Improving communication among health professionals through education: a pilot study

Communication can be thought of as a message that is sent, received, and understood. Each discipline of the health profession has its own jargon and means of expressing ideas in shorthand. These separate forms of communicating are effective among those of the same background but are often at the root of misunderstandings between professional groups. This article reviews communication theory and traces the difficulties created when inter-disciplinary teams of healthcare try to work together and communicate. As multi-disciplinary teams are increasingly dealing with the complex problems of today's healthcare system, clear communication and understanding has never been more important. If educators could assist in creating an understanding of vocabulary used for decision processes, communication could improve. The authors of this study performed a multi-stage Delphi survey that grouped terms used by administrators and clinicians and produced a lexicon of corresponding terms. An expert panel then reviewed and modified the list. The result is a lexicon that can be useful to assist clinicians and administrators to communicate with each other. By utilizing clinical terminology, or vice versa, instead of management or clinical jargon, some of the translation done by administration or clinicians could be reduced. Examples of how the lexicon can be utilized are provided in the article. This includes using it in health administration education to demonstrate the variances in clinical/managerial terms. It could also be provided as a primer to physicians, nurses, and other health professionals who assume administrative positions to enhance their communication with administrators.     

Antitumor effects of GBS toxin: a polysaccharide exotoxin from group Bβ-hemolytic streptococcus

A group B streptococcus (GBS) isolated from human neonates diagnosed with sepsis and respiratory distress (early-onset disease) produces a polysaccharide exotoxin (GBS toxin) that, when infused in sheep, causes lung pathophysiology similar to that seen in humans. Histological studies have demonstrated that GBS toxin induces a strong inflammatory response in the lung, with pulmonary sequestration of granulocytes and extensive capillary endothelial damage. The susceptibility of humans to GBS toxin is age-dependent and limited to about 4 days after birth. It is rarely evident thereafter. This suggests that the binding of GBS toxin to the target endothelium occurs via specific components in the developing lung endothelial cells of the newborn that are later lost. We report here that GBS toxin can also bind to developing endothelium associated with neoplasia and induce an inflammatory response. GBS toxin was shown by immunohistochemistry to bind to capillary endothelium of human large-cell carcinomas. In nude mice bearing human tumor xenografts, intravenously administered GBS toxin caused tumor necrosis and hemorrhagic lesions, and substantially inhibited the rate of growth of the tumors. In BALB/c mice bearing Madison lung tumors, GBS toxin induced an inflammatory response resulting in marked changes in tumor morphology, including vasodilation, endothelial and tumor cell necrosis, invasion of lymphocytes and macrophages, and capillary thrombosis. In these tumor models, no evidence of toxicity to the vasculature of other tissues was observed. The reported pathophysiology of GBS in human neonates, the lack of disease in non-neonates colonized with GBS, and these results suggest that GBS toxin may have potential as a well tolerated agent in cancer therapy of some human tumors.Abbreviations GBS group BStreptococcus - PBS phosphate-buffered saline This work was supported in part by a grant from the March of Dimes Foundation     

The practitioner-teacher model revisited

Much of the recent literature on the future of health administration education notes the importance of strengthening linkages with practitioners by incorporating them into more formal roles within programs. This article describes the Rush University Department of Health Systems Management's process of implementing the practitioner-teacher model. The results of a faculty time commitment study support the conclusion that practitioners can play a key role in the development and administration of a graduate health care management program while maintaining their operational responsibilities. The implications of operating a fully integrated practitioner-teacher model and those aspects transferable to other graduate education settings are discussed.     

Personal response systems in the United States

In summation, although Personal Response Systems are relatively new in the marketplace they have made tremendous inroads over the past fifteen years. The next decade presents some difficult problems for this country in terms of its aging population and the delivery of quality, cost effective health care to all who need it. In light of these problems, the PRS industry can offer viable solutions-solutions for the U.S. health care system in helping to control and reduce the cost of health care delivery; solutions for industry in attempting to meet their employee health care needs; solutions for families who are coping with the strains of eldercare; and most important, solutions for many people who, regardless of age, could not live independently without a Personal Response System.     

5-HT1A agonists and dopamine: the effects of 8-OH-DPAT and buspirone on brain-stimulation reward

Summary Two specific 5-HT_1A agonists, 8-OH-DPAT (0–300 g/kg), and buspirone (0–3.0 mg/kg), were tested on variable-interval, threshold-current self-stimulation of rat lateral hypothalamus. Buspirone produced a prolonged monotonic depression of responding, whereas the effects of 8-OH-DPAT were biphasic: 3.0 g/kg produced a sustained enhancement of responding while higher doses (100–300 g/kg) produced a relatively short-lasting depression. This biphasic pattern parallels previously reported effects of 8-OH-DPAT on food intake and on various other behaviours. Threshold-current self-stimulation is highly sensitive to alterations in dopaminergic transmission but relatively insensitive to changes in 5-HT. Thus the facilitatory effect of low-dose 8-OH-DPAT seems most plausibly interpreted in terms of enhanced dopaminergic transmission. This could be brought about by 5HT_1A autoreceptor-mediated inhibition of 5-HT release and consequent disinhibition of dopaminergic transmission. Depression of self-stimulation by higher doses of 8-OH-DPAT may reflect the activity of 8-OH-DPAT at postsynaptic 5-HT receptors, with consequent inhibition of DA transmission. Suppression of responding after buspirone at all doses tested may reflect the action of this compound as a partial agonist at postsynaptic 5-HT receptors, and/or its effects on other systems.     

Nodular fasciitis. Its morphologic spectrum and immunohistochemical profile

Although nodular fasciitis (NF) is a well recognized pseudosarcomatous proliferation, it continues to cause diagnostic problems. We reviewed the clinical, histologic and immunohistochemical features of 53 lesions from 30 male and 23 female patients, ages 8-76 years, that involved the upper and lower extremities, trunk, and head and neck. Sizes ranged from 0.6 to 6.5 cm. The morphologic spectrum was broad, including the classic pattern of delicate fibroblasts suspended in a myxoid matrix, granulation tissue-like areas, solid and whorled myofibroblastic proliferations with multinucleated cells, mucoid cysts, and so-called "ancient" forms with dense, refractile strands of keloid-like collagen. Nodular fasciitis was correctly diagnosed in 23 cases (43%); a sarcoma was diagnosed in 11 (21%). A characteristic immunohistochemical profile emerged wherein 49 of 53 cases stained for smooth-muscle and muscle-specific actins, vimentin, and KP1 (a histiocyte marker), indicating dual myofibroblastic and histiocytic differentiation. None of the lesions expressed keratin, S-100 protein, or desmin. Knowledge of the immunohistochemical profile of nodular fasciitis and its overlap with certain sarcomas can decrease the likelihood of misdiagnosis.