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Objectives: To investigate communication clarity and understanding at the time of pancreatic adenocarcinoma (PDAC) diagnosis and whether they can influence patient engagement and compliance. Consecutive PDAC patients were enrolled at the time of diagnosis after obtaining informed consent in a single-center study. The patients completed a validated scale (PHE-s®), and the understanding rate was assessed using standardized tools. Patient compliance was evaluated, and the correlation between the PHE-s®, understanding, and compliance was calculated. Thirty patients were enrolled (15 female) with a mean age 64.4, 13 were metastatic. The mean visit time was 31 min, being longer if visiting doctor was an oncologist (p = 0.002). The engagement level was high in 70% of the patients, and all but one were compliant. The analysis of doctor-patient interactions showed a median of 121 conversational turns for doctors, 75 for patients, and 20 for caregivers (p < 0.0001), and the median percentage of speaking time was 77% for doctors, 13% for patients, and 2% for caregivers (p < 0.0001). Female caregivers spent more time speaking than did male caregivers (median 11.6% vs. 1.3%; p = 0.06). There were 290 instances of problematic understanding, most of which occurred during the taking of patients' personal medical history for doctors, while for patients and caregivers, these occurred mainly during the discussion of diagnosis/treatment (p < 0.0001). In a multivariable analysis, only origin from central or southern Italy was associated with high engagement (p = 0.0087). In this first attempt to measure clarity of communication and engagement in patients with PDAC, typical features of conversation and problematic understanding emerged, which deserves further investigation. [ABSTRACT FROM AUTHOR]

An interview with Srikant Sarangi, is presented. Discussing the relevance of rhetoric in healthcare education and practice; Sarangi highlights the importance of effective communication in healthcare delivery and the need to bridge gaps in communication theory; and framework of 'communication ethics', focusing on relationality and responsibility, as well as the need to move beyond a mere 'communication skills' approach.

This paper proposes a method for analyzing the dialogical functions of metaphors in communicative interactions, and more specifically in the context of medical interviews. The dialogical goals proposed and pursued by the interlocutors are coded using a coding scheme that captures seven mutually exclusive categories of dialogical moves. The functions of the moves, including metaphors, can be identified and correlated with other variables relevant to the type of communication under analysis. The coding scheme is used to analyze a corpus of 39 interactions between healthcare providers and patients affected by Type 2 diabetes. The exploratory quantitative analysis, for the purpose of determining the different distributions of metaphor uses between patients and providers, is combined with qualitative analysis in which the thematic areas of the metaphors are considered. The findings show how patients and providers use metaphors for pursuing different dialogical goals and meeting distinct communicative needs. [ABSTRACT FROM AUTHOR]

In argumentation, metaphors are often considered as ambiguous or deceptive uses of language leading to fallacies of reasoning. However, they can also provide useful insights into creative argumentation, leading to genuinely new knowledge. Metaphors entail a framing effect that implicitly provides a specific perspective to interpret the world, guiding reasoning and evaluation of arguments. In the same vein, emotions could be in sharp contrast with proper reasoning, but they can also be cognitive processes of affective framing, influencing our reasoning and behavior in different meaningful ways. Thus, a double (metaphorical and affective) framing effect might influence argumentation in the case of emotive metaphors, such as "Poverty is a disease" or "Your boss is a dictator," where specific "emotive words" (disease, dictator) are used as vehicles. We present and discuss the results of two experimental studies designed to explore the role of emotive metaphors in argumentation. The studies investigated whether and to what extent the detection of a fallacious argument is influenced by the presence of a conventional vs. novel emotive metaphor. Participants evaluated a series of verbal arguments containing either "non-emotive" or "emotive" (positive or negative) metaphors as middle terms that "bridge" the premises of the argument. The results show that the affective coherence of the metaphor's vehicle and topic plays a crucial role in participants' reasoning style, leading to global heuristic vs. local analytical interpretive processes in the interplay of the metaphorical and the affective framing effects. [ABSTRACT FROM AUTHOR]

Background: Misunderstandings in medical interactions can compromise the quality of communication and affect self-management, especially in complex interactions like those in the assisted reproductive technology (ART) field. This study aimed to detect and describe misunderstandings in ART triadic visits. We compared first and follow-up visits for frequency, type, speakers, and topics leading to misunderstandings. Methods: We purposively sampled 20 triadic interactions from a corpus of 85 visits. We used a previously developed coding scheme to detect different types of misunderstandings (i.e., with strong, acceptable, and weak evidence). We analyzed also the different topics leading to strong misunderstandings (direct expressions of lack of understanding, pragmatic alternative understandings, semantic alternative understandings) to provide insights about the contents of the consultation that may need particular attention and care. Findings: We detected an overall number of 1078 misunderstandings in the 20 selected visits. First visits contained almost two-third of the misunderstandings (n = 680, 63%). First visits were particularly rich in misunderstandings with acceptable evidence (e.g., clarifications and checks for understanding), compared to follow-up visits. In first visits, doctors' turns more frequently than couples' turns contained misunderstandings, while in follow-up visits it was the other way around. Looking at the couple, the majority of the misunderstandings were expressed by the woman (n = 241, 22%) rather than by the man (n = 194, 18%). However, when weighting for their number of turns, 9% of the men's turns included an expression of misunderstanding, compared to the 7% of the women's turns. Finally, more than half of the misunderstandings with strong evidence were about history-taking and treatment-related topics, and while the history-taking ones were particularly frequent in first visits the treatment-related ones were more present in follow-up visits. Discussion: Findings indicate that first visits may deserve particular attention to avoid misunderstandings, as they are the moment where a shared understanding can be harder to reach. In particular, misunderstandings happening in first visits seem mostly related to physicians having to reconstruct the clinical history of patients, while those in the follow-up visits seem to reflect residual and unsolved doubts from the couple, especially concerning treatments. [ABSTRACT FROM AUTHOR]

This article proposes a coding scheme for identifying and assessing linguistic evidence of problematic understanding in health-care provider communication with patients affected by type 2 diabetes mellitus. Drawing on the existing literature in pragmatics and linguistics, the scheme is grounded on the distinctions between the different types of linguistic evidence of the occurrence of a misunderstanding or a problematic understanding, divided into three levels (stronger, acceptable and weak) based on their probative force. The application of the scheme is illustrated through a pilot study, conducted on an Italian corpus of 46 transcripts of videotaped consultations between six health-care providers and 13 patients affected by diabetes mellitus type 2. The most frequent types of linguistic evidence of problematic understanding were the categories of "acceptable" (amounting to 58% of the total) and the "strong" evidence (35%). Patients' problematic understanding was detected to occur significantly more frequently than health-care providers. Providers were also found to be significantly more aware of possible misunderstandings, tending to verify more frequently the correctness of their own interpretations. This pilot study represents a first step in the process of developing a productive evidence-based tool for detecting problematic understanding, which can be used for implementing linguistic strategies for helping prevent the risk of misunderstandings in health-care communication. Our findings show that misunderstandings are widespread between patients and that some linguistic strategies may be more effective than others in preventing the risk of misunderstandings, suggesting possible directions of research for improving health-care providers' communicative skills. [ABSTRACT FROM AUTHOR]

Aims: Though various neurohormonal systems are concurrently activated during heart failure (HF), their biological effectors are not always easy to measure due to their short life in vivo, instability in biological samples, or very low concentrations. We measured the plasma concentrations of four stable precursor fragments of neurohormonal systems in patients with chronic HF and evaluated their relationship with outcome. [ABSTRACT FROM PUBLISHER]

AbstractAdvanced glycation end‐products (AGEs) are irreversible compounds which, by abnormally accumulating over proteins as a consequence of diabetic hyperglycaemia, can damage tissues and thus contribute to the pathogenesis of diabetic complications. This study was performed to evaluate whether restoration of euglycaemia by islet transplantation modifies AGE accumulation in central and peripheral nervous tissue proteins and, as a comparison, in proteins from a non‐nervous tissue. Two groups of streptozotocin diabetic inbred Lewis rats with 4 (T1) or 8 (T2) months disease duration were grafted into the liver via the portal vein with 1200–1500 islets freshly isolated from normal Lewis rats. Transplanted rats, age‐matched control and diabetic rats studied in parallel, were followed for a further 4‐month period. At study conclusion, glycaemia, glycated haemoglobin and body weight were measured in all animals, and an oral glucose tolerance test (OGTT) performed in transplanted rats. AGE levels in cerebral cortex, spinal cord, sciatic nerve proteins and tail tendon collagen were measured by enzyme‐linked immunosorbent assay (ELISA). Transplanted animal OGTTs were within normal limits, as were glycaemia and glycated haemoglobin. Diabetic animal AGEs were significantly higher than those of control animals. Protein AGE values were reduced in many transplanted animals compared to diabetic animals, reaching statistical significance in spinal cord (P < 0.05), sciatic nerve (P < 0.02) and tail tendon collagen (P < 0.05) of T1 animals. Thus, return to euglycaemia following islet transplantation after 4 months of diabetes with poor metabolic control reduces AGE accumulation rate in the protein fractions of the mixed and purely peripheral nervous tissues (spinal cord and sciatic nerve, respectively). However, after a double duration of bad metabolic control, a statistically significant AGE reduction has not been achieved in any of the... [ABSTRACT FROM AUTHOR]