Careful Dialogue Research Articles

Oral literacy demand of health care communication: Challenges and solutions

Literacy deficits are widespread; one-quarter of the U.S. population has below basic literacy skills and the health consequences of literacy deficits are well-known and significant. While the need to simplify written health education print material is widely recognized, there has been little attempt to describe or reduce the literacy demand of health care dialogue. Patients with limited literacy complain they are not given information about their problems in ways they can understand, leaving them uninformed, frustrated, and distrustful. The purpose of this article is to review a conceptual approach to describing oral literacy demand in health care dialogue, to review several key studies that support the predictive validity of the conceptual framework in regard to patient satisfaction and recall of information, and to propose several practical ways to diminish literacy demand and facilitate more effective health care exchanges with patients.

Caught Between “The Rock” and a Hard Place: The Native Hawaiian and Pacific Islander Struggle for Identity in Public Health

DURING THE CONGRESSIONAL debate over health care reform in the fall of 2009, Saturday Night Live opened a show with a parody of President Barack Obama trying to persuade reluctant senators to endorse an overhaul of the nation's health care system. His best sales pitch was that each of the senators would have a voice in the process, but his overtures fail to win their support.1 The president becomes so frustrated by the politicians’ steadfast opposition to reform that he transforms into “The Rock Obama,” a Hulk-like character played by Dwayne “The Rock” Johnson. FAR LEFT: Murina Sony and her baby, Ketsen. Printed with permission. The skit evoked a mixed response from Dorothy E. Schmidt-Vaivao of the Samoa National Nurses Association (SNNA). “It made me laugh but it also made me think,” she says. “There is profound irony in The Rock Obama—with his commanding voice—being played by a Samoan American at a time when Pacific Islanders are among the faintest voices in our country's health care dialogue.” SNNA and a growing number of other health advocacy groups believe that giving Native Hawaiians and Pacific Islanders parity in health research and services should be a priority for health care reform but is not because most people assume that they are in large part a healthy group. As Schmidt-Vaivao put it, There is a false perception out there that the highly conditioned Pacific Islander athletes who thrill sports fans on Monday Night Football or Saturday night wrestling are the norm. We are very proud of people like Dwayne Johnson and Troy Polamalu but unfortunately they do not represent the health status of most Pacific Islanders. Taunuu Ve'e-Remmers, Native Hawaiian and Pacific Islanders Affairs Manager of the Asian & Pacific Islander American Health Forum (APIAHF) agrees that Native Hawaiians and Pacific Islanders are at risk for negative health outcomes because of these assumptions. “The scant public health data collected about Native Hawaiians and Pacific Islanders have traditionally been overshadowed because they were combined with much larger data sets about Asian Americans,” she points out, “but the socio-cultural context of Pacific Islanders is different from Asian Americans and as a result their health issues are different.” Historically, there are pros and cons regarding why Asian American, Native Hawaiian, and Pacific Islander census and health data were aggregated. Now, however, most progressive health researchers recognize that aggregating such data distorts the true picture of Native Hawaiian and Pacific Islander health and have begun collecting separate data sets on these distinctly different groups. “Because of their relatively small population sizes, Pacific Islanders have tragically been almost invisible to public health, and as a result resources have not been made available to assess and respond to their particular health needs,” says Ve'e-Remmers. APIAHF and other Native Hawaiian and Pacific Islander advocacy groups have been pushing hard for more disaggregated health data to quantify the health issues facing these groups in an effort to teach others about the disparities and needs that are in plain view within their communities. Armed with data, these groups hope to marshal the support and resources needed to improve Native Hawaiian and Pacific Islander health.

Long wars and long telegrams: containing Al-Qaeda

Can history help the ‘war on terror’? It is a cliche that 9/11 changed the world. But the idea that the war is exceptional lacks historical perspective. Assuming a radically new threat, the Bush administration proclaimed a theology rather than a coherent strategy. It articulated the ‘war on terror’ as a utopian and unbounded quest for absolute security. It did not effectively measure costs against risks or orchestrate ends, ways and means. This led the United States into exhausting wars of attrition. A more careful dialogue with the past can address this. Containment, America's core idea during the Cold War, supplies a logic that can inform a prudent strategy. Like Soviet communism with its fatal self-contradictions, Al-Qaeda and its terror network is ultimately self-destructive without major military operations. America and its allies can contain it with more limited measures in the long term as it destroys itself. The US should show restraint, doing nothing to hinder the growing Islamic revolt against Al-Qaeda. In other words, fight small and wait.

Crosswalking EAD: Collaboration in Archival Description

Different library departments must work together, both formally and informally, in implementing encoded archival description and in repackaging descriptive information about archival collections to other formats, particularly machine-readable cataloging. The authors, one a technical services librarian and the other a special collections archivist, describe their experiences collaborating in these processes at The Ohio State University. Although other institutions may differ in their organizational structure, the authors hope to provide technical guidance, as well as a model of collaboration between archivists and technical services personnel. Careful dialogue and planning are essential to transcend the traditional divide between archival and library descriptive practices and systems.

Guidelines for the diagnosis and management of hereditary spherocytosis

Hereditary spherocytosis (HS) is a heterogeneous group of disorders with regard to clinical severity, protein defects and mode of inheritance. It is relatively common in Caucasian populations; most affected individuals have mild or only moderate haemolysis. There is usually a family history, and a typical clinical and laboratory picture so that the diagnosis is often easily made without additional laboratory tests. Atypical cases may require measurement of erythrocyte membrane proteins to clarify the nature of the membrane disorder and in the absence of a family history, occasionally molecular genetic analysis will help to determine whether inheritance is recessive or non-dominant. It is particularly important to rule out stomatocytosis where splenectomy is contraindicated because of the thrombotic risk. Mild HS can be managed without folate supplements and does not require splenectomy. Moderately and severely affected individuals are likely to benefit from splenectomy, which should be performed after the age of 6 years and with appropriate counselling about the infection risk. In all cases careful dialogue between doctor, patient and the family is essential. Laparoscopic surgery, when performed by experienced surgeons, can result in a shorter hospital stay and less pain.

Outcome of Moderate and Severe Traumatic Brain Injury Amongst the Elderly in Singapore

Introduction: In line with other established protocols, our unit has instituted a standardised protocol for the management of moderate and severe traumatic brain injury since 1996 in our neurointensive care unit. Materials and Methods: We reviewed the outcomes, at 6 months’ postinjury, in an elderly group aged >64 years (73.86 ± 8.0 years) and compared them to a younger group aged 20 to 40 years (29.2 ± 5.7 years) in a cohort of 324 patients. Outcome was dichotomised as favourable (mild and moderate disability but independent; Glasgow Outcome Score [GOS] 4 and 5), unfavourable (severe disability and persistent vegetative state; GOS 2 and 3) and death (GOS 1). Results: In the elderly group, the mortality (55.4%) was slightly more than double that of the younger group (20.9%); 21.5% had an unfavourable outcome (14.2% in the younger group) and only 23% had a favourable outcome (compared to 64.9% in the younger group). The final outcomes were significantly worse in all levels in the elderly group. This was in spite of data showing that the mechanism of injury was of a higher impact in the younger group, with a higher incidence of polytrauma and cervical spine injury. On admission, the mean Glasgow Coma Score (GCS) was 8.3 ± 3.91 for the elderly group and 8.59 ± 4.05 for the younger group (P = 0.763). Computed tomography scan showed that the elderly had a higher incidence of mass lesions (extradural haematoma and subdural haematoma) and traumatic subarachnoid haemorrhage. A subgroup (29.2%) of elderly patients had no surgical intervention based on poor clinical/neurological status, premorbid functional status and pre-existing medical conditions, with their family’s consent. The GCS of <8, on admission, was significant (P <0.001) in predicting mortality in the elderly. In the elderly group, the female gender had a higher mortality rate (70.4%) than the males (44.7%) (P = 0.19). Conclusion: Age must be considered an independent factor in outcome prediction in the elderly with moderate and severe traumatic brain injury. A more conservative approach in the management of an elderly patient with severe head injury may be reasonable given its dismal outcomes after careful dialogue with the relatives.

Exploring Personal History: A Case Study of an Italian Immigrant Woman

This paper is a study of an Italian immigrant woman based on interviews conducted with my grandmother in 1996. Her testimony alongside traditional conceptual frameworks shows that interpreting oral history is a work that must be handled with care. With this article, I have tried to give validity and context to the uniqueness of the experience of an Italian-American immigrant woman. I also argue against Virignia Yans-McLaughlin's interpretation of interviews and the basis of her comparative work. Following Jürgen Habermas's call for self-knowledge in Knowledge and Human Interests (1968), this paper is a work of personal discovery as well as an attempt to liberate and take responsibility for the ways in which interpretation of immigrant testimony can enforce presuppositions and suppress careful and interested dialogue about gender difference and ethnic diversity.

Using the family covenant in planning end-of-life care: obligations and promises of patients, families, and physicians.

Physicians and families need to interact more meaningfully to clarify the values and preferences at stake in advance care planning. The current use of advance directives fails to respect patient autonomy. This paper proposes using the family covenant as a preventive ethics process designed to improve end-of-life planning by incorporating other family members--as agreed to by the patient and those family members--into the medical care dialogue. The family covenant formulates advance directives in conversation with family members and with the assistance of a physician, thereby making advance directives more acceptable to the family, and more intelligible to other physicians. It adds the moral force of a promise to the obligation of respecting a patient's preferences about end-of-life care. These negotiations between patient, family, and physician, from early planning phases through implementation, should greatly reduce the incidence of family disagreements on what the patient would have wanted. The family covenant ensures advance directive discussions within the family, promotes and respects the autonomy of other family members, and might even spur others in the family to complete advance directives through additional covenants. The family covenant holds the potential to transform moral quagmires into meaningful moral conversation.

The diagnosis and management of hereditary spherocytosis

Hereditary spherocytosis (HS) is relatively common in Caucasian populations; most individuals have mild or only moderate disease. There is commonly a family history and a typical clinical and laboratory picture so that the diagnosis is usually easily made without additional laboratory tests. Atypical cases may require measurement of membrane proteins and molecular genetics to clarify the nature of the membrane disorder. It is particularly important to rule out stomatocytosis because splenectomy is contraindicated because of the thrombotic risk. Mild HS can be managed without folate supplements and does not require splenectomy. Moderately and severely affected individuals are likely to benefit from splenectomy, which should be performed after the age of 6 and with appropriate counselling about the risk of infection. In all cases careful dialogue between physician, child and the family is essential. Laparoscopic surgery can result in shorter hospital stay and less pain.

Die Anerkennung der Oxthodoxen Kirche als Schwesterkirche Durch das 2. Vatikanische Konzil

Vaticanum II’s recognition of the Orthodox Church as a Sister Church After centuries-long exclusivism, today the Roman Catholic Church considers the Orthodox Church as a Sister Church. In this process the Second Vatican Council (Lumen gentium, Unitatis redintegratio) played a decisive role. Full communion is pursued. Careful dialogue, especially on papal primacy, is necessary. It is advisable that both Churches start giving each other full communion.

Technological Change, Sexuality, and Family Futures Planning

Planning for both future social, scientific and medical research and for the challenges and changes we will confront as a result of sexological research and reproductive/contraceptive tech-nology requires consideration of four areas of special concern: (1) contraception, (2) reproductive technologies, (3) gender differences, and (4) sexual relationships. In each of these four areas examples are provided illustrating the political, activist, and religous uses and abuses of data to promote partisan views and agendas. Planning for a more humane future requires continual, skeptical, careful, and open dialogue because it will often be impossible to anticipate or define the problems in advance, and weigh the likely costs and benefits of individual and societal options.