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PubMed2004

Development of a multilingual resource manual.

Providing culturally competent health care is a growing need as the population of culturally diverse women continues to rise. Compilation of a multilingual resource manual about maternal-child and women's health topics that can be used by health educators to provide care to non-English-speaking and limited English proficiency (LEP) clients was achieved to address this need. In this article, significant details of this process are described allowing the reader to produce a similar version of the manual.

Communication Barriers↗
PubMed2004

A framework and toolkit for capturing the communicable disease programmes within health systems: tuberculosis control as an illustrative example.

The frameworks and methods used for analysis, monitoring and evaluation of communicable disease control vary greatly. Although a number of manuals exist instruments for a detailed analysis of wider health system context are lacking. This is surprising given that the success of vertical programmes is often determined by the constraints of health systems. The importance of the context and the health system in determining the successful implementation of national tuberculosis programmes is well recognized by the WHO, which recommends analysis of national tuberculosis programmes within the context of health care system, health reform and the economic status of the country. However, current approaches inadequately capture intelligence on the health systems variables impacting on programme efficacy, limiting the ability of policy makers to draw lessons for wider use. A recent WHO report highlights the major systemic constraints to DOTS implementation and recommends a comprehensive and multi-sectoral approach to tuberculosis control. This obviates the need for tools that take into account health systems issues as well as focusing on a particular vertical programme but no such comprehensive tool exists. This paper outlines the conceptual basis for a model and a toolkit for rapid assessment, monitoring, and evaluation of the context, the elements of the health system and vertical communicable disease programme. It describes the framework, the potential strengths and weaknesses, approach and piloting of the toolkit and its two elements: first for 'horizontal assessment' of the health system within which the programme is embedded and second for 'vertical assessment' of the infectious disease-specific programme.

Communicable Disease Control↗
PubMed1991

Body communication is a continuous process. The first encounter between patient and physiotherapist.

First encounters between patients and physiotherapists have been video-taped and analysed as part of a research project encompassing manual, psychomotor, and district physiotherapists. The main focus in this article is on body communication. The common features and differences between the patterns of communication established by the three categories of therapists are described and compared. Since human beings function and relate to each other as physical subjects, messages of interest and involvement will in some way be conveyed through their bodies. The recognition of this fact means that body communication is a central aspect of patient-centredness. The relationship, context, and actual basis of cooperation can only be understood by analysing the way in which professionals relate to their patients through their bodies. This is because body messages are conveyed continuously in any encounter between two people, while verbal communication is discontinuous.

Communication↗
PubMed2000

Multisign combinations by children with intellectual impairments: an analysis of language skills.

Research suggests that people with intellectual impairments who use manual signs to augment or substitute for speech rarely progress beyond the stage of single signs and that word order is particularly problematic. However, the majority of studies have focused on experimental tasks, and relatively little is known about spontaneous sign production in naturalistic settings. The present study explored the linguistic development in sign and speech of 10 children who relied on manual signs (the Makaton vocabulary) as their main means of communication. Mean utterance length in sign ranged from 1.0 to 2.5, and analysis of semantic relations, lexical development, and word order suggested that the children had not developed their language beyond MLU Stage I. Examination of their abilities within the modality of sign indicated that some children were able to manipulate features of sign at a sublexical level. The results are discussed in relation to the language input by teachers, and inferences are drawn regarding the underlying modality of linguistic representation in children who use manual signs.

Adolescent↗
PubMed2003

Alpha-fetoprotein and/or liver ultrasonography for liver cancer screening in patients with chronic hepatitis B.

BACKGROUND: Chronic hepatitis B infection may cause liver cancer (hepatocellular carcinoma (HCC)). Alpha-fetoprotein (AFP) and liver ultrasonography (US) are used to screen these patients for HCC. It is uncertain whether screening is worthwhile. OBJECTIVES: To review randomized trials on screening for HCC with alpha-fetoprotein and/or liver ultrasonography among people with hepatitis B surface antigen (HBsAg) whether asymptomatic or with clinical liver disease. SEARCH STRATEGY: Relevant reports were searched from electronic databases until August 2002 (The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Controlled Trials Register, MEDLINE, EMBASE, HealthStar, and the Chinese Medical Literature Electronic Databases, MedCyber) supplemented with manual searches on the bibliographies of papers found and communication to people familiar with chronic hepatitis B. SELECTION CRITERIA: Randomized trials on screening for liver cancer were included irrespective of language. Studies were excluded if the hepatitis B status was uncertain, if patients were not adequately followed, if the screening tests were not sensitive, widely-used ones, or if the test was used for diagnosis rather than screening for HCC. DATA COLLECTION AND ANALYSIS: We analyzed independently all the studies considered for inclusion. We wrote to the relevant authors for further information. Data were analyzed with Peto's odds ratio (OR) with 95% confidence interval (CI). MAIN RESULTS: Two trials met the selection criteria. One trial (n = 18,816) compared bi-annual AFP plus US screening with no screening for five years. No data on all-cause mortality were available. The two groups did not differ significantly regarding HCC mortality (OR 0.81; 95% CI 0.54 to 1.22). Number of patients with HCC was significantly increased in the screeened group (OR 1.37; 95% CI 1.00 to 1.88). Most HCCs in the screened group, but none in the control group, were at an early stage. The survival rate of patients with resected HCC in the screened group reached 52.7% after three and five years, but was 0% for those in the control group. The authors' estimated lead-time for HCC was 5.4 months, suggesting that screening prolonged the survival of HCC. Another trial (n = 1069) compared AFP plus US versus AFP screening, but could not decide which approach was superior due to the small sample size (number of detected HCC: OR 0.74; 95% CI 0.26 to 2.12). REVIEWER'S CONCLUSIONS: There are not enough quality trials to support or refute screening of HBsAg-positive patients for HCC. It is possible that screening may be effective, but also that harm caused by screening/treatment may outweigh any gain. More and better-designed large randomized trials are required.

Biomarkers↗
PubMed1998

Chronic auditory agnosia following Landau-Kleffner syndrome: a 23 year outcome study.

We report a 27-year-old woman with chronic auditory agnosia following Landau-Kleffner Syndrome (LKS) diagnosed at age 4 1/2. She grew up in the hearing/speaking community with some exposure to manually coded English and American Sign Language (ASL). Manually coded (signed) English is her preferred mode of communication. Comprehension and production of spoken language remain severely compromised. Disruptions in auditory processing can be observed in tests of pitch and duration, suggesting that her disorder is not specific to language. Linguistic analysis of signed, spoken, and written English indicates her language system is intact but compromised because of impoverished input during the critical period for acquisition of spoken phonology. Specifically, although her sign language phonology is intact, spoken language phonology is markedly impaired. We argue that deprivation of auditory input during a period critical for the development of a phonological grammar and auditory-verbal short-term memory has limited her lexical and syntactic development in specific ways.

Adult↗
PubMed1987

A PC-based free text DSS for health care. Case studies and applications.

A free text decision support system (DSS) has been constructed for health care professionals that allows the analysis of complex medical cases and the creation of a diagnostic list of potential diseases for clinical evaluation. The system uses a PC-based text management system specifically designed for desktop operation. The texts employed in the decision support package include The Merck Manual (published by Merck Sharpe & Dohme) and Control of Communicable Diseases in Man (published by the American Public Health Association). The background and design of the database are discussed, along with a structured analysis procedure for handling free text DSS systems. A case study is presented to show the application of this technology and conclusions are drawn in the summary that point to expanded areas of professional interaction and new frontiers yet to be explored in this rapidly progressing field.

Decision Making, Computer-Assisted↗
PubMed1993

A cube model for the classification of work with hand tools and the formulation of functional requirements.

In an interdisciplinary research project, a model, visualized as a cube, was developed for the classification and analysis of work with hand tools and for communication of different ways of solving problems related to manual handling. The dimensions of the cube are demands of force, precision and time. Each dimension is divided into three levels of low, moderate and high demands respectively. Preliminary limits are proposed for acceptable and non-acceptable use situations and for situations that have to be investigated further. Using a case study of plate shears as a starting point, various measures of improving the position in the cube are discussed. The hand tool, the workplace, the work organization as well as the user of the hand tool are included in the analysis.

Journal Article↗
PubMed2004

A group adaptation of Interpersonal Psychotherapy for depressed adolescents.

This paper presents an overview of the adaptation of Interpersonal Psychotherapy for depressed adolescents (IPT-A) to be delivered in a group format (IPT-AG) for the treatment of depressed, nonbipolar outpatient adolescents. The model has been modified to address the challenges of working with several adolescents in a group context. It takes advantage of the group as a laboratory environment for experimenting with new ways of communicating and interacting with others. The IPT-AG manual, described in this paper, provides guidelines for working with multiple interpersonal issues and keeping the group discussion relevant to the group as a whole. These adaptations are discussed in the context of the interpersonal framework with respect to each phase of treatment. Preliminary data about the feasibility and acceptability of conducting IPT-AG are discussed.

Adolescent↗
PubMed1999

Training for telemedicine.

All technology requires training. Simply installing videoconferencing equipment in a hospital or health centre, and leaving the manufacturer's manual nearby, is not sufficient to encourage or maintain its use for telemedicine. Presenting clinicians and other users with thick policy and procedure documents to be read and understood is also not helpful. Following initial awareness raising about telemedicine and its potential, staff must be properly trained: not just in how to turn on the equipment but in how to use it effectively for consultation, education and administrative purposes. Training needs to be continual, especially where staff turnover is high. It should be practical, pitched at different levels, incorporated into mainstream activities such as orientation courses and staff development days wherever possible, and supplemented with clear, straightforward protocols and user-friendly instruction manuals.

Computer Communication Networks↗
PubMed1995

Telemedicine in rural areas. Experience with medical desktop-conferencing via satellite.

Cooperation between physicians in hospitals in rural areas can be assisted by desktop-conferencing using a satellite link. For six weeks, medical desktop-conferencing was tested during daily clinical conferences between the Virchow-Klinikum, Berlin, and the Medical Academy, Wroclaw. The communications link was provided by the German Telekom satellite system MCS, which allowed temporary connections to be established on demand by manual dialling. Standard hardware and software were used for videoconferencing, as well as software for medical communication developed in the BERMED project. Digital data, such as computed tomography or magnetic resonance images, were transmitted by a digital data channel in parallel to the transmission of analogue video and audio signals. For conferences involving large groups of people, hardware modifications were required. These included the installation of a video projector, adaptation of the audio system with improved echo cancellation, and installation of extra microphones. Learning to use an unfamiliar communication medium proved to be uncomplicated for the participating physicians.

Germany↗
PubMed1996

Increasing OR efficiency with a specialty services manual.

The successful operation of a modern ophthalmology OR is dependent on a knowledgeable, well-educated nursing staff. To improve communication and teamwork between ophthalmology surgeons and nursing staff members at the Louisiana State University Medical Center University Hospital, Shreveport, we developed an OR manual. We reduced our level of frustration by producing a manual that facilitates the day-to-day operation of the surgical services department. The manual provides consistent information for our ophthalmic surgical procedures; functions as a reference source; and promotes an efficient, productive OR. Although we designed this manual for the ophthalmology surgical service at our medical center, its structure can be applied to other surgical specialties.

Efficiency, Organizational↗
PubMed2002

Automated production of an on-line laboratory reference manual from a laboratory information system.

Laboratories provide information beyond test results, including information related to patient preparation, specimen collection and handling, test methodology, test availability, and interpretation of results. Most laboratories publish reference manuals to distribute this information to clients, while relying on the laboratory information system to provide this information to laboratory staff. Maintaining duplicate sources of information is expensive and error-prone, and printed materials become rapidly outdated. We developed a process to automate the production of a web-based reference manual directly from the laboratory information system, using a combination of MUMPS programs and HTML templates. We now focus our resources to assure that the laboratory information system database is accurate and complete, and then with minimal additional effort or expense produce an up-to-date on-line reference manual. We are therefore able to provide better sources of information in a sustainable manner.

Clinical Laboratory Information Systems↗
PubMed2001

Increased prevalence of vascular dementia in Japan: a community-based epidemiological study.

BACKGROUND AND OBJECTIVE: It has been suggested that there is a major difference in the ratio of AD to vascular dementia (VaD) between Japan and Western countries. To determine the type-specific prevalence of dementia in community-dwelling elderly from the Japanese community of Nakayama, all patients with dementing illness underwent a CT scan. METHODS: A door-to-door three-phase population survey was carried out on all persons aged 65 years and older residing at home on the prevalence day (January 1, 1997). The ascertainment of cases was made between January 1997 and March 1998. The study included a psychiatric interview; physical, neurologic, and neuropsychologic examinations; comprehensive laboratory tests; and cranial CT. A public health nurse also interviewed a person close to each subject. Dementia was defined according to the Diagnostic and Statistical Manual of Mental Disorders, third edition-revised, criteria, AD according to the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association, and VaD according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition, combined with information from the patient's neurologic history and CT scanning. RESULTS: Of 1438 inhabitants, 1162 (81.0%) completed the protocol. The prevalence of dementia was 4.8%. Of the 60 subjects with dementia, 35% had AD, 47% had VaD, and 17% had dementia resulting from other causes. CONCLUSIONS: The prevalence of dementia was similar to previous reports, but, contrary to results of virtually all studies conducted in developed countries and those recently conducted in Japan, almost half of the cases in the present study appeared to have VaD with neuroradiologic confirmation.

Aged↗
PubMed2006

Gesture handedness predicts asymmetry in the chimpanzee inferior frontal gyrus.

Neuroanatomical asymmetries have been identified in chimpanzee frontal and temporal lobes including regions believed to be homologous to human Broca's and Wernicke's areas. This study examined whether or not neuroanatomical asymmetries in chimpanzees are associated with hand use during gestural communication. Analyses revealed that those chimpanzees that reliably employ their right hand for manual gestures have larger inferior frontal gyri in the left hemisphere than those apes that do not show consistent hand use for gestures. These findings are the first to provide a direct link between neuroanatomical asymmetries and the production of lateralized communicative behavior in non-human primates.

Animals↗