Hospitals do not inform GPs about medication that should be monitored.
(73/4618)
BACKGROUND: General practitioners are now asked to prescribe drugs that, due to possible risks and side effects, had previously been prescribed almost exclusively at hospital. OBJECTIVE: To assess the quality of hospital letters as the key communication between hospitals and GPs. METHOD: Hospital letters examined using a predetermined protocol. RESULTS: Of 224 patients identified who were taking drugs that required regular monitoring, 173 were commenced in hospital. Fewer than one in five (30; 17%) hospital letters indicated that there was a risk associated with the drug or that it should be routinely monitored. Monitoring frequency was identified on only 14 occasions and the majority of letters (129; 74. 6%) did not state who was to be responsible for ongoing monitoring (either GP or hospital). Information was slow to arrive at the practice and, in 12% of cases, the hospital letter had not arrived within 14 days of commencement of medication. CONCLUSION: The information provided in hospital letters is insufficient to allow GPs to put structures in place to monitor drug therapy. (+info)
Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes.
(74/4618)
OBJECTIVE: Self-monitoring of blood glucose (SMBG) is a cornerstone of diabetes care, but little is known about barriers to this self-care practice. RESEARCH DESIGN AND METHODS: This cross-sectional study examines SMBG practice patterns and barriers in 44,181 adults with pharmacologically treated diabetes from the Kaiser Permanente Northern California Region who responded to a health survey (83% response rate). The primary outcome is self-reported frequency of SMBG. RESULTS: Although most patients reported some level of SMBG monitoring, 60% of those with type 1 diabetes and 67% of those with type 2 diabetes reported practicing SMBG less frequently than recommended by the American Diabetes Association (three to four times daily for type 1 diabetes, and once daily for type 2 diabetes treated pharmacologically). Significant independent predictors of nonadherent practice of SMBG included longer time since diagnosis, less intensive therapy, male sex, age, belonging to an ethnic minority, having a lower education and neighborhood income, difficulty communicating in English, higher out-of-pocket costs for glucometer strips (especially for subjects with lower incomes), smoking, and excessive alcohol consumption. CONCLUSIONS: Considerable gaps persist between actual and recommended SMBG practices in this large managed care organization. A somewhat reduced SMBG frequency in subjects with linguistic barriers, some ethnic minorities, and subjects with lower education levels suggests the potential for targeted, culturally sensitive, multilingual health education. The somewhat lower frequency of SMBG among subjects paying higher out-of-pocket expenditures for strips suggests that removal of financial barriers by providing more comprehensive coverage for these costs may enhance adherence to recommendations for SMBG. (+info)
The clinical significance of the digital patient record.
(75/4618)
BACKGROUND: Computer technology has revolutionized the way the world does business, allowing us to work faster, smarter and more efficiently than ever before. Computers first made their way into the dental office in the late 1960s as an accounts receivable device. Today, we can digitize anything and recall it in the operatory with the patient. CLINICAL IMPLICATIONS: This article discusses new trends in the digital patient record and the benefits this technology provides to the dental team in terms of improved data collection and recording. It also discusses the benefits a digital patient record provides to patients, as well as how to communicate patients' oral health needs using these electronic tools. (+info)
Everyday pain responses in children with and without developmental delays.
(76/4618)
OBJECTIVE: To examine whether children with developmental delays respond to painful events differently than nondelayed children. METHODS: Sixty families participated. Children between the ages of 2 and 6 years were observed at daycare centers while engaged in usual daily activities, such as free play. Spontaneous painful incidents and the child's responses were recorded using an observational measure (Dalhousie Everyday Pain Scale) designed to capture pain behavior. RESULTS: Children with developmental delays (n = 24) displayed a less intense distress response to an equivocal pain event than nondelayed children (n = 36). Children with developmental delays were more likely to display no reaction following a pain event, whereas children without delays cried more often. Further, children with developmental delays engaged in fewer help-seeking behaviors and were less likely to display a social response following a pain event than nondelayed children. CONCLUSIONS: Children with developmental delays appear to react in a different manner to pain events than nondelayed children do; we discuss a possible socio-communicative deficit. (+info)
Future prevention and handling of environmental accidents.
(77/4618)
According to the 1995 World Disaster Report, accidents are second only to floods in frequency. Chemical accidents leading to a serious danger to the general public and to the environment rank 10th, just after epidemics and followed by landslides. Can the occurrence of these environmental accidents be reduced in the future and their consequences minimized? The answer is yes, provided that decisions are made and actions implemented now. Future management of environmental accidents requires that the same effort so far devoted to relief measures in the postimpact phase be devoted to advance planning in the preaccident period. International cooperation should be activated to predispose risk reduction measures, including a hazard-oriented approach to prevention, preparedness plans for possible incidents in major hazardous installations, and collaborative programs and resource sharing for response to accidents and the follow-up of their consequences. Clear and unequivocal communication with the public, with other professionals, decision makers, and the media play a key role in each step. (+info)
Consultation skills of medical students before and after changes in curriculum.
(78/4618)
The University of Manchester Medical School has adopted problem-based learning as its main educational method, with a change of emphasis from a biomedical to a biopsychosocial approach. The training of junior medical students in clinical interviewing is intended to reinforce and develop their interpersonal skills. We measured the impact of this new curriculum by assessing two intakes of students covering the period before and after its introduction; a third intake was later added to examine the effect of further curriculum adjustments. 86 students, randomly selected, were videorecorded conducting diagnostic interviews with standardized patients 10 weeks after they had started to learn clinical interviewing. Two instruments were developed--a 23-item communication skills scale and a 13-item information-gathering scale and both showed acceptable inter-rater and test-retest reliability. Communication skills did not differ between years. The total score for information-gathering fell by 13% (95% confidence interval -20 to -6%, P < 0.001) in the first year after introduction of the new educational approach but returned to baseline the following year after further modification of the course. Although the new approach yielded no measurable improvement in the process of communication, assessment 10 weeks after the start of interview training may be too early to permit definitive conclusions. We conclude that it is possible to change to a more patient-centred emphasis in teaching medical interviewing. Some initial loss of information content was rectified by adjustment of the course. Our unfavourable early experience highlights the need to evaluate educational change. (+info)
The impact of risk communication depends upon a complex interaction between the characteristics of the audience, the source of the message, and its content. Audience perception of risk is influenced by demographic factors (e.g. age, gender), personality profile, past experience, and ideological orientation. It is also affected by cognitive biases (e.g. unrealistic optimism) and lay 'mental models' of the hazard. For food hazards, the important dimensions of risk are controllability, novelty and naturalness. The source must be trusted for a risk message to be effective. Trust is associated with believing the source is expert, unbiased, disinterested, and not sensationalising. To maximise impact, risk communications must have a content which triggers attention, achieves comprehension and can influence decision-making. It must be unambiguous, definitive and easily interpretable--rarely achievable particularly when risk is shrouded in scientific uncertainty. Risk messages initiate social processes of amplification and attenuation, consequently their ramifications are rarely controllable. (+info)
Effects of continuous and intermittent reinforcement for problem behavior during functional communication training.
(80/4618)
We evaluated the effectiveness of functional communication training (FCT) in reducing problem behavior and in strengthening alternative behavior when FCT was implemented without extinction. Following the completion of functional analyses in which social-positive reinforcement was identified as the maintaining variable for 5 participants' self-injurious behavior (SIB) and aggression, the participants were first exposed to FCT in which both problem behavior and alternative behavior were reinforced continuously (i.e., on fixed-ratio [FR] 1 schedules). During subsequent FCT conditions, the schedule of reinforcement for problem behavior was made more intermittent (e.g., FR 2, FR 3, FR 5, etc.), whereas alternative behavior was always reinforced according to an FR 1 schedule. Results showed that 1 participant's problem behavior decreased and alternative behavior increased during FCT when both behaviors were reinforced on FR 1 schedules. The remaining 4 participants shifted response allocation from problem to alternative behavior as the schedule of reinforcement for problem behavior became more intermittent. These results suggest that individuals might acquire alternative responses during FCT in spite of inconsistencies in the application of extinction, although even small errors in reinforcement may compromise treatment effects. (+info)