Message Relay Research Articles

The SUPPORT Study: Who's Talking?

In recent years, the public has become increasingly concerned about the use of medical technologies and pain management for seriously or terminally ill patients. The process of death and dying, particularly a hospital setting, is often characterized by feelings of abandonment and loss of control on the part of patients and their families. Efforts to legalize physician-assisted suicide California and Washington, and the success of the referendum Oregon, reflect the public's overwhelming dissatisfaction with what is perceived as physicians' unwillingness to recognize the suffering experienced by terminally ill individuals. Moreover, health professionals, legislators, and patients alike have expressed discontent with the high cost of end-of-life medical care. Taken together, these considerations suggest that innovative attempts to reform health care for the seriously and terminally ill are long overdue. The SUPPORT study represents a major effort this direction. The size and scope of this multisite study make it historically unique. A primary goal of SUPPORT was the development of a model intervention that would enhance the frequency and effectiveness of patient-physician communication about medical decisions. Yet patient care remained unchanged. The SUPPORT intervention's inability to produce any modification patient care illustrates profoundly the force and tenacity of Western biomedical culture. In matters of end-of-life decisionmaking, the production and application of medical knowledge reveal deep-seated values and beliefs about patient-physician relationships, control the practice of biomedicine, and the nature of human mortality. At its core, end-of-life decisionmaking a hospital setting rests on a set of tacit assumptions about biomedical reality that strongly influence the process and experience of death and dying. Power and Control Medical Practice Legitimation of authority biomedicine is expressed and reinforced through a hierarchy of social dominance. Central to this issue of authority are questions surrounding the creation and production of medical knowledge. When end-of-life decisions must be made, who determines what medical data have significance, what information is relevant and whose voices may be heard? Traditionally it is physicians who have held the reins deciding the substance and parameters of medical decisionmaking. Although current developments the reorganization of health care practice toward managed care and managed competition may result fundamental changes the balance of medical power, the conventional authority of physicians as the creators of biomedical knowledge is likely to remain strong. Patients, their surrogates, physicians, and nurses all participated actively Phase II, the experimental stage of the SUPPORT project. However, responsibility for implementing the interventions designed for SUPPORT rested heavily on the nurses. It was the nurse who spoke initially with a patient about his or her concerns and desires for medical treatment; it was the nurse who became the conduit of information about a patient's treatment preferences and prognostic status. To a certain extent, this means business as usual a medical environment where typically nurses are relied upon to talk to patients and their families and relay messages to physicians in charge. In the context of biomedical and social power, perhaps the supplemental knowledge generated by the nurses concerning advance care planning for end-of-life decisionmaking was contained an all too familiar package. The SUPPORT intervention yielded important information about patients and provided opportunities for that knowledge to be used and acted upon. Unfortunately, this production of knowledge replicated the historical pathways of patient care. Do physicians read the nursing notes patient charts or listen to nurses' requests on behalf of patients? If the physician reads the chart or discusses the issues with nurses, is the material taken seriouly? …

Optically Interconnected Processor Arrays with Switching Capability

Array Processors with Pipelined Buses (APPBs) are hybrid optical-electronic multiprocessor architectures in which message-pipelined optical buses are used for interprocessor communications. Presented in this paper is a structural variation of the basic APPB which utilizes optical switches to provide the capability of switching messages between buses without their being relayed by intermediate processors. Such switching capability eliminates the optical-electronic-optical signal conversion due to message relays and offers improved communication efficiency. We discuss routing issues, evaluate bandwidth improvement, and present efficient communications including matrix transpose, binary tree routing, and perfect shuffle which take advantage of the switching capability.

Attitudes and Impressions toward Receiving Phone Calls Made with a Voice Output Device in the United States and Japan

Communication by telephone is a necessary part of daily living. However, for people with hearing and speech impairments, it is often difficult to communicate by telephone in the usual way. To solve this problem, alternative methods for using telephones have been developed. In the United States, people with hearing and speech impairments have TTsrrDDs (text telephones or telecommunication devices for the deaf) to communicate with other people. In addition, there are message relay services that make it possible for TTrrDD users to communicate with people who do not have such devices. In Japan, where there are few such systems, facsimile (fax) machines are a more popular method for telecommunication than TTsffDDs for people with hearing and speech impairments. However, it is not easy to communicate in real time using the fax machine. In addition, it is impossible to communicate directly via fax with people who do not themselves have a fax machine. Certainly, for people with hearing impairments, TTsrrDDs and fax machines can be useful mechanisms for communication. Many people cannot speak, but they can hear. For people with speech impairments, voice output devices are more convenient than TTs/ TDDs or fax machines because there are no restrictions as to who can receive the message. There are many studies of communication via voice output devices. Some evaluate their intelligibility; 1-3 others study their acceptability. 4,5 Mirenda and Beukelman designed a study to compare intelligibility of single words and sentences

Teaching Telephone Skills in a Workshop Setting to Adults who Have Intellectual Handicaps: Two Data-Based Case Studies

Data are presented from two programs designed to teach adults who have intellectual handicaps to answer the telephone in a workshop setting. In the first case telephone skills and relaying messages to workshop staff were successfully taught to a 21-year-old woman. The second case describes teaching an 18-year-old male to answer the telephone, transfer calls to other extensions, and appropriately relay messages to workshop staff. Comment is made on the case study method as a means of recording and evaluating individual teaching programs, and as a means of structuring the involvement of university students as a teaching resource in a workshop setting.

Come in, Ma Bell, wherever you are.

In the complex world of today, it is difficult to conceive of a transaction that can operate effectively without good communication. Language, spoken or silent, directs us in countless ways in our daily lives; misinterpretation can lead to chaos. Breakdown of message relays can result in business catastrophes, wars, or marital dissolution. In the microcosm of our bodies, at the cellular level, there exist communication mechanisms with the same capabilities of creating harmony or wreaking havoc. The language of these cell-to-cell interactions is just beginning to be deciphered. We are used to the concept of neurological impulses instructing mass muscle movements with modulating influences coming from the cerebral cortex; the analogy to telephone messages is easy to comprehend. Directional influences that are just as specific operate at a cellular level, where the surface membrane serves as the central telephone exchange receiving and relaying messages. <h3>Cell Communication Structures</h3> The array of

The Development of Office Nursing

T HIRTY-FIVE years ago the duties of the doctor's girl were quite different from those of the physician's assistant, as she may be termed, today. The professional woman was scarcely heard of. The young woman who chose to find employment in a doctor's office needed no special training. All that was expected of her was ability to answer the telephone, relay messages, and do a very simple kind of bookkeeping. It was not really necessary for her to cultivate the art of being pleasant. If an emergency call came, she must help the doctor off at the earliest possible moment. If patients came to the office, she merely entertained, or bored, them until the doctor appeared. But the statisticians tell us that more progress in the invention and improvement of scientific devices for saving labor, life, and limb has been made in the past hundred years than was made in four thousand years prior to that time. No profession has been more keenly alive to this than the medical profession. No place has undergone more changes than the doctor's office. Every change has made the equipment and the duties of the users more complex and more exacting. The old farmer who sat bewildered in a modern physician's up-todate office expressed the idea in his own language: I jes' tell you, when a man practices medicine these days he shore has to keep a lot of 'round him. One of these inconveniences is the office nurse, yet she is, in a way, the physician's right hand. Oliver Goldsmith in his Deserted