Multilingual education: medical interns perceptions regarding the usefulness of non-mother tongue communications skills taught during the undergraduate curriculum.

BACKGROUND: This paper investigates the perceptions of medical interns regarding the usefulness of non-mother tongue communication skills taught during the undergraduate curriculum at the University of Cape Town in South Africa. In 2003, the university decided to incorporate Afrikaans and IsiXhosa communication skills into the new MBChB curriculum in order to meet the Faculty of Health Sciences goals to promote quality and equity in healthcare, and to prepare graduating health practitioners for multilingual communities where they would be serving. Despite annual internal evaluations and reviews of the languages courses, the usefulness, if any, of the additional languages in the working clinical environment had not been determined. METHODS: Data were collected during the second year of medical internship across a five-year period through survey questionnaires, as well as focus group interviews conducted in the Western Cape, South Africa. Surveys were conducted from 2009 to 2013. RESULTS: The study shows that the usefulness of each of the probed categories was not consistent across both languages. The interns expressed a need for an overall improvement of the isiXhosa course offering, while the outcomes for the Afrikaans language were more positive across all categories except for cultural understanding. CONCLUSION: The study indicates a positive trend amongst the interns towards developing usefulness in communication skills in Afrikaans and isiXhosa to communicate with their patients.

Patient Attitudes and Participation in Hand Co-Washing in an Outpatient Clinic Before and After a Prompt.

Despite recent national emphasis, outpatient hand washing can be less than optimal. We tested a new approach involving both patient and physician hand washing. The study consisted of 384 questionnaires, 184 from phase 1 and 200 from phase 2. Patients stated doctors washed their hands 96.6% before examining them pre-intervention and 99.5% of the time post-intervention. Patients endorsed the importance of hand washing 98.7% of the time. "Co-washing" may offer a process to increase the practice of hand washing and decrease infection risk.

Patient Understanding of Body Mass Index (BMI) in Primary Care Practices: A Two-State Practice-based Research (PBR) Collaboration.

BACKGROUND: The concept of body mass index (BMI) may not be well understood by patients. The purpose of this study was to evaluate patients' knowledge of BMI in the primary care setting. METHODS: Adult patients seen in 18 practices in West Virginia and New Jersey were invited to complete a voluntary survey. The survey assessed the patient's baseline knowledge of BMI as well as demographic information and whether the patient had known chronic conditions associated with increased BMI, including hypertension, hyperlipidemia, diabetes mellitus, and sleep apnea. RESULTS: While the majority (59.9%) of primary care patients knew the meaning of BMI and that it is related to obesity, there was little knowledge of BMI cutoff values; more than 80% of responses were incorrect when asked to define specific BMI levels and their meaning. Self-awareness of obesity was limited as well, with only 16.4% aware of their own personal BMI. Furthermore, nearly 70% of patients could not recall having discussed BMI with their physician. CONCLUSION: Findings indicate low comprehension of the term BMI. Increasing awareness of BMI may help patients address this key risk factor and significantly affect public health.

Pan-Canadian study of mammography screening and mortality from breast cancer.

BACKGROUND: Screening with mammography has been shown by randomized controlled trials to reduce breast cancer mortality in women aged 40 to 74 years. Estimates from observational studies following screening implementation in different countries have produced varyied findings. We report findings for seven Canadian breast screening programs. METHODS: Canadian breast screening programs were invited to participate in a study aimed at comparing breast cancer mortality in participants and nonparticipants. Seven of 12 programs, representing 85% of the Canadian population, participated in the study. Data were obtained from the screening programs and corresponding cancer registries on screening mammograms and breast cancer diagnoses and deaths for the period between 1990 and 2009. Standardized mortality ratios were calculated comparing observed mortality in participants to that expected based upon nonparticipant rates. A substudy using data from British Columbia women aged 35 to 44 years was conducted to assess the potential effect of self-selection participation bias. All statistical tests were two-sided. RESULTS: Data were obtained on 2796472 screening participants. The average breast cancer mortality among participants was 40% (95% confidence interval [CI] = 33% to 48%) lower than expected, with a range across provinces of 27% to 59%. Age at entry into screening did not greatly affect the magnitude of the average reduction in mortality, which varied between 35% and 44% overall. The substudy found no evidence that self-selection biased the reported mortality results, although the confidence intervals of this assessment were wide. CONCLUSION: Participation in mammography screening programs in Canada was associated with substantially reduced breast cancer mortality.

Organized breast screening programs in Canada: effect of radiologist reading volumes on outcomes.

PURPOSE: To examine retrospectively the relationship between radiologist screening program reading volumes and interpretation results. MATERIALS AND METHODS: This research project was reviewed by the University of British Columbia Research Ethics Board. Informed patient consent was not required. Data were requested from Canadian provincial screening programs for the period 1988-2000. Cancer detection rates, abnormal interpretation rates, and positive predictive values (PPVs) were calculated for individual radiologists in those programs. Multivariate Poisson mixed regression models were used to examine the effect of patient age, screening examination sequence (first or subsequent screening examination), province, radiologist reading volume, and interradiologist differences on cancer detection rate, abnormal interpretation rate, and PPV. RESULTS: The results of the interpretation of 1406678 screening mammograms by 304 radiologists from seven provincial programs were analyzed. Cancer detection rate, abnormal interpretation rate, and PPV all varied according to age of woman screened and screening sequence and across the sample of radiologists. None of the rates varied by province. Neither the cancer detection rate nor the abnormal interpretation rate varied by reading volume, but the average PPV was increased by 34% for volumes over 2000 mammograms versus volumes of 480-699 mammograms per year. There was no evidence that the magnitude of variability around the average, for radiologists reading the same volume of mammograms, varied across different volume groups for any of the outcome measures. CONCLUSION: Cancer detection did not vary with reading volume. The average PPV for individual radiologists increased as reading volume rose up to 2000 mammograms per year; it stabilized at higher volumes.

Breast cancer screening in Canada: a review.

Organized screening for breast cancer in Canada began in 1988 and has been implemented in all provinces and 2 of the 3 territories. Quality initiatives are promoted through national guidelines which detail best practices in various areas, including achieving quality through a client-service approach, recruitment and capacity, retention, quality of mammography, reporting, communication of results, follow-up and diagnostic workup, and program evaluation; it also offers detailed guidelines for the pathological examination and reporting of breast specimens. The Canadian Breast Cancer Data Base is a national breast cancer screening surveillance system whose objective is to collect information from provincial-screening programs. These data are used to monitor and evaluate the performance of programs and allow comparison with national and international results. A series of standardized performance indicators and targets for the evaluation of performance and quality of organized breast cancer screening programs have been developed from the data base. Although health care is a provincial responsibility in Canada, the collective reporting and comparison of results both nationally and internationally is beneficial in evaluating and refining both screening programs and individual radiologist performance. The results of Canadian performance indicators compare favourably with those of other well-established international screening programs. There are variations in performance indicators across the provinces and territories, but these differences are not extreme.

High-resolution crossover maps for each bivalent of Zea mays using recombination nodules.

Recombination nodules (RNs) are closely correlated with crossing over, and, because they are observed by electron microscopy of synaptonemal complexes (SCs) in extended pachytene chromosomes, RNs provide the highest-resolution cytological marker currently available for defining the frequency and distribution of crossovers along the length of chromosomes. Using the maize inbred line KYS, we prepared an SC karyotype in which each SC was identified by relative length and arm ratio and related to the proper linkage group using inversion heterozygotes. We mapped 4267 RNs on 2080 identified SCs to produce high-resolution maps of RN frequency and distribution on each bivalent. RN frequencies are closely correlated with both chiasma frequencies and SC length. The total length of the RN recombination map is about twofold shorter than that of most maize linkage maps, but there is good correspondence between the relative lengths of the different maps when individual bivalents are considered. Each bivalent has a unique distribution of crossing over, but all bivalents share a high frequency of distal RNs and a severe reduction of RNs at and near kinetochores. The frequency of RNs at knobs is either similar to or higher than the average frequency of RNs along the SCs. These RN maps represent an independent measure of crossing over along maize bivalents.