A theory-based approach to analysing conversation sequences

Aims - To assess the quality of communication generally two procedures are used: one defines categories of utterances and counts their frequency, the other uses global observer ratings. We investigated whether a sequence analysis of utterances yields results which more precisely reflect the process of a conversation. Methods - We re-examined data from a randomised controlled intervention study in which residents' interviews with simulated patients were analysed with the Maastricht History and Advice Checklist (MAAS-R) and the Roter Interaction Analysis System (RIAS). Using the U-file of the RIAS we studied the effect of different types of physician questions (open, closed questions, facilitators, other physician actions) on the length of uninterrupted patients' speech and content of utterances. We investigated also whether reciprocity indices improve after a communication skills training, and whether they correlate with global scores form MAAS-R. Results - Patients respond to a closed question with a mean of 1.78 (± 1.49) utterances as compared to 2.75 (± 2.72) utterances after an open question. The likelihood of a concern was more than lOfold higher after an open question compared to closed questions. Reciprocal sequences make up less than 2 percent of the conversation, Still, they correlate with global items form MAAS-R. The 'empathy index' improves after the training. Declararation of Interest: preparation of the manuscript was supported by a grant from OncoSuiss

The relationship between hospital patients' ratings of quality of care and communication

Objective To assess the relationship between hospital patients' quality of care ratings and their experiences with health-related information exchanges and communication during hospitalization. Design Cross-sectional multivariate dimensional analysis of data from a quality of care experience questionnaire of hospital patients comparing scores across three levels of reported satisfaction. Setting and participants Five thousand nine hundred and fifty-two patients from a Swiss University Hospital responded to the questionnaire at discharge during 2010. Main outcome measures Survey questions measuring patients' evaluation of quality of care, patient loyalty and overall satisfaction. Results Different levels of reported satisfaction are associated with differing experiences of health-related information and communication during a hospital stay. Conclusions Patients who report lower satisfaction appear to attribute to the hospital staff enduring negative dispositions from behaviours that may be due to specific situational contexts. Negative experiences appear to influence scores on most other communication and information domains. Patients who report higher satisfaction, in contrast, appear to differentiate negative experiences and positive experiences and they appear to relativize and compartmentalize negative experiences associated with their hospital sta

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Illustrated Pollen Terminology

This open access book offers a fully illustrated compendium of glossary terms and basic principles in the field of palynology, making it an indispensable tool for all palynologists. It is a revised and extended edition of “Pollen Terminology. An illustrated handbook,” published in 2009. This second edition, titled “Illustrated Pollen Terminology” shares additional insights into new and stunning aspects of palynology. In this context, the general chapters have been critically revised, expanded and restructured. The chapter “Misinterpretations in Palynology” has been extended with new research data and additional ambiguous terms, e.g., polyads vs. massulae; the chapter “Methods in Palynology” has been extensively enhanced with illustrated protocols showing the majority of the methods and techniques used when studying recent and fossil pollen with LM, SEM and TEM. Moreover, additional information about the description and publication of pollen data is provided in the chapter “How to Describe and Illustrate Pollen Grains.” Various other parts of the general chapters have now been updated and/or extended with more comprehensive textual passages and new illustrations. The chapter “Illustrated Pollen Terms” now features new and more appropriate examples of each term, including additional LM micrographs. Where necessary, the entries for selected pollen terms have been refined by rewording or adding definitions, illustrations, and new micrographs. Lastly, new terms are included, such as “suprasculpture” and the prefix “nano-“ for ornamentation features. The chapter “Illustrated Pollen Terms” is the main part of this book and comprises more than 300 widely used terms illustrated with over 1,000 high-quality images. It provides a detailed survey of the manifold ornamentation and structures of pollen, and offers essential insights into their stunning beauty

Improving Communication in Adolescent Cancer Care: A Multiperspective Study.

BACKGROUND Professionals treating adolescents with cancer must communicate well with them and their parents. Evidence suggests that the communication needs of this population are rarely met. Skills training can improve professional communication, but has been criticized for not being based on the experience of the participants in the clinical encounter. We took a multiperspective approach, drawing on perspectives of former adolescents with cancer, patients' parents, physicians, and nurses with the aim to provide suggestions for improvement in communication in adolescent cancer care. METHODS Adolescent cancer survivors (n = 16), parents (n = 8), pediatric oncologists (n = 12), and pediatric oncology nurses (n = 18) participated in 11 focus groups. They discussed their experiences communicating with each other. Transcripts were analyzed by thematic analysis. RESULTS We identified themes within the following sections: (1) The framework in which professionals communicate with adolescents with cancer (regression in a time of detachment, adolescents' perception and knowledge of illness, cognitive versus legal maturity, "lost in transition" between pediatric and adult oncology); (2) communication difficulties between professionals and patients and parents (professionals and patients/parents identified the other party as the source of difficulties), and (3) effective professional communication (there was some overlap on how doctors and nurses should communicate, along with substantially different expectations for the two professions). CONCLUSIONS The framework within which professionals communicate, the different perspectives on the factors that make communication difficult, and the different expectations regarding good communication by doctors and nurses should be considered when communication skills training courses are developed for professionals who work in adolescent oncology

Swiss Cancer League communication skills training programme for oncology nurses : an evaluation

This paper is a report of an evaluation of the effectiveness of a communication skills training programme for oncology nurses

The relationship between hospital patients' ratings of quality of care and communication

To assess the relationship between hospital patients quality of care ratings and their experiences with health-related information exchanges and communication during hospitalization. Cross-sectional multivariate dimensional analysis of data from a quality of care experience questionnaire of hospital patients comparing scores across three levels of reported satisfaction. Five thousand nine hundred and fifty-two patients from a Swiss University Hospital responded to the questionnaire at discharge during 2010. Survey questions measuring patients evaluation of quality of care, patient loyalty and overall satisfaction. Different levels of reported satisfaction are associated with differing experiences of health-related information and communication during a hospital stay. Patients who report lower satisfaction appear to attribute to the hospital staff enduring negative dispositions from behaviours that may be due to specific situational contexts. Negative experiences appear to influence scores on most other communication and information domains. Patients who report higher satisfaction, in contrast, appear to differentiate negative experiences and positive experiences and they appear to relativize and compartmentalize negative experiences associated with their hospital stay

Using interpreters in medical consultations: What is said and what is translated - a descriptive analysis using RIAS

Objective: To analyse the concordance of original utterances by healthcare providers (HCP) and patients with the corresponding translations by interpreters using the Roter Interaction Analysis System (RIAS). Methods: Video recordings of interpreted consultations were transcribed. Transcription was performed by professional interpreters, who first transcribed consultations in both languages, then provided a translation of what was said in the foreign language. Based on the translations, the videos were coded and analysed using RIAS. Results: Overall, 19 consultations with a total recording time of 865 min were analysed. The main finding is the large difference in the number of utterances in the original language compared to the number of utterances in the target language: about one third of the HCPs’ and the patients’ utterances were not translated. In no instance were omissions explained to HCP or patient. Conclusion: Interpreters in this sample did not always translate what had been said precisely; they omitted utterances by both HCPs and patients. Practice implications: All participants of an interpreted consultation must be made aware of potential omissions in the process of translation. Further understanding of the causes and consequences of omissions is needed