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PubMed1997

HIV testing among Haitian women: lessons in the recognition of risk.

Haitian women in Miami, Florida, responded to recruitment for testing of HIV antibody serostatus in ways that demonstrated the value of ethnographic methods for studying reactions to this kind of test, especially pre- and posttest counseling sessions. A total of 155 women between 14 and 61 years old, recruited in Miami in 1992 and 1993, participated. Response to testing identified three primary obstacles to the women's understanding of content presented in pre- and posttest counseling sessions: (1) their confusion about the meaning of positive versus negative, (2) the investigators' difficulty in communicating the concept of antibody, and (3) vagueness of the concept of window period between exposure and presentation of antibody. Retesting of a subset of Haitian participants helped to define sexual risk among these women in terms of having partners who had other partners and perception of supernatural risk.

AIDS Serodiagnosis↗
PubMedDate not supplied

Facilitating written work using computer word processing and word prediction.

OBJECTIVE: The purpose of this study was to investigate whether occupational therapy intervention that focused on teaching children to use word processing, either alone or with word prediction, was effective in improving the written communication skills of children with learning disabilities and handwriting problems. METHOD: A single-subject alternating treatments design was replicated across three children in grades 4 and 5. During the baseline phase the children wrote stories by hand; during the intervention phase, the children wrote stories, alternating among handwriting, word processing, and word processing with word prediction. Dependent variables focused on percentages of legible words, percentages of correctly spelled words, total amount written, and rate of writing. Data were analyzed by visual inspection. RESULTS: Results were variable. Two children had clear improvements in legibility when using either word processing alone or with word prediction. These same children demonstrated clear improvements in spelling when using word prediction. Though rate of writing was best for two children when using handwriting, relative to total amount produced, one method was not clearly preferable to another. CONCLUSION: Occupational therapy intervention involving word processing with word prediction improves the legibility and spelling of written assignments completed by some children with learning disabilities and handwriting difficulties. It is important to evaluate each child individually and provide training and ongoing support for technology use.

Child↗
PubMed1991

Update: graphic method for presentation of notifiable disease data--United States, 1990.

Since April 1990, data from the National Notifiable Diseases Surveillance System for 14 diseases have been published in a graphic format in the MMWR (Figure I, page 118) (1). The bar graph compares provisional reports for a 4-week period with the mean of 15 4-week totals (from the previous, comparable, and subsequent 4-week periods for the last 5 years) (2). Ratios that exceed national historical limits (calculated based on two standard deviations of the historical baseline) are indicated by striping in the bars. This report summarizes an evaluation of this new method.

Communicable Disease Control↗
PubMed2004

Influence of perceived provider performance on satisfaction with oral health care among adolescents.

OBJECTIVE: To investigate satisfaction with dental care received at the last dental appointment among adolescents and to analyse factors influencing their satisfaction scores. METHOD: A total of 1146 subjects (mean age 15.8 years) attending secondary schools in Kampala (urban, n = 591) and Lira (rural, n = 555) completed structured questionnaires at school in 2001. RESULTS: A total of 63% and 75% of Kampala and Lira students, respectively, reported attendance to dental clinics during the previous 2 years. The corresponding rates of students who confirmed satisfaction with oral health care services received were 73 and 77. In a logistic regression model, the students of Kampala who attended a dentist more than once, had no painful experience at the visit, evaluated their oral condition positively, were satisfied with the dentist's communication and dentist's information, were more likely to be satisfied with the oral health services received (OR = 1.7, 2.2, 4.1, 2.9 and 4.9, respectively). Regarding rural students, being satisfied with oral condition, dentist's communication and dentist's information were associated with higher odds of being satisfied with oral health care services (OR = 2.9, 1.9 and 2.3, respectively). CONCLUSION: Inter-personal interaction with the dentist is a key determinant in establishing satisfaction with dental care among urban as well as rural adolescents.

Adolescent↗
PubMed2005

New insights into the auditory processing of communicative signals in the HVC of awake songbirds.

In the present study, using a systematic recording method and a variety of stimuli, we determined the proportion of responsive sites and their response features in the vocal control nucleus HVC of awake-restrained starlings, a species with multiple song types. Responsive sites were classified into three groups, according to the number of stimuli to which they responded. Sites in the three groups showed responses to individual-specific songs, with sites in the group that showed responses to only one stimulus responding mostly to a bird's own song. In comparison, very few sites exhibited responses to universal species-specific songs and to artificial nonspecific sounds. By contrast, data obtained in the same birds under urethane anesthesia show that, although the total proportion of responsive sites was similar, numerous responses to a universal species-specific song and to an artificial nonspecific pure tone could be observed.

Acoustic Stimulation↗
PubMed2005

The use of digital imaging for colour matching and communication in restorative dentistry.

OBJECTIVE: To develop a shade matching method based on digital imaging and to compare observers' ability using this method with the conventional one set against a spectrophotometric 'gold standard'. METHODS: Two Vita Lumin shade guides were used in this study, nine shades being selected from the first Vita Lumin shade guide, A2, A3, A3.5, B2, B3, B4, C1, C2 and C3. A second shade guide was used to match the selected shades. A Nikon Coolpix 990 digital camera with Nikon SB21B ring flash was used to record the digital images of the shade tabs of the two shade guides and the images were processed using Adobe Photoshop software. A total of 27 samples (three replicates of each shade of the nine tabs selected) were matched with a digital shade guide prepared from the digital images of the second shade guide by 10 observers on a computer screen (computerised matching method). The 10 observers also matched the same shade tabs using the conventional matching method simulated in a phantom head. In addition, colour values were obtained from the digital images using Adobe Photoshop and quantified according to an internationally recognised scale as CIELAB colour values, L*,a*,b*. The relationship of the digitally derived CIELAB values to the CIELAB values obtained using a reflectance spectrophotometer was investigated. RESULTS: The cross tabulation statistical analysis showed a statistically significant difference (p<0.001) between the conventional method and the computer method with a 43% and 61.1% correct match respectively. There was also a statistically significant difference between observers in both methods (p<0.001 and p<0.04 for the conventional and computer methods respectively). A statistically significant high correlation of the CIELAB colour values were found between both colour measurement methods (p<0.001). CONCLUSION: The observers' shade matching performance was significantly better with the computer method compared with the conventional one. There was a large variation in the observers' matching ability. The digital camera can be used as a means of colour measurements in the dental clinic.

Color↗
PubMed2005

Critical care nurses' beliefs about the discharge planning process: a questionnaire survey.

AIM: To report on the beliefs of critical care nurses with regard to the discharge planning process, in Victoria, Australia. METHODS: An exploratory descriptive design was used. A total of 502 Victorian critical care nurses were approached to take part in the study. A total of 218 eligible participants completed the survey, which represented a net response rate of 43.4%. The data were analysed using descriptive statistics. RESULTS: The current discharge planning processes are ad hoc and influenced by patient acuity. Critical care nurses believe that workload issues, unplanned discharges and inadequate communication contribute to difficulties implementing the discharge plan.

Adult↗
PubMed2005

Worldwide use of the ketogenic diet.

PURPOSE: Over the past decade, the use of the ketogenic diet internationally has increased dramatically. The purpose of this survey was to evaluate the use of the diet worldwide. METHODS: With the use of the Internet, e-mail requests for information about international ketogenic diet centers (outside the United States) were made over a 9-month period. Assistance also was obtained from the Child Neurology Society and International League Against Epilepsy. Questions included patient enrollment (total and annually), year the diet was first offered, unique cultural and religious issues in the country, community opinion, and research interests. RESULTS: Successful communication was made with 73 academic centers in 41 countries outside the United States. Sixteen (39%) countries provided information from multiple centers. The median duration offering the diet was 8 years (range, 1-45 years). The average number of patients enrolled to date was 71.6 per country, with 5.4 new patients annually. Common difficulties included avoiding rice intake, tolerating higher fat-to-protein and carbohydrate ratios (e.g., 4:1), finding specific nutritional labels on foods, and handling the growing interest from large populations with limited resources. Nevertheless, cultural and religious issues were generally not limiting; physician and patient acceptance of the diet as an option is high; and most meals were similar among countries. Centers often had great pride in their programs, and international collaborative groups are forming rapidly. A website is now available with updated center information at http://www.neuro.jhmi.edu/Epilepsy/Peds/ketoworldwide.htm CONCLUSIONS: Despite occasional difficulties, the ketogenic diet is being used worldwide.

Academic Medical Centers↗
PubMed2002

Health needs assessment and needs-led health service change: a survey of projects involving public health doctors.

OBJECTIVES: To describe the criteria that define an effective health needs assessment and to explore which factors are important for the delivery of effective health needs assessment in the English National Health Service (NHS). METHODS: A postal questionnaire to all public health doctors in an English health region to describe health needs assessment activity, including initiating factors, methods and outcomes. This was followed by semi-structured interviews with public health professionals and others involved in 10 purposively selected needs assessments. RESULTS: A response rate of 62% identified a total of 102 health needs assessments undertaken between 1993 and 1998. A number of themes emerged as being important in the impact of health needs assessments on policy and planning. These included careful design, methodological rigour, decisive leadership, good communication, involvement and ownership of the work from relevant stakeholders, support from senior decision-makers, appreciation of the political dynamics and engagement with local priorities, availability of resources and, finally, an element of chance. These themes can be categorised broadly into contextual factors and quality or robustness of the work. Our findings suggest that, although methodological and analytical quality are necessary characteristics of effective health needs assessment, they are not sufficient without a favourable political environment. CONCLUSION: There appear to be conditions under which needs assessment is more likely to be effective in terms of its influence on policy and planning. However, it is clear that needs assessment does not occupy a central position in health service decision-making, remaining vulnerable to a range of factors over which those responsible for its conduct have little or no control.

Attitude of Health Personnel↗
PubMedDate not supplied

[Sleep disorders in the aged].

OBJECTIVES: The aim of the study was the assessment of prevalence and risk factors of sleep disorders in the elderly. METHODS: The study sample consisted of a group of institutionalized elderly, from two university affiliated community nursing homes in Turin. The following subjects were excluded: a) those aged less than 65 years; b) had length of stay less than thirty days; c) were not able to communicate because of severe aphasia or severe hearing loss and d) had cognitive impairment based on the Short Portable Mental Status Questionnaire (SPMSQ ) > 5. A total of 88 subjects (65-102 ys; 24 male and 64 female) have been studied. Comorbidity was measured using the Acute Physiology and Chronic Health Evaluation scale (APACHE), disability using the index of Activity Daily Living (ADL), depressive symptoms using the Geriatric Depression Scale (GDS); sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI) and the subjective health by the Self-Rated Health (SRH) was also evaluated. RESULTS: Using the PSQI questionnaire, 70 subjects (79.5%) were identified as "poor sleepers" (PSQI > 5). They complained of difficulties in getting sleep (85.7%) and frequent awakening (75.7%). The most common causes of sleep disturbances were nycturia (51.4%), cough (38.6%) and pain (32.9%). Insomnia correlated with depressive symptoms, poor physical activity, number of medications and bad self-rated health. CONCLUSION: Sleep disorders probably are due to physical, psychological or ambient factors. The identification and correction of treatable causes of insomnia are relevant for improving the quality of sleep and health in the elderly.

APACHE↗
PubMed2001

Facilitating and obstructing factors for development of learning in clinical practice: a student perspective.

AIM OF THE STUDY: The aim of this study was to provide information on what the student nurses found facilitating and obstructing for their learning during clinical practice. BACKGROUND: Earlier studies of experiences of learning in clinical practice have shown that factors as the possibilities of variations of experiences, the culture of the workplace, and communication between the educational institution and health care facilities are of importance. Less is known about the opportunities which students are given in order to practise the skills that they will be expected to perform as new graduate nurses. METHODS: The experiences of 47 degree student nurses from two colleges in Sweden were gathered in weekly diaries during their final period of clinical practice. A content analysis technique was used to analyse their diaries. RESULTS: The students emphasized responsibility and independence, opportunities to practise different tasks, and receiving feedback as facilitating factors. Other perceived promoting factors included perceptions of control of the situation and understanding of the 'total picture'. Examples of obstructing factors were the nurses as supervisors not relying on the students, supervision that lacked continuity and lack of opportunities to practise. Perception of their own insufficiency and low self-reliance were drawbacks for some students. CONCLUSIONS: Recommended proposals are presented to lecturers and supervising staff concerning organizational and educational changes, and changes of attitudes for elucidating the students' experiences of different facilitating and obstructing factors. Changes may contribute to making easier the students' transition into the nursing profession.

Adult↗
PubMed1995

Database access method for autonomous distributed total hospital information system and its object-oriented design.

ADITHIS (Autonomous Distributed Total Hospital Information System) is an information system providing a distributed computing environment for a hospital. The access method to its database enables users to access any patient data stored in individual departmental databases. Its functional design based on the object-oriented approach and its characteristics are described.

Computer Communication Networks↗
PubMed2002

[Evolution of the communication profile of family medicine residents].

AIMS: To study the development of patient relation skills, as used during interviews with patients for health problems that are common within their specialty, in family medicine residents during the third year of their residency program. METHODS: Quasi-experimental (before-after), national-level, multicenter study. The participants were 193 third-year residents in family medicine at 8 training units who were trained between 1996 and 1999. During this period all residents participated in the usual training and clinical activities included in the National Plan for this specialty. The GATHA-RES questionnaire was used to evaluated six clinical scenarios in video recordings of encounters with standardized patients (3 at the start of the third year and 3 at the end of the third year). Descriptive, bivariate and multivariate statistical analyses were used. RESULTS: A total of 1,024 interviews were analyzed. The time spent with each patient decreased significantly at the end of the residency program; the duration of the visit was directly proportional to the score on the GATHA-RES questionnaire (p < 0.05). Improvements were seen in formal and organizational aspects of the interview. In contrast, skills related with the exploration of personal and contextual aspects of the problem, and negotiating skills, were worse at the end of the study. The variables that best predicted residents' communicational profile were age (inverse relation), duration of the interview, training of the tutor in clinical interviewing, and teaching unit. CONCLUSIONS: Residents learn to shorten the duration of the visit to the detriment of communication skills that are basic to appropriate care for their patients' health problems. These results suggest the need for substantial changes in the training of family medicine residents in Spain.

Adult↗
PubMed2005

Nursing activities and use of time in the postanesthesia care unit.

Specialty areas, such as the PACU, are currently characterized by a shortage of qualified nursing personnel along with the pressure for a most cost-conscious function of services. These, in combination with both the increasing acuity of patients and the advances of science and technology, have rendered necessary the investigation of how existing personnel can be better used. The work sampling approach has been widely used in different clinical settings to offer data about the amount of time nurses devote to specific activities. The aim of the current study was to categorize and quantify the activities of nurses employed in the PACU of the General University Hospital of Patras, Greece, and to identify differences with regard to shifts, varying nurse-patient ratios, and nurses' experiences. In the first phase, a classification form, which included all nursing activities, was constructed. This was based on literature review, researchers' experience, and semistructured personnel interviews. In the second phase, the researchers observed all PACU nurses, and activities were recorded on an hourly check sheet. A total of 4,320 observations were collected from 9/1/2004 to 9/30/2004. Nurses spent 35.2% of their time on direct clinical care, 11.6% on patient assessment, 7.0% on communication with patients, 7.2% on communication with other persons, 8.6% on clerical nursing duties, 9.3% on documentation, 2.3% on non-nursing duties, and 18.8% on personal activities. Variations in the use of time were found between shifts, different nurse-patient ratios, and PACU experience. Methods of decreasing time when the nurse-patient ratio is inappropriate and increasing time allocated to direct care activities are proposed.

Greece↗
PubMed2001

Computer usage and its relationship with adolescent lifestyle in Hong Kong.

PURPOSE: To determine the patterns of computer usage among adolescents in Hong Kong and to examine whether computer usage is associated with less physical activity and social support among adolescents. METHODS: A total of 2110 secondary school students (52% boys and 48% girls) in Hong Kong completed a set of questionnaires to measure their computer usage and lifestyle. Mean age of the respondents was 14.16 years (SD = 1.81 years). Computer usage was taped by asking the students to indicate how much time (in minutes) they spent on the computer each day for doing homework assignments; playing computer games; "surfing" the Internet; and communicating with others. The students also provided information on their social-physical lifestyle. Student's t-tests and analysis of variance were used to examine group differences. Pearson product moment correlations were used to explore relationships between computer usage and lifestyle. RESULTS: Boys who use computers for doing homework, "surfing" the Internet, and communicating with others engage in more social-physical activities than others. Boys who use computers to play games tend to be more social-behaviorally inactive. For girls, patterns of computer usage are not related to lifestyle. CONCLUSIONS: Computer users tended to engage in social-physical activities more frequently and had higher social support than nonusers. But among computer users, the amount of time spent daily on the computer was not associated with lifestyle. Instead, patterns of computer usage are more related to lifestyle and the relationship is moderated by gender.

Adolescent↗
PubMedDate not supplied

The incident command system in disasters: evaluation methods for a hospital-based exercise.

OBJECTIVES: No universally accepted methods for objective evaluation of the function of the Incident Command System (ICS) in disaster exercises currently exist. An ICS evaluation method for disaster simulations was derived and piloted. METHODS: A comprehensive variable list for ICS function was created and four distinct ICS evaluation methods (quantitative and qualitative) were derived and piloted prospectively during an exercise. Delay times for key provider-victim interactions were recorded through a system of data collection using participant- and observer-based instruments. Two different post-exercise surveys (commanders, other participants) were used to assess knowledge and perceptions of assigned roles, organization, and communications. Direct observation by trained observers and a structured debriefing session also were employed. RESULTS: A total of 45 volunteers participated in the exercise that included 20 mock victims. First, mean, and last victim delay times (from exercise initiation) were 2.1, 4.0, and 9.3 minutes (min) until triage, and 5.2, 11.9, and 22.0 min for scene evacuation, respectively. First, mean, and last victim delay times to definitive treatment were 6.0, 14.5, and 25.0 min. Mean time to triage (and range) for scene Zones I (nearest entrance), II (intermediate) and III (ground zero) were 2.9 (2.0-4.0), 4.1 (3.0-5.0) and 5.2 (3.0-9.0) min, respectively. The lowest acuity level (Green) victims had the shortest mean times for triage (3.5 min), evacuation (4.0 min), and treatment (10.0 min) while the highest acuity level (Red) victims had the longest mean times for all measures; patterns consistent with independent rather than ICS-directed rescuer activities. Specific ICS problem areas were identified. CONCLUSIONS: A structured, objective, quantitative evaluation of ICS function can identify deficiencies that can become the focus for subsequent improvement efforts.

Communication↗
PubMed1999

[Applicability of the Child Behavior Checklist in developmentally delayed children].

OBJECTIVES: The Child Behavior Checklist is used to assess behavioral problems in a large unselected sample of children. In the present study we assess the usefulness of the CBCL in the evaluation of the typical behavioral problems usually reported in children with developmental disorders. METHODS: We examined two groups of children which both had language or communication problems. The first group consisted of 34 children with infantile autism, the second group consisted of 34 age-, sex- and IQ-matched children with a specific developmental speech and language disorder. The CBCL was filled out by the parents in both groups as part of the routine diagnostic procedures. RESULTS: Half of the language-impaired children have Total Behavioral Problem scores within the clinical range. Problems are mainly reported on the scales: "Attention Problems", "Social Problems" and "Withdrawn". Two-thirds of the autistic children have deviant scores on the syndrome scales mentioned above. 32 out of 34 autistic children score within the clinical range on the scale "Thought Problems", whereas only one language-impaired child does so. Single item analysis shows a high prevalence of developmental problems (speech problems, enuresis ...) in both groups. CONCLUSION: The CBCL records characteristic behavioral problems in children with developmental disorders. The problematic behaviors are shown on the syndrome scale level as well as on the single item level. Children with developmental disorders and high scores on the "Thought Problems" scale of the CBCL should be evaluated for the presence of a possible pervasive developmental disorder.

Adolescent↗
PubMed1998

Videostroboscopy of the pharyngoesophageal segment in total laryngectomees.

OBJECTIVES: The reconstructed pharyngoesophageal segment (PES) serves as the neoglottis following total laryngectomy, as it provides the source of vibration for production of tracheoesophageal puncture (TEP) voice. To date, little information exists regarding the vibratory characteristics of the PES. The purpose of this investigation was to study the anatomy and physiology of the PES using videostroboscopy. STUDY DESIGN: Prospective study investigating the anatomy and physiology of the PES in 34 laryngectomees who used TEP speech as their primary form of communication. MATERIALS AND METHODS: Videostroboscopy and voice recordings were graded by three trained, blinded judges using a seven-point scale. RESULTS: The patients demonstrated differences that allowed for separation of patients into two main groups: "poor" and "effective" TEP speakers. The voice quality differences were explained by anatomic and physiologic characteristics of the PES. Redundant, thick, and dyssynchronous PES features were observed in patients with poor TEP speech skills; the effective speakers exhibited less redundant, thinner mucosa and more synchronous vibratory patterns. Moreover, the latter subgroup consistently demonstrated a greater degree of volitional PES control and less spasmodic activity than their poorly speaking counterparts. Length of the PES opening (measured in the horizontal plane) as well as amount and consistency of secretions did not appear to influence TEP speech or voice proficiency. CONCLUSION: Videostroboscopy in laryngectomees is a noninvasive, inexpensive, easily performed procedure that may contribute valuable information regarding the anatomy and physiology of the PES, especially in patients who experience difficulties achieving satisfactory TEP voice and speech production.

Adult↗