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PubMed2005

Translation and validation of the condom self-efficacy scale with Thai adolescents and young adults.

PURPOSE: To translate the 14-item Condom Self-Efficacy Scale (CSES) into Thai and to validate the Thai version of the Condom Self-efficacy Scale (CSES-T) among Thai adolescents and young adults. METHODS: The CSES was translated using a back-translation technique and validated with a cluster-based sample of 425 participants aged 18 to 22 years from eight randomly selected private vocational schools in Bangkok. Participants completed anonymous self-administered scales. Principal component analysis with varimax rotation was conducted to identify latent factors. RESULTS: Factor analysis indicated three factors: communication, correct use, and consistent use. Items loading on the original CSES also loaded on the same factors of the CSES-T except one item. The Cronbach's alpha coefficients were .85 for the total scale, .70 for consistent use, .79 for correct use, and .80 for communication. CONCLUSIONS: Based on psychometric properties, the CSES-T is a valid and reliable tool. It is culturally appropriate for Thai young adults. Thai researchers and health care providers can use the CSES-T to assess adolescents' and young adults' self-efficacy to use condoms as well as to further develop and evaluate interventions to increase condom use.

Adolescent↗
PubMed2000

One-hydrophone method of estimating distance and depth of phonating dolphins in shallow water.

Previous attempts at localizing cetaceans have generally used multiple hydrophone arrays and multichannel recording systems. In this paper, a low-budget localization technique using only one hydrophone is described. The time delays of the signals traveling via the surface and bottom reflection paths to the hydrophone, relative to the direct signal, are used to calculate the distance and the depth of a phonating animal. Only two additional measures, the depth of the bottom and hydrophone, have to be taken. The method requires relatively shallow waters and a flat bottom surface. Echolocating and burst pulsing Hawaiian spinner dolphins (Stenella longirostris) at the Waianae coast of Oahu, Hawaii, were localized over different bottom substrates. A tracking range of up to 100 m was achieved. The accuracy of the method is estimated by the total error differential technique. The relative distance estimation error is below 35% and the absolute depth error below 0.7 m, so that the location method is sufficiently precise for examining source levels in our study area. Because of its simplicity, the method ideally complements sound recordings and visual sightings of marine mammals and could lead to a better understanding of the nature and use of click trains by dolphins.

Animal Communication↗
PubMed2004

Implementation and evaluation of cultural competency training for pharmacy students.

BACKGROUND: The demographic composition of the US population is rapidly changing. As a result, pharmacists increasingly face the need to interact effectively with and provide care for patients whose ethnic or cultural background may differ from their own. While schools implement curricula to provide pharmacy students with cultural awareness, knowledge, and communication skills they will need in practice, few assessment tools exist to evaluate the impact or effectiveness of such training. OBJECTIVE: To implement and assess the impact of a cultural competency training course designed specifically for pharmacy students. METHODS: An 8-hour elective course offering basic cultural competency training was provided to 60 first-through fourth-year pharmacy students in 2003. A 12-item survey assessing students' perceived awareness, knowledge, and communication skills in the areas of cultural competence and cross-cultural communication skills was administered immediately prior to and upon completion of the course. Surveys were linked, enabling estimation of within-student change as a result of exposure to the program. RESULTS: Fifty-six paired surveys (96.6% of participants) were analyzable. Responses to all survey items (p < 0.05) and total scores (t55 = 16.27; p < 0.001) increased significantly from pre- to posttraining. The mean +/- SD 12-item pretraining scale score was 33.35 +/- 5.48 (range 21-44), and the mean posttraining scale score was 47.88 +/- 4.90 (range 36-59). CONCLUSIONS: Survey results suggest that the course successfully raised student awareness of diversity and provided basic knowledge and skills pertaining to cultural competence and cross-cultural communication.

Adult↗
PubMedDate not supplied

Changes in water mobility measured by diffusion MRI predict response of metastatic breast cancer to chemotherapy.

The goal of oncology is the individualization of patient care to optimize therapeutic responses and minimize toxicities. Achieving this will require noninvasive, quantifiable, and early markers of tumor response. Preclinical data from xenografted tumors using a variety of antitumor therapies have shown that magnetic resonance imaging (MRI)-measured mobility of tissue water (apparent diffusion coefficient of water, or ADCw) is a biomarker presaging cell death in the tumor. This communication tests the hypothesis that changes in water mobility will quantitatively presage tumor responses in patients with metastatic liver lesions from breast cancer. A total of 13 patients with metastatic breast cancer and 60 measurable liver lesions were monitored by diffusion MRI after initiation of new courses of chemotherapy. MR images were obtained prior to, and at 4, 11, and 39 days following the initiation of therapy for determination of volumes and ADCw values. The data indicate that diffusion MRI can predict response by 4 or 11 days after commencement of therapy, depending on the analytic method. The highest concordance was observed in tumor lesions that were less than 8 cm3 in volume at presentation. These results suggest that diffusion MRI can be useful to predict the response of liver metastases to effective chemotherapy.

Adult↗
PubMed2001

Perspectives of people with enduring mental ill health from a community-based qualitative study.

BACKGROUND: The views of people with enduring mental ill health have received limited exploration. Existing work has largely focused on patients in specialist mental health settings, rather than on a wider range of patients in the community. AIM: To explore experiences and perceptions of health care of people with enduring mental ill health. DESIGN OF STUDY: A community-based qualitative study using theoretical sampling, in-depth interviews, and grounded methodology. SETTING: A total of 34 responders registered with four general practices, serving five wards with a mean Townsend Deprivation Score of 7.75. METHOD: Subjects were chosen using a theoretical sampling framework and they participated in one-to-one interviews which were audiotaped. Themes were identified and developed by reading transcripts, then they were further refined and classified manually by open coding into key categories using a grounded approach. RESULTS: The primary goal of the responders was to enhance, sustain, and take control of their mental health. The building of positive therapeutic relationships with professionals based upon effective communication, trust, and continuity were important to achieving this aim. However, the settings in which their health care took place could affect responders' attempts to deal with social stigma. Experiences of social isolation, socioeconomic privation, and stigmatisation were often pervasive. These compromised responders' opportunities and their capacity to enhance their mental health, compounding their illness and marginalisation. CONCLUSIONS: This study shows the potential of health professionals to empower people with enduring mental ill health, by attending to the quality of communication and continuity of care they provide and to where this takes place. It further underlines a need to address the social stigma and exclusion this group experiences.

Adult↗
PubMed2003

[Patient experiences in Norwegian hospitals--changes over time?].

BACKGROUND: Patient experience has been identified as a national indicator of hospital quality. We describe the changes in patient experiences 1996-2000 for seven Norwegian hospitals. MATERIAL AND METHODS: A patient experience questionnaire was sent to medical and surgical patients in a stratified random sample of hospitals in 1996. The same questionnaire was used in similar surveys in 1998 and 2000. Responses from hospital wards included in all three surveys were compared on ten summated rating scales. Changes were identified by multiple linear regression. RESULTS: Responses from a total of 10 600 patients were analysed. For six scales no change was noted: general satisfaction, information on medication, information on examinations, nursing services, doctor services, and organization. Statistically significant improvement was found for three indices: communication, contact with next-of-kin, and information regarding future complaints. For one scale, scores changed for the worse: hospital and equipment. All changes were small. INTERPRETATION: Patient experiences with Norwegian hospitals did not change much between 1996 and 2000. On some indices, our data indicate slight improvement. Patient assessment of buildings and equipment changed negatively.

Communication↗
PubMed1990

Patient satisfaction with diagnostic cardiac catheterization: ambulatory vs. inpatient performance.

In a combined retrospective and historical cohort analysis, 72 patients at The Mount Sinai Hospital were studied to assess satisfaction with diagnostic cardiac catheterization and coronary arteriography performed as an ambulatory procedure (40 patients) and as an inpatient procedure (32 patients). A composite questionnaire designed to measure patient satisfaction was generated by the method of summed ranks, a common method of pooling aspects from several sources. Ten psychosocial dimensions of patient satisfaction were explored to determine if any difference existed between the ambulatory-patient population and the inpatient population. The ambulatory-patient group had a higher total mean satisfaction score than the inpatient group (4.01 vs. 3.60, p less than .001). Analysis of the specific dimensions showed that the ambulatory group had mean satisfaction scores higher than those of the inpatient group in convenience of procedure (4.12 vs. 3.13), continuity of care (3.83 vs. 3.42), technical quality (4.85 vs. 4.05), interpersonal aspects of communication (4.53 vs. 4.01), physical environment (4.14 vs. 3.18), and global satisfaction (4.71 vs. 4.25). These differences were statistically significant using the two-tailed t test (t greater than t.05,70 = 1.994). These data suggest that cardiac catheterization performed as an ambulatory procedure yields greater satisfaction than when performed as an inpatient procedure. This fact, in combination with prior published conclusions that ambulatory cardiac catheterization is more cost effective and has a statistically similar complication rate, supports the recommendation that this procedure be performed as an ambulatory procedure.

Adult↗
PubMed2007

[Determinants of severely injured patients' trust in their hospital physicians].

BACKGROUND: Several studies have shown negative effects of insufficient physician-patient interaction leading to a lack of compliance, worse subjective and objective evaluation of treatment outcome, increased consumption of pain medication, and decreased patient satisfaction. The aim of the present study was to identify patient-, physician-, and/or hospital-specific determinants which have a significant influence on the trust of severely injured patients in their physicians. METHODS: A written questionnaire was sent to 121 severely injured patients hurt predominantly in traffic accidents and treated between July 1996 and July 2001 in two departments of surgery in the German state of Northrhine-Westfalia. Applying the Total Design Method, a response rate of 74.4% (n=90) could be achieved. RESULTS: Using univariate analysis as a preselection tool, we developed a logistic regression model which identified four significant predictors of patients' trust in their physicians: (1) patient evaluation of information, (2) patient evaluation of their physician's decision policy, (3) patient evaluation of treatment success, and (4) patient age. CONCLUSIONS: Besides age of patient and subjective evaluation of treatment success, it is psychosocial aspects of interaction which influence trust in a physician. The results of this analysis confirm the importance of physician-patient communication for medical education, also for surgeons.

Accidents, Traffic↗
PubMed2005

Proteins Markovian 3D-QSAR with spherically-truncated average electrostatic potentials.

Proteins 3D-QSAR is an emerging field of bioorganic chemistry. However, the large dimensions of the structures to be handled may become a bottleneck to scaling up classic QSAR problems for proteins. In this sense, truncation approach could be used as in molecular dynamic to perform timely calculations. The spherical truncation of electrostatic field with different functions breaks down long-range interactions at a given cutoff distance (r(off)) resulting in short-range ones. Consequently, a Markov chain model may approach to the average electrostatic potentials of spatial distribution of charges within the protein backbone. These average electrostatic potentials can be used to predict proteins properties. Herein, we explore the effect of abrupt, shifting, force shifting, and switching truncation functions on 3D-QSAR models classifying 26 proteins with different functions: lysozymes, dihydrofolate reductases, and alcohol dehydrogenases. Almost all methods have shown overall accuracies higher than 73%. The present result points to an acceptable robustness of the MC for different truncation schemes and r(off) values. The results of best accuracy 92% with abrupt truncation coincide with our recent communication. We also developed models with the same accuracy value for other truncation functions; however they are more complex functions. PCA analysis for 152 non-homologous proteins has shown that there are five main eigenvalues, which explain more than 87% of the variance of the studied properties. The present molecular descriptors may encode structural information not totally accounted for the previous ones, so success with these descriptors could be expected when classic fails. The present result confirms the utility of our Markov models combined with truncation approach to generate bioorganic structure protein molecular descriptors for QSAR.

Markov Chains↗
PubMed1996

Regulation of the acute phase response genes alpha 1-acid glycoprotein and alpha 1-antitrypsin correlates with sensitivity to thermal injury.

BACKGROUND: The response to thermal injury is a complex physiologic process requiring communication between sites of injury and distal target organs. The liver, one of these target organs, synthesizes a family of secretory proteins, the acute phase reactants (APRs), that carries out specific protective functions. This study investigates the response of positively regulated (alpha 1-acid glycoprotein and alpha 1-antitrypsin) and negatively regulated (albumin) APR genes to severe thermal injury in three rat strains with differing abilities to survive thermal stress. METHODS: Age and weight matched male Buffalo, Sprague-Dawley, and Fischer 344, 12- to 16-week-old rats (275 to 325 gm) received a 40% total body surface area scald burn. Total RNA was isolated from livers at 0, 2, 5, 12, 24, and 48 hours. Northern blot hybridization was performed with 32P-labeled rat alpha 1-glycoprotein, rat albumin, and mouse alpha 1-antitrypsin cDNAs. Relative amounts of alpha 1-glycoprotein, alpha 1-antitrypsin, and albumin mRNAs were determined by means of densitometric analyses. RESULTS: All three strains elicit both a positive and negative acute phase (AP) response. Significant differences were observed in the degree and kinetics between strains. Those more sensitive to thermal injury exhibited a more intense positive AP response and possibly a delayed recovery. The AP response between these strains correlates with the variation in ability to survive severe trauma. CONCLUSIONS: The differences in the kinetics and intensity of induction of APR genes between Buffalo, Sprague-Dawley, and Fischer rat strains suggest that the least intense AP response and its timely recovery correlated with the ability to survive a severe thermal injury and that, conversely, the more intense and prolonged response correlated with sensitivity to severe thermal injury. We propose that this may be a basis for variation in survival to thermal injury.

Animals↗
PubMed1987

Emergency department complaints: a one-year analysis.

We conducted an analysis of all complaints received in a busy suburban emergency department during 1985. All complaints were handled in a standardized fashion, and were categorized as billing, physician, nursing, or miscellaneous. Data were expressed as a "complaint frequency" (complaints per 1,000 patient visits). Complaints were analyzed for the following characteristics: reason, gender of the patient, gender of the complaining party, relationship of the complaining party to the patient, health care provider, patient age, and patient disposition. The chi-square method was used to identify characteristics associated with a high risk for complaints. There were a total of 244 complaints, arising from 64,910 patient visits, yielding an overall complaint frequency of 3.8. The largest number of complaints (135), involved billing (frequency, 2.0). The most common (60) was insurance carrier rejection of the bill as a nonemergency. The next most common billing complaint (25) was a charge mistakenly billed too high by the ED. There were 70 complaints regarding emergency physicians, for a complaint frequency of 1.1. Of these, 17 were due to a perceived lack of communication with the patient, the patient's family, or the patient's private physician. Eighteen complaints were regarding a perceived misdiagnosis. One physician had a significantly higher complaint frequency than the group as a whole (P less than .005). There were 17 complaints regarding the nursing staff, for a complaint frequency of 0.2. Twenty-two complaints were classified as miscellaneous. Expressing data as complaint frequencies allows comparison of trends in a department, staff members, and different EDs with varied patient populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

Rearranged marriages: marital relationships after head injury.

An in depth study of 18 heterosexual couples investigated the quality of the marital and sexual relationships 1-7 years after the male partner had suffered a severe head injury. Both quantitative and qualitative methods were employed and the focus was on the perspective of the uninjured female partner. The female partners reported both marital and sexual satisfaction as lower following injury. They rated their current marital satisfaction as significantly less than their brain injured partners. The quantitative part of the study revealed major role changes experienced by the women, with many comparing their new role to that of a parent with total decision making responsibility. The incompatibility of this role with that of sexual partner was mentioned by many. A tendency for the males to express gratitude but not to communicate their feelings was described by many women. Most women were resigned to the expectation that there would be little change in the future and, for most, the only positive aspect of the relationship was a sense of commitment and continuing companionship. The implications of the findings for rehabilitation and couple therapy are discussed.

Adaptation, Psychological↗
PubMed2004

Do clerkship directors think medical students are prepared for the clerkship years?

PURPOSE: Educators have begun to question whether medical students are adequately prepared for the core clerkships. Inadequate preclerkship preparation may hinder learning and may be predictive of future achievement. This study assessed and compared the views of clerkship directors regarding student preparation for the core clinical clerkships in six key competencies. METHOD: In 2002, a national survey was conducted of 190 clerkship directors in internal medicine, family medicine, pediatrics, surgery, obstetrics/gynecology, and psychiatry from 32 U.S. medical schools. Clerkship directors were asked to report their views on the appropriate level of student preparation needed to begin the core clinical clerkships (none, minimal, intermediate, advanced), and the adequacy of that preparation (ranging from "much less" to "much more than necessary") in six key clinical competencies. RESULTS: A total of 140 clerkship directors responded (74%). The majority reported that students need at least intermediate ability in five of six competencies: communication (96%), professionalism (96%), interviewing/physical examination (78%), life-cycle stages (57%), epidemiology/probabilistic thinking (56%), and systems of care (27%). Thirty to fifty percent of clerkship directors felt students are less prepared than necessary in the six competencies. Views were similar across all specialties and generally did not differ by other clerkship director characteristics. CONCLUSIONS: Almost half of clerkship directors were concerned that students do not receive adequate preparation in key competencies before starting the core clinical clerkships. Many medical schools may need to give more attention to the preclerkship preparation of students in these high-priority areas.

Attitude of Health Personnel↗
PubMed2002

Patient and nurse assessment of quality of care in postoperative pain management.

OBJECTIVE: To describe and compare patient and nurse assessments of the quality of care in postoperative pain management, to investigate differences between subgroups of patients, and to compare patient assessments in different departments. DESIGN: Patient and nurse questionnaires. SETTING: Five surgical wards in general surgery, orthopaedics, and gynaecology in a central county hospital in Sweden. SAMPLE: Two hundred and nine inpatients and 64 registered nurses. The response rates were 96% for the patients and 99% for the nurses; there were 196 paired patient-nurse assessments. METHOD: The Strategic and Clinical Quality Indicators in Postoperative Pain Management patient questionnaire was used which comprises 14 items in four subscales (communication, action, trust, and environment). The items were scored on a 5 point scale with higher values indicating a higher quality of care. Five complementary questions on levels of pain intensity and overall satisfaction with pain relief were scored on an 11 point scale. Twelve of the 14 items in the patient questionnaire and two of the complementary questions were adjusted for use in the nurse questionnaire. RESULTS: The patients' mean (SD) score on the total scale (scale range 14-70) was 58.6 (8.9) and the nurses' mean (SD) score (scale range 12-60) was 48.1 (6.2). The percentage of patients who scored 1 or 2 for an individual item (disagreement) ranged from 0.5% to 52.0%, while for nurses the percentage ranged from 0.0% to 34.8%. Forty two patients (24%) reported more pain than they expected; these patients assessed the quality of care lower. There were differences between patient and nurse assessments concerning the environment subscale, the question on overall satisfaction, and patients' experience of worst possible pain intensity. CONCLUSION: The results provided valuable baseline data and identified important areas for quality improvement in postoperative pain management.

Adult↗
PubMed1997

The dissected aorta: part I. Early anatomic changes in an in vitro model.

PURPOSE: To define early anatomic changes in the aorta in an in vitro hydrostatic model of acute aortic dissection. MATERIALS AND METHODS: Aortic dissections were created in explanted aortas. A small portion of the dissection flap was resected to allow free communication between the true and false lumina. The aortas were suspended in a saline bath and distended by means of a saline fluid column. By using intravascular ultrasonography, the arc lengths of the outer walls of the true and false lumina and of the dissection flap were measured at increasing hydrostatic pressures and at increasing fractions of dissected wall circumference. RESULTS: The dissected aorta immediately became ectatic. At a given fraction of wall circumference involved in dissection, total aortic cross-sectional area increased with increased hydrostatic pressure. At a given hydrostatic pressure, this area increased with increased fraction of wall circumference dissected. Most of the increase was due to dilatation of the false lumen. There were minimal changes in true-lumen size. Dissection flap length, after initial contraction at the time of dissection, changed minimally with increasing pressure. CONCLUSION: Anatomic changes in the dissected aorta depend on hydrostatic pressure and on the percentage of aortic wall involved in the dissection.

Acute Disease↗
PubMed1996

The quality of cervical cancer screening: a primary care perspective.

The bulk of cervical cancer screening is performed by primary care providers; mostly nurses and physicians. The literature regarding the quality of this screening is largely described from three perspectives; clinical, laboratory, and public health. This article describes the primary care perspective regarding issues of quality in cervical cancer screening and suggests areas for improvement. The authors discuss how effectiveness of the test, sampling methods, interpretation by the laboratory, and reporting results impact on the quality of cervical cancer screening. Other factors which influence the quality of screening such as access to care, recall intervals, communication with the patient, costs of testing, and organizational issues are also reviewed.

Communication↗
PubMed2006

Impact of physician asthma care education on patient outcomes.

OBJECTIVE: We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. METHODS: We conducted a randomized trial in 10 regions in the United States. Primary care providers were recruited and randomly assigned by site to receive the program provided by local faculty. The program included 2 interactive seminar sessions (2.5 hours each) that reviewed national asthma guidelines, communication skills, and key educational messages. Format included short lectures, case discussions, and a video modeling communication techniques. We collected information on parent perceptions of physicians' communication, the child's asthma symptoms, and patients' asthma health care utilization. We used multivariate regression models to determine differences between control and intervention groups. RESULTS: A total of 101 primary care providers and a random sample of 870 of their asthma patients participated. After 1 year, we completed follow-up telephone interviews with the parents of 731 of the 870 patients. Compared to control subjects, parents reported that physicians in the intervention group were more likely to inquire about patients' concerns about asthma, encourage patients to be physically active, and set goals for successful treatment. Patients of physicians that attended the program had a greater decrease in days limited by asthma symptoms (8.5 vs 15.6 days), as well as decreased emergency department asthma visits (0.30 vs 0.55 visits per year). CONCLUSIONS: The Physician Asthma Care Education program was used in a range of locations and was effective in improving parent-reported provider communication skills, the number of days affected by asthma symptoms, and asthma health care use. Patients with more frequent asthma symptoms and higher health care utilization at baseline were more likely to benefit from their physician's participation in the program.

Asthma↗
PubMed2005

[Coarctation of the aorta in infants under one year of age. An analysis of 20 years of experience].

OBJECTIVE: A review of experience with techniques of correction used, in the last 20 years, in children younger than one year old. METHODS: In the period from 1978 to 1998, 148 patients (pt) with coarctation of the aorta (CoAo), under one year of age, with or without associated intracardiac defects, were submitted to surgery. Median age 50 days, 92 female pt (62.1%). The average weight was 4,367 +/- 1,897 gr. The average follow-up was 1,152 +/- 1,462 days. The population was divided in 3 groups: Group I, isolated CoAo: 74 pt (50%); Group II, CoAo and interventricular communication (IVC): 41 pt (27.7%) and Group III, CoAo with complex intracardiac malformations: 33 pt (22.3%). RESULTS: The total mortality was of 43 patients (29%). In patients younger than 30 days, the mortality was 53%, p=0.009, DR=4.5, between 31 and 90 days, 14.7%, p=0.69, and over 91 days, 15%, p=0.004. The probability of actuarial survival of the whole population was 67% at 5 and 10 years. Thirty-six patients (24.3%) had recoarctation, from which 18 patients (50%) were younger than 30 days, DR=6.35. The incidence of recoarctation was with Waldhausen technique in 4 patients (10%) and with the classic termino-terminal technique in 19 patients (26%) p=0.03, and isthmusplastic operation in 6 patients (37.5%). The patients younger than 30 days showed a relative risk for recoarctation de DR=6.35. The probability of actuarial survival, free of coarctation repair, at 5 and 10 years was of 69% with Waldhausen's technique and 63% with the classic termino-terminal technique. CONCLUSION: Patients younger than 30 days showed increased mortality and recoarctation risk. Waldhausen's technique in patients older than 30 days showed effective. The classic termino-terminal technique did not show to be a good option in all age ranges, being imperative to carry out more radical technical variations, such as the extended termino-terminal.

Aortic Coarctation↗