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PubMedDate not supplied

Standardized patient training: a modality for teaching interviewing skills.

BACKGROUND: Standardized patient training involves an experiential approach to clinical training, using laypeople acting as patients to provide skills-building opportunities for health care providers. METHOD: Standardized patient training was used for 2 years in combination with a computer-based continuing education program or traditional inservice program to teach two important communication skills: human immunodeficiency virus-related risk assessment and posttest counseling. FINDINGS: Assessments by more than 500 participants in a rural setting were overwhelmingly positive, with increased willingness and ability to perform the risk assessment and counseling in clinical practice. CONCLUSION: Standardized patient training is viewed very positively by participants. Longitudinal observations of clinical behaviors would be necessary to confirm behavior changes.

Computer-Assisted Instruction↗
PubMed1997

Local impact of the NHMRC early breast cancer guidelines: where to from here?

OBJECTIVES: To determine clinicians' recall of the National Health and Medical Research Council's (NHMRC) Clinical practice guidelines for the management of early breast cancer six months after publication, and their reactions to its content and potential dissemination and implementation strategies. SETTING: Greater Western Region of Sydney, May 1996. METHOD: Self-administered survey of clinicians with an involvement or interest in the management of women with breast cancer. RESULTS: Of the 69 respondents to the questionnaire (77% response rate), 20% did not recall ever seeing the guidelines. Although most agreed with the defined parameters of potential strengths of the guidelines, there was less agreement as to their medicolegal implications. The four treatment sections of the guidelines were the most highly rated, followed by the sections on communication skills and investigations. Education programs, including college-based programs, as well as endorsement of the guidelines by the learned colleges and respected colleagues, were rated highly as dissemination strategies, far outranking Internet availability. Local revision of the guidelines was considered important as an implementation strategy by three-quarters of respondents. Only 20% indicated that the guidelines had influenced clinical practice, although 46% agreed that they would improve outcomes for women with early breast cancer. CONCLUSIONS: The NHMRC early breast cancer guidelines have been relatively well received in the Greater Western Region of Sydney, although local activities within public institutions and private practice will be needed to achieve implementation.

Adult↗
PubMed1991

Physicians' information needs: analysis of questions posed during clinical teaching.

OBJECTIVE: To describe information requests expressed during clinical teaching. SETTING: Residents' work rounds, attending rounds, morning report, and interns' clinic in a university-based general medicine service. SUBJECTS: Attending physicians, medical house staff, and medical students in a general medicine training program. METHODS: An anthropologist observed communication among study subjects and recorded in field notes expressions of a need for information. We developed a coding scheme for describing information requests and applied the coding scheme to the data recorded. Based on assigned codes, we created a subset of strictly clinical requests. MEASUREMENTS: Five hundred nineteen information requests recorded during 17 hours of observed clinical activity were selected for detailed analysis. These requests related to the care of approximately 90 patients by 24 physicians and medical students. Sixty-five requests were excluded because they were not strictly clinical, leaving a subset of 454 clinical questions for analysis. MAIN RESULTS: On average, five clinical questions were raised for each patient discussed. Three hundred thirty-seven requests (74%) concerned patient care. Of these 337 questions, 175 (52%) requested a fact that could have been found in a medical record. Seventy-seven (23%) of these questions, motivated by the needs of patient care, were potentially answerable by a library, a textbook, a journal, or MEDLINE. Eighty-eight (26%) of the questions asked for patient care required synthesis of patient information and medical knowledge. CONCLUSIONS: Clinicians in the study settings requested information frequently. Many of these information needs required the synthesis of patient information and medical knowledge and thus were potentially difficult to satisfy. A typology is proposed that characterizes information needs as consciously recognized, unrecognized, and currently satisfied.

Education, Medical↗
PubMed1986

Dealing with the media: CEOs' perceptions.

Health care executives' greatest concern in dealing with journalists is what they perceive as the media's lack of information and lack of understanding of health care issues. According to a survey to which 175 institutions responded, administrators perceive that they are not well prepared to deal with the media, they fear being quoted out of context, and they exhibit a lack of trust in the media. When the study data were examined according to hospital size and the presence or absence of a public relations function, the following relationships were observed: CEOs in large institutions are more likely than CEOs in smaller institutions to perceive that the media misunderstand health care issues. The degree to which lack of trust in the media and quoting out of context were cited as problems declines as bed size increases. The presence of a public relations function in the institution does not eliminate CEO's perceptions of miscommunication. Providers must take a strong stance in addressing the potential problems highlighted in the study. Seminars and printed materials should be created to update the media on current issues and to foster a sense of cooperation between the parties. Executives themselves must take advantage of continuing education programs that focus on developing communications skills. Efforts to resolve these problems are imperative, since continued dissatisfaction with the media ultimately will result in a misinformed or uninformed public.

Attitude of Health Personnel↗
PubMed1999

[Prevention of severe diseases in apparently healthy newborn infants by new neonatal diagnostic methods].

The benefit of Tamiz Neonatal Ampliado is very high in relation with its cost, which is reasonably low. The Society for Inherited Metabolic Disorders, which is the main association in the world dealing with these diseases, has recently urged the responsible ones for neonatal health, so they increase their programs about Tamiz Neonatal (personal communication), as much as possible; its use should cover all new borns.

Congenital Abnormalities↗
PubMedDate not supplied

Occupational health services for municipal employees.

Most municipalities have departments responsible for fire, policing, public works, parks, sanitation, health, water, administration, and communications. A comprehensive occupational medicine program must address the potential and actual health hazards associated with each of these fields, as well as pre-employment/placement medical evaluations, medical surveillance, wellness programs, work-related injury, case management, return-to-work accommodations, and drug and alcohol testing. While no standard for municipal occupational heath services exists, a comprehensive approach to the variety of work settings that are inherent even in small municipalities is important for the service provider.

Accidents, Occupational↗
PubMed2000

Lab connections. Allina Laboratories, Minneapolis.

PROBLEM: Need for a flexible system to handle lab order entry and results reporting that could roll out quickly to numerous clinics and hospitals. SOLUTION: Implementation of a Web-based lab ordering and results management information system. RESULTS: Increased efficiency, decreased test duplication, reduced misinformation and errors, improved user satisfaction. KEYS TO SUCCESS: Inclusion of clinic clients and lab staff in the program's development and ongoing communication with them to see that their needs continue to be met.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

[Mental health of youths: effect of education on changes in attitude and behavior].

Two final classes of Bjelovar Secondary Medical School were questioned twice about alcohol, nicotine and drugs abuse, early sexual intercourse and confidence in parents and teachers, in order to estimate their knowledge, attitudes and behaviour: at the beginning and at the end of the winter term of the year 2000/2001. The answers show that significant improvement in the knowledge of mental hygiene does not necessarily change the behavior of the examines. Three quarters of the examinees smoke tobacco, over 90% of them consume alcohol and one quarter have been experimenting with the so called "light" drugs. The majority of the examinees consider early sexual intercourse (before the age of sixteen) undesirable. Less than half of the examinees are satisfied with their relationship with parents. Small number of examinees is willing to ask for the teachers' help in solving noneducational problems. The results of this study have showed the need for the constant performing of preventive school programs for the improvement of communication skills between parents, pupils and teachers.

Adolescent↗
PubMedDate not supplied

Skills and abilities needed by environmental health science and protection professionals in the public sector.

The National Environmental Health Science and Protection Accreditation Council (EHAC) accredits undergraduate academic environmental health science programs in the United States. The guidelines used by EHAC include core and technical courses that students should take in order to graduate with a bachelor of science degree in environmental health science. As part of a review of the accreditation guidelines, the research reported in this paper was undertaken with support from the Centers for Disease Control and Prevention. To identify the skills and abilities needed by entry-level environmental health professionals in the public sector, the research 1) examined existing environmental health priorities in public-health agencies, 2) reviewed entry-level job postings, and 3) surveyed more than 120 public-health professionals across the country. The results suggest that students who graduate from accredited programs must be skilled interpersonal communicators with a broad base of technical knowledge.

Accreditation↗
PubMed2004

An implementation of automated individual matching for observational studies.

OBJECTIVES: Individual matching is frequently used in observational studies. Its main purpose lies in efficiency of study conduct and parameter estimation. Ideally, an individually matched index subject differs from the reference subject(s) only by the factor(s) of interest. Matching is used to select comparable subgroups on which further data analysis can then concentrate. Finding optimal subsets is then a closed problem, which may include a lot of guesswork. It is a task that begs an algorithmic solution that can be obtained automatically. METHODS: The problem can be formalized as a minimization of a global loss function that summarizes the deviation from perfect agreement over different variables. Through the representation by a network formed by a bipartite graph of index and reference subjects, one can obtain a solution by finding a minimum cost flow in a certain network. We have implemented a Web-based application using the efficient CS2 algorithm. RESULTS: Variations of the individual matching procedures that have been implemented comprise 1:N matching and matching with a variable number of controls. The user can upload own data, view the proposed result in a list and finally download the matching plan. Representation of quality of individual matches as background colors allows rapid checks for overall matching accuracy. CONCLUSIONS: The computer-assisted variation reduces the human interaction to the tuning of a few parameters, rather than individual decisions on forming separate matches. This not only saves a lot of work but also simplifies communicating the matching process. The program addresses a general class of matching problems. The use of this tool for special cases of matching, as caliper matching or exact category matching, is highlighted.

Algorithms↗
PubMedDate not supplied

Differentiation: an encouraging approach to anticancer therapy.

Differentiation is a complex multistep process of cell specialization that begins with the installation of a genetic programme, named determination, specific for a cell lineage. Development of the differentiation programme includes the cell-type specific silencing of some genes and the expression of other genes, that regulate the biological functions associated with the cellular type and that distinguish the specialized cells. Terminal differentiation is the end stage of this process where the cells irreversibly lose their proliferative capacity and which represents a form of negative control of growing. Regulating molecules interact to produce the correct balance between cellular multiplication and differentiation during embryogenesis and the normal behaviour of an adult. Cancer is a process in which changes in regulating circuits are produced, such as proliferation control, the balance between cellular survival and programmed cellular death (apoptosis), the communication with neighbouring cells and with the extracellular matrix, angiogenesis, and finally, the migration of the tumoural cell, the invasion and metastasic dissemination. This process implies the progressive development of a more malign phenotype with an increase of genetic alterations involving genes at several levels of expression during long periods of time. These genetic changes uncouple the normal balance between multiplication and cellular differentiation with an increase in the rate of proliferating cells. Classic chemotherapeutical agents have been very important; nevertheless, as the mechanism of action of these drugs depends on the cytodestruction of the neoplastic cells, their beneficial effects are normally accompanied by a notable morbidity, cytotoxicity and multidrug resistance. The knowledge of the mechanisms involved in differentiation and malignant transformation has allowed the search of alternative routes for antitumoural therapy that does not imply cellular death. Differentiation therapy focuses on the development and use of specific agents designed to selectively attract the terminal differentiation process, making the elimination of tumoural cells feasible together with the establishment of normal cellular homeostasis.

Animals↗
PubMed2007

Selected eHealth applications in Cyprus from the training perspective.

OBJECTIVES: In this paper a review of selected eHealth applications in Cyprus is presented linked with their success or failure based on their training activities. METHODS: The eHealth systems presented and their training activities include an update of the health information system (HIS) in the public hospitals, a medical system for emergency telemedicine (AMBULANCE and EMERGENCY-112 projects), a home monitoring system for cancer patients (DITIS), a satellite-based network in healthcare applications (EMISPHER and HEALTHWARE projects), and the training activities of the Cyprus Society of Medical Informatics. Different methodologies for training were used ranging from classical approaches like train the trainers, using demo cases followed by personal training, group training, and workshops, to more recent methodologies based on eLearning sessions including teleconsultations. RESULTS: The training was carried out successfully in all cases. However, not all eHealth systems were put into practice successfully, mainly for reasons not related to training. CONCLUSIONS: It is anticipated that this paper will promote the importance of these applications and their training activities as well as help in the spin off of others thus enabling the offering of a better service to the citizen.

Computer Communication Networks↗
PubMed1989

Skills for adolescence: experience with the International Lions-Quest program.

This article describes the development of the Lions-Quest Skills for Adolescence program. The primary purpose of this program is to respond to the needs of young people by helping them become more self aware, more skilled, more able to make positive and healthy choices, and better able to make informed, aware, and considered decisions about their own behavior. Skills for Adolescence is one school/community/parent-based curricular program that attempts to address health, life skills, and prevention issues in ways that have clearly struck a common chord in numerous countries. The program's emphasis on effective communication, on self-efficacy and social skills, and on strengthening the family appear to have a strong appear in many different contexts and cultures. Careful attention to local needs during adaptation while employing collaborative strategies is an essential ingredient to crossing cultural and national boundaries.

Adolescent↗
PubMed1988

Evaluation of a system designed to enhance the resident selection process.

A system was developed to establish standardized student performance information and a common nomenclature to enhance communication between clerkship and residency program directors. The results show such a system is in demand by program directors but that some students clerkship directors feel its use hampers students' chances of acquiring surgery residency positions.

Clinical Clerkship↗
PubMed1984

Family-focused cardiac rehabilitation. A role supplementation program for cardiac patients and spouses.

A review of the literature yields general agreement among investigators regarding the responses of both patients and spouses to a cardiac event. Anxiety, depression, low self-esteem, marital and sexual dysfunction, and psychosomatic symptoms have been consistently documented up to 1 year following a myocardial infarction or cardiac surgery. Although the patient's physiologic status sets limits on the potential level of recovery, psychosocial variables are new recognized as playing a critical role in the rehabilitation process for both patients and their families. Our 3-year experience with patient-spouse groups supports the view that spouses must be involved throughout the rehabilitative process and that effective participation is provided within the context of a role supplementation program. Such a program facilitates direct and consistent communication as well as flexibility within and between roles. Both end points are critical to the re-establishment of family equilibrium and the ultimate recovery of the cardiac patient.

Adaptation, Psychological↗
PubMed1994

Quality improvement programs: alternative rewards.

As the trend continues toward pay for quality in the health care arena, interested organizations will doubtless recognize that pay-for-quality programs reinforce quality values, clarify communications in the organization, and generally support the culture's expectation of compensation for excellence. However, various stakeholders in the industry may have some skepticism, which will be overcome only through careful education and communication of the plan. An overview of the intrinsic issues and opportunities for alternative means to compensate and reward health care professionals and a case study of one hospital's implementation illustrate the typical benefits of quality-based pay for health care institutions and their nursing professionals.

Clinical Competence↗
PubMed1995

Object-oriented modeling of hospital information systems.

We have chosen an object-oriented approach for the modeling of a hospital information system; this avoids some disadvantages of the classic methods (i.e., a combination of Structured Analysis and Entity-Relationship-Model). The primary goal of this procedure was to find and represent the needs of communication in the computer-based part of the information system and, with that, to configure an information server that handles all the interactions. Furthermore, we wanted to develop communication interfaces for the application programs on an object-oriented level.

Computer Simulation↗
PubMed1995

[An electron microscopic study of the natural death of cyst cells in Sarcosporidia. II. Ultrastructural changes in the nuclei of cyst cells of Sarcocystis muris].

Nuclear changes in cyst cells, developing within 6 and 10 month old sarcocysts of Sarcocystis muris, were followed in terms of the programmed cell death phenomenon. This communication extends our previous studies in the cytoplasm of S. muris cyst cells (Radchenko et al., 1995) to include particular nuclear changes in different involve changes in nuclear configuration: the original spherical from is progressively substituted for irregular or lobulated shapes. This may suggest some corresponding changes in cytoskeleton, involved in formation and maintaining of some definite nuclear shape. In normal cyst cells, the nuclear chromatin appears as a filiform and reticulate structure with a few lumps made of granules and filaments. In the cyst stages subject to natural cell death, structural changes in nuclei involve disassembly of lumps into separate granules. Some spherical structures are seen outbudding from the nucleolus. These structures are presumably made of RNA-containing granules. The pattern of nucleolar segregation in S. muris cells resembles somewhat the changes in nucleoli reported for metazoan cells. However, the general picture of morphological evolution in the nuclei of S. muris cells, in the course of natural dying, differs from that in metazoan cell nuclei. No condensation of nuclear chromatin at the nuclear periphery, or blebbing of the nuclear and cytoplasmic membranes, so characteristic of the latter, was followed in the former. The peculiarities noticed in the sarcosporidia may reflect biological peculiarities of these specialized parasitic protozoa.

Animals↗