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PubMed2006

Relations among family discord, caregiver communication, and children's family representations.

This study examined associations among family discord, caregiver communication quality about emotionally stressful family events, and child internal representations of family security in 50 preschool children and their primary caregivers. Consistent with risk and protective models, findings indicate that children's representations were predicted by the interaction between family discord and caregiver communication quality. Children exhibiting the highest level of secure representations of the family experienced a consistency between low levels of family discord and communications emphasizing family security. Conversely, incongruency between family experiences and communication, reflected in high levels of family discord and communications underscoring family security, was associated with the lowest level of child secure representations. Results suggest that child representations hinge on the fit between caregiver communication quality and family experience.

Caregivers↗
PubMed2003

Bone marrow stroma inhibits proliferation and apoptosis in leukemic cells through gap junction-mediated cell communication.

Normal and leukemic blood cell progenitors depend upon the bone marrow (BM) stroma with which they communicate through soluble and membrane-anchored mediators, adhesive interactions and gap junctions (GJ). Regarding hematopoiesis, it is believed that it can be influenced by connexin expression, but the exact role of GJ in cell death and proliferation is not clear. Using flow cytometry, we monitored the division rate of leukemic cell lines, communicating and not communicating with stromal cell line through GJ. We found that GJ-coupled cells (i) did not proliferate; (ii) were kept in G0; and (iii) were protected from drug-induced apoptosis when compared to either total or uncoupled cell population. We conclude that GJ coupling between stroma and leukemic lymphoblasts prevents proliferation, keeping cells in a quiescent state, thus increasing their resistance to antimitotic drugs. Since GJ are particularly abundant in the sub-endosteal environment, which harbors blood stem cells, we also asked which cells within the normal human BM communicate with the stroma. Using a primary BM stroma cell culture, our results show that 80% of CD34+ progenitors communicate through GJ. We propose that blood cell progenitors might be retained in the low-cycling state by GJ-mediated communication with the hematopoietic stroma.

Antigens, CD34↗
PubMed2004

Communicating exposure and health effects results to study subjects, the community and the public: strategies and challenges.

The Mickey Leland National Urban Air Toxics Research Center sponsored a Symposium in August 2002 that focused on the communication of health effects results from community studies involving exposure to hazardous substances in the environment. Some of the audiences identified for presentation of study results were the study subjects, the community, and the general public. Principles and approaches to communicating findings were discussed, as were the challenges that may confront researchers in developing and implementing a communication plan. The Symposium included four sessions. The first was an overview session where Timothy McDaniels (University of British Columbia) described risk communication as a decision-aiding process. In the second session, case studies were presented by Timothy Buckley (Johns Hopkins University), Jane Hoppin (National Institute of Environmental Health Sciences), and Anne-Marie Nicol (University of British Columbia). Approaches and strategies used by different stakeholders to communicate study results was the topic for a panel discussion at the third session. Panelists included: James Collins (The Dow Chemical Company), Mary White (Agency for Toxic Substances and Disease Registry), Richard Clapp (Boston University), Valerie Zartarian (Environmental Protection Agency), Pamela Williams (Chemrisk), and Tina Bahadori (American Chemistry Council). The final session was a summary presentation on lessons learned given by Rebecca Parkin of George Washington University, in which she synthesized the preceding presentations and formulated guidelines for effective risk communication in community research studies.

Communication↗
PubMed1994

Lysophosphatidic acid inhibits gap-junctional communication and stimulates phosphorylation of connexin-43 in WB cells: possible involvement of the mitogen-activated protein kinase cascade.

Lysophosphatidic acid (LPA) was shown to be a powerful inhibitor of gap-junctional communication between cultured rat liver WB cells, as determined by the transfer of Lucifer Yellow, with 50% inhibition obtained at about 0.3 microM LPA. Inhibition of communication was rapid (5 min) and was maintained for at least 80 min. After incubation for 3 h with LPA, communication competence was partially restored and dye transfer was refractory to further addition of LPA. Communication in LPA-refractory cells retained sensitivity to inhibition by phorbol ester and by epidermal growth factor (EGF). LPA-induced inhibition was associated with phosphorylation of connexin-43 protein, as detected by slower migration of the protein detected on Western blots, which could be eliminated by incubation of samples with alkaline phosphatase. A close correspondence was observed between the time- and dose-dependency of LPA effects on communication and the induction of mitogen-activated protein kinase (MAP kinase). Activation of both the 42 kDa and 44 kDa subspecies were confirmed by mobility shifts on Western blots using an anti-(MAP kinase R1) (erk 1-III) antibody and by fractionation on Mono Q columns. Cells pretreated with phorbol ester for 24 h were insensitive to phorbol ester inhibition of communication or activation of MAP kinase, but retained their sensitivity to LPA. The results indicate that LPA initiates the activation of protein kinase cascades in WB cells that are probably independent of protein kinase C and identifies connexin-43 as one substrate for the activated kinases.

Animals↗
PubMed2005

An application of Rasch analysis to the measurement of communicative functioning.

PURPOSE: The purposes of this investigation were to examine the construct dimensionality and range of ability effectively measured by 28 assessment items obtained from 3 different patient-reported scales of communicative functioning, and to provide a demonstration of how the Rasch approach to measurement may contribute to the definition of latent constructs and the development of instruments to measure them. METHOD: Item responses obtained from 421 stroke survivors with and without communication disorders were examined using the Rasch partial credit model. The dimensionality of the item pool was evaluated by (a) examining correlations of Rasch person ability scores obtained separately from each of the 3 scales, (b) iteratively excluding items exceeding mean square model fit criteria, and (c) using principal-components analysis of Rasch model residuals. The range of ability effectively measured by the item pool was examined by comparing item difficulty and category threshold calibrations to the distribution of person ability scores and by plotting the modeled standard error of person ability estimates as a function of person ability level. RESULTS: The results indicate that most assessment items fit a unidimensional measurement model, with the notable exception of items relating to the use of written communication. The results also suggest that the range of ability that could be reliably measured by the current item pool was restricted relative to the range of ability observed in the patient sample. CONCLUSIONS: It is concluded that (a) a mature understanding of communicative functioning as a measurement construct will require further research, (b) patients with stroke-related communication disorders will be better served by the development of instruments measuring a wider range of communicative functioning ability, and (c) the theoretical and methodological tools provided by the Rasch family of measurement models may be productively applied to these efforts.

Activities of Daily Living↗
PubMed1987

Development of the communication profile for the hearing impaired.

The rehabilitative needs of hearing-impaired adults depend on the degree of communication handicap experienced and on many other factors (environmental, behavioral, emotional, and attitudinal) that contribute to communication problems. The Communication Profile for the Hearing Impaired (CPHI) is a 145-item self-assessment inventory for adults. Its 25 scales encompass four areas: Communication Performance, Communication Environment, Communication Strategies, and Personal Adjustment. The inventory was developed at Walter Reed Army Medical Center and pilot tested over a 3-year period on 827 patients who attended the Aural Rehabilitation Program at the Army Audiology and Speech Center. The rationale and methods used to develop the CPHI are discussed, and normative data for the Walter Reed population are presented.

Adult↗
PubMed1990

The relationship between communication problems and psychological difficulties in persons with profound acquired hearing loss.

Communication strategies, accommodations to deafness, and perceptions of the communication environment by profoundly deaf subjects were correlated with indices of psychosocial adjustment to determine whether accommodations to deafness could play a role in the presence of psychological difficulties among deaf persons. Persons with postlingually acquired profound deafness were administered the Communication Profile for the Hearing Impaired (CPHI) and several standardized tests of psychological functioning and adjustment. Inadequate communication strategies and poor accommodations to deafness reported on the CPHI were associated with depression, social introversion, loneliness, and social anxiety. Limited communication performance at home and with friends was related to both social introversion and the experience of loneliness; perceived attitudes and behaviors of others correlated with depression as well as loneliness. In general, the pattern of correlations obtained suggests that specific communication strategies and accommodations to deafness, rather than deafness per se, may contribute to the presence of some psychological difficulties in individuals.

Adult↗
PubMed1984

Profiles of communicative and cognitive-social abilities in autistic children.

The purpose of this study was to examine profiles of communicative and cognitive-social abilities in a small group of autistic children functioning in the prelinguistic and early stages of language development and to compare them with those of normal children functioning at similar stages of language development. The results of measures in the cognitive-social areas of communicative intent, tool use, imitation, and play and in language comprehension demonstrated uneven development for the autistic subjects. A functional analysis of communicative behaviors indicated that, despite a wide variation in communicative means, the autistic subjects displayed a relatively homogeneous profile of communicative functions that was both quantitatively and qualitatively different from the normal profile. Explanations for the heterochrony in communicative and cognitive-social development of these autistic children are discussed.

Autistic Disorder↗
PubMed1988

Analysis of intentional communication of normal children from the prelinguistic to the multiword stage.

The purpose of this study was to collect quantitative measures describing the use of intentional communication by 15 normal children during the prelinguistic, one-word, and multiword stages. A standard communication sample was collected at each language stage from each subject interacting with a clinician. Measures of rates of intentional communicative acts indicated an average of about 1 act per min at the prelinguistic stage, 2 acts per min at the one-word stage, and 5 acts per min by the multiword stage. Analysis of communicative functions indicated that virtually all of the subjects displayed some acts for regulating behavior, engaging in social interaction, and referencing joint attention at all language stages. Changes in the proportions of specific communicative functions at each language stage were found. Analysis of discourse structure using these sampling procedures indicated that most subjects engaged in more initiated than respondent acts. Analysis of communicative means showed that the predominant means were gestural and vocal during the prelinguistic and one-word stage and verbal by the multiword stage. Changes in the proportions of isolated and coordinated gestures and vocalizations at each language stage were found. General descriptions of the syllabic shapes of intentional vocal acts at the prelinguistic and one-word stages demonstrated that most of the subjects used a substantial proportion of consonants in both mono- and multisyllabic vocalizations. Clinical applications of these findings to the early identification of children with the potential for language impairments will be discussed.

Child Language↗
PubMed2000

Communicating with people with stroke and aphasia: understanding through sensation without words.

To illuminate the phenomena of 'communicating with people with stroke and aphasia without words', 10 care providers particularly successful at communicating with stroke and aphasia patients who were working at a stroke rehabilitation ward narrated their experiences of communicating with such patients. A phenomenological hermeneutic approach, inspired by Ricoeur's philosophy, was used in the analysis. Two main themes were found: facilitating openness and being in wordless communication. The care providers sensed the feelings of the patients and experienced similar feelings themselves, thus, the communication is guided by the shared feelings between the care provider and the patient, i.e. communion. For this 'communication through sensation' to take place, the following factors were found to be necessary: creative closeness in combination with protective distance; striving for satisfaction and against exhaustion and desperation; meeting the patient halfway to gain understanding; exhibiting attention and accessibility to the patient; and trust and confidence for both care providers and patients. The findings were interpreted and discussed in the light of works by Levinas, Lögstrup and Stern.

Adult↗
PubMed2002

Communication skills: some problems in nursing education and practice.

This article is based on a literature review carried out as part of a study of communication skills training in pre-registration nursing education in England in 2000. A systematic literature search was conducted and 200 articles were found that were relevant to the study. Definitional problems were found, with terms such as communication skills and interpersonal skills being used interchangeably. The term communications strategies is suggested to overcome these problems, as it reflects the logical organization of a number of different communication skills within a theoretical or empirical framework. Problems in current communication skills teaching and social barriers to using communication skills in practice are discussed. It is concluded that problems continue to exist in these areas and that an emphasis on both aspects is needed if patient and staff satisfaction is to be improved.

Communication↗
PubMed2004

Communication with dying patients--perception of intensive care units nurses in Brazil.

AIMS AND OBJECTIVES: This study aimed to assess whether nurses working in intensive care units view the establishment of communication with patients beyond therapeutic possibilities as an effective palliative therapeutic resource, and which aspects of this communication they valued most. METHOD: Data were collected in November 2002, by semi-structured interviews with 10 nurses of both clinical and surgical intensive care unit at a school hospital in Sao Paulo city, Brazil. Interviews were recorded and transcribed to be further analysed according to the qualitative methodology of content analysis. RESULTS: Four categories of thematic order raised from the collected statements, which clarify (i) the value of communication with terminal patients; (ii) the obstacles found during this process; (iii) the need to identify the individual demands of each patient, (iv) be able to use communication as a tool in the palliative care of the dying patient. CONCLUSION: In conclusion, we found that the nurses working at the intensive care unit do consider communication with dying patients an effective therapeutic resource, in spite of their own difficulties in communicating with dying patients, viewing themselves as ill prepared to the task, and often, distancing themselves from the dying patients because of their inability to deal with their own feelings, which were brought forth by the confrontation with the imminence of death. RELEVANCE TO CLINICAL PRACTICE: Although the number of interviewed nurses in our study was small, the results corroborated the findings of other studies and revealed an educational aspect in nursing training that deserves serious consideration.

Adaptation, Psychological↗
PubMed2001

Examiner fatigue in communication skills objective structured clinical examinations.

CONTEXT: The assessment of undergraduates' communication skills by means of objective structured clinical examinations (OSCEs) is a demanding task for examiners. Tiredness over the course of an examining session may introduce systematic error. In addition, unsystematic error may also be present which changes over the duration of the OSCE session. AIM: To determine the strength of some sources of systematic and unsystematic error in the assessment of communication skills over the duration of an examination schedule. METHODS: Undergraduate first-year medical students completing their initial summative assessment of communication skills (a four-station OSCE) comprised the study population. Students from three cohorts were included (1996-98 intake). In all 3 years the OSCE was carried out identically. All stations lasted 5 minutes with a simulated patient. Students were assessed using an examiner (content expert) and a simulated-patient evaluation tool, the Liverpool Communication Skills Assessment Scale (LCSAS) and the Global Simulated-patient Rating Scale (GSPRS), respectively. Each student was assigned a time slot ranging from 1 to 24, where 1, for example, would denote that the student entered the exam first and 24 indicates the final slot for entry into the examination. The number of students who failed this exam was noted for each of the 24 time slots. A control set of marks from a communication skills written exam was also adopted for exploring a possible link with the time slot. Analysis was conducted using graphical display, covariate analysis and logistic regression. RESULTS: No significant relationship was found between the schedule point that the student entered the OSCE exam and their performance. The reliability of the content expert and simulated-patient assessments was stable throughout the session. CONCLUSION: No evidence could be found that duration of examining in a communication OSCE influenced examiners and the marks they awarded. Checks of this nature are recommended for routine inspection to confirm a lack of bias.

Clinical Competence↗
PubMed2001

Validation of the doctor-patient communication component of the Educational Commission for Foreign Medical Graduates Clinical Skills Assessment.

BACKGROUND: The pivotal role of doctor-patient communication in effective health care delivery led the Educational Commission for Foreign Medical Graduates (ECFMG) to incorporate the assessment of interpersonal skills and spoken English proficiency into its Clinical Skills Assessment (CSA). Furthermore, it was decided that to pass the CSA, a candidate would need to meet or surpass defined performance standards for doctor-patient communication as a discrete component. This requirement, among others, is designed to ensure the readiness of graduates of foreign medical schools (FMGs) to enter postgraduate medical education programmes in the United States. OBJECTIVE: The primary focus of this study was to determine the extent to which performance in a simulated testing environment is related to performance in the clinical setting. METHOD: Nurses were trained to rate the communication skills of residents from the patient's perspective. A total of 43 first-year residents were evaluated. The survey ratings (n=225) were compared with the residents' CSA communication scores. RESULTS: Corrected correlations between CSA ratings and those obtained from nurses ranged from 0.61 to 0.73. CONCLUSION: This study provides evidence for the validity of the communication ratings provided by standardized patients. The reasonably strong associations between ratings obtained during testing and those obtained through observation of 'real' patient interactions suggest that external observers can provide accurate evaluations of doctor-patient communication.

Clinical Competence↗
PubMed2001

Random comparison of 'virtual patient' models in the context of teaching clinical communication skills.

AIMS: Two types of virtual patient designs can be distinguished: a 'narrative' structure and a 'problem-solving' structure. This study compares the same virtual patient with two different structures within the domain of communication skills. METHODS: Two virtual patients were constructed around the same case, one emphasizing a narrative and one a problem-solving model. Use of these packages was trialled with undergraduate medical students over 2 years. Students were randomly assigned to tutorials using the virtual patients, and their communication skills were compared with baseline performance by a separate group. Outcome was assessed by evaluation of an interview with a simulated patient. RESULTS: There was no significant difference between the three groups in overall communication skills. However there was a significant improvement in the communication skills of the narrative group when compared only with the problem-solving group. Additionally, various aspects of communication skills, such as use of open-ended questions and appropriate language, showed significant differences between the three groups. CONCLUSION: There is some evidence to support the value of a narrative design for virtual patients which are to be used to teach communication skills, which encourages further investigation.

Analysis of Variance↗
PubMed2002

The effectiveness of a computer-assisted instruction programme on communication skills of medical specialists in oncology.

BACKGROUND: Although doctor--patient communication is important in health care, medical specialists are generally not well trained in communication skills. Conventional training programmes are generally time consuming and hard to fit into busy working schedules of medical specialists. A computer-assisted instruction (CAI) programme was developed -- 'Interact-Cancer' -- which is a time-efficient learning method and easily accessible at the workplace. OBJECTIVE: To investigate the effect of the CAI training, 'Interact-Cancer', on the communication behaviour of medical specialists, and on satisfaction of patients about their physician interaction. DESIGN: Consultations of medical specialists with cancer outpatients were videotaped at 4 specific stages, 2 before and 2 after Interact-Cancer, with intervals of 4 weeks. PATIENTS/PARTICIPANTS: Participants were 21 medical specialists, mainly internists, working in 7 hospitals, and 385 cancer outpatients. METHODS: Communication behaviour was assessed on 23 observation categories derived from the course content. Frequencies were rated as well as judgements about the quality of the performance of each target skill. Satisfaction was measured by the Medical Interview Satisfaction Scale. Data were analyzed by means of multilevel statistical methods. RESULTS: The behavioural assessment showed course effects on ratings of the physicians' quality of performance. No course effects were found on the frequencies of physicians' behaviours and on the patient satisfaction ratings. CONCLUSIONS: CAI is a promising method to supply medical specialists with postgraduate training of communication skills. The application of judgement ratings of communication behaviour proved to be valuable to evaluate course effects in real-life patient encounters.

Adult↗
PubMed2002

Improving communication between health professionals and women in maternity care: a structured review.

OBJECTIVE: To review trials of the effectiveness of interventions aimed at improving communication between health professionals and women in maternity care. SEARCH STRATEGY: The electronic databases Medline, PsycLit, The Cochrane Library, BIDS Science and Social Science Indexes, Cinahl and Embase were searched. Final searches were carried out in April 2000. INCLUSION CRITERIA: Controlled trials of interventions explicitly aimed at improving communication between health professionals and women in maternity care were included. Other trials were included where two reviewers agreed that this was at least part of the aim. DATA EXTRACTION AND SYNTHESIS: 95 potentially eligible papers were identified, read by one reviewer and checked against the inclusion criteria. The 11 included trials were read, assessed for quality and summarized in a structured tabular form. RESULTS: The included trials evaluated interventions to improve the presentation of information about antenatal testing, to promote informed choice in maternity care, woman-held maternity records and computer-based history taking. Four trials in which women were provided with extra information about antenatal testing in a variety of formats suggested that this was valued by women and may reduce anxiety. Communication skills training for midwives and doctors improved their information giving about antenatal tests. The three trials of woman-held maternity records suggested that these increase women's involvement in and control over their care. CONCLUSIONS: The trials identified by this review addressed limited aspects of communication and focused solely on antenatal care. Further research is required in several areas, including trials of communication skills training for health professionals in maternity care and other interventions to improve communication during labour and in the postnatal period.

Communication↗
PubMed2000

Affective communication of infants with autistic spectrum disorder and internal representation of their mothers.

We have been examining the developmental process of affective communication in infants with autistic spectrum disorders from the viewpoint of relationship disturbance through our developmental and psychopathological studies on autism. In particular, the role of internal representation of the mother in the process of development of affective communication is discussed through the presentation of two cases diagnosed as autistic spectrum disorder in early infancy. In these cases, we postulate approach-avoidance motivational conflict as the primary factor impeding development of affective communication, focusing therapeutic intervention on this perspective. As a result, attachment behavior was remarkably improved in the children, but affective communication with their mothers was not readily improved. Taking up the mothers' own internal representation in mother-infant psychotherapy, in particular, the mothers' problems in attachment behavior with their own mothers in infancy precipitated transition in the mothers' internal representation of their children, leading to active evolution in mother-child interaction and development in affective communication between mother and child. In this context, the basis and significance of internal representation of both parties being determinants in the quality of mother-child communication are discussed.

Affect↗