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Effective presentation of radiation safety training--risk communication: an important function of radiation safety training.

Implementing an effective radiation safety program requires good communication with workers. The process begins with radiation safety. Before workers take a position involving radiation exposures, they should understand the possible health risks and what to do to keep their risks ALARA. The goal is for workers to achieve a balanced perspective on radiation health risks in order to avoid either undue fear or undue complacency about radiation. Workers should have enough understanding of radiation risks to decide to acceptor not accept-or not accept the risk of radiation as a condition of employment. Furthermore, the decision to accept radiation risk for the benefits of employment should be based on informed consent. Workers with a good understanding of radiation health risks will strive to minimize not only their own radiation exposure but also those of their work group. Normally radiation safety training to achieve worker understanding is focused primarily on the technology of radiation. However, understanding is more than a matter of good technical information. What one chooses to understand is also impacted by perceptions of radiation risks.

Adult↗

Programmatic and Communication Issues in Relation to Serious Adverse Events Following Ivermectin Treatment in areas Co-endemic for Onchocerciasis and Loiasis.

In areas co-endemic for loiasis and onchocerciasis, the classic Community-Directed Treatment using ivermectin (Mectizan(R)) must be adapted as additional program activities, better communication and tighter control of ivermectin stocks are required to minimize risk and manage serious adverse events following ivermectin treatment in patients co-infected with Loa loa. The importance of these serious adverse events on community participation in onchocerciasis control efforts has not been adequately studied. Program implementers do not as of yet fully understand the psychological impact of serious adverse events on communities and therefore have not designed communication strategies that adequately address the real concerns of community members. It is clear, however, that along with an effective case detection and management strategy, a reinforced communication strategy will be required to motivate at least 65% of the total population in onchocerciasis and loiasis co-endemic areas to participate in the treatment program and to take ivermectin over an extended period. This strategy must be based on research undertaken at the community level in order to address the concerns, fears and issues associated with adverse events due to ivermectin - to ensure that communities believe that the benefits of taking ivermectin outweigh the risks. In addition to an overall increase in the time required to sustain onchocerciasis control programs in co-endemic areas, each aspect of the reinforced program and communication strategy - rapid epidemiological assessments, materials development, training, advocacy, community sensitization and mobilization, case management and counselling, supervision, monitoring and evaluation will require additional resources and support from all stakeholders concerned.

Journal Article↗

Development of a communication skills training support system for the nurse.

The content, methods, and evaluation of extant training programs in nursing communication skills fall short in terms of objectivity, from which feelings of achievement are difficult to attain. As such, an attempt was made to develop training materials from a more practical, logical, and comprehensive standpoint in line with the instructional design process. The study objects were students of nursing colleges. Efficacy of the program was demonstrated through evaluating implementation of the computer-aided instruction program constructed in the form of a diagnostic program created with egograms as the evaluation index. The findings suggested functionality of the program as a training support system through addition of a remedial program that restructures the tutorial to allow for fortification of the virtual learning experience through promoting further self-reflection.

Communication↗

Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom.

PURPOSE: To determine the communication difficulties experienced by clinicians in cancer medicine and to develop, implement, and evaluate communication skills training courses. METHODS: One hundred seventy-eight senior clinicians attended 1 1/2- or 3-day residential courses designed to enhance skills development, knowledge acquisition, and personal awareness. Course content included structured feedback, video review of interviews, interactive group demonstrations, and discussion in groups of four led by trained facilitators. The main outcomes were self-rated confidence in key aspects of communication, attitudinal shift toward more patient-centered interviewing, perceived changes in personal practice, and initiation of teaching programs for junior staff. RESULTS: Less than 35% of the participants had received any previous communications training. Time, experience, and seniority had not improved skills; before the course, oncologists expressed difficulty with 998 different communication issues. Primary problems concerned giving complex information, obtaining informed consent, and handling ethnic and cultural differences. Confidence ratings for key communication areas were significantly improved postcourse (P < .01). Three months postcourse, 95% of the physicians reported significant changes in their practice of medicine. Seventy-five percent had started new teaching initiatives in communication for junior clinicians. Clinicians showed positive shifts in attitude toward patients' psychosocial needs (P=.0002) and were more patient centered (P=.03). The courses were highly rated and 97% would "definitely" recommend them to colleagues. CONCLUSION: Oncologists are hampered by inadequate communication skills training and will give up time to correct this. Subjective improvements reported immediately postcourse were maintained at 3 months. Resources for educational initiatives are needed to help both patients and their physicians.

Communication↗

Report of the WHO Commission on Macroeconomics and Health: a critique.

The World Health Organization has been able to interest some of the world's top economists in joining the Commission on Macroeconomics and Health, to study macroeconomics of health services for the poor peoples of the world. The commission has been ahistorical, apolitical, and atheoretical. It has adopted a selective approach to conform to a preconceived ideology. It has ignored earlier work done in this field. And it has pointedly ignored such major developments in the health services as the Alma-Ata Declaration. These failings have brought the quality of the scholastic work to an almost rock-bottom level. The commission's tunnel vision in its recommendations on so important a subject is not surprising. Its emphatic recommendations for perpetuating vertical programs against major communicable diseases (tuberculosis, AIDS, and malaria) on the grounds that such programs have proved convenient to "donors" reveals the real motivations for an almost openly ideology-driven agenda. This is a serious danger signal for scholars who wish to take a scientific attitude toward program formulations for the poor that provide maximum returns from limited resources. The concept of DALYs (disability adjusted life years) is bristling with gross infirmities. The WHO-generated data used for DALY calculations, converted into dollar terms, are patently invalid, unreliable, and not comparable between and even within countries.

Acquired Immunodeficiency Syndrome↗

Establishing a communications link between two different, incompatible, personal computers: with practical examples and illustrations and program code.

The increasing need to communicate to exchange data can be handled by personal microcomputers. The necessity for the transference of information stored in one type of personal computer to another type of personal computer is often encountered in the process of integrating multiple sources of information stored in different and incompatible computers in Medical Research and Practice. A practical example is demonstrated with two relatively inexpensive commonly used computers, the IBM PC jr. and the Apple IIe. The basic input/output (I/O) interface chip for serial communication for each computer are joined together using a Null connector and cable to form a communications link. Using BASIC (Beginner's All-purpose Symbolic Instruction Code) Computer Language and the Disk Operating System (DOS) the communications handshaking protocol and file transfer is established between the two computers. The BASIC programming languages used are Applesoft (Apple Personal Computer) and PC BASIC (IBM Personal computer).

Computers↗

Position of the American Dietetic Association: total diet approach to communicating food and nutrition information.

It is the position of the American Dietetic Association that all foods can fit into a healthful eating style. The ADA strives to communicate healthful eating messages to the public that emphasize the total diet, or overall pattern of food eaten, rather than any one food or meal. If consumed in moderation with appropriate portion size and combined with regular physical activity, all foods can fit into a healthful diet. Public policies that support the total diet approach include Reference Dietary Intakes, Food Guide Pyramid, Dietary Guidelines for Americans, Nutrition Labeling and Healthy People 2010. The value of a food should be determined within the context of the total diet because classifying foods as "good" or "bad" may foster unhealthy eating behaviors. Eating practices are influenced by taste and food preferences, concerns about nutrition and weight control, physiology, lifestyle, environment, and food product safety. To increase the effectiveness of nutrition education in promoting sensible food choices, dietetics professionals plan communications and educational programs that utilize theories and models related to human behavior. Communication campaigns/programs should implement an active, behaviorally focused approach within the larger context of food choices. Nutrition confusion can be reduced by emphasizing moderation, appropriate portion size, balance and adequacy of the total diet over time, the importance of obtaining nutrients from foods, and physical activity.

Advertising↗

Communication skills for continuing education in nursing.

Good communication is a vital element in the delivery of quality nursing care, while poor communication can lead to lawsuits and avoidable patient death. This research surveyed 132 hospital nurses in the Midwest to determine their communication education while in school, the availability of continuing education programs related to communication, and the most important communication skills in nursing. The results indicate a great need for inservice education on communication.

Communication↗

Evaluation of an occupational rehabilitation program.

OBJECTIVE: The purpose of this study was to report the findings of a program evaluation for an occupational rehabilitation program in the Midwest. METHOD: An ex-post facto chart review was performed on 50 charts using demographic data, results from tests of performance and pain measures, and data from patient satisfaction questionnaires to find evidence of excellence in the program, and to identify areas for improvement. RESULTS: Over 97% of the participants actually completed the program and 76% returned to work within 3 months after program completion. Ninety-two percent indicated overall satisfaction with the program, and all aspects of the program were rated with a mean score of 4.25 or above on a 1 to 5 Likert scale. Evaluation of perceived pain scales of the participants indicate no discernable relationship between intensity of pain and successful return to work. CONCLUSION: The program showed a high completion rate, a high return to work rate, and high levels of patient satisfaction. Suggestions for improvement include an increase in use of real and simulated work activities, better documentation of pain measures, better programs to address psychosocial issues, lengthening the program, and increased communication with case managers and professionals outside of the work program.

Adult↗

Implementing a simulated client program: bridging the gap between theory and practice.

INTRODUCTION: This paper outlines the design and implementation of an innovative communication skills training program at the Ontario Veterinary College (OVC). Based upon the body of research in human medical education reporting effective results through the use of standardized patients (SPs) for this type of training, an experiential learning laboratory using simulated clients (SCs) and patients was introduced to first-year veterinary students. METHOD: One hundred and four first-year students were assigned to 12 groups of eight or nine students plus a facilitator. Each student interacted with a simulated client and a patient while being observed by peers and a facilitator. The Calgary-Cambridge Observation Guide (CCOG) was used to guide students and facilitators with performance standards and feedback. Assessment strategies were utilized. RESULTS: Implementation of this program required extensive resources, including funding, expertise, facilitator training, time allotment in an already overburdened curriculum, and administrative and faculty support. Preliminary assessment revealed high student and facilitator satisfaction. The potential of this program for student education and assessment was recognized, and it will be expanded in years 2 and 3 of the DVM (Doctor of Veterinary Medicine) curriculum. CONCLUSIONS: Medical educators have created resources, including skills checklists and experiential learning modalities, that are highly applicable to veterinary medical education. Ongoing evaluation of the program is essential to determine whether we are meeting expectations for communication competency in veterinary medicine.

Communication↗

Evaluation of an intervention program: relation between children's phonology and parents' communicative behavior.

Parents of 9 preschoolers with Down syndrome participated in a training program focusing on phonological skills. Three of the children were producing multiword utterances, but their speech was characterized by jargon and/or inconsistent errors. The remaining 6 children had very few spoken words or were mute; some relied on a Makaton sign vocabulary. Parents attended twelve 3-hour training sessions. Videotapes of parent-child interactions (made before, during, and after the program) were analyzed for number and type of children's phonological errors and rating of parents' therapeutic skills. Results showed that measures of the children's phonological abilities were correlated with their parents' interactional communication skills.

Child↗

Using children as simulated patients in communication training for residents and medical students: a pilot program.

Medical schools are charged with the challenge of teaching effective communication skills, a core competency for residents and medical students. Especially challenging is the task of developing effective methods for training residents and students to communicate with children with mental health issues. The authors describe a pilot program at Mercer University School of Medicine that used pediatric standardized patients (SPs), ages 9-19, to aid in training residents and medical students in complex interviewing skills addressing mental health issues. New curriculum components for four pediatric problems, anorexia nervosa, depression, separation anxiety, and attention deficit hyperactivity disorder (ADHD), were designed and implemented by the authors in 2002-04. The training sessions were evaluated by the participating SPs as well as the residents and medical students in training. The components of the training were a lecture and subsequent practice using pediatric SPs and adults acting as their mothers. Evaluation included the qualitative analysis of SPs' reactions to participation in the training as described during a posttraining-session focus-group, as well as questionnaire responses by residents and medical students. The children role-playing the scenario of a difficult-to-manage situation and their adult "parent" actors voiced strongly positive reactions to participating in training residents and medical students. The reactions of physicians in training were also positive. The authors thus conclude that child and adolescent actors can be effectively used as SPs to train residents and students in complex interviewing skills, even in cases involving children with challenging mental health issues.

Adolescent↗

Survey of behavior management teaching in predoctoral pediatric dentistry programs.

PURPOSE: The purpose of this study was to survey directors of predoctoral pediatric dentistry programs regarding the teaching of behavior management techniques. METHODS: Surveys were mailed to all 56 dental schools in the United States. Follow-up mailings were sent to nonrespondents. The survey contained items on program demographics and the program's teaching of communicative and pharmacologic techniques. Information was also obtained on informed consent and parental presence in the operatory. RESULTS: Surveys were returned by 48 schools. Two schools declined to respond because they had not yet accepted or graduated students. The final response rate was 89%. The mean (+/-SD) percentage of total didactic time devoted to behavior management was 12% (+/-6). Communicative techniques were taught as "acceptable" by 96% to 100% of programs, with the exception of the hand-over-mouth exercise (HOME). HOME was taught as "unacceptable" by 62% of programs. Active and passive immobilization of sedated and nonsedated children was taught as "acceptable" by 69% to 85% of programs. Sixty-seven percent to 98% of programs taught that pharmacologic techniques (nitrous oxide, conscious sedation, general anesthesia) are "acceptable." There was little evidence that the teaching of behavior management techniques had changed over the previous 5 years, nor that they were likely to change in the near future. Parental presence in the operatory was common for some procedures, particularly among younger children. CONCLUSIONS: Predoctoral programs teach as acceptable communicative and pharmacologic management techniques, with the exception of HOME. Predoctoral program directors report they are not likely to increase the amount of curricular time devoted to behavior management in the near future.

Anesthesia, Dental↗

The Scottish Centre for Autism preschool treatment programme. I: A developmental approach to early intervention.

Early intervention is an area of intense current interest for parents and professionals. This article describes a mainstream National Health Service (NHS) approach to early intervention, developed at the Scottish Centre for Autism. The aims of treatment are to improve the child's early social communication and social interaction skills, leading to the potential development of play and flexibility of behaviour. This is achieved by 1:1 intensive treatment by trained therapists, and a schedule of parent training. The treatment protocol incorporates a child led approach; the use of imitation as a therapeutic strategy; using language contingent on activities; and the introduction of flexibility into play and social exchanges.

Autistic Disorder↗