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Telephone communications with several commercial respirators.

Previous work showed that telephone communications while wearing military respirators degraded both word comprehension and recognition speed. In addition, electronic amplification of the speech diaphragm signal had shown no advantage to the extra hardware. This experiment was performed to test effects of different configurations of commercially available respirators on telephone communications accuracy and speed. Twelve pairs of subjects were separated into different rooms and communicated by telephone. Modified rhyme-test words were presented by computer to the speaker, who transmitted the word by telephone to the listener. During the first replication, subjects were given no instruction about telephone communications procedure. During the second replication subjects followed a communications protocol that instructed them when to move the telephone handset from their ears to their mouths. Results showed that the protocol uniformly improved communications accuracy without incurring any extra time penalty. Word comprehension was still twice as fast without a respirator as with a respirator. Accuracy with the protocol nearly equaled the no respirator control value for most respirators tested.

Adolescent↗
PubMed2007

Evaluation of noise attenuation and verbal communication capabilities using three ear insert hearing protection systems among airport maintenance personnel.

The goal of this project was to determine whether one type of earplug would allow a user to hear communication in a noisy environment better than two other types of earplugs. The three types of earplugs studied are newly available on the market. Sonomax SonoCustoms are custom fitted to the user. E-A-R Push-Ins are the newest form of foam earplugs, and Howard Leight SmartFits have an adaptable shape. One of the earplug manufacturers claimed to have improved verbal communications due to the design of the earplug. We hypothesized that the type of earplug providing better communication properties would have lower attenuation around the communication frequencies compared with the other types. To test this hypothesis, we used speech intelligibility and attenuation tests in the laboratory on 26 subjects, and real-time video exposure monitoring in the field (airport maintenance personnel) for visual communication cues. ANCOVA was used to analyze the data from the laboratory study. The type of earplug worn was not significant in the model (p-value 0.0849), nor was attenuation of the earplug (p-value 0.2379). Further analysis showed that attenuation did not differ significantly among earplugs (p-value 0.5903). Logistic regression was used to analyze the data from the field study. Again, the type of earplug was not significant in the model (p-value 0.0965). A comfort questionnaire determined that Howard Leight SmartFits and the E-A-R Push-Ins were more comfortable and easier to use than the Sonomax HPDs (p-value <0.0001). We found a definite difference between manufacturers' attenuation data and our attenuation data, especially in the frequencies for 125-1000 Hz. Also, there was no difference in frequency and overall attenuation among the HPDs. This resulted in no difference in communication abilities among the types of HPDs.

Adult↗
PubMed2000

Role of health communications in Russia's diphtheria immunization program.

As part of a broader program in health communication assistance, project staff from Basic Support for Institutionalizing Child Survival worked with staff from Russia's oblast (regional) public health agencies to design and implement communication activities supporting local diphtheria immunization efforts. Because aggressive community outreach efforts and strong administrative sanctions had already achieved impressive adult coverage rates for first doses of diphtheria toxoid vaccine, communication interventions emphasized the need for second and third doses. Outcomes were assessed through vaccination coverage data and more qualitative measures. In one project site, the increase in adult coverage (two or more doses) was very modest. In a second site, with a stronger communications component, coverage increased significantly (from 20% to 80%). Although it is not possible to disentangle completely the effects of communications from other aspects of oblast immunization programs, these and other outcome data suggest that health communications can play an important role in Russia's ongoing mass immunization efforts.

Adult↗
PubMed2002

Unsubscribe, pleeezz!!!: management and training of media competence in computer-mediated communication.

Computer-mediated communication (CMC) has created a new communication divide. Mostly, this division is due to technical and access problems. Overlooked is yet another divide in terms of user communication competence. This contribution focuses on media competence based on theories about communication competence and theories about CMC. Two field studies are presented: an analysis of a virtual seminar chat communication (22 participants, 3 weeks' duration) and an analysis of unsubscribe-failures within 2 years of a German mailing list (average of 1,000 subscriptions). Data from both studies reveal that help-seeking CMC users with low media-specific competence experience setbacks in terms of interpersonal relations and information gathering. There is a spiral of neutral to negative reactions and an increase in stress and aggression-related language in the reaction of the addressed peers. From the perspective of external raters, we found a contraintuitive result: The style, content, and wording of the message of the respondent is considered as an indicator for a less competent and socially attractive person behind the follow-up message than those of the initial message. On the one hand, media experts are needed and appreciated as technical problem-solvers; on the other hand, they might be perceived as socially narrow-minded freaks who are less interested in the task itself than in CMC-based task completion. This leads to the question of how sensibility for the social context, task orientation, and media competence can be combined (and trained for) in one person. Two competence trainings for text-based synchronous and asynchronous communication are introduced as interventions.

Communications Media↗
PubMed2006

Bereaved hospice caregivers' perceptions of the end-of-life care communication process and the involvement of health care professionals.

BACKGROUND: This study was conducted to gain an understanding of bereaved hospice family caregivers' perceptions of the communication process from initial discussion of the need for end-of-life care and hospice through the decision to choose hospice and the transition home. METHODS: One hundred eight bereaved hospice caregivers that were 36 months postpatient death responded to a quantitative mailed survey. Aspects of the end-of-life care communication process, including involvement of health care professionals at each step, were assessed. RESULTS: Serious illness and the need for hospice care were first mentioned to patients and caregivers by physicians. Often the caregivers recalled only one meeting in which hospice was discussed. Other than the physicians, social workers were the professionals most often present in at least one of these meetings. Nurses and social workers were both perceived to be helpful in the transition to home hospice. Social workers were reported to be most comfortable with discussion of end-of-life care, most knowledgeable, and most available during the communication process that led to a decision about end-of-life care. Suggestions that these caregivers had to improve communication with health care professionals were categorized from responses to an open-ended survey question as: the need to discuss vital information earlier and what to expect for care at end stage; be more forthcoming about reality of death; and treat people as individuals. CONCLUSIONS: Although many health care professionals play a role in the communication and transition to hospice care, physicians and social workers were found to be pivotal participants in this process. A coordinated team approach to end-of-life communication and decision-making may facilitate the process and possibly lead to increased and earlier referral to hospice.

Alabama↗
PubMed2004

Communication about the ending of anticancer treatment and transition to palliative care.

BACKGROUND: Communication about the ending of anticancer treatment and transition to palliative care is a difficult task for oncologists. The primary aims of this study were to clarify family-reported degree of emotional distress and the necessity for improvement in communication methods when communicating about the ending of anticancer treatment, and to identify factors contributing to the levels of emotional distress and the necessity for improvement. METHODS: A multi-center questionnaire survey was conducted on 630 bereaved family members of cancer patents who received specialized palliative care in Japan. A total of 318 responses were analyzed (effective response rate, 62%). RESULTS: Thirty-nine percent of the bereaved family members reported that they were 'very distressed' in receiving information about the ending of anticancer treatment, and 19% reported 'considerable' or 'much' improvement was necessary in the communication methods. High-level emotional distress was significantly associated with younger patient age, female family gender, the experience of the physician stating she/he could do nothing for the patient, the physician's unwillingness to explore their feelings, and prognostic disclosure of definite survival periods without probabilities or ranges. High levels of perceived necessity for improvement in the communication methods were significantly associated with the experience of the physician stating she/he could do nothing for the patient, physicians not explaining treatment goals in specific terms, physicians not pacing the explanation with the state of family preparation, physicians not being knowledgeable about the most advanced treatments, and the atmosphere not being relaxing enough to ask questions. CONCLUSIONS: In receiving the information about ending anticancer treatment, a considerable number of families experienced high levels of emotional distress and felt a need for improvement of the communication methods. The strategies to alleviate family distress could include: (i) assuring that physicians will do their best to achieve specific goals, without saying that they can do nothing for the patient; (ii) providing information, including estimated prognosis, in careful consideration of families' preparation and the uncertainty for each patient; (iii) exploring families' emotions and providing emotional support; (iv) acquiring knowledge about advanced treatments; and (v) making the atmosphere relaxing enough to allow families to ask questions.

Aged↗
PubMed1993

Cytochrome P450-mediated metabolism of tumour promoters modifies the inhibition of intercellular communication: a modified assay for tumour promotion.

The role of metabolism of tumour promoters on the inhibition of intercellular communication was investigated in a modified V79 metabolic cooperation system. V79 cells, which stably express different rat cytochrome P450 enzymes (CYP1A1, CYP1A2 or CYP2B1), were used in the metabolic cooperation assay. The inhibitory effect on intercellular communication of four compounds was changed in cells expressing cytochrome P450 enzymes, compared to cells without. The phorbol ester TPA and di(2-ethylhexyl)phthalate blocked intercellular communication in all the cell lines tested, but expression of CYP1A1 enzyme reduced the inhibitory activity in these cells. Diethylstilbestrol caused inhibition only with cells containing cytochrome P450 enzymes. In contrast, the benzene metabolite hydroquinone inhibited metabolic cooperation preferentially in cells without cytochrome P450 enzymes. The inhibition of metabolic cooperation by another benzene metabolite, phenol, was not affected by the cytochrome P450 enzymes. The inhibitory activity of several chemicals that have not been tested previously was analysed in the new metabolic cooperation assay. The inhibitory activity of none of these chemicals was affected by cytochrome P450-associated metabolism. 7-Octylindolactam V was as potent as TPA, whereas the related indolactam V was 100-fold less active. The carcinogenic aromatic amine 4-aminobiphenyl, but not its primary metabolite 4-hydroxyaminobiphenyl, inhibited metabolic cooperation. Other known carcinogens, ochratoxin A, aflatoxin B1 and 4-nitrobiphenyl, did not inhibit metabolic cooperation in either V79 cells expressing or cells not expressing cytochrome P450. We conclude that cytochrome P450-associated metabolism plays an important role in the inhibition of gap junctional intercellular communication of some tumour promoters. The modified metabolic cooperation assay presented here is valuable for detecting some inhibitory chemicals which have been 'false negative' in previous assays for gap junctional intercellular communication. The assay also discloses that cytochrome P450 metabolism alters intercellular communication by a mechanism other than metabolism of the exogenous inhibitor.

Animals↗
PubMed1985

Effects of 6-thioguanine on communication competence and factors affecting reversibility of phorbol ester inhibition in V79 cells measured by the metabolic cooperation assay and by dye coupling.

One assay used to study the role of intracellular communication in tumor promotion examines chemically-induced inhibition of metabolic cooperation between 6-thioguanine (6-TG) sensitive (HGPRT+) V79 Chinese hamster cells in co-culture with 6-TG resistant (HGPRT-) cells. In the present study metabolic cooperation and Lucifer Yellow dye coupling were applied to detect intercellular communication. HGPRT+ cells were still communication competent when pre-incubated with 6-TG for up to 48 h before HGPRT- cells were plated. In both assays the phorbol esters 12-O-tetradecanoylphorbol-13-acetate (TPA) and phorbol-12,13-dibutyrate (PDBu) inhibited intercellular communication completely at 1 ng/ml. Using 6-TG metabolic cooperation, extensive washing of cells failed to reverse the inhibition caused by 100 ng TPA/ml after exposure for as little as 1 h. However, the effect of PDBu was completely eliminated if the drug was removed within 24 h. Complete blockade of dye coupling by 1, 10 or 100 ng TPA/ml was reversible after washing only at 1 ng/ml. Cells cultured in the presence of these TPA concentrations displayed significant reversal of dye coupling inhibition after 40 h. The results indicate that the onset of communication competence impairment between V79 cells by 6-TG is much slower than hitherto implied. Failure of intercellular communication to recover even from short exposure to 100 ng TPA/ml appears to be attributable to its lipophilic nature. Not enough TPA can be removed by washing to overcome its potent inhibitory action. These observations indicate that the physicochemical properties of a chemical must be taken into consideration before making judgements about the duration of inhibition.

Animals↗
PubMed1998

Communication between physicians and with patients suffering from breast cancer.

BACKGROUND: The communication between GP and specialists is vital for the patient suffering from breast cancer. OBJECTIVES: The aim of this study was to investigate (i) the speed and type of communication between GPs, specialists and patients with breast cancer, and (ii) the problems that GPs encounter in the communication with specialists concerning these patients. METHOD: In April 1995, 246 Dutch GPs from the Zwolle region (600 000 inhabitants) were invited to complete a questionnaire, using the information from the medical record and focusing on the last patient consulted with a confirmed diagnosis of breast cancer. RESULTS: Valid replies were received from 150 (61 %) GPs. The median period between initial referral date and receipt of the definite diagnosis from the surgeon was 4 weeks. After the patient's first appointment with the surgeon, the GPs received reports for 24% of the patients within 3 days; for 31% within 3-7 days; and for 16% of the patients after more than 2 weeks. After the first consultation between patient and surgeon, 68 (45%) of the 150 GPs reported that the patient contacted them; at this stage only 30 (20%) of these GPs had received a report from the surgeon. Thirty-one (21%) GPs did not contact the patient after receival of the definite diagnosis. GPs stated that the communication on patients with breast cancer is too slow (49%), or not frequent enough (25%); 25% of GPs found that the distribution of tasks between them and the specialists are not well described. CONCLUSION: In the diagnostic stage of breast cancer the communication between GPs, specialists and patients varies widely, is too slow and is incomplete. An effect of this unsatisfactory communication is that the patient herself is the messenger of the bad news.

Breast Neoplasms↗
PubMed2004

Complexity science and the dynamics of climate and communication: reducing nursing home turnover.

PURPOSE: Turnover in nursing homes is a widespread problem adversely affecting care quality. Using complexity theory, we tested the effect of administrative climate, communication patterns, and the interaction between the two on turnover, controlling for facility context. DESIGN AND METHODS: Perceptions of administrative climate and communication were collected from 3,449 employees in 164 randomly sampled nursing homes, and they were linked to secondary data on facility characteristics, resource allocation, and turnover. We used hierarchical regression to test the hypotheses. RESULTS: Climate and communication both affected turnover, but lower turnover was dependent on the interaction between climate and communication. In nursing homes with reward-based administrative climates, higher levels of communication openness and accuracy explained lower turnover of licensed vocational nurses and certified nurse assistants, relative to nursing homes with an ambiguous climate. Adequate staffing and longer tenure of the nursing director were also important predictors of turnover. IMPLICATIONS: Although context is important, managers can also influence turnover by addressing climate and communication patterns and by encouraging stable nursing leadership.

Communication↗
PubMed2002

Impact of supervision and self-assessment on doctor-patient communication in rural Mexico.

OBJECTIVE: To determine whether supervision and self-assessment activities can improve doctor-patient communication. SETTING AND PARTICIPANTS: Six supervisors, 60 doctors in their last year of training, and 232 primary health care patients at rural health clinics in Michoacan, Mexico. DESIGN: The main evaluation compared post-intervention measures in control and intervention groups. A small panel study also examined changes from baseline to post-intervention rounds in both groups. INTERVENTION: Over a 4-month period, specially trained supervisors added 1 hour of supervision on interpersonal communication and counseling (IPC/C) to regular site visits. Doctors, who had received prior IPC/C training, periodically audiotaped and assessed their own consultations. MAIN OUTCOME MEASURES: These comprised frequency of doctors' facilitative communication, doctors' biomedical information-giving, and patients' active communication. RESULTS: The performance of all doctors improved markedly over the study period, but gains in facilitative communication and information-giving were significantly greater in the intervention than the control group. No single component of the intervention was responsible for the improvement; it resulted from the combination of activities. The doctors appreciated the more supportive relationship with supervisors that resulted from the intervention and found listening to themselves on audiotape a powerful, although initially stressful, experience. CONCLUSION: Supportive supervision and self-assessment activities can reinforce IPC/C training, prompt reflection and learning, and help novice doctors improve their interpersonal communication skills.

Communication↗
PubMed1997

Communication between an occupational physician and other medical practitioners--an audit.

Four hundred and seventy-two consecutive referral episodes relating to 386 patients attending the Occupational Health Department of a general teaching hospital were analyzed to evaluate the frequency, content and effect on management of communications between the occupational physician and other doctors. In all, 250 episodes (53%) were associated with such a communication. The likelihood of a communication was strongly influenced by reason for referral, particularly in respect of long or short term sickness absence; univariate odds ratios (OR) = 10.58, 95% CI = 8.13-27.08) and 2.65, 95% CI = 1.55-4.60) respectively; a medical diagnosis of psychiatric illness (OR = 3.17, 95% CI = 1.69-5.97)); and by number of consultations. Communication was also more likely when the occupational outcome was ill health retirement, rehabilitation in work or modified work. Ninety-eight per cent of specific requests for information or an opinion elicited a reply. Information received from other doctors influenced the occupational health physician's management in 52 referral episodes (20%). Specific action by GPs as a result of communication was documented in 54 and by specialists in 37 episodes. The importance of communication between occupational health physician and other doctors in the occupational health process is confirmed.

Adult↗
PubMed1999

Dealing with competing and conflicting risks in cancer communication.

Applied research on cancer risk communication is sparse, and even less is known about effective communication under conditions of multiple risks. This paper briefly describes the need and rationale for cancer risk communication, then describes what is known and needs to be known about communication addressing multiple risks. Its focus is on two specific communication issues: 1) comparing different risks and 2) prioritizing between multiple risks. There is considerable unmet need in cancer risk communication for new knowledge and recommendations for best practices. Those professionals choosing to pursue this work can make a significant contribution to the field.

Communication↗
PubMed1975

Nonverbal communication during physical therapy.

This study was designed to investigate nonverbal communication in a physical therapy setting. The investigation was accomplished by observing patient-physical therapist interaction during treatment sessions, recording nonverbal behaviors capable of communicating, and interviewing the patient and therapist to discuss the nonverbal communication that occurred during the treatment. Nonverbal communication was present in the physical therapy setting, although both patient and therapist were aware of nonverbal behavior only 50 percent of the time. Nonverbal communication was used to maintain or establish an emotionally supportive treatment setting and to clarify or explain treatment instruction. Nonverbal communication in this setting and for these purposes was deemed effective.

Adult↗
PubMed1999

Public health physicians who contribute to on-call communicable disease control duties: national comparative clinical audit by questionnaire survey.

BACKGROUND: In most health authorities in the UK, general public health physicians provide out-of-hours cover for specialists in communicable disease control. Although communicable disease control was part of their specialist training, there is no current formal mechanism to enable these doctors to keep up to date. The Faculty of Public Health Medicine has an active Continuing Professional Development Programme. A new initiative aimed to assess the knowledge of general public health physicians who take part in on-call communicable disease control rotas, or may do so in the future, by means of an educational clinical audit exercise. METHODS: Experts in communicable disease control developed a questionnaire containing a selection of scenarios, covering six different situations that might arise on-call. This was circulated to all members of the Faculty, but participation was voluntary. Answers were marked against model answers agreed by the experts. Results were analysed by positions held by participants. RESULTS: Response was unacceptably low. Overall scores ranged from 15 per cent to 89 per cent with a mean of 63 per cent. There was a trend of improvement in marks from those not normally involved in on-call (mean score 56.1 per cent (95 per cent confidence interval 51.6-60.7 per cent)) through Directors of Public Health (58.4 (54.9-62.0) per cent), Consultants (62.8 (60-65.6) per cent), and specialist registrars (67.9 (65.2-70.6) per cent), to Consultants in Communicable Disease Control (70.9 (68.1-73.6) per cent). CONCLUSION: The public health physicians who took part in this audit appear to be competent in their knowledge of communicable disease control, and particularly good at dealing with meningitis and salmonella, which are frequently encountered out of hours.

Clinical Competence↗
PubMed2003

Doctor-patient communication in a musculoskeletal unit: relationship between an observer-rated structured scoring system and patient opinion.

OBJECTIVES: To investigate the ability of consultant rheumatologists and orthopaedic surgeons to communicate well with patients and to determine the validity of a structured proforma used to assess medical students' communication skills. METHODS: Seventy new patient appointments with consultant rheumatologists and orthopaedic surgeons were assessed for communication skills exhibited by the consultants and patient satisfaction. Communication skills were assessed using a proforma previously used to examine medical students, and patient ratings were obtained using visual analogue scales. RESULTS: Median scores attained using the structured proforma for rheumatology, elective orthopaedic and fracture clinic consultations were 17, 15 and 14 out of 20 (P < 0.05). Patient satisfaction scores were high in all three domains measured. Scores were statistically significantly higher for rheumatology appointments than in fracture clinic (median scores 29.5, 29.5 and 28 out of 30). Consultation durations varied, with a median of 23 min for rheumatology and 10.5 and 4 min for orthopaedic surgeons in clinic and fracture clinic, respectively. CONCLUSIONS: Consultant rheumatologists and orthopaedic surgeons demonstrate good communication skills, according to a tool used to assess medical students. These scores correlate with patient views, suggesting that teaching and assessment of communication skills at medical schools may address concerns of patients. Scores and satisfaction correlate with the duration of the consultation.

Clinical Competence↗
PubMed2000

Faculty development in communication skills instruction: insights from a longitudinal program with "real-time feedback".

Responsibility for teaching communication skills often falls to a multidisciplinary group of faculty who lack both a common model for teaching and prior experience teaching communication in small groups. This article describes East Tennessee State University's multifaceted faculty development program in teaching communication skills. The program was developed and implemented in three phases. First, a two-step Delphi approach helped identify core communication skills. Phase two gave faculty the opportunity to practice identifying communication teaching issues and effective strategies for working with small groups. The third phase involved the videotaping of faculty teaching small groups of students. These tapes were reviewed both individually and in faculty groups. The tapes were also reviewed by students, who provided realtime, moment-to-moment feedback to the faculty. Implementation and review of the program has helped to identify new strategies for effectively facilitating small-group teaching of communication skills.

Clinical Competence↗
PubMed2001

Essential elements of communication in medical encounters: the Kalamazoo consensus statement.

In May 1999, 21 leaders and representatives from major medical education and professional organizations attended an invitational conference jointly sponsored by the Bayer Institute for Health Care Communication and the Fetzer INSTITUTE: The participants focused on delineating a coherent set of essential elements in physician-patient communication to: (1) facilitate the development, implementation, and evaluation of communication-oriented curricula in medical education and (2) inform the development of specific standards in this domain. Since the group included architects and representatives of five currently used models of doctor-patient communication, participants agreed that the goals might best be achieved through review and synthesis of the models. Presentations about the five models encompassed their research base, overarching views of the medical encounter, and current applications. All attendees participated in discussion of the models and common elements. Written proceedings generated during the conference were posted on an electronic listserv for review and comment by the entire group. A three-person writing committee synthesized suggestions, resolved questions, and posted a succession of drafts on a listserv. The current document was circulated to the entire group for final approval before it was submitted for publication. The group identified seven essential sets of communication tasks: (1) build the doctor-patient relationship; (2) open the discussion; (3) gather information; (4) understand the patient's perspective; (5) share information; (6) reach agreement on problems and plans; and (7) provide closure. These broadly supported elements provide a useful framework for communication-oriented curricula and standards.

Communication↗