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Objective: To explore the experiences of parents of infants admitted to the neonatal intensive care unit towards interaction with healthcare professionals during their infants critical care.Design: Semi-structured interviews were conducted with parents of critically ill infants admitted to neonatal intensive care and prospectively enrolled in a study of communication in critical care decision making. Interviews were transcribed verbatim and uploaded into NVivo V.10 to manage and facilitate data analysis. Thematic analysis identified themes representing the data.Results: Nineteen interviews conducted with 14 families identified 4 themes: (1) initial impact of admission affecting transition into the neonatal unit; (2) impact of consistency of care, care givers and information giving; (3) impact of communication in facilitating or hindering parental autonomy, trust, parental expectations and interactions; (4) parental perception of respect and humane touches on the neonatal unit.Conclusion: Factors including the context of infant admission, interprofessional consistency, humane touches of staff and the transition into the culture of the neonatal unit are important issues for parents. These issues warrant further investigation to facilitate individualised family needs, attachment between parents and their baby and the professional team. [ABSTRACT FROM AUTHOR]

Research is of little use if its results are not effectively communicated. Data visualised in tables (and graphs) are key components in any scientific report, but their design leaves much to be desired. This article focuses on table design, following two general principles: clear vision and clear understanding. Clear vision is achieved by maximising the signal to noise ratio. In a table, the signal is the data in the form of numbers, and the noise is the support structure necessary to interpret the numbers. Clear understanding is achieved when the story in the data is told effectively, through organisation of the data and use of text. These principles are illustrated by original and improved tables from recent publications. Two special cases are discussed separately: tables produced by the pharmaceutical industry (in clinical study reports and reports to data safety monitoring boards), and study flow diagrams as proposed by the Consolidated Standards of Reporting Trials and Preferred Reporting Items for Systematic Reviews and Meta-Analyses initiatives. [ABSTRACT FROM AUTHOR]

Medical terms are a recognised problem in doctor–patient consultations. By contrast, the language difficulties of online healthcare documents are underestimated, even though patients are often encouraged to go to the internet for information. Literacy levels in the community vary, and for patients, carers and health workers with limited reading skills (including first- and second-language users of English), the language of web-based health documents may be challenging or impenetrable. Online delivery of health information is inherently problematic because it cannot provide two-way discussion; and amid the range of health documents on the web, the intended readership (whether general or specialist) is rarely indicated up front. In this research study, we focus on the language and readability of web-based cancer documents, using lexicostatistical methods to profile the vocabularies in two large test databases of breast cancer information, one consisting of material designed for health professionals, the other for the general public. They yielded significantly different word frequency rankings and keyness values, broadly correlating with their different readerships, that is, scientifically literate readers for the professional dataset, and non-specialist readers for the public dataset. The higher type/token ratio in the professional dataset confirms its greater lexical demands, with no concessions to the variable language and literacy skills among second-language health workers. Their language needs can, however, be addressed by a new online multilingual termbank of breast cancer vocabulary, HealthTermFinder, designed to sit alongside health documents on the internet, and provide postconsultation help for patients and carers at their point of need. [ABSTRACT FROM AUTHOR]

Introduction: Pneumonia is the leading cause of death from infection in children worldwide. Despite global treatment recommendations that call for children with pneumonia to receive amoxicillin dispersible tablets, only one-third of children with pneumonia receive any antibiotics and many do not complete the full course of treatment. Poor adherence to antibiotics may be driven in part by a lack of user-friendly treatment instructions.Objective: In order to optimise childhood pneumonia treatment adherence at the community level, we developed a user-friendly product presentation for caregivers and a job aid for healthcare providers (HCPs). This paper aims to document the development process and offers a model for future health communication tools.Methods: We employed an iterative design process that included document review, key stakeholder interviews, engagement with a graphic designer and pre-testing design concepts among target users in India and Kenya. The consolidated criteria for reporting qualitative research were used in the description of results.Results: Though resources for pneumonia treatment are available in some countries, their content is incomplete and inconsistent with global recommendations. Document review and stakeholder interviews provided the information necessary to convey to caregivers and recommendations for how to present this information. Target users in India and Kenya confirmed the need to support better treatment adherence, recommended specific modifications to design concepts and suggested the development of a companion job aid. There was a consensus among caregivers and HCPs that these tools would be helpful and improve adherence behaviours.Conclusions: The development of user-friendly instructions for medications for use in low-resource settings is a critically important but time-intensive and resource-intensive process that should involve engagement with target audiences. [ABSTRACT FROM AUTHOR]

Many families refuse to consent to donation from their deceased relatives or over-rule the consent given before death by the patient, but giving families more information about the potential recipients of organs could reduce refusal rates. In this paper, we analyse arguments for and against doing so, and conclude that this strategy should be attempted. While it would be impractical and possibly unethical to give details of actual potential recipients, generic, realistic information about the people who could benefit from organs should be provided to families before they make a decision about donation or attempt to over-rule it. [ABSTRACT FROM AUTHOR]

In the UK, medical ethics and law are often thought of and taught together, but while 'good medical ethics' is often reflected in law–the need to obtain a patient's adequately informed consent, for example--this is not necessarily the case. Sometimes medical ethics is more demanding than law; at other times, perhaps counterintuitively, the law appears to ask more of doctors than does good medical ethics. [ABSTRACT FROM AUTHOR]

In this article, the author describes his personal experience and efforts which provide evidence of the benefits of urging patients to email their physicians. Topics discussed include reasons doctor patient email use may be limited, recurring themes in emails from patients such as patients satisfaction with email and clarification of consultation. Also mentioned are the unresolved issues with email including data protection, patient confidentiality and recording of clinical activity.

Women recognise that labour represents a mind-altering event that may affect their ability to make and communicate decisions and choices. For this reason, birth plans and other pre-labour directives can represent a form of Ulysses contract: an attempt to make binding choices before the sometimes overwhelming circumstances of labour. These choices need to be respected during labour, but despite the reduced decisional and communicative capacity of a labouring woman, her choices, when clear, should supersede decisions made before labour. [ABSTRACT FROM AUTHOR]

Communication with young people (YP) can be problematic. However, effective communication can improve health outcomes and there is randomised clinical trial--level evidence that communication skills can be learnt. Key issues when communicating with YP: (1) The young person should be central in the communication, with discussions primarily focused on him/her; (2) The young person should be offered time alone with the clinician; (3) Conditional confidentiality should be discussed, and does not reduce rates of disclosure; (4) Ambivalence is normal -- techniques can be learnt to help the young person resolve ambivalence and change behaviour; (5) A psychosocial history is a key part of the adolescent consultation, and should include resilience factors as well as risk. We also discuss pragmatic techniques to use in busy consultations to improve communication and promote behaviour change in YP. [ABSTRACT FROM AUTHOR]

Improving the quality of communication between doctors and their patients and colleagues is of vital importance. Poor communication, especially within and across clinical teams working around patients in pathways of care, leads to avoidable medical error, where an unacceptable number of patients are severely harmed or die each year. The figures from such iatrogenesis have now reached epidemic proportions, constituting one of the major killers of patients worldwide. Despite 30 years' worth of explicit attention to teaching communication skills at undergraduate level, communication in medicine is failing to improve at an acceptable rate. The authors suggest a rather unusual approach to this dilemma of 'communication hypocompetence'dthinking medicine lyricallydas an extension of thinking with Homer's littlediscussed lyrical aesthetic. A key part of the problem of communication hypocompetence is the well-researched phenomenon of 'empathy decline' in students, where 'hardening' and cynicism occur as over-determined ego defences. Empathy decline may be a symptom of the repression of the lyrical genre in medicine, where the epic, tragic and dark comic genres dominate. The lyrical genre emphasises coming to know the patient as a person and an individual. Importantly, central to performing the lyric genre is the heightened use of the senses in taking a history, physical examination and diagnostic work. Framing medicine as lyrical work challenges undue emphasis on 'cure' at the expense of humane 'care'. [ABSTRACT FROM AUTHOR]

The National Heart, Lung and Blood Institute (NHLBI) Asthma Clinical Research Network (ACRN) recently completed its work after 20 years of collaboration as a multicentre clinical trial network. When formed, its stated mission was to perform multiple controlled clinical trials for treating patients with asthma by dispassionately examining new and existing therapies, and to rapidly communicate its findings to the medical community. The ACRN conducted 15 major clinical trials. In addition, clinical data, manual of operations, protocols and template informed consents from all ACRN trials are available via NHLBI BioLINCC (https://biolincc.nhlbi.nih.gov/studies/). This network contributed major insights into the use of inhaled corticosteroids, short-acting and long-acting ß-adrenergic agonists, leukotriene receptor antagonists, and novel agents (tiotropium, colchicine and macrolide antibiotics). They also pioneered studies of the variability in drug response, predictors of treatment response and pharmacogenetics. This review highlights the major research observations from the ACRN that have impacted the current management of asthma. [ABSTRACT FROM AUTHOR]

Background It has been suggested that researchers are obliged to offer summary findings to research participants to demonstrate respect for persons, and that this may increase public trust in, and awareness of, the research enterprise. Yet little research explores researchers' attitudes and practices regarding the range of initiatives that might serve these ends. Methods Results of an international survey of 785 eligible authors of genetics research studies in autism or cystic fibrosis are reported. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the utility of a novel Paediatric Consultation Assessment Tool (PCAT). DESIGN: Developed to measure clinicians' communication behaviour with children and their parents/guardian, PCAT was designed according to consensus guidelines and refined at a number of stages. Volunteer clinicians provided videotaped real consultations. Assessors were trained to score communication skills using PCAT, a novel rating scale. SETTING: Eight UK paediatric units. PARTICIPANTS: 19 paediatricians collected video-recorded material; a second cohort of 17 clinicians rated the videos. MAIN OUTCOME MEASURES: Itemised and aggregated scores were analysed (means and 95% confidence intervals) to determine measurement characteristics and relationship to patient, consultation, clinician and assessor attributes; generalisability coefficient of aggregate score; factor analysis of items; comparison of scores between groups of patients, consultations, clinicians and assessors. RESULTS: 188 complete consultations were analysed (median per doctor = 10). 3 videos marked by any trained assessor are needed to reliably (r>0.8) assess a doctor's triadic consultation skills using PCAT, 4 to assess communication with just children or parents. Performance maps to two factors – "clinical skills" and "communication behaviour"; clinicians score more highly on the former (mean (SD) 95% CI 0.52 (0.075)). There were significant differences in scores for the same skills applied to parent and child, especially between the ages of 2 and 10 years, and for information-sharing rather than relationshipbuilding skills (2-tailed significance <0.001). CONCLUSIONS: The PCAT appears to be reliable, valid and feasible for the assessment of triadic consultation skills by direct observation. [ABSTRACT FROM AUTHOR]

Heat injury is a potentially lethal condition that is considered to be completely preventable. Fatal heat injury is relatively rare (0.20 per 100 000 player-seasons in US high school football) and there are very limited data on non-fatal incidence. Expert recommendations for prevention include gradual acclimatisation of youth athletes to hot conditions, reductions in activity in hot and humid conditions, wearing light and light-coloured clothing, careful monitoring of athletes for signs of heat injury to facilitate immediate detection, having the resources to immediately and rapidly cool affected athletes, and education of athletes, care givers, and coaches about heat injury. Although a base of observational case data, physiological information, and expert opinion exists, the science surrounding this field is devoid of health communication and health behaviour research, and there is a pressing need for analytical studies to evaluate intervention programmes and/or identify new risk factors. There is also a need for ongoing data collection on heat injury incidence and on the knowledge, attitudes and behaviours towards heat injury among youth athletes, their care givers and their coaches. [ABSTRACT FROM AUTHOR]

A linguistic barrier between healthcare professional and patient is a challenging experience for both parties. In many cases, the absence of formally trained medical interpreters necessitates that an informal interpreter, drawn from the immediate environment, be used to facilitate communication. While the presence of an interpreter in a medical interview raises many questions about the effectiveness of the communication between healthcare professional and patient, it also gives rise to new speculations revolving on patient rights, medical ethics and patient privacy. In this article we examine the concept of communication competency in medical interviews, as well as translation theory, and link these theories to Western medical ethics in order to identify potential areas in which informal interpretation could impact on the patient. A linguistic barrier between healthcare professional and patient is a challenging experience for both parties. In many cases, the absence of formally trained medical interpreters necessitates that an informal interpreter, drawn from the immediate environment, be used to facilitate communication. While the presence of an interpreter in a medical interview raises many questions about the effectiveness of the communication between healthcare professional and patient, it also gives rise to new speculations revolving on patient rights, medical ethics and patient privacy. In this article we examine the concept of communication competency in medical interviews, as well as translation theory, and link these theories to Western medical ethics in order to identify potential areas in which informal interpretation could impact on the patient. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To understand definitions of the phrases "good driver" and "safe driver" among teen pre-drivers and early drivers in order to appropriately tailor messages about driving safety. DESIGN: Qualitative study using freelisting, an anthropological research technique, to explore nuances in the ways that teens define a good driver and a safe driver SETTING: Classes in six high schools each in a different state in the USA. SUBJECTS: 193 adolescent pre-drivers and early drivers, aged 15–17. MAIN OUTCOME MEASURES: Meaning of the phrase good driver and safe driver was identified for subgroups of adolescents. RESULTS: Teen pre-drivers and early drivers define a good driver and a safe driver as one who is cautious, alert, responsible, does not speed, obeys the law, uses seatbelts, and concentrates. There are subtle and potentially important differences in the way that subgroups define a good driver and a safe driver. CONCLUSIONS: Injury prevention experts need to attend closely to the implicit meanings that teens attach to everyday terms. Freelisting is a method that identifies perceptions about the meaning of health communication messages and suggests differences in meaning among subgroups. [ABSTRACT FROM AUTHOR]

The aim of this paper is to present and discuss nurses' and physicians' comments in a questionnaire relating to patients' transition from curative treatment to palliative care. The four-page questionnaire relating to experiences of and attitudes towards communication, decision-making, documentation and responsibility of nurses and physicians and towards the competence of patients was developed and sent to a random sample of 1672 nurses and physicians of 10 specialties. The response rate was 52% (n = 844), and over one-third made comments. The respondents differed in their comments about three areas: the concept of palliative care, experiences of unclear decision-making and difficulties in acceptance of the patient's situation. The responses are analysed in terms of four ethical theories: virtue ethics, deontology, consequentialism and casuistry. Many virtues considered to be appropriate for healthcare personnel to possess were invoked. Compassion, honesty, justice and prudence are especially important. However, principles of medical ethics, such as the deontological principle of respect for self-determination and the consequence of avoidance of harm, are also implied. Casuistry may be particularly helpful in analysing certain areas of difficulty--namely, what is meant by "palliative care", decision-making and accepting the patient's situation. Keeping a patient in a state of uncertainty often causes more suffering than necessary. Communication among the staff and with patients must be explicit. Many of the staff have not had adequate training in communicating with patients who are at the end of their life. Time for joint reflection has to be regained, and training in decision-making is essential. In our opinion, palliative care in Sweden is in need of improvement. [ABSTRACT FROM AUTHOR]

The large-scale change of Czech society since 1989 has involved the democratic transformation of the health system. To empower the patient was one important goal of the healthcare reform launched immediately after the Velvet Revolution. The process has been enhanced by the accession of the Czech Republic to the European Union and the adoption of important European conventions regulating the area. The concept of informed consent and a culture of negotiation are being inserted into a traditionally paternalistic culture. Our article describes the current situation on the issue of the communication of information on state of health and treatment, and on the question of the participation of the patient in decisions on treatment. We present empirical results of a public opinion survey on this issue. The results show a still prevailing submissive attitude towards the physicians, despite the fact that the concept of informed consent has become more and more publicly familiar (42% of respondents gave the completely correct answer regarding informed consent). The impact of age, education and sex on answers to the questionnaire was analysed. Men, younger and more educated respondents were more likely to show the autonomous altitude, whereas women, older and less educated people tended to show the traditional submissive attitude. Further, our article raises the question of the cultural and historical background within which the current ethically and legally binding norms (products of western democracies, in fact) are interpreted. The question is how far cultural modifications are tolerable in the practical implementation of universal ethical constructs (informed consent). [ABSTRACT FROM AUTHOR]

Medication errors cause substantial harm to patients, and considerable cost to healthcare systems. Evidence suggests that communication plays a crucial role in the generation, management and prevention of such incidents. This review identifies how paediatric medication errors can be managed, and in particular focuses on the pathway of steps that can operationalise the current research findings. Furthermore, the current data suggesting how communication can help to prevent errors occurring in the first place is examined. From this data, it is apparent that there are three domains in which communication could play an important preventative role: first, patient doctor communication, and second interprofessional communication and finally researcher/professional dialogue. This review is an attempt to identify the importance of communication in paediatric mediation safety and to allow practical application of these findings. [ABSTRACT FROM AUTHOR]

Serious illness and its treatment frequently changes a woman's sense of herself and her body. Narrative medicine posits that individuals permitted to tell their stories regain control over the plotline of the illness, reclaim the central role as protagonist, and thus diminish the sense of helplessness, marginalisation, and isolation that are inevitable aspects of serious disease. The women presented here speak about losses that occur during treatment for advanced cancer. These losses include: loss of the former body; loss of one or both breasts; loss of hair; loss of fertility, and changes in weight, energy, and sexuality. This paper will not review the medical literature on the psychological aspects of change in appearance secondary to disease and/or treatment. As a way of broadening our understanding of what women attempt to communicate to their care providers about who they are and who they are becoming through the experience of illness, this paper will present brief excerpts from the interviews of four women talking about issues of identity and bodily change, using concepts of feminine identity developed by the French psychoanalytic theorist Hélène Cixous in her essay, The laugh of the Medusa. [ABSTRACT FROM AUTHOR]

Objective: Many injuries to children cannot be prevented without some degree of active behavior on the part of parents. A better understanding of social and cognitive determinants of parents' injury prevention behavior and the identification of potential subgroups for targeted message delivery could advance the effectiveness of educational and behavioral interventions. This study assessed the degree to which parents' injury prevention behavior is associated with theoretical determinants and examined whether this relation differs by age or birth order of child. Design: Cross sectional observational study. Setting: Three Midwestern pediatric clinics. Subjects: 594 parents of children ages 0–4 attending routine well child visits. Measures: Injury prevention attitudes, beliefs, and practices. Results: Overall, only modest relations were observed between injury beliefs and attitudes and injury prevention behaviors. However, these relations differed substantially by child age and birth order, with stronger associations observed for parents of older first born children. Outcome expectations and social norms were more strongly related to injury prevention behavior among parents of preschool children than among parents of infants and toddlers, while attitudes were more predictive for parents of first born children than parents of later born children. Conclusions: These findings highlight the complexity of relations between theorized determinants and behavior, and suggest the potential utility of using audience segmentation strategies in behavioral interventions addressing injury prevention. [ABSTRACT FROM AUTHOR]

Objectives To explore the processes leading to inappropriate use of medicines for elderly patients admitted for acute care. Design Qualitative study with semistructured interviews with doctors, nurses, and pharmacists; focus groups with inpatients; and observation on the ward by clinical pharmacists for one month. Setting Five acute wards for care of the elderly in Belgium. Participants 5 doctors, 4 nurses, and 3 pharmacists from five acute wards for the interviews; all professionals and patients on two acute wards for the observation and 17 patients (from the same two wards) for the focus groups. Results Several factors contributed to inappropriate prescribing, counselling, and transfer of information on medicines to primary care. Firstly, review of treatment was driven by acute considerations, the transfer of information on medicines from primary to secondary care was limited, and prescribing was often not tailored to elderly patients. Secondly, some doctors had a passive attitude towards learning: they thought it would take too long to find the information they needed about medicines and lacked self directed learning. Finally, a paternalistic doctor-patient relationship and difficulties in sharing decisions about treatment between prescribers led to inappropriate use of medicines. Several factors, such as the input of geriatricians and good communication between members of the multidisciplinary geriatric team, led to better use of medicines. Conclusions In this setting, improvements targeted at the abilities of individuals, better doctor-patient and doctor-doctor relationships, and systems for transferring information between care settings will increase the appropriate use of medicines in elderly people. [ABSTRACT FROM AUTHOR]

Numerous studies and well publicised complaints from the public have long revealed a pressing need for physicians to improve their communication skills and their ability to interpret and respond appropriately to what they hear from patients. Rushed and dispirited, physicians are routinely urged to become more compassionate and to spend more time listening. This article challenges the myth that listening is a time consuming art propelled by compassion and demonstrates that it is in fact a highly active professional skill that can be greatly clarified and simplified for practising physicians. The lament is offered as a universally encountered, sometimes masked, expression that patients need to have heard and validated. An intellectual understanding of the lament as a symptom of suffering greatly facilitates the listening process and enables the listener to respond therapeutically. This saves time, improves quality of care, and enhances the wellbeing and satisfaction of both physician and patient. [ABSTRACT FROM AUTHOR]

The treatment and management of chronic conditions during adolescence pose specific issues that need to be appropriately handled by health professionals. In this paper, questions related to disclosure of the diagnosis, the management of adherence to therapy, the need for an interdisciplinary network approach, lifestyles' anticipatory guidance and prevention, and the transition into an adult healthcare selling are reviewed. Special areas such as the issue of life threatening diseases and the ethical aspects of the treatment of chronic conditions are also discussed. [ABSTRACT FROM AUTHOR]

The prevalence of chronic conditions among adolescents is difficult to assess due to the lack of quality data focusing specifically on this age group, as well as the diversity in methodology and definitions used. However, surveys carried out by self administered questionnaires among in-school adolescent populations indicate that around 10% of adolescents suffer from such a condition. The aim of this paper is to analyse the reciprocal effects of chronic conditions and adolescent development by reviewing the effect of chronic disease on growth and puberty and on psychosocial development, and the effect of developmental issues on the course and management of chronic disease. [ABSTRACT FROM AUTHOR]

Objectives To describe the multicenter clinical databases that exist in the United Kingdom, to report on their quality, to explore which organizational and managerial features are associated with high quality, and to make recommendations for improvements. Design Cross sectional survey, with interviews with database custodians and search of electronic bibliographic database (PubMed). Studies reviewed 105 clinical databases across the United Kingdom. Results Clinical databases existed in all areas of health care, but their distribution was uneven--cancer and surgery were better covered than mental health and obstetrics. They varied greatly in age, size, growth rate, and geographical areas covered. Their scope (and thus their potential uses) and the quality of the data collected also varied. The latter was not associated with any organizational characteristics. Despite impressive achievements, many faced substantial financial uncertainty. Considerable scope existed for improvements: greater use of nationally approved codes; more support from relevant professional organizations; greater involvement by nurses, allied health professionals, managers, and laypeople in database management teams; and more attention to data security and ensuring patient confidentiality. With some notable exceptions, the audit and research potential of most databases had not been realized: half the databases had each produced only four or fewer peer reviewed research articles. Conclusions At least one clinical database support unit is needed in the United Kingdom to provide assistance in organization and management, information technology, epidemiology, and statistics. Without such an initiative, the variable picture of databases reported here is likely to persist and their potential not be realized. [ABSTRACT FROM AUTHOR]

Objective To obtain feedback from patients receiving palliative care and their relatives from various ethnic backgrounds about their experiences of the disclosure process and their satisfaction with information sharing during the illness. Design A qualitative study with semistructured single interviews. Setting Perth, Western Australia, and Winnipeg, Manitoba, Canada. Participants 72 participants registered with palliative care: 21 patient-family dyads in Perth and 14 dyads and 2 patients in Winnipeg. Results Participants described their experiences in great detail. The analysis indicates that in information sharing the process is as important as the content. The timing, management, and delivery of information and perceived attitude of practitioners were critical to the process. This applied to information interactions at all stages of the illness. Main content areas mentioned related to prognosis and hope. Hope can be conveyed in different ways. Secondary information from various sources is accessed and synthesized with the primary information. All patients, regardless of origin, wanted information about their illness and wanted it fully shared with relatives. Almost all patients requested prognostic information, and all family members respected their wishes. Information was perceived as important for patient-family communication. Information needs of patient and family changed and diverged as illness progressed, and communication between them became less verbally explicit. Conclusions Information delivery for patients needs to be individualized with particular attention to process at all stages of illness. Patients and families use secondary sources of information to complement and verify information given by health carers. [ABSTRACT FROM AUTHOR]

Presents the medical clinician's perspective on electronic medical records and how they affect patient care. Use of narratives in clinical reasoning; Discussion of patient documentation systems; Impact of the construction of patient records on clinical insight; Conversational interaction between clinicians; Problems in entering data; Ease of access to and structure of records; Claim that electronic records systems should allow the clinician to input patient narratives.

Objectives To explore the process of knowledge exchange in an informal email network for evidence based health care, to illuminate the value of the service and its critical success factors, and to identify areas for improvement. Design Illuminative evaluation. Setting Targeted email and networking service for United Kingdom healthcare practitioners and researchers. Participants 2800 members of a networking service. Main outcome measures Tracking of email messages, interviews with core staff, and a qualitative analysis of messages, postings from focus groups, and invited and unsolicited feedback to the service. Results The informal email network helped to bridge the gap between research and practice by serving as a rich source of information, providing access to members' experiences, suggestions, and ideas, facilitating cross boundary collaboration, and enabling participation in networking at a variety of levels. Ad hoc groupings and communities of practice emerged spontaneously as members discovered common areas of interest. Conclusion This study illuminated how knowledge for evidence based health care can be targeted, personalized, and made meaningful through informal social processes. Critical success factors include a broad based membership from both the research and service communities; a loose and fluid network structure; tight targeting of messages based on members' interests; the presence of a strong network identity and culture of reciprocity; and the opportunity for new members to learn through passive participation. [ABSTRACT FROM AUTHOR]

Objective To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people to discuss health related issues remotely. Design and data sources Analysis of studies identified from Medline, Embase, CINAHL, PsycINFO, Evidence Based Medicine Reviews, Electronics and Communications Abstracts, Computer and Information Systems Abstracts, ERIC, LISA, ProQuest Digital Dissertations, Web of Science. Selection of studies We searched for before and after studies, interrupted time series, cohort studies, or studies with control groups; evaluating health or social outcomes of virtual peer to peer communities, either as stand alone interventions or in the context of more complex systems with peer to peer components. Main outcome measures Peer to peer interventions and co-interventions studied, general characteristics of studies, outcome measures used, and study results. Results 45 publications describing 38 distinct studies met our inclusion criteria: 20 randomized trials, three meta-analyses of n of 1 trials, three non-randomized controlled trials, one cohort study, and 11 before and after studies. Only six of these evaluated "pure" peer to peer communities, and one had a factorial design with a "peer to peer only"arm, whereas 31 studies evaluated complex interventions, which often included psychoeducational programs or one to one communication with healthcare professionals, making it impossible to attribute intervention effects to the peer to peer community component. The outcomes measured most often were depression and social support; most studies did not show an effect. We found no evidence to support concerns over virtual communities harming people. Conclusions No robust evidence exists on the effects of consumer led peer to peer communities, partly because most peer to peer communities have been evaluated only in conjunction with more complex... [ABSTRACT FROM AUTHOR]

Objectives To identify the ways in which patients with medically unexplained symptoms present their problems and needs to general practitioners and to identify the forms of presentation that might lead general practitioners to feel pressurized to deliver somatic interventions. Design Qualitative analysis of audiorecorded consultations between patients and general practitioners. Setting 7 general practices in Merseyside, England. Participants 36 patients selected consecutively from 21 general practices, in whom doctors considered that patients' symptoms were medically unexplained. Main outcome measures Inductive qualitative analysis of ways in which patients presented their symptoms to general practitioners. Results Although 34 patients received somatic interventions (27 received drug prescriptions, 12 underwent investigations, and four were referred), only 10 requested them. However, patients presented in other ways that had the potential to pressurize general practitioners, including graphic and emotional language; complex patterns of symptoms that resisted explanation; description of emotional and social effects of symptoms; reference to other individuals as authority for the severity of symptoms; and biomedical explanations. Conclusions Most patients with unexplained symptoms received somatic interventions from their general practitioners but had not requested them. Though such patients apparently seek to engage the general practitioner by conveying the reality of their suffering, general practitioners respond symptomatically. [ABSTRACT FROM AUTHOR]

Abstract Objectives: To determine whether paperless medical records contained less information than paper based medical records and whether that information was harder to retrieve. Design: Cross sectional study with review of medical records and interviews with general practitioners. Setting: 25 general practices in Trent region. Participants: 53 British general practitioners (25 using paperless records and 28 using paper based records) who each provided records of 10 consultations. Main outcome measures: Content of a sample of records and doctor recall of consultations for which paperless or paper based records had been made. Results: Compared with paper based records, more paperless records were fully understandable (89.2% v 69.9%, P=0.0001) and fully legible (100% v 64.3%, P < 0.0001). Paperless records were significantly more likely to have at least one diagnosis recorded (48.2% v 33.2%, P=0.05), to record that advice had been given (23.7% vs 10.7%, P=0.017), and, when a referral had been made, were more likely to contain details of the specialty (77.4% v 59.5%, P=0.03). When a prescription had been issued, paperless records were more likely to specify the drug dose (86.6% v 66.2%, P=0.005). Paperless records contained significantly more words, abbreviations, and symbols (P < 0.01 for all). At doctor interview, there was no difference between the groups for the proportion of patients or consultations that could be recalled. Doctors using paperless records were able to recall more advice given to patients (38.6% v 26.8%, P=0.03). Conclusion: We found no evidence to support our hypotheses that paperless records would be truncated and contain more local abbreviations; and that the absence of writing would decrease subsequent recall. Conversely we found that the paperless records compared favourably with manual records. [ABSTRACT FROM AUTHOR]

The ideal of patient centred medicine remains only partially realised. Within modern Western society, the highly individualistic culture and religious decline linked with medicine's reluctance to relinquish an outmoded form of scientific rationalism can act as reductive influences, stifling conceptual development. Some examples of the recent literature on communication skills in medicine are analysed to discern the underlying philosophy. A rationalist stance invites an examination of the possible nature of rationality. Another example accepts the need to accommodate the emotional and the unconscious. Issues of human suffering with an inherent spiritual dimension seem to remain excluded. The need to move beyond a duality of reason and emotion to embrace the existential and spiritual is suggested as a theoretical prerequisite for developing a more inclusive concept of patient centred medicine, which only then may be realised. Some brief examples are considered of the sort of notions and types of discourse that might effectively inform "teaching" of communication skills. [ABSTRACT FROM AUTHOR]

Describes percutaneous coronary intervention (PCI), and emphasizes the importance of discussing the benefits and risks of the procedure with patients. Likelihood of restenosis after PCI, and the potential for incomplete revascularization compared with bypass surgery; Way that relief of anginal symptoms is the principal clinical indication for percutaneous intervention; Observation that successful PCI depends on adequate visualization of the target stenosis and its adjacent arterial branches; Use of an intra-aortic balloon pump in very high-risk cases; Restenosis within a stent.

Presents letters to the editor on medical topics. View that computer users should design computer interfaces; Opinion that any change in information technology in general practice medicine requires piloting; Comments on an article on ten ways to improve Great Britain's National Health Service; Observation that primary care physicians should become aware of training opportunities; Value of computers in the workplace in medicine; Folate and risk of cardiovascular disease; Opinions on an article about chronic cough; Occurrence of leishmaniasis in Mediterranean countries; Medical experts and the criminal courts; Perception that a statistical monitoring process with high enough sensitivity to detect murder would also give many false-positive signals; View that cleft lip and palate services need to be improved; Argument that insensitivity in physicians should not be encouraged; View that senior medical staff need to be included in severe asthma treatment; Difficulties in giving fully informed consent; Thoughts on the autonomy of children and parenthood.

Objectives: To examine the strengths and weaknesses of the national and local schemes for preregistration house officers to spend four months in general practice, to identify any added value from such placements, and to examine the impact on career choices. Design: Review of all studies that reported on placements of preregistration house officers in general practice. Setting: 19 accounts of preregistration house officers' experience in general practice, ranging from single case reports to a national evaluation study, in a variety of locations in Scotland and England. Participants: Views of 180 preregistration house officers, 45 general practitioner trainers, and 105 consultant trainers. Main outcome measures: Main findings or themes weighted according to number of studies reporting them and weighted for sample size. Results: The studies were unanimous about the educational benefits of the placements. The additional learning included communication skills, social and psychological factors in illness, patient centred consultations, broadening of knowledge base, and dealing with uncertainty about diagnosis and referral. Conclusions: Despite the reported benefits and recommendations of the scheme, it is not expanding. General practitioner trainers reported additional supervision that was unremunerated. The reforms of the senior house officer grade may resolve this problem by offering the placements to senior house officers, who require less supervision. INSETS: Box 1: Experiences gained by preregistration house officers in...;Box 2: Main themes emerging as new areas of learning in...;What is already known on this topic;What this study adds [ABSTRACT FROM AUTHOR]

Objectives: To examine young people's and parents' accounts of communication about cancer in childhood. Design: Semistructured interviews analysed using the constant comparative method. Setting: Paediatric oncology unit. Participants: 13 families, comprising 19 parents (13 mothers, six fathers) and 13 patients aged 8-17 years. The patients had cancer or brain tumour. Results: Most parents described acting in an executive-like capacity, managing what and how their children were told about their illness, particularly at the time of diagnosis. Their accounts were shaped by concerns to manage their identity as strong and optimistic parents and to protect their child's wellbeing. The patients identified elements of their parents' role that both facilitated and constrained their communication, and while they welcomed their parents' involvement, some expressed unease with the constraining aspects of their parents' role. Some young people described feeling marginalised in consultations and pointed to difficulties they experienced in encounters with some doctors. Conclusions: There are difficulties in managing communication with young people who have a chronic, life threatening illness. Health professionals need to be aware of how the social positioning of young people (relative to adults) and the executive role of parents can contribute to the marginalisation of young people and hamper the development of successful relationships between themselves and young patients. [ABSTRACT FROM AUTHOR]

Reviews empirical research that can guide physicians in decisions of whether to withdraw life support, maximizing patient and family involvement in the decision-making process, and negotiating conflicts that might arise with deaths that occur in intensive care. View that good communication might shorten the dying process; Discussion of withdrawal of life support as a clinical procedure requiring good medical skills, cultural sensitivity, attention to ethical principles, and close collaboration with families.

Abstract Objective: To investigate how doctors engage with patients with psychotic illness in routine consultations. Design: Conversation analysis of 32 consultations between psychiatrists and patients with schizophrenia or schizoaffective disorder. Setting: Two psychiatric outpatient clinics in east London and south west London. Participants: 7 psychiatrists and 32 patients with schizophrenia or schizoaffective disorder. Main outcome measure: Mutual engagement in communication during the consultation. Results: Patients actively attempted to talk about the content of their psychotic symptoms in consultations by asking direct questions, repeating their questions and utterances, and producing these utterances in the concluding part of the consultation. In response, doctors hesitated, responded with a question rather than with an answer, and smiled or laughed (when informal carers were present), indicating that they were reluctant to engage with patients' concerns about their psychotic symptoms. Conclusions: Patients repeatedly attempted to talk about the content of their psychotic symptoms, which was a source of noticeable interactional tension and difficulty. Addressing patients' concerns about their illness may lead to a more satisfactory outcome of the consultation and improve engagement of such patients in the health services. [ABSTRACT FROM AUTHOR]

Presents a review focusing on technical issues which prevent the use of computer based patient records in British hospitals despite the use of such documentation by British general practitioners. Description of review methods; Details of technical issues involved with computer based records such as patient record architecture, clinical terminology, inter-operability standards, and security; Conclusion that computer use in hospitals has been hindered by scalability, sighting a need for technological innovation to allow for implementation.

Presents a review focusing on how, over the past 30 years, incentives have led to the adoption of computer based patient records among British general practitioners but alienation of such documentation by hospital doctors. Description of review methods; Discussion about computerization in health services and its origins; Conclusion that differences in leadership and economic incentives can explain why computer documentation is used by general practitioners but not by hospitals; Future issues of focus for hospital computer implementation.

Discusses the importance of good communication skills in medical care. Ability of doctors to identify the problems of their patient more accurately; Likelihood that patients will be satisfied with their care and understand treatment options; Reasons for deficiencies in undergraduate and postgraduate training; How doctors can acquire good communication skills.