Attitude and communication skills of German medical students

Objective While the development of communication competencies in medical schools plays a pivotal role in the curriculum, studies show that students’ communication skills and patient-centred attitudes may vary based on gender and ethnicity. The goal of this study was to investigate the socio-demographic factors that influence medical students’ communication abilities and, more specifically, to what extent their attitude toward communication skills learning and patient orientation associate with communication abilities. Our population included medical students admitted in 2017. Used tools included a communication score, the patient-provider orientation and communication skills attitudes scales. Results Three hundred and sixty-five students participated in the study (56.4% female, 85.2% German native speakers, mean age 24.2 ± 3.5 years). Female and German native speaking students had a better communication skills OSCE performance, were more patient-oriented and had more positive attitudes toward communication skills learning than male and non-native speaking students. There was a significant association between gender, native tongue, attitudes towards communication skills learning and communication skills OSCE performance. In conclusion, to support medical students to improve their communication proficiency and attitudes towards the importance of clear communication and patient-oriented care, medical educators should consider teaching and assessment strategies that address socio-cultural aspects of communication.

Evolution of Intestinal Microbiota of Asphyxiated Neonates Within 1 Week and Its Relationship With Neural Development at 6 Months

Introduction: Asphyxia is an emergent condition in neonates that may influence the function of the nervous system. Research has shown that intestinal microbiota is very important for neurodevelopment. Studies regarding the association between gut microbiota and neurodevelopment outcome in asphyxiated newborns remain scarce.Objective: To study the microbial characteristics of asphyxiated neonates within 1 week of life and to investigate their relationship with neural development at 6 months.Methods: The feces produced on days 1, 3, and 5, and the clinical data of full-term neonates with asphyxia and without asphyxia, delivered from March 2019 to October 2020 at Peking University First Hospital, were collected. We used 16S ribosomal deoxyribonucleic acid amplicon sequencing to detect the intestinal microbiota of asphyxiated neonates and neonates in the control group. We followed up asphyxiated neonates for 6 months and used the Ages and Stages Questionnaires-3 (ASQ-3) to evaluate their development.Results: A total of 45 neonates were enrolled in the study group and 32 were enrolled in the control group. On day 1, the diversity and richness of the microflora of the study group were more than those of the control group. Non-metric multidimensional scaling analysis showed significant differences in the microbiota of the two groups on days 1, 3, and 5. At the phylum level, the main microflora of the two groups were not different. At the genus level, the study group had increased relative abundance of Clostridium_sensu_stricto_1, Lachnoclostridium, Fusicatenibacter, etc. on day 1. On day 3, the relative abundance of Clostridium_sensu_stricto_1, Fusicatenibacter, etc. was still greater than that of the control group, and the relative abundance of Staphylococcus was less than that of the control group. On day 5, the relative abundance of Clostridium_sensu_stricto_1 and Lachnoclostridium was still higher than that of the control group, and the relative abundance of Dubosiella in the study group was significantly increased. At the species level, on day 3, the relative abundance of Staphylococcus caprae in the study group was less than that in the control group. Linear discriminant analysis effect size showed that the microbiota of the study group mainly consisted of Lachnospiraceae and Clostridia on day 1 and Clostridia on day 3. In the control group, Staphylococcus was the dominant bacterium on day 3. Neonates in the study group were followed up for 6 months, and the communication score of ASQ-3 was negatively correlated with the relative abundance of Lachnospiraceae and Clostridia on day 1.Conclusion: The diversity and richness of the microbiota of asphyxiated neonates on the first day of life were significantly increased and mainly consisted of pathogenic flora. Lachnospiraceae and Clostridia found in neonates with asphyxia on day 1 of life may be related to neural development at 6 months.

Proposal for a Global Adherence Scale for Acute Conditions (GASAC): a prospective cohort study in two Emergency Departments

BackgroundAdherence in the context of patients with acute conditions is a major public health issue. It is neglected by the research community and no clinically validated generic scale exists to measure it.ObjectiveTo construct and validate a Global Adherence Scale usable in the context of Acute Conditions (GASAC) that takes into account adherence both to advice and to all types of prescriptions that the doctor may give. To measure adherence and to study its determinants.Materials and methodWe based the construction of the GASAC questionnaire on a theoretical model and a literature search. Then, between 2013 and 2014, we validated it in a prospective observational study in two hospital emergency departments. Patients were contacted by phone about one week after their consultation to answer several questionnaires, including GASAC and the Girerd self-administered questionnaire about medication adherence as a control.ResultsGASAC consists of four adherence subscales: drug prescriptions; blood test/ radiography prescriptions; lifestyle advice and follow-up instructions. An analysis of the 154 sets of answers from patients showed that the GASAC drug subscale had satisfactory internal coherence (Cronbach’s alpha = 0.78) and was correlated with the Girerd score, as was GASAC as a whole (p<0.01)). The median score was 0.93 IQR [0.78-1] for a maximum value of 1 (n = 154). In multivariate analysis, infection was more conducive of good adherence (cut off at ≥ 0.8; n=115/154; 74.7% [67.0-81.3]) than trauma (OR 3.69; CI [1.60-8.52]). The Doctor-Patient Communication score (OR 1.06 by score point, CI [1.02-1.10]) also influenced adherence.ConclusionsGASAC is a generic score to measure all dimensions of adherence in emergency departments for clinical research and the evaluation of clinical practice. The level of adherence was high for acute conditions and could be further improved by good Doctor-Patient Communication.

Metabolomics and Communication Skills Development in Children; Evidence from the Ages and Stages Questionnaire

We hypothesized metabolomic profiling could be utilized to identify children who scored poorly on the communication component of the Ages and Stages Questionnaire (ASQ); which assesses development in childhood, and to provide candidate biomarkers for autism spectrum disorders (ASD). In a population of three-year-old children, 15 plasma metabolites, were significantly (p < 0.05) different between children who were categorized as having communication skills that were “on schedule” (n = 365 (90.6%)) as compared to those “requiring further monitoring/evaluation” (n = 38 (9.4%)) according to multivariable regression models. Five of these metabolites, including three endocannabinoids, were also dysregulated at age one (n = 204 “on schedule”, n = 24 “further monitoring/evaluation”) in the same children. Stool metabolomic profiling identified 11 significant metabolites. Both the plasma and stool results implicated a role for tryptophan and tyrosine metabolism; in particular, higher levels of N-formylanthranilic acid were associated with an improved communication score in both biosample types. A model based on the significant plasma metabolites demonstrated high sensitivity (88.9%) and specificity (84.5%) for the prediction of autism by age 8. These results provide evidence that ASQ communication score and metabolomic profiling of plasma and/or stool may provide alternative approaches for early diagnosis of ASD, as well as insights into the pathobiology of these conditions.

Hubungan Harga Diri dan Komunikasi Terapeutik Mahasiswa Profesi Keperawatan

ABSTRAKTujuan Penelitian: Praktik klinik keperawatan memiliki stresor tinggi yang dapat mempengaruhi harga diri mahasiswa. Komunikasi terapeutik merupakan skill mendasar dan penting dalam mencegah kesalahan medis dan memberikan pelayanan optimal terhadap pasien. Tujuan penelitian ini adalah mengetahui hubungan skor harga diri dan skor komunikasi terapeutik mahasiswa profesi di Program Studi Ilmu Keperawatan, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada. Metode: Jenis penelitian ini adalah kuantitatif korelasional dengan rancangan cross-sectional dengan subyek 60 mahasiswa profesi. Pengambilan data dilakukan selama 1 bulan. Harga diri diukur dengan Kuesioner State Self-Esteem Scale dan komunikasi terapeutik dengan checklist observasi. Hasil penelitian dianalisis dengan Uji Pearson. Hasil: Harga diri sebagian besar responen berada pada kategori rendah atau kurang dari rata-rata (53,4%). Komunikasi terapeutik sebagian besar responden berada pada kategori kurang (86,7%). Uji korelasi skor harga diri dan skor komunikasi terapeutik menghasilkan r=0,057 dan p=0,664. Diskusi: Sebagian responden memiliki harga diri rendah, hal ini disebabkan responden baru tiga minggu mengikuti pendidikan profesi sehingga dalam proses adaptasi dan proses menumbuhkan harga diri. Skor komunikasi terapeutik yang kurang pada sebagian besar responden disebabkan responden terfokus pada tindakan keperawatan untuk menghindari kesalahan. Hasil korelasi skor harga diri dan skor komunikasi terapeutik dalam penelitian ini tidak mendukung adanya hubungan antara skor harga diri dan skor komunikasi terapeutik. Hasil ini disebabkan komunikasi terapeutik tidak hanya ditentukan oleh faktor internal, namun juga faktor eksternal serta perbedaan jenis tindakan keperawatan yang memiliki kesulitan yang berbeda dan perbedaan ruang rawat inap. Kesimpulan: Tidak ada hubungan antara harga diri dan komunikasi terapeutik.Kata Kunci: harga diri, komunikasi terapeutik, mahasiswa profesi keperawatan, pasienCORRELATION BETWEEN SELF-ESTEEM AND THERAPEUTIC COMMUNICATION OF STUDENTS OF PROFESSIONAL NURSING PROGRAM, FACULTY OF MEDICINE, UNIVERSITAS GADJAH MADA WITH PATIENTS AT RSUP Dr. SARDJITO YOGYAKARTAABSTRACTObjective: Nursing clinical practice has high stressors that may affect student self-esteem. Therapeutic communication is a basic and important skill in preventing medical errors and providing optimum services to patients. This research aims to identify the correlation between self-esteem scores and therapeutic communication scores in students in Nursing Professional Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada. Methods: This research is quantitative correlational using cross-sectional design with the subjects of 60 professional students. Data were collected for 1 month. Self-esteem was measured by using State Self-Esteem Scale Questionnaire and therapeutic communication was measured using an observation checklist. The data were analyzed using Pearson Test. Results: 53.4% of respondents had low self-esteem or less than the average. 86.7% of respondents had poor therapeutic communication. The score of correlational test of self-esteem and therapeutic communication score indicated r=0.057 and p=0.664. Discussion: Some respondents had low self-esteem because they had just been three weeks in professional education so that they were in the process of adaptation and the process of developing self-esteem. Low therapeutic communication scores on the majority of respondents were caused by respondents focus on nursing procedures in order to avoid errors. The results of the correlation between self-esteem scores and therapeutic communication scores in this research did not support the correlation between self-esteem scores and therapeutic communication scores. This was because therapeutic communication is not only determined by internal factors, but also external factors and differences in types of nursing actions which have different difficulties and different inpatient rooms. Conclusion: There is no correlation between self­esteem and therapeutic communication.Keywords: self-esteem, therapeutic communication, students of professional nursing program, patients

PENGEMBANGAN BUKU AJAR KIMIA KELAS XII SMA/MA SEMESTER II TERINTERNALISASI NILAI KARAKTER SESUAI DENGAN KURIKULUM 2013

The aim of this research was: (1) to give the standardization of BSNP information from a chemistry text book of the 2nd semester in class XII that internalized by character value in accordance with the curriculum development of 2013, (2) to see the result of learning and to know the result of students' attitude observation in the learning process. The benefits of this research was the existence of textbooks that fit into BSNP standard has been already good and adding the scientific information. The method used in this research was: Research and Development method by using BSNP Standardization in the chemistry book that validated by chemistry teacher in Langsa city and the application test in book development and doing observation process toward student attitude to learning. Based on the research that has been done, it is found that: (1) the development of textbooks has fulfilled the standard of content feasibility assessment with a score about 4.18, score language about 4.64, presentation of score about 4.6 and graphic book or score about 4.5, so it was valid. (2) the students learning outcomes by using this book book indicate the increasing of students' knowledge from the average score of pretest score of 43.3 to postes of 91.66. (3) The result of the attitude assessment was shown from the observation value to the student discussion attitude with the cooperation was score about 2.4, the curiosity score about 2.8, attitude score about 2.6 and communication score about 3.1. The conclusions of this research, were: (1) the result of the book development has been very feasible to use, (2) the increasing of student learning outcomes equal to 84.78%. (3) There is a change in student character to be better.

The Effect of Wearing White Coats on Patients' Appreciation of Physician Communication during Postpartum Rounds: A Randomized Controlled Trial

Objective Wearing a white coat (WC) has been associated with risk of colonization and transmission of resistant pathogens. Also, studies have shown that physicians' attire in general affects patients' confidence in their physician and the patient–physician relationship. Our objective is to evaluate the hypothesis that not wearing a WC during physician postpartum rounds does not affect patient–physician communication scores. Materials and Methods This is an unblinded, randomized, parallel arms, controlled trial of postpartum women at a single university hospital. Women were randomly assigned to having their postpartum physicians' team wear a WC or not (no-WC) during rounds. Our primary outcome was “patient–physician communication” score. Univariable and multivariable analysis were used where appropriate. Results One hundred and seventy-eight patients were enrolled (87 in WC and 91 in no-WC groups). Note that 40.4% of patients did not remember whether the physicians wore a WC or not. There was no difference in the primary outcome (p = 0.64) even after adjusting for possible confounders. Conclusion Not wearing a WC during postpartum rounds did not affect the patient–physician communication or patient satisfaction scores. In the setting of prior reports showing a risk of WC pathogen transmission between patients, our findings cannot support the routine wearing of WCs during postpartum rounds.

Delivery and Measurement of High-Value Care in Standardized Patient Encounters

ABSTRACT Background Residencies have incorporated high-value care (HVC) training to contain health care expenditures. Assessment methods of HVC curricula are limited. Objective In our clinical skills laboratory, we evaluated the effectiveness of HVC curricula using standardized patients (SPs) to determine if there is a correlation with performance in counseling, history and physical, HVC knowledge, and demographics. Methods Through ambulatory cases, SPs evaluated postgraduate year 2 (PGY-2) residents using checklists to determine if they obtained the chief complaint, medical and social history, focused physical examination, and conveyed information regarding patient management. Investigators scored knowledge-based questions on the need for imaging in low back pain, annual stress testing in coronary artery disease, and chest x-ray for gastroesophageal reflux disease. Univariate analysis was used to calculate percentage distribution of residents' ordering of inappropriate tests. Results All 56 PGY-2 residents participated in the study and completed at least 2 of 3 HVC cases. Analysis showed that 48% (27 of 56) ordered at least 1 inappropriate test. Residents who ordered unnecessary testing had similar performance in history and physical as well as knowledge of HVC. Inappropriate ordering was significantly associated with poorer performance in counseling (mean percentage counseling score of 68% versus 56% for those who ordered inappropriately, P &lt; .001) and communication skills (mean percentage communication score of 74% versus 71% for those who ordered inappropriately, P &lt; .003). There were no patterns for ordering by demographics. Conclusions Our evaluation of residents during SP encounters found a correlation between the use of inappropriate testing and lower counseling and communication skills.

Factors affecting adoption of improved farm practices by the farmers of Northern Bangladesh

The present research examined the extent of adoption of improved farm practices by the farmers of Northern Bangladesh and determined the influencing factors for adopting these practices. This study was carried out in purposively selected Parbatipur upazila of Dinajpur district and Sherpur upazila of Bogra district as a representative of the northern Bangladesh. Data were collected from randomly selected 218 farmers through pre-tested interview schedule. Various descriptive and inferential statistical techniques were applied for getting meaningful results. Findings portray that most of the respondents belong to middle age group with a mean age of 47.02 years. The highest 37.2 percent of the respondents completed secondary level of education. Agriculture is the primary occupation of 89 percent of the respondents. The farmers have very low level of participation in various organizations. Contact with various communication media is very low for Sherpur compared to Parbatipur. The farm practices adopted mainly by the farmers are modern varieties, line sowing, power tiller, optimum tillage, balanced fertilizer, STW/DTW, IPM, balanced irrigation, rice weeder, sprayer and threasure. Among all practices, ‘power tiller’ adoption is the highest and ‘line showing’ is the lowest. Mean adoption score is 70.60. Results of multiple regression model indicates that communication score, total cultivable land, and socio-economic score have significant positive relationship, and total land area affected due to drought has significant negative relationship with adoption of improved farm practices by the farmers. Moreover, logistic regression model portrays that technology adoption is 1.49 times lower for Sherpur compared to Parbatipur. Finally, we can say that socio-economic factors influencing adoption of improved farm practices may be taken into consideration while accelerating the face of technology adoption under farming system.J. Bangladesh Agril. Univ. 13(2): 291-298, December 2015