Search

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.

Purpose: The COVID-19 pandemic has introduced lifestyle changes that may negatively impact communication, including the pervasive use of face masks and videoconferencing technology. Here, we examine the effects of age and self-rated hearing on subjective measures of speech understanding via a survey accessed by adults residing in the United States. Method: Responses to an online survey were obtained from adults (21 years of age and older) during the summer and fall of 2020. The survey included questions about hearing and speech understanding in a variety of scenarios and different listening conditions, including when communicating with people using face masks in quiet and noisy environments and when using videoconferencing. Results: Data from 1,703 surveys were analyzed. In general, the use of face masks led to the perception of poorer speech understanding and greater need for concentration, especially in noisy environments. When responses from all participants were considered, poorer self-rated communication ability was noted as age increased. However, among people who categorized their overall hearing as “Excellent” or “Good,” younger adults rated their speech understanding ability in noisy situations as poorer than middle-age or older adults. Among people who rated their overall hearing as “Fair” or “Poor,” middle-age adults indicated having more difficulty communicating with people using face masks, as compared with older adults. Examination of open-ended responses suggested that the strategies individuals use when communicating with people wearing face masks vary by age and self-rated hearing. Notably, middle-age and older adults were more likely to report using strategies that could put them at risk (e.g., asking others to remove their face masks). Conclusions: Even younger adults with self-perceived good hearing are not immune to communication challenges brought about by face masks. Among individuals with similar degrees of self-rated hearing, the expected increase in communication difficulty with age was not noted among our respondents. Supplemental Material: https://doi.org/10.23641/asha.16528431

Children with complex disabilities sometimes have difficulty communicating with their parents, caregivers, and teachers. For these children, eye gaze assistive technology can be used to facilitate communication. Eye gaze assistive technology outcomes for children and youth were analyzed in this systematic review. Database and hand-searches yielded 4412 unduplicated results, of which 11 articles were eligible for this review. Outcome measures, as well as environmental and personal factors, were mapped to the World Health Organization's International Classification of Functioning, Disability and Health framework. Communication outcomes were most prevalent and co-occurred with outcomes in all reported activities and participation domains. Environmental and personal factors were classified as either facilitators or as barriers in relation to device uptake and success. Although comprehensive professional and caregiver support was the primary facilitator for success, barriers could lead to rejection of the technology even when children were successful using the system.

Purpose To use the ICF to classify characteristics and aspirations of multilingual university students and faculty who seek speech-language pathologists’ support for intelligibility in English and to identify activities, facilitators, and barriers that impact participation in society. Method A retrospective record review was conducted on files of 175 clients attending a university clinic for intelligibility enhancement (accent modification). Participants came from 35 countries and spoke 28 different home languages. Results Assessment and intervention for intelligibility enhancement involved consideration of ICF components of Body Functions and Structures (e.g., articulating phonemes, rate, prosody), Environmental Factors (e.g., support), and Personal Factors (e.g., motivation). Consonant substitutions and deletions were common, although participants were often unaware of these. For example, only 25.6% of participants reported English dental fricatives (/θ/ and /ð/) were difficult to pronounce; however, 94.9% substituted them with other phonemes such as [t] and [d]. The combination of substitutions/deletions, fast speech rate, low speaking volume, and differences in word stress exacerbated poor intelligibility. More time conversing in English was associated with greater confidence and less difficulty communicating in English, although more time knowing English was not. Difficult communication situations were reported to be conversing over the phone, talking to strangers, and communicating in English on professional fieldwork placements. Participants were motivated to seek intelligibility enhancement for academic, employment, and social reasons. Conclusions To ensure multilingual speakers are able to participate fully in society, intelligibility enhancement requires a multi-pronged approach where speech and environmental characteristics interweave.

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.

Reverberation is a source of acoustic degradation, present to varying extents in many everyday listening environments. The presence of reverberation decreases speech intelligibility, especially for listeners with hearing impairment. There is substantial variability in how susceptible individuals with hearing impairment are to the effects of reverberation (i.e., how intelligible reverberant speech is to a listener). Relatively little is known about the listener factors which drive that susceptibility.To identify listener factors that are associated with an individual’s susceptibility to reverberation. Another purpose was to investigate how these listener factors are associated with reverberant susceptibility in relation to the amount of reverberation. The listener factors investigated were degree of hearing loss, age, temporal envelope sensitivity, and working memory capacity.This study used a correlational design to investigate the association between different listener factors and speech intelligibility with varying amounts of reverberation.Thirty-three older adults with sensorineural hearing loss participated in the study.Listener temporal envelope sensitivity was measured using a gap detection threshold task. Listener working memory capacity was measured using the Reading Span Test. Intelligibility of reverberant speech was measured using a set of low-context sentence materials presented at 70 dB SPL without individual frequency shaping. Sentences were presented at a range of realistic reverberation times, including no reverberation (0.0 sec), moderate reverberation (1.0 sec), and severe reverberation (4.0 sec). Stepwise linear regression analyses were conducted to model speech intelligibility using individual degree of hearing loss, age, temporal envelope sensitivity, and working memory capacity. A separate stepwise linear regression model was conducted to model listener speech intelligibility at each of the three levels of reverberation.As the amount of reverberation increased, listener speech intelligibility decreased and variability in scores among individuals increased. Temporal envelope sensitivity was most closely associated with speech intelligibility in the no reverberation condition. Both listener age and degree of hearing loss were significantly associated with speech intelligibility in the moderate reverberation condition. Both listener working memory capacity and age were significantly associated with speech intelligibility in the severe reverberation condition.The results suggest that suprathreshold listener factors can be used to best predict speech intelligibility across a range of reverberant conditions. However, which listener factor(s) to consider when predicting a listener’s susceptibility to reverberation depends on the amount of reverberation in an environment. Clinicians may be able to use different listener factors to identify individuals who are more susceptible to reverberation and would be more likely to have difficulty communicating in reverberant environments.

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.

Speech-language pathologists (SLPs) may be approached by multilingual speakers wishing to improve their intelligibility in English. Intelligibility is an essential element of spoken language proficiency and is particularly important for multilingual international students given their need to express complex ideas in an additional language. Intelligibility Enhancement aims to improve the intelligibility and acceptability of consonants, vowels and prosody with multilingual speakers who are learning to speak English. This study aimed to describe the Intelligibility Enhancement Assessment and Intervention Protocols and determine whether the intervention changed multilingual university students' English intelligibility. A multiple-baseline single-case experimental design was applied with direct inter-subject replication across two female participants whose home languages were Vietnamese and Putonghua (Mandarin). English intelligibility was assessed at multiple intervals pre, post and during intervention. The intervention protocol consisted of 11 weekly 1-h sessions with an SLP targeting English consonants, vowels and prosody. Following intervention, both participants displayed increased performance across most measures. For example, the Vietnamese participant's percentage of consonants correct (PCC) increased from 62.5% to 85.0% in probe keywords. Effect sizes, when comparing baseline and withdrawal phases, were 5.5 for PCC, 4.6 for final consonants, 2.3 for consonant clusters and 1.6 for syllables indicating improvements in all variables measured. Her speech rate reduced, word stress increased in accuracy and she perceived less difficulty communicating in English. These promising results suggest further testing of the Intelligibility Enhancement Protocols is warranted to determine effectiveness as an intervention for multilingual speakers.

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.

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.

Purpose Using a multi-dimensional measure of perfectionism: the Frost Multi-dimensional Perfectionism Scale (FMPS: Frost, Marten, Lahart, & Rosenblate, 1990 ), this study investigates: (a) whether adults who stutter (AWS) display more perfectionistic attitudes and beliefs than those who do not stutter, and (b) whether, in AWS, more perfectionistic attitudes and beliefs are associated with greater self-reported difficulty communicating verbally and speaking fluently. Method In the first analysis, FMPS responses from 81 AWS and 81 matched, normally-fluent controls were analyzed using logistic regression to investigate the relative contributions of four FMPS perfectionism-subscale self-ratings to the likelihood of being in the AWS group. In the subsequent analyses, data from the 81 AWS were analyzed using linear multiple regression to determine which FMPS subscale self-ratings best predicted their Communication-Difficulty and Fluency-Difficulty scores. Results Both the likelihood of being a member of the AWS group, and also the magnitude of the AWS group's Communication-Difficulty and Fluency-Difficulty scores, were positively part-correlated to respondents’ Concern over Mistakes-Doubts about Actions (CMD) subscale self-ratings but negatively part-correlated to their Personal Standards (PS) subscale self-ratings. Conclusions The FMPS profiles of respondents who stutter suggest that, as a group, they are not abnormally perfectionistic overall, but may be (or perceive themselves to be) abnormally error-prone. Also, AWS who are more concerned about their errors and uncertain of their actions experience more difficulty communicating verbally and speaking fluently. Educational Objectives: After reading this article, participants will be able to: (a) describe the findings of previous research investigating the role of perfectionism in stuttering and psychopathologies; (b) discuss why a multidimensional assessment of perfectionism is important in relation to stuttering; (c) discuss ways in which data from perfectionism assessments can contribute to the planning of therapy for adults who stutter.

OBJECTIVES The effects of directing, switching, and misdirecting auditory spatial attention in a complex listening situation were investigated in 8 younger and 8 older listeners with normal-hearing sensitivity below 4 kHz. DESIGN In two companion experiments, a target sentence was presented from one spatial location and two competing sentences were presented simultaneously, one from each of two different locations. Pretrial, listeners were informed of the call-sign cue that identified which of the three sentences was the target and of the probability of the target sentence being presented from each of the three possible locations. Four different probability conditions varied in the likelihood of the target being presented at the left, center, and right locations. In Experiment 1, four timing conditions were tested: the original (unedited) sentences (which contained about 300 msec of filler speech between the call-sign cue and the onset of the target words), or modified (edited) sentences with silent pauses of 0, 150, or 300 msec replacing the filler speech. In Experiment 2, when the cued sentence was presented from an unlikely (side) listening location, for half of the trials the listener's task was to report target words from the cued sentence (cue condition); for the remaining trials, the listener's task was to report target words from the sentence presented from the opposite, unlikely (side) listening location (anticue condition). RESULTS In Experiment 1, for targets presented from the likely (center) location, word identification was better for the unedited than for modified sentences. For targets presented from unlikely (side) locations, word identification was better when there was more time between the call-sign cue and target words. All listeners benefited similarly from the availability of more compared with less time and the presentation of continuous compared with interrupted speech. In Experiment 2, the key finding was that age-related performance deficits were observed in conditions requiring anticue but not cue responses. CONCLUSIONS The findings from Experiment 1 suggest that for both age groups, stream continuity mediates the process of allocating and maintaining auditory spatial attention when the target originates at an expected location, but that time is needed for the reallocation of auditory spatial attention when the target originates at an unexpected location. The findings from Experiment 2 suggest that when attention is momentarily misdirected, difficulties disengaging attention may help explain why older adults with good hearing report difficulty communicating in multi-talker listening situations.

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.

Elevated operating theatre noise can be hazardous to patient safety and may cause occupational stress. In a nine-hospital study, background noise and average noise were measured, during operations in different subspecialties, and found to be higher than noise levels recommended by the World Health Organization (WHO) for hospital areas in which patient care takes place. In operations in which nurses had also answered a question about hearing ‘quiet’, ‘normal’, and ‘loud’ talking, speech interference levels were estimated and indicated that nurses and other personnel had to substantially raise their voices to be well understood.

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.

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.

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.

Myocardial infarction patients' use of metaphors to share meaning and communicate underlying frames of experience¶The onset of a myocardial infarction (MI) is frequently associated with distinct sensations that may shape the personal meaning of the MI illness experience. Although highly important, patients may have difficulty communicating the personal meaning of the MI illness experience because of lack of congruence between the clinician's and patient's frames of experience. The frame of experience defines the context and agenda for encounters from each participant's perspective. This secondary analysis of data explored MI patients' use of metaphorical language to convey aspects of their underlying frame of experience. Specifically, this paper addressed (a) the structural and linguistic features of metaphorical language used by patients to describe MI pain, (b) the content and structure of associated patient metaphors, and (c) the similarities and differences between the content of patient metaphors and descriptions of MI pain. Our findings confirm that even in encounters characterized by clinician imposition of an organizing framework upon the patient encounter, patients use metaphors to reveal their underlying frame of experience and aspects of the personal meaning of the MI illness experience. Furthermore, although non-metaphorical descriptions provide insights into the patients' cognitive understanding of events associated with the MI, metaphorical descriptions are particularly helpful in eliciting aspects of the affective response to the MI.

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.

Low health literacy is associated with problems in managing chronic illness, increased chances of experiencing serious medication errors, difficulty communicating with health providers, increased r...

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.

Summary Anecdotally, middle-aged listeners report difficulty conversing in social settings, even when they have normal audiometric thresholds [1–3]. Moreover, young adult listeners with "normal" hearing vary in their ability to selectively attend to speech amid similar streams of speech. Ignoring age, these individual differences correlate with physiological differences in temporal coding precision present in the auditory brainstem, suggesting that the fidelity of encoding of suprathreshold sound helps explain individual differences [4]. Here, we revisit the conundrum of whether early aging influences an individual's ability to communicate in everyday settings. Although absolute selective attention ability is not predicted by age, reverberant energy interferes more with selective attention as age increases. Breaking the brainstem response down into components corresponding to coding of stimulus fine structure and envelope, we find that age alters which brainstem component predicts performance. Specifically, middle-aged listeners appear to rely heavily on temporal fine structure, which is more disrupted by reverberant energy than temporal envelope structure is. In contrast, the fidelity of envelope cues predicts performance in younger adults. These results hint that temporal envelope cues influence spatial hearing in reverberant settings more than is commonly appreciated and help explain why middle-aged listeners have particular difficulty communicating in daily life.

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.

Objective: After the displacement of students following Hurricanes Kat- rina and Rita, schools in several states enrolled many students with po- tential mental health needs. This study sought to understand how schools perceived the mental health needs of these students and what mental health programs they implemented. Methods: Mental health personnel at 19 public schools or school systems and 11 private or parochial schools in Louisiana, Alabama, Texas, and Mississippi were interviewed at two time points (spring and fall-winter of 2006). Results: Schools undertook diverse approaches to interventions, depending on the preexisting mental health infrastructure and personnel, the perceived needs of students, and the barriers or facilitators in each system. Interviewees described a rapid and comprehensive approach to the crisis in the immediate aftermath. Short- ly afterward, some schools perceived little need for mental health servic- es and refocused on their academic missions. Other school systems per- ceived student need but were unable to implement trauma-focused pro- grams because staff were not prepared to deliver such services and fund- ing was lacking. However, some systems and schools were able to imple- ment new programs or extend programs to displaced students. Imple- mentation challenges included difficulty communicating with parents, burnout among staff and program implementers, and efforts to balance the needs of the displaced students with those of the preexisting student population. Conclusions: Despite significant efforts to support students affected by the hurricanes, schools were limited in their ability to imple- ment disaster-focused programs. Extension of crisis plans to include pre- crisis training in mental health programming for students and staff who have ongoing difficulties after a disaster or crisis may be beneficial. (Psy- chiatric Services 58:1339-1343, 2007)

Noise and whole-body vibration measurements were made in the following Canadian Forces vehicles: LAV III, Bison and M113A2 ADATS (air defence anti-tank system). Measurements were made at different crew positions while the vehicles were driven at different speeds over rough terrain and paved roads. The participants completed a questionnaire at the end of each measurement session on their reactions to the noise and vibration. Noise levels were as high as 115 dBA in the ADATS, 102 dBA in the Bison and 96 dBA in the LAV III, exceeding the Canada Labour Code exposure limit of 87 dBA for 8 h(1)). A communications headset was found to be sufficient to reduce the noise exposure to safe levels in most cases. The vector sum vibration magnitudes for the LAV III and Bison were relatively low during highway driving (0.3 m/s(2) for both vehicles) compared to rough terrain (0.71 and 1.36 m/s(2), respectively). The ADATS vibration increased with driving speed (0.62 m/s(2) at 8 km/h and 1.26 m/s(2) at 32 km/h). The questionnaire responses indicated that half the crewmembers had difficulty communicating in vehicle noise, but were generally unaffected physically by vibration. The latter result may have been due to the relatively short exposure duration.

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 examined the relationships among expressed emotion (EE), communication deviance (CD), and ethnicity in a sample of 57 white, Latino, and black relatives of patients with schizophrenia. A new method of assessing CD from the Five Minute Speech Sample was also developed and evaluated against an existing method (the Camberwell Family Interview; CFI). As hypothesized, high expressed emotion rated (from the CFI) was associated with higher levels of CD, and the Five Minute Speech Sample and CFI methods of assessing CD were concordant. CD statements made by white family members focused most on patient behaviors/symptoms that reflected a lack of independent functioning. CD statements of Latino and black relatives, however, focused most on patient behaviors that interfered with the family's interdependent functioning. Family members may have particular difficulty communicating coherently when discussing patients' inability to uphold important values and behaviors that are sanctioned by their ethnic background.

This study examined relationships among couple communication, sexual satisfaction, and marital satisfaction in 387 married couples. Regression analyses demonstrated that communication and sexual satisfaction independently predict marital satisfaction. However, there is a significant interaction between communication and sexual satisfaction; if couples are successful at communicating constructively, sexual satisfaction fails to contribute to marital satisfaction. Alternatively, if couples have difficulty communicating but are sexually satisfied, they will experience greater marital satisfaction than if they have a less satisfying sexual relationship. Thus, sexual satisfaction may partially compensate for the negative effects of poor communication on marital satisfaction.

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.

Healthcare practitioners are often called upon to share their expertise with colleagues. Frequently, expert practitioners are asked to make presentations at patient support groups, professional rounds, workshops, meetings, and conferences. Often these expert practitioners have not had the opportunity to develop strong presentation skills. Consequently, many are reluctant to give presentations. When they do present, they often have difficulty communicating their ideas effectively. This article describes the creation of a presentation skills program for healthcare practitioners. Essential program content is identified as well as measures taken to make this an effective, economical, and popular training program.

In an investigation of the impact of family visits on the behavior of 30 residents in dementia special care units, we found on direct observation that agitation decreased significantly during visits, but returned to the previous level within 30 minutes. No significant differences were found between visits by spouses or adult children. The premorbid quality of relationship was unrelated to family visitor enjoyment of visits or to differences between agitation level before and after visits. While 70 percent of visitors reported that they found visits pleasant (mean number of visits: 12.72 per month), 20 percent found visits unpleasant. Visitors' enjoyment or displeasure was significantly related to the difference between the number of pre-visit and post-visit agitated behaviors. Visitors indicated that the resident's mental status (33 percent) or difficulty communicating with the resident (30 percent) had the most negative impact on their visits. However, these factors appear amenable to education, suggesting that the quality of visits can be improved for visitor and resident with possibly greater positive impact on both.

Multidisciplinary teams of nurses, physicians, and other professionals may have difficulty communicating because of inconsistent theoretical underpinnings. A theoretical base that spans both clinical outcomes and professional boundaries is needed. The web of causation is a theoretical framework that provides a platform of communication connecting issues related to infant mortality among various health-related professions. It includes professional, community, and institutional issues relevant to pregnant women and new mothers as infant caregivers. The article discusses how the web was used for interdisciplinary health care professional interaction and how it was used to develop a series of research protocols that will affect the care of mothers and infants in the District of Columbia.

Objective: The purpose of the study is to determine how frequently critical laboratory results (CLRs) occur and how rapidly they are acted upon. A CLR was defined as a result that met either the critical reporting criteria used by the laboratory at Brigham and Women's Hospital or other, more complex criteria. Design: This is a retrospective cohort study in a large academic tertiary-care hospital. Measurements: The proportion of chemistry and hematology results obtained in a 13-day period that met the hospital laboratory's critical reporting criteria were calculated. The charts of a stratified random sample of patients with CLRs due to sodium, potassium, and glucose were reviewed to determine the time interval until an appropriate treatment was ordered and the time interval until the critical condition was resolved. Results: In 13 days, 1938 of 201,037 laboratory results (0.96%, or 0.44 per patient-day) met the hospital's critical reporting criteria. In the chart review, 222 CLRs were included in the stratified random sample, and 99 of these met the inclusion criteria. Among these 99 CLRs, the median time interval until an appropriate treatment was ordered was 2.5 hours. This interval was 1.8 hours when the CLR met the laboratory's criteria and a phone call was made, and 2.8 hours when the CLR met more complex criteria not requiring a phone call (p = 0.07). For 27 (27%) of the CLRs, an appropriate treatment was ordered only after five or more hours. The median time until the condition resolved was 14.3 hours: 12.0 hours for CLRs that met the hospital's criteria and 20.9 hours for the CLRs that met the more complex criteria (p = 0.006). Conclusion: Although CLRs meeting the hospital's criteria were reported promptly by the laboratory, treatment delays were still common. Results that did not meet the hospital's critical criteria but still represented serious clinical situations were more often associated with treatment delays. Difficulty communicating critical results directly to the responsible caregiver is the likely cause of some delays in treatment. New communications methods, including computer-based technologies, should be explored and tested for their potential to reduce treatment delays and improve clinical care.

Interacting with terminally-ill patients is significantly stressful for caregiving families. To date, few studies have examined how caregivers perceive their communication with dying family members. As such, the present investigation was undertaken. A sample of 10 family caregivers was utilized for the study; informants had to be the spouse or child of the patient, having provided the majority of care during the illness period. Semi-structured interviews were employed by the investigator to collect data on the communicative experiences of these caregivers; they were asked to describe their thoughts and interactional experiences with specific reference to the following: (1) the inevitability of the patient's death, (2) the patient's preferred courses of action, (3) levels of family interaction, (4) patient denial, (5) previous patterns of discourse, and (6) bereavement. All interviews were audio-recorded, transcribed verbatim, and analyzed using a two-tier system incorporating aspects of content analysis methodology. Results indicate that caregivers experience difficulty communicating with their patients and with other family members. Suggestions for developing effective, appropriate, and sensitive communication training programs for terminally-ill patients and their caregiving families are provided.

Parapsoriasis is a group of uncommon but not rare disorders that was created in 1902 as part of a now long forgotten scheme to classify all inflammatory dermatoses. This artificial grouping has led to an enormously confused nosology of these disorders, that are, for the most part, otherwise unrelated. The use of a number of different terms at different institutions and by different physicians to denote the same diseases, together with the use of particular, single terms to denote different diseases, has caused much unnecessary confusion, In this review these terms are examined and an attempt is made to propose a new, unambiguous classification. Using this system, physicians with different views regarding which of the parapsoriases constitute distinct entities should have no difficulty communicating, and should have a clearer frame of reference within which to work. An attempt is made to evaluate critically which of the parapsoriases are distinct entities and whether one or more of them should be considered an early form of cutaneous lymphoma in light of currently available data.