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Content of communication by pediatric residents after newborn genetic screening.

BACKGROUND: Newborn screening saves lives, but psychosocial complications after genetic screening have led to doubts about expanding programs. Because complications have been blamed on ineffective communication of results, a population-scale system to ensure communication quality may improve outcomes. The objective of this study was to develop and evaluate a method to assess the content of communication after newborn genetic screening. METHODS: We abstracted content data and calculated quantitative scores for 3 communication quality indicators (key content, early placement of good news, and excessive background content) for 59 transcribed conversations between pediatric residents and simulated parents of an "infant" who was found via newborn screening to carry either cystic fibrosis or sickle cell hemoglobinopathy. RESULTS: Only 8.5% of transcripts contained the key content items that were thought to be necessary for parental understanding; 27.1% included reassuring news about carrier status within the first 10% of content. Scores for 3 quality indicators fell in the low performance range in 35.6%, 30.5%, and 27.1% of transcripts, respectively. The most common topic was background about the disease (22% of content statements) even though the infant did not have the disease. Surprisingly, 50% of sickle trait transcripts included counseling about a possible risk for sudden death. CONCLUSIONS: Assessment of the content domain of communication quality identified some high-quality communication interspersed with many missed opportunities. If integrated into newborn screening, our method may help to alleviate some of society's ethical concerns about benefit and risk after newborn and other genetic screening.

Adult↗

[On the epidemiological situation in quarantine, natural focal and other infections on the territory of the Southern Federal District].

The data on the sanitary and epidemiological situation in the Southern Federal District are presented. The analysis of morbidity in tuberculosis, measles, HIV infection, viral hepatitis A, typhoid fever, cholera and quarantine infections, Crimean hemorrhagic fever, West Nile fever, rabies, malaria has been carried out. Special attention has been given to "new and newly returning infections", and among them to the spread of SARS ("atypical pneumonia"). The role of regional epidemiological safety programs, in particular such program as "The prophylaxis of quarantine and natural focal infections and the sanitary protection of the territory of the Southern Federal District of the Russian Federation from the import and spread infectious diseases in 2003-2005", has been substantiated.

Animals↗

Teaching communication skills. An essential part of residency training.

OBJECTIVE: To design a structured curriculum concerning issues of communication with patients and families for use during training of pediatric residents. BACKGROUND: The stimulus for this initiative arose from residents perceived need for such a program and the realization that a structured approach to communication techniques did not currently exist in our residency and, in fact, in many undergraduate and graduate medical education curricula. METHODS: Our program was designed to address complex and difficult areas in physician-patient interaction, including how to deliver "bad news," deal with hostile parents, and speak to children about serious illness; the psychosocial aspects of death and dying were also covered in the program. Various teaching techniques were used. We attempted to assess residents' response and alteration in behavior consequent to the program. RESULTS: The program was successfully incorporated into the training of our residents and was carried out by using existent personnel; minimal expense was incurred. The residents thought the course was valuable and effective, although no statistically significant change in the communication skills of residents could be demonstrated. CONCLUSIONS: The area of physician-patient communication can be taught in a structured fashion during residency. Programs should be devised to meet the changing needs of training during residency and should incorporate the unique strengths of individual institutions.

Adult↗

The impact of mass communication campaigns in the health field.

This article analyzes a series of health education projects that used the mass media to change behavior. First, the article describes how persuasion theories are used to maximize impact in mass communication campaigns. Second, this paper discusses theories of social psychology used in such campaigns. One such theory, cognitive dissonance, explains changes at the level of attitudes, beliefs and opinion. Another theory, social learning, defines strategies of behavior changes. A third theory, concerning diffusion of innovations, helps understand the network of interpersonal relationships essential for the adoption of any innovation. McGuire's inoculation theory suggests strategies to aid resistance to harmful environmental influences (e.g. smoking, excessive drinking, etc.). Third, this work reviews public health campaigns that have used one or more of these theories of social psychology. The first project, dealing with smoking behavior cessation and prevention, mainly used strategies of interpersonal communication for inoculating and modeling useful behavior in order to resist social pressures favorable to smoking. The second project, designed to prevent alcoholism, used the mass media primarily. The objective of this campaign was to obtain changes in knowledge, attitude and behavior in the public through modeling desirable behaviors over public service announcements. The third campaign, a heart disease prevention program, used a combination of mass media and interpersonal communication to achieve changes in lifestyle of the population. Finally, this article describes limitations in using mass media in behavior change health programs.

Attitude↗

September 11, 2001. A CEO's story.

On the day of the terrorist attacks on New York's World Trade Center, 1,779 employees of Marsh & McLennan Companies had office space in the twin towers, and another 129 were visiting that day. From his office at MMC headquarters in midtown, CEO Jeffrey Greenberg watched in horror as the second plane hit. By the time the towers fell, he had gathered a team of his colleagues to begin to outline how the company would respond. In this first-person account, Greenberg relates what it was like to manage through the unimaginable. The needs of MMC's people, and the families of employees who perished, took top priority. In the midst of chaos and unforeseeable problems, Greenberg and his colleagues improvised ways of communicating and assembled a broad-based program of support. Help appeared from all sides, from people of various ranks, titles, and functional expertise within MMC as well as past chairmen, outside directors, and retired executives. An emergency communications center was immediately set up at MMC headquarters and became a centralized location for messages and information and a memorial to colleagues lost in the attacks. The company arranged for grief counselors and established a family assistance center and a Family Relationship Management Program for those who had lost MMC employees. It has also provided families with access to long-term psychological and financial counseling. At the same time, Greenberg offers lessons about leadership, company culture, and adaptability. He and his colleagues held responsibility for a business beset by operational destruction and financial losses and facing dramatically changed market conditions. Their resolve was not simply to keep it on course but to come back stronger than ever.

Administrative Personnel↗

Sexual communication skills in residency training: the Robert Wood Johnson model.

Few medical schools or residency programs offer adequate training in sexual medicine. Using the experience gained in our long-standing program in human sexuality for medical students, we have pilot tested a half-day intensive workshop curriculum for residents that focuses on sexual communication skills and management of sexual problems. Unlike our medical school program, this residency course was offered on an elective, one-day basis. The current report describes the successful implementation of our pilot program with 46 medical residents from subspecialty and primary care residency programs. Before the workshop, 22 (48%) residents indicated that they were uncomfortable with open discussion of sexual issues and would not feel comfortable in addressing the topic with their patients. A number of factors were identified as barriers to communication, including lack of time, inadequate training, and personal discomfort. After the workshop, the participants rated themselves as more comfortable with the topic and as more likely to address sexual issues with their patients. The participants evaluated the workshop positively overall and responded well to the interactive format and audience-response components. Most of the participants showed interest and willingness to participate in further training in sexual medicine skills. Our program offers a model for training of residents in communication skills and management of sexual problems. The difficulties in implementation and overcoming institutional barriers to curriculum reform are addressed.

Curriculum↗

[Malaria research for developing countries: the PAL+ program].

Despite extensive national and international intervention, little progress has been made in controlling, malaria and other communicable diseases afflicting many developing countries in the world. In response to the need to pursue and enhance investigation, the French Ministry of Research launched the PAL+ program in 1999 with the purpose of promoting concerted "research on malaria and other communicable diseases afflicting developing countries". The program is focused on developing methods of prevention and treatment for countries in Sub-Saharan Africa, Southeast Asia, and Latin America. Advancement of these scientific goals is further by a determined efforts (i) to provide means for national coordination and scientific organization of malaria research in France and (ii) to revive the spirit and mechanisms that characterized previous operations of cooperation between France and countries in the southern hemisphere. This new vision of cooperation is based on two organizational approaches. The first involves integrated programs in which training and transfer of knowledge are essential. The second involves joint projects in which networks maintained by a continuous exchange in operational seminars contribute to establishing a permanent dialogue between the North and South. Priority research areas have been encouraged to respond to specific public health issues with emphasis on establishing a balance between work in the field and development of knowledge. The priority areas include (i) responding to the increasing incidence of drug resistance by identifying of new antimalarial drugs and defining new therapeutic strategies; (ii) understanding the implications of the pathophysiology and physiopathology mechanisms underlying severe malaria manifestations for development of a malaria vaccine; (iii) finding new opportunities for prevention of malaria based on more effective vector control; (iv) using social anthropology to factor population behaviour and habits into the design of effective malaria control measures. The PAL+ program was founded on a commitment to provide participating countries with the means necessary to improve their research capability and to coordinate and structure scientific research by creating enduring partnerships between investigators in France and southern hemisphere countries. For this purpose the PAL+ workshop program involving regular encounters between northern and southern hemisphere researchers has been set up to encourage discussion, interaction, and multidisciplinary projects. The exceptionally instructive impact of these workshops has proven to be an essential element in the overall PAL+ program that has greatly stimulated malaria research. This program has been successful in creating a new spirit of intervention and has provided a rarely equalled vehicle for collaboration. By bringing the whole research community together over the major research programs now under way in the North/South networks, the PAL+ program represents a new and decisive step in achieving the long-sought goal of meaningful scientific cooperation between northern and southern hemisphere countries in the domain of public health.

Antimalarials↗

Maintenance of a smoking cessation program in public health clinics beyond the experimental evaluation period.

OBJECTIVES: As phase 3 of a study to evaluate a smoking cessation program in public health practice, the authors assess the maintenance and impact of the It's Time smoking cessation program in seven public maternal and child health clinics in Chicago. METHODS: The authors interviewed 404 clinic patients in the study's baseline phase (prior to introduction of the It's Time intervention program), and 610 in the program maintenance phase (in the year after experimental evaluation had ended) to assess exposure to smoking cessation interventions offered at the clinic, and smoking cessation outcomes (quit, actions toward quitting, scores on action, motivation, readiness, and confidence scales). The authors controlled for clustering of smokers within clinics, smokers' characteristics prior to clinic visit, and type of clinic service. They compared outcomes by study group (control or intervention) to which each clinic had been assigned in the earlier experimental phase. RESULTS: Compared to baseline, smokers in the maintenance phase had greater exposure to posters, provider advice and booklet, and better outcomes on seven of eight smoking cessation measures, including quitting. These improvements were larger for clinics with prior experience implementing It's Time. CONCLUSION: Participation in the experimental evaluation of the It's Time program prepared and possibly motivated the clinics to continue the program. Continuing the program resulted in greater delivery of interventions and improved smoking cessation outcomes for smokers in the clinics.

Adult↗

Improving clinical communication through structured conversation.

Communication failure plays an important role in causing medical errors. Clinical communication is highly complex and prone to error especially during transitions of patient care and emergent situations. Standardized approaches and tools may provide potential solutions to improve the quality of communication and prevent subsequent patient harm. The National Patient Safety Foundation, through its Stand Up for Patient Safety Program, is committed to assisting organizations improve clinical communication.

Clinical Competence↗

A cross-cultural survey of residents' perceived barriers in questioning/challenging authority.

OBJECTIVES: To identify perceived barriers to residents' questioning or challenging their seniors, to determine how these barriers affect decisions, and to assess how these barriers differ across cultures. METHOD: A written questionnaire was administered to residents in teaching hospitals in the US and Japan to assess factors affecting residents' willingness to question or challenge their superiors. The responses were analyzed for statistical significance of differences between the two cultures and to determine the importance of issues affecting decisions. RESULTS: Questionnaires were completed by 175 US and 65 Japanese residents, with an overall response rate of 71%. Trainees from both countries believe that questioning and challenging contribute to safety. The perceived importance of specific beliefs about the workplace differed across cultures in seven out of 22 questions. Residents' decisions to make a challenge were related to the relationships and perceived response of the superiors. There was no statistical difference between the US and Japanese residents in terms of the threshold for challenging their seniors. CONCLUSION: We have identified attributes of residents' beliefs of communication, including several cross-cultural differences in the importance of values and issues affecting one's decision to question or challenge. In contrast, there was no difference in the threshold for challenging seniors by the Japanese and US residents studied. Changes in organizational and professional culture may be as important, if not more so, than national culture to encourage "speaking up". Residents should be encouraged to overcome barriers to challenging, and training programs should foster improved relationships and communication between trainers and trainees.

Attitude of Health Personnel↗

Opportunities in preparing global leaders in nursing.

During the past decade, there has been a large increase in the number of international nurses pursuing doctoral education in the United States. The influx of these nurses has ramifications for the institutional systems providing education as well as on international and American nursing students. To begin understanding the issues presented by international doctoral nursing education, a survey of U.S. schools of nursing as well as a focus group of currently enrolled international doctoral students was conducted. The survey revealed that both international students and nursing programs experience challenges with regard to language, communication, financing, and support systems. More specifically, information gathered from the focus group identified issues regarding (1) lack of familiarity with the U.S. health care system, (2) lack of previous experience with the seminar format used in doctoral programs, (3) restricted opportunities to participate in faculty research, and (4) stress from a heavy course load to finish the program within a very short time period. Universally, the surveys and focus group lauded the positive global perspective imbued on all students and faculties via the international connection. Nonetheless, schools of nursing need to identify more effective strategies to aid international students in their development as successful global leaders. Meleis's framework for culturally competent scholarship is offered as a guide for schools of nursing.

Communication Barriers↗

Continuing education needs of biomedical communicators.

Many authors speak of the need for health care professionals to attend continuing education workshops. This study sought to identify the continuing education topics and program characteristics preferred by alumni of the Biomedical Communications Division in the School of Allied Medical Professions at The Ohio State University (OSU). Results indicate a preference for topics which do not review material constituting the basic biomedical communications curriculum. Although the sample population was small and the author is aware of the problems associated with generalizing from the data, the data were helpful in planning continuing education workshops.

Biotechnology↗

Depression in children and adolescents: linking risk research and prevention.

The National Institute of Mental Health has called for translational research linking basic knowledge about vulnerabilities that underlie mood disorders to the development of effective preventive interventions. This paper highlights research about risk factors for depression in children and adolescents and links it to current knowledge about interventions aimed at preventing depression in youth. Basic epidemiologic and clinical research indicates that increased risk for depression is associated with being female; a family history of depression, particularly in a parent; subclinical depressive symptoms; anxiety; stressful life events; neurobiological dysregulation; temperament/personality (e.g., neuroticism); negative cognitions; problems in self-regulation and coping; and interpersonal dysfunction. These vulnerabilities both increase individuals' chances of encountering stress and decrease their ability to deal with the stress once it occurs. Although several existing depression-prevention studies have targeted one or more of these risk factors, the efficacy of these various prevention programs for youth with different combinations of these risk factors needs to be investigated further. Most existing depression-prevention programs in youth have used cognitive-behavioral techniques, with some success. Other depression-prevention strategies have included training in coping, social problem solving, social skills, communication skills, and parenting. A comprehensive prevention program is recommended that includes multiple intervention components, each of which addresses risk and protective factors across different domains and levels of analysis.

Adolescent↗

Spatial perspective taking and referential communication skills in the elderly: a training study.

A training program was designed to test the hypothesis that social interaction or, more specifically, the experience of taking the role of another in social problem solving situations and communicative activities would facilitate elderly adults' spatial perspective taking and referential communication skills. The extent to which such social interaction and role taking practice reduced measured spatial and communicative egocentrism was examined by comparing the performances of 36 elderly participants across three conditions: Training, Placebo and Control. The results provided strong support for this hypothesis and were discussed in terms of their implications for socio-ecological context explanations.

Aged↗

Disaster drills and continuous medical education using satellite-based Internet.

We designed and evaluated a satellite-based Internet system for use in medical applications. Many experimental telemedicine projects use satellites, but we combined digital satellite communication with an ordinary telephone network to realize an economical countrywide network for emergency medicine and continuous medical education. The system appears to be a useful and practical technology for daily clinical activities.

Disaster Planning↗

A declarative implementation of the DICOM-3 network protocol.

We describe a new design for programs using the Digital Imaging and Communications in Medicine (DICOM) protocol, which we have implemented in a DICOM image storage server and a radiation treatment plan transfer facility for our locally developed radiation treatment planning system, Prism. This design is declarative, representing DICOM as a language for describing messages and sequencing of messages. The coding involved implementing an interpreter for this language. The DICOM protocol specifies messages, message formats, and sequencing. In our design, the specification translates almost directly into computer-readable declarative expressions that closely resemble the relevant tabulated DICOM specifications. The resulting programs are small, simple, and extensible, because most of the details of the DICOM protocol are not coded in the procedural control statements but are in the expressions and state table that the interpreter uses to perform all its functions. This approach provides a way to validate the consistency of a specification and the correctness of the implementation. The same method can be generalized to other such protocols. It may also be used to assist the design of new protocols.

Algorithms↗