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PubMed1987

Sources of conflict in the medical marriage.

The authors surveyed a sample of 134 physicians and 125 physicians' spouses regarding marital satisfaction, sources of marital conflict, and complaints about their spouses. Contrary to conventional wisdom, the number of hours at work did not relate to the degree of marital satisfaction. The chief sources of conflict in the medical marriage appear to revolve around differences in the partners' needs for intimacy, perceptions of the problems in the marital relationship and in each other, and communication styles. Lack of time due to the demands of practice seems to be a complaint that serves the function of externalizing the conflicts in the marriage onto factors outside the marriage.

Attitude↗
PubMed2004

A Wireless Health Outcomes Monitoring System (WHOMS): development and field testing with cancer patients using mobile phones.

BACKGROUND: Health-Related Quality of Life assessment is widely used in clinical research, but rarely in clinical practice. Barriers including practical difficulties administering printed questionnaires have limited their use. Telehealth technology could reduce these barriers and encourage better doctor-patient interaction regarding patient symptoms and quality-of-life monitoring. The aim of this study was to develop a new system for transmitting patients' self-reported outcomes using mobile phones or the internet, and to test whether patients can and will use the system via a mobile phone. METHODS: We have developed a prototype of a Wireless Health Outcomes Monitoring System, which allows structured questionnaires to be sent to the patient by their medical management team. The patients' answers are directly sent to an authorised website immediately accessible by the medical team, and are displayed in a graphic format that highlights the patient's state of health. In the present study, 97 cancer inpatients were asked to complete a ten-item questionnaire. The questionnaire was delivered by display on a mobile phone, and was answered by the patients using the mobile phone keypad. RESULTS: Of the 97 patients, 56 (58%) attempted the questionnaire, and all of these 56 completed it. Only 6% of the total number of questions were left unanswered by patients. Forty-one (42%) patients refused to participate, mostly due to their lack of familiarity with mobile phone use. Compared with those who completed the questionnaire, patients who refused to participate were older, had fewer years of education and were less familiar with new communications technology (mobile phone calls, mobile phone SMS, internet, email). CONCLUSION: More than half of the patients self-completed the questionnaire using the mobile phone. This proportion may increase with the use of multichannel communications which can be incorporated into the system. The proportion may also increase if the patient's partner and/or family were able to assist the patient with using the technology. These preliminary results encourage further studies to identify specific diseases or circumstances where this system could be useful in patients' distance monitoring. Such a system is likely to detect patient suffering earlier, and to activate a well-timed intervention.

Cell Phone↗
PubMed1983

Consumerism in hospitals--hospitals are, or should be, for people.

The factory situation: are people seen as number patients or are they handled with care and compassion? Hospital care should aim at treatment of the whole person--role of non clinical services within hospitals, partnership with community--role of parents; better communication needed between treating professionals and patients--would reduce complaints and possible litigation; people wish to be partners with health professionals in their own treatment and recovery not articles on an assembly line; rights of patients to be given full facts of their illness and prospects for recovery. Who "pays the piper"? Medical audit, accountability, peer review; iatrogenesis or "doctor induced" illness e.g. adverse reaction to prescribed drugs, hospital induced infections, malnutrition, faulty diagnosis or failure to diagnose. Who motivates the provider and support personnel and how? Institutionalisation and its effects on treatment and recovery, attitudes by providers and receptors. New trends in treatment patterns and delivery facilities: high technology, birthing centers, is there a role for alternative professions within hospitals? Who looks after the consumer? Ombudsman , medical boards, licensing authorities, Australian Council on Hospital Standards.

Australia↗
PubMed1981

Psychosocial factors in cancer.

Proper attention to psychosocial factors may be important in the long-term outcome of a patient with cancer. If the physician makes the patient a partner in the treatment program, compliance problems are overcome and the patient retains a sense of importance. Communication with the patient and the patient's family is essential throughout all stages of management. The physician should treat the patient with respect, openness and empathy.

Adaptation, Psychological↗
PubMed1994

Social support and sexual risk taking among women on methadone.

This study examines the social support network of 109 female methadone patients and explores the relationship between social support and background variables, attitudes toward safer sex and sexual risk behavior. Subjects reported small supportive networks consisting primarily of drug users. Women who felt more loved by, respected by, and involved with a network of communication and mutual obligation, were more likely to feel comfortable talking about safer sex with their sexual partners and asking their sexual partners about their HIV status. They were also less likely to believe that their sexual partners would be upset if they suggested using a condom. No association was found between social support and frequency of condom use or frequency of sex with IV drug users during the last six months. Findings suggest the plausibility of multifaceted social support network interventions designed for methadone maintained women at high risk for HIV infection.

Adult↗
PubMed1995

The availability of health information in South Africa.

The South African Medical Research Council (MRC) has provided access to on-line health and biomedical information since 1976, when the MRC became an international partner of NLM. This was done to support research and health care when the Institute of Biomedical Communication was established. The institute has since reorganized and is now the Information Systems Division in the Research Systems Support Group MRC. he MRC and medical libraries in South Africa are able to access various automated services via telecommunication. The major systems available are MEDLARS, DIALOG, DATASTAR and BRS, with ECRI being the latest addition; most used are MEDLARS and DIALOG. New technologies (e.g., CD-ROM) have given more people access. This technology is not available to many people working in Primary Health Care (PHC), as they do not have access to computer networks. Beyond on-line is statistical and printed information, called "Gray Literature," not accessible through on-line systems as it is not published in conventional sources used to build databases. With a shift to Essential National Health Research and the focus on PHC and preventative medicine, demand for health information and "gray literature" is growing. The MRC collects and produces this material and has its own database called SAMED, which is to be made available to others as our contribution to health. It is hoped to make this available for inclusion in the proposed African Index Medicus presently investigated by the World Health Organization. Africa as a continent, and South Africa as a country, are experiencing major changes in health care and medical practice, and inevitably, provision of health information services. With South Africa's re-entry into the global village and its acceptance by the rest of Africa, it can be a key player in information provision to the rest of the continent. The MRC, as a major provider of Health information, can play a vital role in the information flow throughout Africa by continuously improving and expanding its services. A large proportion of South Africans live in rural areas where health care is provided by clinics not linked to information networks. This does not mean these clinics are excluded from the use of information. The major challenge is to find the ways and means of getting the relevant information to these clinics. Information is needed to help with patient care and continuing education. With this in mind, the MRC is evaluating different formats in which information can be supplied. Due to the lack of computer literacy, facilities, and financial constraints, it is better to supply printed information. With the spread of technology through the country and continent, it can be assumed that information flow and transfer will be more rapid. Repackaging of information means that it is possible to get the relevant information to the right people at the right time. The first such package developed is for hospital managers. With the help from experts in the field of PHC, it is hoped to develop packages aimed specifically at the CHWs and other workers in the field. All packages developed by the MRC are backed by a document provision service, using the most cost-effective route to obtain documents. A printed product must comply with certain criteria; these are: 1) purpose for which the information is needed; 2) kind of information needed and the format in which it is needed; 3) when the information is needed; 4) is the information to be supplied on an ongoing basis i.e., updated with latest information; 5) cost involved; and 6) how to get the information to the relevant user.

Computer Communication Networks↗
PubMed2005

[Decisions around the end of life on Intensive Care: making the transition from curative to palliative treatment].

The decision to move from curative treatment to palliative care in the intensive-care situation is less related to morals and ethics than it is to the assessment of medical issues, professionalism, communication and orchestration. Treatment should be considered medically pointless if, in the view of the treating physicians, it does not offer realistic chance to return to a meaningful life. Continuing futile care can be seen as disrespectful, both to the patient, his partner and the family, as well as to the members of the ICU team. Intensivists are responsible for withholding or withdrawing life support to patients in whom further life support is considered futile and who are unable to express their wishes due to critical illness and sedation. The intensivist typically makes this type of decision after a period in which medical and other information has been collected and after intensive discussions with other medical professionals as well as the partner and family. This is based on the trust that is built up through their skill, attitude and behaviour and that is perpetuated in a continuing process of intensive communication. Conflicts should be prevented, or at least recognised early and discussed. Ifa conflict is ongoing then it should be tackled by planning a number of consecutive consultations.

Decision Making↗
PubMed1996

Open information systems and data security in medicine.

The realization of the German law for a new structure of health care delivery by the assurance of efficient structures and processes in hospitals calls for an optimal design of informational processes. To realize applications near to the users and just in time as well as to build up the complex functional relationships between departments and subsystems in big hospitals, a new design for Hospital Information Systems (HIS) is necessary. The features of modern HIS outlined in the paper can only be established by open systems, which guarantee portability, scalability and interoperability. This is also true in regionally distributed systems like the tumour register at Cancer Centres. In the paper the necessity and possibilities of open systems and different levels of application integration are discussed. The general statements are illustrated by practical realizations in the HIS of the Magdeburg University Hospital as well as in the tumour register at the Cancer Centre of Magdeburg/Sachsen-Anhalt. The creation of integrated structures for communications makes great demands on the assurance of data security and data protection, especially for the inclusion of external partners from the region. In the context of high sensitive data of cancer patients data protection is of top priority. The legal problems of data collection, data storage and exchange in medicine are discussed first. The paper presents some aspects of the concept for data security and data protection in the Magdeburg University HIS and of the related concept for data protection in the tumour register of the Cancer Centre Magdeburg/Sachsen-Anhalt. Appropriate steps of realization are demonstrated. The application of hardware based modern access control systems with integrated encryption of data follows. The statements are extended to the planned installation of hardware based network access control systems with integrated encryption of data in the LAN.

Computer Communication Networks↗
PubMed2003

Finding sex partners on-line: a new high-risk practice among older adults?

By the year 2004, it is estimated that more than 34 million older Americans will be Internet users. The revolution in mass communication has changed the way people of all ages interact. Studies indicate that love and romance rate very high among the concerns of older adults using the Internet, and older adults are using it to meet other people. Numerous web sites targeting older adults include channels for developing personal relationships. Although studies suggest that individuals who seek out sex partners on the Internet may be at increased risk for contracting sexually transmitted diseases, very little is known about the attitudes and behaviors of older adults who seek and find sexual partners on-line. Because the number of older Internet users is predicted to grow exponentially as baby boomers age, research is needed about the Internet attitudes and practices of older adults.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Supporting patient care beyond the clinical encounter: three informatics innovations from partners health care.

As the focus of medicine moves from acute episodic care in the hospital to chronic disease management in outpatients, the primary care physician will play an increasingly important role in the coordination of patient care activities. Traditional outpatient informatics systems have largely focused on the workflow during the clinical encounter. Many tasks, including management of test results,coordination of subspecialty referrals and communication between patients and the practice,remain unsupported. When these tasks are not performed well, quality of care, patient safety and satisfaction may suffer. To address these issues ,Partners Healthcare in Boston, MA has recently developed several applications to address these issues. This demonstration will showcase 3 of these new applications: i) Results Manager, ii) Referrals Manager and iii) Patient Gateway. All interoperate with a browser-based electronic medical record already used by over 500 primary care physicians at Partners Healthcare.

Ambulatory Care↗
PubMed1981

The pre- and post-therapy measurement of communication skills of couples undergoing sex therapy at the Masters & Johnson Institute.

A battery of five paper and pencil questionnaires designed to measure empirically 10 specific skills hypothesized to be involved in effective interpersonal communication was employed to assess the pre- and post-therapy levels of these skills in couples undergoing treatment for sexual dysfunction at the Masters & Johnson Institute in St. Louis, Missouri. The females exhibited significant increases across the 2-week period of therapy for the following skills: positive assertion in intimate heterosexual peer relationships, assertiveness, verbal expression of feelings, and nonmaterial support and evidence of love. For the males significant increases in the following skills were obtained: assertiveness, verbal expression of feelings, self-disclosure, and tolerance of the less pleasant aspects of the loved one. A significant decrease was observed for the skill entitled feelings not expressed verbally to the loved one. Thus, both the females and males became more assertive and more able to express their feelings openly and thus more able to share more of themselves with their partners as a result of the therapy. These results lend empirical support to Masters and Johnson's theoretical model of communication and to the view that much more than simple behavior therapy is involved in a successful sex therapy program.

Adult↗
PubMed1997

Factors associated with HIV testing among sexually active adolescents: a Massachusetts survey.

OBJECTIVE: To assess sexually active adolescents' knowledge, attitudes, and behaviors associated with human immunodeficiency virus (HIV) testing and to determine the factors important in their decision to obtain voluntary HIV testing. DESIGN: Anonymous, random, digit-dial telephone survey undertaken in 1993. SETTING: Massachusetts households. PARTICIPANTS: Adolescents, 16 to 19 years of age. RESULTS: Of the 567 adolescents surveyed who had sexual intercourse within the past year, 127 (22%) had received HIV testing, with 54 (10%) stating that this testing was for personal reasons. A "great deal" or "some" worry about getting HIV/acquired immunodeficiency syndrome (AIDS) was expressed by 51%, and 56% felt that it was at least a little likely that they will get AIDS. Misconceptions were common about aspects of HIV testing: 35% did not believe or did not know that the HIV test results were kept in confidence, 19% thought that AIDS testers informed partners if the results were positive, and 30% did not think that the HIV test was very accurate. Although 92% (452/490) had seen a physician in the past year, only 30% (136/452) had ever discussed AIDS with a doctor. Multivariable analysis identified five factors as independently associated with voluntary adolescent HIV testing: 1) having had more than one sexual partner within the past year [odds ratio (OR): 2.9; 95% confidence interval (CI): 1.5, 5.5]; 2) believing that condoms are only somewhat effective at preventing the spread of AIDS (OR: 2. 6; 95% CI: 1.4, 4.8); 3) having discussed AIDS with a doctor (OR: 2. 6; 95% CI: 1.4, 4.8); 4) not having had a teacher discuss AIDS (OR: 2.2; 95% CI: 1.2, 4.2); and 5) believing that a positive test result means one has AIDS as opposed to carrying the virus (OR: 2.0; 95% CI: 1.1, 3.7). High-risk behavior of infrequent condom use and a history of a sexually transmitted disease were not significantly associated with voluntary HIV testing. CONCLUSION: Among sexually active Massachusetts adolescents, voluntary HIV testing is uncommon. Teens who have had multiple sexual partners and who do not believe condoms are effective in preventing transmission were most likely to have been tested. Issues requiring clearer communication to patients include the testing process, its availability, and confidentiality. Physicians can play an influential role in the promotion of HIV testing by discussing HIV risk behaviors with patients and offering those at risk voluntary HIV counseling and testing.

AIDS Serodiagnosis↗
PubMed1999

Culturally sensitive assessment.

Issues of cultural interaction and culturally sensitive assessment and treatment of young children have become prominent in recent years for mental health professionals, for reasons having to do with changing demographics, public values, and professional vision. "Culture" refers to the sociocultural adaptation of design for living shared by people as members of a community. Mental health professionals who work with culturally diverse populations need to become culturally self-aware and find abstract and experiential ways to build a useful body of professional knowledge concerning childrearing and discipline practices, health and illness beliefs, communication styles, and expectations about family or professional relations or other group interactions. They also need to learn how to work effectively in intercultural teams, use families as partners and resources, train and work with interpreters, and select and use formal and nonformal assessment procedures in appropriate, culturally sensitive ways.

Attitude to Health↗
PubMed2005

Parental factors and sexual risk-taking among young people in Côte d'Ivoire.

Côte d'Ivoire is the country worst affected by the HIV epidemic in West Africa, and young people in this country are a particularly vulnerable group. This study examined the relation between parental factors and sexual risk-taking among young people using logistic regression and survival analysis methods. Three parental factors (living in the same household as the father during childhood, perceived parental disapproval of early and premarital pregnancy, and parent-child communication about sexual abstinence) were positively associated with primary sexual abstinence (defined as yet to experience sexual debut), secondary sexual abstinence (defined as sexual abstinence subsequent to sexual debut) and reduced number of sex partners. The findings suggest that parental monitoring and control are important predictors of youth sexual behaviours and underscore the need to target parents and guardians in efforts to promote responsible sexual behaviours among adolescents. It is important to promote parent-child communication about sexual issues and empower parents and guardians to communicate effectively with their children and wards about sexual issues.

Adolescent↗
PubMedDate not supplied

Peer evaluation of the professional behaviors of emergency medical technicians.

INTRODUCTION: Professional behavior is one of the cornerstones of effective emergency medical services (EMS) practice and is a required part of the National Standard Curricula for advanced levels of EMS education. However, peer rating of emergency medical technicians with respect to the 11 categories of professional behavior never has been quantified. This study uses a peer evaluation methodology to assess the affective competencies of practicing EMS providers. METHODS: A professional behavior evaluation form was included as part of a survey that was sent to 2,443 randomly selected, nationally registered emergency medical technicians (EMTs). Participants were asked to rate the EMT partner with whom they worked most closely in the past year using 11 different categories of professional behavior using a Likert scale. RESULTS: One thousand, five hundred, ten (61.8%) surveys were returned and analyzed. Both nationally registered EMTs at the Basic and Paramedic levels rated their partners with respect to 11 categories of professional behavior. The overall average score was 0.68 on a 0-1 scale, with one being the highest. The rating of each of the categories was: (1) integrity (0.77); (2) appearance/personal hygiene (0.74); (3) patient advocacy (0.73); (4) empathy (0.72); (5) self-confidence (0.70); (6) careful delivery of service (0.70); (7) respect (0.65); (8) communication skills (0.64); (9) time management skills (0.63); (10) teamwork/diplomacy skills (0.62); and (11) self-motivation (0.61). Overall, the NREMT-Paramedics rated their partners significantly lower than did the NREMT-Basics (p = 0.0156) and experienced EMT-Basics rated their partners significantly lower than did the newer EMT-Basics (p = 0.0002). Those EMTs who indicated high satisfaction with their current EMS assignment rated their partner more highly on professional behaviors than did those EMTs who were not as satisfied. CONCLUSION: Overall, EMTs peer evaluation of professional behavior was "good." The behaviors most highly rated were integrity and appearance/personal hygiene. The behaviors rated lowest were self-motivation and team work/diplomacy. It appears that paramedics are more critical of their colleagues than are EMT-Basics, that experienced EMT-Basics are harsher critics than are newer EMT-Basics, and that there is a relationship between job satisfaction and peer evaluation.

Emergency Medical Services↗
PubMed1989

Communication mode use of two hearing-impaired adolescents in conversation.

Communication mode use in the dyadic conversational speech of adolescent simultaneous communication (SC)-trained hearing-impaired twin boys was investigated. Proportional frequencies of modes and the English structural characteristics of the spoken components of utterances produced in each mode were examined. The results indicated that these adolescents were using an integrated bimodal form of English with a grammatical base that did not vary as a function of the presence or absence of simultaneous signs either in their speech or their partner's speech. Implications of the results are discussed.

Child↗
PubMed1998

[From perception to symptom--from symptom to diagnosis. Somatoform disorders as a communication phenomenon between physician and patient].

Patients with somatoform disorders probably constitute the largest diagnostic group in daily medical practice. A major communication problem forms the core of somatoform disorders: patients report about complaints which their physicians do not understand; there is no sufficient biological reason for the patient's symptoms. This article discusses the multifactorial origin of somatoform disorders, consisting of minimal physiological changes, the perception of bodily sensations, and their interpretation as symptoms (non-normal perceptions), as well as ensuing emotional and behavioral consequences. Concerning the communication problem, it is important to realize that patients normally present symptoms, whereas the underlying bodily perceptions and the explanatory models are rarely communicated to the physician. On the physician's side, symptoms presented by patients are subjected to his or her explanatory concepts translating symptoms into indicators of certain diseases. Thus, the information introduced into physician-patient communication by the patient has usually passed several cognitive circuits within the patient or between the patients and other significant conversation partners thus shaping its specific components. It is recommended that physicians try to trace back their patients' symptoms to bodily sensations and explanatory models in order to base their diagnostic and therapeutic reasoning on the same kind of information. Empirical evidence is presented to support the inter-dependence of the components of the model, on both the patient's and the physician's side. Therapeutic interventions based upon the model are presented.

Awareness↗
PubMed1998

Unconventional therapies for cancer: 1. Essiac. The Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative.

Physicians and patients have been frustrated by the lack of reliable information on unconventional therapies. To help fill this gap in the area of breast cancer therapy, the Canadian Breast Cancer Research Initiative formed a task force to advise it on how best to promote research into unconventional therapies. As part of the work of the task force, a review of the available literature was carried out for each of the following products: Essiac, green tea, Iscador, hydrazine sulfate, vitamins A, C and E, and 714-X. The first article in this series on unconventional therapies for cancer describes the methodology used to obtain and evaluate the information and provides a summary of the findings on Essiac. Subsequent articles will cover the other products. For most of the products reviewed, there has been some indication of possible benefit but no definitive evidence. Innovative and collaborative research needed to meet the information needs of growing numbers of patients and their physicians is now being sponsored by the Canadian Breast Cancer Research Initiative. Open communication between patients and physicians is also necessary for the maintenance of an appropriate therapeutic partnership and for the identification and control of side effects. The Ontario Division of the Canadian Cancer Society, a partner in the Canadian Breast Cancer Research Initiative, supported the preparation of a patient-information piece on unconventional therapies to accompany the series. This item will assist patients who are considering such therapies and will promote open communication between patients and their physicians.

Breast Neoplasms↗