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Better Communication (good + communication)
Terms modified by Better Communication Selected AbstractsPublic Health Nurses and the delivery of quality nursing care in the communityJOURNAL OF CLINICAL NURSING, Issue 10 2008DipHE, Trish Markham MSc (Hons) Aim., The aim of the study was to explore factors which impact on quality nursing care in the community from the Public Health Nurse's (PHN) perspective. Background., Public Health Nursing has significantly evolved over the past few years with the delivery of quality nursing being a focus point. This study explores factors that impact upon the delivery of quality care in Public Health Nursing in Ireland. The findings provide an opportunity for an additional perspective to be included in the existing international findings and act as a starting point from which further research can be built. Method., A qualitative method using semi-structured interviews were conducted. Interviews were taped and content analysed. Findings., Four main categories emefrged from the data, namely role change, components of quality nursing care, barriers to quality nursing care and the factors that facilitate the delivery of quality nursing care in the community. PHNs strive for evidence-based practice; they acknowledged their inability to achieve this and referred to factors that inhibited them from reaching their goal. Conclusion., Enhanced education for PHNs will equip them in the delivery of a quality service and have a positive impact on patient care. Better communication is required between PHNs, line managers and the multidisciplinary team. The delivery of community services need to be reviewed and developed further in accordance with the health strategy policy. Relevance to clinical practice., This study has identified the evolution in clinical practice associated with the changing role and scope of Public Health Nursing. Clinical practice has evolved over time to incorporate societal change, technological advances and the delivery of an evidence-based service responsive to identified need. This study identified the presence of an increase in the specialist clinical work being undertaken as a result of new technological advances entering the community working environment. [source] MD prescribes frameworks for productive interaction: Better communication for better care: Mastering physician-administrator collaboration.JOURNAL OF HEALTHCARE RISK MANAGEMENT, Issue 3 2006FACS (with chapter co-authors) Publisher: Health Administration Press; 78 pages; $3, Kenneth H. Cohn No abstract is available for this article. [source] Pregnancy and the maintenance of self-identity: implications for antenatal care in the communityHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2000BA (Hons) PhD Sarah Earle Abstract It is widely acknowledged that many women prefer to receive their antenatal care in the community. This paper explores one explanation for why this may be the case. The paper is based on a qualitative study of 19 primagravidae, aged between 16 and 30 years, who were interviewed using the technique of repeated in-depth interviewing. The aim of the research was to explore the relationship between women's experiences of pregnancy and the maintenance of self-identity during this time. The research findings indicate that the relationship between the midwife and her antenatal patient can foster both a sense of similarity to others and a sense of personal uniqueness, which appear essential to the maintenance of self-identity during pregnancy. Good communication seems to be an essential tool for the community midwife, as it allows patients to normalise their experiences and yet feel that their experiences of pregnancy are unique. The findings indicate that continuity of care may be important in fostering a sense of similarity to others and that continuity of carer may be required to ensure uniqueness. [source] Clinical teaching: maintaining an educational role for doctors in the new health care environmentMEDICAL EDUCATION, Issue 10 2000D Prideaux Context and objectives Good clinical teaching is central to medical education but there is concern about maintaining this in contemporary, pressured health care environments. This paper aims to demonstrate that good clinical practice is at the heart of good clinical teaching. Methods Seven roles are used as a framework for analysing good clinical teaching. The roles are medical expert, communicator, collaborator, manager, advocate, scholar and professional. Results The analysis of clinical teaching and clinical practice demonstrates that they are closely linked. As experts, clinical teachers are involved in research, information retrieval and sharing of knowledge or teaching. Good communication with trainees, patients and colleagues defines teaching excellence. Clinicians can ,teach' collaboration by acting as role models and by encouraging learners to understand the responsibilities of other health professionals. As managers, clinicians can apply their skills to the effective management of learning resources. Similarly skills as advocates at the individual, community and population level can be passed on in educational encounters. The clinicians' responsibilities as scholars are most readily applied to teaching activities. Clinicians have clear roles in taking scholarly approaches to their practice and demonstrating them to others. Conclusion Good clinical teaching is concerned with providing role models for good practice, making good practice visible and explaining it to trainees. This is the very basis of clinicians as professionals, the seventh role, and should be the foundation for the further development of clinicians as excellent clinical teachers. [source] Communication with Older Breast Cancer PatientsTHE BREAST JOURNAL, Issue 4 2007Ian S. Fentiman MD Abstract:, An increasing proportion of patients with breast cancer are aged above 70 at the time of diagnosis and yet this particular age group has been underserved in terms of clinical research. Good communication between a doctor and a patient implies giving the advice and treatment most appropriate to that particular individual's needs, based upon their health and the tumor characteristics in the framework of their experience and belief system. Doctors need to be able to pick up both verbal and nonverbal cues and whenever possible to place the needs of the patient rather than her relatives as paramount. Consultations may be blighted at the onset by delays, unsympathetic staff, and patronizing doctors. Many older patients will wish to avoid mastectomy and for those with hormonally sensitive tumors wide excision and tamoxifen without axillary clearance or breast irradiation may provide a safe option. Undertreatment of those with hormonally insensitive cancer may lead to an increased risk of recurrence and premature death from breast cancer. Although there is an increasing realization of the need for clinical studies in older patients this group are grossly under-represented in trial portfolios [source] Teaching Culturally Appropriate Care: A Review of Educational Models and MethodsACADEMIC EMERGENCY MEDICINE, Issue 12 2006Cherri Hobgood MD Abstract The disparities in health care and health outcomes between the majority population and cultural and racial minorities in the United States are a problem that likely is influenced by the lack of culturally competent care. Emergency medicine and other primary-care specialties remain on the front lines of this struggle because of the nature of their open-door practice. To provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community that is open to individuals' otherness, thus leading to better communication of ideas and information between patients and their health care providers. This article highlights the rationale for and current problems in teaching cultural competency and examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority patients' clinical outcomes remains insufficient. [source] Automation in an addiction treatment research clinic: Computerised contingency management, ecological momentary assessment and a protocol workflow systemDRUG AND ALCOHOL REVIEW, Issue 1 2009MASSOUD VAHABZADEH Abstract Introduction and Aims. A challenge in treatment research is the necessity of adhering to protocol and regulatory strictures while maintaining flexibility to meet patients' treatment needs and to accommodate variations among protocols. Another challenge is the acquisition of large amounts of data in an occasionally hectic environment, along with the provision of seamless methods for exporting, mining and querying the data. Design and Methods. We have automated several major functions of our outpatient treatment research clinic for studies in drug abuse and dependence. Here we describe three such specialised applications: the Automated Contingency Management (ACM) system for the delivery of behavioural interventions, the transactional electronic diary (TED) system for the management of behavioural assessments and the Protocol Workflow System (PWS) for computerised workflow automation and guidance of each participant's daily clinic activities. These modules are integrated into our larger information system to enable data sharing in real time among authorised staff. Results. ACM and the TED have each permitted us to conduct research that was not previously possible. In addition, the time to data analysis at the end of each study is substantially shorter. With the implementation of the PWS, we have been able to manage a research clinic with an 80 patient capacity, having an annual average of 18 000 patient visits and 7300 urine collections with a research staff of five. Finally, automated data management has considerably enhanced our ability to monitor and summarise participant safety data for research oversight. Discussion and Conclusions. When developed in consultation with end users, automation in treatment research clinics can enable more efficient operations, better communication among staff and expansions in research methods. [Vahabzadeh M, Lin J-L, Mezghanni M, Epstein DH, Preston KL. Automation in an addiction treatment research clinic: Computerised contingency management, ecological momentary assessment and a protocol workflow system. Drug Alcohol Rev 2009;28:3,11] [source] Market-Based Measures of Monetary Policy Expectations and Their Evolution Since the Introduction of the EuroECONOMIC NOTES, Issue 3 2009Fabio Filipozzi The paper considers the relation between monetary policy expectations and financial markets in the case of Europe. A number of money market instruments are compared, with the result that the 1-month forward interest rates extracted from the Libor yield curve has the best prediction power of the future monetary policy path. These forward rates have been used to study the evolution of market expectations regarding the monetary policy of the European Central Bank (ECB). The sharp increases and the following decreases in interest rates during 2000,2001 have reduced the predictive power of money market instruments, but smoother management of interest rates and better communication from the ECB has helped to improve the forecasting power of money market instruments. [source] Evaluating the impact of integrated health and social care teams on older people living in the communityHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2003Louise Brown CQSW BSc(Hons) MSc Abstract Although it is perceived wisdom that joint working must be beneficial, there is, even at this stage, little evidence to support that notion. The present study is an evaluation of two integrated co-located health and social care teams which were established in a rural county to meet the needs of older people and their carers. This study does identify that patients from the ,integrated teams' may self-refer more and are assessed more quickly. This might indicate that the ,one-stop shop' approach is having an impact on the process of service delivery. The findings also suggest that, in the integrated teams, the initial stages of the process of seeking help and being assessed for a service may have improved through better communication, understanding and exchange of information amongst different professional groups. However, the degree of ,integration' seen within these co-located health and social care teams does not appear to be sufficiently well developed to have had an impact upon the clinical outcomes for the patients/service users. It appears unlikely from the available evidence that measures such as co-location go far enough to produce changes in outcomes for older people. If the Department of Health wishes to see benefits in process progress to benefits to service users, then more major structural changes will be required. The process of changing organisational structures can be enhanced where there is evidence that such changes will produce better outcomes. At present, this evidence does not exist, although the present study does suggest that benefits might be forthcoming if greater integration can be achieved. Nevertheless, until the social services and National Health Service trusts develop more efficient and compatible information systems, it will be impossible to evaluate what impact any further steps towards integration might have on older people without significant external resources. [source] Informed choice and public health screening for children: the case of blood spot screeningHEALTH EXPECTATIONS, Issue 2 2005Katrina M. Hargreaves BA BA (Hons) PhD Abstract Objective, To examine parents' and health professionals' views on informed choice in newborn blood spot screening, and assess information and communication needs. Design and participants, A qualitative study involving semi-structured telephone interviews and focus groups with 47 parents of children who were either found to be affected or unaffected by the screened conditions, and 35 health professionals with differing roles in newborn blood spot screening programmes across the UK. Results and conclusions, Parents and health professionals recognize a tension between informed choice in newborn blood spot screening and public health screening for children. Some propose resolving this tension with more information and better communication, and some with rigorous dissent procedures. This paper argues that neither extensive parent information, nor a signed dissent model adequately address this tension. Instead, clear, brief and accurate parent information and effective communication between health professionals and parents, which take into account parents' information needs, are required, if informed choice and public health screening for children are to coexist successfully. [source] Receiving power through confirmation: the meaning of close relatives for people who have been critically illJOURNAL OF ADVANCED NURSING, Issue 6 2007Åsa Engström Abstract Title.,Receiving power through confirmation: the meaning of close relatives for people who have been critically ill Aim., This paper is a report of a study to elucidate the meaning of close relatives for people who have been critically ill and received care in an intensive care unit. Background., Falling critically ill can bring about a difficult change in life. In previous reports such events are described as frightening experiences, and close relatives are described as an important source of support in this difficult situation. Method., A purposive sample of 10 adults, eight men and two women, narrated how they experienced their close relatives during and after the time they were critically ill. The data were collected in 2004. The interview texts were transcribed and interpreted using a phenomenological hermeneutic approach influenced by the philosophy of Ricoeur. Findings., One major theme was identified, experiencing confirmation, with six sub-themes: receiving explanations; a feeling of being understood; a feeling of safety; gaining strength and will-power; having possibilities and realizing their value. Close relatives served as tools for the person who was ill, facilitating better communication and an increased ability to do various things. Simultaneously, feelings of dependence on the close relatives were expressed. There were descriptions of loneliness and fear in the absence of close relatives and, in order to feel safe, the participants wanted their close relatives to stay near them. Conclusion., Close relatives are vital, as they are the ill person's motivation to stay alive and to continue the struggle. Their presence is of great importance for the ill person and must be facilitated by staff. [source] What corporations need to know about how to install an integrated conflict management systemALTERNATIVES TO THE HIGH COST OF LITIGATION, Issue 6 2009Deborah A. Katz In the second of two parts, Deborah A. Katz, of the U.S. Transportation Security Administration, discusses how the agency's recent conflict management system development encourages better communication and operations. The focus this month is on adapting the system to other business settings. She is interviewed by New York conflict resolution consultant Judith Cohen. [source] Value creation by building an intraorganizational common frame of reference concerning project managementPROJECT MANAGEMENT JOURNAL, Issue 3 2009Pernille Eskerod Abstract In this article, we suggest that organizations should not focus on selecting between various project management approaches, tools, or behaviors. Instead, we claim that the real benefit from project management implementations comes from the mere creation of a common frame of reference. Based on four case studies, we identify elements that enhance such a common frame of reference: (1) a common project management model, (2) common project management training, (3) common project management examinations/certifications, and (4) activities for knowledge sharing. Values created, especially when the application of the elements was mandatory, were better communication, better customer satisfaction, and easier knowledge sharing. [source] Social constraints and spousal communication in lung cancerPSYCHO-ONCOLOGY, Issue 8 2006Hoda Badr Abstract The Social Cognitive Processing Model suggests that talking with others facilitates cognitive and emotional processing of experiences such as cancer if the social context in which these discussions take place is supportive and positive. Despite this, patients and spouses may inadvertently constrain each other's attempts to process and cope with the disease. To our knowledge, no previous studies have directly examined the effect of lung cancer on the spousal relationship. We began to examine this effect by identifying the social constraints experienced by couples coping with lung cancer through semi-structured interviews with 13 patients and 12 spouses. Using Grounded Theory methodology, our analyses showed that these couples experienced a wide variety of social constraints, including denial, avoidance, and conflict that can hinder open spousal communication. Specifically, patients and spouses reported trouble discussing continued tobacco use, cancer-related symptoms, prognosis, and the emotional effects of lung cancer on the spouse. Despite these constraints, participants who reported talking with their partners about their relationships reported fewer constraints and better communication about cancer. These findings highlight the importance of a relationship perspective in the study of lung cancer and provide information about how talking together about the spousal relationship may enable couples to minimize social constraints and enhance cognitive and emotional processing of the disease. Copyright © 2005 John Wiley & Sons, Ltd. [source] Phenological growth stages of cacao plants (Theobroma sp.): codification and description according to the BBCH scaleANNALS OF APPLIED BIOLOGY, Issue 1 2010N. Niemenak The detailed description of growth stages of useful plants followed by adequate codification facilitates communication between scientists and practicians if, for example, new findings of science have to be transferred to management procedures or if experiences made at one growing site have to be adapted to another. We describe the growth stages of the worldwide species of cacao trees (Theobroma sp.) to prepare the basis for production management, comparisons of epidemiological studies of disease, of growth patterns under different environmental factors and of genetically clone specific parameters. The codification follows the ,extended BBCH (BBCH, Biologische Bundesantalt, Bundessortenamt and CHemische Industrie, Germany) scale', a numerical system that differentiates between principal, secondary and tertiary growth stages. Each growth stage presented from seed germination to crown development and harvest is correlated with general management practices. This scale will be of great help to cacao growers and scientists around the world for better communication, more efficient planning of management practices and experiments. [source] Opening up Australian preschoolers' lunchboxesAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010Bridget Kelly Abstract Objective: Early childhood services have been identified as key settings for promoting healthy eating and obesity prevention. However, little is known about the obesity-related behaviours of preschool-aged children or food-related policies in these settings. The purpose of this study was to describe the contents of preschoolers' lunchboxes to inform future interventions. Methods: Cross-sectional survey of 259 children attending preschools in the Sydney West and Sydney South West regions of New South Wales in 2008. Lunchbox data were collected using a purpose-designed audit tool. Food and beverages were classified as fruit, vegetables, dairy, breads and cereals, ,extra' (energy-dense) foods, ,extra' drinks or water. Results: Sandwiches and home-cooked meals were the most frequently identified food item, found in 92% of children's lunchboxes, followed by fresh fruit. However, 60% of lunchboxes contained more than one serve of extra food or drink. Conclusion: While nutrition guidelines allow one to two serves of extra foods per day for preschool-aged children, the majority of children appear to consume most of this allocation during their school day, potentially contributing to over-consumption of extra foods and excess kilojoule intake. Implications: Preschool food policies may help to guide the content of children's lunchboxes, however this study emphasises the need for better communication and enforcement of these policies, as well as broader public policy changes. [source] STAFF PERCEPTIONS OF CARE FOR DELIBERATE SELF-HARM PATIENTS IN RURAL WESTERN AUSTRALIA: A QUALITATIVE STUDYAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2002Janine Slaven ABSTRACT: Suicide has been a major community concern in Esperance, a geographically isolated port on the south coast of Western Australia. This study to explores the views of regional health staff on barriers to the effective management of deliberate self-harm (DSH) and ways in which those barriers could be addressed. Semi-structured interviews were tape-recorded, transcribed and subjected to qualitative content analysis. Interviewees included 77% of general practitioners (n = 7), 18% of nurses (n = 13) and 55% of mental health professionals (n = 5). The most important barrier was a lack of structure to treating DSH, resulting in deficiencies and inconsistencies in its management. Suggestions to improve the management of DSH included better communication between services, support for nurses in raising the issue of suicide, use of a simple risk assessment tool, the development of a nurse liaison position, and a multidisciplinary planning group. The higher rates of DSH and completed suicide in rural and remote regions compared with metropolitan areas make secondary prevention particularly important. [source] Staff Perceptions of Care for Deliberate Self-Harm Patients in Rural Western Australia: A Qualitative StudyAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2002Janine Slaven Abstract: Suicide has been a major community concern in Esperance, a geographically isolated port on the south coast of Western Australia. This study to explores the views of regional health staff on barriers to the effective management of deliberate self-harm (DSH) and ways in which those barriers could be addressed. Semi-structured interviews were tape-recorded, transcribed and subjected to qualitative content analysis. Interviewees included 77% of general practitioners (n = 7), 18% of nurses (n = 13) and 55% of mental health professionals (n = 5). The most important barrier was a lack of structure to treating DSH, resulting in deficiencies and inconsistencies in its management. Suggestions to improve the management of DSH included better communication between services, support for nurses in raising the issue of suicide, use of a simple risk assessment tool, the development of a nurse liaison position, and a multidisciplinary planning group. The higher rates of DSH and completed suicide in rural and remote regions compared with metropolitan areas make secondary prevention particularly important. [source] ORIGINAL ARTICLE: Pain in people with learning disabilities in residential settings , the need for changeBRITISH JOURNAL OF LEARNING DISABILITIES, Issue 3 2010Monica Beacroft Accessible summary ,,Pain is not recognised and managed well for people with learning disabilities in residential settings , People with learning disabilities are not getting timely and appropriate ,as required' medication for their pain. ,,Staff do not use pain recognition tools or communication aids. ,,Some staff still believe that people with learning disabilities have a higher pain threshold than people without a learning disability. They also let this belief affect how they manage pain. ,,This research matters to people with learning disabilities. It is important that staff and carers recognise and manage pain well. We have developed a pain training pack for staff and carers and leaflets for both people with learning disabilities and staff and carers. Summary This audit investigated residential staff beliefs around pain thresholds and strategies they adopt to recognise and manage pain in people with learning disabilities across Surrey. A structured interview was constructed to elicit information. Results demonstrated that pain is not being effectively recognised or managed by residential staff in Surrey. It highlighted the need for training for staff in how to recognise and manage pain, as well as the need for appropriate pain recognition tools and communication aids to be utilised to support people with learning disabilities to be able to communicate their pain to others. It also indicated the need for better communication between staff and other services that the person with learning disabilities accesses. [source] How can domestic households become part of the solution to England's recycling problems?BUSINESS STRATEGY AND THE ENVIRONMENT, Issue 2 2005Teresa Smallbone Abstract A waste disposal problem of looming proportions, coupled with a lack of sufficient public engagement in the preferred alternative to disposal, which is recycling, continues to perplex English policy-makers. Based on both a literature review across a wide range of disciplines and a national survey of consumer attitudes towards their own participation in recycling, this paper finds that past efforts at increasing recycling have been based on an implied model of consumer recycling behaviour that is not supported by what happens in practice. By disentangling thinking about recycling behaviour from academic thinking about green consumerism, the paper considers the waste and recycling problem from a different angle. It suggests that research on the personal values of people who recycle could be utilized in marketing communications that show these values being fulfilled by recycling. Focusing greater marketing attention on people who already claim to recycle, and helping them through better communication and improved practical help, could achieve much higher levels of reclaimed materials. Copyright © 2005 John Wiley & Sons, Ltd and ERP Environment. [source] Parental satisfaction with follow-up services for children with major anatomical congenital anomaliesCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2010M. Van Dijk Abstract Background Since 1999 a multidisciplinary follow-up programme for parents and children with major anatomical congenital anomalies is in place in our hospital, run by a dedicated team. The aim of the present study was to evaluate the services of this team from a parental perspective. Methods Parents completed a questionnaire including open and closed questions about satisfaction with the various professional disciplines involved in the follow-up, statements on usefulness of the follow-up services and suggestions for improvement. Results Four hundred and sixty-nine surveys were sent out, of which 71% were returned. Non-responding parents included significantly more parents of non-Dutch origin (P= 0.038) and parents who never responded to invitations for follow-up examinations (P < 0.001). Parental satisfaction differed for the various disciplines. Eighty per cent of the parents were (very) satisfied with the social worker, compared with 92% with nurses. More than half of the parents agreed that the follow-up services give peace of mind. Almost a quarter of parents, however, considered the follow-up services as redundant. The children of these parents had significantly shorter intensive care unit stay (P= 0.02), were older at the time of the questionnaire (P= 0.04), of higher socio-economic status (P= 0.001) and less likely to be of non-Dutch origin (P= 0.008). Sixty-one per cent of the parents had contacted the 24-h helpline. Ninety per cent of the parents were satisfied with the intensive care unit, almost 80% with the general ward. Conclusion Overall, parents were satisfied with the services of the follow-up team. Some parents, however, saw room for improvement related to better communication, recognizability of the team and better planning and organization. [source] The impact of pharmacy computerised clinical decision support on prescribing, clinical and patient outcomes: a systematic review of the literatureINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2010Jane Robertson Abstract Objectives Computerised clinical decision support systems (CDSSs) are being used increasingly to support evidence-based decision-making by health care professionals. This systematic review evaluated the impact of CDSSs targeting pharmacists on physician prescribing, clinical and patient outcomes. We compared the impact of CDSSs addressing safety concerns (drug interactions, contraindications, dose monitoring and adjustment) and those focusing on medicines use in line with guideline recommendations (hereafter referred to as Quality Use of Medicines, or QUM). We also examined the influence of clinical setting (institutional versus ambulatory care), system- or user-initiation of CDSS, prescribing versus clinical outcomes reported and use of multi-faceted versus single interventions on system effectiveness. Methods We searched Medline, Embase, CINAHL and PsycINFO (1990,2009) for methodologically adequate studies (experiments and strong quasi-experiments) comparing a CDSS with usual pharmacy care. Individual study results are reported as positive trends or statistically significant results in the direction of the intentions of the CDSS being tested. Studies are aggregated and compared as the proportions of studies showing the effectiveness of the CDSS on the majority (, 50%) of outcomes reported in the individual study. Key findings Of 21 eligible studies, 11 addressed safety and 10 QUM issues. CDSSs addressing safety issues were more effective than CDSSs focusing on QUM (10/11 versus 4/10 studies reporting statistically significant improvements in favour of CDSSs on , 50% of all outcomes reported; P= 0.01). A number of QUM studies noted the limited contact between pharmacists and physicians relating to QUM treatment recommendations. More studies demonstrated CDSS benefits on prescribing outcomes than clinical outcomes (10/10 versus 0/3 studies; P= 0.002). There were too few studies to assess the impact of system- versus user-initiated CDSS, the influence of setting or multi-faceted interventions on CDSS effectiveness. Conclusions Our study demonstrated greater effectiveness of safety-focused compared with QUM-focused CDSSs. Medicine safety issues are traditional areas of pharmacy activity. Without good communication between pharmacists and physicians, the full benefits of QUM-focused CDSSs may not be realised. Developments in pharmacy-based CDSSs need to consider these inter-professional relationships as well as computer-system enhancements. [source] Relatives in end-of-life care , part 1: a systematic review of the literature the five last years, January 1999,February 2004JOURNAL OF CLINICAL NURSING, Issue 9 2006Birgitta Andershed PhD Aim., To review systematically research conducted during the past five years focusing on the relatives' situation and needs in end-of-life care. Background and aim., That relatives make a large contribution in the care of the dying is well-known. In this situation, relatives often have to solve many new practical problems in the care as well as dealing with the sorrow of both themselves and the dying person. In recent years, palliative care has been developed in many countries and many new studies have been carried out. Methods., A systematic search of the literature was performed in the CINAHL and Medline databases. Of the 94 papers analysed, there were 59 qualitative and 35 quantitative studies with differing designs. The studies were carried out in 11 countries and were published in 34 different journals. Results., The results were categorized in two main themes with several subthemes: (1) being a close relative , the situation: (i) exposed position , new responsibility, (ii) balance between burden and capacity and (iii) positive values; (2) being a close relative , needs: (i) good patient care, (ii) being present, (iii) knowing and communicating and (iv) support from and trusting relationship with the professional. The relative's feelings of security and trust in the professional were found to be of great importance. Conclusion., More than twice as many studies had a descriptive/explorative design, which is of importance in the assessment of evidence. However, different studies complement one another and in summary, it can be said that analytic evidence is unequivocal: good patient care, communication, information and the attitude of the professional are of decisive importance regarding relatives' situation. These results are also in accord with earlier review studies. Relevance to clinical practice., Staff members have a great deal of responsibility for assuring that the patient feels as good as possible, facilitating relatives' involvement based on the family's wishes and limiting the stress and difficulties experienced by the family. The results showed that the relative's satisfaction could depend on the attitude of the professional as well as on good communication, good listening and good information. This can also be viewed as a prerequisite for the professional to get to know the family and to provide ,care in the light'. [source] Overall self-rated health: a new quality indicator for primary careJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007James E. Rohrer PhD Abstract Rationale, aims and objectives, Patient ,empowerment' gives patients choices about their own care and about the outcomes they would most prefer. Many patients can be presumed to regard overall self-rated health as an important outcome. Therefore, overall self-rated health can be considered a relevant and important outcome measure for a patient-centred medical clinic. The purpose of this study was to use this new outcome measure as a dependent variable and to test the hypothesis that patients who are confident about their ability to manage their health will have better health, in comparison to more dependent patients. Methods, We conducted a randomized cross-sectional postal survey of 500 veteran patients from the Panhandle of Texas and the surrounding areas; and 302 participated in the study. Multiple logistic regression analysis was used to test the hypothesis that health confidence is positively related to self-rated health, controlling for obesity, cigarette smoking and participation in recreational activities. Results, Veterans who strongly disagreed with the statement that they usually could overcome illnesses on their own were less likely to report good, very good or excellent self-rated health (adjusted odds ratio = 0.25). Conclusions, Overall self-rated health as measured by a single question proved to be significantly related to behavioural risk factors in this sample of primary care patients, attesting to its validity as an outcome indicator. Furthermore, health confidence was associated with better health. Most primary providers believe that they can, through good communication and providing self-care tools, increase healthy behaviours in their patients. If we are indeed able to increase health confidence in our patients, this study would suggest that self-rated health would improve. [source] Communication skills for behaviour change in dietetic consultationsJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 6 2009K. Whitehead Abstract Background:, Both the UK's National Health Service (NHS) and the National Institute of health and Clinical Excellence (NICE) have recommended increased training for health professionals in communication skills. There is evidence to suggest that communication skills are important in helping people to change health-related behaviour, which is a key role for dietitians. This study investigated the views of UK dietitians about their training needs and experience in relation to communication skills in dietetic practice. Methods:, In October 2007, a cross-sectional survey was mailed to all British Dietetic Association members (n = 6013). The survey gathered quantitative data and free-text comments to ascertain the level, type and effect of communication skills training received by dietitians at both the pre- and post-registration level. Results:, There were 1158 respondents; a response rate of 19.3%. Ninety-eight percent (n = 1117) rated communication skills as either very or extremely important in client consultations. Post-registration training had been undertaken by 73% (n = 904). Of these, over 90% of respondents perceived that post-registration training had led to improvements in their relationships with patients, their confidence in client interviews and their ability to cope with challenging clients. However, 248 (21.4%) felt time keeping in interviews had worsened. Lack of time for client interviews was also the most commonly identified barrier (19%, n = 216) to implementing the skills. Conclusions:, This study has explored an important and under-researched area. Respondents strongly endorsed the importance of good communication skills and the benefits of post-registration training in this area. Some felt that good communication was time consuming but others felt that time management had improved. Further research and training is required to support the implementation of these skills into dietetic practice. [source] Pain related to rotator cuff abnormalities: MRI findings without clinical significanceJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2010Jenny T. Bencardino MD Abstract MRI has become an important diagnostic tool in the evaluation of rotator cuff pathology and the technology continues to evolve. Direct MR arthrography, diagnosis-specific sequencing such as fat suppression, special positioning such as abducted externally rotated (ABER) views and ultra high field magnets allow for an unprecedented level of detail in imaging. In this article, we review MRI findings in patients with rotator cuff abnormalities that are anatomic variants or incidental findings. Although MRI findings may be diagnostic in some cases, we find that clinical correlation with history and physical examination is critical to differentiate between anatomic variants, incidental findings, and true pathology. We conclude that good communication between the orthopedic surgeon and the radiologist is necessary to optimize diagnostic yield. J. Magn. Reson. Imaging 2010;31:1286,1299. © 2010 Wiley-Liss, Inc. [source] Immunization myths and realities: Responding to arguments against immunizationJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2003CR MacIntyre Abstract: As vaccination programs continue to successfully control more and more infectious diseases, and the effects of these diseases become less visible, there has been increased focus on adverse events following immunization. Vaccines have been falsely implicated in the causation of a range of conditions, especially those which affect infants and young children, and whose aetiology is unknown, poorly understood or multifactorial. This paper explores some of the common immunization myths that clinicians may face. It is essential that health professionals have access to accurate information and are able to respond appropriately to parental concerns. This involves good communication; listening, empathy and tailoring advice to the specific concerns of the parent. Finally, health professionals need to provide consistent messages based on solid research evidence. [source] Beyond the "Model Minority" Stereotype: Trends in Health Risk Behaviors Among Asian/Pacific Islander High School StudentsJOURNAL OF SCHOOL HEALTH, Issue 8 2009Sung-Jae Lee PhD ABSTRACT BACKGROUND: Asian/Pacific Islander (API) students have been stereotyped as the "model minority." The objective of this study was to examine the trends in health risk behaviors among API students who participated in the San Diego City Schools Youth Risk Behavior Survey (YRBS) between 1993 and 2005. METHODS: High school students from the San Diego City School District completed the self-administered YRBS between 1993 and 2005. Among sexually active students, logistic regression for survey data was used to examine trends in health risk behaviors. RESULTS: From 1993 to 2005, condom use at last sexual intercourse was consistently lower among API students than their cross-ethnic peers. We observed a significant increasing trend in lifetime smoking, drinking, and marijuana use. Parental communications regarding human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) were significantly less frequent and decreased over time. CONCLUSIONS: Our findings challenge the notion of API youth being the "model minority." API students face unique challenges, including barriers to good communication about sex and lower rates of condom use. School-based prevention programs are needed for API students, including a focus on HIV communication with parents. [source] Latest news and product developmentsPRESCRIBER, Issue 5 2008Article first published online: 3 APR 200 Newer antidepressants no better than placebo? A new meta-analysis suggests that newer antidepressants are no superior to placebo in most patients with depression , the exception being those with very severe depression, who can expect a small benefit. Writing in the online-only open access journal PLoS Medicine (5:e45.doi:10.1371/ journal.pmed.0050045), researchers from Hull and the US analysed published and unpublished trials submitted to the Food and Drug Administration in marketing applications for fluoxetine, paroxetine, venlafaxine (Efexor) and nefazodone (no longer available). Using the Hamilton Rating Scale for Depression (HRSD) score as an endpoint, meta-analysis of 35 trials involving 5133 patients and lasting six to eight weeks showed that mean HRSD score improved by 9.6 points with drug treatment and 7.8 with placebo. The authors say the difference of 1.8 was statistically significant but below the criterion for clinical significance (3.0) set by NICE in its clinical guideline on depression. A review of the study by the NHS Knowledge Service (www.nhs.uk) points out that it omits trials published after the drugs were licensed (1999) and those not sponsored by the pharmaceutical industry. It did not include any patients with severe depression and only one trial in patients with moderate depression. An earlier US study of data submitted to the FDA (N Eng J Med 2008;358:25260) showed that published trials of antidepressants were more likely to be positive (37/38) than unpublished ones (3/25). Further, FDA analysts concluded that 51 per cent of trials (published and unpublished) demonstrated positive findings compared with 94 per cent of those that were published. Audit reveals variations in hospital psoriasis care There are unacceptably large variations in the quality of care for patients with psoriasis in UK hospitals, a report by the British Association of Dermatologists and the Royal College of Physicians reveals. The audit of 100 hospital units found that 39 per cent restricted access to biological therapies because of cost, and over one-third of pharmacies could not supply ,specials' such as topical coal tar preparations. More positively, the units are adequately resourced to provide timely communication with GPs. RCGP responds to Public Accounts Committee The Royal College of General Practitioners has agreed with the Commons Public Accounts Committee that drug package labelling should include the cost of the medication. The suggestion was made by the Committee in its report Prescribing Costs in Primary Care. While recognising the importance of generic prescribing, the RCGP cautions against frequent medication switches because it may unsettle patients. ,Any changes must be carried out for sound clinical reasons with good communication between GPs and their patients,' it adds. Statins for patients with kidney disease? Statins reduce cardiovascular risk in people with chronic kidney disease, a new study suggests, but their effects on renal function remain unclear (BMJ 2008; published online doi: 10.1136/bmj. 39472.580984.AE). The meta-analysis of 50 trials involving a total of 30 144 patients found that statins reduced lipids and cardiovascular events regardless of the severity of kidney disease. However, all-cause mortality was unaffected and, although proteinuria improved slightly, there was no change in the rate of decline of glomerular filtration rate. An accompanying editorial (BMJ 2008; published online doi:10.1136/ bmj.39483.665139.80) suggests that the indications for statin therapy to reduce cardiovascular risk in patients with chronic kidney disease should be the same as for those with normal renal function. New NICE guidance New clinical guidelines from NICE (see New from NICE, pages 14,15) include the diagnosis and management of irritable bowel syndrome in adults in primary care, the care and management of osteoarthritis in adults, and the diagnosis and treatment of prostate cancer. In a public health guideline on smoking cessation services, NICE endorses the use of nicotine replacement patches for 12,17 year olds. Suspect additives in children's medicines The Food Commission (www.foodcomm.org.uk) has drawn attention to the presence in children's medicines of food additives it says are linked with hyperactivity. The Commission, a national nonprofit organisation campaigning for ,the right to safe, wholesome food', says that seven common additives (including tartrazine, sodium benzoate and Ponceau 4R) are associated with hyperactivity in susceptible children. Checking the SPCs, it found that 28 of 70 children's medicines , including formulations of paracetamol, ibuprofen, amoxicillin, erythromycin and codeine phosphate throat linctus , contain at least one suspect additive. Digoxin may increase mortality in AF patients An observational study has suggested that digoxin may increase deaths in patients with atrial fibrillation (Heart 2008;94:191,6). The study was a planned subgroup analysis of a trial evaluating anticoagulant therapy in 7329 patients with atrial fibrillation. Of these, 53 per cent were treated with digoxin. Mortality was significantly higher among digoxin users than nonusers (4.22 vs 2.66 per cent per year); myocardial infarction and other vascular deaths (but not stroke, systemic embolic episodes and major bleeding events) were significantly more frequent with digoxin. Poor communications cause readmission Elderly hospital patients are often discharged with inadequate information or arrangements for care, causing almost three-quarters to be readmitted within a week, say investigators from Nottingham (Qual Safety Health Care 2008;17:71,5). Retrospective review of records for 108 consecutive patients aged over 75 found that readmission was related to medication in 38 per cent and, of these, 61 per cent were considered avoidable. Almost two-thirds had no discharge letter or were readmitted before the letter was typed; two-thirds of discharge letters had incomplete documentation of medication changes. Copyright © 2008 Wiley Interface Ltd [source] ALTERNATIVE CURRICULUM: The integration of an alternative curriculum: Skill ForceBRITISH JOURNAL OF SPECIAL EDUCATION, Issue 3 2009Lynne Rogers The introduction of alternative curricula in the UK for students in the secondary phase is one of a number of strategies designed to improve attendance at school, reduce exclusion and improve attainment. Skill Force is a charitable youth initiative that offers 14- to 16-year-old students a key skills based vocational alternative to the traditional curriculum. In this article, Lynne Rogers, Susan Hallam and Jacquelene Shaw of the Institute of Education, University of London, and Jasmine Rhamie of the University of Southampton set out to explore the views of Skill Force instructors and team leaders, school staff and Skill Force Regional Directors. These participants perceived the critical factors in the successful integration of Skill Force to be: effective introduction of the programme to pupils and parents; careful selection of students; clear introduction of the programme to staff; integrated discipline policies; strong support from senior management; good communication; and a willingness to resolve practical difficulties. [source] | ||||||||||||||||||||||||||||||||||