Understanding chain of trust and business partner agreements. American Health Information Management Association.
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Computer Communication Networks↗
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HIV / AIDS and the Church: Kenyan religious leaders become partners in prevention.
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Acquired Immunodeficiency Syndrome↗
Partners at the bedside: the importance of nurse-physician relationships.
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Agonistic Behavior↗
Lucidity in a woman with severe dementia related to conversation. a case study.
AIMS AND OBJECTIVES: The aim of this study was to explore the presence of lucidity in a woman with severe dementia during conversations and whether it occurred when conversational partners or the woman with severe dementia initiated the conversation topics about the present, past or future time and whether she was presented with support or demands during the conversation. BACKGROUND: Communication problems as well as episodes of lucidity in people with dementia are reported in the literature. DESIGN: A researcher held 20 hours of conversation with a woman with severe dementia. A daughter participated for about three and a half hours. The conversation was tape-recorded and transcribed verbatim. METHODS: The text was divided into units of analysis. Each unit of analysis was then assessed separately and discussed among the authors. Chi-square tests and logistic regression analysis were performed. An ethics committee approved the study. RESULTS: The woman as initiator of the conversation topic and support to the women during conversation from the conversation partner were found to be the most significant factors explaining lucidity, while conversation about the present or past time showed no connection with lucidity. Very few topics (n = 7) concerned future time and they were not used in the statistical analysis. The researcher initiated 41%, the woman 43% and the daughter 16% of the topics. Support was registered in 49%, demands in 15% and both support and demands in 16% of the units of analysis. There were 58% topics about present and 40% about the past time. CONCLUSIONS: The presented study is a case study and the results cannot be generalized. For the woman with severe dementia, lucidity was promoted by the conversational parties carefully focusing on conversation topics initiated by the woman while supporting her during conversation. RELEVANCE TO CLINICAL PRACTICE: To share the same perception of reality, focusing on the topics initiated by the patient with severe dementia and a supporting attitude to what the patient tells, will hopefully give more episodes of lucidity in the patient. This approach in caring for patients with severe dementia might give more meaning and well-being to the conversational partners in daily care.
Adult Children↗
References in conversation between young and old normal adults.
This study compared the way in which young and elderly adults cooperate to achieve a mutually acceptable reference. Pairs of young and elderly interlocutors performed a repeated referential communication task in which they were asked to converse about arranging complex figures in a particular order. With repetition of the task, both partners, regardless of age, needed fewer words and speaking turns to find mutually acceptable references. However, the older Ss were slower to benefit from the repetition and required more collaborative work to reach an agreement. The elderly were less likely to take previously shared information into account; they produced proportionally less requests for potential elaboration, and they were more likely to be idiosyncratic in their interpretation of the referents.
Adult↗
Effects of partner notification on reducing gonorrhea incidence rate.
OBJECTIVE: The objective of this study was to estimate the effectiveness of partner notification (PN) by linking measures of PN with the gonorrhea incidence rate in New York State exclusive of New York City. STUDY DESIGN: Gonorrhea cases were identified from the Communicable Disease Confidential Case Reports system. Case interview data were obtained from the case management database. Gonorrhea incidence data and interview data were aggregated from individual records and then linked at the county level. RESULTS: From 1992 to 2002, 100,756 gonorrhea cases were reported and 37% were interviewed. A total of 34,807 partners were elicited from 37,393 index cases: 18,291 (52.5%) partners sought medical evaluation, 10,159 (29.2%) received preventive treatment, and 7,474 (21.5%) were infected and treated. The gonorrhea incidence rate was inversely correlated with the percent of partners given preventive treatment and positively related to the percent of infected partners. CONCLUSIONS: Our study adds new evidence that PN is an effective mechanism to detect new cases and interrupt disease transmission within communities.
Contact Tracing↗
A molecular-properties-based approach to understanding PDZ domain proteins and PDZ ligands.
PDZ domain-containing proteins and their interaction partners are mutated in numerous human diseases and function in complexes regulating epithelial polarity, ion channels, cochlear hair cell development, vesicular sorting, and neuronal synaptic communication. Among several properties of a collection of documented PDZ domain-ligand interactions, we discovered embedded in a large-scale expression data set the existence of a significant level of co-regulation between PDZ domain-encoding genes and these ligands. From this observation, we show how integration of expression data, a comparative genomics catalog of 899 mammalian genes with conserved PDZ-binding motifs, phylogenetic analysis, and literature mining can be utilized to infer PDZ complexes. Using molecular studies we map novel interaction partners for the PDZ proteins DLG1 and CARD11. These results provide insight into the diverse roles of PDZ-ligand complexes in cellular signaling and provide a computational framework for the genome-wide evaluation of PDZ complexes.
Amino Acid Motifs↗
Healthy women from suspected hereditary breast and ovarian cancer families: the significant others in their lives.
This paper investigates communication and interactions between healthy women from families with a history of breast/ovarian cancer and five statuses of significant others: (1) women friends; (2) sisters; (3) brothers; (4) male partners; and (5) children in order to better understand the way the family deals with cancer genetics risk information and the extent of social support available to its members. We conducted a research ethics committee reviewed exploratory, qualitative study at a major clinical and research cancer centre in the United Kingdom from January to June 2000. Twenty-one semi-structured, in-depth interviews were conducted using a purposive sample of women coming to the cancer genetics risk clinic for the first time, supplemented by 5 months of participant observation. On the whole, women friends consistently provided strong social support. Sisters were usually close, but communication about the breast/ovarian cancer in their family in some cases was quite limited and fraught with emotional overtones. Brothers were the most difficult to relate to regarding cancer in the family and seemed almost to exist in a different 'interrelational space'. The women claimed that their male partners were supportive, but with caveats. Mothers worried about how much information and at what age they should inform their children about the specifics of the family history of breast/ovarian cancer and tried to protect them when they were young. The women were very concerned about their daughters and granddaughters, but were far less concerned about the impact on their sons.
Adult↗
CD44v10 expression in the mouse and functional activity in delayed type hypersensitivity.
We have described recently that expression of CD44 exon v10 (CD44v10) is down-regulated upon metastasis of squamous cell carcinoma, whereas it is up-regulated in skin metastases of malignant melanoma. The striking regulation of CD44v10 prompted us to generate a murine CD44v10-specific monoclonal antibody to define expression and possible functions of this particular CD44 variant isoform. In the mouse, expression of exon v10 was restricted to basal layers of the epidermis and squamous epithelium of the oral cavity, the esophagus, the omasum, glandular epithelium of the submandibular and the uterine gland, as well as subpopulations of bone marrow cells and activated lymphocytes. Expression started late during development, e.g., was not observed before day 16 of gestation and there was no evidence for developmental regulation of CD44v10 expression. Functional in vivo studies revealed that anti-CD44v10 had no effect on wound healing but inhibited edema and granuloma formation in delayed type hypersensitivity (DTH). Furthermore, lymphocyte-monocyte interactions could be inhibited by anti-CD44v10. Because a CD44v10 transfected tumour line did not show any distinct pattern of cell-matrix or cell-cell adhesion, the data point toward an involvement of CD44v10 in cell migration, possibly by acting as a target structure for cytokines/chemokines provided by the contacted partner cell.
Animals↗
The German Center for Research on Aging at the University of Heidelberg: an interdisciplinary approach.
In September 1995, the German Center for Research on Aging at the University of Heidelberg had been founded to become a leading national center of excellence with a clear interdisciplinary scope of ageing research activities. So far, three departments have been built up successively: the Department of Social and Environmental Gerontology (established in 1997, chair: Prof. Hans-Werner Wahl), the Department of Adult Development (established in 1998, provisional chair: Prof. Andreas Kruse), and the Department of Epidemiology (established in 2000, chair: Prof. Hermann Brenner). As one of the next steps, the disciplinary spectrum of the Center will be complemented by setting up several junior research groups in molecular ageing research. Within the few years of its existence, the Center has set up multiple large-scale, extramurally funded cross-sectional, case-control and longitudinal studies. These studies provide a unique common basis for interdisciplinary collaboration both within the Center and with the Center's numerous national and international research partners.
Geriatrics↗
EvoCare: a new standard in tele-therapy.
The necessity for Integrated Care has been debated controversially and the influence of the legislator and the consequences for the medical device industry discussed sufficiently. In fact, the German health system has been suffering from a lot of problems like cost expansions, but only solutions and not discussions can bring a progress. EvoCare has established a new standard in tele-therapy in Germany. This has been possible because this system maps the clinical therapy process to tele-therapy (and not vice versa), it is extendable for virtually any medical field of application, and the user interface is kept so simple that people inexperienced with computers and even with motor deficits are able to use it. Accompanying the patients from the hospital to their homes, EvoCare allows for shorter hospital stays without loss in treatment quality and more intense training without increasing therapists' average work time per patient. The experiences that have already been made with the described system, especially in the area of neurological rehabilitation and orthopedic prevention, underline its advantages for all involved partners.
Comprehensive Health Care↗
Physicians' psychosocial beliefs correlate with their patient communication skills.
OBJECTIVE: To assess the relationship between physicians' beliefs about the psychosocial aspects of patient care and their routine communication with patients. PARTICIPANTS AND SETTING: Fifty community primary care physicians participating in a continuing medical education program and 473 of their patients in Portland, Oregon. METHODS: Routine office visits were audiotaped and analyzed for communication behaviors and emotional tone using the Roter Interactional Analysis System (RIAS). Physician beliefs about psychosocial aspects of care were measured using a self-report questionnaire with a five-point Likert scale. Attitudes were correlated with communication behaviors using the Pearson correlation coefficient. RESULTS: Physicians' attitudes toward psychosocial aspects of care were associated with both physician and patient dialogue in visits. The physicians who had positive attitudes used more statements of emotion (i.e., empathy, reassurance) (p < 0.05) and fewer closed-ended questions (p < 0.01) than did their colleagues who had less positive attitudes. The patients of the physicians who had positive attitudes more actively participated in care (i.e., expressing opinions, asking questions), and these physicians provided relatively more psychosocial and less biomedical information (p < 0.05). CONCLUSION: Physician beliefs about psychosocial aspects of patient care are associated with their communication with patients in routine office visits. Patients of physicians with more positive attitudes have more psychosocial discussions in visits than do patients of physicians with less positive attitudes. They also appear more involved as partners in their care. These findings have implications for medical educators, teachers, and practicing physicians.
Adolescent↗
American adolescents: sexual mixing patterns, bridge partners, and concurrency.
BACKGROUND: American adolescents have a high incidence of sexually transmitted infections. Patterns of sexual partner choice influence the transmission of infections in this population. GOAL: To examine patterns of sexual mixing, bridging, and concurrency in American adolescents and the association of these characteristics with condom use. STUDY DESIGN: This project used the AddHEALTH survey data. The survey selected a sample of schools, then conducted in-home interviews with 18,984 students in 1995. A second wave of data collection was conducted 2 years later. The data on sexual relationships collected in the study were analyzed. RESULTS: Respondents ranged in age from 13 to 17 years. Sex partnerships with persons of differing age groups were very common in this population (45% of sexual partnerships). Relationships with persons of different ethnicity were more common among Latinos (42%) than among white (14%) and black (15%) respondents. A large proportion of the sample reported more than two partners (56%). Among these persons, a large proportion reported partners in two different age groups (69%) and ethnic groups (35%) as well as concurrent partners (54%). Condom use was lower among persons with partners in different age groups and among persons with a larger number of partners. CONCLUSIONS: The large number of adolescents who have sexual relationships with persons of different characteristics creates bridges for infections between different groups. Counseling of sexually active adolescents should include discussion on issues of power and communication in these relationships.
Adolescent↗
Parent-held shared care records: bridging the communication gaps.
Specialist centres provide excellent treatment and expert care, but the best interests of children may not be served if they must always attend a hospital far from home. Systems of shared care have been developed to offer care nearer the family home whenever possible. Parent-held shared care records were introduced at a paediatric haematology/oncology centre in response to issues raised by parents and professionals concerning the management of shared care. These were set up to facilitate communication, teamwork and family involvement. Consultation took place within the multidisciplinary team to ensure that the design of the records met the needs of each group. During a multidisciplinary study day the records were introduced to professionals from shared care hospitals. Before formally incorporating these records into regular clinical practice they were piloted with a group of families. The records have become an accepted part of the service provided for family and professional partners in shared care. Formal evaluation of this innovation is currently taking place.
Child↗
[Social support in the rehabilitation of mastectomized women: the role of the sexual partner].
This study identified the types of social support offered by the sexual partners of women with breast cancer and their perceptions about this support. Nine partners of women in this condition participated in the study. Data was collected through interviews and submitted to content analysis. Partners perceived themselves as important elements of social support to their wives, offering affection, stimulus to self-care and help with household chores. Difficulties faced in offering social support involved sexual relations, communication channels, the feeling of impotence and insecurity to deal with the implications of the diagnosis and to reorganize household chores.
Female↗
Examination of the communication practices between state newborn screening programs and the medical home.
BACKGROUND: As outlined in the Newborn Screening Task Force report published in August 2000, the newborn screening system is more than just testing, but also involves follow-up, diagnosis, treatment, and evaluation. As such, multiple professional and public partners need to be adequately involved in the system to help ensure success. In addition, newborn screening programs are state-based; therefore, policies and procedures vary from state to state. Historically, there has been little uniformity between state newborn screening programs. OBJECTIVE: To examine the communication practices of state newborn screening programs in the United States, particularly in relation to the medical home. METHODS: A facsimile survey of program staff in all US newborn screening programs. Survey data were collected in August 2000. RESULTS: All 51 programs participated. States were questioned about whether or not they had a procedure to identify the infant's medical home before the child's birth. Twelve states (24%) indicated that there was a procedure in place, whereas 39 states (76%) indicated that either no procedure existed or that they were unsure. In contrast, all state programs (except 1) indicated they notified the primary care physician about abnormal results and the need for follow-up. In addition, state programs reported that primary care physicians have responsibilities within the newborn screening system, particularly related to communicating with parents about screen-positive results and coordinating the collection of a second specimen. Thirty states reported that they directly notified parents of screen-positive infants of results and the need for follow-up as well. In regard to informing parents about newborn screening, 45% of states indicated that primary care physicians had some responsibility in informing parents about newborn screening. Most often, parents were informed about newborn screening just before specimen collection, and the most commonly used techniques to educate parents were informational brochures and conversation. Thirty-five states reported that they engaged in long-term tracking of infants after diagnosis confirmation. Only about half of these states provided long-term tracking of all of the conditions included in their state's newborn screening test panel. Of these 35 states that engaged in long-term tracking, 25 reported that they requested patient information from the primary care physician and/or subspecialist about ongoing treatment and follow-up. CONCLUSIONS: Newborn screening roles and responsibilities vary tremendously between states. Improvements in communication and better-defined protocols are needed, particularly between state newborn screening programs and the medical home. Many states identified the medical home as having significant responsibilities related to the short-term follow-up of screen-positive infants. Identification of the correct medical home before testing would help to reduce unnecessary time and frustration for state newborn screening programs, especially in the follow-up of infants that are difficult to locate. In addition, primary care physicians (ie, the medical home) need to have appropriate and ongoing involvement, including a mechanism to provide feedback to their state newborn screening program. This is particularly important given the adoption of tandem mass spectrometry by an increasing number of states, and the likely expansion of newborn screening in the future. Recommendations include the following: Primary care physicians should have appropriate and ongoing involvement in the newborn screening system and should be appropriately represented on state newborn screening advisory committees. States should develop protocols to identify the medical home before heelstick screening. States should work with families, primary care physicians, and prenatal health care professionals to develop well-defined systems for pretesting education of parents. All newborn screening results (both positive and negative) should be sent to the infant's medical home. If results are not received by the medical home, efforts should be made to obtain results. Medical homes and subspecialists should submit follow-up information on screen-positive infants and infants with confirmed diagnoses to the state newborn screening program, regardless of the existence of state requirements to do so, and efforts to build enhanced direct communication systems, linking state newborn screening programs to community-based medical homes, should continue.
Communication↗
Industry perspectives on ICH guidelines.
In 1990 the International Conference on Harmonization (ICH) effort was begun with the intent of standardizing the drug registration and approval process. The need to rationalize and harmonize regulation was driven by concerns over rising costs of health care, escalation of the cost of research and development and the need to meet the public expectation that there should be a minimum delay in making safe and efficacious new treatments available to patients in need. Since most regulatory agencies have limited resources to interact with sponsor companies, standardized guidelines would help expedite communications with companies at the programme design stage. The ICH is a joint initiative involving both regulators and industry as partners in scientific and technical discussions of the testing procedures which are required to ensure the safety and efficacy of medicines. While all regions of the world have some input to the process, the primary development of the guidelines is derived from industry and regulatory representatives from Europe, Japan and the United States. Much progress has been made in the ten years since the initiation of the ICH, but the implementation and maintenance of the guidelines are in the early stages for most if not all of the published guidelines. If the guidelines do not gain a solid foothold early on, then drift between the regions in use of the guidelines will defeat the goals of the ICH. While the ICH covers the entire drug development process, this paper will review the guidelines that pertain most closely to clinical trials and their use in the drug registration process. Some of the guidelines have been approved and some are still in the development stage.
Drug Approval↗
Sexually transmitted disease prevention services for female chronically mentally ill patients.
Chronically and variably impaired autonomy makes women with chronic mental illness particularly vulnerable to contracting sexually transmitted diseases (STDs) including AIDS. A lack of female controlled protective devices also adds to the vulnerability of these patients. In this context, the authors make recommendations for the design of clinically comprehensive and ethically justified programs to minimize the risk of mentally ill women for STDs. When female chronically mentally ill patients are at risk of STDs, barriers to the exercise of their autonomy must be identified and clinically treated. Preventive clinical interventions can also be usefully augmented by educational strategies and facilitate patients' communication and behavioral skills, particularly in order to enable them to abstain from unwanted sex or to make prospective male partners wear a condom. Outreach efforts to the male partners of female patients and to the homeless mentally ill may also be required. Preventive services could be integrated and coordinated with STD clinics, substance abuse treatment programs and family planning programs.
Acquired Immunodeficiency Syndrome↗