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PubMed1989

Open-set speech recognition in children with a single-channel cochlear implant.

We evaluated the ability of profoundly deaf children using the 3M/House single-channel cochlear implant to understand speech without the aid of speechreading. Fifty-one implanted children over the age of 5 years, who had sufficient cognitive and language skills, were tested using word and sentence stimuli presented in an open-set, auditory-only mode. Fifty-two percent of the children demonstrated some open-set performance on word identification, while 41.5% did so on sentence comprehension. Children who scored open-set had a shorter duration of deafness than those who did not. A larger proportion of children using oral communication demonstrated open-set speech recognition than those using total communication. A multiple regression analysis indicated that communication method accounted for the largest proportion of variability in performance on both the word and sentence tasks. Children achieving open-set auditory recognition, however, included both those using oral communication and those using total communication, children deafened by meningitis and those born deaf, and children with varying durations of deafness.

Adolescent↗
PubMed1995

The National Cancer Data Base report on prostate cancer. American College of Surgeons Commission on Cancer and the American Cancer Society.

BACKGROUND: Previous Commission on Cancer data from the National Cancer Data Base (NCDB) examined time trends in disease stage, treatment patterns, and survival for patients with selected cancers. The most current (1992) data for prostate cancer are described in this Communication. METHODS: Calls for data yielded a total of 52,597 prostate cancer reports for 1986/1987 and 101,903 for 1992 from hospital cancer registries across the United States. RESULTS: Data were received for 154,500 patients with prostate cancer. Prostate cancer is detected increasingly at localized stages and among younger men. African American men have a continuing pattern of more advanced disease at diagnosis. Selection of prostatectomy as the primary treatment has increased, and its use varies by region and several patient and hospital characteristics. Selection of radiation treatment has increased to a lesser degree. The 5-year survival for patients diagnosed in 1986/1987 was 60%. Outcomes varied by stage, age, and race. CONCLUSION: The NCDB provides valuable information concerning patterns and trends in prostate cancer care in the United States. The data show that prostate cancer detection and treatment have changed markedly in recent years. These changes appear to be related to the increased use of early detection measures. The improvements in prostate cancer detection and trends in treatment have not affected the population evenly, with African American men having more advanced disease and lower survival. Continued monitoring of these important trends is needed.

Aged↗
PubMed2006

Communication skills competencies: definitions and a teaching toolbox.

BACKGROUND: Doctors' interpersonal and communication skills correlate with improved health care outcomes. International medical organisations require competency in communication skills. The Accreditation Council for Graduate Medical Education (ACGME) developed a toolbox for assessing this competency and 5 others, yet none initially for teaching these skills. PURPOSE AND METHODS: The original focus in the development of the ACGME competencies was evaluation. This paper represents a significant step toward defining methods for teaching communication skills competencies. A total of 16 medical education leaders from medical schools worldwide, participating in the 2003 Harvard Macy Institute Program for Physician Educators, worked together to: (1) further define the ACGME competency in interpersonal and communication skills; (2) delineate teaching strategies for each level of medical education; and (3) create a teaching toolbox to integrate communication skills competencies into medical curricula. Four subgroups defined subcompetencies, identified teaching strategies for undergraduate, graduate and postgraduate medical training and brought their work to the larger group. The expanded communication competencies and teaching strategies were determined by a consensus of the larger group, presented to 80 Harvard Macy Scholars and Faculty for further discussion, then finalised by consensus. CONCLUSION: The teaching toolbox expands the ACGME core communication competencies, adds 20 subcompetencies and connects these competencies to teaching strategies at each level of medical training. It represents the collaboration and consensus of a diverse international group of medical education leaders in a variety of medical specialities and institutions, all involved in teaching communication skills. The toolbox is applicable globally across different settings and specialities, and is sensitive to different definitions of health care.

Clinical Competence↗
PubMed1975

[Total joint surfact replacement in the hip joint. Preliminary communication].

A method of joint surface replacement for the operative correction of severe osteoarthrosis of the hip joint is described. This type of surface replacement has obvious advantages especially in the younger age group. From experience with homogenous carilage transplants in which only the joint cartilage surfaces are transplanted, the method described offers hope of good results. The important advantage of surface replacement is the fact that the substance of the neck and head of femur are not removed. Therefore all alternative future procedures remain available if necessary. Accurate assessment of this method will require more prolonged follow up.

Acetabulum↗
PubMed2002

[Surgical management of anterior communicating artery aneurysms based on computed tomographic angiography with three-dimensional reconstruction and without preoperative angiography].

OBJECTIVE: To demonstrate the usefulness of threedimensional computed tomographic angiography (CT- 3D-angiography) in the microsurgical management of aneurysms of the anterior communicating artery (AComA). MATERIALS AND METHODS: A total of 28 consecutive patients with ruptured aneurysms of the AComA diagnosed by means of CT-3D-angiography and without preoperative angiography were operated on. The findings of the CT-3D-angiography, microsurgical exploration and clínical data were evaluated. RESULTS: There were no false positive findings nor false negative findings in the diagnosis of the AComA aneurysms. The global sensibility of the examination was 87.9%. The CT-3D-angiography study shows a left A1 segment dominance in 53.6% of cases, a right A1 dominance in 14.3% of cases and both A1 segments of the same diameter in 32.1%. Aneurysms growing on the traject of the AComA were associated with both A1 segments of the similar diameter and an AComA traject pararell to the transverse plane. Aneurysms implanted on the A1-A2 junction were associated with a dominant homolateral A1 segment and an oblique AComA traject. Microsurgical management of the lesions was done a mean of 3.7 days after bleeding. CONCLUSION: The study of patients with acute subarachnoid hemorrhage with CT-3D-angiography allows a reliable diagnosis of AComA aneurysms. The examination gives some anatomical data that allow the study of the hemodinamic changes involved in the development of the aneurysms. Moreover, provides usefull information for the microsurgical clipping. CT-3D-angiography allows to improve some health indicators but its impact in the final result of the patients needs more clinical data.

Adult↗
PubMed2001

Assessing medical students' awareness of and sensitivity to diverse health beliefs using a standardized patient station.

PURPOSE: To assess students' performances on a health-beliefs communication OSCE station to determine whether there were differences in cultural competence based on the students' ethnic backgrounds. METHOD: A total of 71 students completed a health-beliefs communication OSCE station in which they were required to address the health beliefs and cultural concerns of a standardized patient (SP) portraying an African American woman with diabetes. The SPs rated students' performances on a ten-item interview assessment checklist. Scores on the station were standardized within SPs to adjust for differences in their use of the rating scale. A factor analysis was performed to determine conceptual constructs on the interview assessment checklist. Subscale means were computed for each student. T-tests of these subscale scores were conducted to investigate gender and ethnic differences between subgroups of students. The underrepresented minority (URM) students (five African Americans and three Mexican Americans) were compared with all other students, and the white students were compared with all others. To assess the magnitudes of the differences between subgroups, effect sizes (ES(m)) were computed for means comparisons. RESULTS: Factor analysis formed two factors: Disease Beliefs and Management, and Cultural Concerns. Two remaining items loaded on a third factor that had reliability too low to support further analysis. Meaningful differences were found in cultural sensitivity based on students' ethnic backgrounds. The URM students performed better than did all other students in addressing the patient's concerns about altering culturally-based dietary behaviors for diabetes self-care [URM students' mean standardized score (SD) = 0.42 (0.15); all others = -0.01 (0.67); ES(m) = 1.05]. White students performed better than did all other students in assessing the patient's concerns about using insulin to control her blood sugar levels [white students' mean standardized score (SD) = 0.13 (0.40); all others = -0.10 (0.64); ES(m) = 0.4]. CONCLUSION: Cultural competency deficits and differences were measurable using a health-beliefs communications station, and these differences were meaningful enough to warrant faculty discussion and research about how to ensure that students master this competency.

Cultural Diversity↗
PubMedDate not supplied

Patients' reports of health care practitioner interventions that are related to communication during mechanical ventilation.

BACKGROUND: The literature supports nursing interventions to maximize communication in mechanically ventilated patients, yet limited research exists on patients' perceptions of the helpfulness of health care practitioner interventions to enhance communication. In addition, the level of frustration experienced by these patients has not been reported. Thus, further research is necessary to examine patients' perspectives of the helpfulness of health care practitioner interventions that enhance communication of the mechanically ventilated patient. OBJECTIVES: This study describes the level of frustration experienced by mechanically ventilated patients and ascertains the helpfulness of methods used by health care practitioners to meet the communication needs of the mechanically ventilated patient. METHODS: A total of 29 critically ill patients, extubated within the last 72 hours, were included in this descriptive study using qualitative and quantitative methods. Subjects participated in an average 30-minute audiotaped interview session consisting of questions pertinent to their perceived level of frustration in communicating and the interventions practitioners used to meet their communication needs. Transcripts were analyzed by question and for overall themes. RESULTS: It was found that 62% of patients (n = 18) reported a high level of frustration in communicating their needs while being mechanically ventilated. There was no significant difference between the duration of intubation and the level of frustration (Spearman r =.109, P =.573) or between the diagnosis and the level of frustration (P =.932). Patients who received anxiolytics (n = 23, 79% of the sample) had a lower level of frustration (mean 3.26) than those who did not receive anxiolytics (n = 6, 21% of the sample, mean 4.33). This difference trended toward significance (P =.084). Patients cited health care practitioner behaviors, characteristics, and attributes that both facilitated communication (kind, informative, and physically present at the bedside) and impeded their ability to communicate (mechanical, inattentive, and "absent" from the bedside). Patients reported problems and stresses associated with communication difficulties that can be alleviated by the health care practitioner. CONCLUSIONS: Mechanically ventilated patients experience a high level of frustration when communicating their needs, and health care providers have a significant impact on the mechanically ventilated patient's experience. Further research is needed to explore and measure methods of facilitating communication that increase patient satisfaction, reduce patient anxiety, and obtain optimal pain management.

Anti-Anxiety Agents↗
PubMed2005

Evaluation of a communication and stress management training programme for infertile couples.

OBJECTIVE: This study evaluates a patient education programme focussed on improving communication and stress management skills among couples in fertility treatment. METHODS: In total, 37 couples completed the intervention. Two teachers conducted all the five courses offered. The effectiveness regarding communication and infertility-related stress was assessed by questionnaires immediately before (time T1) and after the intervention (time T2). Seeking of information and professional support was assessed at a 12-month follow-up (time T3); response rates were: T1, 93.2%; T2, 85.1%; T3, 74.3%. Data were compared at baseline (T1) and at the 12-month follow-up (T3) with a prospective cohort of Danish people in fertility treatment. RESULTS: There were no differences in infertility-related stress at base line between the two groups studied. We estimated the bi-directional changes in communication, e.g., changes from talking often to talking less frequently and vice versa. More intervention participants started to talk often with their partner about infertility and its treatment after the intervention compared to those who stopped to talk often. Women and men changed occurrence, frequency and content of communication with close other people. Among women marital benefit increased significantly. Infertility-related stress was not reduced significantly. Significantly more intervention participants than in the comparison group had contacted support groups, a psychologist and/or agencies for adoption at the 12-month follow-up. CONCLUSION: The intervention resulted in important perceived improvement in the participants' competence to actively manage changes in marital communication and in communication in different social arenas. PRACTICE IMPLICATIONS: We recommend fertility clinics to develop and evaluate different interventions for those fertility couples who ask for more psychosocial support.

Adaptation, Psychological↗
PubMed2006

Sharing BRCA1/2 test results with first-degree relatives: factors predicting who women tell.

PURPOSE: Patient communication with relatives about cancer genetic test results is the primary means for alerting those who may benefit from identification of hereditary risk. This study identifies factors predicting patterns of disclosure of BRCA1/2 test results to first-degree relatives (FDRs) among women tested in a clinical protocol. PATIENTS AND METHODS: A total of 273 women completed a family communication measure 4 months after BRCA1/2 result disclosure. chi2 analyses and logistic regression models identified factors predicting sharing of the test result. RESULTS: Most FDRs were informed of the participant's test result by 4 months; female relatives were more likely to be informed than males. Tested women conveyed inconclusive results (variant or negative without known familial mutation) less frequently to their sisters than conclusive (positive/true negative) results (P = .03). Twenty-three percent of participants did not inform their father. Informing brothers was more likely when BRCA1/2 was inherited through paternal lineage (P = .04), but 29% of brothers were not informed. Women older than age 40 were less likely to share their result with their parents (P = .03) than were women < or = 40. Children's ages influenced communication to offspring; most children were told. CONCLUSION: Demographic, health-, and test-related factors predicted genetic test result communication to FDRs. Additional research investigating the full spectrum of discussion within families and motives for incomplete sharing of genetic test results with relatives may suggest strategies for providers and targeted educational interventions for patients to enhance family communication.

Adult↗
PubMed1991

A parallel computing approach to genetic sequence comparison: the master-worker paradigm with interworker communication.

We have implemented a parallel version of a dynamic programming biological sequence comparison algorithm to study the potential applicability of using parallel computers for genetic sequence comparisons. Our parallel program is built using C-Linda, a machine-independent parallel programming language, and was tested on both a 10 CPU Sequent Symmetry and a 64 CPU Intel Hypercube. C-Linda implements a shared associative memory model, "tuple space," through which multiple processes can communicate and coordinate control. In our master-worker (MW) parallel implementation, a master process creates several worker processes, extracts a test sequence and multiple library sequences from a database and stores them in tuple space. Each worker reads the test sequence and then repeatedly extracts library strings from tuple space, performs pairwise sequence comparison using a local comparison algorithm to generate a similarity score, and returns the similarity scores to tuple space. The master collects the scores from tuple space and identifies the best match over all library sequences. We also implemented a method of global interworker communication to reduce the total search time by stopping those string comparisons that had no chance of improving on the current best match. Comparisons of the total run time, speedup, and efficiency were made for parallel and sequential versions of a basic MW implementation as well as versions with the global abort threshold.

Algorithms↗
PubMed2003

Distribution of hydatid cysts into the liver with reference to cystobiliary communications and cavity-related complications.

BACKGROUND: This study was designed to test a hypothesis that intrahepatic hydatid cyst location can effect the incidence of cystobiliary communications and the cavity-related complications. METHODS: A total of 121 cysts treated by conservative surgical methods in 113 patients were evaluated prospectively. Cysts were grouped as near to the liver hilum (segment I, III, IVb, V, and VI) and far from the hilum (segment II, IVa, VII, and VIII). RESULTS: There were 58 (48%) hilar and 63 (52%) peripheral cysts. We found more cystobiliary communications (48% versus 27%, P = 0.015), more biliary leakage (36% versus 10%, P <0.001), and more biliary fistula (12% versus 3%, P = 0.080) in the cysts near to the hilum than far from the hilum. Postoperative hospital stay was longer in the cysts near to the hilum (12.3 +/- 3.1 days) than the cysts far from the hilum (7.7 +/- 2.7 days, P = 0.022). CONCLUSIONS: The location of the hydatid cyst near to the liver hilum is a risk factor for the cystobiliary communications and the cavity related complications.

Adolescent↗
PubMed1993

Provider-patient communication and metabolic control.

OBJECTIVE: To determine whether nurses' and NIDDM patients' communication styles during consultations are related to subsequent metabolic control and to examine factors influencing patterns of communication in these consultations. RESEARCH DESIGN AND METHODS: A total of 47 NIDDM patients participated in the study and completed the following procedures: 1) assessment of baseline HbA1, 2) attended 3.5 days of diabetes education, 3) returned in 1 mo for a follow-up consultation with a nurse, and (4) returned in 9-12 wk for a follow-up HbA1 assessment. The communication variables coded from the consultations were the frequency with which nurses produced controlling, informative, and patient-centered utterances and the frequency with which patients sought information, engaged in decision making, and expressed negative affect. RESULTS: The results were as follows: 1) patients experienced poorer metabolic control after interacting with nurses who were more controlling and directive in their communication with patients (r = 0.39, P < 0.01); 2) the nurses' use of patient-centered responses was directly related to the degree to which patients expressed feelings (r = 0.34, P < 0.01) and exhibited decision-making behavior (r = 0.62, P < 0.01); and 3) several of the nurses' and patients' communicative behaviors were related to patient characteristics such as age, sex, education, and baseline HbA1 levels. CONCLUSIONS: The results suggest that providers' attempts to exert considerable control during consultations with NIDDM patients may be counterproductive and contribute to poorer outcomes. The findings also indicate that patient-centered behaviors (e.g., encouraging the patient's involvement, respecting the patient's opinion, and offering support) facilitate the patient's ability to be an active participant in the consultation.

Age Factors↗
PubMed2005

Therapists' communication styles and parents' global trust in the therapists: a comparison between Jewish and Bedouin parents.

PURPOSE: This study was designed to examine the level of global trust in therapists for two groups of Israeli parents, Jews and Bedouin, and to assess which of three interpersonal communication styles significantly explain global trust in the therapists. METHODS: A total of 193 parents of children ranging from six months to six years of age participated in this study. Parents' perceptions regarding their communication with the center's therapists were measured by 15 items clustered into three dimensions of communication: caring, collaboration, and interest. RESULTS: Parents of both cultural groups expressed high levels of global trust in the center's therapists. Jewish parents trusted their children's therapists significantly more than their Bedouin counterparts and ranked the therapists' caring and collaboration more highly. The communication style of caring was found to be the sole contributor to the variability in global trust. CONCLUSIONS: Effort should be undertaken to develop effective communication styles for the dimension of caring to increase therapists' ability to promote global trust in their patients' parents.

Adult↗
PubMed1979

Communication and language in severely deaf adolescents.

One of the most important psychological effects of early severe or profound deafness is an impairment in natural language-processing ability, with a consequent reduction in communicative skill secondary to the sensory deficit. Prelingual damage blocks the development of certain sequential/syntactical skills necessary for the acquisition of normal linguistic competence. Educators of the deaf in the UK have typically attempted to improve linguistic ability using amplification and intensive training in lip-reading, but evidence from several psychological studies suggests that communication systems based upon manual signing are more productive of both linguistic and basic cognitive skills. This paper reports an experimental study of the communicative characteristics of both oral and total communication systems as a function of language structure. For almost all types of structure investigated, the total system was found to be the more effective method of communication.

Adolescent↗
PubMed1985

Method of assessing the contribution of components of an anastomosing vascular network to total vascular impedance.

The cerebral circulation has extensive communications between its four feeder arteries, their tributaries, and the extracerebral arteries. A theoretically derived method and its experimental verification is described by which the various impedances in a network can be quantified. It involved serial observations of pulsatile pressure, flow, and input impedance, in response to a pattern of input vessel occlusions. Fourier analysis permitted the response of the network to be studied for the component frequencies, so that linear and phasor algebra could be used to obtain a solution. Possible errors introduced by assumptions in the original model are minimal, and do not invalidate the method in practice.

Animals↗
PubMed1975

[Total substitution of the esophagus after resection or as a temporary measure (author's transl)].

In recent years, communications have been made repeatedly on methods for substitution of the esophagus after total extirpation or as a temporary measure. However, under the impression of disappointments and resignation, the statistical material has remained small and so far it has not been possible to develop a skilled standard procedure. On the other hand, a partial substitution of the lower third of the esophagus by stomach has become a much-practised and usually successful surgical procedure. Total resection of the esophagus with surgical transposition is a big intervention, especially when perfomred as a single operation. But it is our opinion that when the patient's condition is satisfactory in respect of the indication for operation, one should certainly be critical but on the whole less restrained.

Age Factors↗
PubMed2004

Communication assessment using the common ground instrument: psychometric properties.

BACKGROUND AND OBJECTIVES: Recent guidelines from the Association of American Medical Colleges and from the Accreditation Council for Graduate Medical Education strongly suggest that communications teaching and assessment be part of medical education at all levels. This study's objective was to validate an instrument to assess communications skills. This instrument, Common Ground, is linked to the core, generic communication skills emphasized by the consensus statements of Toronto and Kalamazoo. METHODS: A total of 100 medical students were recruited from two medical schools and tested with four-station, communications-focused objective structured clinical examinations. Using Common Ground, trained raters performed checklist and global rating assessments. Experts globally assessed 20 representative interviews. RESULTS: Inter-rater reliability for Common Ground was 0.85 for the overall global ratings and 0.92 for the overall checklist assessment. Generalizability coefficient was 0.80 for 50 minutes of testing. The correlation between the ratings of trained raters and a panel of communication experts was 0.84. CONCLUSIONS: The Common Ground assessment instrument assesses core communication skills with sufficient reliability, validity, and generalizablity to make decisions on medical students' performance.

Communication↗