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PubMed2004

Between the sheets: inter-cell-layer communication in plant development.

The cells of plant meristems and embryos are arranged in an organized, and sometimes extremely beautiful, layered pattern. This pattern is maintained by the controlled orientation of cell divisions within layers. However, despite this layered structure, cell behaviour during plant development is not lineage dependent, and does not occur in a mosaic fashion. Many studies, both classical and recent, have shown that plant cell identity can be re-specified according to position, allowing plants to show remarkable developmental plasticity. However, the layered structure of meristems and the implications of this during plant development, remain subjects of some speculation. Of particular interest is the question of how cell layers communicate, and how communication between cell layers could allow coordinated developmental processes to take place. Recent research has uncovered several examples both of the molecular mechanisms by which cell layers can communicate, and of how this communication can infringe on developmental processes. A range of examples is used to illustrate the diversity of mechanisms potentially implicated in cell-layer communication during plant development.

Cell Communication↗
PubMed1994

An integrated communication strategy for health service managers.

Highlights the importance of communication as a management activity. In particular, examines ways in which internal and external communication strategies can be integrated. To this end, proposes a communication strategy sequence which provides a robust methodology for gathering data and informing decision making regarding communication needs. Details the four key steps in the sequence and provides examples from work done in Northern Ireland. Discusses the principles and practices of data collection and emphasizes the importance of securing the commitment of senior managers. Examines the costs and benefits of introducing comprehensive communication programmes and points out organizational advantages.

Administrative Personnel↗
PubMed2002

Social communication in children with epilepsy.

BACKGROUND: This study examined measures of social communication that involve the use of language in formulating and organizing thoughts and its relationship with seizure-related, developmental, cognitive, and behavioral variables in 92 children with complex partial seizure disorder (CPS), 51 with primary generalized epilepsy (PGE), and 117 normal children, aged 5.1-16.9 years. METHODS: Coding the children's speech samples with the Kiddie Formal Thought Disorder Rating Scale (Caplan et al., 1989) and Halliday and Hasan's (1976) analysis of cohesion demonstrated social communication deficits in both seizure disorder groups. RESULTS: The CPS patients had both formal thought disorder and cohesion deficits and the PGE group had mild cohesion deficits. IQ, as well as fronto-temporal and bilateral spike and wave activity were associated with the severity of the social communication deficits of the CPS group. The social communication deficits of the PGE group, however, were related to IQ and seizure control. CONCLUSIONS: Recurrent CPS and PGE and fronto-temporal localization of epileptic activity might impair the development of children's communication skills.

Adolescent↗
PubMed2004

Intended message versus message received in hypothetical physician risk communications: exploring the gap.

We examined the risk perception that is derived from hypothetical physician risk communications. Subjects (n= 217) completed a questionnaire on the Web for $3. Subjects were presented with four hypothetical cancer risk scenarios that included a physician risk communication in one of three risk communication formats: verbal only, verbal plus numeric probability as a percent, and verbal plus numeric probability as a fraction. In each scenario, subjects were asked to imagine themselves as the patient described and to state their perceived personal susceptibility to the cancer (i.e., risk perception) on a 0 to 100 scale, as well as responses to other measures. Subjects' risk perceptions were highly variable, spanning nearly the entire probability scale for each scenario, and the degree of variation was only slightly less in the risk communication formats in which a numeric statement of risk was provided. Subjects were more likely to overestimate than underestimate their risk relative to the stated risk in the numeric versions, and overestimation was associated with the belief that the physician minimized the risk so they wouldn't worry, innumeracy, and worry, as well as decisions about testing for the cancer. These results demonstrate significant gaps between the intended message and the message received in physician risk communications. Implications for medical decisions, patient distress, and future research are discussed.

Communication↗
PubMed2005

Cancer patients' satisfaction with communication, information and quality of care in a UK region.

Effective patient-professional communication can be of crucial importance to long-term psycho-social outcomes in patients with cancer. This study identifies patient satisfaction with regard to various aspects of communication and perceived quality of care. A well-validated questionnaire was administered to 435 cancer patients throughout Northern Ireland during a 3-month period. Northern Ireland can be regarded as a typical UK region in terms of cancer service configuration. The cohort consisted of patients with breast, colorectal, lung, prostate, gynaecological and gastric cancers. There was a 78% response rate. Satisfaction scores were individually calculated for various aspects of care, particularly diagnosis, treatment, follow-up and overall care. Non-parametric analysis examined the interaction between satisfaction scores and primary tumour site, age and gender. While overall satisfaction scores were relatively high, there was considerable variation. Of particular note was the interaction between perceived satisfaction and quality of care, communication, tumour site and age. Key findings are that there are a number of issues with regard to information and communication which can be clearly improved within Northern Ireland cancer services. The paper concludes that patient-professional communication should be tailored to meet individual need.

Adult↗
PubMed1991

Factors which influence how nurses communicate with cancer patients.

Communication is one of the most important aspects of cancer nursing. Evidence suggests nurses experience communication difficulties and frequently block patients from divulging their worries or concerns. This paper focuses on a study which aimed to determine: (a) the extent to which nurses facilitate or block patients and awareness of their verbal behaviours; (b) whether there is a relationship between nurses' verbal behaviours and levels of anxiety, social support, work support and attitude to death; and (c) nurses' difficulties in caring for cancer patients. The study was conducted in a specialist and non-specialist hospital. Fifty-four registered nurses completed three audio-taped histories (one with a new cancer patient, a patient with a recurrence and a patient for pallative care), a self-administered questionnaire and a semi-structured audio-taped interview. The data were analysed using SPSSX. The findings indicate an overall poor level of facilitative communication, with a patient's recurrence causing most difficulties. There is evidence to suggest the way nurses communicate may depend on the environment created by the ward sister, the nurses' religious beliefs and attitude to death rather than specific education in communication skills.

Adult↗
PubMed1995

Communication in nursing: the theory-practice relationship.

The theory-practice relationship and the use of communication and interpersonal skills in nursing have been recurrently identified as issues causing concern. Four research questions form the basis of this small-scale exploratory study investigating the views of nurse teachers, mentors and students into the theory-practice relationship with regard to the communication and interpersonal skills theme of the Project 2000 common foundation programme (CFP) for British nursing students. Hierarchical focusing, involving individual interviews with teachers and mentors and small-group interviews with students, was undertaken. Volunteer sampling was used. Qualitative data analysis was undertaken using content analysis. Results are summarized with regard to each main research question. There was little consensus of opinion amongst participants, and the nature of the theory-practice relationship with regard to the communication and interpersonal skills theme for the CFP remains unclear. However, there was agreement that communication is fundamental to nursing and that the socialization process strongly influences the development of communication and interpersonal skills. There appears to be a reliance on mentors to assess student progress and determine whether they have knowledge underpinning practice. Classroom teaching was recognized as idealistic but the divisions in participants' opinions led to difficulty in determining whether a theory-practice gap actually exists. The main influences on the theory-practice relationship were the mentor's knowledge of the curriculum and mentoring system, the short amount of time spent in each placement and relationships between teachers, mentors and students. Recommendations include the need to ensure the reliability and validity of progressive assessment.

Clinical Competence↗
PubMed1996

An investigation into the attitudes and practices of intensive care nurses towards verbal communication with unconscious patients.

This study attempted to investigate the attitudes and practices of intensive care nurses towards verbal communication with unconscious patients. A sample of five staff nurses working in an intensive care unit in Northern Ireland formed the basis for the study. The research design was non-experimental and descriptive-exploratory in nature, incorporating 4-hourly observational periods and structured interviews. Qualitative and quantitative analysis indicated that intensive care nurses spend on average 5% of their time verbally communicating with unconscious patients. Most of this communication involves informing the patient of immediate procedural matters or providing reassuring statements. Most intensive care nurses claim that verbal communication with unconscious patients is very important, and some ambiguity is apparent as to the unconscious patient's level of awareness. Major factors influencing communication are the patient's level of consciousness, the amount of physical care being given and the presence of relatives.

Coma↗
PubMed2006

A systematic review on communicating with patients about evidence.

OBJECTIVE: To conduct a systematic search for (1) the effectiveness of evidence-based communication tools to increase patient understanding of evidence, (2) effective formats for representing probabilistic information and (3) effective strategies for eliciting patient preferences about evidence. A case scenario is used to illustrate some of the difficulties of putting these results into practice. DATA SOURCES: Systematic search of The Cochrane Library, Medline, Psychinfo, Embase and Cancerlit. REVIEW METHODS: Systematic reviews of randomized controlled trials (RCTs) and high quality RCTs were included. Studies were excluded if they did not address the question, were focused on behavioural outcomes without attempting to increase understanding, were concerned with counselling as a therapeutic intervention, or were specific to communication regarding clinical trial participation. RESULTS: We found 10 systematic reviews of RCTs and 30 additional RCTs addressing our questions. Communication tools in most formats (verbal, written, video, provider-delivered, computer-based) will increase patients' understanding but are more likely to do so if structured, tailored and/or interactive. Probabilistic information is best represented as event rates (natural frequencies) in relevant groups of people, rather than words, probabilities or summarized as effect measures such as relative risk reduction. Illustrations such as cartoons, or graphs (vertical bar charts) appear to aid understanding. Values clarification exercises may be better than standard utility techniques for eliciting preferences in individual decision making. Looking for effective evidence-based communication tools for prostatic specific antigen testing highlighted the challenges for clinicians and consumers in accessing tools that are evidence-based in design as well as content. CONCLUSION: There is an increasing body of evidence supporting the design of effective evidence-based communication tools but variable access to such tools in practice.

Communication↗
PubMed1986

Aiding the development of communication skills in medical students.

Difficulties with doctor-patient communication continue to be recognized as a major barrier to effective patient care. A fundamental requirement for effective communication has been identified to be an understanding of the patient as an individual, yet most medical students are educationally and socially isolated from their patients and have difficulty in understanding their problems. In an attempt to encourage an understanding of the communication difficulties which follow such ignorance, a simple project was designed for, and conducted by, two groups of medical students during their initial period of clinical contact. Students first estimated the expected level of basic biological knowledge and the likely life-styles of their patients and then compared their estimates with data collected from patients. Students' initial estimates of both knowledge and life-style were poor, but improved significantly after data collection and discussion of results. In addition to improving their knowledge, students also recognized the benefit that such understanding could bring to the quality of communication. From these results, it is suggested that similar class exercises could be valuably introduced with minimum effort into the undergraduate curriculum, as the first of a series of steps in the acquisition of effective communication skills.

Anatomy↗
PubMed2006

Reliability and validity of communication skills questionnaire (CSQ).

A new and easy evaluation method of communication skills has been developed using the Communication Skills Questionnaire (CSQ), which can be self-administered or administered by family members and medical staff. The reliability and validity of this CSQ were evaluated. Eighty-seven patients with mental disorders and 100 normal controls participated in a self-rating evaluation of the CSQ, and 55 family members and four medical personnel also participated in objective rating. The CSQ contained 29 items and these items were divided into three categories: cooperative skills (17 items), assertive skills (six items) and general communication skills (six items, mainly non-verbal skills). Internal consistencies of all groups were between 0.91 and 0.97. Test-retest reliability values for patients, family members and medical staff were between 0.90 and 0.95. Interrater reliability of medical staff was 0.73. The total scores had a moderate positive correlation with Global Assessment of Functioning (GAF) score and doctor's impression of communication skill evaluated on a 10-point scale. The patient group had a lower CSQ score than that of controls and the score differences between controls and patients with schizophrenia, mood disorders or eating disorders were statistically significant. This questionnaire is a good psychometric method of evaluating the communication skills of patients.

Adult↗
PubMed1996

Alteration of intercellular communication in a human urothelial carcinoma cell-line by tumor-promoting agents.

BACKGROUND: Most of the findings that support a good association between inhibition of intercellular communication and tumor promotion have been demonstrated by studies of animal cells, while it has been accepted that most tumor-promoting agents are specific to species and organs. Therefore, the influence of tumor-promoting agents on intercellular communication was investigated using a human urothelial cell-line. METHODS: The effects of six tumor-promoting agents, including dichlorodiphenyltrichloroethane (DDT), butylated hydroxyanisole (BHA), saccharin, cyclamic acid, phenobarbital, and DL-tryptophan, on intercellular communication in a human urothelial cell-line (JTC-30) were investigated by using a dye-transfer assay after 48- and 96-hour exposure to each agent. Cytotoxicity was determined using the colony-forming method after 48-hour and 7-day exposure to each agent. RESULTS: DDT, BHA, saccharin, and cyclamic acid inhibited intercellular communication after either 48- or 96-hour exposure at concentrations that were nontoxic to the cells after 7-day exposure. Phenobarbital and DL-tryptophan inhibited intercellular communication only at toxic concentrations. CONCLUSIONS: Since the former four agents are known to be direct tumor promoters, and the metabolites of the later two agents have been regarded as tumor promoters, the results suggest that current methodology using the JTC-30 cell-line may be applicable to the screening to detect direct tumor promoters of human urothelium.

Adult↗
PubMed1999

Communication between hospitals and isolated aboriginal community health clinics.

OBJECTIVE: This study described the communication dynamics, identified problems and recommended changes to improve patient follow-up and communication between Royal Darwin Hospital (RDH) and isolated Aboriginal community health clinics (CHC) in the Northern Territory (NT). METHOD: In 1995, staff interviews were conducted and an audit of isolated Aboriginal patients' RDH discharge summaries (DS). RESULTS: Eighteen per cent of RDH DSs never arrived in CHCs. DSs were often prepared late and more likely to be in CHC records if written on time and if the referral source was specified. Interviews revealed discontent between CHCs and RDH regarding: communication, DS documentation, the supply of discharge medication, as well as different hospital and community perceptions of Aboriginies' reliability to carry a DS and CHC desire for patients to be given DSs at discharge. CONCLUSION: Aboriginal patients should be given a DS at discharge and resident medical officers should be educated as to the function and importance of the DS. In 18 months following this study, RDH appointed unit-based Aboriginal health workers and a policy was produced for written communication between hospital and CHCs, as well as a discharge planning manual for Aboriginal communities. IMPLICATIONS: Projects investigating communication between hospitals and isolated Aboriginal clinics and patient follow-up may result in significant policy changes concerning these processes.

Australia↗
PubMed1991

Maturity of personality and family communication.

The psychodynamic and the communication/systemic perspectives are commonly considered as two entirely different approaches to psychopathology. The current study is an effort to bridge these opposing perspectives empirically. Maturity of personality, measured according to psychoanalytic principles by the Consensus Couples Rorschach, and relationship control in family communication, as measured by a new coding system (RCC) in an observational study, were related. The results indicate that low level of maturity is associated with egocentric and self-disqualifying communication in situations of conflict, but not in situations involving no or moderate conflict. Additionally, mature wives were prone to react to situations involving perceptual conflict by communicating dominantly, whereas immature wives communicated in more submissive ways. Reversely, the more mature the husbands were, the more they displayed a submissive style of communicating when in conflict.

Adolescent↗
PubMed2006

Increased levels of cyclins D1 and D3 after inhibition of gap junctional communication in astrocytes.

We showed previously that the inhibition of gap junctional communication in astrocytes increased bromodeoxyuridine (BrdU) incorporation and promoted changes in the metabolic phenotype destined to fulfil the requirements of cell proliferation. In the present study we investigated the changes in the cell cycle of astrocytes promoted by the inhibition of intercellular communication through gap junctions. Thus, the presence of endothelin-1 and carbenoxolone, two gap junction uncouplers, promoted an increase in the percentage of astrocytes found in the S, G2 and M phases of the cell cycle, with a concomitant decrease in G0 and G1 phases. In addition, the levels of Ki-67, a protein present during all active phases of the cell cycle but absent from resting cells, increased after the inhibition of gap junctional communication. These effects were not observed when the inhibition of gap junctions was prevented with tolbutamide, indicating that the inhibition of gap junctional communication promotes the entry of astrocytes into the cell cycle. The passage of the cells from a quiescent state to the cell cycle is ultimately regulated by the degree of retinoblastoma phosphorylation. Inhibition of gap junctions increased the phosphorylation of retinoblastoma at Ser 780 but not at Ser 795 or Ser 807/811. In addition, the levels of cyclins D1 and D3 increased, whereas those of p21 and p27 were not significantly modified. Because D-type cyclins are key regulators of retinoblastoma protein phosphorylation, it is suggested that the phosphorylation of retinoblastoma protein at Ser 780, observed under our experimental conditions, is a consequence of the increase in the levels of cyclins D1 and D3. Our work provides evidence for the involvement of cyclins D1 and D3 as sensors of the inhibition of gap junctional communication in astrocytes.

Animals↗
PubMed2006

Doctor and patient perceptions of the level of doctor explanation and quality of patient-doctor communication.

BACKGROUND: Several measures, such as the frequency, duration and ratio of quantitative communication behaviours, have been used to evaluate patient-doctor communication; however, these measures have several major problems. Therefore, we examined whether doctors' and patients' perceptions of the level of doctors' explanations provide a better measure for evaluating the quality of patient-doctor communication. METHODS: The subjects were 630 doctor-patient pairs in Japan. One-way anova and multiple logistic regression analysis were used for the data analysis. RESULTS: Of 190 doctors and 950 patients selected randomly, 126 doctors and 630 patients returned questionnaires (response rates, both 66.3%). We found the following. (i) With respect to the sufficiency of the doctor explanation, the 'patient-better' situation (i.e. when patients' evaluations were better than doctors' evaluations) had a more positive influence on patients' outcome measures than did other situations. (ii) The 'doctor better' situation (i.e. when doctors' evaluations were better than patients' evaluations) had the most negative influence on patient outcome measures compared with the other situations. (iii) The length of clinical experience, patient gender and guidance concerning a change in lifestyle were predictors of the doctor-better condition in the two types of doctor explanations. CONCLUSIONS: A measure that classifies patient-doctor pairs into doctor-better and the other situations might be effective for evaluating the quality of patient-doctor communication. As this is a new approach to evaluating patient-doctor communication, more studies are necessary to verify these findings.

Adult↗
PubMed2005

Shared maternity care: all care--not enough responsibility? An audit of patient care communications pre- and post- a multi-faceted intervention.

BACKGROUND: Shared maternity care is an important model of care in Australia and overseas, but Victorian studies have shown patient dissatisfaction and widespread communication problems. AIMS: This study aimed to implement and evaluate initiatives to improve communication between three maternity hospitals and general practitioners involved in shared maternity care in Melbourne. METHODS: A pre- and post-design with audit of 150 hospital records at each of three hospitals plus audit of 20 general practitioner files for evidence of key communications on shared care patients, before and after a multifaceted intervention. RESULTS: Significant improvements at individual hospitals were seen if one person was made responsible for a communication outcome. Other initiatives did not lead to improvements if they did not include individual accountability. CONCLUSION: The standard of integration of shared maternity care is unacceptable low. Improvements to communication are achievable but depend on the allocation of individual time and responsibility, plus a commitment by hospitals to ongoing audit of their performance.

Family Practice↗
PubMed2006

Four physician communication styles in routine Japanese outpatient medical encounters.

BACKGROUND: Few studies have explored how physicians approach medical encounters in Japan. OBJECTIVE: This study examined how Japanese physicians conduct routine medical encounters in the context of outpatient care to patients with nonmalignant disorders. DESIGN: Qualitative study using semi-structured interviews and direct observation. SETTING: The outpatient department of a general hospital located in an urban area of Japan. PARTICIPANTS: Physicians and nurses providing care and patients receiving care for nonmalignant disorders. RESULTS: A 2-dimensional model was developed, with patient communication (how physician interacted with patients) along 1 axis, and nurse communication (how physicians collaborated with nursing staff) along the other axis. Four physician communication styles (individually adaptive, individually defined, collaboratively adaptive, and collaboratively defined) were identified as typical ways in which the Japanese physicians in the sample interacted with patients and nurses during routine medical encounters. CONCLUSIONS: Results suggest the need for a multiprovider-patient model of medical communication among physician, nurse, and patient. Further research is needed to establish the applicability of this model to the communication styles of physicians in other countries.

Adult↗