The New York State Model Suicide Prevention Training Program for local corrections officers.
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Communication↗
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Results for “Manual Communication”
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Hands-free speech after surgical voice rehabilitation with a Provox voice prosthesis: experience with the Provox FreeHands HME tracheostoma valve system.
Excellent results have been reported with the use of voice prostheses for the rehabilitation of laryngectomees. Patients, however, consider it a disadvantage that the tracheostoma must be closed manually for speech production. This limits their ability to simultaneously communicate by gesture or to work with both hands. An automatic tracheostoma valve helps patients overcome this problem. We describe a prospective clinical trial evaluating our experience with the Provox FreeHands HME Automatic Tracheostoma Valve system. Twenty-four laryngectomees were randomly selected from the patients who had undergone laryngectomy at the ENT Department. Immediately, after 4 weeks and 6 months later having been fitted with a Provox FreeHands HME, the patients were asked to complete a questionnaire in order to assess their satisfaction, voice quality, wearing comfort, fixation, potential problems, and the effectiveness of the HME cassette. In addition, we investigated relevant voice quality parameters including dynamics range, frequency range of the speaking voice, and maximum phonation time. Seven patients discontinued the study due to problems of securing the valve to the skin (four patients) or recurrent cancer (three patients). Ten of the remaining 17 patients wore the valve daily for an average of 8.4 h. A total of 88% of the patients considered it a great advantage to be able to speak without having to use their hands. With the Provox FreeHands HME, maximum phonation time was 8.7 (+/-6.2) s and the dynamic range was 21.9 (+/-5.8) decibels. The results show that the Provox FreeHands HME Automatic Tracheostoma Valve system not only allows hands-free speech but is also associated with excellent compliance and good voice rehabilitation.
Adult↗
An investigation of semantic priming in schizophrenia using a new priming paradigm.
In the present study, twenty schizophrenic patients and twenty healthy controls were tested in a new priming paradigm that allows a clear distinction to be made between automatic, perceptual priming effects and effects related to decision bias. Participants had to identify briefly presented masked target words preceded by clearly visible primes that were semantically related to the target or not. Target presentation duration corresponded to a pre-determined perceptual threshold for each participant, and a two-alternative forced-choice methodology was used. Equivalent amounts of semantic priming were found in schizophrenic patients compared with healthy controls. However, for the schizophrenic patients, a positive correlation was found between the size of automatic perceptual priming effects and formal thought disorders, as measured by Andreasen's Thought, Language and Communication (TLC) scale. The new paradigm tested in the present study overcomes some of the limitations of prior research on semantic priming in schizophrenia, and provides further evidence suggesting that an increased spreading of activation in the semantic network could partly underlie formal thought disorders in schizophrenia.
Cognition Disorders↗
Drug utilization reviews of oral quinolone, cephalosporin, and macrolide use in nonacute care: a systematic review.
Drug utilization review (DUR) is a tool for monitoring the appropriateness of physicians' prescribing patterns. The present systematic overview was undertaken to determine the extent of appropriate use of oral quinolones, cephalosporins, and macrolides in nonacute-care settings in North America reported in published DUR studies. Potentially relevant DURs conducted since 1987 were retrieved from an electronic search of 6 databases (augmented by manual searches of bibliographies of appropriate articles) and from personal communications with local experts. Independent reviewers applied objective criteria to select the DURs for inclusion. Quality assessments were performed by 4 independent reviewers using the Edmonton Quality Assessment Tool for Drug Utilization Reviews, an instrument developed to assess the potential for systematic bias in a DUR. Data from the studies included were abstracted independently by 2 reviewers using a standard data-collection form. Twelve of 587 (2.0%) articles met the inclusion criteria. Eight studies targeted the appropriateness of prescriptions for ciprofloxacin (appropriateness range, 5% to 95%), 3 included cephalosporins (range, 0% to 100%), and 2 examined erythromycin (40%). There were 2 primary reasons for a rating of inappropriate: (1) the prescription was not first-line therapy, or (2) there was insufficient documentation in the patient record. The designation inappropriate did not mean that the drug did not benefit the patient. Of the 4 intervention-based DURs, 1 study showed a significant improvement in appropriate use. Because of heterogeneity in study design, delivery of interventions, and outcome assessment, a pooled estimate of effect was not derived. Four studies estimated the cost of inappropriate prescribing to the institutional study site, which ranged from $20,500 to $173,359 annually; however, these estimates cannot be generalized because of various limitations. When the 12 studies were assessed for methodologic quality, 1 study was rated as high, 7 as moderate, and 4 as low. Levels of prescribing appropriateness reported in the DUR literature should be interpreted cautiously. The DUR studies included in this review varied greatly in the methodologic rigor applied to sample selection, standardized data collection, application of standardized screening criteria, and validated data analysis.
Bacterial Infections↗
Interrater reliability of Alzheimer's disease diagnosis.
To determine interrater reliability of dementia diagnosis, 4 physicians experienced in the evaluation of dementia patients applied 3 sets of diagnostic criteria to each of 62 patients, based on a standardized set of medical record information. All patients had undergone similar examinations and follow-up to establish the initial clinical diagnosis (76% had autopsy). Raters were blind to the diagnosis and to follow-up information after the initial evaluation period. This paper presents interrater agreement (kappa values) for a diagnosis of Alzheimer's disease using the American Psychiatric Association diagnostic criteria from the Diagnostic and Statistical Manual (DSM-III), the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) criteria for the clinical diagnosis of Alzheimer's disease, and the Eisdorfer and Cohen Research Diagnostic Criteria (ECRDC) for primary neuronal degeneration. The NINCDS showed somewhat higher average interrater reliability (kappa = 0.64) than the DSM-III (kappa = 0.55) and considerably higher interrater reliability than the ECRDC (kappa = 0.37). One rater displayed conspicuously lower levels of interrater reliability than the other 3, especially in DSM-III and ECRDC. This study indicates that interrater reliability of DSM-III and NINCDS criteria are comparable. Documentation of interrater reliability and, if necessary, training to improve reliability is an important consideration in research where different observers are diagnosing dementing illnesses.
Aged↗
Variability in lay perceptions of depression: a vignette study.
This paper describes a study investigating lay perceptions of depression in terms of perceived severity. Students (N = 128) were presented with vignettes describing individuals with symptoms of depression based on DSM-IV. The descriptions were varied in terms of gender, social status, and a self-referent manner of communicating depressive symptomatology. Participants were asked to rate the degree to which vignette characters were thought to be depressed on a Likert-type scale. Results indicate that a non-self-referent style of communicating depressive symptoms by female vignette characters was seen as an indication of elevated levels of depression, and these findings are discussed with reference to the literature.
Adult↗
Personnel practices can help discourage unionization.
Unionization presents a potential source of cost escalation for hospitals, particularly involving health benefits. The best way to minimize chances that staff members will opt for union representation is to develop personnel practices that demonstrate management's commitment to treating employees fairly, such as providing competitive salaries and benefits, scheduling regular meetings to address worker questions, and developing detailed policy handbooks.
Attitude of Health Personnel↗
Traumatic pneumocephalus: a hazard of resuscitators.
A patient with traumatic pneumocephalus following use of an oxygen-powered resuscitator with a face mask is presented. Pressures of 50 cm H2O delivered by the device apparently were sufficient to force air into the cranium through a fracture communicating with the nasal cavity. The authors feel that manual-powered resuscitators should be used on patients suspected of skull fracture.
Adult↗
Factors that influence cancer patients' anxiety following a medical consultation: impact of a communication skills training programme for physicians.
BACKGROUND: No study has yet assessed the impact of physicians' skills acquisition after a communication skills training programme on the evolution of patients' anxiety following a medical consultation. This study aimed to compare the impact, on patients' anxiety, of a basic communication skills training programme (BT) and the same programme consolidated by consolidation workshops (CW), and to investigate physicians' communication variables associated with patients' anxiety. PATIENTS AND METHODS: Physicians, after attending the BT, were randomly assigned to CW or to a waiting list. The control group was not a non-intervention group. Consultations with a cancer patient were recorded. Patients' anxiety was assessed with the State Trait Anxiety Inventory before and after a consultation. Communication skills were analysed according to the Cancer Research Campaign Workshop Evaluation Manual. RESULTS: No statistically significant change over time and between groups was observed. Mixed-effects modelling showed that a decrease in patients' anxiety was linked with screening questions (P = 0.045), physicians' satisfaction about support given (P = 0.004) and with patients' distress (P < 0.001). An increase in anxiety was linked with breaking bad news (P = 0.050) and with supportive skills (P = 0.013). No impact of the training programme was observed. CONCLUSIONS: This study shows the influence of some communication skills on the evolution of patients' anxiety. Physicians should be aware of these influences.
Adult↗
Dupuytren's disease: relation to work and injury.
The present status of adjudication for workers claiming compensation for Dupuytren's disease is inconsistent and, therefore, unfair to both workers and employers. In some Eastern European countries Dupuytren's disease is classified as an industrial disease, whereas in other countries it is considered to have no relation to manual work or hand injury. In jurisdictions that sometimes award compensation, the reasons for acceptance or rejection of a claim vary from case to case and are not necessarily based on our present knowledge of the disease. The purpose of this communication is to highlight the features of Dupuytren's disease that are pertinent to manual work and hand injury and to suggest guidelines that would provide some consistency in the adjudication process. It is hoped that these guidelines would be valuable to the individual surgeon, insurance agencies, and compensation boards.
Dupuytren Contracture↗
Impact of automation on aircrew communication and decision-making performance.
Increasing levels of automation are being introduced into the cockpit. Yet, it is difficult to predict the impact of these automatic systems on other elements of flight, such as crew communication and the ability to arrive at an effective decision. This study attempted to clarify the relation among these variables. Forty-eight pilots were assigned to two-person crews and asked to fly a simulated mission in either automated or manual conditions using a low-fidelity simulator. The scenario was designed to require crewmembers to arrive at a collective decision based on information obtained about an evolving simulated disaster. The results indicated that the introduction of automation was not associated with better performance. However, several significant differences were observed in the communications of crews flying in the automated versus manual conditions. The results are discussed in terms of their implications for communications training for advanced technology aircraft.
Adult↗
Manual action in infant chimpanzees: a preliminary study.
In human infants, index finger extension is shown frequently even from 3 months old, and it is considered that such pointing develops into deictic and communicative pointing however, there are many reports that chimpanzees do not point with the index finger. In the present study the manual actions of two infant chimpanzees were observed when the experimenter was trying to make eye contact with them. The result shows that pointing was shown very rarely by these infant chimpanzees even morphologically.
Aging↗
Transforming the traditional discharge planning manual.
Discharge planning resources change frequently, and keeping them current, available, and accessible to case management (CM) staff and others is a challenge. Given the time-consuming and labor-intensive nature of updating, many organizations revise them in preparation for the tri-annual survey or when they are hopelessly out-of-date. The reality is that CM staff and others involved with discharges have their own personal "little black book" of resources. Those personal reference tools are treated with reverence and guarded like the family Bible. Organizations are challenged to have up-to-date resources available and accessible for staff in all areas. One approach is to transform the traditional paper-based manual into an electronic document and make it available on the organization's intranet. This approach means that each page of the current paper-based manual must be in electronic format, ending the use of overcopied resources that become difficult to read and "grandfathered in" to each successive edition of the paper manual. This option permits easy and rapid updates when resources and information change.
Academic Medical Centers↗
The doctor-patient relationship in medical textbooks and manuals of the eighteenth and nineteenth centuries.
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Communication↗
Disaster-readiness of medical facilities in Aichi Prefecture.
One month following the Great Hanshin Earthquake of January 17, 1995, we conducted a survey of 173 hospitals in Aichi Prefecture to pinpoint problems related to their actual disaster-readiness and the medical backup systems in place to deal with such disasters. This study revealed that staff at 50% of the surveyed hospitals could reach the hospital within an hour, but that communication is almost entirely dependent on phone lines, suggesting that cordless/portable/mobile phones, radio systems, Internet, communications satellites and the like should be studied in the days to come for possible use as effective communication alternatives in times of disaster. Whereas 92% of the surveyed hospitals had manuals dealing with fire outbreaks, other areas were less well represented. For example, only 36.9% of surveyed hospitals had manuals for earthquakes, 31.7% had manuals for power outages and 14.2% had manuals to deal with flooding and water disasters. New manuals must be developed incorporating the key points garnered from experience (especially Hanshin) and be ready for use immediately. It is the time for each hospital to seriously rethink the measures it should take to deal with disasters.
Communication↗
Factors that influence physicians' detection of distress in patients with cancer: can a communication skills training program improve physicians' detection?
BACKGROUND: No study to date has assessed the impact of skills acquisition after a communication skills training program on physicians' ability to detect distress in patients with cancer. METHODS: First, the authors used a randomized design to assess the impact, on physicians' ability to detect patients' distress, of a 1-hour theoretical information course followed by 2 communication skills training programs: a 2.5-day basic training program and the same training program consolidated by 6 3-hour consolidation workshops. Then, contextual, patient, and communication variables or factors associated with physicians' detection of patients' distress were investigated. After they attended the basic communication skills training program, physicians were assigned randomly to consolidation workshops or to a waiting list. Interviews with a cancer patient were recorded before training, after consolidation workshops for the group that attended consolidation workshops, and approximately 5 months after basic training for the group that attended basic training without the consolidation workshops. Patient distress was recorded with the Hospital Anxiety and Depression Scale before the interviews. Physicians rated their patients' distress on a visual analog scale after the interviews. Physicians' ability to detect patients' distress was measured through computing differences between physicians' ratings of patients' distress and patients' self-reported distress. Communication skills were analyzed according to the Cancer Research Campaign Workshop Evaluation Manual. RESULTS: Fifty-eight physicians were evaluable. Repeated-measures analysis of variance showed no statistically significant changes over time and between groups in physicians' ability to assess patient distress. Mixed-effects modeling showed that physicians' detection of patients' distress was associated negatively with patients' educational level (P = 0.042) and with patients' self-reported distress (P < 0.000). Mixed-effects modeling also showed that physicians' detection of patient distress was associated positively with physicians breaking bad news (P = 0.022) and using assessment skills (P = 0.015) and supportive skills (P = 0.045). CONCLUSIONS: Contrary to what was expected, no change was observed in physicians' ability to detect distress in patients with cancer after a communication skills training programs, regardless of whether physicians attended the basic training program or the basic training program followed by the consolidation workshops. The results indicated a need for further improvements in physicians' detection skills through specific training modules, including theoretical information about factors that interfere with physicians' detection and through role-playing exercises that focus on assessment and supportive skills that facilitate detection.
Communication↗
Timed intercourse versus intra-uterine insemination with or without ovarian hyperstimulation for subfertility in men.
BACKGROUND: Although intra-uterine insemination (IUI) is widely used, however its effectiveness remains a matter of debate. Although IUI is less invasive and expensive than IVF or GIFT, it should only be applied if the probability of conception is improved significantly as compared to the natural chance of conceiving. To increase the number of available oocytes at the site of fertilization, controlled ovarian hyperstimulation (COH) can be applied in conjunction with IUI. Uncontrolled studies suggest a beneficial effect of COH in combination with IUI, also when a male factor is present. To be able to draw firm conclusions whether IUI and/or COH improve the probability of conception, several comparisons should be performed in randomized controlled trials (RCTs). OBJECTIVES: To determine for male subfertility whether intrauterine insemination (IUI) improves the probability of conception compared with timed intercourse and whether the addition of controlled ovarian hyperstimulation influences the results. SEARCH STRATEGY: 1. The specialist database of the Cochrane Menstrual Disorders and Subfertility Group. 2. Medline search. 3. Embase search. 4. DDFU search. 5. BIOSIS search. 6. SCIsearch. 7. Manual searching of references mentioned in the obtained studies. 8. Personal communication and write letters to experts (14) in the field. 9. Abstracts of The American Society for Reproductive Medicine and European Society for Human Reproduction and Embryology Meetings. When important information is lacking from the original publications the authors will be contacted. SELECTION CRITERIA: Randomized controlled trials only. DATA COLLECTION AND ANALYSIS: Independently by the first 2 authors: 1. Trial design characteristics. 2. Baseline characteristics of participants. 3. Types of intervention. 4. Outcomes where pregnancy is the outcome of main interest. Number of multiple pregnancies and number of cycles with ovarian hyperstimulation syndrome (OHSS) are secondary outcomes. Analysis of agreement between the two observers was determined for the following items: inclusion or exclusion of a trial, method of randomization, definition of male subfertility, design of the trial, number of pregnancies and completed cycles. Sensitivity analysis is performed. MAIN RESULTS: Seventeen trials fulfilled the selection criteria for this review and were included. Four trials are pending. Crude agreement concerning inclusion or exclusion of trials occurred for 41 of 43 (95%) trials reviewed (kappa 0.90). The included trials comprised 3,662 completed cycles. In natural cycles intrauterine insemination (IUI) significantly improved the probability of conception compared with timed intercourse (TI) (combined odds ratio with 95% confidence intervals: 2.43, 1.54 - 3.83). In cycles with controlled ovarian hyperstimulation (COH) IUI significantly improved the probability of conception also compared with TI (combined odds ratio with 95% confidence intervals: 2.14, 1.30 - 3.51). Despite clinical heterogeneity, these results are based on strong evidence. Intrauterine insemination in cycles with COH improved the probability of conception compared with IUI in natural cycles but significance was not reached (combined odds ratio with 95% confidence intervals: 1.79, 0.98 - 3.25). Comparing IUI in COH-cycles with TI in natural cycles the first treatment modality significantly improved the probability of conception (combined odds ratio with 95% confidence intervals: 6.23, 2.35 - 16.52). REVIEWER'S CONCLUSIONS: Intra-uterine insemination offers couples with male subfertility benefit over timed intercourse, both in natural cycles and in cycles with COH. In the case of a severe semen defect (with more than 1 million motile sperm after semen preparation and no triple sperm defect) IUI in natural cycles should be the treatment of first choice. The value of COH need to be further investigated in RCTs. Mild ovarian hyperstimulation with gonadotrophins is advised in cases with less sever
Coitus↗