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PubMed2005

Determination of the anatomic communications among compartments within the carpus, metacarpophalangeal and metatarsophalangeal joints, stifle joint, and tarsus in llamas.

OBJECTIVE: To determine the anatomic communications among compartments within the carpus, metacarpophalangeal and metatarsophalangeal joints, stifle joint, and tarsus in llamas. SAMPLE POPULATION: 88 limbs from 22 llamas necropsied because of reasons unrelated to disease of the carpus; tarsus; or metacarpophalangeal, metatarsophalangeal, or stifle joints. PROCEDURE: 1 compartment (randomly assigned) of each joint was injected with blue latex solution. Communication between joint compartments was determined by observation of latex in adjacent compartments following frozen sectioning. RESULTS: Of the 44 carpi, 30 (68%) had anatomic separation between the radiocarpal and middle carpal joints, whereas the remaining 14 (32%) had communication between the radiocarpal and middle carpal joints. In the metacarpophalangeal or metatarsophalangeal joints, medial and lateral joint compartments remained separate in 83 of 88 (94%) joints injected. The tibiotarsal and proximal intertarsal joints communicated in all tarsi examined, whereas 14 of 38 (37%) communicated between the proximal intertarsal and distal intertarsal joints. Communication between the distal intertarsal and tarsometatarsal joints was detected in 17 of 25 (68%) specimens; all 4 tarsal joints communicated in 11 of 42 (26%) specimens examined. Examination of 33 stifle joints that were successfully injected revealed communication between the femoropatellar, medial femorotibial, and lateral femorotibial joints. CONCLUSIONS AND CLINICAL RELEVANCE: These data suggest that it is important to determine the joint communications specific to each llama prior to treatment of septic arthritis. The metacarpophalangeal or metatarsophalangeal joint compartments may be considered separate, although the lateral and medial compartments infrequently communicate along the proximal palmar or plantar aspect.

Animals↗
PubMed2004

Crossing the digital divide: evaluating online communication between patients and their providers.

OBJECTIVE: To address provider, payer, and patient concerns about the use of online communication in healthcare settings by performing a randomized controlled trial of a Web-based patient-provider communication tool in primary care. SUBJECTS AND METHODS: Forty-one staff physicians and 91 residents in 4 primary care centers were randomized to a Web-based online communication system. Patients of intervention physicians were encouraged to communicate via the system about health issues, scheduling, prescription renewals, referrals, and billing. Data collected included patient Web use, e-mail use, telephone calls, visit distribution, and physician and patient attitudes toward and satisfaction with communication. RESULTS: One thousand thirty-eight patients sent 2238 messages during the 40-week study. Half of the messages were directly related to a patient's health; half were administrative. Patient Web use peaked at 8.5 weekly messages per 100 scheduled visits. Patient e-mail and telephone volume remained similar across groups. Intervention physicians reported more positive attitudes toward Web-based communication than control physicians (mean Web benefits scale score, 4.0 vs 1.1; P = .008), but there were no between-group differences in attitudes toward communication in general. Patients and physicians reported differential preferences for the use of online communication based on problem complexity and sensitivity. CONCLUSIONS: Web-based messaging was lower than expected because of patient-related factors and limitations of the technology. Patients, physicians, and staff had positive attitudes toward online communication. There was no detectable difference in communication volume between study groups, but more sensitive measures of work burden need to be developed and evaluated.

Data Collection↗
PubMed1995

Communication standards: impact on nursing practice.

1. BACKGROUND INFORMATION. In order to meet the demands of processing large amounts of data, hospitals must look to innovative methods of information handling. One new method currently in use is the computerized patient record (CPR) (Dick & Steen, 1991). To successfully implement the CPR, many factors must be considered, including: (a) the fact that the database is dependent upon several different departments and resources for information; (b) the information needs of each department differs, making selection of a single information system that encompasses all users' needs difficult; and (c) operating systems may be incompatible, hampering the process of networking and exchanging, processing, and retrieving data in an integrated manner. Yet the integration of systems is central to the successful development of the CPR. 2. PURPOSE. Establishment of communication standards for health care promotes the effective integration of patient information across various computer systems (McDonald, 1990). To achieve this level of automation, standard organizations must unite in the development and implementation of communication standards for health care. This poster will explore: (a) data on communication standards; (b) the process of reaching standards; (c) established communication standards; and (d) the impact of communication standards on nursing practice. In addition, we will present a model for an integrated patient focused system of the future. Today, communication standards continue to evolve in health care. Many professional organizations share the goal of developing communication standards between clinical systems (McDonald, 1990). Standards to be explored in this poster include: the American Society for Testing and Materials (ASTM), the Medical Data Interchange Standard (MEDIX), the Medical Information Bus (MIB), and Health Level (HL7). Evolving standards will define protocols and procedures for the effective exchange of easy integration of information systems. Once standards are established for health care, society will benefit from the ability to: (a) compare health care costs; (b) measure the effectiveness of treatment; and (c) provide clinicians with comprehensive patient information (Rishel, 1992). 3. IMPLICATIONS. There is very little in existing literature and research studies on the impact of communication standards on nursing practice. Nurse researchers willing to assume the challenge of conducting studies on the impact of communication standards on nursing practice will forge new territory. Implications for nursing from the development of communication standards include: (a) increased productivity, (b) definition of a clinical data set, (c) improved quality patient care, and (d) easier system implementations.

Humans↗
PubMed2005

Assessment of social communication skills in preschoolers.

This paper orients the reader to social communication assessment and reviews methods for assessing social communication behavior in children from toddlerhood through the preschool years. Most standardized, normed tests of language in this age range focus on morpho-syntactic and semantic comprehension and production abilities. While social communication is perhaps one of the most important skills for peer acceptance, these skills are often overlooked in language evaluation with children. However, there are a number of caregiver questionnaires, interviews, or direct social-communication sampling methods that are available to assist clinicians or researchers in documenting social-communication skills or behaviors. Since assessment of social communication is essential in clinical work with children with an autism spectrum disorder, some of the tools described below are outgrowths of autism research or provide autism-related scores. While many children receiving social communication assessments do not have autism, the need to assess social communication skills in children with language impairment is highlighted by the growing literature documenting social and pragmatic difficulties in this population (Bishop 2000 Causes, Characteristics, Intervention, and Outcome. Hove, UK: Psychology press). Regardless of whether the measures presented herein were initially designed for children with autism or not, they will provide insights into the social communicative behaviors or tendencies in young children.

Child, Preschool↗
PubMed2001

Communicative abilities in autism: evidence for attentional deficits.

Although there are many theories about autism, something all of them agree upon is that autistics are impaired in the ability to communicate. The explanation is either their incapacity to attribute mental states to others or the interference of irrelevant stimuli with the access and processing of the communication (low). Our study on mute autistic children aims to investigate their communicative ability in order to bring some new evidence on the debate. We used an experimental technique that allows autistic children to access and process the communicative acts in a familiar context for as long as needed. The experimental results show that our sample of autistic children performs as well as the control group of normal children in dealing with directs, indirects, ironies, deceits, and recoveries of failure. Independent of their respective difficulty, the felicitous outcome of any of these acts requires the capacity to attribute an adequate communicative intention to the actor. Moreover, our results show that, contrary to the established findings in the literature, autistics' performance in the standard false belief task, a task that requires one to understand the mental states of other people, is equivalent to the performance of normal subjects. We argue that an attentional deficit affects the communicative performance of autistics in experiments where classic methodologies are used; with the proper methodology, we can access the unexplored world where mute autistic children also communicate. As far as we know, this is the first systematic experiment on pragmatic abilities in mute autistic children. Indeed, our work shows that tests and methodologies which help to focus on the communicative task improve the autistics' performance with respect to those used in the literature. We conclude that the autistic communicative deficit is at the performance level and that it has an attentional nature.

Adolescent↗
PubMed2006

Heterosexual assumptions in verbal and non-verbal communication in nursing.

AIM: This paper reports a study of what lesbian women and gay men had to say, as patients and as partners, about their experiences of nursing in hospital care, and what they regarded as important to communicate about homosexuality and nursing. BACKGROUND: The social life of heterosexual cultures is based on the assumption that all people are heterosexual, thereby making homosexuality socially invisible. Nurses may assume that all patients and significant others are heterosexual, and these heteronormative assumptions may lead to poor communication that affects nursing quality by leading nurses to ask the wrong questions and make incorrect judgements. METHOD: A qualitative interview study was carried out in the spring of 2004. Seventeen women and 10 men ranging in age from 23 to 65 years from different parts of Sweden participated. They described 46 experiences as patients and 31 as partners. FINDINGS: Heteronormativity was communicated in waiting rooms, in patient documents and when registering for admission, and nursing staff sometimes showed perplexity when an informant deviated from this heteronormative assumption. Informants had often met nursing staff who showed fear of behaving incorrectly, which could lead to a sense of insecurity, thereby impeding further communication. As partners of gay patients, informants felt that they had to deal with heterosexual assumptions more than they did when they were patients, and the consequences were feelings of not being accepted as a 'true' relative, of exclusion and neglect. Almost all participants offered recommendations about how nursing staff could facilitate communication. CONCLUSION: Heterosexual norms communicated unconsciously by nursing staff contribute to ambivalent attitudes and feelings of insecurity that prevent communication and easily lead to misconceptions. Educational and management interventions, as well as increased communication, could make gay people more visible and thereby encourage openness and awareness by hospital staff of the norms that they communicate through their language and behaviour.

Adult↗
PubMedDate not supplied

Generalist-subspecialist communication about children with chronic conditions: an analysis of physician focus groups.

OBJECTIVE: To describe barriers and facilitators to effective generalist-subspecialist communication in the care of children with chronic conditions. METHODS: We conducted 5 focus groups with 14 general pediatricians and 10 pediatric specialty providers to discuss factors that facilitate or obstruct effective communication. The specialty groups included 2 nurse practitioners; the rest were pediatricians from an academic medical center and the surrounding community. We performed a content analysis to generate groups of themes and classify them as barriers or facilitators, and we returned to the participants to solicit their feedback. RESULTS: We identified 201 themes in 6 domains: the method, content, and timing of communication; system factors; provider education; and interpersonal issues. Barriers to communication mostly involved the method of communication and system factors. Most facilitating themes promoted timely communication, understanding of the reasons for referral and the nature of the child's condition, or appropriate definition of generalist and specialist roles. Participants described numerous examples where communication had direct effects on patient outcomes. Generalists and specialists agreed on many issues, although specialists discussed the pros and cons of curbside consults at length whereas generalists emphasized the importance of their own education in the referral-consultation process. CONCLUSIONS: Efforts to improve communication between pediatric generalists and specialists in the care of children with chronic conditions should emphasize the importance of timely information transfer. The content of messages is important, but lack of receipt when needed is more of a problem. Improving generalist-subspecialist communication has great potential to improve the quality of care.

Child↗
PubMed2001

Childhood vaccine risk/benefit communication in private practice office settings: a national survey.

UNLABELLED: Communication about childhood vaccine risks and benefits has been legally required in pediatric health care for over a decade. However, little is known about the actual practice of vaccine risk/benefit communication. OBJECTIVES: This study was conducted to identify current practices of childhood vaccine risk/benefit communication in private physician office settings nationally. Specifically, we wanted to determine what written materials were given, by whom, and when; what information providers thought parents wanted/needed to know, the content of nurse and doctor discussion with parents, and the time spent on discussion. We also wanted to quantify barriers to vaccine risk/benefit discussion and to prioritize materials and dissemination methods preferred as solutions to these barriers. METHODS: We conducted 32 focus groups in 6 cities, and then administered a 27-question cross-sectional mailed survey from March to September 1998, to a random national sample of physicians and their office nurses who immunize children in private practices. Eligible survey respondents were active fellows of the American Academy of Pediatrics or American Academy of Family Physicians in private practice who immunized children and a nurse from each physician's office. After 3 mailings, the response rate was 71%. RESULTS: Sixty-nine percent of pediatricians and 72% of family physicians self-reported their offices gave parents the Centers for Disease Control and Prevention Vaccine Information Statement, while 62% and 58%, respectively, gave it with every dose. In ~70% of immunization visits, physicians and nurses reported initiating discussion of the following: common side effects, when to call the clinic and the immunization schedule. However, physicians reported rarely initiating discussion regarding contraindications (<50%) and the National Vaccine Injury Compensation Program (<10%). Lack of time was considered the greatest barrier to vaccine risk/benefit communication. Nurses reported spending significantly more time discussing vaccines with parents than pediatricians or family physicians (mean: 3.89 vs 9.20 and 3.08 minutes, respectively). Both physicians and nurses indicated an additional 60 to 90 seconds was needed to optimally discuss immunization with parents under current conditions. Stratified analysis indicated nurses played a vital role in immunization delivery and risk/benefit communication. To improve vaccine risk/benefit communication, 80% of all providers recommended a preimmunization booklet for parents and approximately one half recommended a screening sheet for contraindications and poster for immunization reference. The learning method most highly endorsed by all providers was practical materials (80%). Other desirable learning methods varied significantly by provider type. CONCLUSIONS: There was a mismatch between the legal mandate for Vaccine Information Statement distribution and the actual practice in private office settings. The majority of providers reported discussing some aspect of vaccine communication but 40% indicated that they did not mention risks. Legal and professional guidelines for appropriate content and delivery of vaccine communication need to be clarified and to be made easily accessible for busy private practitioners. Efforts to improve risk/benefit communication in private practice should take into consideration the limited time available in an office well-infant visit and should be aimed at both the nurse and physician.

Child↗
PubMed2003

Generalist-subspecialist communication for children with chronic conditions: a regional physician survey.

OBJECTIVE: To identify target areas for interventions to improve communication between pediatric generalists (PCPs) and pediatric subspecialists (SPs) in the outpatient care of children with chronic conditions. METHODS: We constructed a 4-page mailed questionnaire probing communication practices, opinions about the role of communication in care, and perceived barriers and facilitators to PCP-SP communication in the care of children with chronic conditions. In the spring of 2001, we surveyed all 495 New England SPs who were members of the American Academy of Pediatrics (AAP) and/or SP societies and a random sample of 495 generalist AAP members in New England. Eligible were those actively providing outpatient care. Most items were rated on a 5-point scale. RESULTS: Of those eligible, 48% (412/860) completed the questionnaire. Although 98% of respondents agreed that communication was important for good care, reported practices reflected large gaps in this area. Frequent receipt (>60% of the time) of communication about an initial referral was reported by only 28% of SPs. Barriers reported as most important involved inefficiencies in telephone contact, transcription delay, and failure to keep all providers informed when >1 specialist is involved. Important facilitators included letters or phone calls at or before the time of consultation, and clear and specific referral questions from PCPs. PCPs saw communication as more of a problem than did SPs (40% vs 28%), and reported several barriers as more important. Although 86% of respondents had access to e-mail in their practices, <20% used it often. CONCLUSIONS: PCPs and SPs sharing care for children with chronic conditions are troubled by their frequent failure or inability to contact their colleagues by phone and letter. PCPs communicate less frequently than SPs yet perceive more problems with communication. Interventions to promote efficient contact between providers at or before the time of subspecialty visits can lead to improved coordination of care, which in turn may better meet the needs of families.

Child↗
PubMed2003

Improving communication between physicians and patients who speak a foreign language.

BACKGROUND: Communication between physicians and patients is particularly challenging when patients do not speak the local language (in Switzerland, they are known as allophones). AIM: To assess the effectiveness of an intervention to improve communication skills of physicians who deal with allophone patients. DESIGN OF STUDY: 'Before-and-after' intervention study, in which both patients (allophone and francophone) and physicians completed visit-specific questionnaires assessing the quality of communication. SETTING: Two consecutive samples of patients attending the medical outpatient clinic of a teaching hospital in French-speaking Switzerland. METHOD: The intervention consisted of training physicians in communicating with allophone patients and working with interpreters. French-speaking patients served as the control group. The outcomes measured were: patient satisfaction with care received and with communication during consultation; and provider (primary care physician) satisfaction with care provided and communication during consultation. RESULTS: At baseline, mean scores of patients' assessments of communication were lower for allophone than for francophone patients. At follow-up, five out of six of the scores of allophone patients showed small increases (P < 0.05) when compared with French-speaking patients: explanations given by physician; respectfulness of physician; communication; overall process of the consultation; and information about future care. In contrast, physicians' assessments did not change significantly. Finally, after the intervention, the proportion of consultations with allophone patients in which professional interpreters were present increased significantly from 46% to 67%. CONCLUSIONS: The quality of communication as perceived by allophone patients can be improved with specific training aimed at primary care physicians.

Adolescent↗
PubMed1988

Comparison of two types of communication methods used after cardiac surgery with patients with endotracheal tubes.

In this study we compared two types of communication techniques (planned and unplanned) for effectiveness in communication in the early postoperative intubation period with patients who had cardiac surgery. In this quasi-experimental study we used a sample of 40 patients undergoing open heart surgery who participated in preoperative teaching. The control group (n = 20) relied on the experience and creativity of the nurse to provide a method of postoperative communication. The experimental group (n = 20) was introduced to a communication board before surgery and used the board during the postoperative intubation period. Each patient completed an open-ended patient interview, a patient satisfaction questionnaire, and a visual analogue scale to assess satisfaction with communication after discharge from the intensive care unit. An independent t test indicated that a planned method of communication does significantly increase patient satisfaction in the early postoperative intubation period (t = 2.09, p = 0.05, n = 35). Content analyses of the patient interviews further supported this finding. Validity of the patient satisfaction questionnaire was supported by a high correlation (r = 0.70) with results from the visual analogue scale. Nurse satisfaction with communication during intubation was analyzed by use of a nurse satisfaction questionnaire and open-ended questions that were completed by the nurse after caring for the patients in this study. A dependent t test (t = 1.25, not significant, n = 20) and content analysis indicated that planned communication did not increase nurse satisfaction; however, it did add to the repertoire of methods that nurses currently use in trying to communicate with their patients.

Attitude of Health Personnel↗
PubMed2001

Communicating with dying patients within the spectrum of medical care from terminal diagnosis to death.

BACKGROUND: Efforts to improve communication between physicians and dying patients have been unsuccessful, and guidelines for improving patient-physician communication about end-of-life care are based primarily on expert opinion. This study assessed which aspects of communication between patients and physicians are important in end-of-life care. METHODS: Twenty focus groups were held with 137 individuals, including patients with chronic and terminal illnesses, family members, health care professionals from hospice or acute care settings, and physicians with expertise in end-of-life care. Focus group analyses determined domains of physician skill at end-of-life care. Communication with patients was identified as one of the most important domains. Analyses of components important in communicating with dying patients and their families were performed. RESULTS: The following 6 areas were of central importance in communicating with dying patients: talking with patients in an honest and straightforward way, being willing to talk about dying, giving bad news in a sensitive way, listening to patients, encouraging questions from patients, and being sensitive to when patients are ready to talk about death. Within these components, subthemes emerged that provide guidelines for physicians and educators. Dying patients also identified the need to achieve a balance between being honest and straightforward and not discouraging hope. CONCLUSIONS: Several areas emerged for physicians to focus their attention on when communicating with dying patients. These findings provide guidance in how to improve this communication. They also highlight the need to approach communication about end-of-life care as a spectrum that requires attention from the time of a terminal diagnosis through death.

Clinical Competence↗
PubMed2003

Effect of communications training on medical student performance.

CONTEXT: Although physicians' communication skills have been found to be related to clinical outcomes and patient satisfaction, teaching of communication skills has not been fully integrated into many medical school curricula or adequately evaluated with large-scale controlled trials. OBJECTIVE: To determine whether communications training for medical students improves specific competencies known to affect outcomes of care. DESIGN AND SETTING: A communications curriculum instituted in 2000-2001 at 3 US medical schools was evaluated with objective structured clinical examinations (OSCEs). The same OSCEs were administered to a comparison cohort of students in the year before the intervention. PARTICIPANTS: One hundred thirty-eight randomly selected medical students (38% of eligible students) in the comparison cohort, tested at the beginning and end of their third year (1999-2000), and 155 students in the intervention cohort (42% of eligible students), tested at the beginning and end of their third year (2000-2001). INTERVENTION: Comprehensive communications curricula were developed at each school using an established educational model for teaching and practicing core communication skills and engaging students in self-reflection on their performance. Communications teaching was integrated with clinical material during the third year, required clerkships, and was supported by formal faculty development. MAIN OUTCOME MEASURES: Standardized patients assessed student performance in OSCEs on 21 skills related to 5 key patient care tasks: relationship development and maintenance, patient assessment, education and counseling, negotiation and shared decision making, and organization and time management. Scores were calculated as percentage of maximum possible performance. RESULTS: Adjusting for baseline differences, students exposed to the intervention significantly outperformed those in the comparison cohort on the overall OSCE (65.4% vs 60.4%; 5.1% difference; 95% confidence interval [CI], 3.9%-6.3%; P<.001), relationship development and maintenance (5.3% difference; 95% CI, 3.8%-6.7%; P<.001), organization and time management (1.8% difference; 95% CI, 1.0%-2.7%; P<.001), and subsets of cases addressing patient assessment (6.7% difference; 95% CI, 5.9%-7.8%; P<.001) and negotiation and shared decision making (5.7% difference; 95% CI, 4.5%-6.9%; P<.001). Similar effects were found at each of the 3 schools, though they differed in magnitude. CONCLUSIONS: Communications curricula using an established educational model significantly improved third-year students' overall communications competence as well as their skills in relationship building, organization and time management, patient assessment, and negotiation and shared decision making-tasks that are important to positive patient outcomes. Improvements were observed at each of the 3 schools despite adaptation of the intervention to the local curriculum and culture.

Clinical Competence↗
PubMed2004

Breast cancer metastatic potential: correlation with increased heterotypic gap junctional intercellular communication between breast cancer cells and osteoblastic cells.

The breast cancer metastasis-suppressor gene BRMS1 is downregulated in metastatic breast cancer cells. Previous reports have shown restoration of gap junctional intercellular communication (GJIC) in the metastatic human breast carcinoma cell line MDA-MB-435 (435) transfected with BRMS1 cDNA. Metastasis, to a large extent in most breast cancers, occurs to bone. However, the reason for this preferential metastasis is not known. We explored cell-to-cell communication between 435 carcinoma cells and a human osteoblastic cell line, hFOB1.19, to determine whether carcinoma cells can form gap junctions with bone cells and to explore the role of these heterotypic gap junctions and the BRMS1 gene in breast cancer metastasis to bone. 435 cells displayed greater cell-to-cell communication with hFOB 1.19 cells than with themselves. Transfection of BRMS1 into 435 cells increased homotypic gap junctional communication but did not significantly affect heterotypic communication with hFOBs. However, heterotypic communication of BRMS1 transfectants with hFOB cells was reduced relative to homotypic communication. In contrast, parental 435 cells displayed greater heterotypic communication with hFOBs relative to homotypic communication. Our results suggest that there are differences in the relative homotypic and heterotypic GJIC of metastasis-capable and -suppressed cell lines.

Bone Neoplasms↗
PubMed2006

Cancer-related relationship communication in couples coping with early stage breast cancer.

This longitudinal study examined the association between three types of communication strategies couples may use to handle stressors they experience during and after breast cancer treatment and psychological distress and relationship satisfaction of women with early stage breast cancer and their partners. Mutual constructive communication, mutual avoidance, and demand-withdraw communication strategies as well as psychological distress and marital satisfaction were rated by 147 patients and 127 partners during cancer treatment and 9 months later. Mutual constructive communication was associated with less distress and more relationship satisfaction for both patient and partner. Demand-withdraw communication was associated with higher distress and lower relationship satisfaction for both patient and partner. Mutual avoidance was associated with more distress for patient and partner but was not associated with relationship satisfaction. The negative association between mutual constructive communication and patient distress was stronger for patients with more physical impairment. Patients' perceptions of mutual constructive communication and mutual avoidance were associated with partners' distress, and patients' perceptions of mutual constructive and demand/withdraw communication were associated with partners' marital satisfaction. Clinical implications for couple-focused communication skills training for cancer patients and their partners are discussed.

Adaptation, Psychological↗
PubMed2005

Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence.

PURPOSE: Although the importance of communication skills in anesthetic practice is increasingly recognized, formal communication skills training has hitherto dealt only with limited aspects of this professional activity. We aimed to document and analyze the informally-learned communication that takes place between anesthesia personnel and patients at induction of and emergence from general anesthesia. METHODS: We adopted an ethnographic approach based principally on observation of anesthesia personnel at work in the operating theatres with subsequent analysis of observation transcripts. RESULTS: We noted three main styles of communication on induction, commonly combined in a single induction. In order of frequency, these were: (1) descriptive, where the anesthesiologists explained to the patient what he/she might expect to feel; (2) functional, which seemed designed to help anesthesiologists maintain physiological stability or assess the changing depth of anesthesia and (3) evocative, which referred to images or metaphors. Although the talk we have described is nominally directed at the patient, it also signifies to other members of the anesthetic team how induction is progressing. The team may also contribute to the communication behaviour depending on the context. Communication on emergence usually focused on establishing that the patient was awake. CONCLUSION: Communication at induction and emergence tends to fall into specific patterns with different emphases but similar functions. This communication work is shared across the anesthetic team. Further work could usefully explore the relationship between communication styles and team performance or indicators of patient safety or well-being.

Anesthesia Recovery Period↗
PubMed2004

Partner communication and HIV risk behaviors among "at risk" women.

OBJECTIVES: This research focused on communication with one's sexual and dating partners, and addressed two main research questions: First, what is the relationship between partner communication and involvement in HIV risk behaviors? Second, which factors predict women's level of partner communication about key issues salient in their lives? METHODS: Cross-sectional interviews were conducted with 250 adult women living in the Atlanta, Georgia metropolitan area between August 1997 and August 2000. Street outreach was used to identify potential study participants, with further expansion of the sample done via targeted sampling and ethnographic mapping procedures. Path analysis was used to examine the relationships between partner communication and HIV risk taking, and to identify predictors for the extent of women's partner communication. RESULTS: The data revealed an inverse relationship between partner communication and involvement in HIV risk taking. Eight statistically significant predictors of partner communication were identified: age, marital status, length of longest marital-type relationship, level of happiness in longest relationship, knowing anyone who had died from AIDS, number of financial problems experienced, having a sexually transmitted disease during the previous year, and self-esteem level. CONCLUSIONS: Partner communication is an important variable to consider when understanding "at risk" women's HIV risk behavior practices. Finding ways to enhance women's communication with their sexual and dating partners appears to be one promising way of reducing their level of HIV risk.

Adolescent↗
PubMed2006

Self-organisation and communication in groups of simulated and physical robots.

In social insects, both self-organisation and communication play a crucial role for the accomplishment of many tasks at a collective level. Communication is performed with different modalities, which can be roughly classified into three classes: indirect (stigmergic) communication, direct interactions and direct communication. The use of stigmergic communication is predominant in social insects (e.g. the pheromone trails in ants), where, however, direct interactions (e.g. antennation in ants) and direct communication (e.g. the waggle dance in honey bees) can also be observed. Taking inspiration from insect societies, we present an experimental study of self-organising behaviours for a group of robots, which exploit communication to coordinate their activities. In particular, the robots are placed in an arena presenting holes and open borders, which they should avoid while moving coordinately. Artificial evolution is responsible for the synthesis in a simulated environment of the robot's neural controllers, which are subsequently tested on physical robots. We study different communication strategies among the robots: no direct communication, handcrafted signalling and a completely evolved approach. We show that the latter is the most efficient, suggesting that artificial evolution can produce behaviours that are more adaptive than those obtained with conventional design methodologies. Moreover, we show that the evolved controllers produce a self-organising system that is robust enough to be tested on physical robots, notwithstanding the huge gap between simulation and reality.

Algorithms↗