Difficult Communication Research Articles

What can be done to ease the transition to becoming a new paediatric registrar?

BackgroundThe transition period of becoming a new paediatric registrar has limited study. Consequently, the learning needs of such trainees are unclear including educational interventions that may improve the process. This qualitative study examined the negative and positive experiences of transitioning paediatric trainees to identify learning needs and subsequently derive educational interventions that are perceived to ease transition.MethodsThis was a qualitative study of semi-structured interviews with Wales deanery paediatric speciality trainees 3 and 4 (ST3 and ST4) undergoing transition to registrar. Participants were asked to recall one positive and one negative experience during transition using the critical incident technique (CIT). Transcribed responses were coded and thematically analysed and categorised into higher and lower order themes.ResultsSix paediatric trainees were interviewed for the study. A total of eighteen codes relating to learning needs were identified and dichotomised into two higher order themes; clinical skills, and leadership and management skills, with further exploration into lower order themes. Clinical skills included child protection procedures, difficult communication with relatives, emergencies, childhood death, difficult procedures, tertiary level neonatal care, managing family anxiety and expectations, dealing with uncertainty and running clinics. Leadership and management skills involved clinical decision making by new registrars, leading ward rounds, managing workload, leading a team and supervising junior colleagues. For educational interventions, sixty-seven initial codes were recorded and combined to form thirty-two lower order themes under six higher order themes. This outlined six educational interventions perceived to ease the transition to the registrar grade including; acting up whilst a senior house officer, seniors providing feedback, seniors providing support, staff providing support, trainee familiarisation with the new registrar placement and trainees maximising SHO learning opportunities.ConclusionsThis study provided a grounding upon which further research can be based, by identifying learning needs within the themes of clinical skills and leadership and management skills, as well as providing further descriptions of perceived beneficial educational interventions that ease transition to paediatric registrar. Furthermore, this study proposes evidence-based recommendations involving five key stakeholders to improve the experience of transition for future trainees. These stakeholders include; trainees, seniors, educators, nursing staff and rota coordinators.

WP6.5 - Setting Up For Success: Supporting New General Surgical Registrars' Non-Operative Technical Skills Development

Abstract Aim Entry into Higher Surgical Training is associated with new challenges to trainees’ clinical, technical, professional and inter-personal skills. A three-day modular “bootcamp” course was designed for new General Surgery ST3s transitioning from Core Surgical Training to bridge the gap and support areas of developmental need. Methods Four varied modules were undertaken by candidates; one focussed on non-operative technical skills in surgery (NOTSS). Following pre-interviews with all stakeholders, immersive scenarios were developed. The programme encompassed operating in a stressful environment with a focus on crisis resource management principles, ward round leadership, theatre prioritisation, difficult communication, and a further workshop on managing bullying and sexual harassment. A multi-professional faculty included anaesthetists, theatre staff, psychiatrists and geriatricians alongside surgeons. Results All 26 trainees were invited to self-rate confidence using a 5-point Likert scale, as well as free text annotation. 13 (50%) completed both pre- and post-course confidence questionnaires. Data showed significant improvement in self-rated confidence across all NOTSS domains, particularly for operating in a stressful environment ("Confident"/ "Strongly Confident" = 69% pre-course to 100% post-course). Free text responses included highly positive feedback for high faculty to trainee ratio allowing detailed personalised feedback, exposure to multi-professional perspectives and opportunities to reflect on difficult professional scenarios. Conclusion Following the success of this course, it has now become part of ST3 Induction in Yorkshire - an opportunity to promote a positive working culture and strengthen professional relationships. A multi-specialty faculty allows for sharing of transferable inter-specialty skills. We recommend all transitional training stages would benefit from embedded induction courses.

ПОТЕНЦИАЛ ИГРОВЫХ ВИДОВ СПОРТА В ФОРМИРОВАНИИ ГИБКИХ НАВЫКОВ У СТУДЕНТОВ ВУЗА

The conducted research was a continuation of the successful work carried out for several years at the Department of Youth Organization of the Ural Federal University named after the first President of Russia B. N. Yeltsin (UrFU) to study the degree of influence of various areas of extracurricular activities on the development of communicative, intellectual, managerial and other skills that are important for future specialists. The potential of sports activities as one of the most important areas of university extracurricular work for the formation of flexible skills among students is considered. The effectiveness of football, a popular game sport among young people, has been shown for their formation. Presented data on the growth of indicators of the formation of selected skills among football players by years of study. Based on the results of an expert review the survey concludes that football lessons for the majority of students are of a conscious nature and can have an impact on the success of their future professional career. The specific skills that football has the greatest impact on are identified: teamwork, the ability to make decisions in difficult situations, stress tolerance, and communication skills. It has been established that football contributes to the self-education of students in many fields of knowledge.

Supporting Patients with Amputated Lower Limb in Accepting Their New Body Images by Traumatology Nurses of Central Hospital Yaoundé-Cameroon: An Exploratory Study

This study aims at exploring the role of the nurse in supporting patients with the amputated lower limb towards the acceptance of their new body images in the traumatology B unit of the Central Hospital in Yaoundé-Cameroon. The study used a qualitative exploratory design. The study population was made up of eight nurses from the traumatology unit of the central hospital in Yaoundé-Cameroon. Data were collected using a semi-structured interview guide from a purposeful sample of nurses. The saturation level determined the sample size for the study. Data were analyzed using inductive content analysis. The results obtained from this study showed that it is difficult to take care of patients with amputated lower limbs as physical support e.g. hygiene care; wound dressings, pain evaluation and care were outlined by most of the nurses as the main mode of support given to patients. Consideration should be given to non-pharmacological and less invasive surgical interventions for phantom limb pain, as they are associated with less common and less severe side effects. Active listening, reassuring patients, helping relationship and confidence were the main elements of psychological support stated by the nurses. The main challenges nurses encountered in supporting amputated patients were difficult communication and language barrier. The findings from this study proposed that there were many factors to take into account in order to be able to help patients with amputated lower limb: physical and moral pain, the psychological aspect with modification of body image, loss of self-esteem etc... The nurse must demonstrate human and relational qualities and great psychological resistance in order to effectively support the amputated patient on the physical level by providing hygiene and comfort care, dressing; and on the psychological level by questioning the patients about their difficult emotions while being available to listen in order to establish a nursing diagnosis and help the patients to cope with their difficulties.

Analisa Yuridis Penerapan Hukum Pidana Internasional Terhadap Tindak Pidana Pencucian Uang Nasional

Its implementation and application require the use of the TPPU Law by relying on the initial crime or primary crime, the main crime according to investigators and prosecutors is part of the formal and material requirements in an event file, for its fulfillment if it is incomplete it can be considered unable to carry out prosecution by prioritizing formal processes. Money laundering cases are rarely charged under the TPPU Law because the charges given are not cumulative charges, and are only limited to the initial crime, complicated bureaucracy and difficult communication between agencies due to the integrity that does not exist between judicial institutions as a criminal justice system, lack of socialization process and regarding the anti-money laundering regime to investigators, public prosecutors, and PPATK. The problem in this study is how to apply international criminal law to money laundering. The application of International Money Laundering into Indonesia's national criminal law depends on compliance with international treaties governing transnational criminal activities. This agreement has been approved and implemented by the legal and regulatory framework of the country. This impact is seen in lawmaking, the passing of Presidential Decrees, and the legal doctrine articulated in this agreement. The Money Laundering Act serves as an example of domestic criminal legislation promulgated as a means of enforcing international conventions

[formula omitted]-LB: Software-defined IDS with UAV Resource Aware Load-Balancing in FANET disaster scenarios

In critical scenarios like natural disasters, the physical infrastructure of the network may be heavily damaged or completely torn down making difficult communications and rescue activities. In such cases, due to their nature, Unmanned Aerial Vehicles (UAVs) are usually employed to provide a temporary support network by forming a Flying Ad-Hoc Network (FANET). However, this network should be carefully monitored and safeguarded to guarantee its stability by deploying network security appliances, like Intrusion Detection Systems (IDSs). In the wake of these considerations, this paper delves into the utilization of IDS functions deployed on UAVs, named IDS-enabled UAVs, in emergencies leveraging the modern Software-Defined Network (SDN) paradigm. Specifically, the study proposes a dynamic approach to promptly activate IDS-enabled UAVs, in an SDN-FANET, responding to network traffic increasing and/or malicious activities taking place within the network. In order to achieve this objective, a Software-defined IDS with UAV Resource Aware Load Balancing strategy – SURA-LB – is proposed and implemented within the SDN controller, leveraging its programmable nature and its holistic view of the network. The SURA-LB strategy equally distributes the load among the set of IDS-enabled UAVs by considering their resources and energy utilization along with the experienced network traffic conditions. Finally, an extensive experimental campaign shows the benefits of the proposed load-balancing strategy in reducing and fairly distributing the workload among the IDS-enabled UAVs outperforming naive and baseline load-balancing strategies like Random and Round-Robin and, therefore, bolstering the resilience and the reliability of the set of IDS-enabled UAVs while the traffic to be monitored and analyzed increases.

Attitudes toward communication skills with learner needs assessment within radiology residency programs in China: a cross-sectional survey

BackgroundCommunication skills (CS) represent a core competency in radiology residency training. However, no structured curriculum exists to train radiology residents in CS in China. The aim of this study was to evaluate the status and prevalence of doctor–patient communication training among radiology residents in nine Chinese accredited radiology residency training programs and to determine whether there is a perceived need for a formalized curriculum in this field.MethodsWe administered a cross-sectional online survey to radiology residents involved in CS training at nine standard residency training programs in China. The questionnaire developed for this study included CS training status, residents’ demographics, attitudes toward CS training, communication needs, and barriers. Residents’ attitudes toward CS training were measured with the Communication Skills Attitude Scale (CSAS) and its subscales, a positive attitude scale (PAS) and negative attitude scale (NAS).ResultsA total of 133 (48.36%) residents participated in the survey. The mean total scores on the two dimensions of the CSAS were 47.61 ± 9.35 in the PAS and 36.34 ± 7.75 in the NAS. Factors found to be significantly associated with the PAS included receiving previous training in CS, medical ethics, or humanities and the doctor’s attire. We found that first-year residents and poor personal CS were the most influential factors on the NAS. Only 58.65% of participants reported having previously received CS training during medical school, and 72.93% of respondents reported failure in at least one difficult communication during their residency rotation. Most of those surveyed agreed that CS can be learned through courses and were interested in CS training. Some of the most common barriers to implementing formal CS training were a lack of time, no standardized curriculum, and a lack of materials and faculty expertise.ConclusionsMost residents had a very positive attitude toward CS training and would value further training, despite the limited formal CS training for radiology residents in China. Future efforts should be made to establish and promote a standard and targeted CS curriculum for Chinese radiology residents.

Patient Perspectives on Communication Pathways After Orthopedic Surgery and Discharge and Evaluation of Team-Based Digital Communication: Qualitative Exploratory Study.

The transition from hospital to home after orthopedic surgery requires smooth communication and coordination between patients and their team of care to avoid fragmented care pathways. Digital communication is increasingly being used to facilitate easy and accessible asynchronous communication between patients and health care professionals across settings. A team-based approach to digital communication may provide optimized quality of care in the postoperative period following orthopedic surgery and hospital discharge. This study was divided into two phases that aimed to (1) explore the perspectives of patients undergoing orthopedic surgery on current communication pathways at a tertiary hospital in Denmark and (2) test and explore patients' experiences and use of team-based digital communication following hospital discharge (eDialogue). A triangulation of qualitative data collection techniques was applied: document analysis, participant observations (n=16 hours), semistructured interviews with patients before (n=31) and after (n=24) their access to eDialogue, and exploration of use data. Findings show that patients experience difficult communication pathways after hospital discharge and a lack of information due to inadequate coordination of care. eDialogue was used by 84% (26/31) of the patients, and they suggested that it provided a sense of security, coherence, and proximity in the aftercare rearranging communication pathways for the better. Specific drivers and barriers to use were identified, and these call for further exploration of eDialogue. In conclusion, patients evaluated eDialogue positively and suggested that it could support them after returning home following orthopedic surgery.

SEMG-Based Robust Recognition of Grasping Postures with a Machine Learning Approach for Low-Cost Hand Control.

The design and control of artificial hands remains a challenge in engineering. Popular prostheses are bio-mechanically simple with restricted manipulation capabilities, as advanced devices are pricy or abandoned due to their difficult communication with the hand. For social robots, the interpretation of human intention is key for their integration in daily life. This can be achieved with machine learning (ML) algorithms, which are barely used for grasping posture recognition. This work proposes an ML approach to recognize nine hand postures, representing 90% of the activities of daily living in real time using an sEMG human-robot interface (HRI). Data from 20 subjects wearing a Myo armband (8 sEMG signals) were gathered from the NinaPro DS5 and from experimental tests with the YCB Object Set, and they were used jointly in the development of a simple multi-layer perceptron in MATLAB, with a global percentage success of 73% using only two features. GPU-based implementations were run to select the best architecture, with generalization capabilities, robustness-versus-electrode shift, low memory expense, and real-time performance. This architecture enables the implementation of grasping posture recognition in low-cost devices, aimed at the development of affordable functional prostheses and HRI for social robots.

External inspection approaches and involvement of stakeholders’ views in inspection following serious incidents - a qualitative mixed methods study from the perspectives of regulatory inspectors

ObjectiveThe objective was to gain knowledge about how external inspections following serious incidents are played out in a Norwegian hospital context from the perspective of the inspectors, and whether stakeholders’ views are involved in the inspection.MethodsBased on a qualitative mixed methods design, 10 government bureaucrats and inspectors situated at the National Board of Health Supervision and three County Governors in Norway, were strategically recruited, and individual semi-structured interviews were conducted. Key official government documents were selected, collected, and thematically analyzed along with the interview data.ResultsOur findings overall demonstrate two overarching themes: Theme (1) Perspectives on different external inspection approaches of responding and involving stakeholders in external inspection following serious incidents, Theme (2) Inspectors’ internal work practices versus external expectations. Documents and all participants reported a development towards new approaches in external inspection, with more policies and regulatory attention to sensible involvement of stakeholders. Involvement and interaction with patients and informal caregivers could potentially inform the case complexity and the inspector’s decision-making process. However, stakeholder involvement was sometimes complex and challenging due to e.g., difficult communication and interaction with patients and/or informal caregivers, due to resource demands and/or the inspector’s lack of experience and/or relevant competence, different perceptions of the principle of sound professional practice, quality, and safety. The inspectors considered balancing the formal objectives and expectations, with the expectations of the public and different stakeholders (i.e. hospitals, patients and/or informal caregivers) a challenging part of their job. This balance was seen as an important part of the continuous development of ensuring public trust and legitimacy in external inspection processes.Conclusions and implicationsOur study suggests that the regulatory system of external inspection and its available approaches of responding to a serious incident in the Norwegian setting is currently not designed to accommodate the complexity of needs from stakeholders at the levels of hospital organizations, patients, and informal caregivers altogether. Further studies should direct attention to how the wider system of accountability structures may support the internal work practices in the regulatory system, to better algin its formal objectives with expectations of the public.

Factors affecting 30-day mortality in poor-grade aneurysmal subarachnoid hemorrhage: a 10-year single-center experience.

The management of patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is burdened by an unfavorable prognosis even with aggressive treatment. The aim of the present study is to investigate the risk factors affecting 30-day mortality in poor-grade aSAH patients. We performed a retrospective analysis of a prospectively collected database of poor-grade aSAH patients (World Federation of Neurosurgical Societies, WFNS, grades IV and V) treated at our institution from December 2010 to December 2020. For all variables, percentages of frequency distributions were analyzed. Contingency tables (Chi-squared test) were used to assess the association between categorical variables and outcomes in the univariable analysis. Multivariable analysis was performed by using the multiple logistic regression method to estimate the odds ratio (OR) for 30-day mortality. A total of 149 patients were included of which 32% had WFNS grade 4 and 68% had WFNS grade 5. The overall 1-month mortality rate was 21%. On univariable analysis, five variables were found to be associated with the likelihood of death, including intraventricular hemorrhage (IVH ≥ 50 mL, p = 0.005), the total amount of intraventricular and intraparenchymal hemorrhage (IVH + ICH ≥ 90 mL, p = 0.019), the IVH Ratio (IVH Ratio ≥ 40%, p = 0.003), posterior circulation aneurysms (p = 0.019), presence of spot sign on initial CT scan angiography (p = 0.015).Nonetheless, when the multivariable analysis was performed, only IVH Ratio (p = 0.005; OR 3.97), posterior circulation aneurysms (p = 0.008; OR 4.05) and spot sign (p = 0.022; OR 6.87) turned out to be independent predictors of 30-day mortality. The risk of mortality in poor-grade aSAH remains considerable despite maximal treatment. Notwithstanding the limitations of a retrospective study, our report highlights some neuroradiological features that in the emergency setting, combined with leading clinical and anamnestic parameters, may support the multidisciplinary team in the difficult decision-making process and communication with family members from the earliest stages of poor-grade aSAH. Further prospective studies are warranted.

Standardized patients’ experiences of portraying characters in difficult communication scenarios: Narrative inquiry

Background There are limited studies that explored the preparation and challenges faced by standardized patients (SPs) in portraying characters in difficult communication scenarios, and the strategies used to overcome these challenges. The purpose of this study was to understand the experience of SPs in interpreting difficult communication situations and the learning needs of performing similar scenarios. And it allows the researchers to explore the meaning, beliefs, values, and aspiration associated with their role as SPs. The findings could shade light on the significance of their experiences and provide valuable insights for the development of future SP training programs. Methods The design of this study is framed by a narrative inquiry, using semi-structured guidelines to conduct in-depth interviews with 11 SPs who have participated in the performances of difficult communication situations. Research data were analyzed by Polkinghorne narrative analysis, and Riessman’s four criteria were used to establish rigor. Results Analysis revealed the following five themes: scenarios to real life connections, process of preparing for a performance, methods to detach from character, obtaining unexpected rewards, and needs for performance training. There are two to three subthemes that are subsumed under each theme. Conclusions To strengthen training in difficult communication for healthcare professionals, the use of SPs to interpret challenging difficult communication scenarios will continue to increase. Educators need to ensure that SPs are fully prepared physically and emotionally before, during and after their performance. Offering of continuing education and training in feedback techniques are crucial to extend the tenure of SPs, reduce their frustration, prevent attrition, and ultimately, reduce training costs. In the future, SP training should also include detachment and feedback techniques to alleviate SPs’ stress.

The Rise of Jubilee Diplomacy: The Shipka Celebrations of 1902

Grandiose celebrations took place in 1902 in Bulgaria on the occasion of the 25th anniversary of the epopee of Shipka. The idea for the celebration belongs to the “Tsar Osvoboditel Alexander IIˮ Committee. Started as a public initiative, the preparations for the jubilee received the full support of the Bulgarian prince, and at a later stage, the government in Sofia became involved. The present study reveals the activity of the Bulgarian country to organize the celebration and to ensure Russian presence at it. The different visions of Sofia and Petersburg regarding the nature of the celebrations and the reasons for the difficult communication between the two countries are presented. Moreover, the article emphasizes the efforts of the Bulgarians to turn the anniversary into a demonstration of the close relations between Bulgaria and Russia. Last but not least, the study interprets the Shipka celebrations as the first manifestation of the so-called jubilee diplomacy, which gained momentum in this period and used landmark historical events and the celebrations organized in their honor to achieve political goals.

Cross-Layer Methods for Ad Hoc Networks—Review and Classification

The OSI model used to be a common network model for years. In the case of ad hoc networks with dynamic topology and difficult radio communications conditions, gradual departure is happening from the classical kind of OSI network model with a clear delineation of layers (physical, channel, network, transport, application) to the cross-layer approach. The layers of the network model in ad hoc networks strongly influence each other. Thus, the cross-layer approach can improve the performance of an ad hoc network by jointly developing protocols using interaction and collaborative optimization of multiple layers. The existing cross-layer methods classification is too complicated because it is based on the whole manifold of network model layer combinations, regardless of their importance. In this work, we review ad hoc network cross-layer methods, propose a new useful classification of cross-layer methods, and show future research directions in the development of ad hoc network cross-layer methods. The proposed classification can help to simplify the goal-oriented cross-layer protocol development.

The past as a prologue: aspirations for the future portrayed in Chinese vernacular miniature monuments

ABSTRACT Whether to look to the past is a perennial dilemma, as the past evokes both terror and pleasure. Focusing on miniature monuments built for ancestors in the context of pre-modern China, this study reveals that while the peak period of production of miniature monuments occurred during the Han dynasty, the miniature monument building practice can be traced to living cases today. This paper highlights a phenomenon, a vision of the future imagined by descendants was integrated into a dialogue with the past through the agency of symbolic representations of buildings constructed for the deceased. Architecture, in this sense, acted as a facilitator of difficult communication with the deceased and conveyed profound desires that people strongly embraced but could not articulate. Such desires and dreams may not be accommodated in reality, but constructing miniature monuments in honour of ancestors reiterates that architecture is a spiritual home for brave imaginations and deep desires of people.

Brazilian PENSA protocol: practical guide to difficult communication.

Brazilian PENSA protocol: practical guide to difficult communication.

A83Assessment of the Use of Assorted Methods of Scenario Presentation in Communication Skills Simulation

FY2 doctors in Greater Glasgow and Clyde (GGC) participate in simulation-based learning [1] to improve communication skills in difficult consultations. COVID-19 pandemic restrictions from 2020 – 2022 meant actors could not be present in person for this. Scenarios were therefore adapted to run as remote consultations - two were conducted using Zoom video calls and one by telephone with professional actors, and one ward-based manikin scenario with faculty as actors. We compared the effectiveness of the session, and of each scenario, in improving confidence in communication. Questionnaires were completed before and after simulation. Confidence levels were assessed using a Likert Scale (1 – 5) for each scenario. Participants were also asked to rank each scenario (1 – 4) for engagement, realism and relevance to practice at the end of the session, and for which of the three Intended Learning Objectives (ILOs) for each scenario they had gained most information. Over 10 days, 126 FY2s (6 - 8 per group) and 23 Faculty members participated. 92 completed questionnaires were obtained. ‘Take Forward Messages’ (TFM) from scenario debriefs from 12 groups were correlated with the ILOs. Overall, there was a significant improvement in confidence in dealing with difficult communication scenarios after the session; (mean ± SEM) score pre 2.87 ± 0.11, post 3.69 ± 0.08, p < 0.01. These values did not differ significantly from 2019 when actors were present in person. When asked to rank which scenario was most effective in different aspects, the case on how to deal with an angry patient (Zoom video call) performed best overall ( Scenario Quality Assessment and Improvement in Participant Confidence Levels Zoom and telephone consultations, and manikin-based scenarios can be used to provide effective simulation sessions to improve communication skills. Perception of scenario quality does not always correlate with success in achieving the learning objectives. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A37Does simulation-based training increase perceived confidence to address demanding communication situations within critical care?

Training nurses to improve their ability and confidence to communicate effectively in difficult situations is beneficial [1]. Simulation is an effective method to replicate difficult communication situations with colleagues, family or patients and improves communication skills [2]. Iyasere et al., (2022) [2] determined improving perceived confidence to communicate increased team-performance specifically amongst nurses. The main purpose was to evaluate the effectiveness of using simulation-based communication scenarios to improve critical care nurses’ perceived confidence to communicate in difficult situations. Fourteen (Band 5 and Band 6) critical care nurses attended three sessions of communication simulation. Participants were invited based on manager feedback either requiring improved communication or demonstrating excellent communication skills, an equal number from both spectrums attended each session. A diamond debriefing model was used after each scenario as the debriefing model provides reflection resulting in improved practice [3]. Debriefing was conducted by training simulation faculty. A survey was used to measure perceived confidence and ability to communicate in three difficult situations: escalating concern, next-of-kin communication (NOK) and colleague interaction. The survey was presented pre-, post-simulation and at six-weeks post. Results showed an increase in confidence and ability to communicate in all three communication situations, as shown in The average rating (1-10) of perceived confidence in each simulation element, at each interval Simulation-based training is an effective method to increase Critical Care nurses perceived confidence to communicate in demanding situations. Communication situations involving colleagues remains the most challenging communication scenario for nurses. Improving confidence to communicate is essential to effective team working and patient-centred nursing practice. Further study is needed but initial results suggest the method is beneficial to improve critical care nursing practice. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A Study on Impact of Cancellation of Maintenance of Aged Parents in Tamil Nadu

In India, there are some circumstances under which maintenance payments for elderly parents may be cancelled. An important piece of law that deals with the maintenance and welfare of old parents in India is the Maintenance and Welfare of Parents and Senior Citizens Act, 2007. It does not, however, detail any explicit measures for maintenance cancellation. According to the Act, adult children or relatives are required by law to support ageing parents or other senior individuals who are unable to care for themselves. The support Tribunals set up at the district level allow parents or senior persons to request support from their children or relatives. The maintenance support could, however, be cancelled or stopped under some circumstances. The main objective of the study is To know the impacts of cancellation of maintenance of old aged parents. The research method pursued here is empirical research. A total of 210 samples were collected, all of which were collected by practical sampling methods. Elderly parents may experience significant financial stress as a result of the discontinuation of maintenance. Their fundamental requirements, such as shelter, healthcare, and living expenses, could be difficult to meet. Relationships between elderly parents and their adult children or relatives may be strained if maintenance is terminated. It might cause mental distress, difficult communication, and a breakdown in family dynamics. In Tamil Nadu, the termination of maintenance can have serious negative impacts on the health of elderly parents. Financial hardship, restricted access to healthcare, increased stress, and possibly social isolation are all possible outcomes. These elements may have a detrimental effect on their general quality of life

The use of virtual patients for breaking bad news: A rapid review.

Breaking bad news is an imperative skill for clinical practice that health care professionals struggle with. Virtual patients have been adopted as a new teaching aide in medical education and have shown efficacy in teaching clinical skills; however, there is limited research for use in communication skills. Virtual patients are especially well-suited for difficult communication skills, as students can practice without risk to patients. This rapid review aimed to review literature observing the potential of virtual patients as an effective means to teach breaking bad news. A systematic search strategy was applied for papers published between November 2012 and November 2022 on Medline and Embase databases. Following the application of inclusion criteria, three studies were included. The Medical Education Research Study Quality Instrument and Critical Appraisal Skills Programme checklist were used for quality appraisal of the studies. Tabular and narrative synthesis was used to present the findings. The findings of the studies suggest that when teaching breaking bad news, virtual patients are valuable compared with no intervention and are not inferior compared with simulated patients. An unexpected benefit of virtual patients was videotaping. A barrier to learning was the lack of affect and interaction. More research into the design of virtual simulations and its integration into existing curricula is required. Virtual patients are a valuable educational tool for breaking bad news; however, they are yet to replace existing educational approaches. There is a need for more large-scale, homogeneous studies to inform instructional design and curriculum integration.