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PubMed1986

The Vienna cochlear implant program.

The cochlear implant program in Vienna has now gathered 160 patient years of experience with 25 patients who have received an extracochlear implant prosthesis and 31 patients who have received an intracochlear implant prosthesis. The sound processor avoids the transformation of speech into pulses and provides a processed analog broad-band stimulation signal. Approximately one half of the patients are prelingually deaf. The selection criteria include electrical promontory stimulation and acoustic and electrical brain-stem audiometry. The rehabilitation program consisting of counseling, communication training, and auditory training is considered an important part of the program. The results are assessed using the Vienna Auditory Test battery. Sixty per cent of the postlingually deafened patients achieve some open-set speech understanding without lip-reading. Sixty-five per cent of the users show a substantial improvement in aided speech understanding versus lip-reading alone.

Audiometry, Evoked Response↗
PubMed1994

[Growth factors and oncogenes in development and carcinogenesis. Role of the epidermal growth factor system].

The processes of cellular proliferation and progressive acquisition of a specialized phenotype show a remarkable degree of coordination that involves both intracellular programming and intercellular communication. One of the major incentives for studying factors that regulate the processes of cellular proliferation and differentiation is the recognition of their potential contribution to tumorigenesis. In normal cells, stimulatory and inhibitory events are believed to be under the control of growth factors and growth inhibitory factors, which are known to be protooncogene products. Growth regulatory mechanisms usually involve the binding of a growth factor to a specific receptor on the cell surface, which then through an intracellular biochemical cascade leads to cell division. The cell regulation pathways initiated by growth factors may be subverted at several distinct levels in cancer cells. Studies of oncogenes have shown that they may function as abnormal growth factors or abnormal receptors, induce expression of potential signal regulators or encode proteins which modulate gene transcription. The purpose of the present paper is to examine the role of growth factors, growth factor receptors and intracellular proteins involved in signal transduction (with particular regard to the epidermal growth factor receptor system) in the control of normal growth and differentiation, and their contribution to transformation and tumorigenesis. We also review the classical theories of neoplasia and various other models. Chemical carcinogenesis and Vogelstein-Lane model are presented.

Amino Acid Sequence↗
PubMed1977

Coordinators for health science libraries in the Midwest Health Science Library Network.

In the summer of 1973 one resource library in each of the six states of the Midwest Health Science Library Network received funding from the National Library of Medicine to hire a coordinator for health science libraries. The development of the role of coordinator is examined and evaluated. The coordinators have proved valuable in the areas of consortium formation, basic unit development, communication facilitation, and program initiation. The function of the coordinators in the extensive planning effort now being undertaken by the network and the future need for the coordinator positions are discussed.

Administrative Personnel↗
PubMed1993

Graphical access to medical expert systems: IV. Experiments to determine the role of spoken input.

The goal of our research is to design improved interfaces for medical expert systems. Previously, the use of graphical techniques was explored to improve the acceptance by clinicians of the user interface. Now that devices that accept spoken input are available, we wish to design interfaces that take advantage of this potentially more natural modality for interaction. To understand how clinicians might want to speak to a medical decision-support system, we carried out an experiment that simulated the availability of a spoken interface to the ONCOCIN medical expert system. ONCOCIN provides therapy advice for patients on complex cancer therapy protocols based on a description of the patient's current medical status and laboratory-test values. In the experiment, we had oncologists present a clinical case while observing the ONCOCIN flowsheet display. A project member listened to the presentation and filled in values for the flowsheet, as well as introducing purposeful misunderstandings of the input. The results suggest that each individual developed a stereotypical grammar for communicating with the program. Our experience with the purposeful miscommunications suggests particular ways to tailor requests for repetition based on the part of the utterance that was not understood.

Decision Making, Computer-Assisted↗
PubMed1993

[Computer systems in gastroenterologic endoscopy. An analysis of current availability on the Austrian market].

Five systems for computerized documentation (ADAM-Fujinon, ENDOBASE-Olympus, MEDASYS-Pentax, MEPAS-Fritsch & Jirak, OPTAMED-Krötlinger) are compared in their different functions: configuration of system, software, communication, structure of program, user guidance, data-protection, data back-up, patient registration, preparation for examination, terminology setup, report generation, image filing, statistic, system adjustments, costs. This paper should be a help in buying a computer-aided system. All systems fulfil the three basic requirements for a computer-aided documentation in gastrointestinal endoscopy: database, image filing, report generation. Actually none of the programs can be favoured. Peculiarities, weakness and strength of the different programs are discussed. The principle of the scoring-method in choosing a system is explained.

Austria↗
PubMed1976

A civilian air emergency service: a report of its development, technical aspects, and experience.

1) The development of Air Emergency Service sponsored by a private community hospital is described. 2) Helicopter evacuation of the seriously injured and critically ill in civilian life proved feasible if the community is willing to pay for the services rendered. 3) Two thousand six hundred fifty patients have been transported by helicopter (85%) or fixed-wing plane in 27 months. A minimum of 2,000 flights seems a certainty for 1975. 4) The types of patient, causes of death, and other medical aspects are discussed. 5) The helicopter must be considered as only one component in the E.M.S. System. It will be successful only with development of a complete program which includes: communications; cooperation of law enforcement agencies, fire districts, and rescue squads; integration with ground transportation; the inclusion of highly trained allied medical personnel, physicians, emergency departments and hospitals; and community education and acceptance.

Aerospace Medicine↗
PubMedDate not supplied

Toward a symmetrical and an integrated framework of norms for nutrition communication in sub-Saharan Africa.

Nutrition is crucial to national development; an undernourished or a malnourished population is at risk for infectious diseases that may reduce its working and productive capacities. Sub-Saharan Africa leads the world in the proportion of its population that is chronically malnourished. This article presents a symmetrical and an integrated framework of norms for nutrition communication. It uses three nutrition communication projects in Africa to illustrate the application of those norms. Based on that review, it concludes that a community-based framework should emphasize at the outset--and throughout program implementation and evaluation--the importance of folk media (e.g., Africa's "oramedia") as both formative and summative norms for planning, implementing, and evaluating nutrition communication programs in Africa.

Africa South of the Sahara↗
PubMed2006

Putting woman-centered care into practice: a new (ANEW) approach to psychosocial risk assessment during pregnancy.

BACKGROUND: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy. METHODS: ANEW used a before-and-after survey design to evaluate the effects of a 6-month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self-rated communication skills, and open-ended questions about participants' experience of the educational program. RESULTS: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program. CONCLUSIONS: The program increased the self-reported comfort and competency of health professionals to identify and care for women with psychosocial issues.

Adult↗
PubMed2006

Communication skills training at the Atlantic Veterinary College, University of Prince Edward Island.

Communication skills are considered a core clinical skill in human medicine. Recognizing the importance of communication skills and addressing them in veterinary curricula, however, is just beginning. In the fall of 2003, the Atlantic Veterinary College, University of Prince Edward Island, markedly changed the way in which it approaches communication teaching. An intensive one-week elective rotation on client communication was offered in the senior year. This rotation made extensive use of experiential techniques through the use of role plays and videotaped real client interactions. A group of faculty and hospital staff members were trained as coaches to support students as they practiced their communication in various client scenarios. The skills taught were based on the Calgary-Cambridge Observation Guide, which outlines observable behaviors that contribute to effective medical communication. Student response to and feedback on the rotation have been very positive. As a result, the number of rotations given per year has been increased. Long-term plans include expanding communication skills teaching into other years of the DVM program and incorporating simulated clients into the teaching program. Challenges that lie ahead include the development of a fully integrated communication teaching program that spans the whole curriculum, addressing the ongoing need for the professional development of coaches, improving methods of student assessment, and recruiting/training a sufficient number of coaches.

Communication↗
PubMedDate not supplied

Survey of behavior management teaching in pediatric dentistry advanced education programs.

PURPOSE: The purpose of this study was to survey pediatric dentistry advanced education program directors regarding the teaching of behavior management techniques. METHODS: Surveys were mailed to all (65) advanced education programs 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 54 programs. Two programs declined to respond because they had not yet accepted or certified residents. The final response rate was 86%. The mean percentage (+/- SD) of total didactic time devoted to behavior management was 13% (+/-9.5). Communicative techniques were taught as "acceptable" by 98% of programs, with the exception of the hand-over-mouth exercise (HOME), which was taught as "unacceptable" by 54% of programs. Active and passive immobilization of sedated and nonsedated children was taught as "acceptable" by 76% to 98% of programs. All 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 it is likely to change in the near future. Parental presence in the operatory was common for some procedures, particularly among younger children. CONCLUSIONS: Most programs do not teach HOME as an acceptable behavior management technique. The amount of curricular time devoted to behavior management is not likely to change appreciably in the near future.

Anesthesia, Dental↗
PubMed2005

Meeting communication needs: topics of talk in the nursing home.

Nursing home residents primarily rely on staff for communication and interpersonal relationships. Challenged by staffing shortages and increasingly complex care, staff who provide the most communication with residents lack awareness and skills to effectively communicate with older adults. This study, a secondary analysis of staff-resident interactions from one nursing home, explores communication topics and the effects of an intervention. Staff from one unit were recorded during 2 hours of caregiving to provide a representative sample of their communication with residents. Staff then attended an educational program targeting improved awareness of communication needs and reducing "elderspeak". Recording was repeated post-intervention. Baseline conversations focused on activities of daily living (ADLs), personal-social, technical care, and health assessment. Post-intervention ADL talk decreased in staff-resident interactions, while personal-social topics increased. These findings suggest that residents' limited opportunities for communication with staff are primarily focused on care tasks. With increased communication awareness, staff can learn to modify conversational topics to better meet older adults' psychosocial needs.

Activities of Daily Living↗
PubMed2005

Staff development planning in an academic health sciences library.

OBJECTIVE: A staff development committee (SDC) was convened to implement staff development opportunities for an academic health sciences library system comprised of three separate facilities. The charge for the SDC was to: (1) develop programs to enhance workplace skills and personal growth, (2) communicate the availability of existing programs at the university and medical center, and (3) encourage the staff to participate in these opportunities. PROGRAM: The committee created goals and objectives and developed a survey designed to give staff the opportunity to provide input for this initiative. With an 80% response rate, the survey results were used to plan 15 events based on staff needs and preferences. First-year attendance for SDC-sponsored events was 459. Committee members served as liaisons for each event. Two forms were developed to facilitate event planning. A monthly announcement sheet, email reminders, and the library's local area network are used to communicate upcoming SDC events and encourage attendance. CONCLUSION: This approach can serve as a useful model for similar program planning in any organization.

Academies and Institutes↗
PubMed2005

Technology-driven interactive care management identifies and resolves more clinical issues than a claims-based alerting system.

Due to patient or physician factors, people with chronic diseases frequently do not receive evidence-based care. While a physician-directed claims-based alerting system targeting gaps in care was previously shown to increase resolution of specific clinical issues, many apparently relevant issues remained unresolved. The purpose of this research was to demonstrate that adding member interaction with a nurse to a physician alerting system can uncover additional care gaps beyond those identified by a claims, prescription, and lab results-based alerting system, and increase successful resolution of alerts by communicating care gaps to members. An opt-in nurse-managed pilot program focusing on identification and resolution of specific clinical issues was implemented for 205,463 members of self-insured health plans that had been utilizing the claims-based physician alerting system. Specific clinical issues identified by the claims-based system were communicated to both program enrollees and physicians, and new clinical issues were identified based on nurse-directed participant feedback. Participants were encouraged to discuss issues with their physicians. Issue resolution rates were tracked using subsequent claims, pharmacy, and lab data. At 1 year, we studied the rate of new clinical issue identification and compared the program's resolution rate of claims-identifiable issues to that of non-enrollees. While program participants accounted for 0.65% of total member-months in the pilot year, they triggered 4.82% (644) of the population's claims-based clinical alerts, and an additional 514 alerts from data based on participant-supplied data--80.8% more than claims/pharmacy/lab-generated alerts. Of the participants' claims-based alerts, 207 (32.1%) showed claims/lab evidence of successful resolution, compared with 3,380 of 12,714 (26.6%) for non-participants, a 20.9% increase in resolutions (chi2 = 9.8, p < 0.01). Care management technology complemented by a nurse-directed interactive program increased the rate of identification of clinical issues compared to claims alerts alone. Use of this program to communicate specific issues to both patients and physicians significantly increased the rate of issue resolution.

Decision Support Systems, Clinical↗
PubMed1999

Speech perception results in children with cochlear implants: contributing factors.

Speech perception test results were obtained from a group of 40 pediatric cochlear implant users. Half of the children participated in oral-only habilitation programs, which included both traditional oral and auditory-verbal approaches, and half participated in programs that used a combination of oral and manual communication referred to as total communication (TC). Analysis of the scores showed that children enrolled in oral-only habilitation programs scored significantly higher on the speech perception measures than did children who were enrolled in total communication based programs. These results were inconsistent with those of other reports, which suggested that communication methods had little effect on implant outcomes. To further examine the reasons for the differences in performance, we analyzed 7 additional factors, including length of implant use, age at surgery, device type, socioeconomic status, bilingualism, school setting, and participation in private therapy, which may affect implant performance. Multiple-regression analysis again showed communication mode to be the factor most highly correlated with speech perception abilities among this group of children.

Adolescent↗
PubMed1990

Quality assurance in anatomic pathology. An information system approach.

Quality assurance (QA) is the outcome-oriented process by which the performance of a complex production operation is evaluated. It is strongly focused on the use of resources and the end product, and is closely related to marketing. The pathologist's product is information, and the practice of anatomic pathology is evaluated as a system for producing and effectively communicating information. Our integrated program for QA in surgical pathology, autopsy pathology, and cytopathology recognizes that several discrete elements make up the sequence leading to communication of the diagnostic opinion. These are control and processing of the specimen, accuracy of diagnosis, timely and clear communication, efficiency in production of information, coherence with institutional programs in QA, and relation to licensing and accreditation agencies. Each of these elements may be tested separately and sources of error reduced so that the validity and cost of the pathologist's prediction will ultimately be limited only by the state of the art and not by any failure of the information system. Several components of QA, especially resource utilization by pathologists, are potentially productive areas for operations research.

Clinical Laboratory Information Systems↗
PubMed1996

Newsletters as a channel for communication in a community-based Aedes aegypti control program in Marília, Brazil.

In Marília, Brazil, community newsletters were established in a pilot project on community-based Aedes aegypti control. The newsletters were an excellent way of promoting communication between community members and project personnel. While people might not have attended a dengue meeting, they did turn up at meetings to plan the newsletters. During these meetings project staff obtained information about the communities that was crucial for planning a community-based recycling project that targeted many Aedes aegypti larval habitats. The newsletters were not an appropriate channel for transmitting information about dengue prevention and mosquito control.

Aedes↗