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PubMed1993

Facilitated communication: a failure to replicate the phenomenon.

Twenty-one subjects participated in a study of Biklen's and Crossley's hypothesis that persons with autism show unexpected literacy and improved communication ability through the process of facilitated communication (FC). Repeated measures of literacy were conducted at (a) a baseline test of communicative ability before FC; (b) a pretest with facilitation; and (c) a posttest with facilitation after 20 hours of training. At both the pretest and posttest, the facilitators were screened from hearing or seeing the questions or pictorial stimuli. Although some facilitators reported newfound communicative abilities during training sessions, no client showed unexpected literacy or communicative abilities when tested via the facilitator screening procedure, even after 20 hours of training. Separate analyses indicated that some facilitators influenced the communicative output of their clients.

Adolescent↗
PubMed1990

Naturalistic observations of spontaneous communication in autistic children.

Thirty children with autism were observed during their everyday school activities in order to examine patterns of spontaneous communication. The forms, functions, and targets of their communication were recorded by trained observers. The prototypical communicative event consisted of a child directing a motoric form of communication toward the teacher to request something or to attract attention to himself or herself. However, communication patterns were found to vary as a function of the child's cognitive level and severity of autism. Deficits in joint attention functions were observed, and were most striking in the subgroup of children who did not use speech. Results are discussed with reference to Wetherby's (1986) model for the development of communicative functions in autistic children.

Adolescent↗
PubMed1994

Sharing and communicating health care information: summary and recommendations.

Sharing and communicating information is a fundamental task in modern medicine. The health care system of the western world is based on teamwork of professionals who participate in the care of patients. Exchange of information (not just data) requires the communicating parties to agree on a communication channel, an exchange protocol, and a common language. The language includes an alphabet, words, phrases, and symbols that express and assign meaning, understood by all. The most common forms of communication are the spoken word and the paper-based patient record. Computers and communication systems improve the sharing of health care information by overcoming the limitations imposed by the dimensions of time and location. However, natural language is still too complex and too ambiguous for current computing devices to handle the complex interactions between health care professional and patients. A simpler 'language' is needed that uses domain specific vocabularies (and/or codes), well-defined exchange protocols for data, information, knowledge, and, in the future, perhaps even wisdom. This simpler 'language' is expected to handle most of the routine information exchange but not eliminate natural language. It is essential that health care information systems preserve and incorporate natural language expressions and integrate them with structured vocabularies. Today, agreeing on standard data exchange protocols and domain specific vocabularies and codes is our greatest challenge. However, standards alone are not sufficient. Acceptance of the standards by the health care professionals, verifications in clinical environments, and implementation agreements by the medical informatics industry are essential. The group on 'Sharing and Communication of Health Care Information' addressed the issues raised above and unanimously recommends a number of steps that will improve the sharing of information. In addition, specific recommendations are offered to governments, health care institutions, and to developers of health care information systems.

Communication↗
PubMed1991

Body communication as compensation for speech in a Wernicke's aphasic--a longitudinal study.

This case study describes a Wernicke's aphasic who had spontaneously developed a communication pattern involving a large portion of body communication to convey factual information. The study is longitudinal and compares the development of body communication and speech (here: the use of nouns, verbs, adjectives, and pronouns) during the 18-month period of rehabilitation. There is a clear development, showing an increased use of nouns, verbs, and adjectives and a decreased use of body communication to convey factual information. This is taken to show that compensatory body communication for factual information can be used by Wernicke's aphasics, something that is easily obscured by the finding often reported that most aphasics tend to show body communication patterns that are in accordance with their speech patterns. The role of pronouns and gestures for turnkeeping at an intermediate stage, when the patient is shifting from gestures to words for factual content, is also discussed.

Aphasia, Wernicke↗
PubMed2004

Calcium signal communication in the central nervous system.

The communication of calcium signals between cells is known to be operative between neurons where these signals integrate intimately with electrical and chemical signal communication at synapses. Recently, it has become clear that glial cells also exchange calcium signals between each other in cultures and in brain slices. This communication pathway has received utmost attention since it is known that astrocytic calcium signals can be induced by neuronal stimulation and can be communicated back to the neurons to modulate synaptic transmission. In addition to this, cells that are generally not considered as brain cells become progressively incorporated in the picture, as astrocytic calcium signals are reported to be communicated to endothelial cells of the vessel wall and can affect smooth muscle cell tone to influence the vessel diameter and thus blood flow. We review the available evidence for calcium signal communication in the central nervous system, taking into account a basic functional unit -the brain cell tripartite- consisting of neurons, glial cells and vascular cells and with emphasis on glial-vascular calcium signaling aspects.

Animals↗
PubMed2025

Psychological and emotional impacts of communicating breast cancer risk using multifactorial assessment with polygenic risk score: Findings from PERSPECTIVE I&I.

PURPOSE: To examine the psychological and emotional outcomes of personalized breast cancer risk communication up to 1 year after disclosure in a risk-stratified breast screening preimplementation study (Personalized Risk Assessment for Prevention and Early Detection of Breast Cancer: Integration and Implementation). METHODS: Among 3753 females aged 40 to 69, unaffected by breast cancer, with a prior mammogram, and who underwent multifactorial risk assessment to estimate their 10-year breast cancer risk, 2734 completed follow-up questionnaires up to 1 year after risk communication: 78.5% were at average risk, 16.5% at higher than average risk, and 5.0% at high risk. The impact of risk communication on breast cancer worry and psychological distress and factors associated with decisional regret were examined. RESULTS: Breast cancer worry and psychological distress scores remained low after risk communication and at 1 year follow-up. Up to 1 year after disclosure, small significant differences in breast cancer worry were observed between risk levels. Decisional regret was very low 1 year after risk communication. Lower levels of decisional regret were significantly associated with some factors, including higher satisfaction with the information received. CONCLUSION: This study suggests that personalized breast cancer risk communication has low negative psychological and emotional effects and highlights the importance of the information received for implementing this approach at population level.

Humans↗
PubMed2005

Asynchronous communication among clinical researchers: a study for systems design.

Group work is an essential part of modern health care. Although there have been advances in the technology of communication, these have not necessarily led to efficient and effective communication among collaborating health-care professionals. Instead, barriers such as varied organizational cultures, different training backgrounds, and varied time schedules can overwhelm technological solutions and impede efficient communication. We focus on one particular sort of collaboration, that of group work around a clinical trial protocol, where the collaboration is asynchronous and the participants are geographically distributed. In this work setting, we have applied a computer-supported cooperative work (CSCW) approach in two distinct ways. First, we used observational methods to uncover and understand a complex set of communication behaviors and needs. Second, we used participatory design and iterative prototyping to design a system that aims to improve communication and work flow among these collaborators. We found that these methods work well in tandem-our observational study helped better inform our design, and our prototyping cycles provided additional insight into the work. More specifically, we were able to identify a set of communication problems in the work that led us to specify a set of design desiderata for systems that support asynchronous collaboration around an evolving medical document.

Biomedical Research↗
PubMed2005

Socio-economic status of the patient and doctor-patient communication: does it make a difference?

This systematic review, in which 12 original research papers and meta-analyses were included, explored whether patients' socio-economic status influences doctor-patient communication. Results show that patients from lower social classes receive less positive socio-emotional utterances and a more directive and less participatory consulting style, characterised by significantly less information giving, less directions and less socio-emotional and partnership building utterances from their doctor. Doctors' communicative style is influenced by the way patients communicate: patients from higher social classes communicate more actively and show more affective expressiveness, eliciting more information from their doctor. Patients from lower social classes are often disadvantaged because of the doctor's misperception of their desire and need for information and their ability to take part in the care process. A more effective communication could be established by both doctors and patients through doctors' awareness of the contextual communicative differences and empowering patients to express concerns and preferences.

Affect↗
PubMedDate not supplied

Validating the Interpersonal Communication Assessment Scale.

Despite the centrality of interpersonal communication in nursing, there are few psychometrically sound instruments to measure the communication competencies of undergraduate and graduate nursing students. This article reports on the development and testing of the Interpersonal Communication Assessment Scale (ICAS), which was designed to assess the communication competencies of students in undergraduate and graduate nursing programs. Retroductive triangulation, using both deductive and inductive methods, and the Model of Relational Competence guided the measure's conceptualization and development. We used responses from 531 (24%) undergraduate and graduate clinical faculty from 246 American Association of Colleges of Nursing member schools for the psychometric testing of the 54-item content-validated and pilot-tested ICAS. Exploratory-factor analysis resulted in a three-factor solution labeled as advocacy, therapeutic use of self, and validation. These factors accounted for 60% of the variance. Items that loaded .60 or higher were retained, resulting in a 23-item scale with a Cronbach's alpha of .96. The ICAS significantly differentiated the communication competencies of beginning and graduating students in both undergraduate and graduate programs. The ICAS was found to have construct validity and internal consistency, underscoring its potential as a formative and summative tool to assess the interpersonal communication competencies of nursing students.

Analysis of Variance↗
PubMed1999

An evaluation of a communication skills workshop for dentists: cultural and clinical relevance of the patient-centred interview.

The benefits for both doctors and patients of effective communication skills in medical care have been widely documented and are generally accepted. There has been less research on this topic with respect to dental care. However, based on available studies and the reported success of teaching communication skills at the undergraduate level in dental schools, a workshop was developed to improve the communication skills of dentists working in government clinics in Hong Kong. The patient-centred interview as used in medical care formed the basis for teaching communication skills in this workshop. Objective and subjective measures of dentists' knowledge, attitude and skills related to the patient-centred interview were obtained before, immediately and eight weeks after the workshops. Objective measures showed immediate gains in knowledge. However, attitudes declined during the period of study. Subjective evaluations revealed improved communication skills eight weeks after the workshop and that the patient-centred interview was considered relevant to the practices of these dentists. Participants made specific reference to the concept of empathy as a means of promoting more effective communication between dentists and patients.

Attitude of Health Personnel↗
PubMed1984

Decision-making processes in augmentative communication.

The potential population for augmentative communication is large, yet no objective assessment criteria exist. This article provides the clinician with a series of matrices designed to facilitate assessment decision making and implementation of augmentative communication. The first matrix addresses the appropriateness of augmentative communication. In the matrix the clinician will find an indepth, systematic decision-making procedure for aiding in the choice of augmentative procedures as primary or complementary methods of communication. The second matrix provides the clinician with information on modes of augmentative communication. These modes include manual systems, communication boards, and electronic devices. The third matrix focuses on code information. Particular attention is given to visual and manual codes. Together, the matrices provide the clinician with an objective procedure for evaluating and organizing available clinical information on nonspeaking clients.

Cognition↗
PubMed1997

Developing assistive technology strategies for infants and toddlers with communication difficulties.

Communication is a process that begins at birth and continues throughout life. For young children with developmental delay or disability, the acquisition of expected communication skills may be compromised. Compromised communication skills, in turn, may lead to additional challenges when participating in daily activities and routines, forming social relationships, and developing independence. Assistive technology (AT) is one means by which a child's current communication skills can be expanded and enhanced within the child's natural environment. Increased awareness by both parents and professionals of the availability of AT has led to the inclusion of AT strategies within routine day-to-day early intervention practices. This article briefly highlights early aspects of communication development in typically developing infants and toddlers, then provides a framework through which AT strategies can be identified and utilized by parents and professionals to improve a child's existing communication skills.

Child Development↗
PubMed2006

Communication and eating proficiency in 125 females with Rett syndrome: The Swedish Rett Center Survey.

PURPOSE: To describe communication and eating proficiency and related factors in Swedish females with Rett syndrome, from a parental/caregiver view. METHOD: Data from a questionnaire were used and approached descriptively, qualitatively and comparatively. Parents/caregivers of 125 females with Rett syndrome completed the survey. The mean age of the females was 19.6 years. RESULTS: Communication: expressive language was limited and the most common way of expressing will was by producing motor acts, 50% of which were higher level of language (eye- and finger-pointing and gestures). Results also showed communicative behaviour was demonstrated during social activities. Eating proficiency: For eight specific types of eating difficulties, the majority of the females suffered from none, one or two of them. There were significant associations of some specific eating difficulties with breathing dysfunctions and food consistency, but not with dental or oral problems. CONCLUSIONS: Results from this study have confirmed that verbal communication in Rett syndrome is limited. Despite a lack of verbal communication the females in this study were reported to need and enjoy social interplay. Outcomes concerning eating were generally good. For optimal intervention, it is recommended that family and professionals work together to evaluate eating situations and communication ability for females with Rett syndrome.

Activities of Daily Living↗
PubMed2002

Ethics and computer-mediated communication: implications for practice and policy.

Computer-mediated communication, or email, has become a common workplace practice. Interviews with Army nurse managers (n = 9) and their staff nurses (n = 13) revealed that nurses incorporate the ethical principles of autonomy, beneficence, nonmaleficence, and justice into their computer-mediated communication use, but to varying degrees. Without clearly defined policies to guide computer-mediated communication practices, informal norms evolve that have an impact on both individual and corporate communication. The authors provide insight into the ethical considerations that have an impact on computer-mediated communication use. The spectrum of participant interpretation of appropriate use of this type of communication suggests the need for policies to establish clear boundaries for workplace usage. Policy recommendations are included.

Adult↗
PubMed1980

Predicting patient satisfaction from physicians' nonverbal communication skills.

The relationship between physicians' nonverbal communication skills (their ability to communicate and to understand facial expression, body movement and voice tone cues to emotion) and their patients' satisfaction with medical care was examined in 2 studies. The research involved 71 residents in internal medicine and 462 of their ambulatory and hospitalized patients. Standardized, reliable and valid measures of nonverbal communication skills were administered to the physicians. Their scores on these tests were correlated with ratings they received from a sample of their patients on measures of satisfaction with the technical aspects and the socioemotional aspects (or art) of the medical care they received. While the nonverbal communication skills of the physicians bore little relationship to patients' ratings of the technical quality of care, measures of these skills did predict patient satisfaction with the art of medical care received. Across both samples, physicians who were more sensitive to body movement and posture cues to emotion (the channel suggested by nonverbal researchers as the one in which true affect can be perceived) received higher ratings from their patients on the art of care than did less sensitive physicians. In addition, physicians who were successful at expressing emotion through their nonverbal communications tended to receive higher ratings from patients on the art of care than did physicians who were less effective communicators. The implications of successfully identifying characteristics of physicians with whom patients are satisfied are discussed.

Adult↗
PubMedDate not supplied

Wireless technology improves nursing workflow and communications.

Inpatient healthcare delivery involves complex processes that require interdisciplinary teamwork and frequent communication among physicians, nurses, unit secretaries, and ancillary staff. Often, these interactions are not at a nursing unit, or near a phone. In an effort to address the inefficiencies of these workflow processes and communications, St. Agnes HealthCare, Baltimore, MD, installed a new hands-free communications system that uses a wireless network, voice recognition, and a small wearable badge. Developed by Vocera, the communications system permits one-button access to others on the system or connects to outside phones through PBX integration. While many agree that today's technology has the potential to positively impact nursing care delivery, St. Agnes HealthCare and Vocera, with assistance from First Consulting Group, decided to conduct a comprehensive benefits study in December 2003 to quantify the impact of this communications system on workflow and communications. The results identified a number of significant findings that demonstrate its value from a quantitative and qualitative standpoint. The following article describes this study and its findings.

Attitude of Health Personnel↗
PubMedDate not supplied

Family communication about positive BRCA1 and BRCA2 genetic test results.

PURPOSE: The identification of a BRCA1 or BRCA2 genetic mutation can provide important health information to individuals who receive this result, but it can also provide crucial cancer risk information to family members. Most of the research on communication of genetic test results has focused on first degree relatives. The purpose of this retrospective study was to examine the process of communicating a positive BRCA1 or BRCA2 genetic test result to male and female first, second, and third degree relatives. METHODS: Participants were 38 female mutation carriers who responded to a written survey assessing the number and relationship of relatives informed, methods used to inform relatives, topics discussed, and motivations and barriers for communication. RESULTS: Overall, 59% (470/803) of first, second, and third degree relatives were informed. The proportion of informed parents, siblings, and offspring was nearly twice that of more distant relatives including nieces, nephews, aunts, uncles, grandchildren, and cousins (88% versus 45%; P = 0.02). The method of communication differed by the gender of the relative, as did some of the topics discussed. The most important reasons for discussing the genetic test results were (1) to inform the relatives of their risk, (2) to suggest that they be tested, and (3) to fulfill a perceived duty to inform. The major barrier to communication was little contact and/or emotionally distant relationships. CONCLUSION: Female mutation carriers act on a perceived duty to inform close relatives of their positive test result; however, there is a need for genetic counseling strategies that address communication with more distant relatives.

Communication↗
PubMed2004

Making sense in a fragmentary world: communication in people with autism and learning disability.

The communicative capabilities of people with autism are impaired and limited in significant ways. The problems are characterized by a lack of intentionality and symbol formation, which indicates that the deviant development of communication in autism is associated with a specific cognitive style. The central coherence theory can offer insight into the specific communication problems of people with autism, since a weaker drive for central coherence leads to problems in sense-making and, consequently, in communication. In the case of the comorbidity of autism and learning disability, the communication problems are aggravated. The crucial point is the determination of the level of sense-making, taking this comorbidity into account. Assessment and intervention have to be tuned to individual needs, in order to increase the communicative competence of people with autism and learning disability.

Autistic Disorder↗