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Objective To review existing publications in order to evaluate the effect of hearing loss on social isolation and loneliness in the pediatric population. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines were followed. Eight databases were searched. Studies were independently screened and analyzed by two reviewers. Publications were included if pediatric hearing-impaired individuals and social isolation or loneliness were studied. Discrepancies were resolved by a team of five reviewers. Results Thirty-three studies were included in this review. Sixty percent of studies (12/20) found that hearing loss was related to loneliness and 64.7% found that children with hearing loss experienced more social isolation (11/17). The Asher Loneliness and Dissatisfaction Questionnaire was commonly used to assess loneliness. No commonly used tool for assessing social isolation was found. Six articles found that school type was not associated with loneliness. Difficulty communicating was the most mentioned factor leading to loneliness and social isolation. Frequent recommendations to improve social integration included facilitating interactions with the hearing-impaired and educating the nonhearing-impaired to normalize the disability. Conclusion The majority of studies found that hearing impairment results in a higher prevalence of social isolation and loneliness. However, an association cannot be definitively claimed due to the lack of uniform assessment tools. This review emphasizes the need for standardized methods to assess loneliness and social isolation and highlights methods to improve social integration for the hearing impaired. Laryngoscope, 131:1869-1875, 2021.

The hospital may be especially overwhelming to patients with Autism Spectrum Disorder (ASD) and their families. The characteristics and attributes inherently present in patients with ASD provide substantial challenges to nursing care if not recognized, identified and addressed. ASD is a complex disorder and requires preparation, education, and great assessment skills from the nurses for optimal outcomes. Nurses are often the front-line and direct care providers and need to attain the knowledge and skills necessary to understand, interact with and implement excellent care for these individuals. These patients with ASD can present with a range of social and behavioral challenges including difficulty with communication need for structure, and possible aggression and it is difficult to implement care at times. Nowadays the nursing professionals are being increasingly aware of their role in helping to ensure that patients with ASD receive the best possible care. These patients may have difficulty communicating or may find a break in their routine stressful. By understanding ASD-related challenges and devising ways to make patients as well as their parents or caregivers more comfortable, nurses can make a hospital stay, doctor visit or dental checkup less stressful and more effective. Outcomes improve dramatically when health care professionals obtain the education, expertise, and knowledge necessary to provide such care. In this paper we discuss the common challenges that the nursing staff face while dealing with patients with ASD as well as the difficulties families face. Emphasis will be on the role of nursing professionals in making hospital stay less stressful for individuals with ASD.

INTRODUCTION AND OBJECTIVE:Disabled patients are a unique minority population that may have lower literacy levels and difficulty communicating with physicians. Furthermore, their knowledge for canc...

Background: Cognitive impairment is a prominent feature of multiple sclerosis (MS). However, the impact that cognitive symptoms have on daily life, and the effect this has on persons with MS and their relationships with spouses/partners, remains unclear. This qualitative study sought information on the nature of cognitive impairments experienced and the impact of cognitive impairments on the daily lives of adults with MS and their partners to gain further insights into how health care professionals can best support families. Methods: Fifteen persons with MS and their spouses/partners participated in separate semistructured telephone interviews. Results: Six themes and several subthemes were identified: the social impact of cognitive impairments in MS, changes to daily living, relationship quality, communication, ways of coping with MS, and the desire for help in managing MS. Conclusions: These results identified types of support that couples needed and wanted; ways that MS affects couples’ social lives; that there are difficulties negotiating changes in roles due to cognitive challenges; that there are difficulties coping with the impact of cognitive challenges on daily living; that couples often have difficulty communicating about the impact of cognitive changes on daily living and related issues, which also contributes to relationship strain; and finally, that most participants felt that they did not understand enough about the cognitive symptoms of MS. We outline key areas to address these identified needs.

OBJECTIVES To explore patterns of parafunction, and bruxism, and its relationships with genotype and snoring in individuals with Rett syndrome (RTT). METHODS Retrospective observational data of those with confirmed MECP2 mutations in the InterRett database (n = 216) were used to investigate experience of parafunctional habits, and bruxism and their relationships with genotype and snoring using multivariable linear regression. RESULTS The prevalence of parafunction was 98.2%. Bruxism was reported (66.2%) with the patterns mostly both diurnal and nocturnal (44.1%) and exclusively diurnal (42.7%). Compared to individuals with C-terminal deletion, individuals with p.Arg106Trp mutations were less likely to have bruxism reported (aOR = 0.15; 95% CI 0.02-0.98, p = 0.05) and those with p.Arg168* mutation were more likely to have frequent bruxism than none or occasional bruxism reported (aROR 3.4; 95% CI 1.1-10.7 p = 0.04). The relative odds of having nocturnal bruxism constantly, compared to none/occasionally, were higher among those 'always' snoring (aROR 6.24; 95% CI 2.1-18.2, p = 0.001) than those with no snoring. CONCLUSIONS There appeared to be genotypic association with bruxism in p.Arg168* and p.Arg106Trp mutations and association between nocturnal bruxism and frequent snoring in an international sample of individuals with RTT. Clinical significance of the high prevalence of bruxism should be highlighted in relation to difficulty communicating pain and increased dental treatment need in RTT.

Resumo O avanço da medicina aprimorou o tratamento de enfermidades, modificando o padrão de morbimortalidade da população, com aumento de doenças crônicas. Esse fenômeno tornou urgente interpretar adequadamente a terminalidade da vida. Considerando essa necessidade, este estudo, de corte transversal, descritivo e analítico, analisou dados sobre a percepção de 111 estudantes do sexto ano de medicina acerca dos cuidados paliativos no fim da vida. Os dados foram coletados entre agosto e novembro de 2016, por meio de questionário e analisados por testes estatísticos com o programa Iramuteq. 37,3% dos estudantes relataram dificuldade em comunicar a morte do paciente à família; 60% sentem-se despreparados ou com dúvidas sobre como lidar com óbitos em serviço de urgência; 25% desconheciam o termo “eutanásia”, 53% “ortotanásia”, e 56% “distanásia”. Os resultados mostram que ainda há lacunas no conhecimento desses estudantes, explicitando a necessidade de que escolas médicas reforcem práticas pedagógicas sobre a morte. Abstract The advancement of medicine has improved the treatment of diseases, modifying the population’s morbidity and mortality pattern, with an increase in chronic diseases. This phenomenon made it urgent to properly interpret the termination of life. Considering this need, this cross–sectional, descriptive and analytical study analyzed data regarding the perceptions of 111 students from the sixth year of the medical school about end-of-life palliative care. Data were collected between August and November 2016 through a questionnaire and analyzed by statistical tests using the Iramuteq software. 37.3% of students reported difficulty communicating a patient’s death to their family; 60% of them felt unprepared or had doubts regarding how to deal with death in the emergency department; 25% of students reported not knowing the term Euthanasia; 53%, Orthothanasia; and, 56%, Dysthanasia. Results show that there are still gaps in the knowledge of medical students making evident the need for medical schools to reinforce educational practices regarding death. Resumen El avance de la medicina mejoró el tratamiento de enfermedades, modificando el patrón de morbimortalidad de la población, con un aumento de enfermedades crónicas. Este fenómeno tornó urgente interpretar adecuadamente la terminalidad de la vida. Considerando esta necesidad, este estudio, de corte transversal, descriptivo y analítico, analizó datos sobre la percepción de 111 estudiantes de sexto año de medicina acerca de los cuidados paliativos en el final de la vida. Los datos fueron recogidos entre agosto y noviembre de 2016, por medio de un cuestionario, y fueron analizados con pruebas estadísticas y con el programa Iramuteq. El 37.3% de los estudiantes informó dificultad para comunicar la muerte de un paciente a su familia, el 60% no se siente preparado o con dudas respecto de cómo lidiar con las muertes en el servicio de urgencia, el 25% desconocía el término “eutanasia”, el 53%, “ortotanasia”, y el 56%, “distanasia”. Los resultados muestran que aún existen lagunas en el conocimiento de estos estudiantes, explicitando la necesidad de que las facultades de medicina refuercen prácticas pedagógicas sobre la muerte.

Objectives: To assess the experiences of people with hearing loss in healthcare environments to characterize miscommunication and unmet needs, and guide recommendations for improving outcomes and access. Methods: Anonymous survey developed by subject-matter experts was posted on a large national hearing-loss consumer and advocacy organization website and email listserv. Data were collected and managed via RedCAP. Results: Responses were received from 1581 individuals. Respondents reported moderate or significant difficulty communicating with all listed providers. Three communication situations emerged as often presenting communication difficulties: hearing one's name when called in the waiting room, hearing when the speaker's back was turned, and hearing when communicating by telephone. Despite 93% of respondents indicating they sometimes or often let providers know about their hearing loss, 29.3% of all respondents still reported that no arrangements were made to improve communication. Conclusions: This study clearly demonstrates the ongoing difficulties faced by individuals with hearing loss, particularly older adults, as they attempt to navigate both providers and situations associated with a typical primary care office visit. Clinical Implications: Inexpensive and efficient changes to improve communication include (1) Improving one-on-one provider communication by facing the individual with good lighting, clear speaking, and not obstructing one's mouth; (2) Environmental changes such as using visual or tactile alerting devices in waiting rooms and adding noise-dampening carpeting and curtains; and (3) Avoiding telephones and conveying health information in writing.

Background As patient advocates, oncology nurses must attend to varying levels of health literacy among patients and families. However, little is known about nurses' experiences and comfort with health literacy assessment and providing health literacy support. . Objectives The purpose of this study is to explore nurse communication and patient health literacy. . Methods A cross-sectional survey design (N = 74) was used to explore nurse communication challenges with low-literacy patients and to measure nurses' frequency of assisting with patient literacy needs, perceived degree of difficulty communicating with low-literacy populations, and perceived comfort with health literacy support. . Findings A majority of the nurses reported communication challenges with patients who spoke English as a second language. Oncology nurses did not identify patient communication behaviors that indicated low health literacy. Nurses were least comfortable identifying low-literacy patients and assessing a patient's health literacy level. More experienced nurses reported more difficulty with low-literacy populations than less experienced nurses. Providing health literacy support to patients should be a core nursing skill.

Background Since few studies have characterized painful diabetic peripheral neuropathy (pDPN) symptoms in multicultural populations, this study fielded a survey to better understand pDPN and its impact in African-American, Caucasian, and Hispanic populations. Methods Kelton fielded a survey by phone or Internet, in English or Spanish, among adults with pDPN symptoms in the United States between August and October 2015; African-Americans and Hispanics were oversampled to achieve at least 500 subjects for each group. Patients were required to have been diagnosed with pDPN or score ≥ 3 on ID Pain validated screening tool. The survey elicited information on pDPN symptoms and interactions with healthcare providers (HCPs), and included the Brief Pain Inventory and pain-specific Work Productivity and Assessment Questionnaire (WPAI:SHP). Results Respondents included 823 Caucasians, 525 African-Americans, and 537 Hispanics; approximately half of African-Americans and Hispanics were

e17000 Background: Disabled patients are a unique minority population that may have lower literacy levels and difficulty communicating with physicians. Furthermore, their knowledge for cancer prevention recommendations is unknown. Herein, we aim to compare prostate-specific antigen (PSA) testing rates and associated predictors among disabled men and non-disabled men in the USA. Methods: We performed a cross-sectional study utilizing the Health Information National Trends Survey (HINTS) to analyze factors predicting PSA testing rates in men with disabilities (disabled, deaf, blind). Multivariable logistic regression models were used to determine clinically significant predictors of PSA testing in men with disabilities compared to that of the healthy cohort. Results: A total of 782 (14.6%) disabled men were compared to 4,569 (85.4%) non-disabled men. Disabled men were older with a mean age of 65.0 ± 14.2 vs. 55.0 ± 15.9 years (p < 0.001). On multivariable analysis, after adjusting for all available confounders including race, age, geographical region, survey year, marital status, health insurance, healthcare provider, amongst others, men with any disability were less likely to undergo PSA screening (OR 0.772, 95% CI 0.623-0.956, p = 0.018). Variables associated with increased PSA screening rates included age, having a healthcare provider or health insurance, and living with a partner. Although prostate cancer detection rates were shown to be higher among disabled men, this did not reach statistical significance. Conclusions: Our data suggests that significant inequalities in PSA screening exist among men with disabilities in the USA, with disabled men, especially the deaf and the blind, being less likely to be offered PSA screening. There is a clear need to implement strategies to reduce existing gaps in the care of disabled men and strive to reach equality in PSA screening in this unique population.

More than a few pediatric nurses experience difficulty in communicating with children's family members. However, effective means of providing communication support for pediatric nurses have not been examined sufficiently. This study aimed to develop and implement a communication support program for nurses to facilitate improved communication with families of hospitalized children, and to clarify changes in nurses' recognition and behavior toward communication with families in clinical settings. The program lasted 6 months and consisted of lectures, role-play, 4 communication models in which nurses experienced difficulty communicating with family members, and continued individual support. The effects of the program were evaluated qualitatively and descriptively using semi-structured interviews. A total of 7 nurses with less than 5 years of pediatric nursing experience completed the program. Subsequent to program completion, nurses' awareness of careful communication with families increased, and they began to approach families actively using thoughtful words. Furthermore, as nurses received favorable reactions from families, they realized that communication was interactive and recognized that their perception of their communication skills as poor had changed. This program could contribute in reducing nurses' difficulty in communicating with families and encourage them to improve their communication.

Pain is a subjective experience, unfortunately, some patients cannot provide a self-report of pain verbally, in writing, or by other means. In patients who are unable to self-report pain, other strategies must be used to infer pain and evaluate interventions. In support of the ASPMN position statement "Pain Assessment in the Patient Unable to Self-Report", this paper provides clinical practice recommendations for five populations in which difficulty communicating pain often exists: neonates, toddlers and young children, persons with intellectual disabilities, critically ill/unconscious patients, older adults with advanced dementia, and patients at the end of life. Nurses are integral to ensuring assessment and treatment of these vulnerable populations.

Despite recent advances in cancer control, numerous disparities exist in the areas of patient access to care, self-management, and quality of life. However, mobile health technology shows promise as a tool to reduce disparities among patients with cancer and cancer survivors by overcoming such barriers as limited access to providers, difficulty communicating with providers, and inadequate communication between patients and providers regarding symptoms. This narrative review draws on the literature in cancer and noncancer populations to identify factors that create or maintain disparities and to describe opportunities for mobile health technology to reduce disparities.

An inability or difficulty communicating can have a profound impact on a child's future ability to participate in society as a productive adult. Over the past few years the number of interventions for children with speech and language problems has almost doubled; the majority are targeted interventions delivered by speech pathologists. In this paper we examine the distribution of speech pathology services in metropolitan Melbourne and how these are aligned with need as defined by vulnerability in language and social disadvantage. We identified three times as many private sector services compared to public services for the 0-5 year age group. Overall there was poorer availability of services in some of the most vulnerable areas. The profound and long-term impact of impoverished childhood language, coupled with the considerable limitations on public spending, provide a strong impetus to deliver more equitably distributed speech pathology services.

Many patients have difficulty communicating about their healthcare. At present there is no tool to identify these patients. This research investigated whether the Inpatient Functional Communication Interview Staff Questionnaire (IFCI SQ) could detect patients who have difficulty communicating their healthcare needs by investigating the sensitivity, specificity and internal consistency of the IFCI SQ.Fifty patients and their nurses participated in this research. Every second consecutive admission on the general medical ward of a hospital was assessed for communication difficulty by a speech-language pathologist on the IFCI and screened for communication difficulty by a nurse using the IFCI SQ.At a cut off score of 2, the IFCI SQ had a sensitivity of 95% and a specificity of 77% compared with the IFCI. The IFCI SQ is a useful test in identifying patients who have communication difficulty and is an extremely good test at ruling out patients who do not have communication difficulty. The internal consistency of the IFCI SQ was also high at 0.954.The IFCI SQ is a promising tool to detect patients in hospital with communication difficulty. Further research is required to explore the psychometric properties of the IFCI SQ in more detail.

Despite providing a consistent and comprehensible format for over-the-counter (OTC) drug communication, research suggests important limitations in the communication effectiveness of the Drug Facts Label required on OTC drugs in the United States. This literature is reviewed and some of these critical limitations of the Drug Facts Label (DFL) highlighted. These include difficulty communicating complex information that requires integration of multiple pieces of label information and limited adaptability to serve the unique needs of individual populations (e.g., low literacy or older consumers). Potential ways to improve the DFL’s communication effectiveness are identified along with complementary opportunities to improve OTC drug communication by leveraging the role of pharmacists and use of adjunctive technologies.

ObjectiveRecently, rehabilitation therapists have become involved in cancer rehabilitation; however, no communication skills training that increases the ability to provide emotional support for cancer patients has been developed for rehabilitation therapists. In addition, no study has examined associations between rehabilitation therapists’ communication skills and their level of autistic-like traits (ALT), which are in-born characteristics including specific communication styles and difficulty communicating with patients. In this study, we aimed to investigate whether confidence in communicating with patients mitigates communication difficulties experienced by rehabilitation therapists who have high levels of ALT.MethodRehabilitation therapists who treat patients with cancer completed self-administered postal questionnaires anonymously. Scores were obtained on the Autism-Spectrum Quotient short form, confidence in communication, and communication difficulties. We used covariance structure analyses to test hypothetical models, and confirmed that confidence in communication mediates the relationship between ALT and perceived communication difficulties.ResultsParticipants included 1,343 respondents (49.6%). Autism-Spectrum Quotient scores were positively correlated with communication difficulties (r = 0.16, p < 0.001). The correlation was mitigated by confidence in communication in the fit model. However, higher confidence in creating a supportive atmosphere was associated with more difficulty in communication (r = 0.16, p < 0.001).Significance of resultsCommunication difficulty was linked to rehabilitation therapists’ ALTs. By increasing confidence in areas of communication other than creation of a supportive atmosphere, ALT-related difficulties in communication may be ameliorated. Confidence to create supportive environments correlated positively with difficulty. Communication skills training to increase confidence in communication for rehabilitation therapists should be developed with vigilance regarding ALT levels.

Some of the highest rates of sexually transmitted infections (STIs) are reported in the Arctic. For example, the Inuit youth of Greenland have the highest STI rates in the circumpolar region. In this study, we used a mixed method approach to examine parent/guardian–youth communication about STIs and other sexual health topics. The quantitative component of the study involved the parents/guardians completing a brief questionnaire while the qualitative component involved their participation in focus groups. Parents/guardians reported that, although they found little difficulty communicating with youth in general, this was not the case for sexual topics. Similarly, parents/guardians reported a lack of communication about topics such as masturbation, why people engage in sex, and what it feels like to have sex. In general parents/guardians stated that it is uncomfortable for them to talk with their youth about sexual matters. At the same time, they are concerned about the high rates of unwanted pregnancy in their communities, and they would like to see more collaborative partnerships aimed at increasing sexual health education for youth. Future STI prevention efforts in Greenland would benefit from involving Greenlandic youth and their families in the design of community-based sexual health education programs that increase communication skills in families about topics related to sex. Community based efforts that involve families and empower them to educate their youth around STI risk-prevention behaviours is a necessary area of future development in Greenland.

Multiple System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP) are atypical Parkinsonian disorders with extended morbidity and reduced lifespan, known to have marked and early impact upon quality of life (QoL). This study aimed to address the lack of studies in the literature regarding personal perspectives on QoL in MSA and PSP in both patients and carers. Participants took part in qualitative, in-depth interviews in the North East of England, exploring what impacts their QoL and their experiences of living with these complex conditions. Connection to others was found to be a prevailing theme, encompassing difficulty communicating, social isolation, impact on personal relationships, and stigma. This work is helpful in that it emphasises the personal experiences of these patients and carers, which can provide insights into important areas for clinical service planning and best clinical management of individual patients as well as considerations for future research into QoL in these rare disorders.

Deaf people have difficulty communicating with the hearing people around them, but little research has addressed how new technology may help address this issue. The current research objectives were to (1) survey research on communication barriers encountered by deaf people; (2) survey the available communication applications (apps) and features designed for deaf people; (3) recommend the best existing communication apps for Deaf people; and, (4) identify the best designs and features of these apps for developers. A total of 55 communication apps were examined, but only six were found to be designed specifically as communication apps for deaf people. The survey outlines useful features of available communication apps for this population, examines the needs and preferences of the users, and compares these with existing features. We see that there is a serious need to develop more communication apps that meet the needs of deaf people.

Corporate entrepreneurship (CE) has emerged as an important strategy for hotels in recent years, allowing rejuvenation of internal processes and activities for improved performance. Although CE is instigated by senior management, middle managers carry out their instructions and hence have a critical role in its success. This conceptual paper evaluates the antecedents or factors that may impact on the middle manager's entrepreneurial role. Hotel middle managers are expected to be more entrepreneurial, but the findings indicate that centralised structures, although ensuring standardisation of systems and processes, result in a ‘top-down’ approach to leadership and decision making. The middle manager has difficulty communicating issues and ideas to senior management, affecting their ability to be innovative and to take risks on behalf of the hotel. Organisations appear not to be learning from their experiences, with a negative impact on performance.

People with special health care needs (PSHCN) often have difficulty communicating with providers in health care settings, including dental practices. This difficulty can affect access to care as well as the quality of care received. This article provides practical tips and tools dental professionals can use to facilitate communication for a diverse population of PSHCNs. The article discusses communication needs of patients with communication disorders; augmentative and alternative communication; and communication for patients with intellectual disability, psychiatric conditions; and dental fears. Examples are given of communication breakdowns, and descriptions of how communication challenges can be resolved.

Children undergoing surgical procedures may have difficulty communicating. Augmentative and alternative communication (AAC) picture communication may provide a standard communication strategy for postoperative children and facilitate nurse-patient communication. The study purposes were to (1) determine if inconsistency exists between nurse assessments of pain location versus identification of pain location using AAC picture communication aids and (2) determine parent satisfaction with use of AAC picture communication aids. A convenience sample of patients aged 3 to 9 years were recruited in a Midwestern freestanding pediatric hospital's postanesthesia care unit (PACU). The patient's pain location was assessed using an AAC picture communication aid and compared with the PACU nurses' pain assessment. Nurses did not consistently document location of pain, and, when documented, the surgical site was inaccurately identified as the location of pain. Parent satisfaction was measured through completion of a 10-item satisfaction survey. Respondents were satisfied with the use of AAC picture communication aids.

People with learning disability can suffer from the full range of medical problems but may have difficulty communicating their experience. The authors give advice on diagnosis, responsibility for medicine taking, obtaining consent and ensuring that the medication is taken as intended. Copyright © 2011 Wiley Interface Ltd

Farmers experience higher rates of noise-induced hearing loss (NIHL) than workers in most other industries. We developed a model of farmers' use of hearing protection, and tested it with a random sample (n = 532) of farmers from the upper Midwest. Barriers to using hearing protection (e.g., difficulty communicating; OR = .44, p

An 81-year-old female was referred for cochlear implantation due to difficulty communicating in her daily activities despite the use of appropriate amplification. The poorer ear was unable to tolerate amplification for the past 15 years. The open-set sentence-recognition test score in quiet in her "good" ear was 85 percent correct, indicating that the patient was not a traditional cochlear implant candidate. However, the sentence-recognition score in noise at +10 dB signal-to-noise ratio was 0 percent, demonstrating a significant breakdown in the patient's speech understanding in more difficult listening situations. This speech-in-noise score appeared to correlate with the patient's reported communication difficulties as well as with the communicative breakdowns that were observed clinically. The patient underwent cochlear implantation in the better ear. Cochlear implantation in this nontraditional patient provided objective and subjective benefit over hearing aid use. Una mujer de 81 años de edad fue referida para implante coclear debido a sus dificultades para comunicarse en sus actividades diarias, a pesar del uso de amplificación apropiada. El oído peor había sido incapaz de tolerar la amplificación durante los últimos 15 años. El puntaje de la prueba de reconocimiento de palabras de lista abierta en silencio en su oído "bueno" fue de un 85%, indicando que le paciente no era una candidata tradicional para un implante coclear. Sin embargo, los puntajes de reconocimiento de frases en ruido, a una tasa señal/ruido de ±10 dB fueron de 0%, demostrando un colapso en la comprensión del lenguaje por parte de la paciente en situaciones auditivas más difíciles. Este puntaje de lenguaje en ruido pareció correlacionar con las dificultades reportadas por la paciente, así como con el colapso comunicativo que se observó clínicamente. La paciente fue sometida a una implantación coclear en el mejor oído. El implante coclear en esta paciente no tradicional aportó un beneficio objetivo y subjetivo sobre el uso de auxiliares auditivos.

Since the 1980s both the United States and Europe have experienced a simultaneous expansion in social enterprise. However, little has been written comparing and contrasting American and European conceptions of social enterprise resulting in difficulty communicating on the topic and missed opportunities to learn and build on foreign experience. To address this need, this paper compares and contrasts American and European social enterprise through an extensive review of literature from the two regions and discussions with social enterprise researchers on both sides of the Atlantic. It outlines the definitions of social enterprise used by American and European academics and practitioners, identifies historical factors promoting and shaping different conceptions of social enterprise, and highlights the differing institutional and legal environments in which it operates. It concludes by identifying what Americans and Europeans can learn from each others’ experience with social enterprise.

Informed consumer participation in health care is increasingly important, but people with disabilities face barriers to making health care decisions. Using a unique survey, we examine informed health care choices by nonelderly people with diverse disabilities, including mental retardation, mental illness, visual and hearing impairments, and difficulty communicating, in TennCare, Tennessee's Medicaid managed care program. Most people with disabilities chose their plans and providers, felt they had enough information to choose a plan, and rated information from their providers as good to excellent. A minority did not know they could choose their plans and providers and reported poor or fair communication with providers. Adults with mental retardation were less likely than other adults with disabilities to seek information. Adults with serious difficulty communicating were less satisfied than others with information from providers. Medicare, Medicaid, health plans, and providers should tailor information dissemination to the diverse needs of people with disabilities.

Objective: Pediatric inpatients may be at risk for inadequate pain management if they are unable to communicate effectively because of age, physical or cognitive impairment, or medical procedures. We conducted a point prevalence study to estimate the proportion of inpatients at a children’s hospital who have difficulty communicating to hospital staff. Methods: We obtained nurse reports of ability to communicate for all inpatients aged ≥12 months in a pediatric hospital. Demographic information was obtained from the medical record. Results: Questionnaires were completed for 254 inpatients. Forty percent of inpatients had some difficulty communicating, and 69% had experienced pain during the hospitalization. Patient ability to communicate was not related to experiencing pain (χ2 test, P = .30) or effectiveness of pain management (χ2 test, P = .80) but was associated with difficulty communicating about pain and nurses needing help from the caretaker to communicate with the patient (χ2 tests, Ps < .001). Conclusions: A substantial proportion of inpatients aged ≥12 months at a large children’s hospital had difficulties communicating effectively and experienced pain during hospitalization. These communication difficulties were not associated with nurse reports of the effectiveness of pain management. However, patients who had difficulties communicating in general were also more likely to have difficulty communicating about pain specifically, and nurses were more likely to need help from the caregiver to understand these patients. Future directions include identifying which conditions, procedures, and medications are associated with inability to communicate.

People with dementia living in the community interact with a range of people who provide services to the public. Within these interactions, there may be communication problems associated with symptoms of the person's dementia. Problems include memory loss, difficulty communicating clearly, inability to grasp complex ideas, and problems handling money. This article describes a project that set out to promote training in dementia awareness for public contact staff with the expectation that it would help them better cater to people living with dementia. We worked with a police service, members of a city council, and staff of community pharmacies. This report provides suggestions about appropriate learning outcomes and program content and recommends steps to help others set up similar education programs.

Objective: To study the health care experiences and palliative care needs of patients with ALS in their final month of life. Methods: Caregivers of decedent patients with ALS completed a single survey focused on the final month of life. They reported the patients’ physical and emotional symptoms, preferences for end-of-life care, completion of advance directives, and preparation for death. The caregiver reported which life-sustaining treatments were administered, withheld, or withdrawn; whether the patient was enrolled in hospice; and their own satisfaction with the patient’s medical care. Results: Fifty caregivers completed the survey. Caregivers reported that the most common symptoms in the last month of life included difficulty communicating (62%), dyspnea (56%), insomnia (42%), and discomfort other than pain (48%). Pain was both frequent and severe. One-third of caregivers were dissatisfied with some aspect of symptom management. Caregivers reported an advance directive was completed by 88% of patients and the patients’ goals of care were honored by 88% of health care practitioners. Two-thirds of patients were enrolled in hospice. Compared to nonhospice patients, hospice patients were significantly more likely to: 1) die in their preferred location; 2) die outside the hospital; and 3) receive morphine. Most caregivers reported that their loved one was at peace, and prepared for and was accepting of death. Conclusions: Caregivers report that many patients with ALS still experience distressing physical symptoms in the last month of life, despite enrollment in hospice. Most patients with ALS, however, anticipate and plan for their deaths and have their wishes respected.

Communicating about Duchenne muscular dystrophy and its prognosis can be difficult for affected children and their family. We focused on how physicians provide support to the mothers of children with Duchenne muscular dystrophy who have difficulty communicating about the condition with their child. The eligible participants were certified child neurologists of the Japanese Society of Child Neurology. Participants responded to questionnaires consisting of free descriptions of a vignette of a child with Duchenne muscular dystrophy and a mother. We analyzed 263 responses of the participants. We found 4 themes on advising mothers, involving encouraging communication, family autonomy, supporting family, and considering the child’s concerns. These results provide a better understanding of the communication between physicians and family members who need help sharing information with a child with Duchenne muscular dystrophy. These findings will assist clinical practitioners in supporting families and the affected children throughout the course of their illness.

Catatonia is especially concerning in children and adolescents. It leads to significant impairment, including emotional distress, difficulty communicating, and other debilitating symptoms. In this case report, we discuss a patient with no previous history of neuroleptic medication or psychotic symptoms, presenting with first-episode catatonia in the presence of disorganized, psychotic thoughts. We then review the catatonia syndrome, citing examples in the literature supporting its underdiagnosis in children and adolescents, and discuss successful treatment modalities. It is important to diagnose and treat catatonia as efficiently as possible, to limit functional and emotional distress to the patient.

Self-report, the gold standard for pain assessment, is a challenge when critically ill patients have difficulty communicating with the nursing staff. Researchers have begun to investigate how critical care nurses assess pain in the ICU, using a small number of assessment tools. This article reviews the literature related to pain assessment in the critically ill and offers recommendations for pain assessment, including adaptation of a variety of pain measures to the specific needs and abilities of this population.

Measurement of Satisfaction for Patients and Providers ABSTRACT Consumer and provider satisfaction is key to the continued use and expansion of telehealth technology. This pilot study compared satisfaction of providers and patients with wound consultations done in person with those done via real-time interactive video technology. Eleven telehealth consultations with a nurse expert were immediately followed by an in-person consultation with a second nurse expert. Satisfaction questionnaires were administered to patients, referring nurses, and the consultant nurse expert following both the in-person consultation and the telehealth consultation. The referring nurses (100%) were satisfied with both the telehealth and inperson consultations, noting the ability to provide better care for their patients. The patients (55%) were "very satisfied" with the telehealth consultations versus 40% satisfied with the in-person consultations. Difficulty in hearing for the patients was equal in both groups, which resulted in changes in the consultation process. The patients' difficuity in seeing the telehealth consultant was addressed through larger screens and strategic positioning to provide easier viewing for the patient and providers. The telehealth nurse consultant was satisfied overall but had some difficulty communicating. This pilot study helped provide useful information for both the telehealth and inperson consultations.

In small studies lesbians report avoiding health care because of difficulty communicating with providers. This study examines lesbians' perceptions of communication with medical and alternative primary care providers using a statewide self-administered survey of members of a lesbian community organization. Univariate and bivariate statistics were used to analyze lesbians' perceptions of communication with their primary care provider about sexual orientation, difficult issues, and health issues important to lesbians. Of 324 respondents, 31% received primary care from alternative providers and 90% are “out” to one or more providers. Respondents who were “out” to their primary care provider were more likely to seek health and preventive care (p ≤ .05), more likely to have ever had a Pap smear (p ≤ .02), and more likely to be comfortable discussing sensitive issues (p ≤ .0001). Respondents rated alternative providers easier to communicate with than M.D.s (4.53 vs. 3.99, p ≤ .001). They reported being...

Background: Maternal knowledge about serious infant illnesses has significant implications for care after discharge, particularly in countries with high infant mortality rates. No existing studies on this topic in lowincome countries were identified. The study sought to identify the level of maternal understanding about why a newborn was hospitalized and how mothers in Ghana attributed blame for the illness. Methods: The project team conducted semi-structured interviews with mothers aged 18 and older who had infants hospitalized in a tertiary care facility in Kumasi, Ghana, and collected data on demographics, pregnancy and delivery, and beliefs about their infant’s illness. Infant charts were abstracted to identify medical reasons for hospitalization for comparison with the mother’s understanding, and levels of understanding were coded as ‘none’, ‘partial’ or ‘full’. Results: 153 mothers were interviewed and their average age was 28. For 27%, this was their first pregnancy. Forty per cent of mothers had no understanding of why their infant was in the hospital and 28% had only partial understanding. One-third of the women reported blaming themselves for the child’s illness. In multivariable analysis, demographic factors including maternal age, education, primiparous status, and urban vs rural residence did not predict maternal understanding or self-blame. Conclusions: Sick newborns in low-income countries are at very high risk of adverse outcomes. Mothers who lack a clear understanding of why their infant is in the hospital might have difficulty communicating preferences about care, understanding the type of care that is being given, and recognizing future warning signs of illness. Such gaps in understanding could put the discharged infant at significant risk.

Threshold audiometry is currently the foundation of clinical audiology. Yet, many individuals with normal hearing thresholds (NHTs) have difficulty communicating in noisy settings. We previously documented that even among listeners with NHTs and no hearing complaints, large individual differences exist in the ability to perceive subtle temporal features of clearly audible sounds, and to selectively process target speech in the presence of competing sounds. Critically, we find that these suprathreshold differences in individual perceptual sensitivity correlate with physiological measures from the brainstem and auditory nerve. These measures, including brainstem envelope-following responses, auditory brainstem responses, and the middle-ear muscle reflex, show that some perceptually relevant physiological differences arise very early along the auditory pathway. Cochlear synaptopathy—a loss of afferent synapses and nerve terminals innervating the cochlea—is well documented in noise-exposed and aging animals (...

This two-year observational study investigated the use of English in a Korean small-to-medium enterprise (SME) that imports, manufactures, and exports products. It investigated the tasks that required English, how the staff coped with English, and the outcomes of their English use. It was found that despite ten years’ of public education, nearly all the staff had difficulty communicating effectively with overseas suppliers and customers. Problems in email communication stemmed from misapplication of stock phrases, copying incorrect sample emails, and being unable to write email. Telephone and face-to-face meetings were also seriously hindered by incorrect English.

A taxonomy was developed a) to describe surgical procedures with sufficient detail to review differences among surgeons, b) to examine the relationship between individual technique and outcomes, c) to enable surgeons to standardize technique around best practices and d) to identify clinical-evidence-based key points of teaching and assessment for surgical training. Sixty-seven microvascular anastomoses were recorded through video cameras mounted in the dissecting microscope. A hierarchical task analysis was used to decompose the observed procedures into successive levels of detail. The results were then presented to individual and small groups of microvascular surgeons to help define steps and step attributes necessary to describe a procedure so that other surgeons can perform the procedure exactly the same way. Coincidently, it was found that because the surgeons' attention is confined to a very small field of view in which they can see only the veins and arteries and the ends of their instruments, they often have difficulty communicating with others in the operating room. Analyses of selected cases using the proposed taxonomy shows how subtle details are revealed that may affect outcomes, and indicate specific training needs. By comparing different methods and outcomes, it should be possible to identify best practices for given conditions.

Background Stroke symptoms are common among people without a history of stroke or transient ischemic attack; however, it is unknown if particular attention should be focused on specific symptoms for subgroups of patients. Methods Using baseline data from 26,792 REasons for Geographic And Racial Differences in Stroke (REGARDS) participants without a history of transient ischemic attack or stroke, we assessed the association between age, sex, race, current smoking, hypertension, and diabetes and the 6 stroke symptoms in the Questionnaire for Verifying Stroke-Free Status. Results The mean age of participants was 64.4 ± 9.4 years, 40.7% were black, and 55.2% were women. After multivariable adjustment, older persons more often reported an inability to understand (odds ratio [OR] 1.16 per 10 years older age; 95% confidence interval [CI] 1.07-1.25) and unilateral vision loss (OR 1.09; 95% CI 1.01-1.18) and less often reported numbness (OR 0.83; 95% CI 0.79-0.87) and weakness (OR 0.85; 95% CI 0.80-0.90). Women reported difficulty communicating more often than men (OR 1.36; 95% CI 1.19-1.56). The OR for blacks compared to whites for each of the 6 stroke symptoms was increased, markedly so for unilateral numbness (OR 1.97; 95% CI 1.81-2.16), unilateral weakness (OR 1.96; 95% CI 1.76-2.18), and inability to understand (OR 1.87; 95% CI 1.61-2.18). Current smoking, hypertension, and diabetes were associated with higher ORs for each stroke symptom. Conclusions The association of risk factors with 6 individual stroke symptoms studied was not uniform, suggesting the need to emphasize individual stroke symptoms in stroke awareness campaigns when targeting populations defined by risk.

Continuous ST-segment ischemia monitoring is recommended for patients at significant risk for myocardial ischemia that, if sustained, may result in acute myocardial infarction or extension of a myocardial infarction. It is especially useful for patients who do not perceive or cannot communicate symptoms of ischemia. We report 2 case studies of young women with acute coronary syndrome who benefited from continuous ST-segment monitoring. One patient was critically ill and unresponsive, and one patient had atypical symptoms and some difficulty communicating clearly.

Corneal metallic foreign body is a common condition in working-age adults due to occupational exposure, such as grinding, welding, and hammering. Ocular trauma is a leading cause of vision loss in children; however, corneal metallic foreign bodies are rare in the pediatric population. Here we describe 2 children suffering from autism spectrum disorders presenting with recurrent corneal metallic foreign bodies. Meticulous history revealed that both children extensively used a therapeutic home swing with metallic suspensions, suggesting the potential mechanism for the recurrent corneal metallic foreign bodies. Furthermore, the use of protective eyewear during swinging prevented further recurrences. Awareness of this potential danger is particularly important in children with disabilities, who may have difficulty communicating their concerns and cooperating during examination and treatment.

Communication difficulties between hospital doctors and nurses are well documented. A survey undertaken jointly by medical and nursing administration at Sir Charles Gairdner Hospital in Perth, Western Australia, verified difficulties in doctor-nurse communication as perceived by doctors and nurses, as well as by ward clerks as impartial observers. Questionnaire responses revealed some impediments in the flow of communication. Both nurses and doctors perceived less frequency of difficulties in communicating with members of their own professional group than with members of the other group. Nurses with university preparation and other special clinical qualifications perceived significantly fewer communication problems with doctors than nurses with less education. Interns perceived greater frequency in difficulty communicating with nurses than did more highly qualified doctors, and female doctors who were not interns claimed fewer problems than their male counterparts. Moreover, more highly qualified male doctors who had a previous occupation acknowledged fewer doctor-nurse communication problems.

Children with cancer experience short- and long-term symptoms. The symptoms can escalate child and family suffering and impact on their quality of life. Children's perspectives of their cancer symptoms have been increasingly investigated; however, there is still much more to be learned from children with cancer. Accordingly, a qualitative study that sought to arrive at an interpretive description of children's and adolescent's perspectives about their cancer symptoms was conducted, with a focus on exploring what children and adolescents with cancer think and feel about their cancer symptoms. Open-ended individual interviews were conducted with 13 children and adolescents with cancer. The patients ranged in age between 9 and 17 years. Data were analyzed by the constant comparative method of data analysis. Five themes emerged from the data: (1) It is all together, (2) Shared and unique ways of feeling, (3) I am feeling this way because..., (4) Feelings about my feelings, and (5) It is hard to explain. The findings reinforce that children have a lot to tell us about how cancer makes them feel but may have difficulty communicating how they feel to nurses and other healthcare providers.

This film is a classic portrayal of a doctor's transformation as a result of his own experience of illness. Like a lot of Hollywood movies, it shows the hero overcoming adversity and coming out a better person; it also a reflection on the different aspects of being a doctor. William Hurt plays Dr Jack McKee, a cardiac surgeon, who is lively and technically competent, but also arrogant, and who has appalling doctor-patient communication skills. Why is it always the surgeons that seem to be this way? Maybe there is some truth in what Dr McKee says on his ward round with his subservient junior staff, that a surgeon needs to be quick and decisive, and that concentrating on the patient's agenda can be distracting. His big fear seems to be that if he becomes sensitive to the patients' needs and fears, he will be paralysed into inactivity. Dr McKee develops an irritating cough, and eventually after coughing up blood he goes to see an ear, nose, and throat surgeon in his own hospital, the glamorous Dr Lesley Abbott. There is brilliant acting here by William Hurt, as he portrays a patient having a laryngoscope shoved down his choking throat and then being told bluntly by Dr Abbott, “You've got a growth, doctor.” She, rather like Margaret Thatcher, seems to feel that she has to be as tough as the men to survive in her professional world. We follow Jack McKee trying to come to terms with his illness, while also carrying on his work as a heart surgeon, and we see just how difficult it is to be both a doctor and a patient, especially when you are playing both roles in the same hospital. The best scenes show the powerlessness and frustrations of being a patient, from nearly being given a barium enema intended for a neighbouring patient, to the endless waiting around and poor staff communication. The film is much less effective when straying away from the medical arena to portray Jack's close relationships. Finding difficulty communicating with his wife, he seeks solace with a fellow radiotherapy patient, who is dying from a brain tumour. Despite being terminally ill, she is beautiful and elegant with her shaven hair, and they run away together, dancing into the sunset in the Nevada desert. Pure Hollywood schmaltz! Jack discards his female ENT surgeon for a more sensitive male colleague whom he had previously ridiculed for being a nerd, but now clearly recognises as the sort of doctor he needs. He survives surgery and the temporary loss of his voice, and is finally reconciled with his long suffering wife. He returns to work as a much more caring and effective doctor, able to successfully combine the technical and human qualities of being a doctor. I use this film extensively when teaching medical students, but it has a lot to teach all doctors, at all stages of their careers.

Introduction Transfer to hospital in the last weeks of life is common for older adults. It is imperative to better understand factors associated with transition to enable older people to remain in their usual place of care. Aim(s) and method(s) To explore possible determinants of transition from home to institutional care settings in last weeks of life. Post-bereavement survey of carers to people aged over 75 who died in 2012 in the South of England (n=883). Main outcome is death at home versus hospital/care home (hospice deaths excluded) for decedents whose usual place of care was home. Exploration of socio-demographic factors and illness factors using multivariate modified Poisson regression. Results 235 decedents spent most of the last 3 months of life at home. The majority died from non-malignant conditions (71.9%) with mean age 86 years. 51.1% died at home and 48.9% transitioned in the last 3 months to a hospital (44.7%) or care home (4.3%). Death outside usual place of care was independently associated with increasing age (85–90 years [PR=3.4; 95% CI 1.9–6.1] compared with 75–80 years), and severity of breathlessness (PR=1.9; 95% CI 1.2–3.4) and difficulty communicating (PR=2.0; 95% CI 1.5–2.8). Conclusion(s) Transition to hospital at the end of life is common for older adults living at home. Transition occurs most frequently for the oldest old and those with severe symptoms of breathlessness and difficulty communicating. To reduce reliance on hospital care at the end of life requires timely services responsive to increasing symptom distress and wider anticipation of end of life for adults of advanced age.

Little is known about how people with pain seek relief. To estimate the proportion of the population reporting recent pain, to identify ways people seek pain relief, and to report the perceived effectiveness of pain relief methods, we conducted a secondary analysis of results from a nationwide survey of the general U.S. population. Of the 1204 respondents, 31% had experienced moderate to very severe pain within the past 2 weeks and 75% of these had sought medical attention. Only 56% of those who sought medical attention got significant pain relief. Although seeking medical attention was the primary pain relief strategy, almost all of those with pain had tried multiple alternative methods for pain control, with 92% of pain sufferers having tried 3 or more alternative strategies. People who did not seek medical attention were more likely to report pain relief from prayer and going to a chiropractor than were those who sought medical attention. Factors leading to inadequate pain relief included difficulty communicating with a health professional and lack of health insurance. People who perceive that their pain is not understood by medical providers and those without health care insurance coverage are at greater risk for poor pain control. Perspective This article presents an analysis of data from a national survey on pain and the effectiveness of ways people seek pain relief. Difficulty communicating with health professionals and lack of health insurance contributed to inadequate pain relief. Almost all people with pain used multiple methods to control their pain.

This study aimed to clarify the current state of, and factors associated with, modern contraceptive use among married women in the Maldives. A total of 205 women participated in interviews with structured questionnaires. Four sessions of FGIs were conducted to obtain in-depth information about the problems that they faced in using modern contraceptives. Both modern contraceptive users (MCUs) and those who were not modern contraceptive users (NMCUs) had a good knowledge of, and availability and accessibility to, contraceptives and social support for contraceptive use. NMCUs were more likely to have a husband who disapproved of modern contraceptive practice, to have difficulty communicating with their husband, to be afraid of side effects and to be dissatisfied with sexual sensation when using modern contraceptives. Moreover, NMCUs cited more perceived barriers against the use of modern contraceptives and preferred larger families than MCUs.

Technical writers and editors are often caught between engineering or scientific sources who have difficulty communicating their work outside their own disciplines and an audience that lacks basic understanding of rudimentary technical concepts. The result is a growing gap in understanding between the technical community and the rest of the population. Two programs one at CU and one at UCAR, attempt to bridge this gap from opposite directions. One provides flexible curricular materials for teaching science to nonscience majors in colleges and universities; the other is a program to teach humanities to undergraduate engineering students. >