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PubMed1993

Functional communication training with and without extinction and punishment.

Functional communication training has been reported to be a promising treatment for severe behavior problems. In this study, functional communication training alone and combined with extinction and/or punishment was evaluated for 4 clients with severe retardation, behavior problems, and communication deficits. The participants were inpatients on a hospital unit for treatment of severe behavior disorders. They received individualized interventions based on functional assessment that included reinforcement of a communication response with the same function as their destructive behavior. Results showed that for some patients, functional communication training was not sufficient to produce clinically significant reductions in destructive behavior, and the combination of training plus punishment produced the largest and most consistent reductions.

Adult↗
PubMed1996

Communication difficulties of nursing home residents. How can staff help?

Recent studies have found a high prevalence of communication disorders in elderly residents of nursing homes. This study was undertaken to investigate staff attitudes to the communication problems and communicative needs of residents in their care. A questionnaire was administered to 32 staff members from one nursing home. Responses indicate little evidence of the negative staff attitudes previously reported in the literature. Staff wanted more time to spend communicating with residents and wanted to learn more about the residents' communication problems. Implications of the questionnaire responses for staff training are presented.

Aged↗
PubMed2002

Sharing the true stories: improving communication between Aboriginal patients and healthcare workers.

OBJECTIVES: To identify factors limiting the effectiveness of communication between Aboriginal patients with end-stage renal disease and healthcare workers, and to identify strategies for improving communication. DESIGN: Qualitative study, gathering data through (a) videotaped interactions between patients and staff, and (b) in-depth interviews with all participants, in their first language, about their perceptions of the interaction, their interpretation of the video record and their broader experience with intercultural communication. SETTING: A satellite dialysis unit in suburban Darwin, Northern Territory. The interactions occurred between March and July 2001. PARTICIPANTS: Aboriginal patients from the Yolngu language group of north-east Arnhem Land and their medical, nursing and allied professional carers. MAIN OUTCOME MEASURES: Factors influencing the quality of communication. RESULTS: A shared understanding of key concepts was rarely achieved. Miscommunication often went unrecognised. Sources of miscommunication included lack of patient control over the language, timing, content and circumstances of interactions; differing modes of discourse; dominance of biomedical knowledge and marginalisation of Yolngu knowledge; absence of opportunities and resources to construct a body of shared understanding; cultural and linguistic distance; lack of staff training in intercultural communication; and lack of involvement of trained interpreters. CONCLUSIONS: Miscommunication is pervasive. Trained interpreters provide only a partial solution. Fundamental change is required for Aboriginal patients to have significant input into the management of their illness. Educational resources are needed to facilitate a shared understanding, not only of renal physiology, disease and treatment, but also of the cultural, social and economic dimensions of the illness experience of Aboriginal people.

Communication↗
PubMed2001

Web-based e-mail communications: issues in responsive service.

Women's College Hospital (WCH), Toronto, Canada, embarked on a review of 5 years of Web-based e-mail communications to address broad issues of managerial policy and procedure as related to the institution's expanding role in Web-based communication. The hospital looked at who was sending messages, why they were communicating, and how the institution should respond to the new demands placed on them by virtual communicators. The article provides a brief discussion of the results of the review and points out that attention must be given to a broad range of organizational challenges and opportunities posed by such communications. Suggestions related to how health care organizations may respond better to and serve their virtual audiences are offered.

Computer Communication Networks↗
PubMed2004

A report from the Communicable Diseases Network Australia, July to September 2004.

The Communicable Diseases Network Australia (CDNA) consists of communicable disease authorities from various Australian Government agencies and state and territory health authorities, in addition to expert bodies and individuals in the specific areas of communicable disease epidemiology, clinical management, disease control and laboratory diagnosis. The CDNA provides national public health leadership and co-ordination on communicable disease surveillance, prevention and control, and offers strategic advice to governments and other key bodies on public health actions to minimise the impact of communicable diseases in Australia and the region.

Australia↗
PubMed2005

Security infrastructure requirements for electronic health cards communication.

Communication and co-operation processes in the healthcare and welfare domain require a security infrastructure based on services describing status and relation of communicating principals as well as corresponding keys and attributes. Additional services provide trustworthy information on dynamic issues of communication and co-operation such as time and location of processes, workflow relations, integrity of archives and record systems, and system behaviour. To provide this communication and co-operation in a shared care environment, smart cards are widely used. Serving as storage media and portable application systems, patient data cards enable patient-controlled exchange and use of personal health data bound to specific purposes such as prescription and disease management. Additionally, patient status data such as the emergency data set or immunization may be stored in, and communicated by, patient data cards. Another deployment field of smart cards is their token functionality within a security framework, supporting basic security services such as identification, authentication, integrity, confidentiality, or accountability using cryptographic algorithms. In that context, keys, certificates, and card holder's attributes might be stored in the card as well. As an example, the German activity of introducing patient health cards and health professional cards is presented. Specification and enrolment aspects are on-going processes.

Communication↗
PubMedDate not supplied

Communication between women and their health care providers: research findings and unanswered questions.

Although much research has been carried out on communication between health care providers and patients, relatively few studies have investigated the effects of patient or provider gender on the communication process or its outcomes. Women use health services more than men and are more likely than men to report being influenced by health information in the media. No studies are available showing that physicians hold biases about male and female patients that translate into different communication patterns with each sex. Recent studies of verbal communication between patients and primary health care physicians show that female patients tend to ask more questions than men. Evidence that physicians are more likely to withhold information from female patients is not conclusive. Some evidence has been found that female physicians interrupt their patients less often than male physicians, provide more verbalizations of empathy, and provide clearer explanations in response to patients' concerns. Female physician-patient dyads might be expected to improve communication under certain circumstances.

Attitude↗
PubMed1980

Nonvocal communication: performance evaluation.

With the increasing number of communication options available to severely dysarthric individuals, there is a growing need to develop techniques for the evaluation of nonvocal communication performance. A data collection and analysis system was developed in order to assess the performance of 2 nonvocal communicators. Records of entire messages were obtained along with durational measures of communication partner receiving time for each message, identity of the communication partner and location.

Adult↗
PubMed1994

Functional communication with AD patients: a caregiver training program.

The loss of functional communication in Alzheimer disease (AD) results from the disproportionate breakdowns in the pragmatic and semantic areas of language in these patients. Communication breakdown is regularly listed among the top four stressors in measures of stress and burden of AD caregivers. A caregiver training program designed around seven specific communication strategies can be used to alter communication interactions. As a pilot program, the acronym FOCUSED organized the seven strategies for easy recall (Face-to-face, Orientation, Continuity, Unsticking, Structure, Exchanges, and Direct). Significant differences in both attitude toward AD patients, knowledge of AD, and knowledge of communication strategies were shown in comparisons of pre- and posttraining assessments.

Adult↗
PubMed1994

Is communication really the point? Some thoughts on interventions and membership.

This paper presents a brief account of communication interventions and describes recent developments in the field resulting in shifts in intervention focus, perspectives, and strategies. In examining communication interventions as one example of professional efforts to ameliorate the effects of disability, the author concluded that the real point of such efforts is not so much improved communication as membership in society. The concept of membership was explored, including the ways in which individuals construct stories that make the communication acts of individuals with severe disabilities commonplace and socially valuable. Efforts to foster communication (e.g., change behavior, adjust movement) should shift to ensuring that membership in society is achieved.

Adolescent↗
PubMed1997

Behavior change communication strategies.

Appropriate and effective communication is central to the success of interventions to reduce the risk of HIV infection. This paper reviews what has been learned about the nature of communication in the behavior change process. It examines the contexts in which communication occurs, as well as the contribution of communication theory, social marketing theory, and structural intervention theory to intervention development. Guidance is offered on the most appropriate ways in which to communicate with different groups and audiences, and future priorities for research and intervention are identified.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Prelinguistic communication and subsequent language acquisition in children with cochlear implants.

OBJECTIVE: To investigate the relationship between prelinguistic communication behaviors and subsequent language development after cochlear implantation in deaf children. Evaluative tools with predictive validity for language potential in very young deaf children remain elusive. SETTING: A tertiary care cochlear implant center and a preschool setting of spoken language immersion in which oral language development is emphasized through auditory and oral motor subskill practice. SUBJECTS: Eighteen prelingually deaf children who underwent unilateral implantation at an average age of 15 months also underwent testing with the Communication and Symbolic Behavior Scales (CSBS) before device activation and with the Reynell Developmental Language Scales (RDLS) at an average of 20 months after cochlear implantation. METHODS: A prospective study correlated preoperative communication behavior assessments of 18 children who were candidates for cochlear implantation. We examined the value of prelinguistic behavioral testing with the CSBS in predicting later language level after cochlear implantation as reflected in RDLS scores. RESULTS: We found positive, though weak, correlations between prelinguistic communication skills (CSBS scores) and language learning after cochlear implantation (RDLS scores). Linear correlation between test results failed to reach statistical significance (receptive comparisons, P =.17; expressive comparisons, P =.13). CONCLUSIONS: Evaluating the quality of prelinguistic communication behaviors potentially adds important predictive information to profiles of children who are candidates for cochlear implantation. Correlative analysis suggests that early CSBS testing may provide useful clinical information. Poor CSBS scores may serve as a precaution: if children lack an appropriate prelinguistic behavioral repertoire, the emergence of age-appropriate formal language may be at risk. Observations suggest that symbolic prelinguistic behaviors are necessary, but not sufficient, for the development of strong linguistic skills. The variability of behavioral measures in very young deaf children poses challenges in designing objective measures with predictive value for later language level.

Adolescent↗
PubMed1981

Parental communication deviance and affective style. Predictors of subsequent schizophrenia spectrum disorders in vulnerable adolescents.

In an attempt to assess the contributory role of family factors to the development of schizophrenia-like disorders, measures of parental communication deviance and affective styles of communication were obtained for a sample of families of disturbed but nonpsychotic adolescents. Outcome was assessed five years later. Absence of a pathologic affective style was associated with a benign outcome, but neither parental variable alone allowed precise identification of the schizophrenia-spectrum cases. However, an index using a combination of both variables was statistically predictive of subsequent psychiatric status at follow-up. Thus, adolescents whose parents had both a pathologic affective style of communication and a high level of communication deviance had schizophrenia-like disorders develop in young adulthood. Adolescents of parents who had both lower levels of communication deviance and a benign affective style had offspring with healthier outcomes.

Adolescent↗
PubMed1998

Surgeon-patient communication in the treatment of pancreatic cancer.

BACKGROUND: Effective physician-patient communication has been correlated with patient satisfaction and improved outcome. Pancreatic cancer (PC) is a disease with an overwhelmingly poor prognosis that requires a complex level of communication and emotional support. Since the treatment of PC is often surgical, surgeons play a central role in the care of these patients. OBJECTIVES: To assess the quality of long- and short-term surgeon-patient communication. To assess the role of the surgeon in the emotional support of patients with PC. DESIGN: Combined mail and telephone survey of a case series of patients who had undergone a pancreatic resection for PC. SETTING: Urban tertiary cancer referral center. PATIENTS: Forty-eight patients who underwent pancreatic resection for PC. INTERVENTION: Pancreatic resection. MAIN OUTCOME MEASURE: Patient satisfaction. RESULTS: Forty-eight patients completed surveys for a response rate of 70%. Patients were extremely satisfied with the information provided by their surgeon before surgery and while in the hospital. However, 21% of patients reported an unexpected outcome of their operation and 27% had questions about their disease at the time of the survey. Patients were largely satisfied with the emotional support they had received while in the hospital and after discharge. The attending surgeon was the most commonly desired source of additional emotional support. CONCLUSIONS: While surgeon-patient communication was extremely effective before surgery and during hospitalization, patients developed long-term questions and dissatisfaction after discharge from the hospital. Strategies to improve long-term support and communication would benefit a significant number of patients with operable PC. Surgeons play an important role in the emotional support of patients with operable PC.

Adult↗
PubMed2004

Communication skills training for health care professionals working with cancer patients, their families and/or carers.

BACKGROUND: Research suggests communication skills do not reliably improve with experience. Considerable effort is dedicated to courses improving communication skills for health professionals. Evaluation of such courses is important to enable evidence-based teaching and practice. OBJECTIVES: To assess whether communication skills training is effective in changing health professionals' behaviour in cancer care with regard to communication/interaction with patients. SEARCH STRATEGY: We searched CENTRAL (Cochrane Library Issue 3 2001), MEDLINE (1966 to November 2001), EMBASE (1980 to November 2001), PsycInfo (1887 to November 2001), CINAHL (1982 to November 2001), AMED (1985 - October 2001), Dissertation Abstracts International (1861 to March 2002) and EBM Reviews (1991 to March/April 2001). Reference lists of relevant articles were searched. Three further studies were detected in November 2003. SELECTION CRITERIA: Randomized controlled trials or controlled before and after studies of communication skills training in cancer health professionals, measuring changes in behaviour/skills using objective and validated scales. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trials and extracted data. MAIN RESULTS: Of 2824 references, 3 trials involving 347 health professionals were included. One provided an intensive 3 day course then assessed oncology doctors interacting with 640 patients; a second provided a modular course then assessed role plays with oncology nurses; the third was modular and assessed outcomes with clinical and simulated interviews and patient questionnaires. In one trial, course attendees used more focused questions (probability < 0.005), focused and open questions (p = 0.005), expressions of empathy (p < 0.005) and appropriate cue responses (p < 0.05) at follow up than non-attendees. No significant differences were found between attendees and non-attendees for leading questions. From baseline to follow up, attendees had significantly different changes in rates of leading questions (p < 0.05), focused questions (p < 0.005), open questions (p < 0.05) and empathy (p = 0.005). The only observed significant difference in the second trial was that trained doctors controlled the follow-up interview more than untrained doctors (p < 0.05). Neither studies found differences in summarising, interrupting and checking. The third trial found trained nurses used more emotional speech than untrained counterparts, particularly regarding anxiety and distress. Patients interviewed by trained nurses used more emotional terms, but no differences emerged in questionnaires. REVIEWERS' CONCLUSIONS: Training programmes assessed by these trials appear to be effective in improving some areas of cancer care professionals communication skills. It is unknown whether this training would be effective if taught by others, nor the comparative efficacy of these programmes.

Caregivers↗
PubMed1982

The role of inhibited cell-cell communication in teratogenesis.

A mechanistic link between teratogenesis and carcinogenesis has been suggested by a wide variety of scientific observations. This report attempts to provide a theoretical explanation for one of the several possible mechanisms which might be shared during carcinogenesis and teratogenesis. The initiation and promotion concept of carcinogenesis was briefly reviewed and the role of intercellular communication during the complex tumor promotion phase was discussed. Inhibition of intercellular communication by a wide variety of physical, chemical and biological factors was speculated to disrupt the regulation of proliferation and differentiation in stem cells. Chemicals, which interfered with intercellular communication during early organogenesis, have the potential of being teratogens, while if they are present in the developed, initiated organisms have the potential of being tumor promoters. Evidence was presented showing that known tumor promoters which inhibited intercellular communication also had been shown to be teratogens. It was concluded that in vitro assays, designed to measure intercellular communication, although having known limitations, might be used as an in vitro means to screen for potential teratogens.

Abnormalities, Drug-Induced↗
PubMed1993

Communication and implementation of change in crop protection.

The slow adoption of integrated pest management (IPM) has been attributed to the widespread gaps in farmers' knowledge of rational pest management. Other factors such as farmers' perception of high input use and promotion of pesticides also influence decisions to practise rational pest management. To bridge these gaps and improve farmers' pest management practices, most IPM implementation programmes rely on communication strategies. These communication approaches utilize either mass media or interpersonal channels or a combination. The choice of which communication approach to employ depends on project objectives and resources. Among extension and communication approaches used in crop protection, strategic extension campaigns, farmer field schools and farmer participatory research stand out in their ability to bring about significant changes in farmers' pest management practices. While extension campaigns have greater reach, farmer participation and experiential learning achieve more impact because learning effects are sustained. Communication media are important in raising awareness and creating a demand for IPM information but interpersonal channels and group methods such as the farmer field school and farmer participatory research are essential to accomplish the tasks of discovery and experiential learning of IPM skills.

Advertising↗
PubMed2006

Differential use of attentional and visual communicative signaling by orangutans (Pongo pygmaeus) and gorillas (Gorilla gorilla) in response to the attentional status of a human.

In this study we investigated the communicative abilities of 10 orangutans (Pongo pygmaeus) and seven western lowland gorillas (Gorilla gorilla gorilla), and particularly focused on their sensitivity to the attentional state of a human experimenter when choosing from a repertoire of both auditory and visual communication strategies. In experiment 1 a banana was placed in front of the subject's cage and a human experimenter was either present or absent. The subject's behavior was recorded for 60 sec. Both gorillas and orangutans gestured (t(16)=-3.58, P<.005) and vocalized (t(16)=-2.47, P<.05) more when the experimenter was present. In experiment 2 a human experimenter held a banana in front of the subject's cage and was oriented either toward or away from the subject. Again the subject's behavior was recorded for 60 sec. In this experiment both gorillas and orangutans gestured significantly more frequently (t(16)=3.40, P<.005) when the experimenter was oriented toward them. In addition, gorillas and orangutans used other forms of visual communication signals, such as lip pout (t(16)=3.66, P<.005), barter/trade (t(16)=2.31, P<.05), and body present (t(16)=2.31, P<.05) significantly more when an experimenter was facing them. The overall results indicate that both gorillas and orangutans are sensitive to the attentional state of a human experimenter and use appropriate communicative signals to gain that individual's attention. These results are also similar to previous findings on communicative behaviors in chimpanzees.

Animal Communication↗