Three strategies when physicians provide complex information in interactions with patients: How to recognize and measure them.

OBJECTIVE: To define and operationalize three taught strategies for providing information in interactions with patients using videos collected in a randomized controlled trial (RCT). METHODS: This was a qualitative exploratory study embedded in a randomized controlled design, using microanalysis of face-to-face dialogue as an inductive video analysis method to operationalize physicians' use of three information-provision strategies. Data were 34 video-recorded simulated (but unscripted) interactions between 17 physicians and 34 multiple sclerosis patients collected before and after a brief course on information provision. We operationalized (1) mapping the patient's preferences and (2) checking the patient's understanding, and pauses indicative of (3) portioning information. RESULTS: Results are detailed analytical definitions, criteria, and assessable, quantifiable outcomes for each of the three strategies. Patients responded to portioning pauses as expected: whereas 91% of these pauses elicited an immediate patient response, only 23% of non-portioning pauses did so. CONCLUSION: Our methods revealed how to define and evaluate information sharing strategies physicians used within the contingencies of clinical interaction. PRACTICE IMPLICATIONS: Findings provide applicable methods to teach, analyze, and evaluate information sharing strategies and indications for further training.

Development of a measurement system for complex oral information transfer in medical consultations.

BACKGROUND: Information exchange between physician and patient is crucial to achieve patient involvement, shared decision making and treatment adherence. No reliable method exists for measuring how much information physicians provide in a complex, unscripted medical conversation, nor how much of this information patients recall. This study aims to fill this gap by developing a measurement system designed to compare complex orally provided information to patient recall. METHODS: The development of the complex information transfer measurement system required nine methodological steps. Core activities were data collection, definition of information units and the first draft of a codebook, refinement through independent coding and consensus, and reliability testing. Videotapes of physician-patient consultations based on a standardized scenario and post-consultation interviews with patients constituted the data. The codebook was developed from verbatim transcriptions of the videotapes. Inter-rater reliability was calculated using a random selection of 10% of the statements in the transcriptions. RESULTS: Thirtyfour transcriptions of visits and interviews were collected. We developed a set of rules for defining a single unit of information, defined detailed criteria for exclusion and inclusion of relevant units of information, and outlined systematic counting procedures. In the refinement phase, we established a system for comparing the information provided by the physician with what the patient recalled. While linguistic and conceptual issues arose during the process, coders still achieved good inter-rater reliability, with intra-class correlation for patient recall: 0.723, and for doctors: 0.761. A full codebook is available as an appendix. CONCLUSIONS: A measurement system specifically aimed at quantifying complex unscripted information exchange may be a useful addition to the tools for evaluating the results of health communication training and randomized controlled trials.

Using simulated rainfall to evaluate field and indoor surface runoff phosphorus relationships.

While numerous studies have evaluated the efficacy of outdoor rainfall simulations to predict P concentrations in surface runoff, few studies have linked indoor rainfall simulations to P concentrations in surface runoff from agricultural fields. The objective of this study was to evaluate the capacity of indoor rainfall simulation to predict total dissolved P concentrations [TP(<0.45)] in field runoff for four dominant agricultural soils in South Dakota. Surface runoff from 10 residue-free field plots (2 m wide by 2 m long, 2-3% slope) and packed soil boxes (1 m long by 20 cm wide by 7.5 cm high, 2-3% slope) was compared. Surface runoff was generated via rainfall simulation at an intensity of 65 mm h(-1) and was collected for 30 min. Packed boxes produced approximately 24% more runoff (range = 2.8-3.4 cm) than field plots (range = 2.3-2.7 cm) among all soils. No statistical differences in either TP(<0.45) concentration or TP(<0.45) loss was observed in runoff from packed boxes and field plots among soil series (0.17 < P < 0.83). Three of four soils showed significantly more total P lost from packed boxes than field plots. The TP(<0.45) concentration in surface runoff from field plots can be predicted from TP(<0.45) concentration in surface runoff from the packed boxes (0.68 < r(2) < 0.94). A single relationship was derived to predict field TP(<0.45) concentration in surface runoff using surface runoff TP(<0.45) concentration from packed boxes. Evidence is provided that indoor runoff can adequately predict TP(<0.45) concentration in field surface runoff for select soils.

Intracellular synthesis of Clostridium botulinum type B toxin. I. Demonstration of toxin synthesis and sedimentation studies on toxic products.

The synthesis and nature of the toxin of Clostridium botulinum type B were studied in growing cells. It was demonstrated that the toxin was synthesized in the latter stage of logarithmic growth and was released into the culture supernatant fluid during lysis of the cells. Studies were done on the sedimentation properties of intracellular toxin. Two components were demonstrated, one of low molecular weight and low specific activity and one of high molecular weight with specific activity similar to that isolated from culture lysates. The high molecular weight toxin was shown to be composed of an aggregate of small subunits, separable with either high ionic strength or sodium dodecyl sulfate.

Purification and characterization of Clostridium botulinum type B oxin.

Gerwing, Julia (The University of British Columbia, Vancouver, B.C., Canada), Claude E. Dolman, David V. Kason, and Jack H. Tremaine. Purification and characterization of Clostridium botulinum type B toxin. J. Bacteriol. 91:484-487. 1966.-A toxic component of low molecular weight has been isolated from a type B strain of Clostridium botulinum by methods involving ammonium sulfate precipitation and elution through diethylaminoethyl cellulose at pH 5.6. The material thus isolated was shown to be monophoretic and monodisperse in the ultracentrifuge. End-group analysis indicated the presence of a single N-terminal amino acid residue, which was identified as arginine. On the basis of biophysical studies and amino acid analyses, a molecular weight between 9,000 and 10,000 was calculated.