Radiographic method to assess the prevalence of sacral spina bifida occulta.

Spina bifida occulta of the sacrum is the most common type of spinal deformity. Many authors have published data on the frequency of spina bifida occulta, with varying results. Some possible reasons for this variability could include the differing methods used to gather data and differing ways of classifying the condition. This study attempts to develop an X-ray method to study sacral spina bifida occulta in a standardized fashion, using an angulated antero-posterior technique. This technique is then used to estimate the frequency of sacral spina bifida occulta in an Australian sample. The sacra of 53 cadavers were X-rayed and the level of closure of the sacral spinal canal recorded. The X-ray technique was validated by open dissection of six of the cadavers studied and was shown to be accurate to half a sacral segment. No sacra with a completely open sacral canal were found, two sacra (4%) were open from S2 down to S5 and ten sacra (19%) were open from S3 down to S5. The most common condition (43%) recorded was where S4 and S5 only were open. Eighteen cadavers (34%) showed only S5 open, and interestingly, no sacra were recorded as having the dorsal sacral arch completely closed. A study of a larger sample will follow using the validated X-ray technique.

Strategic physician communication and oncology clinical trials.

PURPOSE: Clinical trials are the primary means for determining new, effective treatments for cancer patients, yet the number of patients that accrue is relatively limited. The purpose of this study was to explore the relationship between physician behavior and patient accrual to a clinical trial by videotaping the interaction. PATIENTS AND METHODS: Forty-eight patient-physician interactions involving 12 different oncologists were videotaped in several clinics at the H. Lee Moffitt Cancer Center and Research Institute (Tampa, FL). The purpose of each interaction was to present the possibility of a clinical trial to the patient. A coding system, the Moffitt Accrual Analysis System, was developed by the authors to code behaviors that represented both the legal-informational and social influence models of communication behavior. Thirty-two patients agreed to participate in the clinical trial. RESULTS: Videotaping was found to be a viable, valid, and reliable method for studying the interaction. Physicians who were observed to use both models of influence were found to enroll more patients. Thus, patients were more likely to accrue to the trial when their physician verbally presented items normally included in an informed consent document and when they behaved in a reflective, patient-centered, supportive, and responsive manner. Discussion of benefits, side effects, patient concerns and resources to manage the concerns were all associated with accrual. CONCLUSION: This research has implications for modifying physician behavior and, thus, increasing the numbers of patients accruing to oncology clinical trials.

The crisis of cancer: psychological impact on family caregivers.

Cancer causes changes in the family's identity, roles, and daily functioning. Studies document that spouses are as distressed as cancer patients and that spousal and patient distress are correlated. Three major areas of caregiver concern are: fear of cancer and its spread, helping patients deal with the emotional ramifications of the disease, and managing the disruptions caused by cancer. From 20% to 30% of partners suffer from psychological impairment and mood disturbance as a result of the spouse's cancer. Factors that may predict high levels of spousal distress include: disease stage; emotional adjustment of the patient; gender, age, and other characteristics of the spouse; marital adjustment; and family functioning. Studies show that interventions do not reduce spousal distress. Future studies should explore the role of mediating factors, such as coping style, marital adjustment, and family functioning, on the relationship between illness demands or prognosis and distress. Interventions could then be targeted to high-risk individuals.

Communication, accrual to clinical trials, and the physician-patient relationship: implications for training programs.

BACKGROUND: Previous studies have demonstrated that less than 20% of fully eligible patients participate in cancer clinical trials. One of the major factors determining whether patients will be successfully accrued to trials is the quality of the communication occurring between the physician and patient (and family members if present). The accrual process is embedded within the longer-term relationship between the physician and the patient. It is argued that the interaction occurring during the consent process is part of an "alliance building" that the physician and patient use to confront the uncertainty inherent in both the disease itself and the outcome of therapy. METHODS AND RESULTS: The authors describe the framework of a study currently under way in which they are tracking the variation in ways that this interaction is managed by a sample of oncologists and their patients. Physicians and patients are simultaneously filmed and viewed in a split-screen format. A coding system is being developed to analyze the congruence between physicians and patients as they encode and decode sequences of verbal and nonverbal messages. The goal is to understand how physicians and patients manage uncertainty related to the disease and its outcomes. CONCLUSIONS: The authors suggest implications of these observed patterns for the broader range of communicative competencies that medical students must learn.

Advances in segmentation modeling for health communication and social marketing campaigns.

Large-scale communication campaigns for health promotion and disease prevention involve analysis of audience demographic and psychographic factors for effective message targeting. A variety of segmentation modeling techniques, including tree-based methods such as Chi-squared Automatic Interaction Detection and logistic regression, are used to identify meaningful target groups within a large sample or population (N = 750-1,000+). Such groups are based on statistically significant combinations of factors (e.g., gender, marital status, and personality predispositions). The identification of groups or clusters facilitates message design in order to address the particular needs, attention patterns, and concerns of audience members within each group. We review current segmentation techniques, their contributions to conceptual development, and cost-effective decision making. Examples from a major study in which these strategies were used are provided from the Texas Women, Infants and Children Program's Comprehensive Social Marketing Program.

Communicating with staff nurses: support or hostility?

Communication researchers specializing in social support determine factors that influence and make up supportive encounters in the hospital environment. Effective communication strategies provide a vital dyad's link between nurse managers and staff nurses. Thus, supportive relationships are formed that can ease stressful situations and encourage innovative ideas.