Patient Care Boards - A tool to promote patient participation during hospital ward rounds.

Objective: This pre-post intervention study investigated the effectiveness of the Patient Care Board (PCB) as a tool to increase the participation of patients and relatives during hospital ward rounds. Methods: Using The Activity Barometer (TAB), we rated 121 video-recorded rounds to compare participation before and after implementing the PCB into clinical practice. Associations between scores for the extent to which patients ask questions or express preferences and concerns were tested with multiple linear regression. Results: TAB-scores tended to be higher after implementing the PCB, especially for the relatives. However, no significant differences were found. The greatest impact on participation was time spent on rounds (p < 0.001). Preparing questions in advance of the round, as well as using anatomical drawings for explanations, increased patient participation (p = 0.041, 0.024). Furthermore, the implementation of the PCB led to higher nurse attendance (p = 0.003). Conclusion: Although we found tendencies towards higher participation, the study could not confirm a significant impact of the overall intervention. Innovation: Our results suggest that further research is needed, to ensure a higher degree of preparation among the patients, better opportunities for relatives to participate as well as integration of visual information in the rounds.

Communication Skills Training: A Means to Promote Time-Efficient Patient-Centered Communication in Clinical Practice.

PURPOSE: We hypothesized that health care providers would behave in a more patient-centered manner after the implementation of communication skills training, without causing the consultation to last longer. METHODS: This study was part of the large-scale implementation of a communication skills training program called "Clear-Cut Communication With Patients" at Lillebaelt Hospital in Denmark. Audio recordings from real-life consultations were collected in a pre-post design, with health care providers' participation in communication skills training as the intervention. The training was based on the Calgary-Cambridge Guide, and audio recordings were rated using the Observation Scheme-12. RESULTS: Health care providers improved their communication behavior in favor of being more patient-centered. Results were tested using a mixed-effect model and showed significant differences between pre- and postintervention assessments, with a coefficient of 1.3 (95% Cl: 0.35-2.3; P=0.01) for the overall score. The consultations did not last longer after the training. CONCLUSIONS: Health care providers improved their communication in patient consultations after the implementation of a large-scale patient-centered communication skills training program based on the Calgary-Cambridge Guide. This did not affect the length of the consultations.

Codebook for rating clinical communication skills based on the Calgary-Cambridge Guide.

BACKGROUND: The aim of the study was to confirm the validity and reliability of the Observation Scheme-12, a measurement tool for rating clinical communication skills. METHODS: The study is a sub-study of an intervention study using audio recordings to assess the outcome of communication skills training. This paper describes the methods used to validate the assessment tool Observation Scheme-12 by operationalizing the crude 5-point scale into specific elements described in a codebook. Reliability was tested by calculating the intraclass correlation coefficients for interrater and intrarater reliability. RESULTS: The validation of the Observation Scheme-12 produced a rating tool with 12 items. Each item has 0 to 5 described micro-skills. For each item, the codebook described the criteria for delivering a rating from 0 to 4 depending on how successful the different micro-skills (or number of used jargon words) was accomplished. Testing reliability for the overall score intraclass correlation coefficients was 0.74 for interrater reliability and 0.86 for intrarater reliability. An intraclass correlation coefficient greater than 0.5 was observed for 10 of 12 items. CONCLUSION: The development of a codebook as a supplement to the assessment tool Observation Scheme-12 enables an objective rating of audiotaped clinical communication with acceptable reliability. The Observation Scheme-12 can be used to assess communication skills based on the Calgary-Cambridge Guide.

Translation and cultural adaptation of the Communication Assessment Tool (CAT), developing a Danish and Norwegian version.

OBJECTIVE: To translate and cultural adapt the 14-item Communication Assessment Tool (CAT) into Norwegian and Danish, making them as similar as possible. DESIGN: This was a translation and validation study including individual interviews for content and face validity and a patient survey for internal consistency and floor-ceiling effect. SETTING: Outpatient clinic at the Department of Internal Medicine, Lillebaelt Hospital, Denmark and a Norwegian general practice. PARTICIPANTS: Ten patients were included for individual interviews and 440 participants completed the survey. MAIN OUTCOME MEASURE: Translation and validation of the CAT. RESULTS: Despite minor differences in the use of words in the translated versions of CAT, the final versions were very similar. Based on the content and face validation and after agreement with the developers, it was decided to include a 'non-applicable' answering option, not a part of the original version. The use of 'non-applicable' for each item ranged from 0% to 30% in Norway and from 0% to 6.1% in Denmark. The overall CAT score, i.e. items rated excellent, were 55.5% in Norway and 50.3% in Denmark. For each item, the CAT score ranged between 31.3% and 69.8% in Norway and 33.7% and 57.4% in Denmark. CONCLUSION: The translated and validated CAT can be used to measure patients' perspectives on clinicians' communication skills in Denmark and Norway.

Efficacy of FDG PET/CT imaging for venous thromboembolic disorders: preliminary results from a prospective, observational pilot study.

PURPOSE: In recent years, several case reports have described venous thromboembolism (VTE) on FDG PET/CT. In this short communication, we present results from a proof-of-concept pilot study aimed at providing some preliminary data on the efficacy of FDG PET/CT in prospective patients with suspected VTE. PATIENTS AND METHODS: Fifteen patients with suspected deep venous thrombosis (DVT) and/or pulmonary embolism (PE) were included prospectively and underwent a whole-body FDG PET/CT. Patients were divided into 4 groups as follows: DVT+ (DVT proven by high clinical suspicion and positive compression ultrasound), DVT- (DVT ruled out by low clinical suspicion and negative compression ultrasound), PE+ (PE proven by high clinical suspicion and positive lung scintigraphy), and PE- (PE ruled out by low clinical suspicion and normal lung scintigraphy). Images were interpreted visually by 2 experienced nuclear medicine physicians independently and without knowledge of other imaging results. RESULTS: Seven DVT+, 6 DVT-, 6 PE+, and 1 PE- were included. Five patients were suspected of both DVT and PE. FDG PET/CT correctly diagnosed the presence or lack of DVT in all patients, whereas results are more ambiguous in PE with only 2 of 6 PE patients showing FDG avidity. The readers agreed in all cases. CONCLUSIONS: Although further studies are warranted for further clarification, our preliminary data substantiate that FDG PET/CT is a viable modality for assessing VTE, at least for DVT. We believe our results add positively to the limited data on this subject and are promising enough to warrant further larger series.