Smaller families through China's integrated project.
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Doctor-patient communication: principles and practices.
BACKGROUND: In a formal needs assessment, conducted prior to the Canadian Headache Society's recent national continuing education workshop, participants expressed particular enthusiasm for enhancing their own communication skills or their teaching of those skills. OBJECTIVES: Responding to both interests, this paper offers a practical conceptual framework for thinking systematically about how to improve physician-patient communication to a professional level of competence. METHODS: The three-part, evidence-based framework first defines communication in medicine in terms of five underlying assumptions about communication and the learning of communication skills. It then discusses three categories of communication skills (content, process, and perceptual skills) and six goals that physicians and patients work to achieve through their communication with each other. The second part of the framework explores "first principles" of effective communication and includes a brief look at the historical context that has significantly influenced our thinking about, and practice of communication in health care. Part three of the framework describes one approach for delineating and organizing the specific skills that research supports for communicating effectively with patients - the Calgary Cambridge Guide. RESULTS: It is clear from the literature that better physician communication skills improve patient satisfaction and clinical outcomes and that good communication skills can be taught and learned. CONCLUSIONS: It is important that physicians learn the principles of good physician-patient communication and apply them in clinical practice. Medical education programs at all levels should include teaching of physician-patient communication.
Communication↗
A computerized health screening and follow-up system in diabetes mellitus.
A computerized population health problem targeting program for diabetes mellitus and other common non-communicable disease was tested at St Luke's Hospital, Malta. The program utilizes a patient questionnaire by dialogue with a computer lasting about 20 min. The system evaluates and targets health problems that are followed up through the database. During a period of 10 months, two groups of people were screened using the system, consisting of 128 recently diagnosed diabetic patients presenting consecutively and 320 people from the general population. The age distributions of the two groups were similar. The system indicated 27% of the control group as being within the Diabetes Risk Group; 5% of this control group were confirmed to have diabetes. Eighty-two percent of newly referred diabetic patients were detected, giving false positive results in 23% and a false negative result in 18% of cases. The classification rules in the system were tuned to the population of Moscow, Russia. We have since adjusted these to better suit the Maltese population. The adjusted rules now indicate 20% of the general population as being within the risk group and have correctly detected 84% of the diabetic people, giving a false positive result in 15% and a false negative result in 16% of cases.
Adolescent↗
Beyond fulfilling the core competencies: an objective structured clinical examination to assess communication and interpersonal skills in a surgical residency.
OBJECTIVE: The Accreditation Council for Graduate Medical Education (ACGME) has challenged program directors to assess their residents' core competencies, including communication and interpersonal skills (CIS). We report our institution's experience using a series of standardized patient encounters in an objective structured clinical examination (OSCE) to evaluate CIS in surgical residents. METHODS: Standardized patients rated the residents' ability to maintain a patient-centered approach across 6 challenging communication tasks. Residents received verbal feedback from the patients after each encounter and completed a survey indicating their experience and comfort with each task. Individual and group reports documented resident competency and provided aggregate information for curriculum review. Formal grades were not assigned. RESULTS: Twenty-two residents in 2 surgical residency programs piloted the assessment. The Generalizability of the assessment was 0.81. Scores of second- and third-year residents were not significantly different. Residents found the program to be helpful and able to assess their skills. CONCLUSIONS: The standardized patient-based OSCE is an effective method to assess communication and interpersonal skills and provides useful information for curriculum review.
Communication↗
[Phoniatric and orthophonic management of patients during the awakening phase of coma].
The creation of a structure adapted to serious head injuries, in the awakening phase of a coma, enables early treatment of these patients upon leaving intensive care. Along with a pluridisciplinary team, speech therapists will help establish non-verbal communication by setting up a yes-no code and by favouring and programming the resumption of deglutition before soliciting verbal communication and recuperation of the memory and all the cognitive functions.
Coma↗
Developing and implementing an industrial hygiene and safety program in industry.
The development and implementation of a comprehensive industrial hygiene and safety program is a complex activity for which there does not exist a uniform code or set of guidelines. Although the ultimate goal of such a program is to provide for the welfare of the employee through the use of engineering control and other preventive measures, there is great variation among business establishments on methods necessary to attain this result. Factors which contribute to this variation usually are: type of industry, management philosophy and size of the business establishment. This paper addresses many key elements integral to this activity such as justification and philosophy, organizational reporting relationships, interfunctional communication, technical and personnel requirements and program performance indicators.
Accidents, Occupational↗
The UMLS Knowledge Source server.
The UMLS Knowledge Source server is an evolving tool for accessing information stored in the UMLS Knowledge Sources. The system architecture is based on the client-server paradigm wherein remote site users send their requests to a centrally managed server at the U.S. National Library of Medicine. The client programs can run on platforms supporting the TCP/IP communication protocol. Access to the system is provided through a command-line interface and through an Application Programming Interface.
Computer Communication Networks↗
Developing a valid evaluation for interpersonal and communication skills.
OBJECTIVES: The Accreditation Council for Graduate Medical Education requires that residency programs evaluate the acquisition of six general competencies, including Interpersonal and Communication Skills (ICS). To develop a 360-degree method for accomplishing this, a semantic-differentiation matrix for various communication traits for nurses to evaluate physician ICS was developed. The authors sought to determine whether this evaluation method could discriminate between more experienced medical communicators (faculty) and less experienced medical communicators (residents). METHODS: A 98-item questionnaire measured several communication dimensions by using an eight-element semantic-differentiation scale. In addition, global assessment ratings assessed nursing perceptions of physician ICS skills. This process was repeated for various clinical scenarios. RESULTS: There were 26 nurse evaluators, 19 emergency medicine (EM) residents (EM2 and EM3), and 30 EM faculty. Each physician received five independent evaluations (total, 245 evaluations). All EM residents (EM2 and EM3) were compared with the EM faculty. All eight items on the semantic-differentiation scale were compared. Likewise, the global assessment scores were compared. In every category, the faculty scored higher (Mann-Whitney U: p < 0.001). CONCLUSIONS: An evaluation process integrating a semantic-differentiation matrix was applied to various clinical scenarios (as well as global assessment items) and demonstrated discriminatory results. Faculty physicians scored significantly higher than resident physicians. The ability to provide discriminatory results is a requisite in the development of a valid evaluation process. The described semantic-differentiation matrix and global assessment questions may be valid measurements of ICS.
Communication↗
Teaching public health practitioners about health communication: the MPH curriculum experience.
The dissemination of health information to the public often occurs through the mass media. Media strategies as a component of behavior change assume knowledge of communication theories and methods by public health practitioners. We surveyed the curricula of 52 accredited graduate programs leading to the Master's in Public Health (MPH) degree to assess their communication component. Graduate bulletins for admission year 1996 were examined for public health mission statement, goals and objectives of the MPH training program, and for course titles. Courses were identified as having a communication focus if the terms communication, information, marketing or media were used in the title. There were a total of 82 communication courses offered, with 65 courses in 26 Schools of Public Health (SPH), 13 courses in 18 Community Health and Preventive Medicine departments (CHPM), and 4 courses in 8 Community Health Education departments (CHE). The difference in mean number of health communication courses was significant by type of MPH program (p < 0.003) with SPH offering an average of 3 courses, CHPM departments offering an average of 1 course, and CHE offering an average of 0.5 course. The distribution of communication courses ranged from 10 courses to 0 courses per program. Seven SPH offered 3 or more communication courses, whereas 5 SPH offered no health communication courses in the MPH curriculum. These data point to a shortcoming in the training of MPH students in health communication theory and skills as ascertained by course titles in graduate bulletins.
Communication↗
Immunization programs in non-traditional settings.
BACKGROUND: The Downtown Eastside (DTES) of Vancouver is an inner-city neighbourhood of 10 square blocks where poverty, crowded housing, homelessness, poor nutrition and hygiene, chronic illness, and substance abuse put residents at risk for communicable diseases. The objective of the program was to minimize the burden of illness from vaccine-preventable diseases in this vulnerable population. This article describes the process and lessons learned to enable others to implement similar programs. INTERVENTION: Influenza and pneumococcal vaccinations were offered in community settings to all persons living in, working in, or visiting the DTES by teams of public health nurses and volunteers in the fall of 1999. Hepatitis A and B vaccinations were offered in January/February 2000. All 4 vaccines were offered in Fall 2000, influenza vaccine alone was offered in Fall 2001 and 2002; and pneumococcal, hepatitis A and B vaccines were offered in June 2002. RESULTS: During the initial 5-week influenza/pneumococcal immunization blitz, 8,723 persons were immunized; 79% received both vaccines. There was a reduction in visits for pneumonia to local emergency departments in the 3 months following this blitz. During the 5-week 2000 hepatitis A and B vaccination blitz, 3,542 persons were immunized; 58% received both vaccines. A reduction in reported cases of hepatitis A followed. Uptake of influenza vaccine was considerably reduced when offered in combination with 3 other vaccines. To maximize uptake, influenza vaccine was offered alone in subsequent years. CONCLUSIONS: Immunizations can be successfully delivered to high-risk inner-city populations in non-traditional settings, using public health nursing outreach in a blitz format.
British Columbia↗
A nonvocal system for teaching retarded children to read and write.
This study investigated the development of nonvocal teaching of reading and writing in severely retarded children. Fourteen subjects were selected who demonstrated limited communication skills, and were randomly placed into two groups. Group A received training procedures utilizing abstract plastic symbols which were arbitrarily assigned to represent specific words. The training program was divided into three phases. Phase I consisted of training left to right sequencing of four color--coded forms; Phase II consisted of training of matching symbols to stimulus pictures; and Phase III consisted of training of fading from symbols to printed words. The subjects completing this training program demonstrated the ability to learn selected reading and writing skills, i.e., they learned to sequence an article, subject noun, auxiliary verb, and verb. They also demonstrated functional semantic comprehension of five nouns and five verbs. Thirteen subjects finished the communication training program in less than four months with a mean training of 7 hours and 55 minutes. This is approximately 2 hours of training a month per subject to learn these skills. The data showed that Group B (rebuses) required fewer trials than Group A (abstract symbols) to meet criterion for Phase II, matching symbols to stimulus pictures. This suggests that Group B subjects may have had a meaningful association for the rebus signs which generalized to stimulus pictures. Group A (abstract symbols) required fewer trials than Group B (rebuse) to meet criterion for Phase 111, matching printed words to stimulus pictures. This indicates that perhaps Group A's training with abstract symbols positively affected learning to read printed words. The success of the visual nonvocal treatment program with the severely retarded is encouraging. Indeed, this is a different and viable approach in teaching communication skills (reading and writing) to the retarded.
Adolescent↗
Implementation of the Federal Hazard Communication Standard: does training work?
A joint labor-management training program intended to bring a large US manufacturing firm into compliance with the training requirements of the Federal Hazard Communication Standard appeared to achieve increases in employee knowledge and improved work practices. The program also evidenced positive indirect effects on management's institution of hazard control measures and organizational handling of health and safety issues. Most observed effects were maintained over a 2-year period after the training. More interactive, trainer-intensive delivery methods to smaller groups were associated with more positive effects on reported training usefulness and changes in work practices and working conditions.
Hazardous Substances↗
Respiratory infections: SARS and tuberculosis.
Positive-microscopy TB is a real issue for the respiratory diseases department of N'Djaména General Hospital, with a prevalence rate of 37 cases in 100 patients. The delay of diagnosis for positive-microscopy TB is excessive. Patients seem to be more responsible for this delay than the healthcare facilities. The factors that delay treatment of TB in N'Djaména are that (1) TB diagnosis in peripheral hospitals lengthens physician delay, and (2) seeking initial treatment outside conventional medicine lengthens patient delay. The following recommendations arise from this study: For the public health ministry: Reboost the national program against TB in Chad. Increase personnel in the respiratory diseases department at the N'Djaména General Hospital. Provide refresher TB education to care providers, stressing the importance of communication with the patient. For the national program against TB in Chad: Initiate a public information, education, and communication campaign about TB. Implement use of DOTS nationwide. For physicians increase communication with patients.
Chad↗
The cumulative risk of a false-positive recall in the Norwegian Breast Cancer Screening Program.
BACKGROUND: Biennial breast cancer screening for women ages 50-69 years is recommended by the World Health Organization. It has been claimed that the cumulative risk of a false-positive recall is a significant disadvantage in breast cancer screening programs. The primary objective of this study was to estimate the cumulative risk of a false-positive recall during a screening period of 20 years in women ages 50-51 years who are screened biennially in a population-based screening program. A secondary objective was to estimate the cumulative risk of undergoing fine-needle aspiration cytology, core needle biopsy, and open biopsy with benign morphology in the same group of women. METHODS: The Norwegian Breast Cancer Screening Program invites all women ages 50-69 years who reside in the country to a 2-view mammography biennially. A nationwide data base that covers all of the invited women includes individual information about all screening activity. Results from three screening rounds in four counties were the basis for this study. False-positive recalls due to abnormal mammograms among 83,416 women who participated all the 3 screening rounds were the basis for the estimations. RESULTS: It was calculated that women ages 50-51 years who participate in biennial screening run a cumulative risk of 20.8% for a false-positive recall during a screening period of 2 decades. The cumulative risk of undergoing fine-needle aspiration cytology was estimated at 3.9%, and the risk of undergoing core needle biopsy or open biopsy with benign morphology was 1.5% and 0.9%, respectively. CONCLUSIONS: False-positive recalls are a disadvantage in a breast cancer screening programs, but the cumulative risk seemed to be acceptable in the Norwegian Breast Cancer Screening Program. It is important to communicate the existence and extent of this risk to the target group.
Aged↗
Generalization from single sentence to multisentence production in severely aphasic patients.
Multisentence production was examined in three nonfluent aphasic patients who had undergone a single sentence production training program using a computerized visual communication system (C-VIC). Patients were required to describe videotaped vignettes in English and using C-VIC. C-VIC allowed for an investigation of production abilities previously impossible to measure in severely aphasic patients, since C-VIC does not require internal generation of appropriate lexical items or phonological and articulatory realization. Results are discussed in the context of language production models in an attempt to determine the breakdown(s) in the production system that result in difficulty in trying to produce multiple sentences.
Adult↗
Reducing attrition from conjoint therapy with alcoholic couples.
Premature termination of treatment by the client has been a pervasive problem in the alcohol treatment field. This drop-out problem is compounded in conjoint therapy for alcoholic couples since most clients typically do not view the drinking problem from a systemic, interactional perspective. Within a short-term communication-interaction based conjoint therapy program offered to couples with an alcohol problem on an outpatient basis, specific mechanisms were developed to deal with client-initiated attrition from treatment. These procedures involve the systematic involvement of the spouse in all aspects of intake, assessment and treatment; the use of role induction in a pretherapy interview; and formal contracting during the beginning phase of therapy. Preliminary results suggest that these efforts may be effective in retaining more socially stable alcoholic clients. For the more transient, less socially stable group of individuals with alcohol-related difficulties, the above mechanisms may not be sufficient to forestall unplanned terminations. It is suggested that the latter group may require help to reduce stresses related to concrete concerns prior to receiving conjoint therapy for their alcohol problem.
Adult↗
Assessing adolescent health needs: a factor analytic approach.
Advances in technology are rapidly expanding health educators' resources for presenting information tailored to meet individual health needs and interests. A self-administered questionnaire was given to 510 youths in grades 6 through 9 to ascertain adolescents' health concerns and thus develop more appropriate educational programs. Smoking, diet and weight control, physical fitness, and general health items were included. Factor analysis methods identified ten concerns; smoking, weight control, exercise effects, peer approval of appearance, preparatory health behaviors, planning and maintaining a personal health program, feeling good about oneself, communication issues, comparisons with others, and resistance to negative peer influences. Sex and grade were significantly associated with particular responses. Recommendations include the value of addressing each area of the content domain as it relates to health lessons to ensure that information is relevant to the needs and interests of individual adolescents.
Adolescent↗
A new hermetic antenna for wireless transmission systems of implantable medical devices.
In implantable medical devices (IMDs), the need of telemetry systems able to provide wireless bidirectional communication to interrogate and remotely program the device, as well as to monitor the physiological status of the patient, is growing. The object of the present study was to evaluate a new hermetic antenna for wireless short-range transmission system for IMDs which would assure reliable long-term functioning due to the high level of hermeticity of antenna's housing that limits the influence of body tissue environment on transmitted signals. Experimental tests were conducted on three different prototypes to evaluate the most efficient antenna configuration for transmission both in the air and through a mixture simulating the human thorax. Further tests were performed to assess the influence of electro-catheters connected to IMDs on transmitted signals. Results showed that the hermetic antenna guarantees a good wireless transmission both in the air and through the human thorax simulator. The results also show that the presence of an electro-catheter can influence the effective radiated power (ERP) transmitted depending on its position in relation to the telemetric circuitry. Both a controlled increase of the ERP without exceeding the limits imposed by rules and the optimization of the tuning between the antenna and the transmitter can assure a reliable short-range transmission (several meters) using the new hermetic antenna proposed.
Equipment Design↗