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PubMedDate not supplied

Does crew resource management training work?

INTRODUCTION: Effective crew resource management (CRM) may play a major role in decreasing the number of accidents and increasing overall safety of air medical programs. The purpose of the study was to compare the responses of crew members, in a variety of situations, who received CRM training and those who did not. The numerical results of the responses were used to evaluate the effectiveness of CRM in increasing crew awareness and promoting team concepts. METHOD: During a 12-month period, crew members of randomly selected air medical programs (fixed- and rotor-wing) were surveyed by questionnaire. Participants were asked if they had received CRM, effective communication, and team-building training. The next 15 questions pertained to crew interaction/communication in everyday and emergent situations and were scored on a Likert scale (1 = strongly agree and 5 = strongly disagree). A lower total score indicated a greater understanding of team awareness and effective communication. RESULTS: The mean score of crew members who received the three identified areas of training (initial CRM, team-building, effective communications) (37.96, SD +/- 7.67) was found to be significantly lower than the mean score of those who had received none of the training (44.13, SD +/- 5.0) and P < .05. CONCLUSION: Based on the results, CRM training increases crew awareness and promotes team concepts in both everyday and emergent situations.

Air Ambulances↗
PubMed2006

Multivariate causal attribution and cost-effectiveness of a national mass media campaign in the Philippines.

Cost-effectiveness analysis is based on a simple formula. A dollar estimate of the total cost to conduct a program is divided by the number of people estimated to have been affected by it in terms of some intended outcome. The direct, total costs of most communication campaigns are usually available. Estimating the amount of effect that can be attributed to the communication alone, however is problematical in full-coverage, mass media campaigns where the randomized control group design is not feasible. Single-equation, multiple regression analysis controls for confounding variables but does not adequately address the issue of causal attribution. In this article, multivariate causal attribution (MCA) methods are applied to data from a sample survey of 1,516 married women in the Philippines to obtain a valid measure of the number of new adopters of modern contraceptives that can be causally attributed to a national mass media campaign and to calculate its cost-effectiveness. The MCA analysis uses structural equation modeling to test the causal pathways and to test for endogeneity, biprobit analysis to test for direct effects of the campaign and endogeneity, and propensity score matching to create a statistically equivalent, matched control group that approximates the results that would have been obtained from a randomized control group design. The MCA results support the conclusion that the observed, 6.4 percentage point increase in modern contraceptive use can be attributed to the national mass media campaign and to its indirect effects on attitudes toward contraceptives. This net increase represented 348,695 new adopters in the population of married women at a cost of U.S. $1.57 per new adopter.

Causality↗
PubMed1995

Intracerebral human microdialysis. In vivo study of an acute focal ischemic model of the human brain.

BACKGROUND AND PURPOSE: In vivo microdialysis was introduced in 1982 as a technique to study cerebral neurochemistry in awake, freely moving animals. In small animals, bilateral carotid occlusion produces a 7- to 10-fold increase in extracellular glutamate concentrations. This rapidly falls with reperfusion. Increase in extracellular glutamate is currently believed to be a major factor in initiating neuronal injury. Glutamate antagonists are currently undergoing clinical trials in acute stroke. Human data on the extracellular levels of glutamate and other amino acids in the normal or ischemic brain are limited. In this communication we wish to report the extracellular concentrations of glutamate, serine, glutamine, glycine, taurine, alanine, and gamma-aminobutyric acid, as monitored by in vivo microdialysis, in the simulated ischemic model of the temporal lobe of the human brain. METHODS: Intracerebral microdialysis was carried out in five patients who underwent resection of the temporal lobe for intractable epilepsy. Surgical excision leads to an acute (from partial to total, ie, from incomplete to complete) ischemic state of the resected brain. This was our model to study the changes in human extracellular fluid during acute focal ischemic conditions. RESULTS: Extracellular glutamate concentrations were 15 to 30 mumol/L in the preischemic samples. This increased to 380.69 +/- 42.14 mumol/L with partial (incomplete) ischemia and reached a peak of 1781.67 +/- 292.34 mumol/L (> 100-fold) with total isolation of the temporal pole (complete ischemia). The levels fell to 394.52 +/- 72.93 mumol/L 20 minutes after resection. Similar trends were observed with the onset of ischemia in the dialysate levels of serine, glutamine, glycine, alanine, taurine, and gamma-aminobutyric acid. CONCLUSIONS: Our results show that there is a significant increase in extracellular glutamate and other neurotransmitters with ischemia in the temporal lobe model of the human brain. This increase is of a higher magnitude than that in small animals.

Amino Acids↗
PubMed1997

Direct assessment of functional status in older patients with schizophrenia.

OBJECTIVE: There has been a growing trend in medicine to evaluate the impact of illness on functional abilities. Such studies typically rely on the patient's or caregiver's report. The goal of this study was to assess directly the functional capacity of psychiatric patients, especially older ones. METHOD: The subjects were 55 outpatients with schizophrenia and 72 normal persons ranging in age from 45 to 86 years. The subjects were administered the Direct Assessment of Functional Status Scale, which assess behaviour during simulated daily activity tasks in the areas of time orientation, communication, transportation, finance, shopping, grooming, and eating. RESULTS: The patients with schizophrenia had significantly greater disability than the normal subjects according to total scale scores as well as the communication, transportation, finance, and shopping subscale scores. Global cognitive status was the best predictor of total scale score. CONCLUSIONS: The Direct Assessment of Functional Status Scale is a promising instrument for functional assessment in outpatients with schizophrenia.

Activities of Daily Living↗
PubMed2003

Assessment of communicating systems on the basis of an ecological conceptual framework.

A conceptual framework for auditory communication was constructed based on biological ecosystem theories. The framework was used to analyse and conceptualize the assessment of auditory communication and rehabilitation. Two different strategies for assessment are presented: analytical and holistic. It is observed that the application of the ecological concept preferendum (optimum) calls for both qualitative and quantitative assessment methods. The role of situation, the composition of the communicative system and the perspectives of the different actors were cornerstones of the analytical assessment. The holistic assessment can be approached in terms of matters such as satisfaction (ecological balance) and fatigue. Description of the communicative mass in the present framework, analogous to biomass in biological systems, was identified as a suitable endpoint of holistic assessment, formed from the total knowledge and positive emotions generated in the system. Communicative mass was described in three dimensions: the number of participants in the communicative system, time in communication, and flow of knowledge and emotion. The operationalization and application of this concept are discussed.

Audiology↗
PubMedDate not supplied

Growth factors in early hair follicle morphogenesis.

Classic studies show the embryonic epidermis and mesenchyme must communicate during embryogenesis to form a hair follicle. However, the methods of communication between and within the epidermis and dermis that regulate hair follicle development are poorly understood. Potentially, the epidermis and dermis communicate by utilizing cell surface receptor expression, cell adhesion molecules, extra cellular matrix products, and chemical messaging via secreted molecules. With each product involved in cell communication, intensity, potency, time of production during hair follicle development, production duration, and spatial distribution must all be considered. The total sum of these factors must provide adequate information to cells about their respective location and role within the developing hair follicle. Here we review the potential contribution made to hair follicle embryogenesis by growth factors and their receptors.

Bone Morphogenetic Proteins↗
PubMed2000

[Changes in proton magnetic resonance spectroscopy and Wechsler adult intelligence scale revised after clipping of unruptured aneurysms].

The purpose of this study is to evaluate the influence of surgery for unruptured aneurysms on neuropsychological status and cerebral metabolism. We studied 21 patients with unruptured aneurysms treated with direct surgery accompanied by craniotomy, rather than by the endovascular method. Patients were evaluated before and after surgery, using the Wechsler adult intelligence scale revised (WAIS-R) and proton magnetic resonance spectroscopy which measured the ratio of N-acetyl-aspartate to creatine (NAA/Cr). Although the results of WAIS-R (total IQ, verbal IQ and performance IQ) was not significantly different after surgery in any of the patients, the total IQ of the patients with anterior communicating artery aneurysms (AcoA) showed a significant decline compared with patients with other aneurysms after surgery. Five of eight AcoA patients showed a specific reduction in verbal IQ, suggesting deterioration of recent memory. The NAA/Cr remained within the normal range and was not significantly different before and after surgery. However, the NAA/Cr in the white matter of the frontal lobe of AcoA patients showed a significant reduction compared with that of non-AcoA patients. All three elderly patients older than 70 showed a reduction in NAA/Cr of more than one standard deviation from normal subjects in their frontal or parietal lobes. These results indicated that operation for unruptured aneurysms is reliable and well established but they also show that careful consideration should be given to possible deterioration in neuropsychological status and cerebral metabolism after operation in AcoA and elderly patients.

Age Factors↗
PubMed2006

[The role of a psychologist in a rehabilitation of the patients with laryngeal cancer after total laryngectomy with implantation of the voice prostheses].

The new possibilities of voice rehabilitation in patients with laryngeal cancer who undergo total laryngectomy have been opened with the surgical insertion of voice prostheses after performing of the tracheoesophageal shunt. This method enables to achieve a voice of better quality which leads to improved patients' general well-being. The cornerstone of the rehabilitation after an implantation of voice prosthesis is an appropriate psychosocial attitude of a patient towards combating of a cancer and his motivation for a verbal communication. In this review we have characterized both a role of the psychologist in the diagnostic and therapeutic team and psychological attitudes of the patients with cancer. These problems were illustrated by the clinical cases.

Humans↗
PubMed2005

Patient-reported medication symptoms in primary care.

BACKGROUND: Little is known about the prevalence and character of medication-related symptoms in primary care and their relationship to adverse drug events (ADEs) or about factors that affect patient-physician communication regarding medication symptoms. METHODS: The study included 661 patients who received prescriptions from physicians at 4 adult primary care practices. We interviewed patients 2 weeks and 3 months after the index visit, reviewed patients' medical records, and surveyed physicians whose patients identified medication-related symptoms. Physician reviewers determined whether medication symptoms constituted true ADEs. We used multivariable regression to examine factors associated with patients' decision to discuss symptoms with a physician and with physicians' decision to alter therapy. RESULTS: A total of 179 patients identified 286 medication-related symptoms but discussed only 196 (69%) with their physicians. Physicians changed therapy in response to 76% of reported symptoms. Patients' failure to discuss 90 medication symptoms resulted in 19 (21%) ameliorable and 2 (2%) preventable ADEs. Physicians' failure to change therapy in 48 cases resulted in 31 (65%) ameliorable ADEs. In multivariable analyses, patients who took more medications (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.04-1.08; P<.001) and had multiple medication allergies (OR = 1.07; 95% CI = 1.03-1.11; P = .001) were more likely to discuss symptoms. Male physicians (OR = 1.20, 95% CI = 1.09-1.26; P = .002) and physicians at 2 practices were more likely to change therapy (OR = 1.24; 95% CI = 1.17-1.28; P<.001; and OR = 1.17; 95% CI = 1.08-1.24; P = .002). CONCLUSION: Primary care physicians may be able to reduce the duration and/or the severity of many ADEs by eliciting and addressing patients' medication symptoms.

Adult↗
PubMed1998

A high throughput screen to identify secreted and transmembrane proteins involved in Drosophila embryogenesis.

Secreted and transmembrane proteins play an essential role in intercellular communication during the development of multicellular organisms. Because only a small number of these genes have been characterized, we developed a screen for genes encoding extracellular proteins that are differentially expressed during Drosophila embryogenesis. Our approach utilizes a new method for screening large numbers of cDNAs by whole-embryo in situ hybridization. The cDNA library for the screen was prepared from rough endoplasmic reticulum-bound mRNA and is therefore enriched in clones encoding membrane and secreted proteins. To increase the prevalence of rare cDNAs in the library, the library was normalized using a method based on cDNA hybridization to genomic DNA-coated beads. In total, 2,518 individual cDNAs from the normalized library were screened by in situ hybridization, and 917 of these cDNAs represent genes differentially expressed during embryonic development. Sequence analysis of 1,001 cDNAs indicated that 811 represent genes not previously described in Drosophila. Expression pattern photographs and partial DNA sequences have been assembled in a database publicly available at the Berkeley Drosophila Genome Project website (). The identification of a large number of genes encoding proteins involved in cell-cell contact and signaling will advance our knowledge of the mechanisms by which multicellular organisms and their specialized organs develop.

Animals↗
PubMed1992

Communication key for family planning.

4 reports published by Demographic and Health Surveys (DHS) include information from husbands of the wives interviewed in the main part of the survey. All are from Africa--Burundi (1987), Ghana (1988), Kenya (1988) and Mali (1987). These surveys of husbands indicate the importance of programs that work to improve communication between spouses about family planning. In particular, they show a positive association between contraceptive prevalence and husband and wife communication about family planning. Husbands and wives were asked how often they discussed family planning in the past year. In Kenya, with a 27% contraceptive prevalence rate--the highest among the 4 countries--about 2/3 of the couples had discussed family planning during the past year. In Ghana, with a rate of 13%, and in Burundi, at 9%, about 1.2 of the couples had discussed family planning during the year. Mali had the lowest contraception prevalence rate of 5% and the least communication among the couples, with only 1.4 discussing family planning during the year. The importance of communication also emerges in data on methods used. In all 4 surveys, the wives reported lower use of male methods than did their husbands. Estimates of use of female methods were more consistent between husbands and wives. Questions were not exactly the same in all 4 surveys, so summaries for each country vary slightly. In Burundi, about 2 of 5 husbands said they used periodic abstinence, compared to about 1 of 5 wives. Husbands said 0.7% used condoms, with 0.3% of the wives giving that response. Husbands an wives agreed that there was no use of male sterilization. The use of vasectomy in Africa is considerably lower than for other regions of the world (see chart below). Ghana showed a similar pattern. Husbands said 2.1% of couples used condoms, compared to 0.3% according to the wives. Husbands also indicated more widespread use of periodic abstinence than did the wives. In contrast, except for pill use, husbands and wives gave similar responses for use of female methods. In Kenya, 1 of every 2 husbands said they were using family planning, compared to about 1 of every 4 wives. The largest discrepancy was in the data for use of periodic abstinence, where 3 times more husbands than wives said they were using this method--26% compared to 8%. Only in Mali, where total contraceptive use is only 5%, were responses from husbands and wives consistent. Even here, husbands gave higher rates of condom use (0.5%) than did wives (none). When it comes to choosing a method of family planning, women apparently think first of female methods. In general, women assume that their husbands will not be interested in using contraception themselves. Women may, however, underestimate their husbands interest or participation in family planning. Or men could be overstating the use of male methods. These DHS husband surveys suggest that programs aimed at both men and women should encourage more and better communication between spouses about family planning. More data related to communication on family planning will soon become available. Other DHS husbands surveys in various stages of completion are from Pakistan, Cameroon, Tanzania, and Egypt.

Africa↗
PubMed1999

Using 3 data sources and methods to shape a nutrition campaign.

The first objective of this research was to define a target population of African-American women more clearly. The second was to provide specific information about the needs and preferences of that population in order to design an effective, culturally relevant, community-based communications campaign to promote more healthful lifestyles. Data collection and analysis included the following: interviews with 10 community nutritionists and the director of the State Office of Nutrition, 6 focus groups with a total of 47 members of the target population, and direct observation and documentation of key community resources. This approach, called "triangulation," permits more in-depth understanding of issues, provides different perspectives on the problem, and helps ensure accuracy of conclusions. Interviews with nutritionists identified young African-American women as the appropriate target population for the campaign. These interviews and the focus-group discussions confirmed the acceptability of higher weight and better body-esteem among African-American women than among white women. Both the nutritionists and the focus-group members identified the need and desire for information and skills related to food preparation and provided specific direction for program content. Community observation confirmed the need for food markets with merchandise of consistently high quality, especially in the fresh and frozen produce sections. Observation also helped identify community services and programs. The 3 sets of data, which augmented a comprehensive literature review, provided a firm foundation for the campaign's design and development. Dietitians and nutritionists working in community settings can use triangulation to gain a better understanding of their populations in order to develop more effective interventions.

Adolescent↗
PubMed1977

[Ventricular fluid pressure measurement by microcatheter and pressure-controlled external fluid drainage (author's transl)].

Long term control of ventricular fluid pressure by means of a ventricular catheter offers the advantage of pressure-controlled external fluid drainage, especially in patients with space-occupying processes which lead to acute disturbances of the fluid circulation. In a measuring system with the possibility of drainage it is advisable to measure the VFP with a microcatheter. The microcatheter is introduced through the drainage catheter. Both catheters are placed in the anterior part of a lateral ventricle. Communication between the drainage system and the transducer is avoided. There is no necessity for frequent disinfection or changing of parts of the system during long term control of the patient. Any occlusion of the drainage system can be recognized immediately because the measuring procedure will not be interrupted by such an occlusion. In 201 patients the ventricular fluid pressure was recorded by the microcatheter method for a total of 1086 days. The infection rate was under 1%. With simultaneous external fluid drainage it rose to 2.2%. For patients with space--occupying processes of the posterior cranial fossa external drainage is recommended for 5--10 days postoperatively as a precaution against rises in CSF pressure.

Catheterization↗
PubMed2006

Personal medical documents management--how patients perceive, keep and manage their medical documents: a qualitative study.

BACKGROUND: Absence of medical documents damages the quality of treatment and service. Despite the computerized medical folder, its use is still limited, and not all countries have a national health communications systems. That is why the patients are asked to bring with them the documents they hold. However, some patients lose the documents and others are uncooperative due to forgetfulness, and a lack of knowledge. OBJECTIVES: To examine how patients perceive, keep and manage medical documents. DESIGN: The research was conducted in the qualitative method. SETTINGS: A cardiology clinic, in a big medical center in Israel. PARTICIPANTS: A total of 28 patients suffering from ischemic heart disease and/or rhythm disorders. The sample was a convenience one, and were taken from the population visiting the Cardiology Clinic from May to October 2003. METHODS: Semi-structured interviews were held with the participants. The data were processed by means of content analysis. RESULTS: The findings indicate that, even though the participants expressed that it is the health system's responsibility to manage medical documents, most of them kept, and some even managed, their medical documents via a personal folder. By keeping documents and deciding to whom and when to show them the patient functions as a self-care manager. This made them more involved in their treatment and, they felt in control and empowered. CONCLUSION: Patient's attention to documents, as keeper and router, results in demonstrations of responsibility and involvement in treatment, consequently empowering the patient.

Adult↗
PubMed2000

A new and successful chance in surgical treatment of gastrooesophageal reflux in severely neurologically impaired children: Bianchi's procedure.

AIM: Neurologically impaired (NI) children present with neuromuscular incoordination and severe gastroesophageal reflux (GER). In these cases, Bianchi has proposed total oesophagogastric dissociation (OGD) as a primary procedure and not only after failed fundoplication. METHODS: Anthropometric and laboratory data, incidence of respiratory symptoms, days of hospitalisation, time of feeding, stool frequency and quality of life were tested preoperatively and after OGD over a 12-month period in 13 severe NI patients. RESULTS: Results are shown in Table 1. We also recorded improvement in quality of life, based on communication by the person responsible for the care of the subject, and determined by psychological interviews. CONCLUSIONS: OGD is a successful and feasible procedure and can be included as a primary definitive surgical treatment in individualised nutritional rehabilitation planning for each severe NI child.

Adolescent↗
PubMed2004

Body mass index and cardiovascular disease in the Asia-Pacific Region: an overview of 33 cohorts involving 310 000 participants.

BACKGROUND: Few prospective data from the Asia-Pacific region are available relating body mass index (BMI) to the risks of stroke and ischaemic heart disease (IHD). Our objective was to assess the age-, sex-, and region-specific associations of BMI with cardiovascular disease using individual participant data from prospective studies in the Asia-Pacific region. METHODS: Studies were identified from literature searches, proceedings of meetings, and personal communication. All studies had at least 5000 person-years of follow-up. Hazard ratios were calculated from Cox models, stratified by sex and cohort, and adjusted for age at risk and smoking. The first 3 years of follow-up were excluded in order to reduce confounding due to disease at baseline. RESULTS: A total of 33 cohort studies, including 310 283 participants, contributed 2 148 354 person-years of follow-up, during which 3332 stroke and 2073 IHD events were observed. There were continuous positive associations between baseline BMI and the risks of ischaemic stroke, haemorrhagic stroke, and IHD, with each 2 kg/m(2) lower BMI associated a 12% (95% CI: 9, 15%) lower risk of ischaemic stroke, 8% (95% CI: 4, 12%) lower risk in haemorrhagic stroke, and 11% (95% CI: 9, 13%) lower risk of IHD. The strengths of all associations were strongly age dependent, and there was no significant difference between Asian and Australasian cohorts. CONCLUSIONS: This overview provides the most reliable estimates to date of the associations between BMI and cardiovascular disease in the Asia-Pacific region, and the first direct comparisons within the region. Continuous relationships of approximately equal strength are evident in both Asian and Australasian populations. These results indicate considerable potential for cardiovascular disease reduction with population-wide lowering of BMI.

Asia↗
PubMed2003

Hidden financial costs in treatment for childhood cancer: an Australian study of lifestyle implications for families absorbing out-of-pocket expenses.

PURPOSE: The impact of out-of-pocket expenses on five domains of family lifestyle were explored: social, assets, credit, utilities, and charity. METHODS: Using a cross-sectional survey, 100 parents of pediatric cancer patients reported on the types of out-of-pocket expenses incurred and the perceived lifestyle impact of meeting those expenses. RESULTS: Eighty percent of the sample reported a minimum of five different out-of-pocket expenses (total mean value = 19,064 Australian dollars; approximately 9,723 US dollars). The majority reflected travel, accommodation, and communication costs, use of work-related entitlements, and changes in paid employment. In lifestyle terms, the area of greatest impact was found for the social domain, such as cancelling vacations and giving up recreational pleasures and social expenditure. Those families living furthest from the major cancer treatment center reported the greatest range of out-of-pocket expenses and subsequent lifestyle impact. While there were few differences as a function of cancer type, results suggested that families most vulnerable to financial distress tended to be those whose child had spent relatively longer on treatment. CONCLUSIONS: In meeting out-of-pocket expenses, parents primarily seek ways to "trim the fat" off existing family expenditure. While all families may incur extra expenses, parents of patients located a significant distance from the cancer treatment center remain especially vulnerable (despite increased government allowances). Creative solutions for addressing some expenses may include applications of telemedicine to augment outreach services.

Adolescent↗
PubMed2004

The PedsQL Family Impact Module: preliminary reliability and validity.

BACKGROUND: The PedsQL Measurement Model was designed to measure health-related quality of life (HRQOL) in children and adolescents. The PedsQL 4.0 Generic Core Scales were developed to be integrated with the PedsQL Disease-Specific Modules. The newly developed PedsQL Family Impact Module was designed to measure the impact of pediatric chronic health conditions on parents and the family. The PedsQL Family Impact Module measures parent self-reported physical, emotional, social, and cognitive functioning, communication, and worry. The Module also measures parent-reported family daily activities and family relationships. METHODS: The 36-item PedsQL Family Impact Module was administered to 23 families of medically fragile children with complex chronic health conditions who either resided in a long-term care convalescent hospital or resided at home with their families. RESULTS: Internal consistency reliability was demonstrated for the PedsQL Family Impact Module Total Scale Score (alpha = 0.97), Parent HRQOL Summary Score (alpha = 0.96), Family Functioning Summary Score (alpha = 0.90), and Module Scales (average alpha = 0.90, range = 0.82 - 0.97). The PedsQL Family Impact Module distinguished between families with children in a long-term care facility and families whose children resided at home. CONCLUSIONS: The results demonstrate the preliminary reliability and validity of the PedsQL Family Impact Module in families with children with complex chronic health conditions. The PedsQL Family Impact Module will be further field tested to determine the measurement properties of this new instrument with other pediatric chronic health conditions.

Activities of Daily Living↗