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PubMed1983

Late language development in a child unable to recognize or produce speech sounds.

A boy with severe quadriplegia who neither recognized nor uttered speech sounds acquired language. Until the age of 6 years he was considered to be of severely subnormal intelligence. At age 6 years 9 months he was introduced to a manual sign system. Subsequently he was able to read, write, converse, and produce imaginative stories. Attention and memory were unimpaired and affective and social responsiveness developed appropriately. The case history demonstrates the selective effects of brain lesions that, despite extensive damage, may spare functional systems necessary for cognitive and linguistic development. It highlights the difficulty in diagnosing and evaluating the intellectual and affective potential of a multihandicapped child without functional hearing or speech and emphasizes the importance of sign language as a communication channel and prerequisite for the acquisition of reading and writing skills.

Aphasia↗
PubMed2004

Development of a community pharmacy-based model to identify and treat OTC drug abuse/misuse: a pilot study.

OBJECTIVE: The aim of this study was to develop and pilot a harm-minimisation model for the identification and treatment of over-the-counter (OTC) drug abuse/misuse by community pharmacists. METHOD: Extensive consultation was conducted during the development of the model. This included an exploratory conference involving an interdisciplinary group of delegates and detailed individual consultation with a range of healthcare practitioners. Consultation with a psychologist specialising in communication skills allowed development of the communication aspects of the model. A comprehensive manual detailing the model was prepared. RESULTS: The model is designed to be used by community pharmacists in conjunction with other healthcare professionals. It focuses on the abuse/misuse of opioids, laxatives and antihistamines and can be broadly divided into three phases, namely: patient identification and recruitment, treatment/referrals and data collection/outcome measurement. Client identification is via record-keeping which is implemented alongside an information campaign promoting safe use of OTC medicines. Once identified, the pharmacist aims to recruit clients using the developed communication strategies. Treatment depends on whether the problem is misuse or abuse and on the product. Several treatment paths are available including treatment according to an agreed protocol and referring to the GP or community addiction team (CAT). Two pharmacists were recruited and trained to pilot the model. Of the clients, 18 were identified as abusing/misusing OTC products over a one-month period. The subject of inappropriate OTC use was raised with 14 of these clients. Some success was noted in that clients agreed to stop using the product and/or to try safer alternatives. As expected, some sales had to be refused, as the client was unwilling to accept the pharmacist's intervention. CONCLUSION: This study represents the first reported structured attempt by community pharmacists in the UK to address the abuse/misuse of OTC medication. Work is now ongoing to modify this model in light of the pilot study findings.

Algorithms↗
PubMed2003

Medical telematics in disaster response.

INTRODUCTION: Every year many disasters cause thousands of injuries, deaths, refugees. Depending on the kind of disaster (train/plane accident, flood, earthquake) not only an acute emergency medicine treatment but also general and family medicine and hospital treatment have to be safeguarded over a longer time-period in the disaster area. PROBLEM: Regarding to a lot of organizations, institutions and disaster teams taking part in the disaster assistance is there any lack of work or data flow in the medical treatment? METHODS: From the ODRA flood 1997, the high speed train crash in ESCHEDE 1998, the DANUBE flood 1999 and the ELBE flood in 2002 experience reports were collected. They were analysed with emphasis on data and work flow in the medical treatment and its command system: Standardised command structure? Communication problems? Used communication lines? Language problems? Medical Intelligence distribution? Use of Patient Tracking System? Triage problems? RESULTS: The use of spoken radio communication causes transmission mistakes or misunderstandings and radio-overload and need connection-set-up-time for each call. Manual distribution of same data for many receivers using different communication lines causes a time shift in the up-to-date-information. Language problems during the ODRA flood between German and Polish people led to longer reaction times. Up-to-date triage results as well as up-to-date transportation and hospital information are necessary for medical evacuation. Compared with other reports about these disasters the quality of disaster management depends on the quality of communication and information. CONCLUSION: The use of health telematics in disaster response helps to cope with the scenario. Modern technologies provide support for building up medical aid although the normal infrastructure is destroyed. To cope with disaster scenarios there are some telematic tools which can be used:--Computer-based Command and Control System--Telemedical support --Data-ressources-network /Medical Intelligence. A further study is recommended to evaluate the real impact of using these telematic tools in a disaster.

Disaster Planning↗
PubMedDate not supplied

Making policy and procedure systems work effectively.

Policy and procedure manuals can be cumbersome to keep current and updated. One approach to meet this challenge is by implementing a decentralized system to develop, review, revise and approve policies and procedures. Mechanisms to operationalize such a system involve sharing of responsibility and accountability of specified policies and procedures by various existing committees and development of coordinating systems and support mechanisms. Other key attributes of a decentralized system included collaboration and extensive communication strategies.

Humans↗
PubMed2006

Communication technology in trauma centers: a national survey.

The relationship between information and communication technology (ICT) and trauma work coordination has long been recognized. The purpose of the study was to investigate the type and frequency of use of various ICTs to activate and organize trauma teams in level I/II trauma centers. In a cross-sectional survey, questionnaires were mailed to trauma directors and clinicians in 457 trauma centers in the United States. Responses were received from 254 directors and 767 clinicians. Communication with pre-hospital care providers was conducted predominantly via shortwave radio (67.3%). The primary communication methods used to reach trauma surgeons were manual (56.7%) and computerized group page (36.6%). Computerized group page (53.7%) and regular telephone (49.8%) were cited as the most advantageous devices; e-mail (52.3%) and dry erase whiteboard (52.1%) were selected as the least advantageous. Attending surgeons preferred less overhead paging and more cellular phone communication than did emergency medicine physicians and nurses. Cellular phones have become an important part of hospital-field communication. In high-volume trauma centers, there is a need for more accurate methods of communicating with field personnel and among hospital care providers.

Analysis of Variance↗
PubMed1992

[The "Emmerich Arthritis Record", function and acceptance within the scope of an integrated treatment concept].

For a comprehensive model of rheumatoid arthritis treatment, we designed an arthritis manual for continuous treatment of chronic illness. One goal of introducing the manual to the patients was the improvement of communication between patient and different doctors and therapists. The first part includes of a doctor's documentation sheet and a patient calendar (6 months each) for daily self-documentation of drug compliance. The second part is a daily pain-rating scale. The 3-year evaluation of 655 patient manuals for 286 patients was analyzed to estimate the compliance in using the manual. Overall, 87% of diagnoses, 83% of disease-modifying anti-rheumatic drugs (DMARDs), 87% of non-steroidal anti-rheumatic drugs (NSAIDs) had been documented in the manual. Data indicates that the general practitioner and the rheumatologist accepted the manual form. In addition, 85% of the documented patients used the DMARDs, 74% used the daily pain score, and 43% the daily physiotherapy. Subgroup data (n = 130 RA patients) suggest additional results: 1) there was no difference in sociodemographic data between the patient manual user group and the non-user group; 2) the user group consisted of patients with higher disease activity (ARA-criteria), higher pain score, and negative mood pattern. Furthermore, the user group was more active in daily physiotherapy, ergotherapy, and balneotherapy.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Recommendations for the care of individuals with an inherited predisposition to Lynch syndrome: a systematic review.

CONTEXT: About 2% of all colorectal cancer occurs in the context of the autosomal dominantly inherited Lynch syndrome, which is due to mutations in mismatch repair genes. Potential risk-reducing interventions are recommended for individuals known to have these mutations. OBJECTIVES: To review cancer risks and data on screening efficacy in the context of Lynch syndrome (hereditary nonpolyposis colorectal cancer) and to provide recommendations for clinical management for affected families, based on available evidence and expert opinion. DATA SOURCES AND STUDY SELECTION: A systematic literature search using PubMed and the Cochrane Database of Systematic Reviews, reference list review of retrieved articles, manual searches of relevant articles, and direct communication with other researchers in the field. Search terms included hereditary non-polyposis colon cancer, Lynch syndrome, microsatellite instability, mismatch repair genes, and terms related to the biology of Lynch syndrome. Only peer-reviewed, full-text, English-language articles concerning human subjects published between January 1, 1996, and February 2006 were included. The US Preventive Services Task Force's 2-tier system was adapted to describe the quality of evidence and to assign strength to the recommendations for each guideline. EVIDENCE SYNTHESIS: The evidence supports colonoscopic surveillance for individuals with Lynch syndrome, although the optimal age at initiation and frequency of examinations is unresolved. Colonoscopy is recommended every 1 to 2 years starting at ages 20 to 25 years (age 30 years for those with MSH6 mutations), or 10 years younger than the youngest age of the person diagnosed in the family. While fully acknowledging absence of demonstrated efficacy, the following are also recommended annually: endometrial sampling and transvaginal ultrasound of the uterus and ovaries (ages 30-35 years); urinalysis with cytology (ages 25-35 years); history, examination, review of systems, education and genetic counseling regarding Lynch syndrome (age 21 years). Regular colonoscopy was favored for at-risk persons without colorectal neoplasia. For individuals who will undergo surgical resection of a colon cancer, subtotal colectomy is favored. Evidence supports the efficacy of prophylactic hysterectomy and oophorectomy. CONCLUSIONS: The past 10 years have seen major advances in the understanding of Lynch syndrome. Current recommendations regarding cancer screening and prevention require careful consultation between clinicians, clinical cancer genetic services, and well-informed patients.

Adult↗
PubMed1991

Chronic occupational exposure to manganese and neurobehavioral function.

Comprehensive examinations of neurobehavioral function were performed in two groups of workers with chronic exposure to industrial manganese, and two control groups. Group 1 included 17 exposed workers without parkinsonism while Group 2 consisted of four exposed workers with parkinsonian syndrome resulting from chronic manganese poisoning. Group 3 was composed of eight idiopathic parkinsonian patients while Group 4 included 19 control subjects. Age, sex, and educational level of these four groups were matched. The neuropsychological battery consisted of tests of orientation, intelligence, learning and memory, language and communication, visuospatial and visual perception, visual attention, manual dexterity, and information processing speed. There was no evidence of neurobehavioral impairment in the non-parkinsonian workers whereas impaired general intelligence, visuoperceptive impairment and defective manual dexterity, as well as slowdown in response speed were manifested in the parkinsonian workers.

Adult↗
PubMed2002

Centres for Clinical Education (CCE): developing the health care education of tomorrow--a preliminary report.

A new interdisciplinary concept of medical and health care education has been introduced at Karolinska Institute in collaboration with the County Council in Stockholm under the motto Learning together to be able to work together. Centres of Clinical Education are built up in four major hospitals to promote meeting places during clinical education for students from different categories. During a three-year project more than 5000 students from four educational programmes have been involved--medicine, nursing, occupational therapy and physiotherapy. The project started in 1998 and will turn into regular activities in 2002. The Centres consist of three parts. First is the Clinical Training Ward, a ward without patients where manual skills as well as skills in communication are taught, practised and videotaped. Second is the Clinical Education Ward, a student-driven ward where students during two-week periods experience their own professional roles in day-to-day work and learn how to work together. Third is the Multidisciplinary Team, where teachers from the four programmes plan and provide opportunities for students to learn together. Opportunities to meet and learn together have promoted a wider understanding of each professional in health care teams among students and staff. The Centres of Clinical Education provide excellent opportunities to bridge professional borders and to coordinate undergraduate studies and clinical reality.

Journal Article↗
PubMed1998

Potential for meeting clinician information requirements in an intensive care unit (ICU) via the web.

OBJECTIVE: A web interface allows ICU-oriented information to be accessed from other patient care areas and clinical applications, optimizing information integration in the hospital. In preparation for installation of a web-enabled bedside patient charting application, we attempted to maximize the percentage of our ICU-information requirements that could be met via the web and designed a web interface for accessing this information. DESIGN: A comprehensive inventory of the information needs of our ICU was made by taking an inventory of existing paper and electronic documents, manuals, handouts, patient chart elements, and clinician communication about patients. We then designed a web site, created web-based prototype applications, and linked to hospital web applications. MEASUREMENTS: Before and after implementation of the web site, each category of requirements that were identified were marked as available, partially available, or unavailable via the web. RESULTS: After implementation of the ICU web site, 56.3% of identified information category requirements (+18.3%) were available via the web, 23.9% were partially available (+4.2%) and 19.8% were still unavailable (-22.5%). Implementation of the web-enabled bedside charting application would increase the percentage of information categories available via the web to 73.2% (+16.9%) and 18.3% of required information would be partially web-accessible. CONCLUSIONS: The majority of information required by clinicians in an ICU can be made accessible via the web if a systematic approach is taken to identify needs and to develop or link to applications and web pages to meet these needs.

Evaluation Studies as Topic↗
PubMed1986

Retroactive and proactive interference effects in dual learning of blissymbolics and manual sign.

Nonspeech systems can be either aided or unaided. Each system possess its unique learning and memory characteristics. One instructional strategy designed to give learners the advantages of both systems is dual instruction in aided and unaided communication. One problem with this approach, however, might be that of retroactive and proactive interference in learning and memory. The current experiment investigated whether dual instruction in Blissymbolics and manual (ASL) sign would lead to retroactive and proactive interference. Lists of sign/symbol referents in the two systems were taught to nonhandicapped adults in a controlled setting. No effects of retroactive or proactive interference were found. Additionally, a proactive facilitation effect was found for immediate retention. Results are discussed in terms of the nature of the task, the learning memory attributes of the nonspeech systems, and the effects of sign/symbol translucency.

Communication Devices for People with Disabilities↗
PubMed2005

From monkey-like action recognition to human language: an evolutionary framework for neurolinguistics.

The article analyzes the neural and functional grounding of language skills as well as their emergence in hominid evolution, hypothesizing stages leading from abilities known to exist in monkeys and apes and presumed to exist in our hominid ancestors right through to modern spoken and signed languages. The starting point is the observation that both premotor area F5 in monkeys and Broca's area in humans contain a "mirror system" active for both execution and observation of manual actions, and that F5 and Broca's area are homologous brain regions. This grounded the mirror system hypothesis of Rizzolatti and Arbib (1998) which offers the mirror system for grasping as a key neural "missing link" between the abilities of our nonhuman ancestors of 20 million years ago and modern human language, with manual gestures rather than a system for vocal communication providing the initial seed for this evolutionary process. The present article, however, goes "beyond the mirror" to offer hypotheses on evolutionary changes within and outside the mirror systems which may have occurred to equip Homo sapiens with a language-ready brain. Crucial to the early stages of this progression is the mirror system for grasping and its extension to permit imitation. Imitation is seen as evolving via a so-called simple system such as that found in chimpanzees (which allows imitation of complex "object-oriented" sequences but only as the result of extensive practice) to a so-called complex system found in humans (which allows rapid imitation even of complex sequences, under appropriate conditions) which supports pantomime. This is hypothesized to have provided the substrate for the development of protosign, a combinatorially open repertoire of manual gestures, which then provides the scaffolding for the emergence of protospeech (which thus owes little to nonhuman vocalizations), with protosign and protospeech then developing in an expanding spiral. It is argued that these stages involve biological evolution of both brain and body. By contrast, it is argued that the progression from protosign and protospeech to languages with full-blown syntax and compositional semantics was a historical phenomenon in the development of Homo sapiens, involving few if any further biological changes.

Animal Communication↗
PubMed2005

Improved communication between doctors and with managers would benefit professional integrity and reduce the occupational medicine workload.

BACKGROUND: Professional expectations for communication skills are explicit. These skills are needed for professional integrity and personal morale. Nevertheless, occupational physicians see doctors as patients for whom communication among between doctors and with their managers are the principal cause of their presenting health problems. AIM: To describe the frameworks of professionalism in medicine and the duty to care for good communication; present issues surrounding competency in communication skills; identify health problems among doctors associated with poor communication; and consider roles of economic appraisal and preventive strategies. METHOD: A literature review identified key publications of professional expectations and requirements of doctors for their communication skills. Health problems among doctors associated with poor communication and presenting at least twice in a National Health Service (NHS) occupational health (OH) department during January-December 2002, were sought by manual retrieval of all doctor-patient records. The categories of communication difficulty were agreed in the focus group discussion of the presenting problems with occupational physicians. RESULTS: Nine categories of communication difficulties among doctors resulting in their presentation in OH departments with health problems were identified. CONCLUSIONS: Personal health problems caused by poor communication involve considerable time and potential litigation costs. Doctors need to be reminded of their responsibilities. Opportunity cost studies would help to strengthen an evidence base for the need of doctors to adhere to the professional requirements of good communication skills.

Communication↗
PubMed1992

Signing out patients for off-hours coverage: comparison of manual and computer-aided methods.

UNLABELLED: This paper evaluates the communication of information to physicians who provide off-hours coverage to inpatients in two Family Practice residency programs. METHOD: To describe the importance and accessibility of clinical information used by on-call residents in covering hospital patients, we administered a questionnaire. Then following the use of a new computerized sign-out system in one of the programs, residents filled out the same questionnaire again. RESULTS: Residents felt that a "to do" list and information about the patient's "code status" were the most important data desired from sign-out sheets. However, 69% of residents in both programs felt that provision of this information was normally poor. Nearly all of the residents in Buffalo, using an entirely handwritten sign-out sheet, felt it was in need of improvement. Residents in Pittsburgh, using a summary aided by the hospital's computer print-out, felt this need much less acutely. After implementation of a new computerized sign-out sheet in Buffalo, residents indicated a slightly higher level of satisfaction. The work of data entry and re-entry into the computer was unpopular and inefficient. CONCLUSION: The present method of transferring information at the end of a work day is not satisfactory for residents. Provision of data summaries from existing hospital information systems is a good first step in improving data transfer. A further study of more comprehensive automated sign-out systems is important, because of the increasing discontinuity of house officer care.

Attitude to Computers↗
PubMed2000

Chiropractic through the eyes of physiotherapists, manual therapists, and osteopaths in The Netherlands.

OBJECTIVES: To identify current perceptions and levels of awareness of chiropractic among physiotherapists, osteopaths, and manual therapists in The Netherlands. In addition, to investigate how future communication and interprofessional collaboration between the four professions may be improved in the interests of patient care as perceived by these groups. DESIGN: Four hundred and ninety-four (494) questionnaires were distributed to 100 manual therapists, 299 physiotherapists, and 95 osteopaths across The Netherlands. Questionnaires were identical for each profession. RESULTS: An overall response rate of 48% was achieved. The majority of practitioners reported limited knowledge of chiropractic. However, chiropractic was generally perceived as a primary health care profession most suited to extramural care. Sixty-seven percent (67%) of the manual therapists regarded it as direct competition, while 45% of the osteopaths and 48% of physiotherapists considered chiropractic complementary to their professions. While the majority of osteopaths felt that statutory self-regulation should be granted to chiropractors in The Netherlands, this was not supported by the manual therapists and physiotherapists. Moreover, there was only minimal (4%-11%) support for the availability of chiropractic treatment as part of the Dutch National Health Service. Although most respondents had never had contact with a local chiropractor, all osteopaths and 50% of the manual therapists and physiotherapists considered chiropractors to be skilled practitioners. However, this was more likely to be so if they had had contact with a chiropractor in the past. Current levels of communication and cooperation were thought to be poor to nonexistent although the majority welcomed closer links, particularly in relation to the treatment of spinal complaints. CONCLUSION: Greater awareness appears to be associated with increased levels of interprofessional acceptance and respect. The professions may wish to pursue areas of broad agreement identified by their practitioners in the interests of professional development and optimal standards of care for individuals in need of musculoskeletal services.

Adult↗
PubMed1986

Deaf children's expression of communicative intentions.

This study investigated the expression of communicative intentions by 3-year-old hearing-impaired children who were learning a system for manually coded English. Children were videotaped in their homes, interacting with their mothers. Children's communicative expressions were identified and coded according to a system modified from those developed to describe hearing children's pragmatic functioning. Between 4.5 and 5.5 communicative expressions were produced per minute. A large proportion of the expressions consisted of social or imperative intentions while a much smaller proportion were used for heuristic or informational purposes. Implications for the deaf children's future language use and development are discussed. The data presented provide some guidelines for pragmatic expectations for young deaf children and may help clinicians to identify deaf children who have developmental problems in addition to their hearing loss.

Child, Preschool↗