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PubMedDate not supplied

Early intervention for infants with deaf-blindness.

Few individuals labeled deaf-blind are, in fact, totally deaf and totally blind. Many of these individuals have residual sight and hearing, but may not receive adequate early training in using these senses effectively. Effective early sensory training with infants entails the use of consistent reinforcement methods in natural social contexts. Preservice and inservice teachers must become knowledgeable in high-quality programming components in which the goal is to increase the abilities of students with dual sensory impairments--in both mobility and communication--and to help them become independent, responsible adults.

Blindness↗
PubMed1998

Nurse-patient communication in palliative care: an evaluation of a communication skills programme.

Good communication between nurses and patients is a central aspect of palliative care. However, evaluation of courses designed to improve nurses' communication skills has been inconclusive. Most courses have concentrated on skills training, although communication training programmes which have been integrated into clinical practice over time and have also focused on attitudes and used a range of teaching methods, have been shown to be effective. A study was set up to evaluate whether a communication skills course which would focus on knowledge, attitudes and skills would improve nurses' communication skills. One-hundred-and-ten nurses completed a 26 h training programme over six months and completed precourse and postcourse audiotape recordings of a patient assessment. An overall statistically significant improvement in assessment skills between pretest and post-test mean total scores (P < 0.001) was found, with statistically significant improvements in six of the nine key areas assessed. The nurses reported that although some elements of the programme, such as role play, had been stressful they felt more confident in handling difficult situations. The longer integrated communication skills programme which allows nurses to explore attitudes, raise self-awareness and develop knowledge and skills appears to be effective.

Adult↗
PubMed1993

[Voice rehabilitation with esophageal speech in the laryngectomized].

From January 1988 to December 1990, 186 patients with laryngeal cancer or hypopharyngeal cancer underwent total laryngectomy in our hospital. We studied voice restoration in 110 of these patients by means of a direct interview method at the end of 1991. Seventy-six cases were excluded because of death (70) or being lost to follow-up (6). About 80% of the patients (89/110) attended esophageal speech classes, with a success rate of 78% (69/89). Seventy-four percent (51/69) had no problems with daily oral communication using esophageal speech. Neither radiation therapy nor post operative pharyngocutaneous fistula formation influenced the success rate. Neither did the site of the primary tumor in the larynx or hypopharynx exert an influence, although patients with laryngeal cancer were superior to those with hypopharyngeal cancer in terms of the quality of esophageal speech. It was found that age was the most important factor. Patients below 60 years old had a 90% success rate, between 60 and 75 the rate was 60% and above 75 it was only 10%. Unfortunately, 15% (17/110) of the laryngectomized patients used a pen and pad alone. Most were too old to attend esophageal speech classes.

Adult↗
PubMed1986

[Is the PACS feasible for a large radiological department? Reflections on the image data volume of the Medical Radiation Institute of the University of Tübingen in 1983. Picture Archiving and Communication System].

Picture Archiving and Communication Systems (PACS) are getting more and more important for departments of radiology with the increasing spread of digital imaging methods. To determine the demands made on such systems, we calculated the digital image data volume for all examinations carried out in 1983 at the Department of Medical Radiology of the University of Tübingen. 20.37% of all examinations were performed with digitalised equipment. Plain radiography takes the lion's share among the total number of image data. If digitalisation is based on a spatial resolution of 8 Lp/mm, the share is 98.4% of the total image data volume of 7 123 GByte. This figure is far in excess of the estimates stated in literature. The possibilities of image data reduction and feasibility of a major PACS are discussed.

Academic Medical Centers↗
PubMed1979

[Microbial emission, immission and changes in the germ count in the cooling water during operation of wet cooling towers ii. communication: measuring methods, emission values and changes in the germ count in the cooling system (author's transl)].

The second in the series "Microbial emission, immission and changes in the germ count in the cooling water of wet cooling towers" describes measuring methods and results of the measurements for determining the emission values and the changes in the germ count in the cooling system. The content of colony-forming units (KBE) in the cooling water varied widely, depending on the germ content of the surface water and the preparation of the cooling water (filtration, chemical conditioning). In summer the KBE values were as a rule higher than the values recorded in winter (factor of about 10). The introduction of cooling tower water into the surface water thus did not result in any noticeable changes in germ content, either in summer or in winter. An emission rate of 8.3 10(7) KBE/s (CSA) measured at the top of the cooling tower was the maximum emission value recorded. This resulted in a total germ content in the plume of 1.2 . 10(4) KBE/m3. In order to place this finding into perspective, it should be noted that fluctuations in the KBE values of the air of considerably more than 1000 KBE/m3 can occur because of biological release and meteorological conditions alone (see IVth communication). The KBE-P values recorded (content of particles with units which are capable of forming colonies) in the plume were of the same order as the KBE values. From this it can be concluded that the drops of cooling water which are swept away with the plume are normally only charged with individual colony-forming units. It is worth noting that the KBE values of the plume are only indirectly dependent on the KBE values of the cooling water used in the cooling tower.

Air Microbiology↗
PubMedDate not supplied

Use of a customer satisfaction survey by health care regulators: a tool for total quality management.

OBJECTIVES: To conduct a survey of health care providers to determine the quality of service provided by the staff of a regulatory agency; to collect information on provider needs and expectations; to identify perceived and potential problems that need improvement; and to make changes to improve regulatory services. METHODS: The authors surveyed health care providers using a customer satisfaction questionnaire developed in collaboration with a group of providers and a research consultant. The questionnaire contained 20 declarative statements that fell into six quality domains: proficiency, judgment, responsiveness, communication, accommodation, and relevance. A 10% level of dissatisfaction was used as the acceptable performance standard. RESULTS: The survey was mailed to 324 hospitals, nursing homes, home care agencies, hospices, ambulatory care centers, and health maintenance organizations. Fifty-six percent of provider agencies responded; more than half had written comments. The three highest levels of customer satisfaction were in courtesy of regulatory staff (90%), efficient use of onsite time (84%), and respect for provider employees (83%). The three lowest levels of satisfaction were in the judgment domain; only 44% felt that there was consistency among regulatory staff in the interpretation of regulations, only 45% felt that interpretations of regulations were flexible and reasonable, and only 49% felt that regulations were applied objectively. Nine of 20 quality indicators had dissatisfaction ratings of more than 10%; these were considered priorities for improvement. CONCLUSIONS: Responses to the survey identified a number of specific areas of concern; these findings are being incorporated into the continuous quality improvement program of the office.

Attitude of Health Personnel↗
PubMed1983

Correction of attenuation in whole-body determination of Co-57 B12 absorption: concise communication.

The use of Co-57-labeled B12 for whole-body measurement of B12 uptake in humans has the advantage over Co-58 of easy commercial availability and lower cumulative radiation to the liver, but the disadvantage of significant attenuation. Methods devised to correct for the attenuation have used inaccurate early 100% counts. A method is described here that uses a liver phantom, containing a dissolved Co-57 B12 capsule, in a water tank. The ratios of upper to lower detector counts is related to total counts; it varies at different depths in the tank, and with the overall tank depth that is selected to accord with measured body habitus. The ratio of detector counts in the final patient count is used to read off the appropriate 100% total count. With this technique there is a clear discrimination between normal patients and those with pernicious anemia.

Absorption↗
PubMed2002

The effect of qualitative vs. quantitative presentation of probability estimates on patient decision-making: a randomized trial.

BACKGROUND: Given the greater uncertainty surrounding probability estimates associated with qualitative (use of words or phrases) descriptions, the use of quantitative (numerical) information to communicate the risks and benefits of therapies is recommended but the impact of its use in decision aids is unexplored. OBJECTIVE: Using stroke prevention in atrial fibrillation as an example, to compare the impact of quantitative vs. qualitative descriptions of probability risk estimates in decision aids on the clinical decision-making process. DESIGN: Randomized trial with a 2 x 2 factorial design. SUBJECTS: A total of 198 volunteers aged 60-80 years. SETTING: Outpatient clinics of a university-affiliated, tertiary-care teaching hospital. METHODS: Participants were asked to imagine that they had atrial fibrillation, and using a decision aid, were then randomized to two ways of receiving pertinent risk information regarding the probability of stroke and major bleeding when taking warfarin, aspirin or no therapy: (1) quantitatively, in which the 2-year probabilities of stroke and major haemorrhage were presented both numerically and graphically with 100 faces (e.g. 8 of 100), and (2) qualitatively in which these probabilities were presented with the use of verbal phrases (e.g. very low, moderate). OUTCOME MEASURES: Primary: decisional conflict. Secondary: participants' choices, knowledge and expectations of outcomes using qualitative and quantitative scales. RESULTS: Participants reviewing quantitative risk information scored better on the informed subscale of the decisional conflict scale (P < 0.05) and, as expected, were better able to estimate numerically their chance of stroke and bleeding when taking warfarin, aspirin or no medication. For the low risk arm, there were no significant differences in treatment choices for the qualitative and quantitative groups. For the moderate risk arm, treatment choices between the two groups were significantly different (P = 0.01), with those in the quantitative group more likely to make an actual choice and to choose therapies at the extremes of effectiveness (warfarin and no treatment). There were no significant differences between the quantitative and qualitative groups in their ability to rank-order their stroke risk when taking warfarin, aspirin and no treatment, overall knowledge about atrial fibrillation and its treatment, and other dimensions of decisional conflict (all P-values >0.05). CONCLUSIONS: For participants without the disease in question, this study found that providing sufficient quantitative risk information makes them feel more informed, which sometimes affects their treatment choices. Further studies are necessary to confirm these findings for patients making actual clinical decisions.

Aged↗
PubMed2000

Tuberculosis control in Sudan against seemingly insurmountable odds.

SETTING: Sudan, Africa's largest and one of its poorest countries, in which civil disturbance, resource limitation and communications difficulties are substantial impediments to delivery of health services. OBJECTIVES: To 1) illustrate the burden of tuberculosis; 2) review measures taken to control the disease; 3) outline the introduction of the DOTS strategy; and 4) demonstrate the trend in the output of the DOTS strategy. METHODS: Published information on general health, tuberculosis and health structure provide the setting. Routine reports illustrate the trend in case notification in Sudan, and outcome of treatment by period of enrollment on treatment (cohort). RESULTS: Since 1992, sputum smear microscopy centres have been established in existing health facilities (179 of a total 290 targeted centres). By the end of the second quarter of 1998, 82,860 cases of tuberculosis had been reported, of whom 52% were sputum smear-positive cases. Of these, 89% had no history of previous treatment for as much as one month. The treatment outcomes for 11,000 new smear-positive cases were reported by the end of the second quarter of 1997; the proportion of notified cases for whom treatment results were available increased from 16% in 1994 to 63% in 1996. Of these, 72% were successfully treated, increasing from 62% in 1994 to 73% in 1996. CONCLUSIONS: Despite seemingly overwhelming odds, the DOTS strategy has been successfully commenced and is in the process of expansion throughout the country, with monitoring of the quality of diagnostic examinations and improvements in treatment outcome. Further improvement is necessary, but appears feasible.

AIDS-Related Opportunistic Infections↗
PubMed1994

Developing a standard of care for patients at risk for long-term hospitalization.

At one hospital, during 1 month, charts of patients whose length of stay was greater than or equal to 60 days were reviewed to determine current dietetics practice. Several areas that affect overall nutrition care were identified: consistent follow-through on recommendations, continuity of care, consistent protocol for addition of supplements, communication of results of calorie counts, and assessment of nutritional status over the course of hospitalization vs documentation on a particular day. A protocol was developed to provide weekly information about patient weight for ongoing nutrition assessment. A profile of patients at risk for increased length of hospital stay was developed using historical information. Patient age and diagnosis at the time of admission were the basis of the profile, which was incorporated into the screening program. A standard of care was designed to provide early, aggressive nutrition intervention to patients at risk. Clinical managers can follow the steps outlined to develop consistent nutrition care standards. Such standards can be incorporated into a quality improvement program to assess the effectiveness of the nutrition care methods and improve the quality of care provided.

Age Factors↗
PubMed2005

Conversational strategies with parents of newly diagnosed leukaemic children: an analysis of 4880 conversational turns.

GOALS OF WORK: Communication with parents of children newly diagnosed with cancer poses a number of problems, mostly due to the psychological effects of parental trauma. This study was designed to answer the following questions: How can we sustain the flow of communication with parents of children newly diagnosed with leukaemia so that it may become easier and more effective? What should we say to gather more reliable information from parents? How can we help empower their coping strategies? PATIENTS AND METHODS: We analysed 4880 conversational turns in individual conversations carried out between psychologists and 21 parents of children with leukaemia. The conversations were aimed at gathering information of the families' daily routines. Dialogues were audiotaped and fully transcribed. The type and frequency of speech acts present in each turn were coded along 18 categories by two independent judges (inter-rater agreement, Cohen Kappa =0.73). MAIN RESULTS: The parental speech acts expressing emotion in various ways go up to 58% of the total number of their speech acts. The lag-sequential analysis showed that such expressions are not associated with any of the interviewer's speech act. The same analysis showed that, by contrast, the interviewer's style has an effect upon the cognitive aspects of parents' conversation. Support of hope favoured parental ability to identify their coping strategies. Explicit requests, confirmations such as "sure" and key words summarizing parents' viewpoints are followed by parental factual and objective narratives. CONCLUSIONS: Based on these results, a few practical recommendations for health care professionals are given in order to better communicate with parents of children newly diagnosed with cancer.

Adolescent↗
PubMedDate not supplied

Parents' experiences of living through their child's suffering from and surviving severe meningococcal disease.

The aim of this study was to describe the lived experience of parents whose child had suffered from and survived severe meningococcal disease. A Heideggerian phenomenological approach was used within the study and data were collected from long focused interviews. In total, eight parents took part in the study; one was a woman recruited as a pilot interview and the other seven were recruited for the main study. The data were analysed using Colaizzi's (1978) method. Eleven themes emerged: (1) complications/side effects; (2) emotional turmoil; (3) child's physical appearance; (4) family disruption; (5) fear of death; (6) loss of parenting role; (7) need for support and understanding; (8) need and value of communication, information and publicity; (9) parental intuition; (10) technological interventions and (11) the impact of care delivery. A review of the literature arising out of the data was undertaken, and a final synthesis statement as perceived by the parents was achieved. Living through this experience is perceived as a major emotional stressor, and although health professionals have some insight into the experience, they are largely naive to the enormity of the situation.

Adolescent↗
PubMed2006

Growth of infant communication between 8 and 12 months: a population study.

AIM: To describe changes in infant prelinguistic communication skills between 8 and 12 months, and identify factors associated with those skills. METHODS DESIGN: Parent questionnaire data for a prospective population-based cohort of infants in metropolitan Melbourne, Australia. PARTICIPANTS: 1911 infants born November 2002-August 2003. OUTCOME: Infant communication (Communication and Symbolic Behaviour Scales (CSBS)) at 8 and 12 months. Potential risk factors: sex; prematurity; multiple birth; sociodemographic indicators; maternal mental health, vocabulary and education; non-English speaking background; and family history of speech-language difficulties. Linear regression models were fitted to total standardised CSBS scores at 8 and 12 months. RESULTS: Social communication, especially the use of gesture, developed rapidly from 8 to 12 months. Female sex, twin birth, and family history were strongly associated with CSBS scores. The combined model accounted for 5% and 6% of the total variation at 8 and 12 months, respectively. CSBS score at 8 months strongly predicted CSBS score at 12 months (coefficient = 0.56, partial R(2) = 37.0). CONCLUSIONS: There is a dramatic increase in communication skills between 8 and 12 months, particularly the development of gesture, which (as in previous studies) predates and predicts future language development. Risk factors explained little variation in early communication trajectories and therefore, based on our findings, this developmental course is more likely to be biologically predetermined. Rather than focusing on risk factors, we suggest that language promotion activities in otherwise healthy young infants should either be universal or, if targeted, be based on the level of communication skills displayed.

Australia↗
PubMed2006

Determinants of cardiovascular disease and other non-communicable diseases in Central and Eastern Europe: rationale and design of the HAPIEE study.

BACKGROUND: Over the last five decades, a wide gap in mortality opened between western and eastern Europe; this gap increased further after the dramatic fluctuations in mortality in the former Soviet Union (FSU) in the 1990s. Recent rapid increases in mortality among lower socioeconomic groups in eastern Europe suggests that socioeconomic factors are powerful determinants of mortality in these populations but the more proximal factors linking the social conditions with health remain unclear. The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study is a prospective cohort study designed to investigate the effect of classical and non-conventional risk factors and social and psychosocial factors on cardiovascular and other non-communicable diseases in eastern Europe and the FSU. The main hypotheses of the HAPIEE study relate to the role of alcohol, nutrition and psychosocial factors. METHODS AND DESIGN: The HAPIEE study comprises four cohorts in Russia, Poland, the Czech Republic and Lithuania; each consists of a random sample of men and women aged 45-69 years old at baseline, stratified by gender and 5 year age groups, and selected from population registers. The total planned sample size is 36,500 individuals. Baseline information from the Czech Republic, Russia and Poland was collected in 2002-2005 and includes data on health, lifestyle, diet (food frequency), socioeconomic circumstances and psychosocial factors. A short examination included measurement of anthropometric parameters, blood pressure, lung function and cognitive function, and a fasting venous blood sample. Re-examination of the cohorts in 2006-2008 focuses on healthy ageing and economic well-being using face-to-face computer assisted personal interviews. Recruitment of the Lithuanian cohort is ongoing, with baseline and re-examination data being collected simultaneously. All cohorts are being followed up for mortality and non-fatal cardiovascular events. DISCUSSION: The HAPIEE study will provide important new insights into social, behavioural and biological factors influencing mortality and cardiovascular risk in the region.

Aged↗
PubMed1999

Results of faculty evaluation at the Aga Khan University, Karachi, Pakistan.

OBJECTIVE: The aim of the retrospective correlational analysis was to identify the attributes valued most by students for assessing the overall effectiveness of a teacher. METHODS: Responses of the students to the two versions of evaluation questionnaires, each attempting to assess 4 and 8 characteristics respectively on a scale of 1-5 were included in the analysis. The third and fourth year students, at the end of each course/module completed a total of 2110 evaluation forms, which were studied. RESULTS: The over all effectiveness of the teacher showed statistically significant correlation of .914 and .895 with ability to communicate ideas effectively and clarity and organisation of the lectures. Whereas the knowledge of subject and the successful use of teaching aids showed a correlation of .658 and .637 with a statistical significance of P < .01. CONCLUSION: Students need a basic outline of what they have to learn and guidance to plan their studies.

Education, Medical↗
PubMed2001

Minimally invasive subclavian/axillary artery to coronary artery bypass (SAXCAB): review and classification.

BACKGROUND AND PURPOSE: Subclavian/axillary artery to coronary artery bypass (SAXCAB) surgery is defined as a minimally (or less) invasive coronary revascularization procedure where one or more grafts are anastomosed to the second or third parts of the subclavian artery or any of the three parts of the axillary artery (inflow source) and attached to one or more coronary arteries, and where there are two separate minimally invasive incisions to expose the target coronary artery and the inflow sources, respectively. The indications and contraindications for SAXCAB surgery are discussed, and the relevant chest wall anatomy and that of the subclavian and axillary arteries are reviewed. The effect of respiration and anatomic variability as they impact the SAXCAB graft are discussed. Three components of the anatomy that are important in SAXCAB surgery are discussed: The relation of the first rib to the clavicle insofar as it affects access to the third part of the subclavian artery, the anatomy of the subclavian and axillary arteries and their branches, and the anatomy of the chest wall and its movement. In addition, the different SAXCAB variations that have been applied clinically are reviewed and classified, and future aspects of SAXCAB research are discussed. SAXCAB surgery is unique among the different types of minimally invasive direct coronary artery bypass (MIDCAB) surgery because of the enormous diversity of the techniques that have been described. Based on these descriptions, a new classification of SAXCAB grafting is proposed depending on whether the graft is inside or outside the rib cage and whether or not the coronary artery is exposed by rib resection or through an intercostal space. The third part of the classification takes into consideration the mode of entry into the chest, whether it is by rib resection or through an intercostal space. METHODS: Inquiries were made by telephone and by mail in the year 2000 to a number of surgeons who had published details of their SAXCAB techniques, and informal information was obtained by a series of personal communications as to the estimated number of operations they had performed and the outcomes. Published data was also used to formulate a rough guide as to the international status of the procedure at this time. RESULTS: The total estimated international experience is about 100 cases and the patency is between 70 and 100 percent in the time frame of about one to two years. CONCLUSIONS: The MIDCAB technique in general has been successful in providing an alternative way to revascularize the coronary arteries, and the SAXCAB has proved to be one of the most interesting classes of MIDCAB surgery. SAXCAB grafts seem to be unique among coronary revascularization procedures and, indeed, probably almost all vascular procedures, in that there is enormous diversity in the route for the graft from the inflow source to the target coronary artery. Being knowledgeable about the different varieties of SAXCAB surgeries will help the surgeon during a rescue operation as the surgery can be tailored to suit a particular patient. The SAXCAB seems to be a very safe operation, and it is striking that so far no one has reported any major complications.

Axillary Artery↗
PubMed2006

[HIV-infection in Norway before 2006].

BACKGROUND: Our goal is to give an epidemiological description of the HIV epidemic in Norway until 2006, with emphasis on the decade 1996 - 2005. METHODS: We analysed data from the Norwegian Surveillance System for Communicable Diseases. In this system, the year of infection has been estimated using results of previous tests and other information. We can thus measure an annual minimum incidence of HIV infection. RESULTS: Before 2006, HIV infection had been diagnosed in 3263 persons in Norway. Persons who had been heterosexually infected before arrival in Norway and homosexual men account for one third of the total each, while injecting drug users and persons who have been heterosexually infected while living in Norway comprise one sixth each. Each year for the last few years about 50 persons have been infected homosexually, 20 heterosexually and 10 by injecting drug use. In addition, every year at least 100 heterosexually infected immigrants have arrived in Norway. INTERPRETATION: The HIV epidemic is considerable in Norway, although far from the prospects one had 20 years ago. The prevention of HIV infection must continue. Presently, prevention among homosexual men should be prioritised. In addition, continued measures are needed among injecting drug users and men who engage with casual sex partners in countries with a high prevalence of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Cost of health services provided at a primary health centre.

BACKGROUND: Information on the cost of health services is essential for good planning and management and leads to an efficient use of resources. Very little information on this is available in India. We estimated the distribution of costs incurred on the Primary Health Centre, Chhainsa, Haryana by the type of service provided and their average unit costs. METHODS: We calculated the total costs incurred in running the primary health centre for one year using standard costing methods. This cost was apportioned under different heads on the basis of time and space utilization. The number of activities carried out, between April 1991 and March 1992, was obtained from the monthly reports of the centre maintained by the health assistant and supervised by the medical officer. RESULTS: The total cost incurred for one year was Rs 777,020 (US$ 24,250). Curative care accounted for 32% of the total costs followed by communicable disease control (17%), child care (17%), maternal care (11%) and family welfare (10%). An expenditure of Rs 24 was incurred on each outpatient. The cost of giving full primary immunization to a child was estimated at Rs 131, while Rs 127 was incurred on providing antenatal, natal and postnatal care to each pregnant woman. Tuberculosis-related activities in the community cost Rs 3 per head per year and malaria-related activities Rs 2 per head per year. The cost incurred annually on family welfare services to an eligible couple was Rs 19. CONCLUSIONS: Our findings suggest that the cost estimates from this primary health centre are comparable with the estimates from other developing countries. These cost estimates may be used to determine user fees by health agencies or for premiums for community health insurance schemes.

Capital Expenditures↗