Listening in the helping relationship.

Physical therapists have been reported to spend nearly one-quarter of their time with patients in listening or talking. Listening is an important tool for observation and a valuable information gathering medium. Interference with effective listening occurs when 1) the listener is unwilling to listen, 2) the listener attends only to what he wishes to hear, 3) the listener's thoughts wander, and 4) a language difference exists. Guidelines are provided for control of these problems within the context of physical therapy.

Sex-role stereotyping in health care: perceptions of physical therapists.

Eighty-nine physical therapists reported their observations and perceptions on six dimensions of sex-role stereotyping of women, either as patients or as providers of health care. Three dimensions focused on negative attitudes or beliefs about women as patients: female behavior, female physiology, and need for different standards of health care for men and women. The other three dimensions focused on women as health care providers: sex-role conflicts, male-dominant female-subordinate role play, and capacity for leadership. A significant majority of the participants did not believe that female patients are often stereotyped. They also disputed the belief that female health workers are viewed as sex objects, are passive in making recommendations, and are more limited in their effectiveness in leadership and in professional growth than are their male counterparts. They did perceive that female health workers experience certain career conflicts. We concluded that the respondents could not, or were unwilling to, attest to the dilemmas of female clients and providers in health care as claimed in recent literature.

Empathy: can it be learned and retained?

The effects of a one-semester course aimed at empathic discrimination and communication was measured 18 months after its completion. An experimental group of physical therapy students who had participated in the course and a control group who had not were given the Allied Health Professions Empathy Discrimination index and the Cartoon Listening Test. The results indicate that students who participated in the course were better able to respond empathically. Formal preparation in communication skills as described was both effective and lasting.

Physical therapists' knowledge of sexuality of adults with spinal cord injury.

Helping the adult with spinal cord injury to adjust to sexual limitations is an important and neglected part of his rehabilitation. Health professionals of all fields have been perceived to be deficient in their knowledge of the sexuality of the adult with spinal cord injury. A test with 40 statements reflecting myths, misconceptions, and truths about the effect of spinal cord injury on sexual function was administered to 30 physical therapists responsible for rehabilitating these adults. At least 28 of the 40 items were missed by 10 percent or more of the therapists. Experience and participation in educational programs appeared to contribute to the respondents' knowledge, as reflected by the test, but only experience was a statistically significant variable.

Productivity of respiratory therapy personnel.

An analysis was conducted of 630 periodic observations of work activities of 10 respiratory therapy personnel of a department during 14 consecutive days. It was found that the staff were spending about one-third of their working hours non-productively. The natures of the productive activities related to patient care were identified and each activity was categorized according to the level of difficulty and the skill required for performing it. The peak loads of the department were found to occur immediately before and after patients' meal hours and visiting hours. Nearly one-third of all the staff's productive time was spent administering IPPB. The personnel of various skill levels appeared to be performing different tasks regardless of their levels of difficulty.

Human relations skills of respriatory therapy supervisors.

The most critical factor in effective supervision is the supervisor's skill in human relations. A standardized test, the Supervisory Inventory of Human Relations, was administered to 39 credentialed respiratory therapists who were responsible for the work performance of at least two other individuals. It was found that (1) respiratory therapy supervisors are nearly comparable in this respect to industry's middle and top level management supervisors whose scores were available as norms, (2) respiratory therapy supervisors showed a lack of understanding in the principles of learning/training, development of positive attitudes, and the supervisor's role in management, and (3) relatively few of the subjects had received any formal preparation in human relations or pursued an advanced degree. Statistical analysis indicated that those who had attended human relations classes had scored significantly higher on the Inventory than those who had not (P less than .01).

Bacterial contamination potential of sterile, prefilled humidifiers and nebulizer reservoirs.

Contaminated respiratory therapy equipment may be responsible for the spread of pathogens to hospital patients. This study focused on the potential for contamination of prefilled, sterile, disposable water and saline systems for humidification and nebulization. Gas and liquid samples from 48 prepacked oxygen humidifier/cannula and 26 prepacked nebulization setups were taken at the initial application of devices and at 8, 24, 48, and 72 hour intervals, totaling 386 cultures. All samples from the humidifier units were found to be pathogen-free for up to 3 days. A total of six or 3.84% of the nebulizer samples showed contamination with Enterobacter cloacae after 8 to 24 hours of operation. It was concluded that the potential for contamination of the humidifiers is low for up to 72 hours, but the nebulizer units should be changed after 24 hours even though their contamination rate is markedly lower than that of conventional nondisposable units.

Static orthoses for the management of microstomia.

Microstomia is a complication of facial burns, traumatic injuries, scleroderma, or surgical reconstructions involving the oral aperture. A variety of orthoses for the correction or prevention of microstomia are offered by dentists, occupational therapists, physical therapists, and other specialists. This paper provides an overview of the structural and clinical features of 12 common tissue-borne or tooth-borne microstomia appliances. The review is intended to facilitate the selection of suitable orthoses, and to indicate the need for interdisciplinary management of microstomia patients.

Dynamic orthoses for the management of microstomia.

Oral wounds and burns may result in microstomia with significant management problems. An important early management decision involves the selection of an appliance capable of applying forces that will halt and reverse the condition. A selection appropriate to the patient may be based on the need for teeth suitably placed to retain and position a particular device. Limited access to the patient's mouth because of recent trauma, surgery, wiring, inability to tolerate anesthetic, etc., may further restrict choices. Thus, the process of selection involves a weighing of the specific patient's condition and program of treatment against an understanding of the unique features, including complexity of fabrication and durability, of the range of prostheses available. This article provides an overview of the structural and clinical characteristics of seven dynamic intraoral and extraoral microstomia appliances. The need for interdisciplinary management of microstomia with appliances has been noted, and opportunities for research have been pointed out.

Clinical trial of foam cushions in the prevention of decubitis ulcers in elderly patients.

Polyurethane foam cushions in a slab form or a customized contoured form are commonly used in wheelchairs to prevent the development of decubitus ulcers (DU) in elderly chronically ill persons. Sixty-two consenting subjects, 60 years or older, were randomly assigned to sit on one of the two types of cushions for 3 or more hours daily for 5 months. A total of 72 DU developed in the 52 subjects who completed the study. These were mostly in the areas of ischial tuberosities, buttocks, and thighs; were of persistent erythema level in severity; and took an average of 6 to 8 weeks to heal. No statistically significant differences were found in the incidence, location, severity, or healing time of the sores that developed in the subjects who used the slab (N = 26) and those who used the contoured (N = 26) cushions. But, more severe sores did develop among the slab cushion group in the area of ischial tuberosities. It appears that foam customization for elderly persons could be justified only if DU have been a particular problem in this region. Incontinence as a contributory factor to DU formation should receive careful attention with respect to prevention. The trials described are being continued, using a larger number of subjects.

Effectiveness: a neglected dimension in the assessment of rehabilitation devices and equipment.

Effectiveness is a term used by research methodologists when referring to the attributes of a new health care intervention (e.g. device, medication, or procedure) which if lacking may result in its rejection despite its efficacy and efficiency. Administrators and consumers increasingly require evidence to ensure that a proposed new product or manoeuvre not only 'works' (efficacy, efficiency) but is 'practical' (effective). Yet, effectiveness data are rarely described in research literature or adequately measured. Common effectiveness qualities that might be considered in the formal evaluation of new rehabilitation devices and equipment are cost, convenience to the user ('user-friendliness'), and compliance with the local standards. This article identifies some of the most important variables related to these attributes and suggests strategies for appropriate data collection and analysis. A comparison of two products evaluated in an institutional setting is used to illustrate the suggested method.

The role of alternating air and Silicore overlays in preventing decubitus ulcers.

Patients with chronic neurological diseases who were at high risk of decubitus ulcers were randomly assigned to alternating air on silicore mattress overlays for a period of 3 months. Of 148 subjects who completed the trial, more than 50% in each group developed one or more ulcers. No statistically significant differences between groups were found in the incidence, severity, healing duration or the location of the ulcers; with the exception of a significant difference (p less than 0.001) in the categorical location of the trochanters.

Pressure ulcer prophylaxis in elderly patients using polyurethane foam or Jay wheelchair cushions.

A significantly lower proportion of the patients in the Jay group (25%) experienced pressure ulcer formation during the three months of observation as compared to the foam group (41%). No statistically significant differences were found between groups on the location, severity, or healing duration of the pressure ulcers. Most lesions (65%) were limited to persistent erythema of intact skin, and healed in three to four weeks. Significantly higher proportions of patients in the Jay groups (7%) rejected their cushion because of discomfort as compared to foam (1%). The incidence of pressure ulcers was significantly higher among those patients who experienced peak interface pressures recorded at 60 mmHg or higher, had low Norton scores (< or = 11), or were malnourished.

Assessment of an infra-red non-contact sensor for routine skin temperature monitoring: a preliminary study.

The accuracy and reproducibility of a new non-contact sensor for monitoring skin temperature was examined. Thirty measurements taken by the device were compared with those taken by a commonly used thermocouple contact sensor. The result was a very high correlation coefficient (r = 0.9999). This accuracy was achieved with the probe held at an angle of 90 degrees 1 cm from the skin. Changes in angle and distance were found to contribute to measurement error. Little difference was found between 39 pairs of measurements taken of the left and right sides of subjects. However, intra-subject variability was noted with respect to the dermotomal segmental fields. Inter-tester reliability analysis resulted in a correlation of r = 0.937 involving two independent testers and 26 pairs of measurements. These preliminary data will be used for power calculations to study further the device which we found to be simple to operate, portable, and practical for routine clinical use. This sensor may have applications in the diagnosis of nerve and vascular disorders and in prospective monitoring of skin conditions such as bony areas at risk of pressure ulcers.

Work sampling: a tool in management.

"Work sampling" was used to determine the productivity of the employees of a small occupational therapy department and the nature and extent of the activities in which they were involved. Twelve general categories of activities were identified--peak loads occurred on Wednesday each week between 9:10 to 11:30 a.m., and daily between 1:40 to 3:20 p.m. It was found that the therapists spent more of their working hours productively compared to an aide's productive time. "Work sampling" is a convenient and inexpensive technique that may be used by small or large departments to justify staff size, hours of work, and assignments on the basis of activities and productivity.

An assessment of occupational therapists' roles and attitudes toward sexual rehabilitation of the disabled.

Sexual adjustment is believed to be a fundamental aspect of the medical and psychosocial rehabilitation of the disabled and chronically ill. A sample of 26 occupational therapists involved in adult rehabilitation services were given a list of specific tasks identified in the literature to be related to medical (physical) aspects of sexual rehabilitation. The results indicated that a small percentage of occupational therapists participate in these tasks. The majority believed that the tasks were important in occupational therapy but that their preparation to perform the tasks was inadequate. The subjects, as a group, held positive attitudes toward sexual rehabilitation and considered it a legitimate aspect of health care for which an appropriate content should be integrated into the basic curricula in occupational therapy.

The user--friendliness of protective support surfaces in prevention of pressure sores.

Special mattress overlays and seat cushions for the prevention of pressure sores constitute a large portion of the rehabilitation products market. Consumers frequently face economic concerns in choosing among these products. This article summarizes the favorable and unfavorable features of major support surface types: foam, air-filled, flotation, and alternating air. A careful consideration of characteristics, such as fire safety, patient comfort, and ease of transfer and handling, may facilitate selection and result in more satisfied users and caregivers.

Costs and acceptability of two special overlays for the prevention of pressure sores.

In a randomized clinical trial, 187 adult patients with chronic neurologic conditions who were at a high risk of developing pressure sores were assigned for 3 months to either an alternating air (AA) mattress overlay or a silicore (S) mattress overlay. Costs associated with each overlay were calculated and compared by adding depreciation and yearly expenses related to maintenance, operation, and repair for 148 patients who completed the trial. Acceptability was measured by questionnaires and interviews involving 45 of the patients' primary nurses and a sample of 40 patients (20 from each overlay group). The annual cost of the AA overlay was 54% more than that of the S overlay. Although most nurses (more than 74%) believed that both overlays helped prevent pressure sores and deter their progression, many (more than 56%) would not recommend either type to other facilities or to patients at home due to specific negative features. Implications for manufacturers, investigators, clinicians, and administrators are identified.

Methods of selection of hospital equipment.

With increasingly specialized and sophisticated equipment on the market, our procedures for evaluating possible alternative products must become more scientific and reliable than simply performing cost comparisons and depending on good faith.

Overseas careers in allied health professions.

As the allied health services gain recognition in other countries, an increasing number of overseas positions are becoming available to American professionals. There is considerable confusion as to the realities of international employment. This article provides information intended to guide persons who might be interested in careers abroad.