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PubMed1993

Ratings of the performances of practicing internists by hospital-based registered nurses.

PURPOSE: To examine the feasibility and reliability of ratings completed by hospital-based registered nurses of the humanistic qualities, communication skills, and selected aspects of the clinical skills of practicing internists. METHOD: In 1988-1989, registered nurses who worked in the same 175 hospitals as 232 internists with admitting privileges at these hospitals rated the internists' performances. The nurses were selected from medicine floors, specialty floors, and intensive care units and/or critical care units, using lists provided by head nurses. A total of 1,877 rating questionnaires with 13 performance categories were collected (with a mean of 8.01 nurses per internist). The ratings were analyzed to determine measurement characteristics and the relationships of the nurses' demographic characteristics to the ratings. In addition, for each of ten performance categories for 152 of the internists, the average rating each internist received from nurses was compared with the average rating each internist received from peer physicians. Statistical analysis used Pearson correlations, canonical correlations, factor analyses, Student's t-tests, analysis of variance, and stepwise multiple regression. Finally, the internists themselves, including physicians who were not actually rated by the nurses, were asked to complete a brief questionnaire that included questions about their opinions of the use of nurses' ratings. RESULTS: The nurses' ratings correlated moderately strongly with the peer physicians' ratings and had a common structure. However, the nurses' ratings were lower for several humanistic qualities, including respect, integrity, and responsibility, and their ratings were higher for medical knowledge and verbal communications. Across the 13 performance categories, approximately 10-15 ratings from nurses were needed to obtain a reliable assessment of an internist's humanistic qualities and communication skills. Many internists felt that nurses' ratings should be used equally with, or at least as a lesser contribution to, ratings by peer physicians of humanistic qualities and communication skills. CONCLUSION: Nurses' ratings appear to provide a feasible and reliable method of evaluating the internists' communication skills and humanistic qualities, when used in conjunction with ratings by peer physicians.

Adult↗
PubMed2003

Systematic review of the use and value of computer simulation modelling in population health and health care delivery.

BACKGROUND: The objective of the review was to evaluate the extent, quality and value of computer simulation modelling in population health and health care delivery. METHODS: A narrative systematic review was carried out of world literature from 1980 to 1999, searching Medline, INSPEC, Embase, HealthSTAR, Science Citation Index, CINAHL, MathSci, INFORMS Online and SIGLE databases, and researchers in the field were contacted. Papers were included if they contained a computer simulation model of individuals in a stochastic system and the topic or setting related to population health or health service delivery. RESULTS: A total of 182 papers met the inclusion criteria. Simulation modelling has been undertaken in a wide range of health care topic areas, including hospital scheduling and organization, communicable disease, screening, costs of illness and economic evaluation. However, the quality of published papers was variable and few reported on the outcomes of implementation of models, so that the value of modelling could not be assessed. CONCLUSION: Simulation modelling is a powerful method for modelling both small and large populations to inform policy makers in the provision of health care. It has been applied to a wide variety of health care problems. Although the number of modelling papers has grown substantially over recent years, further research is required to assess the value of modelling.

Communicable Disease Control↗
PubMed2004

Potential of chemotherapy-herb interactions in adult cancer patients.

GOALS OF WORK: The purpose of this study was to examine the specific herbs or vitamins (HV) used by patients receiving chemotherapy. Specifically, the following aspects were investigated: (1) HV use among adult cancer patients receiving chemotherapy, (2) the frequency of potential chemotherapy-HV interactions, (3) communication patterns between oncologists and their cancer patients taking HV, and (4) patients' reactions to two hypothetical scenarios of chemotherapy-HV interactions. PATIENTS AND METHODS: Adult cancer patients receiving chemotherapy at a university-based outpatient clinic over a 1-month period were sent a validated eight-page questionnaire regarding the use of complementary/alternative medicine, focusing on HV use. A total of 76 patients participated; relevant medical information was obtained from study participants' charts. The chemotherapy received was compared with HV use to assess for potentially detrimental chemotherapy-HV interactions. RESULTS: HV use in patients receiving chemotherapy was common (78%), with 27% of the study participants being at risk of a detrimental chemotherapy-HV interaction. Most patients (>85%) would discontinue their HV or ask their medical oncologist for advice if a detrimental chemotherapy-HV interaction was suspected. Although most patients discussed HV use with their oncologist, the majority also relied on their friends and naturopathic physician for information regarding HV. CONCLUSIONS: Considerable potential exists for detrimental chemotherapy-HV interactions. Methods to improve communication of HV use between cancer patients receiving chemotherapy and health-care practitioners are necessary to identify and minimize the risk of these interactions.

Adult↗
PubMed2002

Missed opportunities for prevention of osteoporotic fracture.

BACKGROUND: Osteoporotic fracture is a growing public health problem burden to society. Despite the importance of physician practices in preventing it, relatively little is known about the osteoporosis-related practices of US physicians. METHODS: A total of 1500 female members of a Connecticut independent practice association model health plan (aged 40-69 years) were surveyed to identify women's receipt of osteoporosis-related services (eg, prevention counseling, bone mineral density [BMD] testing, and communication about treatment options). These findings were compared with recommendations of the US Preventive Services Task Force and the National Osteoporosis Foundation. We received 1007 completed questionnaires, for a response rate of 69%. RESULTS: Only 49% of the sample reported that a health care provider ever discussed osteoporosis with them. In multivariate analyses, women with multiple risk factors were not more likely than other women to have been counseled about osteoporosis and its prevention, although those with an osteopenia/osteoporosis diagnosis were. In contrast to National Osteoporosis Foundation recommendations, only a small minority of high-risk women (12%-34%) had their BMD tested. Although most women with an osteopenia/osteoporosis diagnosis reported receiving information on estrogen replacement therapy, calcium, and weight-bearing exercise, fewer reported receiving information on pharmaceutical alternatives to estrogen (33%) and vitamin D (20%). CONCLUSIONS: The main trigger to physician counseling of women about osteoporosis and its prevention is an osteopenia/osteoporosis diagnosis. Women with multiple risk factors for osteoporosis are not being identified for preventive counseling interventions or BMD testing.

Adult↗
PubMed1976

The contribution of communications signals to noise exposure.

Man-mounted miniature recording equipment has been used to measure the electroacoustic conditions obtaining in cockpits of aircraft and at the pilot's ear during operational sorties in the Royal Air Force. Although this paper considers the measurements taken that relate to the total noise exposure (noise dose) received by aircrew, the results apply equally to anyone who is exposed to high noise and requires communications. Comparison of the noise at the ear with the cockpit noise gave a measure of headgear attenuation which was used to adjust a [Formula: see text] filter. Playing cockpit noise tapes through this filter to a noise dose meter gave the noise dose that would have been experienced had there been no communications signals. The results showed that the communications signals at the ear, averaging 40% of the sortie time, are a major contributor to the total dose, and, without the signals, the dose averaged about 6 dB less. In view of the Health and Safety at Work Act, 1974, employers should be aware of the additional dose to which employees are exposed because of communications. A method for the prediction of noise dose is proposed where communication takes place in a noisy environment.

Journal Article↗
PubMed2003

[Workflow improvement and efficiency gain with near total digitalization of a radiology department].

PURPOSE: To determine the temporal changes of the workflow caused by digitalization of the radiology department after installation of digital luminescence-radiography (DLR), a radiology information system (RIS) and picture archiving and communication system (PACS) at the Missionsärztliche Klinik in April 2000. MATERIALS AND METHODS: In a comparative study, a workflow analysis by manual registration of different work steps was performed before (1999) and after (2001) digitalization of a radiology department. RESULTS: The digitalization shortened the examination time for patients from a mean of 8 min to 5 min. The time the patient is absent from the emergency room did not change. Reporting radiographic examinations including comparison with previous studies begins earlier from a mean of 2 h 37 min to 17 min. Using PACS, 85.9 % of all cases could be interpreted on the day of the examination (without PACS 41.2 %) and 87.2 % of the reports were completed the day after the examination (without PACS 64.5 %). No time differences were found between reading conventional studies on the monitor or as soft-copy. CONCLUSION: Compared to conventional film-screen systems, complete digitalization of a radiology department is time saving at nearly all steps of the workflow, with expected positive effects on the workflow quality of the entire hospital.

Efficiency, Organizational↗
PubMed1990

Comparison of transcranial and cervical continuous-wave Doppler in the evaluation of intracranial collateral circulation.

Adequate intracranial collateral circulation reduces risk of stroke in carotid artery surgery. To evaluate their relative accuracies in assessing intracranial collateral blood flow, we prospectively compared transcranial Doppler and continuous-wave Doppler of the cervical carotid arteries combined with compression of the common carotid artery in 28 consecutive patients before carotid endarterectomy. Ten healthy volunteers served as controls. Three patients (11%) were excluded from compression of arteries because of diffuse disease in the common carotid artery. A total of 199 compressions were performed without complications. Lack of a suitable transtemporal window precluded the performance of transcranial Doppler in three patients (12%). The anterior communicating artery was identified in all the normal volunteers and 80% of patients by both methods. The posterior communicating artery was identified by both methods in 16 of 20 attempts in controls. Continuous-wave Doppler identified the posterior communicating artery in 30 of 50 attempts in patients; transcranial Doppler identified the posterior communicating artery in 20 of 44 attempts in patients (p greater than 0.5). Detection of intracranial collaterals correlated with intraoperative carotid artery back pressure measurements in 23 of 25 patients (92%). We conclude that continuous-wave Doppler of the extracranial arteries combined with common carotid artery compression is a safe and easy way to detect intracranial collaterals, with an accuracy equivalent to transcranial Doppler.

Adult↗
PubMed2005

The impact of an intervention in intercultural communication on doctor-patient interaction in The Netherlands.

OBJECTIVE: Findings of scarcely available studies indicate that there are substantial gaps in intercultural doctor-patient communication. In order to improve intercultural communication in medical practice in The Netherlands, an educational intervention was developed. The aim of the present study was to examine the effects of this intervention on doctor-patient communication. METHODS: Participants (general practitioners: n=38; patients: n=124) were assigned at random to an intervention or a control group. GPs in the intervention group received 2.5 days training on intercultural communication. Patients in the intervention group were exposed to a videotaped instruction in the waiting room, right before the consultation. Data were collected through videotapes of visits of ethnic minority patients to their GP and home interviews with the patients after their medical visit. Communication behaviour was assessed using the Roter interaction analysis system (RIAS). Interview length was assessed as well. RESULTS: The length of the medical encounter increased significantly after having received the intervention. Total number of GP utterances increased significantly too. When comparing relative frequencies on affective and instrumental verbal behaviour of both patients and doctors, no significant changes could be detected. CONCLUSION: It is concluded that there seems to be some change in doctor-patient interaction, but RIAS may not be suitable to detect subtle changes in the medical communication process. It is recommended to use other analysis methods to assess cultural differences in medical communication. PRACTICE IMPLICATIONS: Knowledge about possible antecedents of gaps in intercultural medical communication should be increased in order to be able to design effective interventions for intercultural doctor-patient communication.

Communication↗
PubMed2005

Nurses' communication of prognosis and implications for hospice referral: a study of nurses caring for terminally ill hospitalized patients.

BACKGROUND: Although nurses are ideally situated to facilitate communication about prognosis and hospice referral among patients, patients' family members, and hospital staff, nurses do not always assume this task. OBJECTIVE: To identify common obstacles to nurses' discussions of prognosis and referral to hospice care with terminally ill patients in the hospital setting. METHODS: Data from a previous study were analyzed. In that study, a total of 174 experienced staff nurses working full-time in hospital practice areas where terminally ill patients routinely receive care at 6 randomly selected community hospitals in Connecticut participated. Each nurse completed a self-administered, cross-sectional survey. In this study, the open-ended responses of the nurses were examined by using content analysis and descriptive analysis. RESULTS: The most common obstacles were unwillingness of a patient or the patient's family to accept the prognosis and/or hospice, sudden death or noncommunicative status of the patient, belief of physicians' hesitance, nurses' discomfort, and nurses' desire to maintain hope among patients and patients' families. CONCLUSIONS: The reasons for noncommunication of prognosis and referral to hospice care by nurses are complex. Because limited discussion between clinicians and patients about prognosis and treatment options can reduce the likelihood of referral to hospice care, improved communication skills may result in more referrals and a smoother transition to hospice.

Attitude of Health Personnel↗
PubMedDate not supplied

A proposal for strengthening medical school training in STD prevention techniques.

Despite increases in national rates of sexually transmitted disease (STD), surveys indicate that medical students generally lack programs to train them in STD prevention techniques and in counseling patients about STD. The authors of this proposal investigated STD education for medical students at the University of California at Los Angeles and propose a project to involve third-year medical students in STD prevention techniques during their STD-clinic rotation. The long-term goal is to decrease the incidence and prevalence of STD. The immediate aims are to increase medical students' knowledge of STD prevention and to help them develop the communication skills necessary to effectively counsel patients about STD. Interventions would consist of a series of lectures and workshops using audiovisual aids, small group discussions, and role playing, and would be conducted by health educators and guest lecturers. A quasi-experimental research design would be used in testing the effectiveness of the project in two experimental and two control groups involving a total of 80 third-year medical students. The first intervention would be a 1-week lecture series. Written tests would be given before and after the first intervention to measure the baseline of the students' knowledge of STD prevention methods. The second intervention would be a 1-week workshop series. Students' interviews with patients would be videotaped before and after the second intervention so that the interviewer's communication skills may be assessed and compared. Sets of interventions would be scheduled for the fall of 1990 and the spring of 1991. Six months after the completion of the project, a followup questionnaire would be given to evaluate the project's overall effectiveness.

Counseling↗
PubMed2001

Direct-to-consumer advertisements for prescription drugs: what are Americans being sold?

BACKGROUND: Pharmaceutical companies spent US$1.8 billion on direct-to-consumer advertisements for prescription drugs in 1999. Our aim was to establish what messages are being communicated to the public by these advertisements. METHODS: We investigated the content of advertisements, which appeared in ten magazines in the USA. We examined seven issues of each of these published between July, 1998, and July, 1999. FINDINGS: 67 advertisements appeared a total of 211 times during our study. Of these, 133 (63%) were for drugs to ameliorate symptoms, 54 (26%) to treat disease, and 23 (11%) to prevent illness. In the 67 unique advertisements, promotional techniques used included emotional appeals (45, 67%) and encouragement of consumers to consider medical causes for their experiences (26, 39%). More advertisements described the benefit of medication with vague, qualitative terms (58, 87%), than with data (9, 13%). However, half the advertisements used data to describe side-effects, typically with lists of side-effects that generally occurred infrequently. None mentioned cost. INTERPRETATION: Provision of complete information about the benefit of prescription drugs in advertisements would serve the interests of physicians and the public.

Advertising↗
PubMed1997

Human immunodeficiency virus risk behavior among white and Asian/Pacific Islander high school students in the United States: does culture make a difference?

PURPOSE: This article analyzes sexual behavior among white and Asian/Pacific Islander (API) adolescents, to determine the risk for human immunodeficiency virus (HIV) transmission from a multicultural point of view. METHODS: A total of 5,385 white and 408 API high school students were included. The national school-based Youth Risk Behavior Survey (YRBS 1991) was used. RESULTS: After controlling for academic performance, white students were 2.3 times more likely to communicate about acquired immunodeficiency syndrome (AIDS)/HIV, 2.7 times more likely to be sexually experienced, and 2.5 times more likely to use alcohol or other drugs before sex than APIs. There were no significant differences between these two groups in the age of initiating sex, the number of lifetime partners, the proportion of being currently sexually active (having had sex during the past 3 months), and condom use behavior. Although APIs had a low rate of AIDS/HIV, they have behaviors at as high a risk as white students once they became sexually experienced, and they have an even greater number of recent partners if they are currently sexually active. Use of alcohol or other drugs before sex and condom use is significantly related. CONCLUSIONS: Given the importance of attention to risks among API adolescents, this study underscores the need for more research to explore how culture values play a role among all API students, those who are sexually experienced, and those who are currently sexually active API students, to develop culturally sensitive AIDS/HIV prevention programs.

Adolescent↗
PubMed2003

Guillain-Barré syndrome: a prospective, population-based incidence and outcome survey.

OBJECTIVE: The authors evaluated the incidence and long-term prognostic factors of Guillain-Barré syndrome (GBS) in a prospective, population-based study. METHODS: Patients with GBS diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke criteria in the 2-year period 1995 to 1996 in two Italian regions were prospectively followed up for 2 years after onset of GBS. RESULTS: A total of 120 patients were found, corresponding to a crude annual incidence rate of 1.36/100,000 population (95% CI, 1.13 to 1.63). A total of 7 (5.8%) patients, all but one with axonal or mixed EMG pattern, died acutely within 30 days from the onset of the disease. Acute mortality was due to respiratory involvement and intensive care unit complications. In multivariate analysis, a worse 2-year outcome (Hughes score >or=2) was related to a higher Hughes grade at nadir, axonal or mixed EMG, age >or=50 years, and absence of respiratory infections preceding GBS. The persistence of disability 2 years after the acute phase was related to axonal involvement and a worse status at nadir. CONCLUSIONS: After adjustment to US population, the incidence rates for GBS from different countries showed no significant differences. Both acute mortality and long-term disability in GBS seem to be related to an axonal involvement and a Hughes grade >or=2 at nadir.

Adolescent↗
PubMedDate not supplied

Novel metabolism of nitrogen in plants.

Our previous study showed that approximately one-third of the nitrogen of 15N-labeled NO2 taken up into plants was converted to a previously unknown organic nitrogen (hereafter designated UN) that was not recoverable by the Kjeldahl method (Morikawa et al., 2004). In this communication, we discuss metabolic and physiological relevance of the UN based on our newest experimental results. All of the 12 plant species were found to form UN derived from NO2 (about 10-30% of the total nitrogen derived from NO2). The UN was formed also from nitrate nitrogen in various plant species. Thus, UN is a common metabolite in plants. The amount of UN derived from NO2 was greatly increased in the transgenic tobacco clone 271 (Vaucheret et al., 1992) where the activity of nitrite reductase is suppressed less than 5% of that of the wild-type plant. On the other hand, the amount of this UN was significantly decreased by the overexpression of S-nitrosoglutathione reductase (GSNOR). These findings strongly suggest that nitrite and other reactive nitrogen species are involved in the formation of the UN, and that the UN-bearing compounds are metabolizable. A metabolic scheme for the formation of UN-bearing compounds was proposed, in which nitric oxide and peroxynitrite derived from NO2 or endogenous nitrogen oxides are involved for nitrosation and/or nitration of organic compounds in the cells to form nitroso and nitro compounds, including N-nitroso and S-nitroso ones. Participation of non-symbiotic haemoglobin bearing peroxidase-like activity (Sakamoto et al., 2004) and GSNOR (Sakamoto et al., 2002) in the metabolism of the UN was discussed. The UN-bearing compounds identified to date in the extracts of the leaves of Arabidopsis thaliana fumigated with NO2 include a delta2-1,2,3-thiadiazoline derivative (Miyawaki et al., 2004) and 4-nitro-beta-carotene.

Arabidopsis↗
PubMed2001

The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994.

OBJECTIVE: To classify the causes of death in Maputo City, Mozambique, using the methods of the Global Burden of Disease study, in order to provide information for health policy-makers and to obtain a baseline for future studies in Maputo City and provincial capitals. METHODS: Data were taken from the Maputo City death register and autopsy records for 1994. FINDINGS: A total of 9011 deaths were recorded in the death register, representing a coverage of approximately 86%. Of these, 8114 deaths (92%) were classified by cause. Communicable, maternal, perinatal, and nutritional disorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961. The 10 leading causes of registered deaths were perinatal disorders (1643 deaths); malaria (928); diarrhoeal diseases (814); tuberculosis (456); lower respiratory infections (416); road-traffic accidents (371); anaemia (269); cerebrovascular diseases (269); homicide (188); and bacterial meningitis (178). CONCLUSIONS: Infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register. AIDS-related deaths were underreported. With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City. The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes.

Autopsy↗
PubMed1996

[Total quality in radiology].

The objective of the paper is to summarize the concept of total quality and the principles and methods of quality assessment and improvement and to demonstrate the usefulness of quality improvement in a department of diagnostic radiology and medical imaging.

Communication↗
PubMedDate not supplied

The seasonality of total hospitalizations in Ontario by age and gender: a time series analysis.

BACKGROUND: Consistent and predictable seasonal fluctuations in hospitalizations have been demonstrated for diverse communicable and non-communicable health conditions. The objective of this study was to examine the seasonal patterns of all hospitalizations by age and gender in order to determine whether the hospital system for a large geographical area was subject to consistent, predictable temporal variations. METHODS: A retrospective population-based study of approximately 14 million residents of Ontario was conducted to assess temporal patterns in all hospitalizations from April 1, 1988 to March 31, 2000. Time series analysis, using spectral analysis, was conducted to assess seasonal variations and trends over time and to account for autocorrelation. RESULTS: Conspicuous seasonality in hospitalizations was found in every age group for both sexes with the exception of males between the ages of 20 and 39. The average monthly variability ranged from lows of 15% for the age group 20-29 for both sexes, to highs of 34% in males between 5 and 9 years. For the total population, this represents a 12-year average variability of approximately 20% or 20,000 out of 97,000 hospitalizations. For both sexes, peak hospitalizations typically occurred in the spring and autumn for the youngest and oldest age groups, and in January for the middle age groups. CONCLUSION: Seasonal factors play an important role in the utilization of hospital services in Ontario. The determinants of this seasonality, which include environmental and social/behavioural factors, are not well understood.

Adolescent↗
PubMed1976

A simplified approach to radionuclide venography: concise communication.

A simplified method has been developed for performing radionuclide venography. The method makes use of the scintillation camera and a synchronized whole-body scanning bed. This technique permits a more integrated presentation of the data and is performed in conjunction with a standard ventilation-perfusion lung study. The total amount of 99mTc tracer injected is 2 mCi.

Humans↗