Ylisabyth S. Bradshaw

The Internet as a Health Information Source: Findings from the 2007 Health Information National Trends Survey and Implications for Health Communication

A wealth of health information is available online, but we do not fully understand the implications for health communication. This study examined whether health information seekers who turn to the Internet first differ from those who turn elsewhere. Data from the 2,338 respondents to the mail portion of the National Cancer Institutes Health Information National Trends Survey (HINTS) 2007 who reported looking for health information for themselves were analyzed. Logistic regression was used to examine whether health information seekers turning to the Internet first differed in terms of demographics, information preferences and seeking confidence, and communication with providers from those using other sources. In the final model, Internet users were younger, more educated, higher income, preferred numbers rather than words to describe chance, and think it is very important to get personal medical information electronically. There were no differences in terms of gender, health status, confidence seeking health information, or communication with providers. Health information seekers who turn to the Internet first are different, both in terms of demographics and information preferences. As the use of communication technologies increases, health communicators need to be attentive to the potential for communication inequalities.

Communicating the Experience of Chronic Pain and Illness Through Blogging

Background Although more individuals are sharing their experiences with chronic pain or illness through blogging (writing an Internet web log), research on the psychosocial effects and motivating factors for initiating and maintaining a blog is lacking. Objective The objective was to examine via online questionnaire the perceived psychosocial and health benefits of blogging among patients who use this media to communicate their experience of chronic pain or illness. Methods A 34-item online questionnaire was created, tested, and promoted through online health/disease forums. The survey employed convenience sampling and was open from May 5 to July 2, 2011. Respondents provided information regarding demographics, health condition, initiation and upkeep of blogs, and dynamics of online communication. Qualitative data regarding respondents’ blogging experiences, expectations for blogging, and the perceived effects from blogging on the blogger’s health, interpersonal relationships, and quality of life were collected in the form of written narrative. Results Out of 372 respondents who started the survey, 230 completed the entire questionnaire. Demographic data showed survey respondents to be predominantly female (81.8%) and highly educated (97.2% > high school education and 39.6% with graduate school or professional degrees). A wide spectrum of chronic pain and illness diagnoses and comorbidities were represented. Respondents reported that initiating and maintaining an illness blog resulted in increased connection with others, decreased isolation, and provided an opportunity to tell their illness story. Blogging promoted accountability (to self and others) and created opportunities for making meaning and gaining insights from the experience of illness, which nurtured a sense of purpose and furthered their understanding of their illness. Conclusions Results suggest that blogging about chronic pain and illness may decrease a sense of isolation through the establishment of online connections with others and increases a sense of purpose to help others in similar situations. Further study involving a larger sample size, a wider range of education levels, and respondents with different types and magnitudes of illnesses will be needed to better elucidate the mechanism of the observed associations in this understudied area.

Discussion of Sexual Risk Behavior in HIV Care is Infrequent and Appears Ineffectual: A Mixed Methods Study

Consensus guidelines in HIV care call for clinicians to provide a brief sexual risk behavioral intervention in each visit. Studies based on participant reports find this occurs infrequently, but studies based on direct observation of clinical encounters are lacking. We conducted a mixed method study that used audio recordings of 116 routine outpatient visits by 58 different patients with HIV, in five different practice sites. Transcripts of the visits were coded and analyzed using a quantitative system. In addition, we conducted a qualitative analysis of the dialogue segments in which sexual risk behaviors arose as a topic. Discussion of sexual risk behavior occurred in 10 visits, and was generally quite brief. Two visits featured substantial counseling about sexual risk reduction; two others included substantial discussion which was not evidently directed at the patient’s changing behavior. Cues suggesting a need or opportunity for such discussion that physicians did not follow up on occurred in seven additional visits. Interactions about sexual risk had less patient engagement than interactions about other health behaviors. Physicians seldom provide sexual risk reduction counseling in HIV care, even where specific indications are present.

Respiratory hygiene in the emergency department.

The emergency department (ED) is an essential component of the public health response plan for control of acute respiratory infectious threats. Effective respiratory hygiene in the ED is imperative to limit the spread of dangerous respiratory pathogens, including influenza, severe acute respiratory syndrome, avian influenza, and bioterrorism agents, particularly given that these agents may not be immediately identifiable. Sustaining effective respiratory control measures is especially challenging in the ED because of patient crowding, inadequate staffing and resources, and ever-increasing numbers of immunocompromised patients. Threat of contagion exists not only for ED patients but also for visitors, health care workers, and inpatient populations. Potential physical sites for respiratory disease transmission extend from out-of-hospital care, to triage, waiting room, ED treatment area, and the hospital at large. This article presents a summary of the most current information available in the literature about respiratory hygiene in the ED, including administrative, patient, and legal issues. Wherever possible, specific recommendations and references to practical information from the Centers for Disease Control and Prevention are provided. The “Administrative Issues” section describes coordination with public health departments, procedures for effective facility planning, and measures for health care worker protection (education, staffing optimization, and vaccination). The patient care section addresses the potentially infected ED patient, including emergency medical services concerns, triage planning, and patient transport. “Legal Issues” discusses the interplay between public safety and patient privacy. Emergency physicians play a critical role in early identification, treatment, and containment of potentially lethal respiratory pathogens. This brief synopsis should help clinicians and administrators understand, develop, and implement appropriate policies and procedures to address respiratory hygiene in the ED. The emergency department (ED) is an essential component of the public health response plan for control of acute respiratory infectious threats. Effective respiratory hygiene in the ED is imperative to limit the spread of dangerous respiratory pathogens, including influenza, severe acute respiratory syndrome, avian influenza, and bioterrorism agents, particularly given that these agents may not be immediately identifiable. Sustaining effective respiratory control measures is especially challenging in the ED because of patient crowding, inadequate staffing and resources, and ever-increasing numbers of immunocompromised patients. Threat of contagion exists not only for ED patients but also for visitors, health care workers, and inpatient populations. Potential physical sites for respiratory disease transmission extend from out-of-hospital care, to triage, waiting room, ED treatment area, and the hospital at large. This article presents a summary of the most current information available in the literature about respiratory hygiene in the ED, including administrative, patient, and legal issues. Wherever possible, specific recommendations and references to practical information from the Centers for Disease Control and Prevention are provided. The “Administrative Issues” section describes coordination with public health departments, procedures for effective facility planning, and measures for health care worker protection (education, staffing optimization, and vaccination). The patient care section addresses the potentially infected ED patient, including emergency medical services concerns, triage planning, and patient transport. “Legal Issues” discusses the interplay between public safety and patient privacy. Emergency physicians play a critical role in early identification, treatment, and containment of potentially lethal respiratory pathogens. This brief synopsis should help clinicians and administrators understand, develop, and implement appropriate policies and procedures to address respiratory hygiene in the ED.

Time to Flip the Pain Curriculum

W ITh reluctance, the Nobel Laureate Richard Feynman was persuaded in 1961 to teach introductory physics to undergraduates at California Institute of Technology, Pasadena, California. his creativity and insight led him to approach this challenge in a novel way, producing an iconic series of lectures and a landmark text that has inspired students for over 50 yr. Today’s educational innovators speak of “flipping the classroom”: using Internet-based distance learning to convey factual content, thereby freeing up time in face-toface or online class discussions to explore students’ questions about content or assignments. A concurrent trend in this era of patient-centered practice is the increasing attention given to pain in medical education.2 We believe, however, that the now-standard approach to pain education, which begins with and emphasizes processes at the subcellular and cellular scale, poorly prepares trainees to assess and treat pain in everyday clinical practice. The anesthesiologists Beecher and Bonica demonstrated that context plays a major role in the experience of acute or chronic pain, an insight that led Melzack and Wall to propose their seminal “gate theory” of endogenous modulation of nociception.3 Recent anatomical (e.g., functional magnetic resonance imaging) and biochemical (e.g., oxytocin related) studies affirm and extend earlier evidence that a dysphoric social dimension involving isolation, withdrawal, distress, and often stigma contributes to the multidimensional experience of pain nearly as much as does nociception per se.4 Every mother who soothes and promptly settles down her crying toddler after a minor scrape or tumble— essentially, every mother—knows this instinctively. In contrast, the clinician trained to think that “mechanism-based pain therapy” is limited to an initial appraisal to decide whether the patient’s pain is neuropathic or nociceptive, followed by detailed testing to assign a phenotype of aberrant ion channel expression or other cellular-level phenomena, risks overlooking mechanisms involving group processes. however, group processes (e.g., family, job, culture, religion) unquestionably mold the experience, report, and response to therapy of acute, chronic, and cancer-related pain. Failure to address the social dimensions of pain can render rehabilitative efforts futile.5 For the above reasons, and inspired by Feynman’s bold inversion, we propose that pain education could be improved by “flipping the curriculum.” In this new approach, students would be offered a perspective on pain as a population-based social phenomenon whose mechanisms and mediators at the cellular level have evolved through evolutionary differentiation and selection over hundreds of millions of years.6 In other words, we propose to reframe the pain curriculum from its current standard formulation as a bottom-up “biopsychosocial” phenomenon to a top-down “sociopsychobiological” one. We believe that “hard” scientific evidence supporting the reframing of pain as an interpersonal, inherently social process has accumulated to reach a tipping point such that relatively little effort will be needed to implement this change.2,4,7 how is the biopsychosocial model of pain taught at present? Typically, early chapters or opening lectures emphasize Time to Flip the Pain Curriculum?

How Do I Ask About Your Disability? An Examination of Interpersonal Communication Processes Between Medical Students and Patients with Disabilities

Medical student behaviors were examined through digital recordings of interpersonal skills communication training framed around a brief curriculum on disability within a family medicine clerkship. This analysis focuses on interpersonal communication processes and ways medical students ask standardized patient educators about visually apparent disability (N = 142). Primary themes of asking about or avoiding disability were identified with regard to language and nonverbal communication in how medical students asked and whether they integrated chronic disability with new musculoskeletal pain complaints. Secondary themes related to timing and communication further contextualized the primary themes. Seventy-four percent of students asked about the disability. Analysis of feedback sessions immediately following the interactions revealed that more than half the students who did not ask about disability spontaneously recognized that they avoided disability language. Results suggest that some ways of asking about disability may inhibit patient disclosure and restrict relationship building. In particular, asking about disability, but then avoiding integrating disability disclosure into the treatment plan, or responding to disability-related disclosure with overly positive, infantilizing-type communication, may pose more difficult dilemmas than never asking about the disability. On the contrary, students who ignored disability altogether often also recognized they missed disability cues, thus providing a learning experience of considerable value. Underlying student attitudes and possibilities for integrating biomedical concerns with social–psychological impacts of disability are addressed.

Mutual Influence Processes in Physician-Patient Communication: An Interaction Adaptation Perspective

The current study proposes that physicians and patients become more similar over the course of the interaction in their nonverbal rapport-building behaviors and talk about roles and relationships; and, conversely, that they diverge from one another in their negative nonverbal behaviors and talk about the organization and delivery of care. Physicians and patients in continued-care interactions (N = 34) were videotaped and analyzed. Results provide evidence for physicians and patients becoming more similar in smiling and head nodding; diverging in their negative eye behaviors, sentence disfluencies, and talk about barriers to wellness; and changes in both similarity and divergence in their relationship talk. Implications for relationship-centered care and dyadic analysis of physician-patient interactions are described.

Respiratory Hygiene in the Emergency Department

The emergency department (ED) is an essential component of the public health response plan for control of acute respiratory infectious threats. Effective respiratory hygiene in the ED is imperative to limit the spread of dangerous respiratory pathogens, including influenza, severe acute respiratory syndrome, avian influenza, and bioterrorism agents, particularly given that these agents may not be immediately identifiable. Sustaining effective respiratory control measures is especially challenging in the ED because of patient crowding, inadequate staffing and resources, and ever-increasing numbers of immunocompromised patients. Threat of contagion exists not only for ED patients but also for visitors, health care workers, and inpatient populations. Potential physical sites for respiratory disease transmission extend from out-of-hospital care, to triage, waiting room, ED treatment area, and the hospital at large. This article presents a summary of the most current information available in the literature about respiratory hygiene in the ED, including administrative, patient, and legal issues. Wherever possible, specific recommendations and references to practical information from the Centers for Disease Control and Prevention are provided. The “Administrative Issues” section describes coordination with public health departments, procedures for effective facility planning, and measures for health care worker protection (education, staffing optimization, and vaccination). The patient care section addresses the potentially infected ED patient, including emergency medical services concerns, triage planning, and patient transport. “Legal Issues” discusses the interplay between public safety and patient privacy. Emergency physicians play a critical role in early identification, treatment, and containment of potentially lethal respiratory pathogens. This brief synopsis should help clinicians and administrators understand, develop, and implement appropriate policies and procedures to address respiratory hygiene in the ED. The emergency department (ED) is an essential component of the public health response plan for control of acute respiratory infectious threats. Effective respiratory hygiene in the ED is imperative to limit the spread of dangerous respiratory pathogens, including influenza, severe acute respiratory syndrome, avian influenza, and bioterrorism agents, particularly given that these agents may not be immediately identifiable. Sustaining effective respiratory control measures is especially challenging in the ED because of patient crowding, inadequate staffing and resources, and ever-increasing numbers of immunocompromised patients. Threat of contagion exists not only for ED patients but also for visitors, health care workers, and inpatient populations. Potential physical sites for respiratory disease transmission extend from out-of-hospital care, to triage, waiting room, ED treatment area, and the hospital at large. This article presents a summary of the most current information available in the literature about respiratory hygiene in the ED, including administrative, patient, and legal issues. Wherever possible, specific recommendations and references to practical information from the Centers for Disease Control and Prevention are provided. The “Administrative Issues” section describes coordination with public health departments, procedures for effective facility planning, and measures for health care worker protection (education, staffing optimization, and vaccination). The patient care section addresses the potentially infected ED patient, including emergency medical services concerns, triage planning, and patient transport. “Legal Issues” discusses the interplay between public safety and patient privacy. Emergency physicians play a critical role in early identification, treatment, and containment of potentially lethal respiratory pathogens. This brief synopsis should help clinicians and administrators understand, develop, and implement appropriate policies and procedures to address respiratory hygiene in the ED.

Lessons From an Acupuncture Teaching Clinic: Patient Characteristics and Pain Management Effectiveness

OBJECTIVES To understand the following about patients using an acupuncture teaching clinic: (1) sociodemographic characteristics and main complaints and (2) self-reported level of patient-centered outcomes regarding pain management. METHODS/DESIGN Retrospective chart review. SUBJECTS A total of 458 new patients at NESA clinic during October 1, 2009 to July 31, 2010 were enrolled in the study. INTERVENTIONS A variety of styles of Oriental medicine, primarily Chinese and Japanese style acupuncture and also heat treatments (MOXA or heat lamps) and Tui Na (Asia bodywork). RESULTS Results from Objective 1 were descriptive (n = 421). Objective 2 focused on the 59 patients from the larger sample who completed both an initial and a follow-up Measure Your Medical Outcome Profile (MYMOP) form and who used acupuncture for pain management of (1) diseases of the musculoskeletal system and/or connective tissue or (2) migraine/headache. Both the symptom severity and activity of daily living/well-being scales of the MYMOP showed over 15.8% improvement from baseline to at least six weeks of treatment: 28.6% for Symptom 1, 19.4% for Symptom 2, 35.7% for activities of daily living, and 25.0% for well-being. The relative majority for each sociodemographic trait investigated were as follows: female, about 40 years old, white, not Hispanic or Latino, married, highly educated, and employed. Most patients were confident in acupuncture treatment. Out of the 421 acupuncture patients, 68.2% wanted acupuncture in order to manage pain. Overall, 20.6% of the patients (59, N = 287) who used acupuncture for pain management for diseases of the musculoskeletal system and/or connective tissue or migraine or headache completed the sixth-week follow-up MYMOP form. Of these patients, 57.6% (34, N = 59) returned during week 6 of the semester for acupuncture treatment and reported clinical improvement in at least one MYMOP severity score, and no score got worse. CONCLUSIONS The information about sociodemographic characteristic and patient-centered outcomes of pain management can be used for service provision, future study planning, and marketing. Future studies should address the low follow-up rate, the quality of self-reported clinic data, and the reasons that patients chose acupuncture treatments and teaching clinics.

Deconstructing One Medical School's Pain Curriculum: I. Content Analysis

Objective Inventory one medical schools first- and second-year pain-related curriculum in order to explore opportunities to teach about pain both as a social, population-based process and as a neuron-centered phenomenon. Design Deconstruction of pain-related curricular content through a detailed content inventory and analysis by students and faculty. Setting and Subjects University-affiliated US medical school. Methods Detailed inventory and content analysis of first- and second-year curricular materials. Results The inventory of pain content showed fragmentation, mostly presenting it as a symptom without an underlying framework. Conclusion Analysis of one medical schools pain-related curricular materials reveals opportunities for a more unified perspective that includes pain as a widespread disease state (not merely a symptom) and to provide an emphasis in the curriculum consistent with pains public health burden.