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PubMed2002

Effective communication of drug safety information to patients and the public: a new look.

Recent parallel developments in the fields of medicine and the social sciences are providing us with new insights and resources that have the potential for improving the effectiveness of drug safety communication and decision-making. These developments include medicine's new look at patient safety with its emphasis on complex adaptive systems, education's new appreciation for learning as an internal change process and risk communication's evolving recognition that relevant knowledge may not be the exclusive property of 'experts'. Eight principles are drawn from this analysis: there cannot be a safer drug until there is a safer system;all stakeholders are equal partners and have an equal voice in all deliberations;paternalism must be eliminated;the expertise for determining acceptable benefit and risk is dispersed throughout society;patients and all stakeholders serve as both teachers and learners;all stakeholders are involved in the identification of their learning needs, processes and evaluation of outcomes;in a complex adaptive system all individual actions are interconnected and;patients must be involved in the continuous feedback and redesign of the evolving drug safety information system. The conclusion is that we are not asking the right questions; 'what information should we communicate?' and 'how do we communicate more effectively?' should be reframed to ask 'how do we provide an equal voice for patients with the other stakeholders in the determination and communication of benefit-risk information?' Some patients are not waiting. The International Alliance of Patient Organizations (IAPO), the Database of Individual Patient Experience (Dipex) and the Self-Help Group Clearinghouse are examples of international patient driven efforts to actively participate in their own care. The author suggests that the emerging discipline of inter-active management can contribute methodologies for creating citizenship models to generate the collective wisdom and translate it into action. A future research agenda calls for creating new models of public accountability that support these evolving systems of engaging the entire community in benefit-risk determination, communication and management.

Communication↗
PubMed2004

Communication of medical product risk: how effective is effective enough?

Ever-increasing attention is being paid worldwide to the safety of medical products, and the risks associated with their use. The integral role of risk communication in overall risk management is demonstrated by several recent market withdrawals of drugs, in which a perceived incapability of healthcare systems to manage well-characterised, avoidable risks was a significant factor. With advances in clinical pharmacology, pharmacogenomics and pharmacoepidemiology expanding our knowledge of medical products, effective delivery of the latest safety-related information to health professionals and consumers becomes even more imperative. In this regard, it is important to evaluate whether current modes of risk communication lead to desired changes in relevant behaviours such as prescribing or drug monitoring, particularly in context with which achieved level of effectiveness is deemed acceptable. This is crucial, as there have been product-specific risk communication efforts that achieved a fair degree of success, yet were not seen as effective enough to prevent market withdrawal of the medical product in question. In the service of improving public health through enhanced risk communication, it is essential to critically assess current methods, both as to results achieved (or not), and whether each method is applicable to the various types of risks associated with medical product use. Furthermore, just as combining methods may well improve overall risk communication, there are societal and psychological factors that must be considered in attempting to maximise effectiveness. However, in assessing risk communication effectiveness, the particular benefit- risk relationship of any individual medical product must also be part of the evaluative process.

Communication↗
PubMed1999

Communication of socioeconomic research findings.

Socioeconomics is research that identifies, measures and compares the costs and the clinical, economic and humanistic consequences of diseases and healthcare interventions. Research findings must be communicated to be valuable. Publication moves research findings into the public domain and exposes hard won ideas to critical appraisal. The analyst or researcher informs the decision process by defining an answerable question, applying standard economic methodology, developing a credible study, and using appropriate analytical and communication tools. The decision-maker is more likely to listen if the message is relevant, clear, simple and timely, and if he/she has influence over the relevant budget. Traditional print media provide a standardised process for quality control, whereas electronic media can provide speed of publication and wide access, usually at the expense of quality. The quality of both published medical and socioeconomic research articles varies widely. Published checklists can greatly assist in determining the structural quality of a study, but they cannot guarantee that the content of an article is useful to a decision-maker. Barriers to communication include perceived lack of study credibility, lack of relevance to the decision under consideration, suspicion of bias and inadequate training of the readers. Journal editors aim to improve the readability and clarity of articles and to bring them into conformance with journal policies. Recommendations for effective communication include the following: determine the target audience(s) and develop the appropriate perspective; set the study in its clinical context; keep the language simple where possible and use multiple communication media. Well conducted and well communicated studies can influence policy and outcomes.

Bibliometrics↗
PubMed2004

Chemical and visual communication during mate searching in rock shrimp.

Mate searching in crustaceans depends on different communicational cues, of which chemical and visual cues are most important. Herein we examined the role of chemical and visual communication during mate searching and assessment in the rock shrimp Rhynchocinetes typus. Adult male rock shrimp experience major ontogenetic changes. The terminal molt stages (named "robustus") are dominant and capable of monopolizing females during the mating process. Previous studies had shown that most females preferably mate with robustus males, but how these dominant males and receptive females find each other is uncertain, and is the question we examined herein. In a Y-maze designed to test for the importance of waterborne chemical cues, we observed that females approached the robustus male significantly more often than the typus male. Robustus males, however, were unable to locate receptive females via chemical signals. Using an experimental set-up that allowed testing for the importance of visual cues, we demonstrated that receptive females do not use visual cues to select robustus males, but robustus males use visual cues to find receptive females. Visual cues used by the robustus males were the tumults created by agitated aggregations of subordinate typus males around the receptive females. These results indicate a strong link between sexual communication and the mating system of rock shrimp in which dominant males monopolize receptive females. We found that females and males use different (sex-specific) communicational cues during mate searching and assessment, and that the sexual communication of rock shrimp is similar to that of the American lobster, where females are first attracted to the dominant males by chemical cues emitted by these males. A brief comparison between these two species shows that female behaviors during sexual communication contribute strongly to the outcome of mate searching and assessment.

Analysis of Variance↗
PubMed2004

Use of the roter interaction analysis system to analyze veterinarian-client-patient communication in companion animal practice.

OBJECTIVE: To identify specific components of veterinarian-client-patient communication during clinical appointments in companion animal practice. DESIGN: Cross-sectional descriptive study. SAMPLE POPULATION: A random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets. PROCEDURE: For each practitioner, 6 clinical appointments (3 wellness appointments and 3 appointments related to a health problem) were videotaped, and the Roter interaction analysis system (RIAS) was used to analyze the resulting 300 videotapes. Statements made during each appointment were classified by means of a communication framework reflecting the 4 essential tasks of the appointment (ie, data gathering, education and counseling, relationship building, and activation and partnership). RESULTS: 57% of the veterinarians contacted (50/87) and 99% of the clients contacted agreed to participate in the study. Mean duration of the appointments was 13 minutes. Typically, veterinarians contributed 62% of the total conversation and clients contributed 38%. Fifty-four percent of the veterinarian interaction was with the client, and 8% was with the pet. Data gathering constituted 9% of the veterinarian-to-client communication and was primarily accomplished through closed-ended questioning; 48% of veterinarian-to-client communication involved client education and counseling, 30% involved relationship building, and 7% involved activation and partnership (the remaining 6% constituted orientation). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the RIAS was a reliable method of assessing the structure, process, and content of veterinarian-client-patient communication and that some veterinarians do not use all the tools needed for effective communication.

Adolescent↗
PubMed2000

Unwillingness to communicate and satisfaction in organizational relationships.

To examine the relationship between unwillingness to communicate and quality of organizational relationships 200 employees of several organizations completed the Unwillingness to Communicate Scale and the Organizational Communication Relationships subscale of the International Communication Association Audit. Correlations indicated that people who reported increased communication and high reward in communication also reported greater relational satisfaction and greater perceived organizational influence.

Adult↗
PubMed1997

Dentist-patient communication: a review of relevant models.

A review of the literature on dental treatment was conducted and models presented of the doctor/dentist-patient relationship. These models are listed and divided into two subgroups, empirical and normative models. The models are scrutinized with focus on the dentist-patient communicative relationship exclusively. Different doctor/dentist-patient relationships are described. External factors influencing these relationships are defined. An analysis of dentist-patient communication is made, and a new model of dentist-patient communication is suggested, which states that what is done and what is said during dentist-patient encounters will have an impact on outcome. Three different purposes of dentist-patient communication are presented. The process of attaining these is discussed. It is concluded that a theory of communication is lacking in the dental context, and the need to develop a reliable and valid interaction analysis system for the patient-dentist communication is confirmed.

Attitude of Health Personnel↗
PubMed2000

Quantitative determination of gap junction intercellular communication using flow cytometric measurement of fluorescent dye transfer.

Gap junction intercellular communication (GJIC) is involved in several aspects of normal cell behaviour, and disturbances in this type of communication have been associated with many pathological conditions. Reliable and accurate methods for the determination of GJIC are therefore important in studies of cell biology. (Tomasetto, C., Neveu, M.J., Daley, J., Horan, P.K. and Sager, R. (1993) Journal of Cell Biology, 122, 157-167) reported some years ago the use of flow cytometer to determine transfer between cells of a mobile dye, calcein, as a measure of cell communication through gap junctions. In spite of this being a method with potential for quantitative and reliable determination of GJIC, it has been modestly used, possibly due to technical difficulties. In the present work we have illustrated several ways to use flow cytometric data to express cell communication through gap junctions. The recipient cells were pre-stained with the permanent lipophilic dye PKH26, and the donor cell population were loaded with the gap junction permeable dye, calcein. We show that the method may be used to measure the effect of chemicals on GJIC, and that the information is reliable, objective and reproducible due to the large number of cells studied. The data may give additional information to that obtained with other methods, since the effect observed will be on the establishment of cell communication as compared to what is observed for microinjection or scrape loading, where the effect is on already established communication. This is probably the reason for the more potent effects of DMSO on GJIC measured by the present method than on already existing GJIC measured by microinjection or quantitative scrape loading. We also show that the problem related to the mobile dye calcein not being fixable with aldehydes will not affect the results as long as the cells are kept on ice in the dark and analysed by flow cytometer within the first hours after formalin cell fixation.

Animals↗
PubMed2001

A survey of reading, writing, and oral communication skills in North American veterinary medical colleges.

In the 1989 report by the Pew National Veterinary Education Program (PNVEP), communication skills topped the list of characteristics the veterinary graduate should possess in order to function effectively in the twenty-first century. To determine the reading, writing, and oral communication requirements and opportunities in veterinary curricula in the US and Canada, and to determine the perceived communication tasks that might be commonly required of practicing veterinarians in the next century, we sent a 15-item communications skills questionnaire to the academic deans of the 31 veterinary curricula in the US and Canada. The results reinforce the importance of communication skills in veterinary medicine, as detailed by the PNVEP over 10 years ago. Based on the responses to our questionnaire and on our own experiences with veterinary medical students, we make several recommendations to enhance communication instruction in veterinary medical curricula.

Canada↗
PubMed2004

[Development of a brief communication ability scale for Japanese demented elderly].

We developed a brief scale to evaluate communication ability of the demented elderly. This scale assesses not only abilities related to overall communication such as verbal function, judgment and emotional function, but also non-verbal communication such as eye-contact, nodding and smiling. The scale places little burden on the demented elderly subject and takes only a few minutes to perform, even if the dementia is severe. We evaluated 106 demented elderly residents of nursing homes using this brief communication ability scale, and the following results were obtained. The validity of this scale was confirmed by the high correlation coefficient between this scale and the formal caregiver questionnaire scores concerning communication ability, and the high-correlation coefficient between this scale and intellectual functions (r = -0.904), emotional functions (r = -0.841) and motor functions (r = -0.679) of dementia syndromes rating scale (Gottfries, Bråne, Steen scale; GBS scale), Hasegawa's Dementia Scale-Revised (HDS-R) (r = 0.625) and the Mini-Mental State Examination (MMS) (r = 0.733). The reliability of this scale was confirmed by the high interrater reliability coefficient of 0.828, test-retest reliability coefficient of 0.940 and Cronbach alpha coefficient of 0.938. These results indicate that the new scale is useful in the assessment of communication ability among the demented elderly.

Aged↗
PubMed2003

Communicable diseases surveillance. Highlights for 4th quarter, 2002.

Communicable disease surveillance highlights report on data from various sources, including the National Notifiable Diseases Surveillance System (NNDSS) and several disease specific surveillance systems that provide regular reports to Communicable Diseases Intelligence. These national data collections are complemented by intelligence provided by State and Territory communicable disease epidemiologists and/or data managers. This additional information has enabled the reporting of more informative highlights each quarter. The NNDSS is conducted under the auspices of the Communicable Diseases Network Australia. NNDSS collates data on notifiable communicable diseases from State or Territory health departments. The Virology and Serology Laboratory Reporting Scheme (LabVISE) is a sentinel surveillance scheme which collates information on laboratory diagnosis of communicable diseases. In this report, data from the NNDSS are referred to as 'notifications' or 'cases', and those from ASPREN are referred to as 'consultations' or 'encounters' while data from the LabVISE scheme are referred to as 'laboratory reports'.

Australia↗
PubMedDate not supplied

Communication skills for continuing education in nursing.

Good communication is a vital element in the delivery of quality nursing care, while poor communication can lead to lawsuits and avoidable patient death. This research surveyed 132 hospital nurses in the Midwest to determine their communication education while in school, the availability of continuing education programs related to communication, and the most important communication skills in nursing. The results indicate a great need for inservice education on communication.

Communication↗
PubMed2002

Using family-style meals to increase participation and communication in persons with dementia.

Although researchers stress the importance of encouraging independent behavior in persons with dementia, institutional practices often foster dependence. This study took place in a six-resident locked dementia care unit that followed the common institutional practice of serving meals on prepared plates. The purpose of this study was to examine if changing the mode of meal delivery to "family-style," where residents were presented with serving bowls and empty plates, would increase resident communication and participation in mealtime tasks. An ABAB' reversal design revealed very low rates of appropriate communication (5% of intervals) and mealtime participation (10% of tasks) during baseline, when residents received prepared plates (A). Communication and participation doubled when family-style meal delivery was introduced (B) and dropped back to baseline levels when it was withdrawn (A). Because the levels of communication and participation during family-style meals were still low, the nursing assistant was provided with instruction on prompting and praising appropriate mealtime behaviors (B'). After instruction was provided and family-style meals were reintroduced, resident participation rose to 65% of tasks and appropriate communication increased to 18% of observations. This study suggests family-style meals may result in modest increases in mealtime participation and communication of residents with dementia, but staff training in prompting and praising may be necessary to see large changes in these behaviors.

Aged↗
PubMed2004

Enhancing communication with older adults: overcoming elderspeak.

Gerontological nurses promote health and successful aging for a growing population of older adults. Care providers unknowingly may communicate messages of dependence, incompetence, and control to older adults by using elderspeak, a speech style similar to baby talk, that fails to communicate appropriate respect. This article describes a communication training program that significantly reduced the use of elderspeak by nursing assistants and led t more respectful, less controlling, and equally as caring communication between nursing assistants and nursing home residents. Strategies to use in evaluating and enhancing interpersonal communication with older clients are provided. Therapeutic communication is a critical tool for nurses who provide health care to the growing populati of older adults.

Aged↗
PubMedDate not supplied

Beginning the journey to skilled communication.

Intimidating behavior and deficient interpersonal skills create a culture of silence, where there can be a breakdown in team communications and an inability to collaborate and achieve high-quality outcomes. A study from VitalSmarts (Provo, Utah), Silence Kills: The Seven Crucial Conversations for Healthcare, described 7 crucial conversations healthcare professionals struggle with that contribute to patient harm and unacceptable error rates. The American Association of Critical-Care Nurses' first standard (from AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence), skilled communication, states: "Nurses must be as proficient in communication skills as they are in clinical skills." Once it is accepted that being competent in skilled communication is essential to excellent patient care, it then takes skill development and added courage to hold crucial conversations and address difficult situations. The first step begins with a self-assessment to determine current effectiveness as a communicator and manager of conflict and to realize opportunities for growth. Three key strategies to begin the development of skilled communication include: (1) understanding the importance of a climate of safety, (2) acknowledging one's mental stories, and (3) realizing that the only people we control are ourselves.

Communication↗
PubMed1993

[A study of organizational communication in a school during the pre- and post-innovation periods].

The purpose of this study was to examine changes in organizational communication behavior in an elementary school during the pre- and post-innovation periods. The turning point of the pre- and post-innovation periods were determined by transference of decision making systems in the school. Data were collected through participant observation, and the analyses indicated the following results. Compared to the pre-innovation period, during the post-innovation period, 1) overall communication level increased; 2) discussions, rational persuasion , and proposals increased, while assertions decreased as the contents of communication; and 3) the number of those who spoke at teaching staff meetings increased. Concerning downward communication, 1) rational persuasive communication was used most frequently throughout the pre- and post-innovation periods; and 2) communication suggesting a compromise increased during the post-innovation period. These findings were discussed in terms of organizational effectiveness of the school.

Communication↗
PubMed2003

The role of stem cells and gap junctional intercellular communication in carcinogenesis.

Understanding the process of carcinogenesis will involve both the accumulation of many scientific facts derived from molecular, biochemical, cellular, physiological, whole animal experiments and epidemiological studies, as well as from conceptual understanding as to how to order and integrate those facts. From decades of cancer research, a number of the "hallmarks of cancer" have been identified, as well as their attendant concepts, including oncogenes, tumor suppressor genes, cell cycle biochemistry, hypotheses of metastasis, angiogenesis, etc. While all these "hallmarks" are well known, two important concepts, with their associated scientific observations, have been generally ignored by many in the cancer research field. The objective of the short review is to highlight the concept of the role of human adult pluri-potent stem cells as "target cells" for the carcinogenic process and the concept of the role of gap junctional intercellular communication in the multi-stage, multi-mechanism process of carcinogenesis. With these two concepts, an attempt has been made to integrate the other well-known concepts, such as the multi-stage, multimechanisn or the "initiation/promotion/progression" hypothesis; the stem cell theory of carcinogenesis; the oncogene/tumor suppression theory and the mutation/epigenetic theories of carcinogenesis. This new "integrative" theory tries to explain the well-known "hallmarks" of cancers, including the observation that cancer cells lack either heterologous or homologous gap junctional intercellular communication whereas normal human adult stem cells do not have expressed or functional gap junctional intercellular communication. On the other hand, their normal differentiated, non-stem cell derivatives do express connexins and express gap junctional intercellular communication during their differentiation. Examination of the roles of chemical tumor promoters, oncogenes, connexin knock-out mice and roles of genetically-engineered tumor and normal cells with connexin and anti-sense connexin genes, respectively, seems to provide evidence which is consistent with the roles of both stem cells and gap junctional communication playing a major role in carcinogenesis. The integrative hypothesis provides new strategies for chemoprevention and chemotherapy which focuses on modulating connexin gene expression or gap junctional intercellular communication in the premalignant and malignant cells, respectively.

Cell Communication↗
PubMed2005

Processes for effective communication in primary care.

Communication in the delivery of health care services occurs along 2 axes: between providers and patients and among several providers. In primary care, a principle objective in the provider-patient relationship is facilitating whole-person care, which is care provided in the context of family and community. In addition, primary care emphasizes communication between the primary care physician and other providers with the goal of integrated care, or care provided in the context of a patient's overall health care needs. However, considering both the U.S. health care delivery system and medical education programs, several obstacles interfere with the necessary processes of communication. This paper addresses those obstacles with a conceptual framework for effective communication in primary care. Recommendations propose formalizing requirements for the exchange of information among providers, enhancing communication training, disseminating information technology, and mitigating external factors that disrupt communication in primary care.

Case Management↗