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PubMed2005

Video informed consent improves knee arthroscopy patient comprehension.

PURPOSE: The purpose of this study was to test the hypothesis that video informed consent improves knee arthroscopy patient comprehension and satisfaction compared with traditional verbal informed consent. TYPE OF STUDY: Prospective, randomized controlled trial. METHODS: Consecutive patients having informed consent in preparation for knee arthroscopy by a single surgeon were stratified by educational level < or =12th grade or greater than 12th grade, then randomized to video or traditional verbal informed consent groups. Immediately after the informed consent process, patients completed an outcome questionnaire evaluating comprehension and satisfaction. RESULTS: Patients in the video group showed significantly higher comprehension (78.5%) than patients in the verbal group (65.4%) (P = .00001). In the subgroup with < or = 12th grade education level, the video patients scored 73.1% comprehension and the verbal patients only 54.2% (P = .0011). In the subgroup with greater than 12th grade education level, the video patients scored 82.3% and the verbal patients scored 72.2% (P = .0002). There was no significant difference in subjective self-assessment of satisfaction between groups. CONCLUSIONS: Video informed consent improves knee arthroscopy patient comprehension compared with traditional verbal informed consent. LEVEL OF EVIDENCE: Level I.

Adolescent↗

PubMed2005

Criteria for identification of comprehensive pediatric hospitals and referral regions.

OBJECTIVE: To identify comprehensive pediatric hospitals on the basis of publicly available data. STUDY DESIGN: We developed identification criteria for comprehensive pediatric hospitals, then evaluated the number of hospitals meeting these selection criteria. Criteria for a comprehensive pediatric hospital included pediatric residency accreditation, pediatric inpatient volume, and diversity of pediatric disorders at each hospital. New York State hospital administrative discharge data were analyzed for patients 0 to 14 years of age, excluding neonatal diagnoses. RESULTS: Infants and children (n = 125,588) with 375 different diagnosis-related groups were discharged from 230 hospitals in 2000. Through the use of higher selective criteria (educational accreditation plus both high volume and diversity in the top decile), 11 comprehensive pediatric hospitals were identified. These hospitals serve populations of 1.7 +/- 0.3 million (mean +/- SD) each, with 8 referral regions throughout the state, collectively providing care for 29% of all pediatric statewide hospitalizations. CONCLUSIONS: Comprehensive pediatric hospitals serve the population of New York widely and evenly. The ability to identify pediatric hospitals will permit evaluation of the relative quality of care and suggest appropriate regulatory interventions to improve pediatric hospital utilization.

Accreditation↗

PubMed2005

Comprehension of humor in primary agenesis of the corpus callosum.

Individuals with agenesis of the corpus callosum (ACC) can, in some cases, perform normally on standardized intelligence tests. Nevertheless, recent studies suggest that individuals with ACC and normal IQ scores have deficits in domains of fluid and social intelligence. Anecdotal reports from families suggest diminished appreciation of the subtleties of social interactions, and deficits in the comprehension of jokes and stories. In this research, both the cartoon and narrative joke subtests of a humor test (developed by Brownell et al. [Brownell, H., Michel, D., Powelson, J., & Gardner, H. (1983). Surprise but not coherence: sensitivity to verbal humor in right-hemisphere patients. Brain and language, 18(1), 20-27] and Bihrle et al. [Bihrle, A. M., Brownell, H. H., Powelson, J. A., & Gardner, H. (1986). Comprehension of humorous and non-humorous materials by left and right brain-damaged patients. Brain and Cognition, 5(4), 399-411]) were given to 16 adults with complete ACC (all with IQs>80) and 31 controls of similar age and IQ. Individuals with ACC performed worse than controls on the narrative joke subtest (p<.025) when VIQ was controlled. However, on the cartoon subtest the two groups were not significantly different. Covarying age, forms of IQ, narrative memory, set-switching, and literal language comprehension did not substantially alter the group difference. However, covarying comprehension of nonliteral language and proverbs eliminated the difference, suggesting a common origin for the comprehension of jokes, nonliteral language, and proverbs, most likely related to capacity for understanding second-order meanings.

Adolescent↗

PubMed2004

Idiom comprehension in aphasic patients.

Idiom comprehension was assessed in 10 aphasic patients with semantic deficits by means of a string-to-picture matching task. Patients were also submitted to an oral explanation of the same idioms, and to a word comprehension task. The stimuli of this last task were the words following the verb in the idioms. Idiom comprehension was severely impaired, with a bias toward the literal interpretation. Very few errors were produced with words, making impossible to establish a correlation between comprehension of idioms and of individual words. The difficulties in idiom comprehension seemed to be due to the fact that patients rely on a literal-first strategy, accessing a figurative interpretation only when the linguistic analysis fails to yield acceptable results.

Aged↗

PubMed2006

The effect of aided language modeling on symbol comprehension and production in 2 preschoolers with autism.

PURPOSE: The purpose of the present study was to examine the effectiveness of an instructional procedure called aided language modeling (ALM) on symbol comprehension and expression in 2 preschool children with autism who used few words functionally. ALM consists of engaging the child in interactive play activities and providing models of use of augmentative and alternative communication symbols during play. METHOD: A multiple-baseline design across sets of symbol vocabulary was used with 2 children who had autism. Four vocabulary items were taught in each of 3 legs of the design, for each child. RESULTS: Both participants demonstrated increased symbol comprehension and elicited symbol production. In addition, both participants demonstrated that symbol comprehension and symbol production could be maintained. For both children, performance on symbol production lagged behind rate of responses on symbol comprehension. CONCLUSIONS: The current research presents preliminary evidence that a modeling intervention may be effective in increasing symbol comprehension and production, and may be an appropriate intervention strategy for some preschoolers with autism. Future research should continue to investigate this strategy and its effects on functional communication.

Autistic Disorder↗

PubMed1983

The effect of repeated testing upon comprehension of informed consent materials by elderly volunteers.

One hundred elderly adults (mean = 71.3 years of age, range = 59-88 years) in four WAIS vocabulary subgroups (less than 40, 40-49, 50-59, greater than or equal to 60) served in an evaluation of the effects of using multiple comprehension test trials to improve informed consent procedures. Participants in Group I were given a single comprehension test and feedback before signing consent documents, while those in Group II were provided with as many as three comprehension trials, if necessary. All participants were tested for memory of the information 2-3 weeks later. Results indicated that both comprehension and memory performance varied directly with vocabulary level. The multi-trial approach improved comprehension scores at all vocabulary levels, but had no effect upon memory.

Aged↗

PubMedDate not supplied

Comprehension of information in three direct-to-consumer television prescription drug advertisements among adults with limited literacy.

Direct-to-consumer (DTC) television advertisements present a number of facts about prescription drug risks and benefits in a brief time. This study assessed comprehension of information in three advertisements among 50 adults with limited literacy. Participants correctly answered an average of 59% of comprehension questions. The percentage of respondents correctly answering individual comprehension questions ranged from 26% to 92%. A multivariate analysis suggested that type of information (risk vs. other) and channel (text vs. audio) predicted comprehension. There was a significant interaction effect for literacy and place of birth. Our results suggest key areas for future research on comprehension of DTC advertising.

Adult↗

PubMed2006

Dichotic listening performance predicts language comprehension.

Dichotic listening performance is considered a reliable and valid procedure for the assessment of language lateralisation in the brain. However, the documentation of a relationship between language functions and dichotic listening performance is sparse, although it is accepted that dichotic listening measures language perception. In particular, language comprehension should show close correspondence to perception of language stimuli. In the present study, we tested samples of reading-impaired and normally achieving children between 10 and 13 years of age with tests of reading skills, language comprehension, and dichotic listening to consonant-vowel (CV) syllables. A high correlation between the language scores and the dichotic listening performance was expected. However, since the left ear score is believed to be an error when assessing language laterality, covariation was expected for the right ear scores only. In addition, directing attention to one ear input was believed to reduce the influence of random factors, and thus show a more concise estimate of left hemisphere language capacity. Thus, a stronger correlation between language comprehension skills and the dichotic listening performance when attending to the right ear was expected. The analyses yielded a positive correlation between the right ear score in DL and language comprehension, an effect that was stronger when attending to the right ear. The present results confirm the assumption that dichotic listening with CV syllables measures an aspect of language perception and language skills that is related to general language comprehension.

Adolescent↗

PubMed2005

Exposure-effect relations between aircraft and road traffic noise exposure at school and reading comprehension: the RANCH project.

Transport noise is an increasingly prominent feature of the urban environment, making noise pollution an important environmental public health issue. This paper reports on the 2001-2003 RANCH project, the first cross-national epidemiologic study known to examine exposure-effect relations between aircraft and road traffic noise exposure and reading comprehension. Participants were 2,010 children aged 9-10 years from 89 schools around Amsterdam Schiphol, Madrid Barajas, and London Heathrow airports. Data from The Netherlands, Spain, and the United Kingdom were pooled and analyzed using multilevel modeling. Aircraft noise exposure at school was linearly associated with impaired reading comprehension; the association was maintained after adjustment for socioeconomic variables (beta = -0.008, p = 0.012), aircraft noise annoyance, and other cognitive abilities (episodic memory, working memory, and sustained attention). Aircraft noise exposure at home was highly correlated with aircraft noise exposure at school and demonstrated a similar linear association with impaired reading comprehension. Road traffic noise exposure at school was not associated with reading comprehension in either the absence or the presence of aircraft noise (beta = 0.003, p = 0.509; beta = 0.002, p = 0.540, respectively). Findings were consistent across the three countries, which varied with respect to a range of socioeconomic and environmental variables, thus offering robust evidence of a direct exposure-effect relation between aircraft noise and reading comprehension.

Aircraft↗

PubMed2003

Idiom comprehension in Alzheimer's disease: the role of the central executive.

Idiom comprehension of 15 patients with mild probable Alzheimer's disease was examined by means of a sentence-to-picture matching task. Patients had to choose between two pictures, one representing the figurative and the other the literal interpretation. They were also submitted to a literal sentence comprehension test and to a pencil-and-paper dual task. Whereas literal comprehension was normal in seven subjects and mildly impaired in the others, idiom comprehension was very poor in all of them and correlated with the performance on the dual task. When the idiom test was repeated using an unrelated situation as an alternative to the picture representing the figurative meaning, performance significantly improved. It was hypothesized that the response in the sentence-to-picture matching task in the case of idioms requires sentence processing followed by the suppression of the literal interpretation. Alzheimer's disease patients proved to be unable to inhibit the literal meaning, although they had not lost the idiomatic meaning. In a second experiment, 15 Alzheimer's disease patients with a comparable level of cognitive impairment were submitted to the same idiom comprehension test, and to a test of verbal explanation of the idioms. The results showed significantly better performance in the oral task than in the sentence-to-picture matching task. In oral explanation, however, Alzheimer's disease patients also produced some literal interpretation whenever this represented a possible situation in the real world. We suggest that, during idiom interpretation, the literal meaning needs to be suppressed in order to activate the figurative meaning, and we stress the fact that both linguistic and extralinguistic factors must be taken into account to explain idiom interpretation.

Aged↗

PubMed2006

The natural evolution of haemophilia care: developing and sustaining comprehensive care globally.

Comprehensive care is vital for patients with haemophilia to prevent early death and free patients from the complications that inhibit living normal lives. Experience has shown that once introduced in a country, there is a progressive restoration of normal healthy lives to the haemophilia community. Accompanying this progress is a gradual decreased dependency on the haemophilia comprehensive centre - except during brief periods when expertise contained within the comprehensive centre is mandatory for life-saving clinical management or to prevent severe morbidity. During each stage of the natural evolution of comprehensive haemophilia care in a country, challenges to the existence of the centre occur, which threaten the comprehensive treatment concept. The haemophilia community must understand this natural evolution and be prepared to work collaboratively with governments, physicians and other patients to ensure that centres retain the expertise to meet the emergent needs when they arise.

Comprehensive Health Care↗

PubMed2005

Decoding, knowledge, and strategies in comprehension of expository text.

We examined the relative contribution of decoding, topic knowledge, and strategic processing to the comprehension of social science text in a sample of Norwegian junior high school students. Additionally, we examined the interaction of topic knowledge with strategic processing on students' text comprehension, and whether poor word-level skill could be effectively compensated for by higher-level processing involving knowledge or strategies. Multiple regression analysis indicated that students' prior knowledge about the topic of the text contributed most to their comprehension. Students' reported use of organization and monitoring strategies contributed less but still significantly to text comprehension, as did their word decoding skills. However, no interaction between topic knowledge and strategic processing was found. Analyses of variance and post-hoc comparison tests, supplemented by a descriptive analysis, suggested that the coexistence of poor decoding skill and good text comprehension may be related to much topic knowledge, good strategy use, or both.

Adolescent↗

PubMed1995

Community nursing in Finland: the division of fields of activity and patterns of care--comprehensive or specialized care?

The aim of this study was, first, to describe the changes taking place in the division of fields of activity in Finnish community nursing during a national project on primary health care; second, to describe and analyze patterns of care by categorizing different points of view in nurses' personal experiences. Data on the division of fields of activity in all project areas were collected in a survey and in annual registrations of public health nurses' tasks (n = 87-113). Care patterns were discerned in focused interviews with public health nurses (n = 18). Three types of division of fields of activity were identified: the comprehensive, semi-comprehensive and specialized model. The comprehensive and semi-comprehensive models became more common during the project and the specialized one less common. Patterns of care were classified into four main categories: structural, individualistic, family-centred and community-centred. The division of fields of activity was not always compatible with the care patterns. The study identified several issues that should be considered in the definition and implementation of comprehensive and specialized care.

Community Health Nursing↗

PubMed2005

Effects of limited English proficiency and physician language on health care comprehension.

OBJECTIVE: To determine the effect of limited English proficiency on medical comprehension in the presence and absence of language-concordant physicians. DESIGN, SETTING, AND PARTICIPANTS: A telephone survey of 1,200 Californians was conducted in 11 languages. The survey included 4 items on medical comprehension: problems understanding a medical situation, confusion about medication use, trouble understanding labels on medication, and bad reactions to medications. Respondents were also asked about English proficiency and whether their physicians spoke their native language. MEASUREMENTS AND MAIN RESULTS: We analyzed the relationship between English proficiency and medical comprehension using multivariate logistic regression. We also performed a stratified analysis to explore the effect of physician language concordance on comprehension. Forty-nine percent of the 1,200 respondents were defined as limited English proficient (LEP). Limited English-proficient respondents were more likely than English-proficient respondents to report problems understanding a medical situation (adjusted odds ratio [AOR] 3.2/confidence interval [CI] 2.1, 4.8), trouble understanding labels (AOR 1.5/CI 1.0, 2.3), and bad reactions (AOR 2.3/CI 1.3, 4.4). Among respondents with language-concordant physicians, LEP respondents were more likely to have problems understanding a medical situation (AOR 2.2/CI 1.2, 3.9). Among those with language-discordant physicians, LEP respondents were more likely to report problems understanding a medical situation (AOR 9.4/CI 3.7, 23.8), trouble understanding labels (AOR 4.2/CI 1.7, 10.3), and bad medication reactions (AOR 4.1/CI 1.2, 14.7). CONCLUSION: Limited English proficiency is a barrier to medical comprehension and increases the risk of adverse medication reactions. Access to language-concordant physicians substantially mitigates but does not eliminate language barriers.

Adolescent↗

PubMed2006

Relational processing and working memory capacity in comprehension of relative clause sentences.

Previous research has indicated that the cognitive load imposed by tasks in various content domains increases with the complexity of the relational information processed. Sentence comprehension entails processing noun-verb relations to determine who did what to whom. The difficulty of object-extracted relative clause sentences might stem from the complex noun-verb relations they entail. Across three studies, participants read 16 types of object- and subject-extracted relative clause sentences at their own pace and then responded to a comprehension question for each sentence. Relational processing was assessed using a premise integration task or a Latin square task. These tasks predicted comprehension of object-relatives before and after controlling for subject-relatives. Working memory (WM) capacity was assessed using reading span or forward and backward digit span tests. WM tasks predicted comprehension of object-relatives before but not after controlling for subject-relatives. Comprehension of object-relatives relied more heavily on a domain-general capacity to process complex relations than on WM capacity.

Adolescent↗

PubMed2000

Comprehensive care: the healthcare provider's perspective.

A paradigm shift, or change in worldview, is currently occurring in which clients are being comprehensively viewed within the environmental context. This shift addresses both mind and body in client care and views healthcare providers as part of the environment. Wound care specialists can refine and extend their practice by: a) using concepts from comprehensive care and holistic nursing, b) focusing on the outcome and process of delivering care, and c) caring for themselves in a comprehensive manner. This article describes the author's development as a comprehensive and holistic healthcare provider and the impact of comprehensive care on her practice.

Attitude of Health Personnel↗

PubMed2000

Student productivity in a comprehensive care program without numeric requirements.

As the dental students of the Class of 2000 entered the Comprehensive Care Clinic at the University of Colorado School of Dentistry in the spring of their second year (spring of 1998), a different, competency-based set of clinical expectations was communicated to them. These students were presented a list of "Recommended Core Experiences" and told that the "requirements" for completion of the Comprehensive Care Program were 1) successful performance on all departmental competency examinations, and 2) timely completion of the comprehensive dental treatment appropriate to each assigned patient. This study examined the number of procedures completed during the six semesters in the Comprehensive Care Clinic for the Class of 2000, as compared to the clinical activity for the Class of 1999 during the same stage of their career. The overall mean number of clinical procedures performed per student was 7 percent greater for the students in the Class of 2000 than for those in the Class of 1999. These results suggest that numerical requirements are not necessary to ensure dental student productivity and that, in fact, students can complete more clinical procedures in a comprehensive care clinical environment without numerical requirements.

Clinical Competence↗

PubMed2001

Personal doctoring. Its impact on continuity of care as measured by the comprehensiveness of care score.

OBJECTIVE: To determine the impact of personal provider continuity on continuity of care as measured by the comprehensiveness of care score. DESIGN: Retrospective cross sectional analysis of medical records. SETTING: The setting was a four doctor practice on the New South Wales Central Coast of Australia. METHOD: The subjects were 131 male and 123 female patients with a mean age of 42.7 years (SD 25.9) median age of 42 years and an age range of 1-95 years. The main outcome measures were a comprehensiveness score for each patient in the personal provider continuity and discontinuity of care group over a two year period. RESULTS: The overall comprehensiveness scores in the personal provider continuity group was 7.38 (95% CI: 7.04-7.71) compared to 6.03 (95% CI: 5.7-6.35) for those in the discontinuity group (p < 0.000). A linear regression model revealed that 15.8% of the total variance of the comprehensiveness score is explained by the two independent variables 'modified continuity index' (13.6%) and 'age' (2.2%). Nonrelated independent variables are gender, number of visits and number of years attending the practice. CONCLUSION: Personal doctoring significantly improves continuity of care as measured by the comprehensiveness of care score, and this observation is essentially age independent. These findings clearly suggest that patients should be encouraged to find and stay with one doctor, and that practices should develop systems to enable patients access to their usual provider. Both strategies, combined with the awareness of potential gaps in our service provision, will increase the likelihood of achieving increased continuity of care.

Adolescent↗