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PubMed1998

A survey of communication skills training in UK schools of medicine: present practices and prospective proposals.

It is now widely accepted that effective interpersonal communication is at the heart of quality health care delivery but that current standards in medicine must be improved (Numann 1988; Cowan et al. 1992). One approach acknowledged by the General Medical Council (1991) devotes more attention during training to the theme of communication, and quite significant modifications of the undergraduate medical curriculum are presently taking place. This article documents the results of a postal survey of the 26 UK Schools of Medicine, designed to illuminate current practices and future plans in respect of communication skills training (CST). As such, it takes advantage of the present period of ongoing curricular innovation and change to extend and update earlier reviews (Whitehouse 1991; Frederikson & Bull 1992). A total of 19 responses was received. Following preliminary analysis, the four schools who had already implemented their new curriculum were selected for further in-depth investigation by means of telephone interviews. In addition to reporting frequencies and percentages for responses to questions, cross-tabulations were carried out to explore relationships between certain of the findings. Apart from some consistency in CST teaching methods adopted, the overall picture to emerge is one of considerable variability in such areas as course content, timing, duration and assessment. Foremost among the difficulties encountered in implementing CST appeared to be lack of adequate physical resources and suitably trained staff. Future plans were often sketchy and inchoate. Results are discussed and tentative recommendations for the further development of CST in the medical curriculum proffered.

Clinical Competence↗
PubMed1997

Influence of sexual abuse on HIV-related attitudes and behaviors in adolescent psychiatric inpatients.

OBJECTIVE: To investigate the associations between sexual abuse and human immunodeficiency virus (HIV)-related attitudes and behaviors of adolescents with a psychiatric disorder. METHOD: HIV-related knowledge, attitudes, and behaviors were examined by self-report assessment of adolescents admitted to a psychiatric hospital (N = 100). A subsample (n = 30) completed a role-playing exercise regarding HIV-preventive behavior that was scored for the degree of effective communication by raters blind to the subjects' abuse history. RESULTS: HIV-related risk behaviors were prevalent, including unprotected sexual intercourse (67%) and multiple partners (27%) among the sexually active (71% of the total). Also frequent were alcohol and drug use (25%) and sharing cutting instruments (22%) among those engaged in self-cutting behavior (62%). The 38% of the sample identified as having a history of sexual abuse indicated significantly poorer self-efficacy concerning condom use than their peers. Abused females scored significantly lower on the self-efficacy of condom use scale and reported significantly more frequent alcohol use than nonabused females (p = .003). A hierarchical multiple regression that controlled for consistency of condom use and tolerance of people with acquired immunodeficiency syndrome found that abuse history uniquely accounted for 16% of the variance in condom use self-efficacy. Analysis of the videotaped role-play found that abused adolescents were significantly less competent and had more difficulty in effective communication than their peers (p = .003). CONCLUSION: A history of sexual abuse is associated with impaired safe sexual decision-making and HIV-preventive communication skills, even in this already at-risk group. This study also underscores the importance of actively addressing these issues in the context of clinical care.

Adolescent↗
PubMed1991

Importance of the study protocol in epidemiologic research.

The overall quality of an epidemiologic research project depends on how well both the design and execution phases of the project have been accomplished. The written prestudy protocol, by serving as a bridge between these two project phases, plays a pivotal role in determining the success of the total research effort. The study protocol can contribute to improved observational research in four key areas. Arguments are presented for enhancing the scientific integrity of observational studies and for providing better study documentation, efficiency, and communications, all through careful prestudy planning.

Clinical Protocols↗
PubMed2004

Validation of the 'Vienna List' as a proxy measure of quality of life for geriatric rehabilitation patients.

The reason for the study was to investigate the discriminative, content- and criterion-related validity of the 'Vienna List', a newly developed proxy-rating measurement for quality of life in very old and severely demented persons. The total population of patients of a geriatric rehabilitation clinic of one year (from November 2001 to October 2002; n = 687) was evaluated at admission and discharge by means of this proxy rating method together with the mini mental state examination, the timed up and go test, the Tinetti measure, the Barthel Index, and the Katz activities of daily living list. Differences, mainly on factors communication, mobility, aggression, and negative affect, appeared between seven diagnostic groups as well between several care-related categories and destination after discharge. The five factors of the measurement explained a significant amount of variance with a high specificity and more than 50% of the Barthel Index scores. The 'Vienna List', originally developed for the assessment of quality of life in severely demented patients, proved to be a useful, differentiating, less time-consuming and practical tool for the documentation of the outcome of geriatric inpatient rehabilitation, as well.

Activities of Daily Living↗
PubMed2004

Health care lobbying in the United States.

PURPOSE: To assess the relative political influence of different organizations, we examined the efforts of health care organizations to influence policy decisions by lobbying lawmakers. METHODS: We reviewed reports filed by lobbyists from 1997 to 2000, as required by the Lobbying Disclosure Act, to characterize health care lobbying at the federal level in the United States. RESULTS: Health care lobbying expenditures totaled 237 million dollars in 2000. These expenditures accounted for 15% of all federal lobbying and were larger than the lobbying expenditures of every other sector, including agriculture, communications, and defense. A total of 1192 organizations were involved in health care lobbying. Pharmaceutical and health product companies spent the most (96 million dollars), followed by physicians and other health professionals (46 million dollars). Disease advocacy and public health organizations spent 12 million dollars. From 1997 to 2000, lobbying expenditures by physicians and other health professionals grew more slowly than lobbying by other organizations (10% vs. 26%). CONCLUSION: Although policy decisions are influenced by many factors, our findings may indicate a limited political influence of disease advocacy and public health organizations and a declining political influence of physicians and other health professionals.

Drug Industry↗
PubMed2004

The economic burden of depression and reimbursement policy in the Asia Pacific region.

OBJECTIVE: To determine the economic burden of depression in the Asia Pacific region, review the negative economic consequences attributable to depression, and describe the reimbursement policies for health-care services throughout the Asia Pacific region. METHODS: Both direct and indirect costs were obtained via a literature review of international mental health journals. Disability adjusted life year (DALYs) estimates were obtained from the World Health Organization. Reimbursement policy data were obtained from personal communication with the SEBoD International Advisory Board. RESULTS: There are only two studies of the economic costs of depression in the Asia Pacific region. From these, the total cost of depression in Australia for 1997-98 was estimated as US$1.8 billion (22% direct costs), and in Taiwan for 1994 as US$1.4 billion (25% direct costs). In the year 2000, it was estimated that unipolar major depression accounted for 14.2 million DALYs in China and 22.7 million DALYs for all other Asia Pacific countries. The majority of Asia Pacific health-care systems have extensive insurance coverage, but not specific provisions for depression. However, relatively low overall fee schedules diminish financial barriers for outpatient treatment of depression. CONCLUSIONS: Untreated depression is a very costly disorder across the Asia Pacific region, with indirect costs constituting a substantial proportion. Consequently, treatment of depression should be the focus of policy makers to avoid major negative cost repercussions. It is encouraging that most Asia Pacific health service reimbursement policies enable the treatment of depression (especially outpatient treatment) to be relatively affordable. To advance this issue, the paucity of specific information on the epidemiology of depression, as well as service use and cost, needs to be addressed.

Asia, Southeastern↗
PubMed2001

Effects of electronic communication between the GP and the pharmacist. The quality of medication data on admission and after discharge.

BACKGROUND: When a patient is admitted to a hospital, the need for information about the medications prescribed is an important issue. OBJECTIVES: Our aim was to assess whether electronic communication between the GP and the pharmacist provides better information regarding current medication when a patient is admitted to the hospital than paper-based communication. METHODS: A prospective study was carried out whereby on the day of admission and 10 days after discharge, three different data collectors independently asked the patient, the GP and the pharmacist details of the patient's current medication. Five GPs and a local pharmacy relying on electronic communication, and five GPs and a local pharmacy relying on paper-based communication were studied. RESULTS: A total of 139 patients were included on the first day of their admission, and 116 on the tenth day after discharge. Of the 275 drugs that the patient, the GP and/or the pharmacist reported on admission in the electronic group, 134 (49%) were reported by the patient, the GP and the pharmacist, and 79 (29%) were not reported by the patient. For the paper group, these figures were 340 drugs on admission, of which 107 (31%) were reported by the patient, the GP and the pharmacist, while 130 (38%) were not reported by the patient. CONCLUSIONS: We conclude that electronic communication between the GP and the community pharmacist results in a better agreement between them with respect to the current medication of the patient than paper-based communication. However, electronic communication does not suffice as a solution to obtain reliable information.

Clinical Pharmacy Information Systems↗
PubMed2002

Examination of primary care characteristics in a community-based clinic.

PURPOSE: To (a) examine the reliability and validity of the Primary Care Assessment Survey (PCAS), (b) describe the primary care characteristics of a community-based clinic in an underserved area in Appalachia, (c) examine the relationships between primary care characteristics and socioeconomic factors, (d) compare and contrast patients who have regular providers of care with those who did not have regular providers of care; and (e) examine provider primary care characteristics that predict comprehensive knowledge of patients. DESIGN: Data for this cross-sectional survey (N = 227) were collected over a 4-month period using face-to-face interviews at a not-for-profit, community-based clinic serving patients in three Appalachian states in the southeastern United States. METHODS: The PCAS was used to measure 11 domains of primary care provider performance and to identify and group patients who had regular providers of care (n = 126) and patients who did not have regular providers of care (n = 98) at the clinic. FINDINGS: Cronbach's coefficient alpha for the total scale was .74 after deleting one subscale. Factor analysis revealed one PCAS dimension, Communication, accounting for 44% of the total variance. Primary care providers' Interpersonal Treatment and Longitudinal Continuity were predictors of Comprehensive Knowledge of the patient and accounted for 26% and 6% of the variance, respectively. CONCLUSIONS: The PCAS showed evidence of reliability and validity with underserved Appalachian patients receiving care in a community-based clinic. The findings showed that patients receiving care from primary care providers had sustained relationship that affected communication aimed at improving primary care outcomes.

Adult↗
PubMed2002

Newborn screening program practices in the United States: notification, research, and consent.

OBJECTIVE: To define current practice among US newborn screening programs for notification of results, research, and consenting procedures. METHODS: A telephone survey of all US newborn screening program supervisors. RESULTS: All 51 programs participated. All states reported abnormal results to the infant's physician, and some also reported to the hospital and parents. Cases with abnormal results were tracked to different endpoints but usually (92.1%) at least until a follow-up appointment was made. A total of 66.6% of programs can communicate with programs in other states; 9.8% enable families to suppress reporting of results to the infant's physician. No state has a mechanism for parents to prevent results from entering the medical record. Parents or physicians who request results are often authenticated by providing their name (52.9%). Many programs (45.1%) report only to physicians and require just their name (43.5%), an identification number (17.4%), a letter (26.1%), or a parent's signature (26.1%). A total of 70.6% retain residual blood samples; of these, only 8.3% store them completely devoid of patient identifiers. A total of 49.0% of programs aggregate data for research. In 16.0% of these, the data are publicly available. In 24.0%, researchers obtain approval at their own institution; in 24.0%, researchers obtain approval through the state laboratory Institutional Review Board. In 74.5% of programs, parents are notified but not asked for consent before collection of the sample; 19.6% neither notify parents nor obtain consent before screening. CONCLUSIONS: There is wide variation in practice among the US newborn screening programs. Because the programs collectively manage a comprehensive nationwide genomic databank, careful consideration of how information technology and high-throughput genomic analysis are used will be essential to allow progress in clinical care, public health, and research while protecting individual privacy.

Communicable Disease Control↗
PubMed2001

[Experience in surgical treatment of 110 patients with craniopharyngiomas].

OBJECTIVE: To study the effective method for surgical treatment of craniopharyngioma. METHODS: 110 patients with craniopharyngioma were operated on. Their tumors were totally removed. Of the 110 patients, 62 were male and 58 female, with age ranging from 15 to 67 years (mean 34.4 years). Pterional approach was performed in 102 patients, subfrontal approaches in 5, and transcallosum into the anterior third ventricle part in 3. The perforating arteries from the carotid, posterior and anterior communicating and anterior choroidal arteries to the hypothalamic structures were preserved when the tumors were excised by pterional approaches via the parachiasmal opticocarotid, carotidotentorial spaces and by opening the lamina terminals. The neural structures of the third ventricular floor were preserved by the transcallosum approach to the anterior part of the third ventricular floor. The cystic fluid was initially aspirated from cystic tumors, solid portion of the tumor was excised by piecemeal and calcification mass was crushed for removal. RESULTS: Of the 110 patients, 101 had a total removal of tumor, 7 a subtotal removal of tumor, and 3 a partial removal of tumors. The pituitary stalk was preserved in 57 patients, ruptured in 29, and unidentified in 24. In 54 patients with diabetes insipidus after surgery, 52 recovered from 3 months to one year after surgery and only two patients failed to over one year after surgery. 52 patients had normal blood sodium level 3 months after surgery. Three patients after surgery had decreased visual acuity. In 3 patients with oculomotor paralysis after surgery, one failed recover till one year. Two patients after surgery had temporal paralysis of the extremities. All the patients after surgery were followed up for one month to five years (mean, 1.1 years). Four patients died after surgery. CONCLUSIONS: The proper surgical approaches for the removal of craniopharyngiomas are the key to achieve good surgical results and avoid the injury to the hypothalamic structures and the perforating arteries to hypothalamus.

Adolescent↗
PubMed2005

Tositumomab and (131)I therapy in non-Hodgkin's lymphoma.

UNLABELLED: Tositumomab and (131)I-tositumomab constitute a relatively new radioimmunotherapeutic regimen for patients with CD20+ follicular non-Hodgkin's lymphoma (NHL). Currently, it is approved for use in patients whose disease has relapsed after chemotherapy and is refactory to rituximab, including patients whose tumors have transformed to a higher histologic grade. This review outlines the current and evolving status of this therapeutic regimen at nonmyeloablative doses. METHODS: Clinical data from multiple published studies and preliminary communications encompassing more than 1,000 patients were reviewed to describe the current status of tositumomab and (131)I-tositumomab therapy. The therapy is delivered in 2 parts, a dosimetric dose and a therapeutic dose. The therapeutic radioactivity millicurie dose is calculated on a patient-individualized ("tailored") basis. A series of 3 total-body gamma-camera scans are used to determine the patient-specific pharmacokinetics (total-body residence time) of the radiolabeled antibody conjugate required to deliver the desired total-body radiation dose, typically 75 cGy. RESULTS: In clinical trials, objective response rates in patients who had been extensively pretreated with chemotherapy ranged from 47% to 68%. Tositumomab and (131)I-tositumomab therapy also was effective in patients who had failed to respond to or who had relapsed after rituximab therapy, with a 68% overall response rate. Thirty percent of such patients achieved complete responses that were generally of several years duration. Single-center trials using tositumomab and (131)I-tositumomab therapy alone or after chemotherapy in previously untreated patients have shown response rates in excess of 90%, with most responses complete. Retreatment with tositumomab and (131)I-tositumomab and use of lower total-body radiation doses of tositumomab and (131)I-tositumomab to treat patients who have relapsed after stem cell transplantation have been shown feasible in limited clinical studies. Toxicity is predominately hematologic; however, human antimouse antibodies, hypothyroidism, and myelodysplastic syndrome have been reported in a small fraction of patients. CONCLUSION: Tositumomab and (131)I-tositumomab therapy at patient-specific, nonmyeloablative doses is safe and effective in treatment of relapsed and refractory follicular NHL. Toxicity is mainly hematologic and reversible. Tositumomab and (131)I-tositumomab therapy is assuming a growing role in this common malignancy.

Animals↗
PubMed1983

Optimum fourier filtering of cardiac data: a minimum-error method: concise communication.

Random fluctuations limit the accuracy of quantities derived from cardiac time-activity curves (TACs). To overcome this problem, TACs are often fitted with a truncated Fourier series giving rise to two sources of error: (a) the truncated series may not adequately describe the TAC shape, causing errors in parameters calculated from the fit: and (b) successive TACs acquired from the same subject under identical circumstances will fluctuate due to limited counts, causing the Fourier fits (and parameters derived from them) to fluctuate. These two errors, respectively, decrease and increase as the number of harmonics increases, suggesting the existence of a minimum in total error. This number of harmonics for minimum error (NHME) was calculated for each of six common parameters used to describe LV TACs. The "true" value of each parameter was determined from TACs of very high statistical precision. Poisson noise was added to simulate lower count rates. For low-count TACs, use of either a smaller or a larger number of harmonics resulted in significantly greater error. NHME was found to occur at two harmonics for the systolic parameters studied, regardless of the noise level present in the TAC. For diastolic parameters, however, NHME was a strong function of the noise present in the TAC, varying from three harmonics for noise levels typical of regional TACs, to five or six harmonics for high-count global TACs.

Diastole↗
PubMedDate not supplied

Placement of mechanically detachable spiral coils in the endovascular treatment of intracranial aneurysms. Work in progress.

PURPOSE: To determine the usefulness of mechanically detachable spiral tungsten coils (MDSs) in the endovascular, endosaccular occlusion of intracranial aneurysms. MATERIALS AND METHODS: Anterior communicating artery aneurysms shown at angiography in two patients and a basilar tip aneurysm shown in one patient were treated with MDSs. RESULTS: In the basilar artery aneurysm, eight coils were delivered. Two additional coils were placed at 3 months because of filling of the residual aneurysm neck. Angiography at 1 year showed no recanalization. The smaller aneurysm in the anterior communicating artery was totally occluded by a single coil. Angiography at 6 months showed no recanalization. The other aneurysm was occluded by two coils, with a small amount of residual filling. A third coil was withdrawn before detachment. The patient had aspiration pneumonia and electrolyte imbalance, but he was in stable condition 3 weeks later and was discharged. CONCLUSION: The pliable, soft, retrievable MDS system provides instantaneous release of a spiral coil.

Adult↗
PubMed2001

[Factor structure of the Autism Diagnostic Interview-Revised (ADI-R): a study of dimensional versus categorical classification of autistic disorders].

OBJECTIVES: This study investigated whether empirically derived dimensions of autistic behavior are consistent with the content-valid construction of the autistic behavior domains according to ICD-10 and DSM-IV (social interaction, communication and repetitive, stereotyped behavior). METHODS: A principal component exploratory factor analysis routine with varimax-rotation and extraction of factors following the Scree criterion was run using data from the Autism Diagnostic Interview-Revised (ADI-R) of N = 262 individuals exhibiting autism or autistic features. RESULTS: A three-factor solution consisting of two socio-communicative and one language dimension and accounting for 46.1% of the total variance was found to best describe the data. These factors yielded only vague correspondence with the idea of behavior domains described in ICD-10 and DSM-IV. In addition, factor loadings of items representing repetitive, stereotyped patterns were generally weak. CONCLUSIONS: The factor-analytic approach to autism indicates a conception of the disorder divergent from that defined in the contemporary psychiatric classification systems, especially regarding the area of repetitive, stereotyped behavior.

Adolescent↗
PubMed2000

The impact of the quality of family planning services on safe and effective contraceptive use: a systematic literature review.

The aim of this review is to identify the features of family planning service provision that are influential in ensuring safe and appropriate contraceptive use and optimal effectiveness of user-dependent methods. A systematic search was carried out of the published and unpublished studies available up to December 1997 that examined the relationship between family planning service provision and contraceptive use. Articles that reported primary data on long-term outcomes were scored by at least two of the authors of the present study. Particular attention was paid to evaluating methods of measuring quality of care. A total of 142 articles were identified, but only 16 reported primary data relating to long-term outcomes. The quality of provider--client exchanges was found to have a net incremental effect on contraceptive use. Evidence of effectiveness of methods to improve uptake, continuation of method use, and safe and appropriate use of fertility control is scant. The evidence that is available indicates that training in communication with clients (particularly about side-effects of contraceptive methods) and an emphasis on client choice are key components of effective interventions. The tasks of listening to clients, and tailoring services to local needs, are crucial to the success of family planning service provision.

Journal Article↗
PubMed1991

Italian experience of voice restoration after laryngectomy with tracheoesophageal puncture.

This report concerns 102 cases of tracheoesophageal puncture performed as a means of secondary voice restoration after total laryngectomy, in 70 patients proving unable to learn esophageal speech and as a treatment of choice in a further 32 cases. Complications arose in 21 cases but were generally minor and could be overcome. Results were favorable in 45 of 70 and 29 of 32 cases, respectively. The method was considered effective, particularly when supported by the patient's determination to learn a verbal communication method.

Adult↗
PubMed2000

Patients' perceptions of drug therapy counseling in Israel.

BACKGROUND: The more patients know about their medications the higher their compliance with drug therapy, reflecting an effective communication between health professionals and their patients. Numerous studies on this subject have been published, but none has been conducted in Israel. OBJECTIVES: To evaluate patients' perceptions of drug counseling by health professionals--the prescribing physician and dispensing pharmacist--and to determine whether there is a difference in the patient's perception according to his or her place of birth and mother tongue. METHODS: A total of 810 patients were interviewed following receipt of their medications from in-house pharmacies at two community clinics of Israel's largest sick fund. Each patient was interviewed in his or her mother tongue according to a constructed questionnaire, which included the patient's demographic background, type of medications received, the patient's perceptions of drug counseling given by both the physician and the pharmacist, and the patient's perception of non-prescription drug counseling given by the dispensing pharmacist. RESULTS: Of the 810 patients enrolled in this study, 32% received three or more medications at each physician visit. The main therapeutic classes of medications prescribed and dispensed were for neurological disorders, cardiovascular diseases, gastrointestinal problems and respiratory diseases. While 99% of the patients claimed that they knew how to use their medications, only 96% reported receiving an explanation from either physician or pharmacist. The quality of counseling, as evaluated by the patients, was ranked above average for 75% of the consultations with the prescribing physician and 63% with the dispensing pharmacist. CONCLUSIONS: Although few conclusions can be drawn from this study based on the initial statistical analysis of the data, the major findings were that patients value highly the counseling they receive and that 99% believe they have the requisite knowledge for using their medications. Compared to the international literature, our results--based on the patients' perceptions--indicate that counseling by pharmacists is a common and well-accepted activity in Israel and occurs at a high rate.

Counseling↗
PubMed2002

[The Good Medical Department. The quality of patient information at the departments of internal medicine].

INTRODUCTION: The purpose of this study was to identify the factors that influence the quality of information given in medical departments and to examine the efforts made to ensure the quality and further improvement of this information. The study is part of the research project "The Good Medical Department". MATERIAL AND METHODS: A total of 73 semi-structured interviews were carried out with patients, doctors, nurses and departmental managements. The medical records and nursing case notes were analysed. RESULTS: The quality of information given correlates with the staff's knowledge of the period of hospitalization of their patients. Contact with various doctors and nurses results in patients perceiving statements as being divergent. Information is best communicated in a dialogue. The patients want detailed and written information. Documentation of given information in the medical records was scanty. DISCUSSION: The outcome of this study indicates some areas that can contribute to ensuring the quality and improvement of patient information. Recent studies also describe lack of quality in these areas. It is a question of restructured planning, delegation of responsibility, documentation, written patient information, and training in communication skills.

Communication↗