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At least 163 records · Page 9Linked to original sources
PubMed2006

Impact of patient-centered decision support on quality of asthma care in the emergency department.

OBJECTIVE: Communication barriers between parents of children with asthma and clinical emergency department (ED) providers and subsequent underrecognition of chronicity and severity impede improvements in disease management for patients with asthma in the ED setting. The asthma kiosk, a novel patient-driven decision-support tool, provides ED clinicians with tailored recommendations for guideline-based treatment. We evaluated the impact of the asthma kiosk on measures of quality during ED care, specifically, parent-reported satisfaction with dimensions of care related to communication and providers' adoption of guideline-endorsed processes of care. METHODS: A clinical trial composed of a baseline and an intervention period was conducted at a single tertiary care pediatric ED. Eligible participants were English- or Spanish-speaking parents of children who were 1 to 12 years of age and had a respiratory complaint and history of asthma. Parents used the kiosk to report children's symptoms, current medications, and unmet needs. During a 2-month baseline, no output from the kiosk was shared, and usual care proceeded. During a 3-month intervention that followed a 1-week run-in period, the output was shared with ED clinicians. All parents completed a telephone follow-up interview 1 week after discharge. Primary outcomes were (1) prescription of controller medication to patients who had persistent asthma symptoms and were not on controllers and (2) mean problem scores for 2 specific dimensions of care: information-sharing and partnership. RESULTS: Over 5 months, 1090 parent-child dyads were screened and 430 were eligible. A total of 286 (66.5%) of 430 parents enrolled in the trial. The kiosk generated severity classifications for 264 (92.3%) of 286 children. A total of 131 parents enrolled during baseline, 13 during a 1-week test phase, and 142 during intervention. Baseline participants were older (mean age: 5.3 years) compared with intervention (4.4 years) but did not differ on chronic severity, current use of controllers, or race. The total number of prescribed inhaled corticosteroids did not vary significantly between intervention and baseline (9 of 50 vs 4 of 43). Providers did prescribe inhaled fluticasone to eligible patients more often during intervention than baseline (9 of 50 vs 2 of 43). The number of reported information problems was unchanged between the baseline and intervention periods. The mean number of partnership problems increased from a mean of 1.5 (SD: 1.9) at baseline to a mean of 1.9 (SD: 1.4) during the intervention. This difference was marginally significant after adjustment for child gender, age, and severity category. When ED providers acted on kiosk data, reports of information problems were fewer (0.6 +/- 0.8) than when no action was taken (1.1 +/- 1.1). CONCLUSIONS: The asthma kiosk demonstrated small and variable impact on quality. Physicians' nonuse of kiosk-generated recommendations may explain the limited impact of the intervention.

Asthma↗
PubMedDate not supplied

Developing research criteria to define medical necessity in emergency medical services.

"The Neely Conference: Developing Research Criteria to Define Medical Necessity in EMS" convened emergency medical services (EMS) physicians, researchers, administrators, providers, and federal agency representatives to begin the development of a set of uniform triage criteria and outcome measures that could be used to study and evaluate medical necessity among EMS patients. These standardized criteria might be used in research studies examining EMS dispatch and response (e.g., dispatch triage protocols, alternative response configurations), and EMS treatment and transport (e.g., field triage protocols, alternative care destinations). The conference process included review and analysis of the literature, expert judgment, and consensus building. There was general agreement on the following: 1. Any dispatch triage or field triage system that is developed must be designed to offer patients alternatives to EMS, not to refuse care to patients. 2. It is theoretically possible to develop a set of clinical criteria for need. Some groups of patients will clearly need a traditional EMS response and other groups will not, but this has yet to be defined. 3. In addition to clinical criteria, certain social and other nonclinical criteria such as pain or potential abuse may be used to justify a response. 4. Communication barriers, patient age, special needs, and other conditions complicate patient assessment but should not exclude patients from consideration for alternate triage or transport. 5. These research questions are important, and standard sets of outcome measures are needed so that different studies and innovative programs can be compared.

Adult↗
PubMed2004

Everyone here speaks TXT: deaf people using SMS in Australia and the rest of the world.

This article examines the extent to which Short Message Service (SMS) messages are breaking down communication barriers among deaf people and between deaf and hearing people. It is predicted that deaf texters will use SMS to increase the bonds between themselves in deaf communities, creating new opportunities to develop relationships, understanding, and intimacy with those not physically present. The most exciting question raised by this article is whether those kinds of relationships, understanding, and intimacy will develop to the same extent with hearing colleagues, friends, and intimates.

Asia↗
PubMed2005

The influence of primary caregivers on the sexual behavior of early adolescents.

PURPOSE: To describe rates of sexual intercourse initiation, anticipated level of sexual activity in the next 12 months, and other risk behaviors among fifth graders and to examine parental factors associated with such behaviors. METHODS: This study is based on a cross-sectional, self-administered survey conducted with a nonrandom sample of 408 fifth graders and their caregivers. Children answered questions regarding sexual intercourse initiation, anticipated sexual activity in the next 12 months, and involvement in other risk behaviors. Caregivers answered questions about parenting factors such as monitoring behaviors, parent-child relationship quality, and parent-child communication. Bivariate and multivariable analyses examined the association of these variables with the adolescents' behaviors. RESULTS: Almost 5% of girls and 17% of boys reported they had engaged in sexual intercourse. Only 34% of girls and 13% of boys said they did not expect to engage in any type of sexual contact in the next 12 months if they were going with someone they "liked a lot." Parental factors associated with fewer risk behaviors and expected sexual behaviors included higher levels of monitoring, fewer communication barriers, less permissive attitudes regarding adolescent sexual behavior, higher relationship quality with child, having fewer than five children in the household, higher levels of education, and being employed. Significant gender interactions were found for several variables. CONCLUSIONS: Adolescents are initiating sexual intercourse at extremely young ages. To delay early sexual activity and prevent adolescent pregnancy, prevention efforts must begin during the elementary school years and include those who raise and care for the adolescent.

Adolescent↗
PubMed1977

A collaborative model for university nursing education and agency staff development.

A model is proposed for the integration of the education of senior nursing students and staff at a mental hospital, maximizing utilization of time and resources. A pilot study employed small group techniques with faculty as facilitators and resource persons, with the dual purpose of increasing competence and reducing communication barriers. Four students and four nursing staff participated in weekly meetings, alternating supervision groups (2 groups, each composed of 1 faculty, 2 students and 2 staff) with discussion groups (2 faculty, 4 students and 4 staff). Evaluation tools used did not yield significant differences between pre- and post-tests. However, objective and subjective indices point to positive changes of attitudes between all unit staff and students, improved therapeutic skills of students and staff, both on individual and group level. Ongoing group meetings of patients run by students and staff resulted.

Clinical Competence↗
PubMed1991

Easing the strain. The physician and the long-term care facility should work together to improve patient care.

Numerous regulations, inadequate reimbursement, and poor communication can strain the physician--long-term care facility relationship. Three major roles define the physician's responsibilities in the nursing home: care giver, communicator, and complier. Although the physician's roles in the nursing home may be similar to those in an office practice, they can be complicated by a number of factors. Many professionals, such as the nutritionist, social worker, and pharmacist, care for the nursing home resident. The physician thus loses some control over the patient's care. Communication barriers, such as the nursing home's misinterpretation of federal regulations, can frustrate both the physician and the facility's medical staff. This can lead to suboptimal patient care. Nursing homes must ensure that they keep physicians who treat residents abreast of facility regulations and federal and state guidelines. Although a physician may want to continue providing care to a patient who has entered a long-term care facility, he or she may find it necessary to transfer care to the medical director or house physician. Often the time and distance a physician must travel prohibit the physician from giving patients the high-quality care to which they are entitled.

Caregivers↗
PubMed2026

Ten years on, still out of reach: barriers to PrEP access and retention in France according to frontline actors (QualiPrEP Study).

Pre-exposure prophylaxis (PrEP) for HIV has been available in France since 2014, and reimbursed since 2016, with general practitioners allowed to prescribe it since 2021. Despite these policy advances, uptake remains low among some of the most affected populations. This community-based qualitative study explored barriers to PrEP access and retention ten years into its implementation.Interviews were conducted with 28 PrEP frontline actors (healthcare professionals and community-based workers involved in promoting, prescribing, or supporting PrEP). The sample included one group discussion (n = 5), two triads (n = 6), two dyads (n = 4), and nine individual interviews (n = 13). Thematic analysis was inductive, with barriers classified across four main domains.Participants were mostly cisgender men, median age 48, born in France and abroad, and employed by NGOs in Paris. Thirteen barriers and four major themes emerged: (1) Internal psychosocial barriers: lack of knowledge, negative health-related reactions; HIV stigma; STI risk perception, taboos; (2) Internal pragmatic barriers: perceived limits of protection, usage and follow-up constraints; (3) External psychosocial barriers: limited physician knowledge and reluctance; (4) External pragmatic barriers: communication failures; structural constraints, lack of human and financial resources.Findings call for more targeted messaging, simplified care models and provider training. They highlight the need to address social and symbolic dimensions of PrEP, with insights from those supporting users to ensure more equitable implementation.

Humans↗
PubMed2002

Health and safety hazards in Northwest agriculture: setting an occupational research agenda.

BACKGROUND: Agriculture is among the most hazardous occupations in the United States. Research can provide new insights about disease and injury and serve as the foundation for occupational health and safety policies. The determination of research priorities can be problematic. Public participation approaches offer opportunities to identify and integrate various perspectives. METHODS: The agenda process was modeled on the NIOSH National Occupational Research Agenda. Center staff contacted representatives of producer groups, labor, health care, academia, and public agencies to participate in telephone interviews and a daylong workshop. RESULTS: Twelve research priorities were identified: musculoskeletal disorders; respiratory disease; skin disease; traumatic injuries; chemical exposures; special populations at risk; social and economic foundations of workplace safety; risk communication barriers; diagnostic approaches; hazard control technology; intervention effectiveness; and surveillance research methods. CONCLUSIONS: The agenda process engaged stakeholders in priority setting. The resulting document is a useful guide for occupational safety and health in agriculture.

Accidents, Occupational↗
PubMed1993

"Learning to cope"--an intervention in cancer care.

As reported, cancer patients and their significant others need information to promote their understanding of events throughout the illness, and support to mobilize coping strategies when they consider the demands of the situation exceed their personal resources. It has, however, repeatedly been reported that communication barriers exist and that information does not always reach the target. In the present study the provision of information entered the field of education. An education and support program was developed, based on results from a learning-needs assessment. The program has now been evaluated. Cancer patients and their significant others (n = 127) participated in group sessions. After completion of the program, open interactive interviews organized around experiences of increased knowledge and understanding, and enhanced coping capacity related to participation in the program were conducted with the participants. The interviews were analyzed using the grounded theory approach. The findings indicate that supportive education, sensitively responsive to expressed needs and learning capability, has the power to promote proper understanding and facilitate coping efforts. Becoming familiar with facts and feeling reinforced confidence in evolving appropriate coping strategies for living with cancer.

Adaptation, Psychological↗
PubMed2005

Transcultural pediatrics: compliance and outcome of phenylketonuria patients from families with an immigration background.

Living in a foreign country with a different lifestyle and a different orientation is a many-faceted challenge for immigrants. A considerable percentage (30-50%) of patients with metabolic disease come from immigrant families from Turkey and the Middle East. Phenylketonuria is one example of metabolic disease in which severe mental retardation can be entirely prevented by early detection via newborn screening and consistent dietary treatment. We report 7 phenylketonuria patients from 3 Turkish families who had considerable difficulty in coping with the diagnosis and adherence to the diet. Blood phenylalanine levels beyond recommended limits and IQ values below average, clearly demonstrate the risks arising from language as well as psychological and cultural communication barriers, despite standardized follow-up care structures and the observance of continuity by medical caregivers. To propose a basis for systematic improvement in the care of patients from immigrant families we suggest that a) the services of professional interpreters be used in case of language barriers; b) social workers with appropriate sociocultural and language competence should accompany the family in a professional manner; c) it would be meaningful to introduce treatment contracts that clearly establish the limits of the client's rights and duties as well as those of the care-givers. From the viewpoint of legislation, providing medical information is duty of the hospital and the use of translator is mandatory with patients from foreign countries and with foreign languages.

Adolescent↗
PubMed1994

Facilitated communication: a response by child protection.

Using a new technology called facilitated communication, a 7-year-old autistic child reported that she had been sexually abused. Because this method of reporting was the first of its kind at Hennepin County's (Minneapolis) Child Protection Agency, steps were taken not only to understand facilitated communication, but also to assess the reliability of the child's report. This article includes a description of the client's complaint, the subsequent referral process that it provoked, and a background description of the client and family situation. It also describes the client's method of communication, including the assessment procedure that was devised to examine her communication production. The article ends with a summary of results from implementation of the assessment procedures, and a discussion of the limitations of these procedures. What is evident is that facilitated communication cannot be ignored.

Adolescent↗
PubMed2005

Communication interaction in ICU--Patient and staff experiences and perceptions.

Patients on intensive care units (ICU) have difficulty with communication [Menzel LK. Factors related to the emotional responses of intubated patients to being unable to speak. Heart Lung 1998; 27(4):245-52]. Feelings of anger and low mood have been reported, which can lead to reduced participation in rehabilitation. For members of the multidisciplinary team breakdown in communication with patients may be frustrating and related to a limited knowledge of strategies and resources to facilitate communication. The NHS Modernisation Agency Critical Care Programme (2002) identified speech and language therapists (SLTs) as having a role in the assessment and management of patients with communication difficulties on ICU. This multi-centre pilot study aimed to investigate staff and patient perceptions and experiences of communication within ICUs. A short questionnaire was devised using semi-structured interviews to collect quantitative and qualitative information. Patterns were identified including insights into SLT service delivery and possible directions for future research and development.

Adaptation, Psychological↗