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PubMed1991

Factors influencing the communication skills of first-year clinical medical students.

The aim of this study was to examine the factors influencing medical students' communication skills. The sample comprised all first-year clinical students. Thirty-two received teaching in communication skills during the year; the remaining 56 did not. Students' career preferences, attitudes towards communication skills and confidence in their ability to communicate with patients were assessed by questionnaire at the beginning and end of the year. At the end of the year each student was videotaped interviewing a simulated patient. Students' communication skills were assessed on the basis of this interview by raters using a standardized rating scale, and by patient questionnaires. While there was some evidence that brief communication skills training improved skills, sex of student was a more significant predictor of level of skill. Students who perceived communication skills as less relevant to medicine and those who were more confident about their own communication skills were more likely to prefer a career in hospital medicine. Students' judgements of their ability to communicate effectively were poor. In the main there was no relationship between confidence and level of skill: where they were related, the association was negative. The benefits from communication skills training might be enhanced by involving hospital doctors in the teaching, and providing students with detailed video feedback on their skills at the outset.

Attitude of Health Personnel↗
PubMed1998

Comparison of continuing care communication.

PURPOSE: To describe and compare the patient-care communication exchanged between personnel in hospitals and nursing homes (NHs) and hospitals and home health agencies (HHAs) in referrals of elderly patients using an adaptation of classic communication theory. Little research on patient-care communication across organizational settings has been reported. This study offers baseline information about inter-organizational communication and insight into barriers to patient care communication. DESIGN: A retrospective, descriptive study using a convenience sample of 455 medical records of referrals to NHs and 300 to HHAs. METHODS: Medical records were audited and a Referral Data Inventory (with established reliability and validity) was completed for each of the records reviewed. Data were collected between January and June 1995. FINDINGS: Greater amounts of referral data were transferred to NHs, than to HHAs. Patient information was composed largely of background and medical data, followed by some nursing care data and limited psychosocial data. Hospitals employed more formal channels of communication in referring patients to NHs than to HHAs, and communicated information more promptly. Some organizational factors related to both the referring hospitals and receiving organizations resulted in discrepancies in patient-care communication. CONCLUSIONS: Continuity of patient care involves a series of coordinating linkages across time, settings, providers, and consumers of health care. Communication is a core task in coordinating patient care. Increased and improved inter-organizational communication is needed when patients are discharged to nursing homes or home health agencies.

Aged↗
PubMed2004

Colorectal cancer screening among African American church members: a qualitative and quantitative study of patient-provider communication.

BACKGROUND: A healthcare provider's recommendation to undergo screening has been shown to be one of the strongest predictors of completing a colorectal cancer (CRC) screening test. We sought to determine the relationship between the general quality of self-rated patient-provider communication and the completion of CRC screening. METHODS: A formative study using qualitative data from focus groups and quantitative data from a cross-sectional survey of church members about the quality of their communication with their healthcare provider, their CRC risk knowledge, and whether they had completed CRC screening tests. Focus group participants were a convenience sample of African American church members. Participants for the survey were recruited by telephone from membership lists of 12 African American churches located in rural counties of North Carolina to participate in the WATCH (Wellness for African Americans Through Churches) Project. RESULTS: Focus Groups. Six focus groups (n = 45) were conducted prior to the baseline survey. Discussions focused on CRC knowledge, and perceived barriers/motivators to CRC screening. A theme that emerged during each groups' discussion about CRC screening was the quality of the participants' communication with their health care provider. Survey. Among the 397 participants over age 50, 31% reported CRC screening within the recommended guidelines. Participants who self-rated their communication as good were more likely to have been screened (36%) within the recommended guidelines than were participants with poor communication (17%) (OR = 2.8, 95% CI 1.2, 6.4; p = 0.013). Participants who had adequate CRC knowledge completed CRC screening at a higher rate than those with inadequate knowledge (p = 0.011). The percentage of participants with CRC screening in the recommended guidelines, stratified by communication and knowledge group were: 42% for good communication/adequate knowledge; 27% for good communication/inadequate knowledge; 29% for poor communication/adequate knowledge; and 5% for poor communication/inadequate knowledge. CONCLUSIONS: Participants who rated their patient-provider communication as good were more likely to have completed CRC screening tests than those reporting poor communication. Among participants reporting good communication, knowledge about colorectal cancer was also associated with test completion. Interventions to improve patient-provider communication may be important to increase low rates of CRC screening test completion among African Americans.

Adult↗
PubMed2002

Communication between physicians and older women with localized breast cancer: implications for treatment and patient satisfaction.

PURPOSE: To identify factors associated with patient-physician communication and to examine the impact of communication on patients' perception of having a treatment choice, actual treatment received, and satisfaction with care among older breast cancer patients. MATERIALS AND METHODS: Data were collected from 613 pairs of surgeons and their older (greater-than-or-equal 67 years) patients diagnosed with localized breast cancer. Measures of patients' self-reported communication included physician- and patient-initiated communication and the number of treatment options discussed. Logistic regression analyses were conducted to examine the relationships between communication and outcomes. RESULTS: Patients who reported that their surgeons mentioned more treatment options were 2.21 times (95% confidence interval [CI], 1.62 to 3.01) more likely to report being given a treatment choice, and 1.33 times (95% CI, 1.02 to 1.73) more likely to get breast-conserving surgery with radiation than other types of treatment. Surgeons who were trained in surgical oncology, or who treated a high volume of breast cancer patients (greater-than-or-equal 75% of practice), were more likely to initiate communication with patients (odds ratio [OR] = 1.62; 95% CI, 1.02 to 2.56; and OR = 1.68; 95% CI, 1.01 to 2.76, respectively). A high degree of physician-initiated communication, in turn, was associated with patients' perception of having a treatment choice (OR = 2.46; 95% CI, 1.29 to 4.70), and satisfaction with breast cancer care (OR = 2.13; 95% CI, 1.17 to 3.85) in the 3 to 6 months after surgery. CONCLUSION: Greater patient-physician communication was associated with a sense of choice, actual treatment, and satisfaction with care. Technical information and caring components of communication impacted outcomes differently. Thus, the quality of cancer care for older breast cancer patients may be improved through interventions that improve communication within the physician-patient dyad.

Age Factors↗
PubMed2005

[Factors affecting subjective satisfaction with verbal communication among the disabled elderly and their family caregivers].

The aims of the present study were to investigate satisfaction with verbal communication among the disabled elderly and their family caregivers; and to find the significantly influential factors of satisfaction with verbal communication. The subjects were 85 disabled elderly and 85 family caregivers. For the disabled elderly, satisfaction with verbal communication, demographic, and physical factors were examined using an interview survey. For the caregivers, satisfaction with verbal communication, demographic factors, and some factors related caregiving were examined using a self-administered questionnaire. In the disabled elderly, 82.4% were satisfied with their verbal communication while 55.3% of family caregivers were satisfied. Satisfaction with verbal communication between the disabled elderly and their caregivers showed low agreement (kappa = 0.17). Bivariate analysis revealed that satisfaction with verbal communication of the disabled elderly was significantly related to ADL (p < 0.01), dysphagia risk (p < 0.05), and ability of comprehension (p < 0.05) while satisfaction with verbal communication of caregivers was significantly related to the gender of the disabled elderly and caregivers' burden. Furthermore, multiple regression analysis showed that the factor most related to satisfaction with verbal communication for the disabled elderly was ability of comprehension (p value = 0.032, odds ratio = 2.960), and the most related factor for their caregivers was the burden evaluated by J-ZBI_8 (p value = 0.004, odds ratio = 0.842). These results suggest that satisfaction with verbal communication of the disabled elderly disagrees with that of the family caregivers, and that some related factors for the disabled elderly are different from those in their family caregivers.

Aged↗
PubMed1999

Adolescent interpersonal communication patterns.

Adolescents are admitted to psychiatric wards presenting with psychiatric problems which are essentially secondary to problematic interpersonal relationships. Successful interpersonal relationships however depend on effective interpersonal communication. Therefore the aim of research on adolescent interpersonal communication was to explore and describe the interpersonal communication patterns of adolescents and to develop an interpersonal communication skills approach to facilitate adolescent interpersonal communication skills within a training programme for adolescents. In this article however attention will be given to the description of the interpersonal communication patterns of adolescents. The target population of the research was 17 year old adolescents. The research consisted of a pre-phase where two contextual scenarios were formulated within group discussions with adolescents. During phase one of the research these scenarios were used to obtain video taped role plays from pairs of adolescents of the target population which were transcribed for data gathering purposes. Written dialogues were also obtained from each pair of adolescents on the same scenarios used for triangulation purposes. During phase two of the research the data was analysed according to Tesch's method and a literature control was done to verify the results. Guba's model for the trustworthiness of qualitative research was used. Four recurrent interpersonal communication patterns were identified, namely: Recurrent patterns of defocusing and externalizing the topic under discussion; Recurrent patterns of struggling for power; Recurrent patterns of not listening; and Recurrent patterns of focusing only on cognitive contents of messages and not on feelings. The research showed that adolescents have ineffective interpersonal communication patterns. Recommendations were made to facilitate adolescent interpersonal communication within an interpersonal communication skills approach.

Adolescent↗
PubMed1999

Effect of clinician communication skills training on patient satisfaction. A randomized, controlled trial.

BACKGROUND: Although substantial resources have been invested in communication skills training for clinicians, little research has been done to test the actual effect of such training on patient satisfaction. OBJECTIVE: To determine whether clinicians' exposure to a widely used communication skills training program increased patient satisfaction with ambulatory medical care visits. DESIGN: Randomized, controlled trial. SETTING: A not-for-profit group-model health maintenance organization in Portland, Oregon. PARTICIPANTS: 69 primary care physicians, surgeons, medical subspecialists, physician assistants, and nurse practitioners from the Permanente Medical Group of the Northwest. INTERVENTION: "Thriving in a Busy Practice: Physician-Patient Communication," a communication skills training program consisting of two 4-hour interactive workshops. Between workshops, participants audiotaped office visits and studied the audiotapes. MEASUREMENTS: Change in mean overall score on the Art of Medicine survey (HealthCare Research, Inc., Denver, Colorado), which measures patients' satisfaction with clinicians' communication behaviors, and global visit satisfaction. RESULTS: Although participating clinicians' self-reported ratings of their communication skills moderately improved, communication skills training did not improve patient satisfaction scores. The mean score on the Art of Medicine survey improved more in the control group (0.072 [95% CI, -0.010 to 0.154]) than in the intervention group (0.030 [CI, -0.060 to 0.1201). CONCLUSIONS: "Thriving in a Busy Practice: Physician-Patient Communication," a typical continuing medical education program geared toward developing clinicians' communication skills, is not effective in improving general patient satisfaction. To improve global visit satisfaction, communication skills training programs may need to be longer and more intensive, teach a broader range of skills, and provide ongoing performance feedback.

Adult↗
PubMed2004

Communicating about health care: observations from persons who are deaf or hard of hearing.

BACKGROUND: Achieving patient-centered care requires effective communication between physicians and patients. Persons who are deaf or hard of hearing face considerable barriers to communicating with physicians. OBJECTIVE: To understand perceptions of health care experiences and suggestions for improving care among deaf or hard-of-hearing individuals. DESIGN: 4 semistructured group interviews, 2 conducted in American Sign Language (for deaf individuals) and 2 using Communication Access Realtime Translation (for hard-of-hearing individuals). Men and women were interviewed separately. Tapes of interviews were transcribed verbatim for analysis. SETTING: Greater Boston, Massachusetts, and Washington, DC, in 2001. PARTICIPANTS: 14 deaf adults (23 to 51 years of age) and 12 hard-of-hearing adults (30 to 74 years of age). MEASUREMENTS: Commonly expressed themes or views organized around dimensions of communication. RESULTS: Concerns coalesced around 6 broad themes: conflicting views between physicians and patients about being deaf or hard of hearing; different perceptions about what constitutes effective communication (such as lip reading, writing notes, and sign language interpreter); medication safety and other risks posed by inadequate communication; communication problems during physical examinations and procedures; difficulties interacting with office staff, including in waiting rooms; and problems with telephone communication, such as lengthy message menus. Participants offered extensive suggestions for improvements, starting with clinicians' asking patients about their preferred communication approach. Having patients repeat critical health information (such as medication instructions) can identify potentially dangerous miscommunication. CONCLUSIONS: As the population ages, physicians will encounter many more persons with hearing limitations. Physicians are not reimbursed for making some accommodations, such as hiring sign language interpreters. However, ensuring effective communication is essential to safe, timely, efficient, and patient-centered care.

Adult↗
PubMed1992

Digital electronic communication between ICU ventilators and computers and printers.

UNLABELLED: Although many modern ICU ventilators offer the option of electronic communication, most of these systems are not used because there is a huge communication gap between the ventilator and the computer it might be connected to. When such systems are now used, a large part of what is communicated is artifactual and misleading. We need to overcome both legal and knowledge barriers in the effort to provide seamless communication between ventilators and computers. With regard to the specific issues raised in this paper, here are our answers. Issue #1: Is it essential to have a digital electronic communication port on an ICU ventilator? ANSWER: No, it is not essential. The purpose of the mechanical ventilator is to support pulmonary ventilation by supplying gas and pressure. There is no vital role for digital communication in the gas-delivery function of the ventilator; however, in the future it will be essential to have effective electronic communication in order to guarantee accurate and timely charting. Issue #2: What impact does electronic communication between a ventilator and a computer have on patient outcome? ANSWER: Our preliminary data show that electronic communication can reduce the number of charting errors and can improve the timeliness of data entry. However, there is little evidence, other than anecdotal, that this has any impact on patient outcome. Automated charting has been shown to reduce the time spent on charting. This time-savings could be used to increase time spent in direct patient care, but there is no conclusive evidence that this occurs. In fact, one report on computerized charting systems indicates that the result is less time spent in direct patient care. Issue #3: If electronic communication is to be effective in the future, how should these interfaces be configured for mechanical ventilation? ANSWER: We recommend an optimal algorithm for automated respiratory care charting that has been suggested. Sampling frequency: Sample data from the ventilator every 10 seconds. Ventilator-setting changes: Report every new setting if change lasts more than 3 minutes. Measured respiratory care data: Filter raw MIB-collected data with a 3-minute moving-median filter. Report one filtered value every hour for each variable. In addition, use a threshold table (Table 3) to define significant events. Report changes that remain above threshold more than 3 minutes. Report all measured respiratory-care data 1 minute following any ventilator-mode changes.

Computer Communication Networks↗
PubMed2001

Teaching patients to communicate with physicians: the impact of race.

Research on physician-patient communication has focused on the effect of physician communication training on health care outcomes. Much less is known about patient communication training, and even less about the impact of patient race on the effectiveness of patient communication interventions. One hundred and fifty patients of 25 family physicians were randomly assigned to one of three groups: 14-page patient communication workbook received 2-3 days pre-visit, 2-page patient communication handout received in the waiting room, or control group. Racial differences in the impact of patient communication training communication variables, immediate and delayed recall of information, and adherence to treatment were analyzed by t-test and ANOVA techniques. Across analyses, workbook communication skills training had a strong and significant effect on white patients but minimal or no effect on African-American patients. Minimal differences in dependent variables between racial groups existed for the patient handout and control groups. A partial correlation analysis was conducted to factor out the variance due to education. Results suggested that patient race accounted for the results over and above differences in education between racial groups. Our results suggested that the benefits of communication training can be enhanced by taking into account patient characteristics such as race and culture.

Adolescent↗
PubMed2003

Beyond hearing aid fitting: improving communication for older adults.

Many older adults with hearing impairment continue to have substantial communication difficulties after being fitted with hearing aids, and many do not choose to wear hearing aids. Two group communication education programs aimed at such older people are described. The 'Keep on Talking' program has a health promotion focus, and is aimed at maintaining communication for older adults living in the community. An experimental group (n = 120) attended the program, and a control group (n = 130) received a communication assessment but no intervention. Significant improvements were found in the experimental participants in terms of knowledge about communication changes with age and about strategies to maintain communication skills. At the follow-up evaluation at 1 year, 45% of the experimental group, compared to 10% of the control group, had acted to improve their communication skills. The 'Active Communication Education' program focuses on the development of problem-solving strategies to improve communication in everyday life situations. Preliminary outcomes have been assessed on a small scale (n = 14) to date. It is concluded that communication programs represent an important adjunct to, or supplement for, the traditional approach that focuses on hearing aid fitting.

Activities of Daily Living↗
PubMed2001

A transdisciplinary conceptual framework for the early identification of risks for communication disorders in young children.

The early identification of infants with communication disorders or at risk for communication delays is still one of the biggest challenges of early communication intervention (ECI) and threatens to compromise its efficacy. Current approaches to the early identification of young children at risk for communication disorders involve strategies aimed at the identification of general developmental delays and may not be sufficiently sensitive and specific enough to detect the early stages of communication disorders. The risks for mortality and health are often identified early in life, but the concomitant risks for communication disorders in the same young children are frequently not identified at that opportune time. The current study involved a descriptive survey, describing the identification of communication disorders in 153 subjects, whose data was stored in and retrieved from a customized ECI database system. The findings revealed that the subjects were assessed at the average age of 18 months, but that identifications of risk conditions occurred prenatally, at birth, after the perinatal period and later in life. The time of identification related to the different communication disorders identified in the subjects and caregivers played a major role in detecting the first signs of communication disorders in their children. In order to provide a guideline for clinical practice, a transdisciplinary conceptual framework towards a coordinated effort for the early identification of risks for communication disorders in young children is proposed.

Caregivers↗
PubMed2005

[Selective heterologous communication among human lung epithelial cells, fibroblasts, and lung cancer PG cells].

OBJECTIVE: To further understand the roles of gap junctional intercellular communication in carcinogenesis and progression of human lung cancer. METHODS: The heterologous communication was characterized among human lung epithelial cells HLEC, human lung fibroblasts HLF, human lung giant carcinoma PG cells and its Cx43 transfectants PG/C4 by using a preloading assay. Cx43 immunofluorescent staining and Northern blot were performed to examine Cx43 gene expression. RESULTS: Although both human lung fibroblasts HLF and epithelial cells HLEC expressed Cx43 and had very strong homologous communication, HLEC cells were unable to communicate with HLF cells. The human lung carcinoma cell line PG was defective of both homologous communication, and heterologous communication with its epithelial origin HLEC. Transfection of Cx43 into PG cells, which rescued PG cells' homologous communication and enhanced heterologous communication with HLF cells, could restore heterologous coupling with HLEC cells. CONCLUSION: Selective heterologous communication exists among different kinds of human lung cells, when human lung carcinoma cells lost coupling with its epithelial origin, Cx43 gene expression is not enough to establish heterologous communication between them.

Cell Communication↗
PubMed1993

[Three levels of communication of people with senile dementia. An attempt to understand the 'life world' structured by people with senile dementia].

The aim of this paper is to study the communication of people with senile dementia for understanding the life-world structured by them. This research was conducted in special ward for senile dementia patients in the Aomori Prefectual Hospital, using the method of participant observation. The investigation period extended from September 1990 to August 1991 for a total of 62 days. First, the life-world of patients with senile dementia is described as follows: Patient' backgrounds, an outline of their everyday life in the institution. These patients have a serious intelligence disorder, therefore they have to live in a closed ward. However, the care system in the ward is very flexible so they are not restricted in their movements. An individual's ability to deal with the demands of everyday life is quite variable. And the quality of an individual's life is not limited to the sum total of his or her abilities. Second, the patients' communication processes are described. The procedure was as follows: The first step was to classify an individual's character and methods which they used to facilitate communication into five types. The second step was to illustrate their communication processes. There are many types of communication processes. But when we take notice of the essential qualities of their communications they fall into three basic patterns as follows: 1. Patients engaged in interactive connections in which the form, or the social fact of the interactions was valued over its narrative content. 2. During most communications each patient will inevitably experience a lack of comprehension. When this occurs they respond by introducing a new subject for discussion, or in other ways attempt to manipulate the interaction back to an area they understand. 3. Most interactions provoke intense interest among the other patient, who often gather to watch and comment among each other. In discussion, some common features that support humans' communication were studied through to compare the communication of people with senile dementia and normal people. In conclusion, the feature of their communication as exposure of the form not the content were explained.

Aged↗
PubMed1999

Communication between the axillary and radial nerves in the human upper arm.

The communication between the axillary (Ax) and the radial (R) nerves, which was observed in eight upper arms from 602 arms of 301 Japanese cadavers, was studied to determine its origin and distribution. The brachial plexus and spinal segments contributing to the Ax and R in all cases where communication occurred had no distinct differences from those in cases having no communication. According to the direction, the communication is divided into two groups: the communication from the Ax to R (7 cases) and vice versa (2 cases). One specimen had both groups of communication. The origin of communicating branches in these groups extended into the overlapping area (C5 + 6) of the origin of the Ax with that of the R, mainly from the ventral layer of the posterior cord from C6. The distribution of the communicating branch varied in development according to specimens. The communication from the Ax to R has a tendency to invade, from proximally to distally, the distribution of the muscular branches of the R to the radial extensor muscles of the forearm including the supinator muscle. However, the development into the cutaneous branches has no distinct inclination. These findings in humans and some other comparative anatomical descriptions show that in phylogeny the radial extensor muscles of the forearm have a different origin from other extensor muscles of the forearm and have a close relationship with the Ax. Therefore, the communication between the Ax and R holds an important clue in clarifying the morphological significance of the extensor nerves and muscles of the forearm.

Arm↗
PubMed1999

Communication forms and functions of children and adults with severe mental retardation in community and institutional settings.

The forms and functions of expressive communication produced by 84 individuals with severe mental retardation were assessed, using a structured communication sampling procedure. Symbolic communication acts were produced by 39 participants, and 27 of these symbolic communicators produced one or more multiword/multisymbol utterances. Of the remaining participants, 38 produced intentional but nonsymbolic communication acts; 7 were not observed to produce any intentional communication. For all participants who produced intentional communication, there were significantly more imperative than declarative communication acts. Significant differences in the frequencies and functions of communication acts produced by these participants were associated with differences in their communication levels (contact gesture, distal gesture, or symbolic), age (child vs. adult), and residential status (community home vs. large facility).

Adult↗
PubMed2005

Interventions to enhance communication among patients, providers, and families.

Whether patient suffering is caused by physical symptoms, unwanted medical intervention, or spiritual crisis, the common pathway to relief is through a provider who is able to elicit these concerns and is equipped to help the patient and family address them. This paper reviews the current state of knowledge in communication at the end of life, organized according to a framework of information gathering, information giving, and relationship building; and then focuses on interventions to enhance communication among patients, providers, and families. Several observations emerge from the existing literature. Patients have highly individualized desires for information and we cannot predict patient preferences. Communication coding methodology has advanced significantly yet the current systems remain poorly understood and largely inaccessible. Physicians and other health care providers do not discuss sufficiently treatment options, quality of life or respond to emotional cues from patients, and there is plenty of room for improvement. On the positive side, we have also learned that physicians and other health care providers can be taught to communicate better through intensive communication courses, and that communication interventions can improve some patient outcomes. Finally, huge gaps remain in our current knowledge, particularly with regard to understanding the relationship between communication style and outcomes. These findings suggest several recommendations. We should create larger and more diverse datasets; improve upon the analysis of recorded communication data; increase our knowledge about patient preferences for information; establish a stronger link between specific communication behaviors and outcomes; and identify more efficient ways to teach providers communication skills.

Family Relations↗
PubMed1993

Three-compartment wrist arthrography: correlation of pain site with location of uni- and bidirectional communications.

OBJECTIVE: Our objective was twofold: (1) to determine whether the site of patients' pain correlates with abnormal findings on three-compartment wrist arthrograms and (2) to determine whether the directional nature (uni- vs bidirectional) of communication(s) between adjacent wrist joint compartments shown on three-compartment wrist arthrograms correlates with the presence and site of pain. MATERIALS AND METHODS: We retrospectively studied 462 three-compartment wrist arthrograms of 458 patients. The patients were divided into four groups according to the site of pain, the correlation of that site with the site of the communication, and the directional characteristics of communications shown on the arthrogram: (1) exact correlation between site of pain and arthrographic findings, (2) correlation only between side of pain (ulnar or radial) and arthrographic findings, (3) ambiguous correlations (e.g., multifocal, midline, or diffuse pain), and (4) no correlation between site of pain and arthrographic findings. RESULTS: In 191 patients (42%), 226 intercompartmental communications were detected (51 uni- or 173 bidirectional). One hundred sixty-one patients had only one communication (uni- or bidirectional), and 30 patients had more than one (uni- and/or bidirectional) communication for a total of 65 defects. Regardless of the directional nature of the communication, no positive association between sites and/or the side of symptoms and sites of communications was demonstrable. However, a potential association appears to exist between ulnar-sided pain and combined lunotriquetral and triangular fibrocartilage tears. CONCLUSION: Our results suggest that the directional nature of interjoint communications has little or no clinical significance. Thus, with the exception of seeking the cause of ulnar-sided pain, our results question the usefulness of routine arthrography for correlating sites of patients' symptoms and individual interjoint communications.

Adolescent↗