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PubMed2006

Communication in young children with motor impairments: teaching caregivers to teach.

Communication between caregivers and children with moderate to severe motor impairments is a tremendous challenge, and one that deserves attention as a central component of early intervention programs. This article examines a caregiver-training program that explored key elements to creating strong communicative interactions between young children with moderate to severe motor impairments and their primary caregiver. Three caregiver-child dyads participated in a 3-week treatment program teaching caregivers how to provide communicative opportunities, wait for a clear communication signal from their children, recognize their children's signal, and finally, shape a more advanced communicative behavior. These adult behaviors were designed to increase the children's use of conventional engaging signals of communication. Results revealed that caregivers demonstrated success learning all behaviors except for shaping during the brief treatment period. Children's engaging communicative behaviors increased correspondingly with the caregivers' changes. These findings have positive implications for caregiver training. Implications for "best practice" are considered.

Adult↗
PubMedDate not supplied

Comparison of Health Buddy with traditional approaches to heart failure management.

The purpose of this pilot study was to (a) determine the feasibility of providing a heart failure disease management program through an in-home telehealth communication device (Health Buddy) and (b) compare the effectiveness of the Health Buddy with traditional home management strategies (telephonic, home visit) in achieving selected patient outcomes (self-efficacy, functional status, depression, and health-related quality of life). Ninety participants completed the study through 2 months. Thirty percent of participants were either eliminated prior to or withdrawn after enrollment from the study based on Health Buddy issues. A mixed model ANOVA revealed those who received telephonic disease management experienced decreased confidence in their ability to manage their heart failure whereas all other groups experienced increased confidence. Further ANOVA analyses indicated improvement over time with no group differences for functional status, depression, or health-related quality of life. These findings suggest that delivering a disease management program through a telehealth communication device is feasible and may be as effective as traditional methods.

Adult↗
PubMed2006

Cost-effectiveness of environmental-structural communication interventions for HIV prevention in the female sex industry in the Dominican Republic.

Behavior change communication often focuses on individual-level variables such as knowledge, perceived risk, self-efficacy, and behavior. A growing body of evidence suggests, however, that structural interventions to change the policy environment and environmental interventions designed to modify the physical and social environment further bolster impact. Little is known about the cost-effectiveness of such comprehensive intervention programs. In this study we use standard cost analysis methods to examine the incremental cost-effectiveness of two such interventions conducted in the Dominican Republic in sex establishments. In Santo Domingo the intervention was environmental; in Puerto Plata it was both environmental and structural (levying financial sanctions on sex establishment owners who failed to follow the intervention). The interventions in both sites included elements found in more conventional behavior change communication (BCC) programs (e.g., community mobilization, peer education, educational materials, promotional stickers). One key aim was to examine whether the addition of policy regulation was cost-effective. Data for the analysis were gleaned from structured behavioral questionnaires administered to female sex workers and their male regular paying partners in 41 sex establishments conducted pre- and post-intervention (1 year follow-up); data from HIV sentinel surveillance, STI screening results conducted for the intervention; and detailed cost data we collected. We estimated the number of HIV infections averted from each of the two intervention models and converted these estimates to the number of disability life years saved as compared with no intervention. One-way, two-way, three-way, and multivariate sensitivity analysis were conducted on model parameters. We examine a discount rate of 0%, 3% (base case), and 6% for future costs and benefits. The intervention conducted in Santo Domingo (community mobilization, promotional media, and interpersonal communication) was estimated to avert 64 HIV infections per 10,000 clients reached, and resulted in a cost per disability-adjusted life year (DALY) saved of $1,186. In Puerto Plata a policy/regulatory intervention was added, which resulted in 162 HIV infections averted per 10,000 clients reached, and yielded a cost per DALY saved of $457. Cost-effectiveness estimates were most correlated to the discount rate used and base rates of sexually transmitted infection (which affects the HIV transmission rate). Both intervention models resulted in cost-effective outcomes; however, the intervention that included policy regulation resulted in a substantially more cost-effective outcome.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Media impact of the SESPAS (Spanish Public Health Association) 2000 report]].

OBJECTIVE: To measure the mediatic effect of different communication strategies used in public health advocacy. More specifically, to compare the effectiveness of the World Wide Web as a tool to attract the attention of journalists, with other more traditional formulas. METHODS: For the Spanish Public Health Association (SESPAS) Report 2000, two types of media strategies to communicate the report contents were programmed: a) traditional and passive strategies, centred in approaching journalists through press releases and press conferences around the SESPAS meeting (November 15-20 1999); b) interactive strategies, since August 15 to December 30, focused towards attracting health journalists to the non-embargoed, full text SESPAS report launched in a web site. To facilitate the web page use, we wrote a letter, in the first week of August, to all the members of the Spanish Health Communicators Association giving them the URL and the website map. In parallel, a monitoring system of the media impact was established from August to December 99, covering 250 magazines and 70 newspapers, in order to locate and recover all the stories about the SESPAS report for further analysis. RESULTS: Sixty-six stories were recovered; they were published in 32 press media from 24 provinces with an advertising value of 18,243,873 Ptas. As a whole, smaller circulation rate papers published more stories than larger ones. During five months, the SESPAS report was present in the press agenda, even though stories were not distributed homogeneously over time. Information concentrated around three moments: the first one, a week after our summer mailing; the second one, in the occasion of the publication of a story about the increase in traffic accidents in El País, and the third one during the SESPAS meeting. There were significant differences among those stories published from the traditional strategies of communication and those published from the interactive ones, the latter being more diverse, with more contributions of the journalists and tackling a wider range of issues. CONCLUSIONS: The combination of traditional and alternative communication strategies was a effective option. Unlike previous experiences in this occasion, with the network aid, the presence of SESPAS in media was not punctual around the Congress, but maintained during five months. The results and the obtained experience of this research can be useful for future public health advocacy interventions in Spain.

Health Promotion↗
PubMedDate not supplied

Meeting the continuing education needs of pediatric nurses: the Pediatric Nurse Exchange Program.

Today's dynamic health care environment offers multiple challenges as hospitals attempt to design and implement successful nursing career plans and support the development of professional nurses along such plans. The Pediatric Nurse Exchange Program is designed as a means for personal and professional development to support professional nurses as they are challenged to provide quality nursing care to children and their families. A pilot project is designed to provide experiences for professional nurses in three children's hospitals in Ohio. Exchange experiences, of two to five days in length, provide opportunities for nurses to share expertise, exchange patient care strategies, and develop skills as consultants, change agents, educators, and communicators. Nurse participants in the program are awarded continuing education contact hours for the experience.

Clinical Competence↗
PubMed1990

HIV/AIDS in Mexico.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Public communication, risk perception, and the viability of preventive vaccination against communicable diseases.

Because of the nature of preventive vaccination programs, the viability of these public health interventions is particularly susceptible to public perceptions. This is because vaccination relies on a concept of 'herd immunity', achievement of which requires rational public behavior that can only be obtained through full and accurate communication about risks and benefits. This paper describes how irrational behavior that threatens the effectiveness of vaccination programs--both in crisis and non-crisis situations--can be tied to public perceptions created by media portrayals of health risks. I concentrate on childhood vaccination as an exemplar of 'non-crisis' preventive vaccination, and on the recent flu vaccine shortage as a 'crisis' situation. The paper concludes with an examination of the steps necessary to resolve these threats through better public communication.

Child↗
PubMed2002

A communication assessment and skill-building exercise (CASE) for first-year residents.

OBJECTIVE: Good communication skills are essential for residents entering postgraduate education programs. However, these skills vary widely among medical school graduates. This pilot program was designed to create opportunities for (1) teaching essential interviewing and communication skills to trainees at the beginning of residency, (2) assessing resident skills and confidence with specific types of interview situations, (3) developing faculty teaching and assessment skills, (4) encouraging collegial interaction between faculty and new trainees, and (5) guiding residency curricular development. DESCRIPTION: During residency orientation, all first-year internal medicine residents (n = 26) at the University of Minnesota participated in the communication assessment and skill-building exercise (CASE). CASE consisted of four ten-minute stations in which residents demonstrated their communication skills in encounters with standardized patients (SPs) while faculty members observed for specific skills. Faculty and SPs were oriented to the educational purposes and goals of their stations, and received instructions on methods of providing feedback to residents. With each station, residents were provided one and a half minutes of direct feedback by the faculty observer and the SP. The residents were asked to deal with an angry family member, to counsel for smoking cessation, to set a patient-encounter agenda, and to deliver bad news. A resident's performance was analyzed for each station, and individual profiles were created. All residents and faculty completed evaluations of the exercise, assessing the benefits and areas for improvement. DISCUSSION: Evaluations and feedback from residents and faculty showed that most of our objectives were accomplished. Residents reported learning important skills, receiving valuable feedback, and increasing their confidence in dealing with certain types of stressful communication situations in residency. The activity was also perceived as an excellent way to meet and interact with faculty. Evaluators found the experience rewarding, an effective method for assessing and teaching clinical skills, a faculty development experience for themselves in learning about structured practical skills exercises, and a good way to meet new interns. The residency program director found individual resident performance profiles valuable for identifying learning issues and for guiding curricular development. Time constraints were the most frequently cited area for improvement. The exercise became feasible by collaborating with the medical school Office of Education-Educational Development and Research, whose mission is to collaborate with faculty across the continuum of medical education to improve the quality of instruction and evaluation. The residency program saved considerable time, effort, and expense by using portions of the medical school's existing student skills-assessment programs and by using chief residents and faculty as evaluators. We plan to use CASE next year with a wider variety of physician-patient scenarios for interns, and to expand the program to include beginning second- and third-year residents. Also, since this type of exercise creates powerful feedback and assessment opportunities for instructors and course directors, and because feedback was so favorable from evaluators, we will encourage participation in CASE as part of our faculty educational development program.

Clinical Competence↗
PubMed2002

Brain-computer interfaces for communication and control.

For many years people have speculated that electroencephalographic activity or other electrophysiological measures of brain function might provide a new non-muscular channel for sending messages and commands to the external world - a brain-computer interface (BCI). Over the past 15 years, productive BCI research programs have arisen. Encouraged by new understanding of brain function, by the advent of powerful low-cost computer equipment, and by growing recognition of the needs and potentials of people with disabilities, these programs concentrate on developing new augmentative communication and control technology for those with severe neuromuscular disorders, such as amyotrophic lateral sclerosis, brainstem stroke, and spinal cord injury. The immediate goal is to provide these users, who may be completely paralyzed, or 'locked in', with basic communication capabilities so that they can express their wishes to caregivers or even operate word processing programs or neuroprostheses. Present-day BCIs determine the intent of the user from a variety of different electrophysiological signals. These signals include slow cortical potentials, P300 potentials, and mu or beta rhythms recorded from the scalp, and cortical neuronal activity recorded by implanted electrodes. They are translated in real-time into commands that operate a computer display or other device. Successful operation requires that the user encode commands in these signals and that the BCI derive the commands from the signals. Thus, the user and the BCI system need to adapt to each other both initially and continually so as to ensure stable performance. Current BCIs have maximum information transfer rates up to 10-25bits/min. This limited capacity can be valuable for people whose severe disabilities prevent them from using conventional augmentative communication methods. At the same time, many possible applications of BCI technology, such as neuroprosthesis control, may require higher information transfer rates. Future progress will depend on: recognition that BCI research and development is an interdisciplinary problem, involving neurobiology, psychology, engineering, mathematics, and computer science; identification of those signals, whether evoked potentials, spontaneous rhythms, or neuronal firing rates, that users are best able to control independent of activity in conventional motor output pathways; development of training methods for helping users to gain and maintain that control; delineation of the best algorithms for translating these signals into device commands; attention to the identification and elimination of artifacts such as electromyographic and electro-oculographic activity; adoption of precise and objective procedures for evaluating BCI performance; recognition of the need for long-term as well as short-term assessment of BCI performance; identification of appropriate BCI applications and appropriate matching of applications and users; and attention to factors that affect user acceptance of augmentative technology, including ease of use, cosmesis, and provision of those communication and control capacities that are most important to the user. Development of BCI technology will also benefit from greater emphasis on peer-reviewed research publications and avoidance of the hyperbolic and often misleading media attention that tends to generate unrealistic expectations in the public and skepticism in other researchers. With adequate recognition and effective engagement of all these issues, BCI systems could eventually provide an important new communication and control option for those with motor disabilities and might also give those without disabilities a supplementary control channel or a control channel useful in special circumstances.

Brain Diseases↗
PubMed2005

Impact of modem-transferred blood glucose data on clinician work efficiency and patient glycemic control.

BACKGROUND: Communication of blood glucose (BG) results between patients and health care providers (HCPs) is of established benefit and remains a critical part of the diabetes management process. Currently, HCPs typically receive BG data from patients at the time of clinic visits or by telephone. The Accu-Chek Acculink modem (Roche Diagnostics Corp., Indianapolis, IN) provides an additional and attractive option that can potentially facilitate this communication. METHODS: To assess the impact of modem transfer of BG, we studied 47 participants with diabetes enrolled in a diabetes education program. Subjects were randomized to weekly communication of BG data to their HCP by either telephone (n = 23) or modem (n = 24) for 4 weeks. Mean age (+/- SD) was 44 +/- 15 years, 62% were female, 74% used insulin, 53% had type 1 diabetes, and mean baseline glycosylated hemoglobin (A1C) was 8.8% (range 5.2-13.2%). RESULTS: There were no differences between groups in the amount of time the HCP spent analyzing BG data and communicating with patients (12.6 +/- 6.1 min/week in the telephone group and 11.5 +/- 5.1 min/week in the modem group) or in the number of patient and HCP attempts needed to make contact. There were similar improvements in A1C between groups (change of -0.4 +/- 0.7% in the telephone group and -0.9 +/- 1.4% in the modem group, P = 0.18). BG data provided by telephone had a 6% error rate, in contrast to modem-sent data, which were transmitted without error. CONCLUSIONS: Modem transfer of BG data can provide an accurate and clinically useful option for communication between patients and their HCP and has comparable effects on A1C.

Adult↗
PubMedDate not supplied

Community-based nurse health coaching and its effect on fitness participation.

This article reports on the characteristics of the individuals participating in Health Matters, a community-based health promotion and fitness program for the elderly. A total of 255 persons were recruited into the program. Eligibility criteria included having one or more qualifying chronic health conditions, being 65 or older, having membership in a participating health plan, and ownership of a CalPERS long-term care insurance policy. The intervention included nurse health coaching, training in self-management of chronic illness, referrals to community resources, and a fitness program. More than 90% of participants were in exercise programs at 12 months, and 30% had participated in one or more condition management classes. Health Matters' senior-oriented fitness program was more successful in attracting higher disability risk members than were either community-based or self-exercise programs. Health Matters demonstrated that it is possible to proactively recruit and retain individuals in a health-promotion program. The nurse coaches/case managers communicated with primary care physicians about the enrollees and their health action plans, but recruitment did not rely on physician referrals.

Aged↗
PubMed1995

Effective physician-patient communication and health outcomes: a review.

OBJECTIVE: To ascertain whether the quality of physician-patient communication makes a significant difference to patient health outcomes. DATA SOURCES: The MEDLINE database was searched for articles published from 1983 to 1993 using "physician-patient relations" as the primary medical subject heading. Several bibliographies and conference proceedings were also reviewed. STUDY SELECTION: Randomized controlled trials (RCTs) and analytic studies of physician-patient communication in which patient health was an outcome variable. DATA EXTRACTION: The following information was recorded about each study: sample size, patient characteristics, clinical setting, elements of communication assessed, patient outcomes measured, and direction and significance of any association found between aspects of communication and patient outcomes. DATA SYNTHESIS: Of the 21 studies that met the final criteria for review, 16 reported positive results, 4 reported negative (i.e., nonsignificant) results, and 1 was inconclusive. The quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes. The outcomes affected were, in descending order of frequency, emotional health, symptom resolution, function, physiologic measures (i.e., blood pressure and blood sugar level) and pain control. CONCLUSIONS: Most of the studies reviewed demonstrated a correlation between effective physician-patient communication and improved patient health outcomes. The components of effective communication identified by these studies can be used as the basis both for curriculum development in medical education and for patient education programs. Future research should focus on evaluating such educational programs.

Communication↗
PubMed2004

The role of the applied epidemiologist in armed conflict.

BACKGROUND: Applied epidemiologists are increasingly working in areas of insecurity and active conflict to define the health risks, suggest feasible means to reduce these risks and, monitor the capacity and reconstruction of the public health system. In 2001, The Carter Center and the United States Institute for Peace sponsored a conference within which "Violence and Health" was discussed and a working group on applied epidemiology formed. The group was tasked to describe the skills that are essential to effective functioning in these settings and thereby provide guidance to the applied epidemiology training programs. METHODS: We conducted a literature review and consultation of a convenience sample of practitioners of applied epidemiology with experience in conflict areas. RESULTS AND CONCLUSIONS: The health programs designed to prevent and mitigate conflict are in their early stages of implementation and the evaluation measures for success are still being defined. The practice of epidemiology in conflict must occur within a larger humanitarian and political context to be effective. The skills required extend beyond the normal epidemiological training that focuses on the valid collection and interpretation of data and fall into two general categories: (1) Conducting a thorough assessment of the conflict setting in order to design more effective public health action in conflict settings, and (2) Communicating effectively to guide health program implementation, to advocate for needed policy changes and to facilitate interagency coordination. These are described and illustrated using examples from different countries.

Journal Article↗
PubMed1995

[Educational needs of home health care nurses].

Because of the rapid growth and changes occurring in home health care, nurses have a need for acquiring additional education and nursing skills. Post-RN (registered nurse) education in home health care, however, has not been developed yet. The purpose of this study was to identify the significant educational needs of the home health care nurses in order to upgrade nursing skills. A survey was conducted of members of the nursing society for intractable-diseases and other home health nurses introduced by some of the members. The survey questionnaires were sent to 172 subjects and the response rate was 79.6%. Practical nurses and inactive nurses were excluded to leave 125 registered nurses who were subjects of this analysis. The major findings in this study were as follows: a) The mean age of the respondents was 42.1 years old. The average length of clinical nursing experience was 17.0 years. b) Among fifty home care nursing skills indicated higher implementation percentage than high-technology nursing skills. c) The personal care skills as well as high-technology nursing skills showed low difficulty, while interviewing and counseling skill and communication skill showed high difficulty. d) The respondents showed high educational needs for mastering high-technology nursing, communication and counseling skills. e) Clinical nursing experience of hospital service was found to be significantly useful means for the respondents to perform most of the home care nursing skills. Reference books were utilized as supplementary to the clinical experience. f) When asked about their desire for educational resources to provide high quality home health care nursing, approximately 80% responded that they wanted to obtain up-to-date information, and opportunities for clinical practice training courses. On the basis of our findings, the following skills could be crucial for the home health nurses and should be included in continuing educational programs; interviewing and counseling, interpersonal communication, high-technology home health care nursing, and independent decision-making.

Adult↗