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PubMed1998

Lesion site patterns in severe, nonverbal aphasia to predict outcome with a computer-assisted treatment program.

OBJECTIVE: To test whether lesion site patterns in patients with chronic, severe aphasia who have no meaningful spontaneous speech are predictive of outcome following treatment with a nonverbal, icon-based computer-assisted visual communication (C-ViC) program. DESIGN: Retrospective study in which computed tomographic scans performed 3 months after onset of stroke and aphasia test scores obtained before C-ViC therapy were reviewed for patients after receiving C-ViC treatment. SETTING: A neurology department and speech pathology service of a Department of Veterans Affairs medical center and a university aphasia research center. PATIENTS: Seventeen patients with stroke and severe aphasia who began treatment with C-ViC from 3 months to 10 years after onset of stroke. MAIN OUTCOME MEASURE: Level of ability to use C-ViC on a personal computer to communicate. RESULTS: All patients with bilateral lesions failed to learn C-ViC. For patients with unilateral left hemisphere lesion sites, statistical analyses accurately discriminated between those who could initiate communication with C-ViC from those who were only able to answer directed questions. The critical lesion areas involved temporal lobe structures (Wernicke cortical area and the subcortical temporal isthmus), supraventricular frontal lobe structures (supplementary motor area or cingulate gyrus 24), and the subcortical medial subcallosal fasciculus, deep to the Broca area. Specific lesion sites were also identified for appropriate candidacy for C-ViC. CONCLUSIONS: Lesion site patterns on computed tomographic scans are helpful to define candidacy for C-ViC training, and to predict outcome level. A practical method is presented for clinical application of these lesion site results in combination with aphasia test scores.

Adult↗
PubMed2006

Identification of nutrition communication styles and strategies: a qualitative study among Dutch GPs.

OBJECTIVE: The objectives of this study were to identify nutrition communication styles of Dutch GPs, their strategies regarding nutrition communication and nutrition information seeking behaviours. Another aim is to provide a hypothetical model for nutrition communication style, including psycho-social and socio-demographic variables. METHODS: Nine focus groups with 81 GPs were used to obtain GPs' perceptions of nutrition communication. Data were analysed with the computer software program NUD*IST. RESULTS: Five nutrition communication styles were identified, namely informational, reference, motivational, confrontational and holistic style. Referring to a dietician, providing advice according to Dietary Guidelines, and offering written education materials were mentioned as strategies regarding nutrition communication. GPs sought nutrition information in scientific studies, specialist literature, and postgraduate training courses. CONCLUSION: The informational style of nutrition communication was dominant among Dutch GPs. GPs hardly provided maintenance advice for nutrition behaviour. Many GPs referred patients to dieticians, who were viewed as colleagues. GPs tried to get basic information about nutrition by scanning the literature, but they were seldom actively involved in seeking specific nutrition information. Although GPs felt that patients expect expert nutrition information, they perceived their nutrition knowledge as restricted. PRACTICE IMPLICATIONS: We advise to raise self-efficacy of GPs regarding nutrition communication and to build good collaboration with dieticians.

Attitude of Health Personnel↗
PubMed2006

Physician-patient communication: a study on the observed behaviours of specialty physicians and the ways their patients perceive them.

OBJECTIVE: To explore the communicative behaviours as used by specialty physicians, and their patients' perception of the communicative act as well as their satisfaction with the encounter. METHODS: Cross-sectional study involving 27 specialty physicians and 257 outpatients. Encounters were video-recorded and analysed through the GATHA-ESP scale. Patients rated the quality of the interaction and their satisfaction with it in a questionnaire. RESULTS: Most specialist doctors use a "managerial" style where there is no exploration of their patients' emotions (22%), expectations (28%) or psychosocial aspects (10-20%). Less than one doctor out of every four ever gave the patient an opportunity to participate in any type of decision making at the surgery. Patients were more satisfied with those encounters they felt more patient-centred (F: 11.37; p<0.001); higher scores on the GATHA-ESP characterised these visits. CONCLUSIONS: Specialty physicians show a limited range of communicative skills as they use a doctor-centred style that allows for little patient participation. Patients' perceptions of patient-centeredness are linked to satisfaction more than the analysis of doctors' behaviour at the consultation does. PRACTICE IMPLICATIONS: It seems important to foster training in communication skills in the different specialist vocational training programs. Studies on physician-patient communication should deal with the perceived and observed perspectives on this domain.

Adult↗
PubMed2006

[Communication training for family caregivers of dementia patients].

The program Kommunikations-TAnDem was developed with the primary purpose of increasing the communication competence of family caregivers of dementia patients. Further aims were to reduce the burden of family caregivers and to increase the quality of life of dementia patients. The effectiveness of the Kommunikations-TAnDem was tested in a controlled training study with 22 participants using a waiting-group control design and process measurement. The results of the study verify effects for the variables "Communication competence", "Caregivers knowledge about communication in dementia", "Quality of life of dementia patients" and "Directly perceived burden of family caregivers. Therefore it can be concluded that the Kommunikations-TAnDem is a method of indirectly supporting dementia patients by training the family caregivers. The results of research in this program underline very clearly the relevance of the inclusion of the family caregivers in intervention programs and the importance of communication competence for the well-being of dementia patients and their caregivers.

Caregivers↗
PubMed2001

Medicare's outpatient code editor is key to APC payments.

Since implementation of the outpatient prospective payment system (PPS) in August 2000, HCFA has used an inadequate communication process to inform providers about billing and coding requirements. Numerous program memorandums have been issued to communicate changes to the outpatient PPS and even to correct information that was provided in previous program memorandums. Providers need to monitor changes in outpatient PPS policy by reading the program memorandums posted on HCFA's Web site (www.hcfa.org) and through reviewing other informal communications posted to the HCFA Web site. In addition, the outpatient code editor (OCE) contains information about quarterly APC classification updates. In fact, the OCE is the only source of this information in many cases. Because the outpatient PPS differs from any other PPS implemented by HCFA, providers should ensure that they have all the current information they need to comply with the system's billing and coding requirements.

Abstracting and Indexing↗
PubMed2001

RECODE: a database of frameshifting, bypassing and codon redefinition utilized for gene expression.

The RECODE database is a compilation of 'programmed' translational recoding events taken from the scientific literature and personal communications. The database deals with programmed ribosomal frameshifting, codon redefinition and translational bypass occurring in a variety of organisms. The entries for each event include the sequences of the corresponding genes, their encoded proteins for both the normal and alternate decoding, the types of the recoding events involved, trans-factors and cis-elements that influence recoding. The database is freely available at http://recode.genetics. utah.edu/.

Base Sequence↗
PubMed1996

[Evaluation of a new AIDS communication and prevention model. Analysis of reactions to the program "3000 scenarios against a virus"].

In June 1994, 31 films on AIDS prevention have been broadcasted on the French television networks. Because of their cinematographic construction, the diversity of the situations, and the presentation of prevention as a relation, these films represent a new model for AIDS information campaigns. This campaign has been evaluated through both qualitative and quantitative approaches. A telephone survey was conducted on a representative sample of 1000 persons who had seen at least three films, that is 30% of the general population. The formal characteristics of the campaign induced particular interest while the content of the films induced emotion and lead to a personal implication. This new kind of communication lead to discussions, but these were mostly restricted to prevention in general and to people with AIDS. Personal and social experience characteristics, in particular the ability to talk about sexuality, seem to be determinant to explain the observed reactions. In contrast, the impact of the campaign is not different according to the age of the respondent and to sexual activity. These results show that it may be of some interest to define communication tools on AIDS that would take into account people's attitudes toward sexuality and their ability to talk about it.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Developing end-of-life interdisciplinary programs in universitywide settings.

Interdisciplinary programs in end of life are widely discussed as valuable, particularly approaches to end-of-life care. Despite this emphasis, interdisciplinary programs have not been easy to implement. In universities, the implementation of interdisciplinary programs encounters administrative obstacles, including credit for the time spent in these group efforts and "ownership" of interdisciplinary courses (IDCs). This article details the process of development and the activities of an end-of-life interdisciplinary program at one urban university with a major medical center. The issues faced in the first year are examined. These included trust, group identity, and communication. The lessons from the first-year activities are presented and efforts of the second year described.

Education, Professional↗
PubMed1995

Structured knowledge representation: an improved methodology for communication of hospital policy.

The optimal operational integrity of a health care facility depends upon the correct interpretation of an adherence to well designed and written policies. Memos describing policy and procedures can be ambiguous, hindering their comprehension rather than helping it. Two alternative methods have been developed for communicating policy: the algorithmic flow chart and a computer decision support program. To determine the best means of communicating policy, the written memo, flow chart, and computer program were compared in scenario presentation interviews. The average time required to complete the test scenarios was five minutes for the traditional memo, two minutes for the algorithm, and two minutes for the computer program. Accuracy improves markedly from the traditional memo to the computer program. ANOVA reveals that the flow chart and computer program are significantly superior to memos as methods for communicating hospital policy.

Algorithms↗
PubMed2007

Brief report: application of the TEACCH program on Chinese pre-school children with autism--Does culture make a difference?

A longitudinal study was conducted on 34 children with autism to evaluate the usefulness of the Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH) program for Chinese pre-school children in Hong Kong. Eighteen children received full-time center-based TEACCH program training. The control group included 16 children who received different types of individualized or group training but not TEACCH program training. Instruments validated in Hong Kong were used to assess the children's cognitive, social adaptive functioning and developmental abilities before and during the training at 6-month intervals for 12 months. Children in the experimental group showed better outcomes at posttest. They also showed progress in different developmental domains over time. The study provided initial support for the effectiveness of using the TEACCH program with Chinese children.

Asian People↗
PubMed2004

Practical effects of educating nurses on the Natural Death Act.

BACKGROUND: The aim of this study was to investigate a nursing staff's knowledge of the Natural Death Act before and after an educational intervention. PATIENTS AND METHODS: This was a quasi-experimental designed study. Questionnaires were sent to 135 nurses in a medical center who volunteered to participate in the educational program. Demographic data and knowledge of the Natural Death Act were collected. The return rate was 85.37% (n=105). The educational program lasted for 6 h and included five subjects: hospice-palliative care, Natural Death Act, how to face suffering patients, nursing for agonized patients, and communicating with families. The program was a combination of lectures, case discussions, evaluation of individuals' values, and attitudes toward patient death. MAIN RESULTS: At baseline, the average total score in the 18-item questionnaire on the Natural Death Act was 12.96, with a range of 5-18. After the educational intervention, the average total score increased from 12.9 correct answers to 17.04 (of 18). The average increase was 4.08 points, a statistically significant difference. CONCLUSIONS: A provision of appropriate training for medical professionals appears to be a useful educational strategy, and this result shows that the Natural Death Act should be included in nursing school educational program. In the future, more effort should be made to fulfill patients' expectations and to follow medical ethics guidelines.

Adult↗
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↗
PubMed1993

Under pressure program: using live theatre to investigate adolescents' attitudes and behavior related to drug and alcohol abuse education and prevention.

This paper describes the Under Pressure Program, an innovative communication-centered approach designed to involve Chicago public junior and senior high school students in considering the problems and prevention of adolescent substance abuse. The centerpiece of the program is a 30-minute live musical play, Captain Clean, which incorporates extensive postperformance dialogue and role play to explore the pressures and feelings of adolescents regarding substance abuse. This unique blend of live entertainment and applied learning techniques enables adolescents to understand the pressures they face and teaches them to make responsible choices, in addition to serving as a vehicle for effective school and community substance abuse intervention. By going beyond the 60-second "just say no" television and radio campaigns, the Under Pressure Program addresses the underlying causes of adolescent substance abuse. Students are engaged in active participation rather than the traditional "teach and preach." The goals of the program are (1) to evaluate the effectiveness of live theatre in preventing and intervening in adolescent substance abuse, and (2) to examine the effectiveness of live theatre, via postperformance dialogue and role playing, in soliciting feedback from adolescents as to their own feelings about substance abuse and using school counselors and other available resources, and to build upon their recommendations for improving substance abuse prevention and intervention programs. The program is targeted at predominantly minority, low-income students who have been identified as "high risk." The Under Pressure format consists of four integral parts: faculty/staff community in-service: theatrical performance (Captain Clean); postperformance dialogue and role play; and student, faculty, counselor, and community follow-up.

Adolescent↗
PubMed1997

Newborn hearing screening in Hawaii.

Hawaii has been a pioneer and national leader in implementing universal newborn hearing screening. In fact, Hawaii is one of only two states (Rhode Island is the other) which have a statewide newborn hearing screening program in which 95% or more of all newborns are screened. Hawaii is the best example of a truly integrated system of services to provide effective intervention for all infants and toddlers who are identified as having a hearing loss. The success of the newborn hearing screening program is measurable in two ways: 1) all available information indicates that not a single infant with hearing loss has been missed by the screening process and not a single infant has been misdiagnosed as having a hearing loss; and 2) many of the children identified with hearing loss by the newborn hearing screening program have transitioned out of the early intervention program with age-appropriate developmental and communication skills. The success of Hawaii's program is a tribute to the enthusiastic support and collaboration of legislators, pediatricians, hospital staff, and DOH personnel.

Hawaii↗