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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↗
PubMed2006

Communication between older women and physicians: preliminary implications for satisfaction and intention to have mammography.

OBJECTIVE: To explore the associations between physician communication styles and their older patients' intentions to get mammography and satisfaction with physician communication. METHODS: This cross-sectional mixed methods study was conducted in a teaching hospital outpatient clinic with faculty general internists (n=7) and their female patients aged 65 years and older (n=56). Audiotaped communication was coded by researchers using the multidimensional interactional analysis and assisted doctor-elderly patient transactions coding systems. Demographic data was collected prior to the visit. Data on intention to have mammography and satisfaction with communication were collected immediately post-visit. RESULTS: The majority of encounters had some degree of joint decision-making. Communication styles tended to be associated with women's intentions to have screening mammography. Patients who described communication as "deep", "trusting" and "bonding" were more satisfied with communication than women who rated physician communication as less trusting (p=0.03, 0.02 and 0.02, respectively). CONCLUSION: Physicians' communication styles affect their older female patients' satisfaction. In this preliminary study, older women who rated communication as being deep, trusting and bonding tended to have a greater intention to have mammography. PRACTICE IMPLICATIONS: Improving physicians' communication styles may increase satisfaction with physician communication and result in higher mammography adherence among older female patients.

Aged↗
PubMed2003

Dimensions of patient-provider communication and diabetes self-care in an ethnically diverse population.

BACKGROUND: Patient-provider communication is essential for effective care of diabetes and other chronic illnesses. However, the relative impact of general versus disease-specific communication on self-management is poorly understood, as are the determinants of these 2 communication dimensions. DESIGN: Cross-sectional survey. SETTING: Three VA heath care systems, 1 county health care system, and 1 university-based health care system. PATIENTS: Seven hundred fifty-two diabetes patients were enrolled. Fifty-two percent were nonwhite, 18% had less than a high-school education, and 8% were primarily Spanish-speaking. MEASUREMENTS AND MAIN RESULTS: Patients' assessments of providers' general and diabetes-specific communication were measured using validated scales. Self-reported foot care; and adherence to hypoglycemic medications, dietary recommendations, and exercise were measured using standard items. General and diabetes-specific communication reports were only moderately correlated (r =.35) and had differing predictors. In multivariate probit analyses, both dimensions of communication were independently associated with self-care in each of the 4 areas examined. Sociodemographically vulnerable patients (racial and language minorities and those with less education) reported communication that was as good or better than that reported by other patients. Patients receiving most of their diabetes care from their primary provider and patients with a longer primary care relationship reported better general communication. VA and county clinic patients reported better diabetes-specific communication than did university clinic patients. CONCLUSIONS: General and diabetes-specific communication are related but unique facets of patient-provider interactions, and improving either one may improve self-management. Providers in these sites are communicating successfully with vulnerable patients. These findings reinforce the potential importance of continuity and differences among VA, county, and university health care systems as determinants of patient-provider communication.

Aged↗
PubMed2001

Communication between general practitioners and chiropractors.

OBJECTIVE: Good communication between health care professionals has proved to be important in ensuring high standards of care. Patients have shown an increased use of complementary medicine (eg, chiropractic) in addition to conventional medicine. However, this does not automatically guarantee good cooperation and communication between complementary practitioners and conventional practitioners. The objective of this study was to assess the nature and quality of communication between general practitioners and chiropractors (in The Netherlands) and to look for areas for improvement. DESIGN AND SETTING: Postal questionnaires were sent to general practitioners requesting personal and practice details and asking about their knowledge of chiropractic, present communications, opinions on chiropractic terminology, and preferences with regard to communications with patients. SUBJECTS: A total of 252 general practitioners in 84 Dutch cities. RESULTS: A total of 115 questionnaires (46%) were returned. Almost all of the general practitioners had at least heard of chiropractic. Most information came from patients who were treated by chiropractors (78%). Only 10% of the general practitioners refer their patients to a chiropractor on a regular basis. Referral of patients was found to be significantly related to the general practitioners' perceived knowledge of chiropractic and positive opinions regarding their past communications with chiropractors. More than 80% of the general practitioners said that they were interested in receiving (or continuing to receive) feedback reports, even if they did not personally refer the patient to the chiropractor. Chiropractic feedback reports often seem to contain confusing terminology (40%), which might negatively influence communication (66%). General practitioners preferred a typed (88%), short (69%) feedback report, preferably sent after the last treatment (72%). CONCLUSIONS: The results of this study show most general practitioners to have a neutral to positive attitude toward communication with chiropractors. The general practitioners' preferences with regard to the technical aspects of a feedback report concur with the results of similar surveys in the field and can be used as guidelines for written communications. Factors that negatively influence communication between general practitioners and chiropractors seem to be confusing terminology, a limited knowledge of chiropractic, and bad experiences in previous communications. Recognition and illumination of these factors is a prerequisite to the development of good communication.

Adult↗
PubMed2002

Working with older people with communication difficulties: an evaluation of care worker training.

Studies suggest that a high proportion of older people in residential and nursing care have communication difficulties and there is some awareness of the need for staff training to allow effective communication to be achieved. This paper describes part of the evaluation of a one-day training package aimed at enabling care staff to communicate with older people who have a variety of communication difficulties. Care staff from four partner agencies completed questionnaires pre- and post-training, addressing contact with people with communication disorders, previous training on communication, knowledge about communication, attitudes towards communication problems and strategies to help communication with people who have communication difficulties. Positive gains were found in attitudes and self-perceptions of knowledge and competence, as well as in appropriate citations of strategies to enhance communication. The findings are discussed with reference to the need for enhanced communication skills in care workers engendered by current developments in care policy.

Adult↗
PubMed2002

Teaching communication skills: a skills-based approach.

OBJECTIVES: The purpose of this project was to design structured training activities to emphasize key points about patient-physician communication. Effective communication has been shown to enhance patient satisfaction, compliance with treatment, and medical decisions and outcomes. Basic communication skills and behavioral-change interview skills are taught. DESCRIPTION: Communication is a core "building block" of a four-semester, two-year Essentials of Clinical Medicine Course (ECM), which is in its second year of existence. Four interactive lab sessions have been designed, each with structured learning exercises. At the beginning of each session, students work in groups of 30 completing activities based on videos developed by the Bayer Institute for HealthCare Communication.(1) Subsequently, two groups of three students each work with a behavioral or physician facilitator. A formal training and administration manual for all activities has been developed and an evaluation system developed and implemented. Session 1, "Initial Interview Skills," teaches opening, mirroring, and encouraging non-interrogation activities. Session 2, "Empathic Responses," includes activities entitled "Cue Detection," "Accurate Empathy," and "Getting the Story Straight." In Session 3, "Obtaining an HPI," students view an exemplary medical interview, then role-play computerized cases(2) and practice the HPI data collection based on clinical facts taken from the computerized cases. During the Session 4, "Putting It All Together," students interview a standardized patient (SP) for five to seven minutes and receive and give feedback from peers, SPs, and facilitators. Subsequent to the communication lab, students conduct six physician-supervised patient interviews practicing their medical interviewing skills and write-ups. Two subsequent small-group sessions include "group" interviews of SPs in which students assess readiness for behavioral change (e.g., quitting smoking, losing weight) and also learn to conduct more "difficult' health-promotion conversations (e.g., sexual behavior, alcohol use). Evaluation methods include the use of a professional behavior evaluation form completed by communication facilitators and small-group leaders. This assessment form consists of ratings on: reliability and responsibility, relationships with others, self-improvement and adaptability, upholding professional standards, and communication skills dimensions. A formal interview-behavior checklist is used during the training and in the feedback sessions. Finally, SP OSCEs of communication and behavioral-change interviewing occur at the end of the first year of training. DISCUSSION: The communication labs have been well received by students. Students have reported increased understanding of their upcoming roles as physicians, have stated they have gained insights about the importance of connecting with patients in order to give them proper medical treatment, and have requested additional training in communication. Students have reported increased confidence in their interviewing skills prior to interactions with "actual" patients, and clinical preceptors have reported increased levels of preparedness among students who have participated in the structured learning experience. Future plans include adding communication training with problem patients, and about end-of-life and other challenging issues.

Communication↗
PubMed2006

Communication skills training as part of a problem-based learning curriculum.

Communication skills are an essential element of professionalism. The goal of the problem-based learning (PBL) model is to provide nursing students with the communication skills needed in the helping process. This article addresses the structure of communication skills training at the Dokuz Eylül University School of Nursing. There, students work within a module, first determining the part of the scenario related to communication, adapting this as a learning topic, and then learning the communication skills related to that topic on a cognitive level. A communication laboratory has been set up to permit implementation of the communication skills related to the topic within each learning module. This is necessary because communication requires both knowledge and skill development. Another important facet of communication skills training in this PBL model is that this training occurs during a 4-year learning period. In keeping with the structure of the PBL curriculum, the aim of this study was to provide students first with the skills for self-communication, then for communication with other healthy individuals and groups, and finally, for communication with individuals and groups with specific problems.

Communication↗
PubMed2004

[Marital communication and depressive symptoms in couples in which the woman has cancer of the breast].

If doctor-patient communication is a frequent subject of research, couples communication where one partner has cancer is quite recent. Some studies deal with couples communication, but from an anecdotic perspective, without any operational measure. The aim of this paper is to study couples' communication frequency and link it to depressive symptomatology. Marital communication was assessed with three scales: frequency of general communication, frequency of communication about cancer and satisfaction with communication. About one month following surgery, 120 breast cancer patients were interviewed; only 11 partners (9%) refused to be interviewed. Results show less communication is associated with higher depressive level. Patients and partners with a passable level of communication, particularly about cancer, are clinically at risk for depression. Communicating frequently about cancer in the couple seems thus associated with a positive effect, i.e. a depressive level found in the general population. Direction of causality between frequency of marital communication and depressive symptomatology cannot be established from this study.

Breast Neoplasms↗
PubMed1993

Communication intervention for persons with severe and profound disabilities.

Traditionally, communication interventionists focused on teaching a beginning repertoire of communicative behavior, once learners with severe to profound disabilities had emitted intentional behavior. Increasingly, interventionists are recognizing that valuable opportunities may be lost if intervention does not begin at an earlier point. In part, intervention strategies at increasingly earlier points have resulted from a prevailing change from semantically-focused intervention logic to pragmatic, interaction-focused intervention logic. At the same time that intervention content has increasingly focused on pragmatics, there has been a wealth of information addressing the social functions served by repertoires of simple idiosyncratic (as well as socially unacceptable) behavior. The increasing availability of augmentative and alternative communicative options has provided an extensive array of motorically simple strategies to exert significant control and influence over one's environment. We have long since passed the need to demonstrate that persons with severe disabilities can be taught a repertoire of communicative functions. However, we have not been as successful in demonstrating that the communicative behavior taught is well maintained solely in the presence of natural maintaining contingencies. Nor have we adequately demonstrated that established repertoires are sufficiently generalized. Most recently, interventionists have begun to focus on more efficient strategies to use in the selection of the most critical teaching instances to teach a new communicative response. Additionally, interventionists are considering response efficiency as an important variable in determining the likelihood that a learner will choose to emit members of his or her communicative repertoire. There appears to be a consensus among those who currently serve individuals with severe disabilities that inclusion represents an attainable objective for students with even the most severe disabilities. Unfortunately, it is not clear that either special or regular educators are being adequately prepared to accomplish included placements. There remains a significant need to recognize those aspects of best practice which must be further explored in regular education settings. What once were considered best practice methods may not meet the test of social validity and be considered best practices in regular classrooms. The vast majority of intervention research has selected a fairly narrow communicative form or function to teach. Increasingly, information on maintenance and generalization is considered. However, often the periods sampled postacquisition are very modest. Among the plethora of available communication intervention curricula, there are virtually none that have taken a learner from a point of engaging in no intentional communicative behavior to the establishment of an effusive repertoire of communicative functions and corresponding vocabulary.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2005

Communication of prognostic information for critically ill patients.

STUDY OBJECTIVES: The purpose of this study was to determine whether the timing of prognostic information delivery by physicians is associated with caregiver satisfaction with communication or decision making in the ICU. DESIGN: Multicenter, prospective, longitudinal observational study. SETTING: Medical and surgical ICUs in a community and university hospital. PARTICIPANTS: Decision makers for critically ill patients. MEASUREMENTS AND RESULTS: Longitudinal surveys assessed both actual and desired frequency of communication with physicians, timing and content of physician prognosis, and subject satisfaction with physician communication and subject's role in decision making. Seventy subjects were enrolled and completed 216 surveys. Fifty-seven caregivers (81%) received prognostic information during the ICU stay, with a mean time between ICU admission and provision of prognostic information (prognostic interval) of 1.7 +/- 2.8 days (median, 1 day). This interval was not associated with patient age, severity of illness, clinical service, hospital, socioeconomic status, or prior patient ICU admission. A shorter prognostic interval was associated with increased satisfaction with communication, with a trend toward statistical significance (p = 0.06). Both the measured communication rate (p < 0.001) and subjects' desired communication rate with physicians decreased over time in the ICU (p < 0.001). Although 78% of subjects rated their overall satisfaction with frequency of communication as "good," "very good," or "excellent," their satisfaction with communication frequency decreased with time in the ICU (p = 0.006). CONCLUSIONS: Families of critically ill patients were generally satisfied with communication in the ICU; however, 19% were unable to recall receiving any prognostic information from physicians. Providing all decision makers with some prognostic information, even if it consists of a statement of uncertainty (as was commonly done in this study), may further improve satisfaction with ICU care. A widening gap between the actual and desired communication rate may result in a decline in communication satisfaction over the course of the ICU stay. This suggests that the capacity of physicians and other ICU personnel to manage families' communication expectations may positively influence caregiver satisfaction.

Adult↗
PubMed2001

Communication between nurse and patient during ventilator treatment: patient reports and RN evaluations.

BACKGROUND: The current treatment preference for patients requiring artificial ventilation is to have them non-sedated whenever feasible. To be aware but unable to communicate is a novel experience for patients and produces problems in nursing. A review of the literature shows that few studies have focused on this significant issue in intensive care nursing. AIM: To study patient experiences of communication problems during ventilator treatment. SUBJECTS AND METHODS: Twenty-two consecutive patients treated in an intensive care unit (ICU) were interviewed three times over a 2-month period about their experiences of changes to their communication during ventilator treatment. Structured questionnaires, including open-ended questions were used on each occasion. The registered nurse (RN) in charge of each patient evaluated the extent of communication during the ventilator treatment in a nurse protocol. RESULTS: Thirteen of the twenty-two patients reported that the RNs were able to understand their needs and wishes during the ventilator treatment. The RNs, however, reported functional communication in nineteen patients. A functional communication was typically related to the use of effective communication methods, while a lack of communication was associated with compromised medical status of the patients. DISCUSSION: The results suggest the need for detailed examination of patients' potential for effective communication, evaluation of the communication skills of the RNs, and further investigation of devices that can help facilitate communication between RNs and patients during ventilator treatment.

Adolescent↗
PubMed2005

Dentist-patient communication in the multilingual dental setting.

BACKGROUND: Communication between dentists and patients can be exceptionally challenging when the patient and the dentist do not speak the same language, as is frequently the case in multicultural Australia. The aim of this study was to describe the issues involved in dealing with limited-English speaking patients in order to formulate recommendations on how to improve dental communication. METHODS: A cross sectional study was performed using a postal survey to Australian Dental Association member dental practitioners in Western Australia. Responses were collated and data analysis was performed using SPSS 11.5 for Windows. RESULTS: Most respondents encounter language-related communication barriers weekly or monthly, and the most satisfactory method of communication is informal interpreters. Despite reporting satisfaction working with professional chairside interpreters or dental staff interpreters, most respondents did not use them. The most common alternative communication methods were diagrams and models. Endodontics and periodontics provided the greatest challenge in communication. Informed consent was reportedly compromised due to language barriers by 29 per cent of respondents. Recommendations to improve communication included access to interpretation services, dentist technique/attitude to communication and patient preparedness for English-speaking encounters. CONCLUSIONS: Many respondents do not utilize the preferential communication methods, creating a potential compromise to both informed consent and the patients' best interests. The use of professional interpreters is recommended, and discussion should be supplemented with means of non-verbal communication. Dentists require access to lists of multilingual dentists and greater awareness of interpretation services to improve multilingual dentist-patient communication.

Attitude of Health Personnel↗
PubMed1993

Augmentative communication for the non-speaking child.

In this article, the term non-speaking will be used to refer to those individuals who have limited or no functional speech because of severe physical impairment, neuromuscular or cognitive deficit and whose communication impairment is not due primarily to a hearing problem. Augmentative communication has developed in order to compensate for impairments and disabilities of the non-speaking individual. It is all communication that supplements speech. Pediatric dental patients who may benefit from augmentative communication systems include those with cerebral palsy, multihandicaps, severe mental retardation and autism. The communication board is given as an example of an augmentative communication system. It is a visual display which can use symbols, pictures, letters and words. It allows the non-speaking child to communicate either by listener-assisted scanning or pointing directly to the symbol or word with their hand or eye-gaze, or with an aid such as a pointer or light. A communication board for use in the pediatric dental setting is described. The pediatric dentist should consult with the speech-language pathologist, family/caretaker, special educator/teacher, and health care members when deciding on communication systems for the non-speaking child in the dental setting. Augmentative communication systems need to be individualized for each non-speaking child. The systems need constant evaluation and updating also as the child develops. The ultimate aim of augmentative communication is to help the non-speaking child to have a more active and fulfilling role in everyday life.

Child↗
PubMed2000

Why don't patients and physicians talk about end-of-life care? Barriers to communication for patients with acquired immunodeficiency syndrome and their primary care clinicians.

BACKGROUND: Patients with chronic and terminal disease frequently do not talk to their physicians about end-of-life care. Interventions to improve this communication have generally been unsuccessful, suggesting that important barriers to this communication must exist. OBJECTIVES: To determine the barriers to and facilitators of patient-clinician communication about end-of-life care and to identify barriers and facilitators that are more common among those patients who are least likely to discuss end-of-life care: minorities and injection drug users. METHODS: We conducted a prospective study of 57 patients with advanced acquired immunodeficiency syndrome and their primary care clinicians who were recruited from university and private clinics. Barriers to and facilitators of end-of-life communication were identified from a prior qualitative study and assessed for frequency and importance and for an association with the occurrence and quality of end-of-life communication. RESULTS: Clinicians identified more barriers than patients. Barriers identified by patients and clinicians fell into 3 categories of potential interventions: education about end-of-life care, counseling to help address end-of-life concerns, and health care system changes to facilitate patient-clinician communication. Although none of the patient-identified barriers was associated with the occurrence of communication, 2 clinician-identified barriers were associated with less communication: "the patient has not been very sick yet" and "the patient isn't ready to talk about end-of-life care." Nonwhite patients were more likely to identify the following 2 barriers than white patients: "I feel that if I talk about death, it could bring death closer" and "I don't like to talk about the care I want if I get very sick." CONCLUSIONS: The diversity of barriers and facilitators relevant to patients with acquired immunodeficiency syndrome and their clinicians suggests that interventions to improve communication about end-of-life care must be focused on individual needs and must involve counseling interventions and health system changes in addition to education. Clinician barriers are more common and more strongly associated with the occurrence of end-of-life communication than patient barriers, suggesting that clinicians are an important target group for improving this communication.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Physician-patient communication among Southern European cancer physicians: the influence of psychosocial orientation and burnout.

Physician-patient communication is a critical factor for comprehensive care in oncology. Although a number of studies have been carried out in Northern Europe and the US on this subject, no data are available in Southern European countries. As a part of a multicenter Southern European Psycho-Oncology study (SEPOS), the present investigation was conducted to examine communication skills and related variables (i.e. psychosocial orientation, and burnout) among 125 physicians from Italy, Portugal, and Spain. The Self-Confidence in Communication Skills (SCCS) scale was given to assess physicians' perception of their communication skills and the Expected Outcome of Communication (EOC) scale was administered to examine the physicians' expectations about the effects of communicating with their patients. Doctors' psychosocial orientation was measured by using the Physician Belief Scale (PBS) and burnout was measured by using the Maslach Burnout Inventory (MBI). Although the physicians reported receiving minimal training in communication during their education, they tended to perceive themselves as skilled in patient communication, apart from some areas (e.g. dealing with denial, managing uncertainty, assessing anxiety and depression, and promoting patient-family openness). Low psychosocial orientation and burnout symptoms (i.e. emotional exhaustion, depersonalization, and poor personal accomplishment in their job) were associated with lower confidence in communication skills and higher expectations of a negative outcome, following physician-patient communication. The results suggest that there is a need for training cancer physicians in communication and for increasing a more definite psychosocially oriented approach in cancer care in Mediterranean countries.

Adult↗
PubMed2003

[Can communication with terminally ill patients be taught? Evaluation of a course model].

BACKGROUND AND PURPOSE: Communication with terminally ill patients is a main responsibility of physicians. However, many physicians feel insufficiently prepared for this task. Models of courses resulting in improvements of communicative skills of participants have been published mainly in the Anglo-American literature. This study describes the realization of a 2-day course model based on the experiences of the first three courses of this kind in Rhineland-Palatinate, and analyzes changes of participants' communication behavior. METHODS: After each seminary, an evaluation form concerning participants' satisfaction with the course was filled in. Furthermore, all course participants received a questionnaire at the beginning and at the end of the course, as well as 3 months afterwards. The participants were asked to assess their own sense of security in seven different communication settings on a visual analog scale, and to specify perceived changes in their communication behavior 3 months after the course. RESULTS: The first three courses were attended by 31 participants. Course evaluation revealed high satisfaction scores with methods as well as with clarity and relevance of the contents. Self-assessment of participants showed a growing sense of security in different communication settings. Important increases could be demonstrated for communicating a diagnosis of cancer with good or less good prognosis, recurrence of cancer or a far progressive cancer disease without curative approach. 3 months after the course, participants described multiple changes indicating increased sensibility and professionalism in communication behavior. CONCLUSION: The realized communication skills courses resulted in relevant changes in communication behaviour and self-confidence of participants. Communication with terminally ill patients can be taught.

Communication↗
PubMed1986

Intercellular communication of transformed and non-transformed rat liver epithelial cells. Modulation by TPA.

Gap-junctional intercellular communication of transformed and non-transformed rat liver epithelial cell lines was compared using a dye transfer method in the presence and absence of 12-O-tetradecanoylphorbol 13-acetate (TPA). Whereas non-transformed cells (IAR 20, non-tumorigenic in newborn rats and in nude mice) showed very high communication capacity throughout a culture period of 3 weeks, transformed cells (IAR 6-1, tumorigenic in newborn rats and in nude mice) were less able to communicate. Similar correlation between intercellular communication and expression of transformed phenotypes were also found in newly cloned epithelial cell lines, IAR 27E and IAR 27F. When TPA was added to culture medium at 100 ng/ml, intercellular communication in all lines tested was reduced within 60 min. However, communications recovered completely from the effect within 10 h after addition of TPA. Further addition of TPA to the cultures every 24 h for 3 weeks had no effect on intercellular communication (measured 30 min after each TPA addition), suggesting that a single application of TPA made these cells refractory to further doses. A known stimulator of gap-junctional communication, db-cAMP, also increased dye transfer in IAR 20 and IAR 6-1 cells. TPA added to db-cAMP-treated cultures of IAR 20 and IAR 6-1 cells inhibited intercellular communication, suggesting that cAMP is not an antagonist of the effect of TPA on intercellular communication in these cell lines. These results are in sharp contrast to those obtained with the fibroblast cell line BALB/c 3T3, in which db-cAMP antagonized TPA effect and inhibition by TPA of intercellular communication was transient only when administered during their growth phase, and was stable and continuous when TPA was applied at confluence, and suggest that TPA may not be an effective tumour promoter in rat liver.

Animals↗
PubMed1998

Identification of communication apprehension in medical students starting a surgery rotation.

BACKGROUND: Most methods used to critically evaluate young surgeons for advancement or certification in surgery require oral communication skills, eg, case and research presentations, rounds, morbidity and mortality conferences, interviews, journal clubs and oral examinations. The irony, though, is that much of surgery training focuses on technical skill lists, and the rhetorical aspects are often neglected until the surgeon encounters failure in an oral examination or is sued for not "talking" appropriately. Early identification of those at risk for difficulty with oral skills would provide programs with time needed to arrange for the appropriate types of interventions. Therefore, the purpose of this study was to identify those medical students with high communication apprehension scores in dyadic, group, or public speaking situations before they encountered failure and caused problems, not only for themselves, but also for their programs and practices. METHODS: Two scales, Willingness to Communicate (WTC) and the Personal Report of Communication Apprehension (PRCA-24), were administered to medical students at two large university medical centers during new student orientation to the surgery rotation. The WTC is a 20-item probability-estimate scale designed to measure one's predisposition toward approaching or avoiding the initiation of communication. The PRCA-24 is a scale designed to measure one's fear associated with either real or anticipated communication in four different contexts. In addition to the 44 items, a lengthy list of demographic items was added for possible correlations. These items were based on the student's perception of the communication or language environment in which he was raised. Therefore, a student ranked past and future socioeconomic status (eg, blue collar or white collar) according to his or her own criteria. The chairman was provided with a list of individual scores. Those students who were below the group means on skills required during a surgery rotation were identified for immediate intervention. RESULTS: The published data show a norm mean of 65.6 for PRCA-24 and 65.2 for WTC for college students. The current study found medical students to be more willing to communicate (WTC) and less anxious about communication (PRCA-24) than college students (mean 70.7 versus 65.2, P = 0.003, and 61.6 versus 65.6, P = 0.01, respectively). This difference was accentuated for blue-collar medical students compared with college students and persisted when blue-collar medical students were compared with white-collar medical students (73.9 blue-collar versus 70.9 college students, P = 0.15 for WTC, and 58.5 blue-collar versus 63.6 white-collar, P = 0.002 for PRCA-24). Male medical students were found to be less anxious about communication than female medical students. CONCLUSIONS: These instruments are easily administered at orientation and produce simple class lists with individual scores. They can be used to identify students who are below the mean for specific forms of communication before they encounter failure.

Clinical Clerkship↗