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While technical communicators are increasingly involved in visual design tasks, they frequently have difficulty communicating verbally about the visual, and, therefore, contributing effectively to design development. The visual analysis procedure outlined in the paper provides a common framework and language for both design evaluation and group communication. >

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.

People often have difficulty communicating in the presence of concurrent conversations. This well‐known ‘‘cocktail party effect’’ can be described as a combination of energetic and informational masking. The purpose of this study was to measure and model the effects of energetic and informational masking that occur when two people speak at the same time. The word identification test used in the experiments was the Modified Rhyme Test (MRT), which afforded a multitude of initial and final consonant pairs when phrases were played simultaneously. The MRT was used as both the stimulus and the masker, which were presented monaurally at 75 dB SPL over Sennheiser HD‐520 headphones to four normal hearing listeners. The independent variables included 30 pairs of MRT word lists, and twelve pairs of same‐sex talkers. The dependent variable was speech (consonant) intelligibility as measured with the MRT. Results will be discussed in the context of place of articulation, manner of articulation, signal‐to‐noise‐ratio o...

Many investigators have noted the high frequency of medical disorders among psychiatric patients, and the fact that medical disorders can mimic functional psychiatric illnesses (e. g., Marshall, 1949). An extensive literature documents failures to diagnose physical illness among psychiatric patients (Lazare, 1989). There are a number of reasons, which may be classified as patient-related, physician-related, or disease-related (Hoffman & Koran, 1984). For example, certain characteristics of the psychiatric patient may conspire to thwart an accurate medical diagnosis. Psychiatric patients may be unattractive (e. g., dirty, unkempt, malodorous, and hostile), may be uncooperative, or may have difficulty communicating clearly, and these factors may discourage accurate history taking or a thorough physical examination. Psychiatric patients may also be less likely to show evidence of physical pain, even in the face of acute, life-threatening medical illness (Talbott & Linn, 1978).

Older adults with and without clinically significant hearing loss often report difficulty communicating in multitalker environments. Past work in our laboratory has shown that older listeners with hearing loss benefit less from differences in talkers’ vocal characteristics (e.g., fundamental‐frequency differences) relative to younger listeners with comparable hearing losses. The present study examined the extent to which age‐related changes in the perceptual organization of speech cues are due to task demand. Two experiments used the Coordinate Response Measure to examine how the benefit listeners derive from talker characteristics interacts with the complexity of the response task as a function of both age and hearing status. Stimuli were amplified to assure audibility for listeners with hearing loss. Task complexity depended on whether the distracting signal was linguistically meaningful as well as the level of auditory processing required (discrimination versus identification). Older listeners generall...

Clinical studies in children may play a broader role in medicine in the days ahead. Walson, for one, foresees a time in the not-too-distant future when physicians may be able to treat conditions years before they develop. “If we’re able to figure out who’s going to have a heart attack at 50, and we learn that we can prevent that by treating at the age of 5, we’d better be ready for testing things in children,” he said. “Because if we’re not, we will miss the chance to treat.” He imagines that a number of conditions exist that could best be treated at a young age, so physicians would likely face ethical issues related to delaying treatment. Researchers are also likely to apply what they learn in designing and conducting clinical trials in children to research in adults, said Walson. “We are going to have to figure out how to do trials in all populations. Studies in children will teach us how to deal with adults who cannot give true consent,” such as patients of who are elderly, mentally ill, or have difficulty communicating.

Gail Molnar Pfeifer is a freelance writer based in Middletown, NJ. She has varied nursing experience working in hospitals and as a faculty member of several nursing schools. C lose your eyes and think about the patients you've cared for over the course of your career. Chances are, you'll remember the ones you had difficulty communicating with at least as vividly as those with whom you developed a good rapport. Our difficulties, though painful to reflect on, often affect us deeply because we remember them so well. The nursing literature presents many examples of successful interventions and information about changing practices, but it doesn't provide us with rationalization for the mistakes or errors in judgment we've made. By studying poor patient outcomes, we can learn valuable information on which to build future suc

Ed Amanda Buckland Available from Child Health information Unit, Royal Alexandra Hospital for Children, Camperdown NSW 2050, Australia (A$25, pp 72) ISBN 0–9599152–7–3 To be an adolescent is to be disadvantaged, caught in a limbo between the child and adult worlds, misunderstood by almost everyone. To be a chronically ill adolescent is a double disadvantage. Adolescents often find it difficult to cope with their feelings and have difficulty communicating their problems. Art is one medium through which adolescents can express their feelings, a medium that they do not find threatening; and the act of creativity can itself be therapeutic. Art Injection provides a detailed and practical account of how one hospital's youth art programme has developed. The department of adolescent …

Although trends in health care point to the increasing involvement of the family in caring for the ill family member, little attention has been directed toward the needs of other healthy family members or the impact that cancer has on their lives. In this article, literature on the impact of cancer on the family will be reviewed and specific problems that family members confront over the course of the patient's illness will be identified. During the initial phase of cancer family members feel excluded from care, have difficulty communicating with staff and experience considerable emotional tension. In the adaptation phase family members have problems with lifestyle changes, meeting the needs of well family members and living with uncertainty. In the terminal phase family members experience role strain, communication problems on the subject of death and feelings of loss. Intervention strategies that have been used to assist family members to cope with the cancer experience are also reviewed. Finally, how past research on this topic has suffered from methodological problems, such as using a single spokesperson for the whole family, relying on subjects' long term recall and using only one data collection period for multiphase questions will be discussed. Directions for additional research are suggested.

Head and Heart are two strangers who live together and often have difficulty communicating with each other. They do agree that one of the highest priorities of prevention ought to be to help them understand each other. It is suggested that there are primary and secondary causes of difficulty in their thinking processes but that institutions which serve children could do a better job of helping overcome such deficiencies. Finally, the idea of a Child Growth Center is proposed as an initial step in the promotion of friendlier conversations between Heart and Head.

Many teachers must confront-and help overcome-the problem of the child who has difficulty communicating in his own language. This perennial challenge is rendered more difficult in the context of the international school-away from the child's native surroundings and culture and yet likely to impose on him a higher standard of academic performance. We describe some of the ways in which this disability manifests itself and offer some suggestions for dealing with it.

The influence of being in a mainstreamed class on nonhandicapped children's abilities to communicate with the handicapped was investigated in this two‐year study. The results indicate that both nonhandicapped and handicapped children have difficulty communicating with handicapped peers. Being in a mainstreamed class has no impact on the nonhandicapped children. No differences were discovered between children studied at the conclusion of the first or second years of the mainstreaming program.

Field experiments investigated the relationship between a political campaigner's dress and appearance and his campaign effectiveness. In one study deviant, “freaky” appearing campaigners attempting to hand out innocuous leaflets in a shopping center had a lower acceptance rate than did more conventionally dressed campaigners. Those shoppers who did accept leaflets from “freaks” were more likely to throw them away unread. The first experiment suggested that deviant-appearing campaigners have difficulty communicating information to potential voters, but it was argued that, in another sense, they convey all too much information. Knowing only that the campaigners for one candidate were deviant and “hippy” in appearance as compared to the conventionally dressed campaigners supporting a second candidate, voters in a second experiment were willing to ascribe more radical opinions to the deviants' candidate. Voters then used their inferences as the basis on which to select a candidate. The rationality of inferring beliefs from appearances is discussed in terms of correspondent inference theory.

Foreign body ingestion is very common in the pediatric population. Children with developmental delay are at an increased risk of foreign body ingestion for several reasons, including poor gross and fine motor control, prolonged oral phase, oral and pharyngeal dysphagia, impaired protective mechanisms, and difficulty communicating. Four patients between the ages of 3 and 18 years old with developmental delay presented with nonspecific gastrointestinal and pulmonary symptoms. Foreign bodies along the upper gastrointestinal tract were identified as the cause of these symptoms, and all four patients improved after endoscopic retrieval. A high index of suspicion should be had even in the absence of findings on routine imaging. Once symptoms are displayed, clinicians should aim to endoscopically or surgically remove the foreign body, depending on the location along the gastrointestinal tract.

Oftentimes/frequently the consumers/clients/patients of community/private mental health agencies/facilities experience/encounter difficulty communicating with the mental health professionals/paraprofessionals. Presented is a glossary that should aid novice clients to better communicate with their helpers/therapists/counselors/ caregivers. On the other hand (at the same time), it might just confuse the clients further. This is clearly a risk with counseling.

For some time, I have been aware of problems with the definitions we use for what is typically called the affective domain. In discussions about the affective domain, psychologists, mathematics educators interested in research on problem solving, and mathematics educators interested in research on attitudes toward mathematics have had difficulty communicating clearly with one another owing to, in part, the lack of common usage of terms. These three groups of people seem to be using the same terms to mean different things and different terms to mean the same thing. The following quote from Herb Simon communicates some of my concerns.

Enormous amounts of clinical data accumulate over months and years in patients with chronic renal failure. The medical supervision often includes over 50 different time-varying clinical and laboratory parameters. It is virtually impossible to keep track of all these data with conventional records even if these are well-organized and used with discipline (Gordon et al 1983). As a result nephrologists have been among the first physicians to use computers in patient care (Stead 1984). There are by now several reports on successful applications of computer technology for the handling of clinical data in dialysis and transplantation units (Pollak et al 1977, Gordon et al 1983, Knapp 1983, Morgan and Will 1983, Pollak et al 1983, Stead et al 1983, Stead 1983, Taylor and Sells 1983, Trimbel et al 1983, Wing et al 1983, Stead 1984). However, it is also known but less well-docunented that many medical computing projects have failed when transferred from a research base to clinical practice (Stead 1983). One reason for such failures may have been a frustrating and unsuccessful dependence on computer experts with whom clinical staff have had difficulty communicating; such problems have been particularly severe in large, “mainframe” projects, which use a central computer (Gordon et al 1983). In recent years many of the difficulties inherent in early computer technology have been eliminated. Software has become more and more user friendly. Furthermore, improved computerized medical records systems (Pollak et al 1983, Stead et al 1983) and clinical database systems for handling of numerical data in dialysis and transplantation units (Gordon et al 1983) have been developed. Although this has solved many of the problems concerning computing per se the introduction of computer technology in the clinic may lead to other problems including difficulties to integrate the new technology within the existing organizational framework. Furthermore, problems may arise if nurses and other users are not well-informed about the purposes and functions of the computer system.

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.

Even before Labour’s victory in 1964, Mr. Wilson had been acutely conscious of the advantages accruing to any government simply from the fact of its being in power. The personal authority of the Prime Minister of the day usually far exceeds that of the Leader of the Opposition. He alone determines the date of the election. Because the Prime Minister and his colleagues control the parliamentary timetable and the timing of official announcements, their power to command public attention is almost unlimited. By contrast, the opposition is seldom in a position to do much more than respond to government initiatives. Whereas the government can perform, the opposition can only promise. It will have difficulty communicating its policies to the public. It is always in danger of appearing negative and carping, particularly since a party out of power is deprived of all access to official information and the advice of the civil service.

To the Editor: —I read with great consternation the editorial by Dr. Arthur Keeney, "To Haptic or Not to Haptic." I should like to comment on this editorial sequentially as it was written. Dr. Keeney initially discusses the complexities of full understanding between nations. This sweeping observation may be appropriate to the world of politics but it certainly does not apply to medicine. If anything, the language of medicine is the one true international means of communication. At any rate, Dr. Ridley had no difficulty communicating to me. I was most impressed by his review in International Ophthalmology Clinics (2:687-716, 1962). This impression was reinforced after hearing his paper at the AMA meeting last June. At that time we implemented the organization of a scleral contact lens unit, fashioned after the Ridley model, at the New York Downstate Medical Center. Working with a technician trained in the Ridley technique, which