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PubMed1992

Employer evaluations of nurse graduates: a critical program assessment element.

Accountability in higher education dictates implementation of a comprehensive evaluation plan. Employer evaluation of graduates is an important component of program evaluation and contributes a different view that is rarely reported in the literature. The purpose of this study was to establish a database by surveying employers of baccalaureate-prepared nurses, postgraduation, over a five-year period. Employer surveys measured perceptions of graduates' functioning. Findings indicated that graduates function above expected levels for leadership skills, nursing skills, communication skills, and professionalism. Systematic program evaluation by employers is recommended at one and five years after graduation. A tool for employer evaluation of baccalaureate graduates is discussed.

Curriculum↗
PubMed2005

Comprehensive training for hazard communication.

Long before the Bloodborne Pathogens Standard caught the attention of the dental profession, the Occupational Safety and Health Administration required all employers to collect information about hazardous chemicals in the workplace and provide information and training to employees regarding the materials. The Hazard Communication Standard requires employers to establish written programs, collect specific information regarding workplace chemicals, and conduct a formal training program for employees.

Communication↗
PubMed1978

Modification of the eight-step continuum for treatment of apraxia of speech in adults.

A previously reported treatment program for patients with severe apraxia of speech suggested that (1) some communicative ability could be restored, (2) it might be feasible to develop home programs from the original program, (3) the complete eight-step continuum may not be necessary, and (4) some patients had difficulty at step 4 in the program. Protocols from four severely apractic patients supported the contention that some communicative ability could be restored using this program. Effective home programs, based on the original program, were successfully developed. The complete program was not needed for two of the four patients. Finally, a methodology for reducing the difficulty at step 4 in the program was discussed.

Aged↗
PubMed2002

Mass media as a population-level intervention tool for Chlamydia trachomatis screening: report of a pilot study.

PURPOSE: To determine the feasibility and affect of mass media use in a population-level intervention for chlamydia screening promotion. METHODS: A population-level chlamydia intervention protocol was field tested. The intervention, targeting 15-25-year-old individuals, was designed to: (a) increase awareness of personal risk for chlamydial infection; (b) facilitate dissemination of chlamydia knowledge by use of a telephone hot line; and (c) promote care-seeking behavior (report for a chlamydia screening program). The intervention activities included: (a) mail outreach, (b) a television and radio campaign, (c) a prerecorded Check-It-Out chlamydia hot line, (d) a staffed chlamydia Options information line, and (e) a free confidential urine ligase chain reaction (LCR) test for chlamydia. Mass mailings were scheduled at intervals, starting two-weeks before the beginning of the television advertisement. The 30-second television advertisement was aired on local television stations 130 times in a 6-week period. The outcome measures were quantity and characteristics of incoming calls to the automated hot line and staffed chlamydia information phone line in response to the chlamydia campaign, and response to the urine screening program. Descriptive and bivariate analyses were used to evaluate the outcomes. RESULTS: The hot line was called 642 times during the monitoring period (November 1, 1999 to March 8, 2000), the majority (92%) during the 6 weeks of television advertisement, with an average of 99 calls per week, compared with an average of 9 calls per week after the commercial ended. Each bulk mailing was accompanied by a boost in the incoming hot line calls. The research staff triaged 133 calls to the "Options" phone line, 81% in the 6 weeks of the TV ad. The mean age of the 133 callers was 23.9 +/- 7.7 years (range 14-49 years). A majority called for screening information; 67% of callers were females and 84% of female callers were under age 26 years. Five percent of callers identified themselves as a parent of a teenager. The majority credited the TV ad as their source of the hot line number. Thirty-one individuals reported for a confidential chlamydia screening, 27 of 31 (87%) during the 6 weeks of TV advertising. No negative responses regarding the chlamydia campaign were encountered. CONCLUSION: This report describes strategies used to implement and measure the effectiveness of a mass media campaign and demonstrates evidence that mass media is effective in delivering STD intervention messages to young people.

Adolescent↗
PubMed1996

Communication, accrual to clinical trials, and the physician-patient relationship: implications for training programs.

BACKGROUND: Previous studies have demonstrated that less than 20% of fully eligible patients participate in cancer clinical trials. One of the major factors determining whether patients will be successfully accrued to trials is the quality of the communication occurring between the physician and patient (and family members if present). The accrual process is embedded within the longer-term relationship between the physician and the patient. It is argued that the interaction occurring during the consent process is part of an "alliance building" that the physician and patient use to confront the uncertainty inherent in both the disease itself and the outcome of therapy. METHODS AND RESULTS: The authors describe the framework of a study currently under way in which they are tracking the variation in ways that this interaction is managed by a sample of oncologists and their patients. Physicians and patients are simultaneously filmed and viewed in a split-screen format. A coding system is being developed to analyze the congruence between physicians and patients as they encode and decode sequences of verbal and nonverbal messages. The goal is to understand how physicians and patients manage uncertainty related to the disease and its outcomes. CONCLUSIONS: The authors suggest implications of these observed patterns for the broader range of communicative competencies that medical students must learn.

Classification↗
PubMed2004

Communication skills, cultural challenges and individual support: challenges of international medical graduates in a Canadian healthcare environment.

Physicians require good communication skills to develop effective patient-physician relationships. Externally funded international medical graduates (IMGs) move directly from their home countries to complete residency training at the University of Ottawa, Canada. They must learn quickly how to work with patients, families and colleagues. A detailed needs assessment was designed to assess IMGs' communication skill needs through focus groups, interviews and surveys with IMGs, program directors, allied healthcare professionals and experts in communication skills. There was a high degree of consensus amongst all participants concerning specific educational needs for communication skills and training issues related to the healthcare system for externally funded IMGs. Specific recommendations include (1) English-language skills; (2) how to get things done in the hospital/healthcare system; (3) opportunities to practise specific skills, e.g. negotiating treatment, (4) adequate support system for IMGs; (5) faculty and staff education on the cultural challenges faced by IMGs.

Attitude of Health Personnel↗
PubMed2026

11β-HSD2 buffers fetal glucocorticoid exposure inducing Per1 expression under maternal stress.

Glucocorticoids (GCs) have been proposed as maternal-fetal communication signals. However, fetal circadian rhythms are initially shielded from maternal entrainment, in addition to delayed circadian clock emergence due to CLOCK suppression. Premature CLOCK/BMAL1 activation disrupts Hes7-driven somite-like structure in gastruloids. Given the genomic proximity of Per1 to Hes7 and their transcriptional ripple effect, the physiological significance of delayed cell-autonomous circadian clock development and the temporal program of maternal-fetal communication during the developmental process has remained unclear. Here, based on a marked decline in Hsd11b2, encoding a GC-inactivating 11β-HSD2 enzyme, during organogenesis, we performed split-litter embryo-transfer experiments in which Hsd11b2 knockout (KO) and wild-type embryos shared the same maternal environment. Amniotic fluid GCs remained low and arrhythmic under basal conditions. In contrast, maternal stress caused a pronounced GC surge and Per1 induction in KO, suggesting that 11β-HSD2 buffers acute maternal GC surges. Despite the genomic proximity of Per1 to Hes7 and their transcriptional ripple effect, stress-associated and pharmacological GC exposure recapitulated no overt segmentation defects in vivo. Embryonic stem cell-derived gastruloid assays confirmed that neither GC exposure nor Per1 induction arrested Hes7 oscillations, whereas premature CLOCK/BMAL1 activation impaired these processes even in Hes7 KO gastruloid with ectopic rescue, suggesting that interference with the segmentation clock is mediated by premature CLOCK/BMAL1 activation, not by GC-induced Per1 expression. These findings clearly show that maternal GC signals are selectively buffered during early development. In addition, suppression of CLOCK/BMAL1 activity preserves segmentation clock function, indicating delayed circadian clock emergence is actively regulated during embryogenesis.

11β-HSD2↗
PubMed2006

Communication in heart failure: perspectives from older people and primary care professionals.

The objective of this study was to explore the attitudes of older people and primary care professionals towards communication of diagnosis, prognosis and symptoms in heart failure. Forty-four interviews were conducted with people aged>60 years with heart failure (New York Heart Association III-IV) recruited from general practices in the UK. Ten focus groups were held with primary care professionals involved in heart failure management. Data were analysed thematically with the aid of the NUD*IST computer program. Participants reported problems with communication, including not being given enough information about their condition, or being given complex information that they did not understand. Many understood little about heart failure and the causes of, and ways to manage, their symptoms. Few participants had had discussions about the prognosis with any health professional, and this was confirmed in professional accounts. Difficulties with terminology were frequently reported: a diagnosis of 'heart failure' was rarely communicated to patients to avoid causing anxiety. Educational needs were identified by most primary care professionals in relation to heart failure management and specifically in relation to communication. In conclusion, communication was identified as being inadequate within primary care from both the patient and professional perspectives. These findings point to a need for an educational intervention tailored specifically to the need to improve the communication skills of primary care professionals in chronic heart failure.

Aged↗
PubMed2005

The efficacy of a structured group therapy intervention in improving communication and coping skills for adult cochlear implant recipients.

This paper reports on an evaluation of a structured group therapy intervention for adult cochlear implant (CI) recipients designed to improve overall communication and coping skills. 33 adult CI recipients (14 males, 19 females; mean age 61; 1-14 years since Cl) participated in a 2-day structured group therapy intervention with a follow-up session 4 weeks later. Measures were: communication behaviors (CPHI), assertiveness (Rathus), depression (DASS), and behavior during conversation (Dyalog). TCI personality traits were utilized as predictors of change. Repeated measures analyses showed that participants demonstrated significant improvements on measures of assertiveness, emotional well-being, and coping behaviors at 3 months post-intervention that persisted at a 12-month follow-up. Several personality traits predicted change. Although subjects had presumably adapted to their cochlear implants and had learned communication strategies in hearing rehabilitation programs, the improvements on several measures suggest that a structured group therapy intervention can enhance outcome following cochlear implantation.

Adaptation, Psychological↗
PubMed2000

Recertification in internal medicine: a program of continuous professional development. Task Force on Recertification.

In 2000, the American Board of Internal Medicine (ABIM) introduced a second-generation recertification process that builds on the current knowledge-centered program by adding assessments of clinical and communication skills, clinical performance, and medical outcomes. The three-part process, called a program of continuous professional development, includes innovative self-evaluation exercises, documentation of essential knowledge, and confirmation of satisfactory qualifications and professional and community good standing. The program introduces the principles of continuous quality improvement; deemphasizes the summary nature of the traditional secure examination; and is designed to be a more continuous, less saltatory process for maintaining clinical competence. With the continuous professional development program, ABIM believes that it has taken a substantial step toward creating a recertification process that meets its goal of being valuable, doable, tolerable, and affordable" while maintaining the high standards expected of an accountable profession.

Certification↗
PubMed1992

A historical perspective on the classification developed and used for chemical carcinogens by the National Toxicology Program during 1983-1992.

To evaluate, interpret, and better communicate the data and findings from long-term chemical carcinogenesis studies on laboratory animals, the National Toxicology Program began using five categories or levels of evidence of carcinogenicity in 1983 (clear, some, equivocal, and no evidence and inadequate experiment). Through July 1991 these defined terms had been used to describe 144 chemical carcinogenesis studies comprising 530 sex-species experiments. Together with a selected descriptor of the chemically associated level of evidence for each experimental unit (male rats, female rats, male mice, female mice), mention is made of the length of the experiment, route of exposure, and the particular tumor type or types for each organ or system affected. The scientific judgements are comprised of this relevant information to inform the readers and users of these evaluations. In this paper the background rationale for the development and proper use of these categories of evidence of carcinogenicity are detailed, together with some personal reflections.

Animals↗
PubMed2004

The role of industry in improving quality of life for persons with an ostomy: a Canadian consensus.

Financial and clinical resources (which include 260 enterostomal therapy nurses nationwide) to provide clinical and rehabilitative expertise to the estimated 50,000 to 60,000 Canadians living with an ostomy are limited. Hence, many persons with an ostomy fall through the cracks in the early pre- and postoperative period or are lost to follow-up afterdischarge. Problems and issues related to ostomy management continue to surface throughout their lives. As a result,the time required for rehabilitation is often lengthy, affecting the person's quality of life. The First Canadian Enterostomal Therapy Nurses' Advisory Council consisting of 10 Canadian enterostomal therapy nurses met in February 2004 to identify key issues and concerns for Canadians living the ostomy experience and to identify gaps in information and services available before surgery, during the immediate postoperative period, and as the time from surgery lengthened and patients moved through age-related life issues. The two most important gaps identified were the development of quality, pertinent resources and the dissemination of those resources. The Council also identified potential strategies to bridge these gaps, including utilizing the resources of manufacturer Customer Service departments to follow a communications protocol to provide information to patients, retailers, and providers. Finally, a process map from which individual ostomy manufacturers can build programs and processes for improving patient/provider/manufacturer communication was developed.

Adaptation, Psychological↗
PubMed1988

International programs of the National Library of Medicine.

The National Library of Medicine (NLM) has a broad mission in biomedical information service. There are three major reasons for NLM, as a national institution, having an international program: first, the global nature of disease; second, the international scope of medical literature; and third, the universal goal of better communication. This paper reviews NLM's programs in relation to international medical information exchange: International MEDLARS Centers, collaboration with WHO and PAHO, NLM Special Foreign Currency Program, and development of the NLM collection.

International Cooperation↗
PubMed1996

The use of fluorescent marker dyes for studying intercellular communication in nematode embryos.

As more and more cases of necessary cell-cell interactions are revealed, the classical view of mosaic development in nematodes has to be replaced by a more dynamic picture showing different types of intercellular communication. To investigate the pattern and function of communication pathways between cells, we have developed different techniques to shunt fluorescent marker dyes into embryos and hatched animals and study their distribution in vivo. During embryogenesis we find that for a long time all somatic cells form a single dye-coupling compartment while transfer into the germline is restricted already at an early stage. Considerable variations between species with respect to the size of communication channels and the time during which these are functional are observed and can be correlated to differences in the developmental program. A different kind of intracellular communication can be visualized with the help of fluorescent dyes: a transfer of yolk proteins in two phases of the life cycle, in the adult hermaphrodite from the gut into the maturing germ cells, and in the embryo from non-gut cells into the gut primordium. Cell-cell interactions in the nematode embryo can be inhibited with polysulfated hydrocarbon dyes (e.g. Trypan Blue) which bind strongly to the plasma membrane. In summary our data indicate that fluorescent marker dyes can be helpful tools to identify and understand the role of intercellular communication and transfer processes in nematode development.

Animals↗
PubMed1998

Predictors of infant mortality among college-educated black and white women, Davidson County, Tennessee, 1990-1994.

Strategies to reduce US infant mortality rates often focus on the black-white disparity in rates. Linked Infant Birth and Death Files for Davidson County, Tennessee, from 1990 through 1994 were used to determine infant outcomes for infants born to college-educated white and black women. Risks for adverse outcomes were identified by comparing infant deaths to live births using logistic regression analyses. The following variables entered the logistic model process: maternal and paternal age; race and education; nativity status; maternal risk factors; interpregnancy interval; parity; infant gender; tobacco or alcohol use; number of prenatal visits; trimester in which prenatal care began; marital status; gestational age; and birthweight. After adjustment for the effects of the other variables, a gestational age < 28 completed weeks of gestation was the most significant independent predictor of infant death. Black race was not identified as a significant predictor of infant mortality. Regardless of race, a decrease in infant mortality rates among college-educated women in this country depends on the prevention of preterm births. Strategies to diagnose early preterm labor must proceed from a comprehensive maternal care program for all women. Open channels of communication between patient and provider will form the cornerstone for preterm prevention-intervention programs. Analysis of state and local infant mortality data may identify regional differences in infant mortality rates and differences in risk factors associated with adverse infant outcomes.

Adult↗