of 199 dental laboratories. The survey asked questions pertaining to the following areas of work authorization: legibility and thoroughness of prescriptions, patient information, choice of materials for the prosthesis, design of the prosthesis, and shade description. For each question, the number of responses received was tabulated and converted to a percentage. RESULTS: Of the 199 laboratories surveyed, 114 (57%) responded to the questionnaire. Results from this survey suggest that there is lack of communication between dentists and dental laboratories through work authorization forms regarding choice of metal alloy, type of porcelain to be used, and choice of margin and pontic design for the prosthesis. CONCLUSIONS: Information obtained from the responding laboratories included effectiveness of work authorization forms. There were some similar trends indicated by the large percentage of dental laboratories agreeing on lack of communication by the dentists as reflected by the work authorization forms.

Communication↗
PubMedDate not supplied

Training volunteers as conversation partners for people with aphasia.

BACKGROUND: One of the most disabling consequences of aphasia is the way it excludes the person from conversation. A number of studies have attempted to tackle this problem by training the conversational partners of aphasic people. This study offers an evaluation of this approach. AIMS: Six volunteers were trained in conversing with people with moderate or severe aphasia. The study aimed to evaluate whether training changed the volunteers' knowledge about aphasia and their interactions with aphasic people. It also explored whether changes in the volunteers were matched by improved participation of the aphasic people in conversation. METHODS & PROCEDURES: Volunteers were recruited from an aphasia group in Milton Keynes. They were trained as a group over three sessions (9 hours in total). The training drew on the techniques of Kagan (1998, 1999). It included presentation of information using different media, group discussions, viewing of videos and role play. The course aimed to improve (1) the volunteers' understanding of the nature of aphasia, (2) the volunteers' knowledge about communication strategies to use with aphasic people and (3) the skills of the volunteers in supporting aphasic people in conversation. An additional aim was to increase the aphasic subjects' participation in conversation. Two evaluation methods were employed. Specially designed questionnaires were administered before and after training to evaluate the volunteers' knowledge and understanding. Volunteers were also videotaped in conversation with aphasic people before and after training. The videos were rated by speech and language therapists, using nine-point rating scales, derived from Kagan (1999). OUTCOMES & RESULTS: Significant improvements were seen on the questionnaire scores and in ratings of the volunteers' videos. The rating gains were attributed to the training course, since baseline scores were stable and improvements only occurred after the training period. There were comparable gains in the participation of the aphasic subjects, which again occurred after training. CONCLUSIONS: The study demonstrates that a short training course can change the knowledge and practice of experienced volunteers. The findings have implications for teaching generic skills to volunteers working with aphasic people.

Aged↗
PubMed2004

Progressive left ventricular remodeling in patients with hypertrophic cardiomyopathy and severe left ventricular hypertrophy.

OBJECTIVES: The aim of this study was to determine the natural history of patients with hypertrophic cardiomyopathy (HCM) and severe left ventricular hypertrophy (LVH) (i.e., maximal left ventricular wall thickness [MLVWT] >/=30 mm) and whether changes in cardiac morphology influence the course of the disease. BACKGROUND: Severe LVH is common in young and rare among elderly patients with HCM. This has been explained by a high incidence of sudden death. We hypothesized that this age-related difference might be explained by left ventricular wall thinning. METHODS: A total of 106 (age 33 +/- 15 years; 71 males) consecutive patients with severe LVH underwent history taking, examination, electrocardiography, echocardiography, cardiopulmonary exercise testing, and Holter analysis. Survival data were collected at subsequent clinic visits or by communication with patients and their general practioners. In order to assess morphologic and functional changes, 71 (67.0%) patients (mean age 31 +/- 15 years; 47 males) followed at our institution underwent serial (>/=1 year) assessment. RESULTS: Of the 106 patients, the majority (78 [71.6%]) were <40 years of age. During follow-up (92 +/- 50 months [range 1 to 169]), 18 (17.0%) patients died or underwent heart transplantation (13 sudden cardiac deaths, 2 heart failure deaths, 1 heart transplantation, 1 stroke, 1 postoperative death). Five-year survival from sudden death was 90.1% (95% confidence interval [CI] 84.0% to 96.3%), and that from heart failure death or transplantation was 97.7% (95% CI 94.5 to 100). In patients serially evaluated over 85 +/- 51 months, there was an overall reduction in MLVWT of 0.6 mm/year (95% CI 0.31 to 0.81, p = 0.00004). Wall thinning >/=5 mm was observed in 41 patients (57.7%; age 35 +/- 13 years; 28 males). On multivariate analysis, the follow-up duration only predicted wall thinning (0.6 mm/year, 95% CI 0.38 to 0.85, p < 0.00001). CONCLUSIONS: Left ventricular remodeling is common in patients with severe LVH and contributes to the low prevalence of severe LVH seen in middle age and beyond.

Adult↗
PubMed2005

Community interventions for cardiovascular disease.

Review of the community-based CVD intervention programs suggests that a number of components have been successful using varying methods and materials for CVD risk reduction. It should be noted, however, that in multi-intervention programs it is often difficult to determine which components of the intervention were responsible for the overall success of the study. The community-based approach to CVD prevention is generalizable, cost-effective (because of the use of mass communication methods), and has the potential for modifying the environment and influencing health policies. Based on the experiences and successes of a number of community projects, recommendations have been proposed for developing future programs. Although they are not totally comprehensive, it has been suggested that a community-based intervention program should consider the following recommendations: 1) An understanding of the community: the needs and priorities of the community should be assessed, and close collaboration with individuals from the community, including community leaders, opinion leaders, community health care providers, and community organizations from various sectors of the community, should be consulted. Efforts should be focused on underserved and vulnerable populations. 2) Inclusion of community activities: these activities should be integrated within the context of the community environment, including primary health care services, voluntary organizations, grocery stores, restaurants, work sites, schools, and local media. 3) Inclusion mass media messages: the mass media can provide information and reinforcement of the behavior change. 4) Develop cost-effective interventions to assure that the community is exposed to an effective dose of the intervention. 5) Work with community organizations to help change social and physical environments to make them more conducive to health and healthy life-styles changes. 6) Develop a reliable monitoring and evaluation system: monitor the change process and conduct summary evaluations. 7) Disseminate the results to ensure that the benefits from the community program reach all communities. 8) For national implementation, the intervention program should work closely with national policy makers throughout the project.

Cardiovascular Diseases↗
PubMed2004

Potential factors associated with contraceptive intention among adolescent males in Taiwan.

This study explored the predictors of contraceptive intention in adolescent males in Taiwan. It used a cross-sectional design and a sample of 1,000 vocational high school male students to determine the potential factors associated with contraceptive intention. Data were collected on an anonymous, self-administered questionnaire, including personal background variables, prior sexual experience, contraceptive knowledge, contraceptive attitude, contraceptive self-efficacy, perception of peers' contraceptive behavior, perception of support from significant others, and parental-adolescent communication about contraception. A total of 230 participants (23%) had prior sexual experience, 13% (30) of whom reported being involved in their girlfriends' pregnancies. Of the participants, 45% recognized the use of condoms as the most favorable contraceptive method for future sexual intercourse. Second to condom use, the combination of the calendar method and condom use was also popular (13.1%). Multiple stepwise regression indicated that better contraceptive attitudes, higher contraceptive self-efficacy, no prior sexual experience, more perception of peers' contraceptive behavior, and higher perception of support from significant others were predictors of higher contraceptive intention. The above predicting factors explained 31.9% of the total variance for contraceptive intention among adolescents. These results provide health professionals with important information to understand the reality adolescents encounter and to design effective contraceptive programs for male adolescents.

Adolescent↗
PubMed2000

[Tobacco prevention in apprentices--evaluation of a general practice project "not smoking is cool!"].

PURPOSE: In recent years the incidence of adolescent smokers has increased steeply. Taking this into account, current anti-smoker campaigns should be reconsidered. Great importance must be attached to the apprentice group, since adolescents in professional training have frequently not been reached sufficiently by the preventive efforts. This study presents a tobacco prevention campaign among adolescents which was conducted in a large Swiss industrial company in 1998. METHODS AND SAMPLE: A total of 430 apprentices took part in the prevention campaign which intentionally targeted adolescent behaviour. Of these, 40 apprentices were trained as mediators for tobacco prevention in advance. On the prevention day, the mediators communicated their know-how and experiences to their working groups. To evaluate the campaign, the apprentices were surveyed via standardised questionnaires on their smoking habits before the prevention campaign began. One month after the prevention day they were surveyed again on their current smoking habits and how the campaign had affected them. RESULTS: The study showed that apprentices smoke heavily despite high awareness of the negative consequences. Some 30% of the trainees admitted smoking regularly. Another 11% said they were occasional tobacco consumers. No significant gender difference was noticeable. Especially striking was that the adolescents often justified their own smoking as habit and dependence on tobacco. The prevention campaign was well received by the adolescents. It set about half of the smokers thinking over their smoking habits. No change in smoking habits, however, could be demonstrated one month after the campaign. CONCLUSIONS: Prevention among adolescents beyond the mandatory school period is a special challenge, since one cannot take advantage of the school's network. Within the scope of the campaign described here, it was possible to reach 430 apprentices of a major company. The study shows a great need for on-target smoking prevention in this sector. In the future, studies should examine whether tobacco prevention campaigns for apprentices should already contain secondary prevention elements from the outset. They should also assess if the effects could be further improved by introducing structural and other ongoing health-promotion measures.

Adolescent↗