Evaluating “Not in Mama\u27s Kitchen” Second-Hand Smoke Campaign in Georgia

In 2003-2005, the Association of Black Cardiologists, Inc. initiated the Not in Mama’s Kitchen (NIMK) second-hand smoke (SHS) prevention campaign in Georgia as part of their effort to reduce exposure to SHS in African American communities statewide. This initiative was evaluated using baseline data from pledge cards as well as data from a self-administered mail survey of 1,000 campaign participants. 14,770 Georgians participated in NIMK, signing pledges to make their homes and cars smoke free. Majorities of those surveyed followed through with their pledge, banning tobacco use in their homes (76.1%) and cars (80.2%). The program was cited by 65.4% of respondents as being instrumental to their decision to ban smoking and by 81.6% as an important source of information on the dangers of SHS. Participants even became advocates, with 74.3% reporting talking to family and/or friends about the dangers of SHS and encouraging them to make their own homes smoke-free

Using an Accessible Room Multisensory Stimulation Environment to Reduce Dementia Associated Behaviors

Objectives: To reveal whether an accessible open floorplan Multisensory Stimulation Environment (MSSE) room design has a positive impact as a nonpharmacologic intervention for episodes of Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults living in a Memory Care Assisted Living (MCAL) facility as well as reducing the need for direct care supervision. Methods: Retrospective pre/post cohort design of 24 residents living in a Midwest MCAL facility in the United States with a diagnosis of dementia and over 65 years of age, analyzed by secondary medical chart review for 12 months to assess impact of an accessible open floorplan MSSE room design. The pre/post design analyzed secondary data over two periods of time; 6 months prior to the MSSE installation and 6 months following the MSSE installation. Results: Following the installation of an open floorplan MSSE, the number of observed BPSD episodes changed from 367 (17%) pre-test to 298 (10%) post-test over a 12-month time period. The Comparison of Proportions test determined that the difference in the proportion of BPSD episodes documented was statistically significant with clinical implications. Conclusions: The accessible open floorplan MSSE room design, located within a single-site MCAL facility, utilized as a nonpharmacological intervention for BPSD, was found in this explorative study to be effective and potentially clinically meaningful in improving behavioral episodes for older adults diagnosed with dementia in MCAL settings

Impact of Managed Care on Physicians\u27 Decisions to Manipulate Reimbursement Rules: An Explanatory Model

Objective: To develop and test an explanatory model of the impact of managed care on physicians\u27 decisions to manipulate reimbursement rules for patients. Methods: A self-administered mailed questionnaire of a national random sample of 1124 practicing physicians in the USA. Structural equation modelling was used. The main outcome measure assessed whether or not physicians had manipulated reimbursement rules (such as exaggerated the severity of patients conditions, changed billing diagnoses, or reported signs or symptoms that the patients did not have) to help patients secure coverage for needed treatment or services. Results: The response rate was 64% (n = 720). Physicians\u27 decisions to manipulate reimbursement rules for patients are directly driven not only by ethical beliefs about gaming the system but also by requests from patients, the perception of insufficient time to deliver care, and the proportion of Medicaid patients. Covert advocacy is also the indirect result of utilization review hassles, primary care specialty, and practice environment. Conclusions: Managed care is not just a set of rules that physicians choose to follow or disobey, but an environment of competing pressures from patients, purchasers, and high workload. Reimbursement manipulation is a response to that environment, rather than simply a reflection of individual physicians\u27 values

Methodologies for Improving Response Rates in Surveys of Physicians: A Systematic Review

Although physician surveys are an important tool in health services and policy research, they are often characterized by low response rates. The authors conducted a systematic review of 66 published reports of efforts to improve response rates to physician surveys. Two general strategies were explored in this literature: incentive and design-based approaches. Even small financial incentives were found to be effective in improving physician response. Token nonmonetary incentives were much less effective. In terms of design strategies, postal and telephone strategies have generally been more successful than have fax or Web-based approaches, with evidence also supporting use of mixed-mode surveys in this population. In addition, use of first-class stamps on return envelopes and questionnaires designed to be brief, personalized, and endorsed by legitimizing professional associations were also more likely to be successful. Researchers should continue to implement design strategies that have been documented to improve the survey response of physicians

Communication Techniques for Patients With Low Health Literacy: A Survey of Physicians, Nurses, and Pharmacists

Objective: To explore the self-reported techniques used by health care professionals to enhance communication with patients with low health literacy. Methods: A survey was administered to physicians (n=99), nurses (n=87), and pharmacists (n=121) attending continuing education programs on patient safety and health care quality. Each was asked to rate communication-enhancing strategies by frequency of use and effectiveness with patients with low health literacy. Results: Using simple language (94.7%), handing out printed materials (70.3%), and speaking more slowly (67.3%) were the most commonly used strategies. Strategies currently recommended by health literacy experts were less routinely used. Conclusions: Further research is needed that evaluates the effectiveness of communication strategies for patients with limited literacy skills within diverse clinical encounters

The Use of Human Patient Simulators: Best Practices With Novice Nursing Students

Only recently have nursing educators begun to consider the enormous implications of using high-fidelity human patient simulation in general nursing education. As a first step in exploring the potential of this new technology with novice nursing students, faculty conducted a quantitative and qualitative analysis of students\u27 reactions to a simulation. In addition, from the analysis and the review of literature, the faculty identified specific best practices for using this educational methodology with novice nursing students

Evaluating a Health Literacy Kit for Physicians

About 90 million adults in the United State have difficulty accurately and consistently locating, matching, and integrating information. These people are less likely to be able to obtain, process, and understand basic health information and services; they have low health literacy. Patients with low health literacy struggle with prescription instructions, medicine labels, requited medical forms, have longer hospitals stays, experience poorer health outcomes, and cost the health care system billions of dollars, annually. The American Medical Association (AMA) developed a health literacy kit to help physicians meet the needs of these patients. The AMA evaluated the kit through a written survey and structured interviews with early adopters.Physicians utilized the kit in their own practices and shared the materials, especially the videotape, during staff meetings, in-service training programs, and other venues to reach more that 9700 professionals. Interviewees recommended improvements for the kit and areas for future research

Validating the Utility of the Spanish Version of the American Diabetes Association Risk Test

The American Diabetes Association (ADA) Risk Test, often used for decisions to blood glucose screen or not, lacks studies reporting the reliability or validity for the Spanish version of the tool. The objective of this study is to further validate the utility of the Spanish version of theADA’s RiskTest for Latino Populations. A convenience sample of 316 Latinos participated in this study. A positive but weak statistical correlation was found between blood glucose and the Risk Test score (.138), suggesting low reliability and validity of the Spanish version of the instrument. Two internal consistency estimates of reliability techniques were computed for the Risk Test for diabetes scale items, indicating low reliability