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PubMed1992

Electronic communication between providers of primary and secondary care.

OBJECTIVE: To study the effects of the introduction of electronic data interchange between primary and secondary care providers on speed of communication, efficiency of data handling, and satisfaction of general practitioners with communication. DESIGN: Comparison of traditional paper based communication for laboratory reports and admission-discharge reports between hospital and general practitioners and electronic data interchange. SETTING: Twenty-seven general practitioners whose offices were equipped with a practice information system and two general hospitals. OUTCOME MEASURES: Paper based communication was evaluated by questionnaire responses from and interviews with care providers; electronic communication was evaluated by measuring time intervals between generation and delivery of messages and by assessing doctors' satisfaction with electronic data interchange by questionnaire. RESULTS: Via paper mail admission-discharge reports took a median of 2-4 days, and laboratory reports 2 days, to reach general practitioners. With electronic data interchange almost all admission-discharge reports were available to general practitioners within one hour of generation. When samples were analysed on the day of collection (as was the case for 174/542 samples in one hospital and 443/854 in the other) the laboratory reports were also available to the general practitioner the same day via electronic data interchange. Fifteen general practitioners (of the 24 who returned the questionnaire) reported that the use of electronic admission-discharge reports provided more accurate and complete information about the care delivered to their patients. Ten general practitioners reported that electronic laboratory reports lessened the work of processing the data. CONCLUSION: Electronic communication between primary and secondary care providers is a feasible option for improving communication.

Communication↗
PubMed1998

Communication behaviours in a hospital setting: an observational study.

OBJECTIVE: An exploratory study to identify patterns of communication behaviour among hospital based healthcare workers. DESIGN: Non-participatory, qualitative observational study. SETTING: British district general hospital. SUBJECTS: Eight doctors and two nurses. RESULTS: Communication behaviours resulted in an interruptive workplace, which seemed to contribute to inefficiency in work practice. Medical staff generated twice as many interruptions via telephone and paging systems as they received. Hypothesised causes for this level of interruption include a bias by staff to interruptive communication methods, a tendency to seek information from colleagues in preference to printed materials, and poor provision of information in support of contacting individuals in specific roles. Staff were observed to infer the intention of messages based on insufficient information, and clinical teams demonstrated complex communication patterns, which could lead to inefficiency. CONCLUSION: The results suggest a number of improvements to processes or technologies. Staff may need instruction in appropriate use of communication facilities. Further, excessive emphasis on information technology may be misguided since much may be gained by supporting information exchange through communication technology. Voicemail and email with acknowledgment, mobile communication, improved support for role based contact, and message screening may be beneficial in the hospital environment.

Attitude of Health Personnel↗
PubMedDate not supplied

[Relation between social cognitive aspects and the functional communicative profile in a group of adolescents of the autistic spectrum].

BACKGROUND: Issues concerning language development and their relation with social cognitive aspects give direction to the clinical practice when assisting the population with the diagnosis within the autistic spectrum. The deficits or differences in this development can result in different ways of analyzing and counseling this population. Adolescence becomes a question mark in this analysis since, in most cases, researches address only early childhood. The speech pathologist must assess the relationship between language abilities and communicative competence. Language abilities refer to the possibilities to understand and formulate spoken or written symbolic systems, whereas the communicative competence refers to the ability to use language as an effective tool to interact with other people in several social contexts. PURPOSE: To verify the development of the functional communicative profile and of the social cognitive aspects of adolescents, who attend a specialized institution and who have a psychiatric diagnosis within the autistic spectrum in three different situations of communication during a 12 months period and to study the relation between these variables in the same situations, during the same period of time. METHOD: Subjects of this study were five adolescents with ages between 12 and 17 years. Two recording sets, with a 12 month interval, were obtained for each subject. Each recording set was composed by three 30 minutes videotaped situations of different interactive contexts: Situation I--individual language therapy; Situation II--child in a group with coordinator; Situation III--child in a group without coordinator. RESULTS: Differences exist between the subjects in the three studied situations regarding the social cognitive performance and the functional communicative profile. CONCLUSION: There is a relationship between the development of the social cognitive aspects and the functional communicative profile in the three situations of communication for the studied period.

Adolescent↗
PubMed2000

[Effective communication with the mentally challenged person during treatment of minor ailments].

The research objectives were to explore and describe the nature of communication with the mentally retarded adult during treatment of minor ailments; and to describe guidelines for the community nurse in order to facilitate more effective communication during the treatment of minor ailments in the mentally retarded adult for the promotion, maintenance and restoration of the mentally retarded individual's health. The community nurse pays attention to the protection of the mentally retarded individual's health, and identifies and treats minor ailments encountered by the mentally retarded individual. Because of the disability of the adults, lacking communication and obstacles in the exchange and interpretation of communication, could take place between the community nurse and the mentally retarded adult. The responsibility lies with the community nurse to facilitate effective communication, since the mentally retarded individual is not always capable of speaking on his/her own behalf. Guidelines are needed for the facilitation of effective communication between the community nurse and the mentally retarded adult during the treatment of minor ailments. In this research, use were made of a qulitative, exploratory, descriptive and contextual design. The research method consisted of participative observation during which video recording and the taking of field notes were applied. Two themes were identified during data analysis, namely: Verbal communication is aimed at the treatment of wounds. The more functional and task-orientated the community nurse's interaction with the mentally retarded individual, the more the mentally retarded individual would generate symptoms to establish emotional contact and interaction; The non-verbal behaviour of the community nurse focuses on the treatment of wounds and organisation of the environment. The more structure is created, the more play-out-behaviour is shown by the mentally retarded individual in need of contact. The researcher came to the conclusion that the community nurse refrains form near/close contact with the mentally retarded individual, to bridge her own discomfort. The community nurse is "busy" with the act of treating wounds, in order to refrain from effective interaction.

Adolescent↗
PubMed2004

[Scientific communication at the beginning of the 21st century--Hungarian survey and international outlook in medicine and the life sciences].

INTRODUCTION: Rapid developments take place in communication technology. It is a hard task to keep pace with them, but unavoidable. The scene of electronic communication and publication, the Internet has originally been constructed for scientific communication and publication of scientists. Nowadays, the electronic communication has spread all over the world. Though the share of sciences has been diminished, the progress in the scientific electronic communication has not been broken. AIM: The authors delineate the present situation in electronic communication in general and in Hungary. METHODS: The authors asked by questionnaire survey the medical scientists and professionals about their knowledge and usage of modern publication possibilities. For comparison's sake, the authors referred to some foreign surveys as well. RESULTS: In Hungary, the communication possibilities on the Internet--and the electronically accessible publications--are at the readers' disposal at the universities and academic institutions. The opinions about the popularity and effects of electronic publication are generally positive. Concerns were expressed in connection with the possible weaker professional control in case of certain types of publication. In the opinion of the majority of questioned people the electronic form of publication will never replace the traditional one completely, it will be, however, dominant.

Biological Science Disciplines↗
PubMed2006

[Communication aids in amyotrophic lateral sclerosis].

BACKGROUND: Many patients with amyotrophic lateral sclerosis lose the ability to speak, and in late-stage disease also the ability to communicate through gestures. Social isolation is one of the greatest burdens of this disease. Implementation of alternative and augmentative communication can increase the quality of life even in advanced disease. MATERIALS AND METHODS: We have systematically recorded alternative and augmentative communication aids given to patients treated by the amyotrophic lateral sclerosis team at Ullevål University Hospital from 1998 to 2005, and evaluated the results in the light of current literature. RESULTS: 62 out of 92 patients received alternative and augmentative communication aids. Alternative and augmentative communication was more often used by female than male patients (p = 0.01). Except for two who developed dementia, all patients were able to express basic needs until the terminal stage of the disease. INTERPRETATION: Most patients retain enough mobility of head and eyes to use communication aids until the terminal stage. Physicians must know the possibilities and limitations of assisted and augmentative communication in order to give appropriate treatment and information, also concerning life-sustaining treatment.

Adult↗
PubMed1987

Communicating with adolescents who have behavior problems.

Any clinician providing health care to adolescents needs to be able to communicate with them about behavior problems. For reasons relating both to adolescents and to health care providers, such communication is often challenging and sometimes frustrating. Nevertheless, one can develop a method of communicating with adolescents about their problems that will provide information that can be used therapeutically and will make the practice of adolescent medicine more rewarding for the professional. Numerous skills and techniques have been presented that enable the practitioner to initiate, facilitate, and encourage effective communication. These include both verbal and nonverbal methods. Methods for maintaining communication also have been discussed, since there are numerous ways in which communication with adolescents can go awry once it is established. Many health care providers already have developed other individualized skills and techniques; they are encouraged to consider adding those presented in this article. However, communication skills and techniques are useless unless they are based on an interest in the patient. As Peabody wrote almost 6 decades ago: "The secret of the care of the patient is in caring for the patient."

Adolescent↗
PubMedDate not supplied

Relationship of parent-child communication to child's exploratory behavior and self-differentiation.

In a study that investigated the relationship between patterns of acknowledgment in parent--child communication and the child's exploratory behavior and self-differentiation, subjects included 77 healthy perschool children between the ages of 3 years, 3 months and 4 years, 9 months and their mothers. Data on parent--child communication were collected in the home setting during a 30-minute observation in which mothers and children were engaged in a series of semi-structured play activities. Maternal responses to their children's assertions were coded as nonevaluative recognition, positive recognition, negative recognition, direction, or nonrecognition. A score on parent--child communication was the ratio of parental nonevaluative recognition and positive recognition combined to parental negative recognition, direction, and nonrecognition combined. Testing of the children on exploratory behavior and self-differentiation was done on an individual basis in their respective nursery schools. A low positive correlation (r = .237, p less than .05) between parent--child communication and children's self-differentiation was observed. Contrary to expectation, a slight negative correlation (r = -.101, p greater than .05) between parent--child communication and children's exploratory behavior was observed. Auxiliary analyses of the data, taking into consideration the child's sex, revealed that the negative relationship between parent--child-communication and children's exploratory behavior was characteristic of the mother-daughter dyads only (r = -.325, p = .08). A correlation of .078 (p greater than .05 was obtained for mother--son communication with boys' exploratory behavior.

Child Behavior↗
PubMed1994

Theory-based approaches for improving biomedical communications.

Using communication theory to improve biomedical communication may seem overly academic and beyond the practicality of day-to-day project deadlines. However, using communication theory allows us to organize the "big picture" while providing insight concerning the elements of successful communication. This article reviews and illustrates how the organizational power of communication theory can help biomedical communicators approach difficult communication tasks with greater opportunity for success. Overviews of selected theoretical frameworks and models are discussed along with practical implications.

Communication↗
PubMed1994

The utility of electronic mail as a medium for patient-physician communication.

OBJECTIVE: To examine patients' knowledge, use, and attitudes regarding electronic mail communication with their family physicians. DESIGN: Mail survey. SETTING: A university-based family practice center. PARTICIPANTS: Adult patients (18 years and older) of full-time faculty physicians at a university-based family practice center who had seen their physicians at lease once in the 10-month period between July 1, 1992, and April 30, 1993 (N = 4094). Subjects were eligible for participation if both they and their physicians had an electronic mail address at the University of Kentucky, Lexington (n = 117). INTERVENTION: None. MAIN OUTCOME MEASURES: Patient-reported knowledge, use, and attitudes regarding the utility of electronic mail as a means of patient-physician communication. RESULTS: The response rate to the survey was 74% (n = 87). Patient-physician communication via electronic mail was positively perceived by patients for whom electronic mail was accessible Patient-physician communication via electronic mail was perceived to increase speed, convenience, and access to medical care. Electronic mail communication was perceived to be good for simple and nonurgent problems, such as refilling prescriptions, communicating laboratory results, and making appointments. Ninety percent of the patients who had corresponded with their physicians via electronic mail used the medium to discuss a medical problem. CONCLUSIONS: Although electronic mail is not presently in wide use for patient-physician communication, there is great potential for its widespread acceptance.

Attitude↗
PubMed2004

Mode of communication and classroom placement impact on speech intelligibility.

OBJECTIVE: To examine the impact of classroom placement and mode of communication on speech intelligibility scores in children aged 8 to 9 years using multichannel cochlear implants. DESIGN: Classroom placement (special education, partial mainstream, and full mainstream) and mode of communication (total communication and auditory-oral) reported via parental rating scales before and 4 times after implantation were the independent variables. Speech intelligibility scores obtained at 8 to 9 years of age were the dependent variables. PARTICIPANTS: The study included 131 congenitally deafened children between the ages of 8 and 9 years who received a multichannel cochlear implant before the age of 5 years. RESULTS: Higher speech intelligibility scores at 8 to 9 years of age were significantly associated with enrollment in auditory-oral programs rather than enrollment in total communication programs, regardless of when the mode of communication was used (before or after implantation). Speech intelligibility at 8 to 9 years of age was not significantly influenced by classroom placement before implantation, regardless of mode of communication. After implantation, however, there were significant associations between classroom placement and speech intelligibility scores at 8 to 9 years of age. Higher speech intelligibility scores at 8 to 9 years of age were associated with classroom exposure to normal-hearing peers in full or partial mainstream placements than in self-contained, special education placements. CONCLUSIONS: Higher speech intelligibility scores in 8- to 9-year-old congenitally deafened cochlear implant recipients were associated with educational settings that emphasize oral communication development. Educational environments that incorporate exposure to normal-hearing peers were also associated with higher speech intelligibility scores at 8 to 9 years of age.

Child↗
PubMed1997

Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons.

OBJECTIVE: To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons. DESIGN: Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician. SETTINGS: One hundred twenty-four physician offices in Oregon and Colorado. PARTICIPANTS: Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims (> or =2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty. MAIN OUTCOME MEASURES: Audiotape analysis using the Roter Interaction Analysis System. RESULTS: Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons. CONCLUSIONS: Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. Malpractice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups.

Colorado↗
PubMed1984

Parental communication of Holocaust experiences and personality characteristics among second-generation survivors.

Examined communication concerning wartime experiences that went on in survivor families. Sixty-four Jewish children of survivors filled out questionnaires on parental communication, as well as the MMPI, Mosher's Forced Choice Scale of Guilt, and Hogan's Scale of Empathy. Findings indicate that mother's willingness to talk about her experiences and the frequency of her communication were related significantly to the presence of negative personality traits in the second generation. Guilt-inducing communication (by both parents), early experiential awareness of the Holocaust, and indirect communication about the Holocaust also were related significantly to negative characteristics. Father's willingness to talk about his experiences and the frequency of his communication, however, were related to positive factors among his offspring. When separated along gender lines, most forms of communication were related to negative personality factors for female, but not male, children of survivors.

Adaptation, Psychological↗
PubMed2003

Communication about carrier testing within hemophilia A families.

Genetic diseases are family diseases. Although there is considerable research on how individuals decide to have genetic testing and their individual reactions to testing, there is limited research on the familial context of genetic testing. In the present study, we focus on three aspects of the family context of genetic testing for hemophilia A carrier status among women at risk to be carriers. We look at the extent to which there was discussion of carrier testing for hemophilia before we offered DNA-based carrier testing to these at-risk women; with which family members these tested women communicated the results of their carrier testing; and concerns these women had about communicating their carrier test results with relatives, including their children. Data suggest that members of families with hemophilia discussed carrier testing prior to study participation, that the communication of testing information within families was selective, not universal, largely following gender lines for this X-linked disorder, and that there was limited concern about communicating carrier status information to children and other relatives. These data reinforce observations that families are social systems, and within these systems information is selectively communicated. A more complete understanding of how families communicate genetic test information will enable providers to develop more effective means of assisting individuals in handling the familial communication aspects of genetic testing.

Adolescent↗
PubMed2004

Assessing normative approaches to communicating violence risk: a national survey of psychologists.

There is growing attention to the importance of violence risk communication, and emerging empirical evidence of how evaluating clinicians who conduct risk assessments communicate their conclusions about the risk of violence toward others. The present study addressed the perceived value of different forms of risk communication through a national survey of practicing psychologists (N = 1,000). Responses were received from a total of 256 participants, who responded to eight vignettes in which three factors relevant to risk communication were systematically varied in a 2 x 2 x 2 within-subjects design, counterbalanced for order: (i) risk model (prediction oriented versus management oriented), (ii) risk level (high risk versus low risk), and (iii) risk factors (static versus dynamic). Participants were asked to rate the value of six styles of risk communication for each of eight vignettes. The most highly valued style of risk communication involved identifying risk factors applicable to the individual, and specifying interventions to reduce risk. These results were consistent with findings from several previous studies in this area, and reflect an emerging trend in preferences for style and context of risk communication of violence.

Communication↗
PubMed2003

Can intensive three-day programmes improve nurses' communication skills in cancer care?

Effective communication is widely regarded as a crucial component of patient care that can determine patient satisfaction, compliance and recovery. The plethora of communication skills training programmes available to health professionals is also a testament to the importance of this element of care. However a review of studies evaluating the effectiveness of such training programmes concluded that little behavioural change in health professionals' communication skills was evident. This paper reports the findings of a programme offered to cancer/palliative care nurses (n=108) via eight condensed three-day workshops at various UK venues. Behavioural change was assessed through evaluation of audiotaped nursing assessments made pre- and six weeks post-course, scored along nine previously identified key communication areas. Mean overall scores rose by 6 points ( p<0.001) to 20 (out of 27) with statistically significant improvements on eight of the nine individual areas. Improvements in subjective levels of confidence in the areas of communication found difficult pre-course were observed immediately post-course ( p<0.001) and were still evident six weeks later. Similar improvements immediately post-course for teaching communication skills to colleagues ( p<0.001) were further improved six weeks post-course for seven of the eight areas assessed. These results suggest that three-day training courses can lead to clinically relevant behavioural change and improvements in perceived confidence in communication and dissemination of skills.

Adult↗
PubMed1999

Expression of a Cx43 deletion mutant in 3T3 A31 fibroblasts prevents PDGF-induced inhibition of cell communication and suppresses cell growth.

Communication through gap junctions was first suggested to have a role in the social control of cell growth over 30 years ago. However, despite extensive experimentation, the importance of gap junctions as a general mechanism of growth control remains to be established. A number of different studies have shown that a common early response of cells in culture to polypeptide growth factors such as PDGF is a rapid and transient inhibition of cell communication suggesting that a cell may have to lose communication with its neighbors before it can undergo cell division. Here we show that 3T3 A31 fibroblasts exposed to PDGF exhibit a 50% decrease in cell communication as measured by dye transfer in the absence of significant changes in the cellular content and distribution of Cx43. Likewise, PDGF inhibited cell communication in cells transfected either with a vector which did not contain a cDNA or with an expression vector encoding full-length Cx43 fused to a c-myc tag (Cx43-M). In contrast, 3T3 A31 fibroblasts transfected with an expression construct encoding a deletion mutant of Cx43 (Cx43-256M) consisting of amino acids 1-256 of Cx43 fused to a c-myc tag maintain high levels of gap junction activity following exposure to PDGF. These results suggest that sites which trigger loss of cell communication in response to PDGF are located within amino acids 257 to 382 of the Cx43 molecule. Cells transfected with an expression vector encoding full-length Cx43 fused to a c-myc tail exhibited a reduced basal growth rate compared to both parent cells and cells transfected with a control vector but maintained a strong mitogenic response to PDGF. In contrast, both the basal growth rate and the mitogenic response to PDGF was markedly reduced in cells which expressed Cx43-256M consistent with the hypothesis that loss of cell communication is required before a cell can respond to mitogenic stimuli.

3T3 Cells↗
PubMed1998

Mum's the word: mothers' perspectives on communication about sexuality with adolescents.

Mothers' perceptions of the style, content and frequency of their communications with their adolescents about sex and sexuality were examined. We administered semi-structured interviews to 30 mothers of 16-year-olds (16 mothers of sons, 14 mothers of daughters). Despite a uniform assessment that they were effective sexual communicators, mothers varied greatly in their style of sexual communication. Qualitative analyses revealed five communication styles: avoidant, reactive, opportunistic, child-initiated and mutually interactive. These styles differed in who initiated and maintained sexual communication, the comfort level of mother and of teenager, the frequency of sexual communications, the context in which communications took place and the topics discussed and avoided.

Adolescent↗