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PubMed1991

Use of a multichannel electrotactile speech processor by profoundly hearing-impaired children in a total communication environment.

As part of a larger subject group, four profoundly hearing-impaired children enrolled in a total communication educational program were fitted with the University of Melbourne's multichannel electrotactile speech processor (Tickle Talker). Sound detection thresholds for pure tones were at lower levels with the tactile device than with hearing aids, especially for high frequency sounds above 2 kHz. Two of the children also detected all speech sounds of the Ling five-sound test at normal conversational levels using only the Tickle Talker. The children were able to use tactile input to achieve higher scores on three speech feature subtests of the PLOTT test when using the Tickle Talker plus hearing aids as compared to hearing aids alone. Mean improvements were 22.4 percent on vowel length, 28 percent on vowel identification, and 35 percent on consonant manner. Improvements were also shown by individual children on the closed-set WIPI and open-set PBK word tests, and on the open-set BKB sentence test, when the Tickle Talker was combined with hearing aids, and with hearing aids and lipreading. Comparisons of these results with those of children using the Tickle Talker in other educational settings show that children in a total communication environment can potentially benefit to a similar degree from use of tactual input. Anecdotal reports from the children and school staff members indicated that daily use of the Tickle Talker did not interfere with the signing aspects of total communication.

Adolescent↗
PubMed1991

The impact of religion and cultural values on AIDS education programs in Malaysia and the Philippines.

This paper examines the impact of cultural values and government policies on the content of AIDS educational literature prepared by public health agencies in Malaysia and the Philippines. The literature from these countries, which has been distributed to the public and is intended to inform them of the danger of AIDS, how the HIV is and is not transmitted, and how to avoid infection, is analyzed and evaluated for effectiveness and congruence with the dominant religious tenets and cultural practices in each country, and attitudes to sexual behavior. The paper also describes the response of these countries to the AIDS pandemic, and concludes with suggestions about how this form of AIDS education can be improved.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Cultivating quality. CQI helps a system's members provide efficient, effective care to their clients.

In 1990 the SSM Health Care System (SSMHCS), St. Louis, introduced its employees to continuous quality improvement (CQI), a new management paradigm focusing on process, customers, and statistical thinking. For nearly a year before the introduction of CQI, a system implementation team studied CQI and its impact on businesses and healthcare providers. Team members were struck by the close correlation between the system's own mission and CQI principles. When it had completed its study, the team began to develop strategies for implementing CQI. System leaders committed themselves to ensuring that CQI would address both clinical and managerial processes, encouraging managers and medical staff to support CQI, establishing a structure at each entity to support involvement in the process, fostering a high level of awareness in CQI, recognizing employees who make significant contributions to the effort, offering education programs, and communicating successes and encouraging their replication. Before any facility appointed a quality improvement team and began to apply CQI principles, its administrative council (leadership team) was required to work through a series of readiness screens. The implementation process has involved redefining the manager's role as one of empowering employees, cultivating and securing physician involvement, and educating employees and physicians about processes. In the early phases of implementation, the major barriers the system has faced have involved time-the time required of administrators and managers to teach CQI courses and the time it takes teams to work through the SSMHCS CQI model and adapt the system to CQI implementation.

Catholicism↗
PubMedDate not supplied

Quality in ambulatory care: the two minute demonstration.

When asked to produce convincing evidence of quality, 281 ambulatory healthcare professionals suggested 98 different components of an ambulatory program. Obviously no overwhelming majority exists, nor is there a clear focus on what constitutes quality in the ambulatory setting. This demonstrates and highlights both the diversity of ambulatory care and the difficulty of defining quality in the ambulatory environment. We all feel that we know what quality is and that we provide quality care in our organizations. Quality is high priority, yet when asked for the most important demonstrator of quality, ambulatory care professionals gave 98 different answers. Based upon the Pareto diagram's top five categories as shown in Figure One, we can put together a composite definition. This composite would present the combined judgment of nearly 80% of the 281 seminar attendees. Quality ambulatory health care--meets the expectations (pleases) the patients, is enhanced and demonstrated by an effective quality assurance program, is the achievement of desired outcomes for patients, is dependent upon the excellence of the provider staff, and is enabled by an accurate, timely, and complete medical record system. The message for those of us in ambulatory care is that the process of working toward the definition of quality may be just as important as the actual definition of quality. A consensus on a definition of quality in the ambulatory setting is unlikely as there is too much diversity. It is important that each of our ambulatory centers should set out to determine its own definition of quality. The process itself is useful because it will help us to focus on the dimensions of quality. (ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care Facilities↗
PubMed2000

Recruiting women into a smoking cessation program: who might quit?

This article describes women who called a research line to quit smoking and identifies correlates of confidence in quitting among the callers. Approximately 4,000 women called the study line to participate after a single press release, indicating intensive interest in quitting. Overall, the randomized sample of women was aged 26 to 65 years, reported smoking just over one pack per day, was mostly White, predominantly employed, and had quit an average of two times the past year before joining the study. Standard background variables, such as age, income, body weight and smoking history variables did not predict baseline self-efficacy or confidence in quitting. However, level of stress, cognitive restraint, and weight gain concerns did predict self-efficacy. These data indicate strong interest in quitting among women and highlight the role of affect and weight concerns in quitting confidence.

Adult↗
PubMed2007

Seeking informed consent to cancer clinical trials; evaluating the efficacy of doctor communication skills training.

INTRODUCTION: Clinical trials have come to be regarded as the gold standard for treatment evaluation. However, many doctors and their patients experience difficulties when discussing trial participation, leading to poor accrual to trials and questionable quality of informed consent. We have previously developed a communication skills training program based on a typology for ethical communication about Phase II and III clinical trials within four categories. The training program consisted of a 1 day experiential workshop that included didactic teaching, exemplary video and role play. The aim of this study was to evaluate the effectiveness of the communication skills training workshop. METHOD: Oncologists were recruited from three major teaching hospitals conducting oncology outpatient clinics in three Australian capital cities. Ten oncologists and 90 of their adult cancer patients who were eligible for a Phase II or III clinical trial participated. Ninety informed consent consultations were audiotaped before (n = 59) and after (n = 31) training, and fully transcribed. The presence or absence of each domain component was coded and these were summed within categories. A coding manual was produced which enabled standardization of the coding procedure. Patients completed questionnaires before and after the consultation, and doctors completed a short measure of satisfaction after the consultation. RESULTS: Doctors increased their use of some aspects of shared decision-making behavior (t(87) = -1.945, p = 0.05) and described some aspects of essential ethical/clinical information more commonly. In addition they used less coercive behaviors (z = -1.976, p = 0.048). However, they did not provide more clinical information or structure their consultations in the recommended fashion. Patients in the post-training cohort reported more positive attitudes to clinical trials, but other outcomes were not affected by the intervention. CONCLUSIONS: This short training programme demonstrated limited success in improving the oncologist's communication skills when gaining informed consent. A larger randomized controlled trial of extended training is now underway.

Adult↗
PubMed1999

Effect of clinician communication skills training on patient satisfaction. A randomized, controlled trial.

BACKGROUND: Although substantial resources have been invested in communication skills training for clinicians, little research has been done to test the actual effect of such training on patient satisfaction. OBJECTIVE: To determine whether clinicians' exposure to a widely used communication skills training program increased patient satisfaction with ambulatory medical care visits. DESIGN: Randomized, controlled trial. SETTING: A not-for-profit group-model health maintenance organization in Portland, Oregon. PARTICIPANTS: 69 primary care physicians, surgeons, medical subspecialists, physician assistants, and nurse practitioners from the Permanente Medical Group of the Northwest. INTERVENTION: "Thriving in a Busy Practice: Physician-Patient Communication," a communication skills training program consisting of two 4-hour interactive workshops. Between workshops, participants audiotaped office visits and studied the audiotapes. MEASUREMENTS: Change in mean overall score on the Art of Medicine survey (HealthCare Research, Inc., Denver, Colorado), which measures patients' satisfaction with clinicians' communication behaviors, and global visit satisfaction. RESULTS: Although participating clinicians' self-reported ratings of their communication skills moderately improved, communication skills training did not improve patient satisfaction scores. The mean score on the Art of Medicine survey improved more in the control group (0.072 [95% CI, -0.010 to 0.154]) than in the intervention group (0.030 [CI, -0.060 to 0.1201). CONCLUSIONS: "Thriving in a Busy Practice: Physician-Patient Communication," a typical continuing medical education program geared toward developing clinicians' communication skills, is not effective in improving general patient satisfaction. To improve global visit satisfaction, communication skills training programs may need to be longer and more intensive, teach a broader range of skills, and provide ongoing performance feedback.

Adult↗
PubMed1995

Communication as an essential part of program and institutional development.

The Longitudinal Primary Care Program, an innovative curriculum in generalist medicine at the University of Illinois at Chicago College of Medicine, has been enhanced by a commitment to fostering good communication among all of its participants (who include more than 350 students and nearly 300 office-based generalist preceptors) and between participants and administrators. The diverse and widely scattered group of preceptors is brought together through orientation sessions and faculty development workshops that stress precepting skills and mentoring. Preceptors are regularly surveyed and the survey data are analyzed to help administrators learn how best to recruit and retain these faculty members. Students' input comes through surveys, small-group meetings, and their participation on committees. Program evaluation data and formal notes from committee meetings are promptly compiled and disseminated. Such efforts to promote good communication among preceptors, students, program administrators, and the medical college have both enhanced the generalist program and encouraged other curricular reforms in the college.

Chicago↗
PubMedDate not supplied

Effects of an osteoporosis prevention program incorporating tailored educational materials.

PURPOSE: To evaluate the effects of two interventions on calcium intake and exercise and assess whether intervention effects varied as a function of participants' stage of change. DESIGN: The study used a 2 by 2 factorial research design. Baseline, 3-, 6-, and 12-month follow-up data were collected. SETTING: Twelve counties in western North Carolina. SUBJECTS: Of 714 women recruited, 547 (76.6%) completed all data collection procedures. INTERVENTION: One intervention, conducted at the individual level, compared the effects of tailored vs. nontailored educational materials. The tailored educational intervention was delivered via two packets of written materials and one telephone counseling session. The written materials and counseling session were tailored according to participants' current calcium intake and exercise level, perceived adequacy of these behaviors, stage of change, behavioral goals, and perceived barriers to change. A community-based intervention was also evaluated. This intervention, implemented in 6 of the 12 counties, included establishing an Osteoporosis Resource Center, conducting a workshop on osteoporosis prevention, and offering free bone density screening. MEASURES: Outcome measures were calcium intake and exercise level. Stage of change was assessed as a moderating variable. RESULTS: Irrespective of intervention group, among women not consuming adequate calcium at baseline, intake increased an average of about 500 mg/d over the course of the study. Changes involving exercise were more modest. Repeated measures regression analyses were used to evaluate intervention effects. The effect of the tailored educational intervention varied, in appropriate ways, among women in different stages of change at baseline (F2,527 = 6.37, p < .002). Among women in the Engaged stage, the tailored intervention was associated with a greater increase in calcium intake. In contrast, among women who were obtaining adequate calcium at baseline (i.e., Action stage), the tailored intervention appeared to forestall inappropriate increases in calcium intake. The community-based intervention had no consistent effects on calcium intake, either alone, or in combination with the tailored intervention. Finally, neither intervention had an effect on exercise, either alone or in combination. CONCLUSIONS: Limited support for the superiority of tailored vs. nontailored educational interventions was found. The differential effects observed could be due to the telephone counseling received by women in the Tailored Education Group, however.

Calcium↗
PubMed1984

A non-supervised training program for Carkhuff's discrimination and communication skills and its effects upon the reactions of others during brief interactions.

Used Carkhuff's Indices of Communication and Discrimination along with other measures to assess the level of communication and discrimination skills at various stages of communication training. Ss were 14 male and 9 female students in a psychology of adjustment class. Results indicated that: (a) treatment and control groups did not differ in communication skills before they went through training; (b) the treatment group offered higher levels of communication skill after it had completed training than did the control group before it began training; (c) the control group offered levels of communication skill equal to those of the treatment group once the control group also had completed training. A similar pattern was found for discrimination skill. The effects of training cannot be dismissed as paper-and-pencil artifacts because others who were ignorant of the growth conditions concept reacted differently in brief unstructured interactions to those who had completed training.

Adult↗
PubMedDate not supplied

Long-term responses of higher and lower risk youths to smoking prevention interventions.

BACKGROUND: Adolescents at risk for cigarette smoking are difficult to reach with conventional interventions but have substantial exposure to the mass media. This study is the first to show that smoking prevention messages presented through the mass media can have large and durable effects on higher risk adolescents. METHODS: Students in two communities received media and school interventions beginning in grades 5-7; those in matched comparison communities received school interventions. Media interventions were targeted to higher risk youths. School surveys were conducted before and after the interventions, in grades 4-6 and grades 8-10. Two years after interventions ended, when participants were in grades 10-12, school and telephone surveys were conducted to assess smoking status. Survey participants (n = 2,860) were classified at baseline as having higher or lower risk for becoming a smoker. RESULTS: Smoking prevalence within the higher risk sample was significantly lower for those receiving media-school interventions than for those receiving school interventions only (odds ratio = 0.71). Effects on the lower risk sample were similar in magnitude but marginally significant. CONCLUSIONS: Mass media and school interventions achieved lower smoking rates among higher risk youngsters 2 years following completion of the interventions. This strategy represents a uniquely effective method for communicating with a high-priority group.

Adolescent↗
PubMed1992

Determinants of hospital ethics committee success.

In December 1990, an empirical study assessing hospital ethics committee (HEC) success was completed. Success was measured in terms of the number of interventions undertaken by the committees in four functional areas: education, guidelines development, prospective and retrospective case review. Some commonly quoted success determinants, such as multidisciplinarity, physician chairpersons, and a high institutional status of the chairperson were found not to foster success; the latter two, actually decreased committee success.

Data Collection↗
PubMed2006

Morphine overdose from error propagation on an acute pain service.

PURPOSE: To highlight a case in which multiple errors occurred during programming and administration of analgesia via a patient-controlled analgesia (PCA) pump, and to formulate recommendations on how to avoid such errors in the future. CLINICAL FEATURES: Following lumbar surgery, a 43-yr-old woman was switched from epidural analgesia to a PCA pump. This change was associated with numerous errors at several points of delivery of her care. Errors included incorrect connection of the PCA adapter, incorrect pump programming, and communication lapses which resulted in a morphine overdose and subsequent respiratory arrest. The patient was promptly resuscitated, and she had an uneventful recovery. The event resulted in a complete review of pain management equipment and the training and education of staff using this equipment at our institution. CONCLUSION: This case highlights how multiple individual errors can combine to result in a serious adverse event. While equipment design was an important factor in this adverse event, human factors played a critical role at multiple levels.

Adult↗
PubMed2002

[The patients' perception of the anaesthetist in a Swiss university hospital].

OBJECTIVES: The role or recognition of the anaesthetist as an independent medical specialist has been the subject of many studies. Since most of this work was performed in English speaking countries, only few data are available for Germany, Austria, or Switzerland. The goal of this study was to determine how much knowledge patients had of the training and activities of anaesthetists. The study included patients ( n=685) who underwent elective operations in all surgical subspecialties at the University Hospital of Basel. METHODS: The data were collected using a questionnaire distributed at the end of the preoperative visit, which included 14 different questions examining the role of the anaesthetist. RESULTS: Surprisingly, and in contrast to previous studies, almost all patients (99%) knew that the anaesthetist is a qualified physician. In addition, 75% of the patients were aware that the anaesthetist is also engaged in activities outside the operating room; these percentages compare favourably with previous results. However, when asked about the specifics of these activities or about how long it takes to train an anaesthetist, the Swiss patients knew little more than patients from other countries. Only one fifth of all patients estimated the duration of postgraduate training correctly and 45% thought that the anaesthesia team worked under the supervision of the surgical team. Previous anaesthetic experiences as well as additional informational material such as a booklet or videofilm did not improve the patients' knowledge with respect to the training or activities of anaesthetists. DISCUSSION: Since other even more elaborate and expensive methods such as large exhibitions, national anaesthesia days, or increased coverage on radio and television also failed to enhance patients' knowledge, the focus is once again on the relationship between the patient and anaesthetist. If we wish to improve the role and recognition of anaesthetists for patients and/or the public, the anaesthetist must be visible for the patients as a true physician in the pre- and postoperative period. To improve this important patient-anaesthetist relationship, we have begun a training program in communication skills for all physicians in our department.

Anesthesia↗
PubMed2001

[Reducing work stress in geriatric care: a training program for nursing team and administrators].

Caregivers of the residents in nursing homes are exposed to a high degree of physical and mental stress. The purpose of this study was to develop and to test the effects of skill training aimed at reducing occupational stress. The training consisting of 12 sessions of 90 minutes each was designed for nursing assistants and for care supervisors, respectively. Contents of the program are communicating with the demented, coping with job stress and cooperating with colleagues and subordinates, respectively. Eleven homes for the elderly and nursing homes were involved in the pilot study; 88 caregivers participated in the training, 34 of them were supervisors and 54 nursing assistants. The participants mainly appreciated the contents of the training. A controlled study design was applied to evaluate the training effects. 56 participants assessed their competencies, their job conditions and their health status at the beginning, at the end of the training as well as 12 weeks after the intervention had been finished. 56 persons completed the questionnaire receiving no training. Among the training participants, particularly the self-care skills improved. In addition, occupational stress could be reduced and the climate with the residents improved significantly, whereas the frequency of health problems did not change. Compared to the changes also observed in the control group, statistically significant effects were confined to the improvement of the climate with the residents. Care supervisors in general reported a higher benefit from the training than did nursing assistants. The results of the pilot study were used to adapt the training to the caregivers' needs.

Adaptation, Psychological↗
PubMed2006

Medication errors and patient complications with continuous renal replacement therapy.

Continuous renal replacement therapy (CRRT) is commonly used for renal support in the intensive care unit. While the risk of medication errors in the intensive care unit has been described, errors related specifically to CRRT are unknown. The purpose of this study is to characterize medication errors related to CRRT and compare medication errors that occur with manually compounded solutions versus commercially available solutions. We surveyed three separate internet-based, pediatric list serves that are commonly used for communications for programs utilizing CRRT. Data regarding CRRT practices and medication errors were recorded. Medication errors were graded for degree of severity and compared between programs using manually compounded dialysis solutions versus commercially available dialysis solutions. In a survey with 31 program responses, 18 reported medication errors. Two of the 18 were related to heparin compounding, while 16/18 were due to solution compounding errors. Half of the medication errors were classified as causing harm, two of which were fatal. All medication errors were reported by programs that manually compounded their dialysis solutions. Medication errors related to CRRT are associated with a high degree of severity, including death. Industry-based, commercially available solutions can decrease the occurrence of medication errors due to CRRT.

Child↗