Teaching residents to put patients first: creation and evaluation of a comprehensive curriculum in patient-centered communication.

BACKGROUND: Patient-centered communication is essential for successful patient encounters and positive patient outcomes. Therefore, training residents how to communicate well is one of the key responsibilities of residency programs. However, many residents, especially international medical graduates, continue to struggle with communication barriers. METHODS: All residents and faculty from a small community teaching hospital participated in a three-year, multidimensional patient-centered communication curriculum including communication training with lectures, experiential learning, communication skills practice, and reflection in the areas of linguistics, physician-patient communication, cultural & linguistically appropriate care, and professionalism. We evaluated the program through a multipronged outcomes assessment, including self-assessment, scores on the Calgary-Cambridge Scale during Objective Structured Clinical Examination (OSCE), a survey to measure the hidden curriculum, English Communication Assessment Profile (E-CAP),, the Maslach Burnout-Inventory (MBI), and residents' evaluation of faculty communication. RESULTS: Sixty-two residents and ten faculty members completed the three-year curriculum. We saw no significant changes in the MBI or hidden curriculum survey. Communication skills as measured by Calgary Cambridge Score, E-CAP, and resident communication improved significantly (average Calgary-Cambridge Scale scores from 70% at baseline to 78% at follow-up (p-value < 0.001), paired t-test score from 68% at baseline to 81% at follow-up (p-value < 0.004), average E-CAP score from 73 to 77% (p-value < 0.001)). Faculty communication and teaching as rated by residents also showed significant improvement in four out of six domains (learning climate (p < 0.001), patient-centered care (p = 0.01), evaluation (p = 0.03), and self-directed learning (p = 0.03)). CONCLUSION: Implementing a multidimensional curriculum in patient-centered communication led to modest improvements in patient-centered communication, improved language skills, and improved communication skills among residents and faculty.

Britain Breathing: using the experience sampling method to collect the seasonal allergy symptoms of a country.

Objective: Allergies are increasing, but the reasons for this are unclear. Although environmental factors are thought to be important, there is a lack of data on how they contribute to symptom development. To understand this relationship better, we need accurate data about both symptoms and environmental factors. Our objective here is to ascertain whether experience sampling is a reliable approach for collecting allergy symptom data in the general population, allowing us to map symptoms and understand etiology. Materials and Methods: We conducted a 32-week cross-sectional study where individuals reported their seasonal allergy symptoms and severity via a mobile application. Symptom geographical location and timestamp were also collected automatically. Results: The experience sampling method reliably infers the incidence of seasonal allergies as indicated by the strong correlation (r = 0.93, P < .003) between the reported lack of wellness and the number of antihistamines prescribed by General Practitioners. Discussion and Conclusion: The project has resulted in the first dataset to map allergy symptoms over time and place and reveals periods of peak hay fever symptoms in the UK.

Ambient and Emission Trends of Toxic Air Contaminants in California.

After initiating a toxic air contaminant (TAC) identification and control program in 1984, the California Air Resources Board adopted regulations to reduce TAC emissions from cars, trucks, stationary sources, and consumer products. This study quantifies ambient concentration and emission trends for the period 1990-2012 for seven TACs that are responsible for most of the known cancer risk associated with airborne exposure in California. Of these seven, diesel particulate matter (DPM) is the most important; however DPM is not measured directly. Based on a novel surrogate method, DPM concentrations declined 68%, even though the state's population increased 31%, diesel vehicle-miles-traveled increased 81%, and the gross state product (GSP) increased 74%. Based on monitoring data, concentrations of benzene, 1,3-butadiene, perchloroethylene, and hexavalent chromium declined 88-94%. Also, the ambient and emissions trends for each of these four TACs were similar. Furthermore, these declines generally occurred earlier in California than elsewhere. However, formaldehyde and acetaldehyde, which are formed in the air photochemically from volatile organic compounds (VOCs), declined only 20-21%. The collective cancer risk from exposure to these seven reviewed TACs declined 76%. Significant reduction in cancer risk to California residents from implementation of air toxics controls (especially for DPM) is expected to continue.

Determination of causal connectivities of species in reaction networks.

We present an approach to the determination of causal connectivities and part of the kinetics of complex reaction systems. Our approach is based on analytical and computational methods for studying the effects of a pulse change of concentration of a chemical species in a reaction network, either at equilibrium or in a nonequilibrium stationary state. Such disturbances generally propagate through a few species, depending on the values of the kinetic coefficients, before being broadened and dissipated. This short range gives a local probe of the kinetics and connectivity of the reaction network. The range of propagation also indicates species to perturb in further experiments. From piecing together these local connectivities, the global structure of the network can be constructed. The experimental design allows deduction of both reaction orders and rate constants in many cases. An example of the usefulness of the approach is illustrated on a model of a part of glycolysis.

Bifurcation structures of periodically forced oscillators.

A theoretical investigation of bifurcation structures of periodically forced oscillators is presented. In the plane of forcing frequency and amplitude, subharmonic entrainment occurs in v-shaped (Arnol'd) tongues, or entrainment bands, for small forcing amplitudes. These tongues terminate at higher forcing amplitudes. Between these two limits, individual tongues fit together to form a global bifurcation structure. The regime in which the forcing amplitude is much smaller than the amplitude of the limit cycle is first examined. Using the method of multiple time scales, expressions for solutions on the invariant torus, widths of Arnol'd tongues, and Liapunov exponents of periodic orbits are derived. Next, the regime of moderate to large forcing amplitudes is examined through studying a periodically forced Hopf bifurcation. In this case the forcing amplitude and the amplitude of the limit cycle can be of the same order of magnitude. From a study of the normal forms for this case, it is shown how Arnol'd tongues terminate and how complicated bifurcation structures are associated with strong resonances. Aspects of model and experimental chemical systems that show some of the phenomena predicted from the above theoretical results are mentioned.