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PubMed2006

Communication about euthanasia in general practice: opinions and experiences of patients and their general practitioners.

OBJECTIVE: Public opinion and professional organisations dominate the euthanasia debate, and there is a need to understand the opinions of people confronted with euthanasia. The aim of this study was to investigate whether patients and their GPs talk about euthanasia, and if so, how they communicate about this. METHODS: Qualitative, semi-structured interviews were held with 20 GPs and 30 of their patients in primary care in the Netherlands, where euthanasia is legalised. The patients had a life expectancy of less than 6 months, and cancer, heart failure or chronic obstructive pulmonary disease as underlying disease. RESULTS: Many patients did not communicate about euthanasia with their GP. Neither the patient nor the GP were clear in formulating their expectations concerning future decision making. CONCLUSION: The initial patient-GP communication consisted of an exchange of opinions about situations in which euthanasia would be desirable. GPs had different opinions about who should initiate communication, and found it difficult to judge the right moment to talk. PRACTICE IMPLICATIONS: It is essential to pay attention to education in communication about dying and euthanasia and to train the GPs to gain insight in the patient's end-of-life preferences, and to direct care at the best possible quality of life.

Advance Care Planning↗
PubMedDate not supplied

Communication channels to help build an international community of education and practice.

Two-way communication is required if nurses are to build knowledge networks of international communities of nursing education and practice. Are expensive new technologies feasible or preferred for effective communication and productive outcomes? In this report from a longstanding partnership between schools of nursing at Peking University and the University of Michigan, case study methodology is used to evaluate more than a decade of experience with communication modalities: in person, postal mail, express mail, e-mail, fax, telephone, hand delivery by other travelers, and Web sites. Although each education and practice community develops unique ways to build its shared knowledge, a communications plan is suggested, with use of multiple communication techniques, especially those that are low cost and the most dependable. High-cost technologies are not always feasible or preferred. For the project described, they were not necessary to the major outcome, a nursing education and practice network that resulted in the first nurse-managed community-based clinic in China.

China↗
PubMed2004

Ilimaquinone inhibits gap junctional communication in a connexin isotype-specific manner.

Ilimaquinone (IQ) and brefeldin A (BFA) disrupt the Golgi complex structure and block protein transport to the plasma membrane, and inhibit gap junctional communication. HeLa cells expressing rat connexin26, 32, or 43, or mouse connexin31, 36, 45, or 57, were used to study the response patterns of gap junctional communication (dye transfer) to ilimaquinone, brefeldin, and the potent protein kinase C (PKC) activator 12-O-tetradecanoylphorbol-13-acetate (TPA). 12-O-Tetradecanoylphorbol-13-acetate (followed for 2 h) caused dose- and time-dependent decreases in communication for five of seven connexins, the unresponsive being connexin45 and 57. Brefeldin (followed for 6 h) caused dose- and time-dependent decreases in communication for six of seven connexins, the exception being connexin26. These results are consistent with Golgi-mediated transport to the cell membrane for all connexins except connexin26. In contrast, ilimaquinone (followed for 6 h) caused a rapid (15-30 min) and nearly complete inhibition of dye transfer through connexin43 channels. For the other connexins, there was a slow and weak response for connexin26, 31, and 32, reaching 65-70% of control communication level, while connexin36, 45, and 57 were unresponsive. Thus, among the tested connexins, ilimaquinone has a strong specificity for connexin43, and the mechanism appears independent of the Golgi complex and of protein kinase C.

Animals↗
PubMed2001

Time as a catalyst for tension in nurse-surgeon communication.

Carefully studying communication patterns between nurses and surgeons questions popular stereotypes about OR discourse and expands educators' understanding of the factors that motivate team communication, patterns that are habitual among team members, and issues that act as catalysts for tension. This study examines the nature of communication between perioperative nurses and surgeons and identifies patterns and sites of tension. Researchers observed 128 hours of interaction between nurses and surgeons in four surgical divisions at one teaching hospital in Ontario, Canada. Field notes were read, coded, and analyzed independently. Results showed that higher tension in nurse-surgeon communication clusters around particular themes, the most dominant of which is time. Analysis of this theme reveals communication strategies that allow surgeons and nurses to achieve individual goals and support social cohesion among team members.

Anesthesiology↗
PubMed2002

Communication between family physicians and registered dietitians in the outpatient setting.

OBJECTIVE: To elicit how registered dietitians and family physicians communicate in the outpatient setting. DESIGN: A descriptive pilot study using two mailed surveys was conducted to elicit aspects of outpatient communication between registered dietitians and family physicians. A sample of nutrition correspondence from registered dietitians to family physicians was also requested. SUBJECTS: Surveys were distributed to 504 licensed dietitians and 626 family physicians. STATISTICAL ANALYSES: Descriptive statistics were used to analyze survey results. RESULTS: Responses were received from 389 registered dietitians (77% return rate) and 235 family physicians (37.5% return rate). We received 104 sample notes of correspondence with physicians from dietitians. Among dietitians, 80% reported that they always assess a patient's lifestyle and educational level before choosing an educational approach, and 69% send the nutrition treatment plan to the referring family physician. Among family physicians, 49% often or always find the communications they receive from registered dietitians to be helpful. However, 41% of family physicians reported that they rarely receive detailed nutrition assessments or recommendations about the referred patient from the dietitian, and 54% of all family physicians surveyed often think that this lack of feedback compromises patient care. APPLICATIONS/CONCLUSION: Dietitians can improve communications with family physicians by standardizing the format and focus of nutrition correspondence and assuring that the referring family physician receives the patient's nutrition care plan. These simple changes would close a very important communication loop, forge stronger partnerships between dietitians and family physicians, and potentially improve patient outcomes.

Ambulatory Care↗
PubMed2000

An intensive communication intervention for the critically ill.

PURPOSE: We sought to determine the effects of a communication process that was designed to encourage the use of advanced supportive technology when it is of benefit, but to limit its burdens when it is ineffective. We compared usual care with a proactive, multidisciplinary method of communicating that prospectively identified for patients and families the criteria that would determine whether a care plan was effective at meeting the goals of the patient. This process allowed caregivers to be informed of patient preferences about continued advanced supportive technology when its continuation would result in a compromised functional outcome or death. MATERIALS AND METHODS: We performed a before-and-after study in 530 adult medical patients who were consecutively admitted to a university tertiary care hospital for intensive care. Multidisciplinary meetings were held within 72 hours of critical care admission. Patients, families, and the critical care team discussed the care plan and the patients' goals and expectations for the outcome of critical care. Clinical "milestones" indicative of recovery were identified with time frames for their occurrence. Follow-up meetings were held to discuss palliative care options when continued advanced supportive technology was not achieving the patient's goals. We measured length of stay, mortality, and provider team and family consensus in 134 patients before the intensive communication intervention and in 396 patients after the intervention. RESULTS: Intensive communication significantly reduced the median length of stay from 4 days (interquartile range, 2 to 11 days) to 3 days (2 to 6 days, P = 0.01 by survival analysis). This reduction remained significant after adjustment for acute physiology and chronic health evaluation (APACHE) 3 score [risk ratio (RR) = 0.81; 95% confidence interval (CI), 0.66 to 0.99; P = 0.04). Subgroup analysis revealed that this reduction occurred in our target group, patients with acuity scores in the highest quartile who died (RR = 0.60; 95% CI, 0.38 to 0.92; P = 0.02). The intervention, which allowed dying patients earlier access to palliative care, was not associated with increased mortality. CONCLUSIONS: Intensive communication was associated with a reduction in critical care use by patients who died. Our multidisciplinary process targeted advanced supportive technology to patients who survived and allowed the earlier withdrawal of advanced supportive technology when it was ineffective.

APACHE↗
PubMed2001

Regulation of gap junctional communication by a pro-inflammatory cytokine in cystic fibrosis transmembrane conductance regulator-expressing but not cystic fibrosis airway cells.

Airway inflammation is orchestrated by cell-cell interactions involving soluble mediators and cell adhesion molecules. Alterations in the coordination of the multicellular process of inflammation may play a major role in the chronic lung disease state of cystic fibrosis (CF). The aim of this study was to determine whether direct cell-cell interactions via gap junctional communication is affected during the inflammatory response of the airway epithelium. We have examined the strength of intercellular communication and the activation of nuclear factor-kappaB (NF-kappaB) in normal (non-CF) and CF human airway cell lines stimulated with tumor necrosis factor-alpha (TNF-alpha). TNF-alpha induced maximal translocation of NF-kappaB into the nucleus of non-CF as well as CF airway cells within 20 minutes. In non-CF cells, TNF-alpha progressively decreased the extent of intercellular communication. In contrast, gap junctional communication between CF cells exposed to TNF-alpha remained unaltered. CF results from mutations of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Interestingly, transfer of wild-type CFTR into CF cells by adenovirus-mediated infection was associated with the recovery of TNF-alpha-induced uncoupling. These results suggest that expression of functional CFTR is necessary for regulation of gap junctional communication by TNF-alpha. Gap junction channels close during the inflammatory response, therefore limiting the intercellular diffusion of signaling molecules, and thereby the recruitment of neighboring cells. Defects in this mechanism may contribute to the excessive inflammatory response of CF airway epithelium.

Bronchi↗
PubMedDate not supplied

Mutual patient-psychiatrist communication and the therapeutic contract.

The increasing complexity and subspecialization of medicine make the patient feel lost in the anonymity and strange complexity of modern hospitals, lead to a misunderstanding of the increasing risks and impact of modern treatments, and restrict personal communication due to the prevalence of a knowledge-oriented approach, to a shortage of time, and to insufficient communication skills. All of this may cause increasing dissatisfaction and complaints of patients. Therefore, it is a future task (1) to develop a concept of medicine and psychiatry well-balanced for science-based knowledge and the value-based art of communication, (2) to change the framework of communication in medical and psychiatric practice, and (3) to improve the training of physicians in communication skills in order to fulfill the therapeutic contract successfully.

Communication↗
PubMed2005

Referential communication in Alzheimer's type dementia.

This paper investigates factors that underlie reduced informative content and lack of reference in the discourse of patients with Alzheimer's Type Dementia (DAT). Patients with DAT, fluent aphasics and normal controls were given a referential communication task structured to assess lexical encoding of information, pragmatic/conceptual elaboration of information and effectiveness in establishing reference. The subjects also received standardised aphasia tests (CADL, Holland, 1980; and Cookie Theft Picture Description, Nicholas and Brookshire, 1993). Comparable reduction of lexical encoding of information was found in the discourse of aphasic and DAT participants both on the referential communication task measures and on the standardised evaluation with the Cookie Theft Picture Description test. However, the DAT subjects' discourse on the referential communication task was less efficient in establishing reference than that of the aphasics since the former presented more misunderstandings and required more explicit prompts from the listener. Furthermore, the DAT language on the referential communication task contained confounding and irrelevant information; also, the number of these errors correlated negatively with their referring abilities. Results of the CADL test confirmed that the DAT participants had less communicative effectiveness than their lexical deficit alone predicted. Finally, examination of the performance of individual DAT subjects showed that lexical encoding of information could dissociate from effectiveness in making reference. These findings support the view that difficulty in pragmatic/conceptual elaboration of discourse information content plays a substantial role in the development of reduced information content and lack of reference of DAT "empty speech". These results are discussed in the framework of the hypothesis of early attentional/executive impairment in DAT (Perry and Hodges, 1999).

Aged↗
PubMedDate not supplied

Nurse-elderly patient communication in home care and institutional care: an explorative study.

This study explores communication patterns between nurses and elderly patients in two different care settings. In a sample of 181 video-taped nursing encounters, involving 47 nurses and 109 patients, a study was made of nurse-patient communication. The video recordings were observed using an adapted version of Roter's Interaction Analysis System, which yields frequencies of 23 types of verbal behaviours. These data were analyzed using correspondence analysis, to reduce them to a smaller number of verbal categories, in which two socio-emotional categories and three categories with task-related communication, could be distinguished. For each encounter five summary statistics corresponding to these categories were calculated. Using analysis of variance, it was shown that the amount of socio-emotional interaction in both settings appeared to be higher than was reported in previous studies into nurse-patient communication. Compared with the home for the elderly, communication was more task-related in home care.

Adult↗
PubMedDate not supplied

The relationship between gap-junctional intercellular communication and the proliferative activity of retinal pigment epithelial cells.

PURPOSE: To investigate the relationship between gap-junction mediated intercellular communication and the proliferative activity of retinal pigment epithelial cells in the retinal tear base. METHODS Retinal tears were created experimentally in white rabbits, and the changes of intercellular communication via gap junctions between retinal pigment epithelial cells in the retinal tear base were investigated using the dye-coupling method, which involves observing the spread of a fluorescent dye, Lucifer Yellow CH. In addition, the proliferative activity of these cells was investigated using an antibody for proliferating cell nuclear antigen and was compared with the changes in intercellular communication. RESULTS: Immediately after the creation of retinal tears, extensive spreading of Lucifer Yellow CH into adjacent cells was observed, which was markedly reduced 1 week later. After 1 month, the spreading of dye to adjacent cells was observed again. On the other hand, proliferative activity was enhanced at 1 week after retinal tear creation and was reduced again after 1 month. CONCLUSIONS: It is known that tumor cells with enhanced proliferative activity show decreased intercellular communication via gap junctions. The present study suggests a possible relationship between intercellular communication and the proliferative activity of retinal pigment epithelial cells in the base of retinal tears.

Animals↗
PubMedDate not supplied

Perceptions of communicative disorders: verification and specification of rater variables.

UNLABELLED: Using semantic differential scales with nine trait pairs, 600 students at three universities rated five descriptions, one depicting an individual without a disorder and four portraying individuals with communicative disorders. Statistical analyses indicated that the description with no disorder was rated as significantly less ambitious than the described articulation disorder. Other differences emerged when raters were divided by gender and age. Male subjects rated the portrayed individuals as more highly stressed than did females. A significant negative correlation was found for age of respondent and ratings of self-esteem. Results support previous research suggesting that rater gender and age impact perceptions of communicative disorders. LEARNING OUTCOMES: As a result of this activity, the participant will be able to: (1) identify the different means by which investigators have studied the stereotyping of people with communicative disorders, (2) discuss how listeners perceive those with and without communicative disorders, and (3) identify listener traits that may be associated with negative perceptions of people with communicative disorders.

Adolescent↗
PubMed2002

Factors predicting communication about the diagnosis of maternal breast cancer to children.

OBJECTIVE: To identify factors influencing mothers' communication with their children about their diagnosis and initial treatment. DESIGN: Cross-sectional cohort. SETTING: Two breast cancer treatment centres. SUBJECTS: Thirty-two women with Stage I or Stage II breast cancer with 56 school-aged children. MAIN OUTCOME MEASURES: Semistructured interview regarding timing and extent of communication with children from the time that a problem was first identified to initial treatment, and children's reactions. RESULTS: Children were most likely to be told about their mother's illness after the diagnosis had been confirmed by biopsy but a minority were told nothing until after surgery and some nothing at all. The information children received did not necessarily include mention of cancer. Predictors of communication were child age, with older children being told earlier and more information, and maternal education, with children of more highly educated mothers being told less. Child gender was not related to communication. CONCLUSION: Mothers who are being investigated for breast cancer are likely to benefit from the opportunity to consult a supportive professional about communication with their children during all stages of their diagnosis and treatment, but particularly early on in the investigation when they are more reluctant to initiate discussions with their children. At later points, those with children of varying ages may need specific advice on ways to discuss their illness in relation to children's understanding.

Adolescent↗
PubMed2003

Vocal communication and the triune brain.

This paper tests the 'fit' between Paul MacLean's triune brain scheme of brain organization and existing knowledge about the pathways mediating vocal communication in mammals. One component of MacLean's limbic system ('paleomammalian brain'), the 'thalamocingulate circuit,' is found to have an important role in expression of vocalizations, particularly the 'isolation call' (such as are given by mammalian infants when distressed or separated from their caregivers). Recent evidence suggests that this circuit may also have a role in perception of infant cries in humans. Outside of this circuit, the triune brain model has little to offer in the way of insights into how the brain is organized to mediate vocal communication. There is little evidence that the striatal complex ('R-complex' or 'protoreptilian formation') is involved in any major way in vocal communication, although it appears to be involved in some visual displays in both reptiles and nonhuman primates. Interestingly, components of the reptilian brain may be involved in human speech production, and avian homologues involved in birdsong. The neocortex ('neomammalian formation') has well-known importance in speech production and perception, but little evidence exists for a role in vocal production in nonhuman mammals. However, cortical mechanisms do play a role in perception of vocalizations, at least in nonhuman primates. It is concluded that a set of neural structures termed the 'communication brain' mediate vocal communication in mammals, and that this model does not fit well into the triune brain scheme of brain organization.

Animals↗
PubMedDate not supplied

A comparison of patients' communication-related responses during intubation and after extubation.

OBJECTIVE: The purpose of this exploratory pilot study was to examine patients' communication-related responses during intubation and after extubation, and to determine whether differences in patients' report of responses at these two points in time, if present, were associated with demographic and situational variables. DESIGN: Descriptive comparative. SETTING: Four intensive care units in a midwestern, university-affiliated medical center. PATIENTS: Convenience sample of 29 patients intubated for 24 or more hours, alert and oriented to person, place, and setting during intubation and after extubation. OUTCOME MEASURES: Emotional responses (anger and worry/fear) to being unable to speak, perceived difficulty with communication. RESULTS: Paired t tests showed no significant differences over time in the mean scores of the Emotion subscales and Ease of Communication scale. However, more than 30% of subjects reported postextubation responses that were different from their earlier responses by 20% or more. Significant differences in subjects' worry/fear at being unable to speak and difficulty with communication were found in relation to history of prior intubation and total number of days intubated. Subjects varied in the number of days that they were intubated, and the number of days intubated when they first participated in the study. CONCLUSIONS: Results provide direction for larger longitudinal prospective and retrospective studies with larger samples that examine patients' recall of their responses during intubation, especially related to communication.

Adult↗
PubMed1996

Inhibition of gap junction intercellular communications of cultured rat hepatocytes by ethanol: role of ethanol metabolism.

BACKGROUND/AIMS: In a previous study, we reported that in cultured rat hepatocytes, ethanol inhibits intercellular communication which is known to play a central role in the regulation of cell growth and differentiation. This work was designed to find out if ethanol exerts a direct action on cell membranes, comparable to other long-chain (C6-C9) alcohols, or an indirect action. METHODS: Intercellular communication was measured on short-term cultured rat hepatocytes by the fluorescent Lucifer-Yellow CH transfer method. Intracellular pH was measured by spectrofluorimetry and membrane expression of connexin 32 by indirect immunofluorescence. RESULTS: Under our conditions, ethanol (20 mM) inhibited intercellular communication of hepatocytes to the same extent as did octanol and 1 mM. Immunofluorescence semi-quantitative studies of connexin 32 suggested that the observed inhibition was not related to a decrease in the number of gap junction plaques. In contrast with those of octanol, the inhibitory effects of ethanol appeared to be indirect because the inhibition of ethanol metabolism by 4-methyl pyrazole abolished its effects on intercellular communication, while 4-methyl pyrazole did not influence the effects of octanol. Acetaldehyde, the main metabolite of ethanol was without effect on gap junctions. CONCLUSIONS: This suggests that the inhibition of intercellular communication induced by ethanol may be included among the consequences of intermediary cell metabolism disturbances indirectly due to ethanol oxidation. This may be one of the mechanisms by which ethanol metabolism exerts a hepatotoxic possibly carcinogenic action.

1-Octanol↗
PubMed2000

Communication after laryngectomy: an assessment of quality of life.

The purpose of this study was to examine quality of life in laryngectomees using different methods of communication. A survey was mailed to all the living laryngectomees in Nova Scotia. Patients were asked to rate their ability to communicate in a number of common situations, to rate their difficulty with several communication problems, and to complete the EORTC QLQ-C30 quality-of-life assessment tool. Sixty-two patients responded (return rate of 84%); 57% were using electrolaryngeal speech, 19% esophageal speech, and 8.5% tracheoesophageal speech. These groups were comparable with respect to age, sex, first language, education level, and years since laryngectomy. There were very few differences between these groups in ability to communicate in social situations and no difference in overall quality of life as measured by these scales. The most commonly cited problem was difficulty being heard in a noisy environment. Despite the fact that tracheoesophageal speech is objectively most intelligible, there does not seem to be a measurable improvement in quality of life or ability to communicate in everyday situations over electrolaryngeal or esophageal speakers.

Aged↗
PubMed1983

The effect of communicative demands on request-making in the moderately and severely mentally retarded.

Two experiments were reported investigating the conditions that elicit request-making in the moderately and the severely mentally retarded. In both experiments single-subject designs were used with a store game task designed to closely approximate a naturalistic communication situation. In the first experiment moderately retarded adults were able to consistently communicate which of two objects they wished to obtain from a store counter. In the second, severely retarded adolescents initially made some errors but communicated effectively on 100% of the trials by the end of the experiment. These results contrast markedly with the results from the less naturalistic task used previously. In both experiments the amount of verbalization was greater when the task was arranged to create a demand for communication. Applications of these findings to everyday communicative situations involving the mentally retarded are discussed.

Adolescent↗