Deficiencies In Communication Research Articles

A more comprehensive investigation of disability and associated factors among older adults receiving home-based care in rural Dongguan, China

BackgroundNo previous study has evaluated disability in older persons according to the International Classification of Functioning, Disability and Health Framework guidelines. We conducted a more comprehensive investigation of disability and associated factors among older adults receiving home-based care in rural Dongguan, a city in the central Guangdong Province of Southern China.MethodsA total of 819 individuals aged ≥60 years were recruited from Dongguan home-based care system of via a two-stage selection process. We interviewed participants and assessed their ability level using the Ability Assessment for Older Adults, which defined by a combination of activity of daily living, sensory perception, mental status and social involvement. Conditional probability and Logistic regression approaches were used to assess the strength of association between each pair of conditions. Factors significantly associated with disability were identified via χ2 tests and multinomial ordinal logistic regression.ResultsOf the 819 included participants (mean age 87 ±4.7 years), 75.5% were female, 76.7% had any disability, and 62.3% had a mild disability. The occurrence of any deficits significantly increased the likelihood of the co-occurrence of other deficits (odds ratio [OR] > 1, P < 0.05), with the lowest prevalence odds ratio observed among individuals with sensory and communication deficiency (OR: 2.99; 95% confidence interval [CI]: 2.21–4.05). Multivariable ordinal logistic regression analysis indicated that physical activity (OR: 0.96; 95% CI: 0.93–0.99), sedentary behavior (OR: 1.25; 95% CI: 1.13–1.38), not watching television (OR: 1.7; 95% CI: 1.07–2.72) and age (OR: 1.09; 95% CI: 1.02–1.17) were significantly associated with disability.ConclusionsImpairment of ADL, sensory perception, mental status or social involvement increased the likelihood of risk of the co-occurrence of other deficits. Comprehensive disability among older adults receiving home-based care is associated with age, sedentariness, physical activity and TV viewing.

Pragmatics Communication Deficiencies and the Role of Gamification

The proper use of language for communication in any context is defined as Pragmatics. Pragmatics includes the linguistic adjustments made (what is said, how it is said, body language, appropriateness) in order to accomplish the communication goal. Children and adults may be referred for rehabilitation when pragmatic communication deficits have an impact on social functioning, employment, and family/marital relationships (Turkstra, et al., 2016). The aim of this study is to examine gamification as an alternative to supplement clinical assessment procedures of an individual’s communication deficiencies with a focus on pragmatics perception, which led to the creation of a mobile gamified procedure designed to collect data on pragmatics perception. The gamified procedure was created in Kahoot! and was played by a sample of two hundred and fifty-six (256) university students with non-acquired communicative deficits studying health related courses in Greece. Data on points scored, response accuracy and duration of time spent on of each language feature was recorded. A detailed description on students’ pragmatics abilities and motivation was reported. The results of the study described normative data concerning points scored, response time and accuracy of language features. Statistically significant differences were found between genders in terms of response accuracy and time for some language features. The gamified e-assessment has the clear potential to contribute innovatively to the clinical assessment procedures of pragmatic communicative deficits including the needs of individuals with developmental disorders, psychiatric disorders, acquired brain injury, neurodegenerative disorders in a motivating way along with current technological advances of face to face and/or telepractice services.

Utilization of oral health services network among children and adolescents with leukemia.

To evaluate the use of the network of oral health services by children and adolescents with leukemia, according to the phase of cancer treatment, type of dental treatment received, and access barriers. An exploratory cross-sectional study carried out in a referral hospital in cancer in northeast of Brazil, with all children and adolescents (3-16 years old) with leukemia who used dental services and who attended the medical consultation in the outpatient clinic between March and August 2016. The analysis of the medical records and a structured interview with caregivers were performed. The majority who used only the specialized network were in a single phase of cancer treatment (49.1%), had oral mucositis treatment (79.2%), and had a time of displacement for oral health services greater than 40 minutes (92.6%). In addition, dental care was centered in the specialized network (76.8%) and during hospitalization (37.7%). The findings suggest that the oral health care of these individuals is centered on tertiary care, reflecting a deficiency in communication between the network services, as well as the nonrecognition of the basic network as a caregiver source by its users. Despite this, more research is needed.

Barriers faced by adults with intellectual disabilities who experience sexual assault: A systematic review and meta-synthesis.

Sexual violence is associated with significant morbidity and mortality. The incidence of sexual violence against adults with intellectual disability is significantly higher than in the general population. The aim of this systematic review and qualitative meta-synthesis was to explore the barriers faced by adults with intellectual disability in reporting sexual assault from the perspective of different stakeholders. A systematic literature search was conducted to identify relevant studies. A hermeneutic interpretive approach was employed to review and assess the methodological quality of the studies. Findings were meta-synthesized and juxtaposed to identify themes, concepts and interpretations. Thirteen studies were included. Three overarching themes emerged from an interpersonal, professional and social context, and within these domains, eight subthemes emerged as barriers to reporting sexual assault, including fear, communication, sexual knowledge and understanding, intellectual disability identification, lack of collaboration between service providers, presumption of capacity/credibility, lack of resources, myths and misconceptions. The research demonstrates that deficiencies in communication and collaboration among agencies, a lack of appropriate legislation and specific training needs and education programmes are significant barriers in the reporting of sexual assault by people with intellectual disability. These findings are not unique to adults with intellectual disability and have also been identified among people from the general population who experience sexual assault. However, adults with intellectual disability have additional barriers to overcome in order to access equal rights to healthcare, education and the legal system.

Identifying quality markers of a safe surgical ward: An interview study of patients, clinical staff, and administrators

BackgroundPostoperative care quality is variable. Risk-adjusted mortality rates differ between institutions despite comparable complication rates. This indicates that there are underlying factors rooted in how care is delivered that determines patient safety. This study aims to evaluate systematically the surgical ward environment with respect to process-driven and structural factors to identify quality markers for safe care, from which new safety metrics may be derived. MethodsSemistructured interviews of clinicians, nurses, patients and administrators were undertaken for the study. ResultsIn the study, 97% of staff members recognized the existence of variation in patient safety between surgical wards. Four main error-prone processes were identified: ward rounds (57%), medication prescribing and administration (49%), the presence of outliers (43%), and deficiencies in communication between clinical staff (43%). Structural factors were categorized as organizational or environmental; organizational included shortage in staffing (39%) and use of temporary staff (27%). Environmental factors considered layout and patient visibility to nurses (49%) as well as cleanliness (29%). Safety indicators identified included staff experience level (31%), overall layout of the ward, cleanliness and leadership (all 27% each). The majority of patients (87%) identified staff attentiveness as a safety indicator. ConclusionThis study demonstrates that there are a number of factors that may contribute to safety on the surgical ward spanning multiple processes, organizational, and environmental factors. Safety indicators identified across all these categories presents an opportunity to develop broader and more effectual safety improvement measures focusing on multiple areas simultaneously.

The structure of complaints related to the quality of obstetric and gynecological care

Obstetrics and gynecology, like surgery, most often fall into the scope of litigation over the quality of medical care provided. The author has reviewed the researches devoted to the solution of the problem of minimizing the consequences of emerging conflicts. Often these conflicts are not associated with specific adverse outcomes of treatment. They are results of communication deficiencies between patients and medical personnel, of high cost of medical services and of the unwillingness to pay for them, and of the organization of the work of the medical institution. The main reasons for the frequent occurrence of disputes over obstetric and gynecological care: the emergency nature of obstetric care, the deterioration of general and gynecological health of women of reproductive age, the negligent attitude of some pregnant women to adherence to medical recommendations and a high level of their tendency to conflicts. The literature suggests measures to achieve a «professional consensus», that is, the resolution of disputes without the involvement of law enforcement agencies: a thorough investigation of the clinical cases that led to the a complaints, the use of the obtained results for staff development, the immediate apologies to the patient if the complaint is justified. Among the patients and especially their representatives, «consumer extremism» has spread. In order to counteract this, it is proposed to intensify the activities of professional associations and to introduce more widely tools professional liability insurance.

Quality of prostate cancer screening information on the websites of nationally recognized cancer centers and health organizations

PurposeThe purpose of this study was to survey the accessibility and quality of prostate-specific antigen (PSA) screening information from National Cancer Institute (NCI) cancer center and public health organization Web sites. Methods and materialsWe surveyed the December 1, 2016, version of all 63 NCI-designated cancer center public Web sites and 5 major online clearinghouses from allied public/private organizations (cancer.gov, cancer.org, PCF.org, USPSTF.org, and CDC.gov). Web sites were analyzed according to a 50-item list of validated health care information quality measures. Web sites were graded by 2 blinded reviewers. Interrater agreement was confirmed by Cohen kappa coefficient. ResultsNinety percent of Web sites addressed PSA screening. Cancer center sites covered 45% of topics surveyed, whereas organization Web sites addressed 70%. All organizational Web pages addressed the possibility of false-positive screening results; 41% of cancer center Web pages did not. Forty percent of cancer center Web pages also did not discuss next steps if a PSA test was positive. Only 6% of cancer center Web pages were rated by our reviewers as "superior" (eg, addressing >75% of the surveyed topics) versus 20% of organizational Web pages. Interrater agreement between our reviewers was high (kappa coefficient = 0.602). ConclusionNCI-designated cancer center Web sites publish lower quality public information about PSA screening than sites run by major allied organizations. Nonetheless, information and communication deficiencies were observed across all surveyed sites. In an age of increasing patient consumerism, prospective prostate cancer patients would benefit from improved online PSA screening information from provider and advocacy organizations. Validated cancer patient Web educational standards remain an important, understudied priority.

Критические случаи материнской смертности – тяжелое акушерское осложнение, отражающее качество оказанных медицинских услуг

Maternal near miss and maternal death audit has become an esssential process in the context of obstetric care in both developed and developing countries. The objective: of the present study was to assess the quality of medical services provided within the multilevel regionalized Perinatal Health System in the Republic of Moldova, by identifying the inconsistencies with existing standards of medical care, in cases of severe obstetric complications and maternal deaths. Materials and methods. All cases of maternal near miss cases and maternal deaths recorded in the Secondary and Tertiary Perinatal Centers of the Republic of Moldova during the period 2009–2014 were analyzed retrospectively. To assess the quality of obstetric care, the following indices have been calculated: maternal near miss/ maternal deaths ratio; the mortality index for each obstetric condition/ complication. Results. During a period of 6 years, in 11 Secondary and Tertiary Perinatal Centers of the Republic of Moldova there were registered 154 651 births, 2881 cases of maternal near miss and 21 maternal deaths. The General Mortality index was 0.72%, and the Mortality Index by direct obstetric morbidity was 0.48%. 92.86% of maternal deaths through direct obstetric causes were avoidable, and the proportion of near miss cases with substandard care was 81.85%. The most frequent gaps (82.48%) were caused by human factors, such as insufficient team work, communication deficiency, lack of knowledge and clinical skills necessary to properly recognize and treat critical obstetric patients, delay and errors in diagnosis and treatment, non-compliance with clinical protocols. Conclusions. The excessively high proportion of avoidable factors highlighted in the study is alarming and implies the need for more extensive activities and the development of strategies focused on ensuring the presence of qualified medical workers in medical institutions, which will allow the provision of qualitative care and safety for patients in the Republic of Moldova, reducing maternal morbidity and mortality. Key words: severe maternal morbidity, maternal near miss, maternal death, maternal mortality.

Identification of the Effective Algorithms in Language-Assessment Programmes for Autistic Children

In the case of an autistic child, the language does not occur at the usual age, and there is no gesture communication. The first form of language describes several features: the immediate or delayed echolalia (which equates to what the interlocutor has just said), the specific monotonous and staccato prozodia, the reversal of the pronouns (you or he is designated), the poor syntax and the total or partial absence of expression emotions. The novelty of this pre-experimental study for determination and observation of speech disorders consists of structuring a series of theoretical frames (concepts, principles and models) in what concerns the speech disorders specific to preschool autistic children, as well as in providing a psycho-linguistic profile and proposing programmes and games useful in early detection of communication deficiencies. Keywords: Autistic children, evaluation, language disorders, algorithms.

The absence of resting-state high-gamma cross-frequency coupling in patients with tinnitus

Tinnitus is a psychoacoustic phantom perception of currently unknown neuropathology. Despite a growing number of post-stimulus tinnitus studies, uncertainty still exists regarding the neural signature of tinnitus in the resting-state brain. In the present study, we used high-gamma cross-frequency coupling and a Granger causality analysis to evaluate resting-state electroencephalographic (EEG) data in healthy participants and patients with tinnitus. Patients with tinnitus lacked robust frontal delta-phase/central high-gamma-amplitude coupling that was otherwise clearly observed in healthy participants. Since low-frequency phase and high-frequency amplitude coupling reflects inter-regional communication during cognitive processing, and given the absence of frontal modulation in patients with tinnitus, we hypothesized that tinnitus might be related to impaired prefrontal top-down inhibitory control. A Granger causality analysis consistently showed abnormally pronounced functional connectivity of low-frequency activity in patients with tinnitus, possibly reflecting a deficiency in large-scale communication during the resting state. Moreover, different causal neurodynamics were characterized across two subgroups of patients with tinnitus; the T1 group (with higher P300 amplitudes) showed abnormal frontal-to-auditory cortical information flow, whereas the T2 group (with lower P300 amplitudes) exhibited abnormal auditory-to-frontal cortical information control. This dissociation in resting-state low-frequency causal connectivity is consistent with recent post-stimulus observations. Taken together, our findings suggest that maladaptive neuroplasticity or abnormal reorganization occurs in the auditory default mode network of patients with tinnitus. Additionally, our data highlight the utility of resting-state EEG for the quantitative diagnosis of tinnitus symptoms and the further characterization of tinnitus subtypes.

Barriers to Effective Teamwork Relating to Pediatric Resuscitations: Perceptions of Pediatric Emergency Medicine Staff.

In the pediatric emergency department (PED), resuscitations require medical teams form ad hoc, rarely communicating beforehand. Literature has shown that the medical community has deficiencies in communication and teamwork. However, we as medical providers do not know or understand the perceived barriers of our colleagues. Physicians may perceive a barrier that is different from nurses, respiratory therapists, pharmacists, or technicians. Perhaps we do not know in which area of teamwork and communication we are deficient. Only when we understand the perceptions of our fellow coworkers can we take steps toward improvement in quality resuscitations and therefore patient safety. The primary objectives of this study were to describe and understand the perceived barriers to effective communication and teamwork among different disciplines forming spontaneous resuscitation teams at a tertiary urban PED and to determine if providers of different disciplines perceived these barriers differently. This was a mixed-methods study conducted in a single, tertiary care freestanding children's hospital emergency department. Survey questions were iteratively developed to measure the construct of barriers and best practices within resuscitation teamwork, which was administered to staff among 5 selected roles: physicians, nurses, respiratory technicians, PED technicians, and PED pharmacists. It contained open-ended questions to provide statements on specific barriers or goals in effective teamwork, as well as a priority ranking on 25 different statements on teamwork extracted from the literature. From the participant data, 9 core themes related to resuscitation teamwork were coalesced using affinity diagramming by the authors. All statements from the survey were coded to the 9 core themes by 2 authors, with high reliability (κ = 0.93). Descriptive statistics were used to summarize the prevalence of themes mentioned by survey participants. A χ test was used to determine differences in prevalence of core themes by role. Rank data for the 25 statements were converted to a point system (5 points for most important, 4 points for second most important, etc), and a mixed within-between analysis of variance was used to determine the association of role and relative rank. There were 125 respondents (62% response rate) who provided 893 coded statements. The core theme of communication-in particular, closed-loop communication-was the most prevalent theme, although no differences in the proportion of themes represented were seen by PED staff of different roles (P = 0.18). There was a significant effect from the core theme (P = 0.002, partial η = 0.13), with highest priority on team leader performance (mean points out of 5 = 2.5 ± 1.9), but neither effect nor interaction with role (P = 0.6, P = 0.7). When answering open-ended questions regarding barriers to effective resuscitations, all disciplines perceived communication, particularly closed-loop communication, as the primary theme lacking during resuscitations. However, when choosing from a list of themes, all groups except physicians perceived deficiencies in team leader qualities to be the greatest barrier. We as physicians must work on improving our communication and leadership attributes if we want to improve the quality of our resuscitations.

Quality of Information Addressing Prostate Specific Antigen Screening on NCI Cancer Center and Public Health Organization Websites

To survey accessibility and quality of prostate-specific antigen (PSA) screening information from National Cancer Institute (NCI) cancer center and public health organization websites. We surveyed the December 1, 2016 version of all 63 NCI-designated cancer center public websites and 5 major online clearinghouses from allied public/private organizations (Cancer.gov, Cancer.org, PCF.org, USPSTF.org, and CDC.gov). Websites were analyzed according to a 50-item list of validated healthcare information quality measures. Websites were graded by two blinded reviewers. Inter-rater agreement was confirmed by Cohen’s kappa coefficient. Ninety percent of websites addressed PSA screening. Cancer center sites covered 45% of topics surveyed, while organization websites addressed 70%. All organizational webpages addressed the possibility of false positive screening results; 41% of cancer center webpages did not. Forty percent of cancer center webpages also did not discuss next steps if a PSA test was positive. Only 6% of cancer center webpages were rated by our reviewers as “superior” (e.g. addressing > 75% of the surveyed topics), versus 20% of organizational webpages. Inter-rater agreement between our reviewers was high (kappa coefficient = 0.602). NCI-designated cancer center websites publish lower quality public information about PSA screening than sites run by major allied organizations. Nonetheless, information and communication deficiencies were observed across all surveyed sites. In an age of increasing patient consumerism, prospective prostate cancer patients would benefit from improved online PSA screening information from provider and advocacy organizations. Validated cancer patient web educational standards remain an important, understudied priority.

The determinants and outcomes of good provider communication: a cross-sectional study in seven African countries

ObjectivesTo determine the extent of provider communication, predictors of good communication and the association between provider communication and patient outcomes, such as patient satisfaction, in seven sub-Saharan African countries.DesignCross-sectional, multicountry...

Medical students’ communication skills in clinical education: Results from a cohort study

ObjectiveTo assess students’ communication skills during clinical medical education and at graduation. MethodsWe conducted an observational cohort study from 2007 to 2011 with 26 voluntary undergraduate medical students at Hamburg University based on video-taped consultations in year four and at graduation. 176 consultations were analyzed quantitatively with validated and non-validated context-independent communication observation instruments (interrater reliability ≥0.8). Based on observational protocols each consultation was also documented in free-text comments, salient topics were extracted afterwards. Results26 students, seven males, were enrolled in the survey. On average, graduates scored higher in differential-diagnostic questioning and time management but showed deficiencies in taking systematic and complete symptom-oriented histories, in communication techniques, in structuring consultations and in gathering the patients’ perspectives. Patient-centeredness and empathy were rather low at graduation. Individual deficiencies could barely be eliminated. ConclusionMedical students were able to enhance their clinical reasoning skills and their time management. Still, various communication deficiencies in final year students became evident regarding appropriate history taking, communication skills, empathy and patient-centeredness. Practice implicationsThe necessity of developing a longitudinal communication curriculum with enhanced communication trainings and assessments became evident. A curriculum should ensure that students’ communication competencies are firmly achieved at graduation.

Autism spectrum disorder-associated genes and the development of dentate granule cells.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe clinical symptoms such as the deficiency of the social communication, repetitive and stereotyped behaviors, and restricted interests. Although complex genetic and environmental factors are thought to contribute to the development of ASD, the precise etiologies are largely unknown. Neuroanatomical observations have been made of developmental abnormalities in different brain regions, including dentate gyrus of hippocampus, which is widely accepted as the center for learning and memory. However, little is known about what roles ASD-associated genes play in the development of hippocampal dentate granule cells. In this article, we summarized functions and pathophysiological significance of 6 representative ASD-associated genes, SEMA5A, PTEN, NLGN, EN-2, FMR1, and MECP2, by focusing on the development of dentate gyrus. We then introduced a recently developed gene transfer method directed to neonatal dentate granule cells. This new method will be useful for elucidating physiological as well as pathophysiological significance of ASD-associated genes in the development of hippocampal formation.

Políticas Públicas de desenvolvimento local e adensamento de capital social: análise do Programa de Aquisição de Alimentos (PAA) em quatro municípios de Minas Gerais

The paper analyzed the effectiveness of the Food Acquisition Program (FPA) as a public policy of local development, in densify the level of social capital in four cities in the state of Minas Gerais. Data was collected by conducting semi-structured interviews with several segments of actor involved in the implementation and operation of the FPA, subsequently categorized and analyzed by operating categories of social capital previously defined. Results indicated that the analyzed regions have low levels of social capital. Moreover, the existence of operational biases in the design and implementation of the FPA, notably in relation to deficiency in government communication among all the actors involved and the limited function of collective organizations, favors the perpetuation of the status quo. Thus, the modern model of the government intervention, arising with implementation the FPA, not have been transformer in relation to local development, in the cities studied. This scenario, however, can be changed when there is support from the municipal government and the existence of local leaders among the beneficiaries.

Are language disorders in Alzheimer's disease simply aphasia?

Alzheimer's disease is accompanied by gradual aphasia, becoming more severe when the cognitive disorders are more marked. However, the quality of care provided to the patient can modulate the evolution of these language difficulties. Aphasia is linked to a human communication deficiency and can be limited by taking into account the phatic function of language to keep the channels of communication open.

Planungstheorie und Planungswissenschaft im Praxistest: Arbeitsalltag und Perspektiven von Regionalplanern in Deutschland

Spatial planning challenges increasingly cross local boundaries. Statutory planning, which is organized along all different levels of government, is very complex and with its mix of informal and formal instruments difficult to put into fixed categories. It acts between local self-autonomy and large-scale spatial changes. Available empirical evidence about how and whereby planning is currently done, is often unclear or weak. This article is grounded on a survey of practitioners within regional planning administrations in Germany to investigate the development and use of theories and the perspectives of practitioners on these theories. Theories and their understanding prove to be as diverse as practice itself. The challenge to translate scientific evidence into working progresses of practitioners, the understanding of theories and the self-perception of planning practitioners has also been addressed. One main aim of this article is to show perspectives on the daily work in practice, the transfer of expertise between research and practice, the emergence and use of theories as well as the perception of planning theories by practitioners. Results reveal a highly diverse landscape of planning practices and a duality between a vested interest in research evidence and planning theories, but also deficiencies in communication and mutual understanding.

Changes in safety climate and teamwork in the operating room after implementation of a revised WHO checklist: a prospective interventional study

BackgroundInter-professional teamwork in the operating room is important for patient safety. The World Health Organization (WHO) checklist was introduced to improve intraoperative teamwork. The aim of this study was to evaluate the safety climate in a Swedish operating room setting before and after an intervention, using a revised version of the WHO checklist to improve teamwork.MethodsThis study is a single center prospective interventional study. Participants were personnel working in operating room teams including surgeons, anesthesiologists, scrub nurses, nurse anaesthetists and nurse assistants. The study started with pre-interventional observations of the WHO checklist use followed by education on safety climate, the WHO checklist, and non-technical skills in the operating room. Thereafter a revised version of the WHO checklist was introduced. Post-interventional observations regarding the performance of the WHO checklist were carried out. The Safety Attitude Questionnaire was used to assess safety climate at baseline and post-intervention.ResultsAt baseline we discovered a need for improved teamwork and communication. The participants considered teamwork to be important for patient safety, but had different perceptions of good teamwork between professions. The intervention, a revised version of the WHO checklist, did not affect teamwork climate. Adherence to the revision of the checklist was insufficient, dominated by a lack of structure.ConclusionsThere was no significant change in teamwork climate by use of the revised WHO checklist, which may be due to insufficient implementation, as a lack of adherence to the WHO checklist was detected. We found deficiencies in teamwork and communication. Further studies exploring how to improve safety climate are needed.Trial registrationNCT02329691.

Development and initial evaluation of an online decision support tool for families of patients with critical illness: A multicenter pilot study

• Families of intensive care unit (ICU) patients perceive severe deficiencies in communication about decision making.