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The forms and functions of expressive communication produced by 84 individuals with severe mental retardation were assessed, using a structured communication sampling procedure. Symbolic communication acts were produced by 39 participants, and 27 of these symbolic communicators produced one or more multiword/multisymbol utterances. Of the remaining participants, 38 produced intentional but nonsymbolic communication acts; 7 were not observed to produce any intentional communication. For all participants who produced intentional communication, there were significantly more imperative than declarative communication acts. Significant differences in the frequencies and functions of communication acts produced by these participants were associated with differences in their communication levels (contact gesture, distal gesture, or symbolic), age (child vs. adult), and residential status (community home vs. large facility).

Most psychiatrists enter into a variety of professional relationships with other clinicians in which they prescribe medications or make recommendations about pharmacotherapy. This paper describes a set of guidelines for prescribing psychiatrists involved in consultation, collaboration, and supervision with other clinicians. The guidelines were developed by psychiatrists for the Harvard Risk Management Foundation. The terms consultation, collaboration, and supervision are defined, and the psychiatrist's roles and responsibilities in each type of arrangement are described. The guidelines limit consultation and collaboration to relationships with professionals who are licensed or credentialed. Based on the definitions, the paper describes a structure for working with other clinicians, which begins with a thorough assessment of the context and circumstances of the clinical situation. The guidelines strongly encourage structured communication among clinicians and with the patient and significant others, as well as clarification by clinicians of their respective responsibilities for treatment and follow-up.

The goals of Pilates training can best be met through detailed analysis and structured communication.

Session types model structured communication-based programming. In particular, binary session types for the pi-calculus describe communication between exactly two participants in a distributed scenario. Adding sessions to the pi-calculus means augmenting it with type and term constructs. In a previous paper, we tried to understand to which extent the session constructs are more complex and expressive than the standard pi-calculus constructs. Thus, we presented an encoding of binary session pi-calculus to the standard typed pi-calculus by adopting linear and variant types and the continuation-passing principle. In the present paper, we focus on recursive session types and we present an encoding into recursive linear pi-calculus. This encoding is a conservative extension of the former in that it preserves the results therein obtained. Most importantly, it adopts a new treatment of the duality relation, which in the presence of recursive types has been proven to be quite challenging., Comment: In Proceedings BEAT 2014, arXiv:1408.5564

Vehicle formations with ring structured communication graphs are considered in this paper. A ring communication graph is a type of directed graph. The ring communication graph in its basic form for a platoon of vehicles consists of information flow from each vehicle to its following vehicle and the lead vehicle receives information from the last vehicle. This causes some implementation issues as the communication distance between the first and last vehicle increases with the increase in size of the platoon. Alternative ring structured graphs may be employed to overcome the communication limitations. We provide a quantitative comparison of the basic and alternative ring graph using the communication time as a metric and employing a token ring protocol. A ring structured communication graph has been applied to two dimensional formations of differential drive robots. A platform consisting of four differential drive mobile robots is considered for experimental evaluation of formation control using ring graphs; square and triangle formations are implemented with non-zero initial spacing errors. We will present and discuss results from these experiments. We also discuss the robustness and stability margin of formations employing ring structured information flow graphs with vehicles subject to disturbing inputs.

We aim here to leverage supervised learning to enable large-scale analysis of performance logs, in order to accurately classify code runs and understand the importance of different performance metrics. Previous work has demonstrated structured communication patterns in high performance codes. By categorizing these patterns, we can identify what code was executed. The ability to identify a code by its performance profile is useful for specializing HPC security systems and for identifying common optimizations for similar codes. Supervised machine learning is used on an extensive set of data of real user runs from a high performance computing center. We employ and modify a rule ensemble method to predict what code was run given a performance log. This naive method achieves greater than 93% accuracy. When modified to allow an "other class," accuracy increases to greater than 97%. This modification allows an anomalous run to be flagged as not belonging to a previously seen, or acceptable, code and provides additional latitude in monitoring what is run on supercomputing facilities. We conclude by interpreting the resulting rule model, as it tells us which components of a code are most distinctive and useful for identification.

Conference of 28th Annual ACM Symposium on Applied Computing, SAC 2013 ; Conference Date: 18 March 2013 Through 22 March 2013; Conference Code:96995; International audience; Session types offer a powerful type-theoretic foundation for the analysis of structured communications, as commonly found in service-oriented systems. They are defined upon core programming calculi which offer only limited support for expressing adaptation and evolvability requirements. This is unfortunate, as service-oriented systems are increasingly being deployed upon highly dynamic infrastructures in which such requirements are central concerns. In previous work, we developed a process calculi framework of adaptable processes, in which concurrent processes can be replaced, suspended, or discarded at runtime. In this paper, we propose a session types discipline for a calculus with adaptable processes. Our framework offers an alternative for integrating runtime adaptation mechanisms in the analysis of structured communications. We show that well-typed processes enjoy consistency: communicating behavior is never interrupted by evolvability actions.

Little is known about the socialization of compassion, intimacy, sexuality, and risk management within family contexts. In this study, the authors observed parents and young adolescents (N = 140 dyads) in Grades 6-8 during structured communication tasks focused on AIDS. Communication styles were compared across gender pairings, and their relations with AIDS-related knowledge, worry, and stigmatizing attitudes were examined. Parents were more mutual with daughters and more directive toward sons. Girls were more mutual and expressive than boys, whereas boys were more withdrawn. Father-son dyads were particularly distinctive. Student stigmatizing attitudes were associated with low levels of both positive engagement in students and support from parents during the interaction. Discussion focused on family relations during early adolescence and implications for family involvement in AIDS prevention efforts.

The paper examines a specific aspect of regulation of voice and representation: that covering indirect participation at the workplace through employee committees. The purpose of these committees is to provide representative consultation or structured communication between employee representatives and management (Rogers & Streeck). The paper posits that there is a legal spectrum of regulation of representative consultation. At one end of the spectrum, representative councils, known as works councils, exist in EU countries. The EU Information and Consultation Directive 2002 both supports employees rights to representation through works councils and also promotes new schemes of employee participation.

The offer of “integrative oncology” is one option for clinics to provide safe and evidence-based complementary medicine treatments to cancer patients. As known from merger theories, corporate culture and integration models have a strong influence on the success of such integration. To identify relevant corporate culture aspects that might influence the success in two highly visible integrative oncology clinics, we interviewed physicians, nurses, practitioners, and managers. All interviews (11 in a German breast cancer clinic and 9 in an integrative medicine cancer service in the USA) were audio-recorded, transcribed and analyzed with content analysis. According to the theoretical framework of mergers, each clinic selected a different integration type (“best of both worlds” and “linking”). Nonetheless, each developed a similar corporate culture that has a strong focus on research and safe and evidence-based treatments, and fosters a holistic and patient-centered approach. Structured communication within the team and with other departments had high relevance. Research was highlighted as a way to open doors and to facilitate a more general acceptance within the hospital. Conventional physicians felt unburdened by the provision of integrative medicine service but also saw problems in the time required for scheduled treatments, which often resulted in long waiting lists.

Context Structured communication, especially at the time of handovers is essential to promote patient safety. Mnemonics are memory aids hence can be used as an effective communication tools. SBAR mnemonic is effectively used as a situational briefing tool and is appropriate for use across hierarchical boundaries and emergency situations. But, there are limitations in its applicability in routine handovers, particularly in situations that include transmission of information about complex patients who require broader information and context. IPASS which is an evidence-based, standardised approach to teaching, evaluating, and improving handovers is widely being used in North America and is being introduced in UK. IPASS stands for Illness Severity, Patient Summary, Action List, Situation Awareness and Contingency Planning and Synthesis by Receiver. Problem With the implementation of European Working Time Directive in UK, the number of medical handovers has increased significantly there by increasing the potential for communication gaps which can further compromise patient safety. Most medical schools in UK do not have curriculum based handover teaching and our survey from foundation doctors did reflect this. Also, as people vary in the way they communicate due to cultural, intellectual and social factors, standardisation of the handovers becomes more important to eliminate the risks posed by different communication styles. Assessment of problem and analysis of its causes We aimed to standardise patient handovers by introducing IPASS. Initial assessment of the handovers was done using standardised observation of the handovers by using a pre-tested questionnaire proforma and by collecting responses on survey monkey from doctors of all tiers. These assessments highlighted the need to standardise the handovers. Intervention IPASS was then introduced. Study design The handovers were prospectively monitored for the implementation of IPASS. Strategy for change Small workshops, power point presentations, wall charts and pocket cards were used to teach IPASS. The format of the handover sheet was changed as per IPASS. Staff members received continuous support and guidance during the implementation process. Handovers were monitored and feedback was provided regularly. Measurement of improvement After 6 months, handovers were re-evaluated with the same assessment tools that were used pre- IPASS. Effects of changes With IPASS, the use of standard communication for handovers was increased by 17%, identification of the sickest patients increased by 23% and provision of action plan for all patients was improved by 24%. The contingency plan was made during handovers for most of the sick patients and overall, there was improvement of 10% regarding contingency plans for all the patients. Gaining the situational awareness became sort of a practice in the unit. Out of all respondents, 74% thought that IPASS overall improved the handovers. Lessons learnt IPASS improved the handovers by standardising the communication. It is now being introduced into the Trust induction for all the doctors. An e-learning module is also being prepared for the benefit of final year medical students from Birmingham University. Message for others IPASS is a good communication tool to standardise handovers there by to promote patient safety.

Background Effective communication is recognised as a cornerstone of good medical practice and is key to maintaining patient safety. Poor communication is often highlighted as a factor in medical errors. Despite structured communication tools (e.g. SBAR) and guidelines to encourage collaborative working between middle grade trainees (MGT) and on-call consultants (OCC) in many trusts, there is a paucity of information about this communication pathway and specifically which positive (bridges) and negative (barriers) factors play an influential role. Aims To explore perceptions of MGT about contacting the OCC. To examine factors about MGT, consultants, hospital environment and working structure, which facilitate or obstruct communication. Methods Following a pilot study, an anonymous on-line questionnaire was distributed to all MGT in a large deanery in 2015. Demographic data, experience regarding bridges and barriers to communication and clinical scenarios were collected in addition to free text comments. Results To date 61 MGT have responded (25.2% response rate): 72% female, 80% UK-trained, 61% full-time. 56% reported having time out of training. When presented with 10 scenarios, all respondents would contact the OCC in the case of a child death, most for safeguarding and few in the case of failed practical procedures. When analysing the statements the strongest agreement was with “I feel able to ask for help when I need it”, “I find it easier to phone for advice when I know the consultant is in the hospital” and “effective communication with the OCC is harder if they have missed handover”. 32 respondants (52%) reported experience of consultants being resident out of hours (OOH). Two-thirds agreed this provided increased learning opportunities, improved patient safety and experience. Themes identified as bridges included approachability, clear expectations and attending handover. Not knowing the patients and not being readily accessible acted as barriers to communication. Conclusion This is the first study of its kind. The surveyed MGT were generally confident in their communication with OCC and identified bridges and barriers which may aid more effective communication pathways, improving patient safety and trainee job satisfaction. Consultant presence both at handover and OOH were highlighted as important.

Aim To evaluate the long-term utilisation of strategic communication as a factor of importance when changing work practices among primary care staff. Background In many health care organisations, there is a gap between theory and practice. This gap hinders the provision of optimal evidence-based practice and, in the long term, is unfavourable for patient care. One way of overcoming this barrier is systematically structured communication between the scientific theoretical platform and clinical practice. Methods This longitudinal evaluative study was conducted among a primary care staff cohort. Strategic communication was considered to be the intervention platform and included a network of ambassadors who acted as a component of the implementation. Measurements occurred 7 and 12 years after formation of the cohort. A questionnaire was used to obtain information from participants. In total, 846 employees (70%) agreed to take part in the study. After 12 years, the 352 individuals (60%) who had remained in the organisation were identified and followed up. Descriptive statistics and multivariate analysis were used to analyse the data. Findings Continuous information contributed to significant improvements over time with respect to new ideas and the intention to change work practices. There was a statistically significant synergistic effect on the new way of thinking, that is, willingness to change work practices. During the final two years, the network of ambassadors had created a distinctive image for itself in the sense that primary care staff members were aware of it and its activities. This awareness was associated with a positive change with regard to new ways of thinking. More years of practice was inversely associated with willingness to change work practices. Strategic communication may lead to a scientific platform that promotes high-quality patient care by means of new methods and research findings.

The first cohort of IIPE projects from 2009 are beginning to realize some early successes. We bring you this article in the spirit of sharing what works and what doesn't. The lesson about the importance of context is critical in adopting and adapting innovations to your own learning environment. —Carol Carraccio, MD, MA Section Editor New duty hours standards have increased the frequency of transitions in care or handoffs for resident physicians. Because miscommunications are a leading cause of adverse events in hospitals, optimizing the handoff process is essential for patient safety. The I-PASS Study aims to determine the effectiveness of implementing a “resident handoff bundle” to standardize inpatient transitions in care and decrease medical errors in 10 pediatric institutions.1 The resident handoff bundle includes 3 major elements: team training by using focused TeamSTEPPS communication strategies,2 implementation of a standardized template for the written or printed computerized handoff document, and introduction of several evidence-based verbal handoff processes, which are referred to by using a novel verbal mnemonic. This multisite collaborative education and research project was launched with the support of the Initiative for Innovation in Pediatric Education (IIPE) and the Pediatric Research in Inpatient Settings (PRIS) network. The title I-PASS is an acronym that not only denotes the title and purpose of our research study—IIPE-PRIS Accelerating Safe Sign-outs—but also serves as the verbal mnemonic for the standardized handoff itself. Individual elements of the I-PASS mnemonic will be defined in this article. Mnemonics are memory aids. Effective mnemonics are catchy, symbolic, parsimonious, utilitarian, and may conjure up a visual image linked to a process or subject. In this report, we emphasize the importance of structured communication strategies to enhance patient safety, review literature pertinent to the handoff process, including the use of verbal mnemonics, and describe the creation of … Address correspondence to Amy J. Starmer, MD, MPH, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Mail code: CDRCP, 707 SW Gaines St, Portland, OR 97239-2998. E-mail: starmer{at}ohsu.edu

PurposeThe purpose of this paper is to investigate the effectiveness of supply chain integration in different contexts. More specifically, it aims to show that supply chain integration is only effective in buyer‐supplier relationships characterised by high supply complexity.Design/methodology/approachA survey‐based research design is developed to measure different dimensions or aspects of supply chain integration and supply complexity. Data were collected among manufacturers in The Netherlands and Spain.FindingsThis research shows that supply chain integration increases performance if supply complexity is high, while a very limited or no influence of supply chain integration can be detected in case of low supply complexity. The results also show that in high supply complexity environments the use of structured communication means to achieve supply chain integration has a negative effect on cost performance.Research limitations/implicationsThe limited sample size prohibits estimating and testing of more comprehensive models of the relationship between supply chain integration and performance. Specifically, the authors were not able to further investigate how different supply chain integration dimensions are inter‐related and mutually reinforce one another to improve performance.Practical implicationsThe main managerial lesson is that, in contrast to what has been written in many books and other popular publications, high levels of supply chain integration are only necessary in environments characterised by high supply complexity.Originality/valueThis study helps to better understand context in supply chain management research. Specifically, it investigates the moderating effect of supply complexity on the integration‐performance relationship, a topic suggested by Bozarth et al. as a line for further research.

Under pressure from both the ever increasing level of market competition and the global financial crisis, clients in consumer electronics (CE) industry are keen to understand how to choose the most appropriate procurement method and hence to improve their competitiveness. Four rounds of Delphi questionnaire survey were conducted with 12 experts in order to identify the most appropriate procurement method in the Hong Kong CE industry. Five key selection criteria in the CE industry are highlighted, including product quality, capability, price competition, flexibility and speed. This study also revealed that product quality was found to be the most important criteria for the 'First type used commercially' and 'Major functional improvements' projects. As for 'Minor functional improvements' projects, price competition was the most crucial factor to be considered during the PP selection. These research findings provide owners with useful insights to select the procurement strategies. Refereed/Peer-reviewed

Psychotherapy is an interactive process that addresses maladaptive behaviors and mental states through the use of structured communication. Although psychotherapeutic systems and techniques have evolved independently of neurobiological science, there has been a tacit understanding, at least since the days of Freud, that psychotherapy produces its effects by acting on the brain. Modern technology has underscored the importance of this concept, as functional imaging reveals the neural activation patterns associated with behavioral dysfunction, and how these patterns can be modified through psychotherapy.

As colleges and schools of pharmacy develop core courses related to patient safety, course-level outcomes will need to include both knowledge and performance measures. Three key performance outcomes for patient safety coursework, measured at the course level, are the ability to perform root cause analyses and healthcare failure mode effects analyses, and the ability to generate effective safety communications using structured formats such as the Situation-Background-Assessment-Recommendation (SBAR) situational briefing model. Each of these skills is widely used in patient safety work and competence in their use is essential for a pharmacist's ability to contribute as a member of a patient safety team.

Part 4: eParticipation Initiatives and Country Studies; International audience; iLeger is a Web Application that seeks to concentrate, in a single place, the stakeholders in a political election allowing multi-directional and structured communication between them. Using a citizen and candidate centered approach; iLeger supports collaborative interaction with the purpose of fostering communication, deliberation and participation. This paper aims at presenting the main functionalities of this Web application, as well as the results from a case study about the Portuguese Presidential Elections held in 2011.

For the current study, clinical observations of communication between patients, families, and clinicians during chronic, serious, or terminal illness in a cancer care trajectory were examined for patterns and trends. Five communication characteristics were concluded, which informed a typology of illness journeys experienced by patients with cancer and their families. The isolated journey characterizes an illness path in which communication about terminal prognosis and end-of-life care options are not present; communication is restricted by a curative-only approach to diagnosis as well as the structure of medical care. The rescued journey signifies a transition between curative care (hospital narrative) to noncurative care (hospice narrative), challenging patients and their families with an awareness of dying. The rescued journey allows communication about prognosis and care options, establishes productive experiences through open awareness, and affords patients and families opportunities to experience end-of-life care preferences. Finally, palliative care prior to hospice provides patients and families with an illness journey more readily characterized by open awareness and community, which facilitates a comforted journey. Nurses play a pivotal role in communicating about disease progression and plans of care. The typology presented can inform a structured communication curriculum for nurses and assist in the implementation of early palliative care.

This is the first part of a two-part special issue on Behavioural Types, which has its origin in a workshop we organized in April 2011, in Lisbon. The aim of the workshop was to bring together the active and expanding community of researchers using type-theoretic approaches to describe and analyse behavioural aspects of software. A particular concern of this field is the identification and description of structured communication in concurrent and distributed systems, but behavioural typing also addresses issues of liveness, fairness, deadlock-freedom, security, observable equivalence and typestate.

Problem statement: Most of Medicare data exchanges are textual, poorly structured and often not accessible by clinical professionals. Otherwise, the variety of medical applications and medical standards makes difficult sharing and communicating Medicare data in a highly heterogeneous environment. Approach: XML and related standards (XML schema, XSL) provided an infrastructure that might change the situation. Our aim in this study was to define an exchange model providing a common structure of shared Medicare data to allow a better, easier and structured communication within and between hospital information systems. Results: We realized an XML-based model that we detailed the content and the structure. Thus, seen the confidential character of Medicare data, we described an approach to secure the data transfer. We were situated regarding existing models and standards such as HL7, DICOM and the PMSI and we took into account critics made for them. Conclusion/Recommendations: The model we proposed provide a practical solution allowing a secure and structured Medicare data exchange and will serve as a summary version of the common Computerized patient record.

Many individuals with Huntington's disease experience reduced functioning in cognition, language and communication. Talking Mats is a visually based low technological augmentative communication framework that supports communication in people with different cognitive and communicative disabilities.To evaluate Talking Mats as a communication tool for people in the later stages of Huntington's disease.Five individuals with Huntington's disease participated in the study. Three conditions were compared: unstructured communication, verbally structured communication, and communication using Talking Mats. The conversations were videotaped and analysed quantitatively and qualitatively.Talking Mats increased communicative effectiveness for all participants. Verbally structured conversation resulted in higher effectiveness than the unstructured counterpart and effectiveness differed depending on the type of conversational topic.Talking Mats could be a valuable resource for people with Huntington's disease and their conversation partners. It could be used for social purposes, for understanding a person's opinions and for making decisions. Additional research is necessary in order to generalize the results to the population of individuals with Huntington's disease and to understand better the mechanisms behind the positive effects observed.

A variation on the conventional Delphi was used to assemble an informational summary of expert opinion regarding the risks involved with the application of sewage sludge to farmland. The aim was to reduce uncertainties surrounding the associated health and environmental risks so agreement among citizens, farmers, and regulators could be reached. An expert panel was assembled for one day to take part in a structured communication process modeled after the Delphi. A Two-part questionaire using Likert scaling and open questions was iterated among rotating subgroups to build consensus and define disagreement. Plenary discussions were held between iterations to foster peer review. There was consensus about the risks of heavy metals, pathogens, and nutrients; but clear disagreement about the risk of organic toxins. Existing state regulations were deemed inadequate only for lead and some organic toxins. Expert quantitative ratings were found to differ radically for two hypothetical contexts: academic and public.

Providers of emergency medical services (EMS) must communicate vital information during critical phases of operations. Errors in communications, for example, the failure to hear a directive, will compromise safe and effective patient care. This article presents a case that resulted in litigation because of communication failures during the interfacility transfer of a trauma patient who subsequently died in the ambulance. The communication failure involved members of a ground ambulance crew, their dispatcher, and a supervisor. The failure of the emergency medical technician (EMT) who was driving to hear from the treating EMT and her dispatcher vital information pertaining to changes in their destination and of plans to intercept another ambulance, or alternatively, the driver's ignoring this information, led to a delay in care and may have contributed to the patient's death. Factors contributing to the cause of this communication failure may have been related to the nature of the EMS setting: the physical separation between crew members (the driver, and the care provider in the back of the ambulance); the noise of the ground ambulance transport environment, most notably, the siren; and the stress of treating a patient in critical condition. The case highlights the importance of using structured forms of communication, specifically the read-back tool and the critical assertion strategy, to limit failures in communication during EMS operations and in operations in other high-risk medical settings.

Communications failures have been identified as a significant cause of adverse outcomes in obstetrics. Following the lead of some high reliability organizations, healthcare has introduced structured communication such as SBAR as a way to make sure communications between professionals are direct, complete and effective. The authors have observed, however, that structured communication in healthcare often requires a cultural change in the way that professionals relate to each other; PURE conversations (Purposeful/prepared/productive, Unambiguous, Respectful and Effective) can facilitate this cultural shift. PURE conversations stress the mental processes necessary to conduct and monitor structured communications in real time by taking into account the context and relationships that exist among professionals. This article describes the elements of a multidisciplinary workshop based on clinical scenarios incorporating the PURE concept to improve the effectiveness and adoption of structured communication by the perinatal team.

In the field of Computer Supported Collaborative Work several studies have explored the possibility to improve the collaboration in software development teams by integrating into IDEs tools to support the coordination and sharing of common resources. Similar studies have emphasized the need of integrating into IDEs collaboration and communication functionalities to improve the building of a shared knowledge. In this paper we describe how we enhanced Rational Team Concert (an IBM CDVE built on Eclipse and Jazz) with structured communication tools by integrating a collaborative platform named CoFFEE, that was developed for structured argumentation and discussion in an educational setting.

nor has it been introduced into a mental health care environment. We report here on a case study of the implementation of Team- STEPPS at an inpatient mental health facility in South Australia. We sought to determine whether the training intervention changed staff attitudes and behaviours and had an impact on patient care. Our aim was to evaluate the effectiveness of the intervention with measures developed to address three outcome constructs: observed team behav- iours; attitudes and opinions; and clinical performance and outcomes. 5 ABSTRACT Objective: To evaluate the effectiveness of the implementation of a TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) program at an Australian mental health facility. Design, setting and participants: TeamSTEPPS is an evidence-based teamwork training system developed in the United States. Five health care sites in South Australia implemented TeamSTEPPS using a train-the-trainer model over an 8-month intervention period commencing January 2008 and concluding September 2008. A team of senior clinical staff was formed at each site to drive the improvement process. Independent researchers used direct observation and questionnaire surveys to evaluate the effectiveness of the implementation in three outcome areas: observed team behaviours; staff attitudes and opinions; and clinical performance and outcome. The results reported here focus on one site, an inpatient mental health facility. Main outcome measures: Team knowledge, skills and attitudes; patient safety culture; incident reporting rates; seclusion rates; observation for the frequency of use of TeamSTEPPS tools. Results: Outcomes included restructuring of multidisciplinary meetings and the introduction of structured communication tools. The evaluation of patient safety culture and of staff knowledge, skills and attitudes (KSA) to teamwork and communication indicated a significant improvement in two dimensions of patient safety culture (frequency of event reporting, and organisational learning) and a 6.8% increase in the total KSA score. Clinical outcomes included reduced rates of seclusion. Conclusion: TeamSTEPPS implementation had a substantial impact on patient safety culture, teamwork and communication at an Australian mental health facility. It encouraged a culture of learning from patient safety incidents and making

Following a government mandate to use the assessment portion of the Resident Assessment Instrument, S&WCHSC began to integrate the RAI into the care of its Aging Program residents. S&WCHSC have used this as an opportunity to provide a structure for assessment and care planning within the existing philosophy of Patient Focused Care. Implementation of the RAI required the development and implementation of a Communication Plan. An adaptation of a framework, “Effective Strategic Planning for Communications” provided guidelines for assessment of key stakeholders' communication needs.

Introduction The Structured Communication Adolescent Guide (SCAG) has been developed as a teaching, learning, and assessment tool for medical students to obtain feedback from adolescents, both in standardized patient (SP) encounters and real patient examinations. The goal is to improve feedback to learners on their adolescent interviewing Methods The SCAG can be used in a teaching session, for practice by medical students, and in assessment. The time to complete an adolescent interview, depending on the learner and how experienced they are, can take approximately 30-40 minutes (without examination). The written feedback using the SCAG takes the adolescents 5-7 minutes to complete. Verbal feedback given by a SP may also take an additional 5 minutes. Results The SCAG has been used at Dalhousie University for over 7 years, University of Calgary for 3 years, and Queen's University and the University of British Columbia began adopting the SCAG in 2007-2008. The SCAG has been validated and is reliable to be used with untrained adolescents. Therefore, medical schools that are unable to offer an SP program can use the SCAG with a lecture or tutorial after which the students can use the SCAG independently with patients. Discussion The SCAG is considered generalizable as it has been successfully adopted by a number of schools for undergraduate teaching both nationally and internationally with minimal modifications. The SCAG has been shown to be a reliable and valid tool when used by trained adolescent SPs to assess medical student and resident interviewing abilities. The SCAG has also been shown to be reliable with untrained adolescents within a school-based pilot study. More research is needed regarding how the SCAG could be used in family practice, perhaps with trained SPs who are coming in undercover, and/or with the general adolescent patient population that the family practitioners see.

Mary Salisbury is President, The Cedar Institute, Inc., N. Kingstown, RI. Susan M. Hohenhaus is President, Hohenhaus & Associates, Inc, Wellsboro, Pa. For correspondence, write: Susan M. Hohenhaus, MA, RN, FAEN, 6 Willard Terrace, Wellsboro, PA 16901; E-mail: shohenha@ptd.net. J Emerg Nurs 2008;34:46-8. 0099-1767/$34.00 Copyright n 2008 by the Emergency Nurses Association. doi: 10.1016/j.jen.2007.11.008

Background and Purpose: Professionalism refers to the professional character and manners of an individual, which encompasses different attributes and a lifestyle reflecting responsibility and commitment. Effective communication between physicians and nurses enhances the quality of patient care, reduces medical errors. Over the years, there have been repeated admonitions to improve nurse-physician communication, which is influenced by several factors. This study aimed to evaluate the effect of professionalism on the professional communication between nurses and physicians. Methods: This qualitative study was conducted using the phenomenological approach developed by Husserl. Semi-structured interviews (n=15) were performed on eight nurses and seven physicians engaged in the hospitals of different cities in Iran in 2014. Participants were asked to describe their experiences regarding the professional communication between nurses and physicians. All interviews were recorded and transcribed, and data analysis was performed using Colaizzi's method. Results: Four main themes emerged from data analysis, including professionalism, communication patterns, confounders, and communication usefulness, the most important of which was professionalism. In this study, we focused on professionalism and its subthemes, including autonomy, dignity and respect, responsibility and preparedness. Conclusion: According to the results of this study, professionalism plays a key role in establishing efficient professional communications. Therefore, it is recommended that structured communication interventions be implemented in clinical environments in order to improve the quality of nurse-physician communication.

In a recent quality assurance project we learned that nearly half of the handovers we examined were characterized as unsatisfactory by our residents, who provided examples in which their anxiety had been piqued and patient care had been affected. These reports substantiated a growing body of literature on the relationship between the quality of handover and the quality of patient care, so we sought to improve the quality and consistency of the in-hosptial handovers undertaken by our internal medicine residents. Senior residents attended morning report for three consecutive month long blocks and evaluated the quality of the handovers using an observational protocol comprised of 16 aspects of effective handover.During the first block, the resident observed a median of eight of the 16 practices occurring across the 46 handovers, and a large amount of variability. At the beginning of the subsequent block we presented a concise introduction to a structured handover procedure (SBARR). The median quality of the subsequent 33 handovers rose to 11, and the variability decreased considerably. In the next block we refined the SBARR orientation to focus on the errors observed in the previous blocks, and the improvement in the quality and variability was sustained. The minor change, which requires few resources to sustain, had a favourable impact on the quality of our residents' in-hospital handovers.

The effects of a pragmatic teaching strategy on 4 nonspeaking children's abilities to initiate requests for information (i.e., who, what, and where) using manual communication boards were investigated. A teaching strategy based on milieu teaching and time-delay procedures was developed and embedded in naturally structured communication tasks to evoke information requests. Results indicated that information requests using the communication board occurred only after the pragmatic teaching strategy was applied sequentially to the three request types during the experimental condition. This effect was demonstrated repeatedly across the 4 subjects. Although generalization across request types was not demonstrated, substantial generalization was found across partners and environments. A social validation measure confirmed the treatment effectiveness. Independent raters perceived significant differences when viewing before- and after-training videotapes on 7 of 10 communication variables for all subjects.

International audience; The development of reconfigurable devices that could make themselves domain-specialized at run time is becoming more and more common. Future reconfigurable architecture will have these computing devices as basic blocks, and reconfigurable architecture could make assemblies of these devices, on the fly, to execute concurrent applications. The migration from completely generic lookup tables and highly connected routing fabrics to self adaptive specialized coarse-grain reconfigurable devices and very structured communication resources presents designers with the problem of how to best customize the system based upon anticipated usage. Then there is a need of not only exploiting parallelism from applications at micro-thread level, dynamically, but system also starves for a dynamic and self adaptive middleware to schedule these micro-threads on thousands of such computing devices. This paper focuses at the problem of dynamic allocation and scheduling of resources to numbers of applications on such architecture.

Identifiers of illness, including catastrophic change, are based on a set of assumptions that are not always true or accurate for older adults. Atypical findings in combination with the more subtle or different presentation of illness can result in missed opportunities for early treatment and prevention of more dire consequences. Assessment instruments described in this article can guide the investigation and communication of a resident's change in status: SPICES (Sleep; Problems with Eating and Feeding; Incontinence; Confusion; Evidence of Falls; Skin Breakdown), FANCAPES (Fluid; Aeration; Nutrition; Cognition/Communication; Activity/Abilities; Pain; Elimination; Skin/Socialization), DELIRIUM (Drug use: Electrolyte imbalance; Lack of scheduled meds; Infection; Reduced sensory input; Intracranial problems; Urinary problems; Myocardial problems), PQRST (Provokes/Palliates; Quality/Quantity; Region/Radiates; Severity; Timing) and COLDSPA (Character; Onset; Location; Duration; Severity; Pattern; Associated Symptoms), (for pain assessment). "Should I call?" scenarios are described using case studies. A systematic approach to assessment, recognition of change in functional status, protocols to guide calling for emergency assistance, and structured communication are essential elements of early recognition of illness, can reduce caregiver anxiety, and improve the health care outcomes for the resident. Imagine you or one of your staff standing in the dining room of your residence and looking at the residents for whose health and well-being you are responsible. Could you spot someone who was not doing well? Who might be ailing? If you saw 2 residents who looked ill, whom would you assess first? How would you decide? Identification of illness, including catastrophic change, is based on a set of assumptions that are not always true for older adults and can result in a set of findings that does not fit with our conventional understanding and knowledge of illness presentation. All too often, these atypical findings in combination with the more subtle presentation of illness in older adults results in missed opportunities for early treatment. A systematic approach to assessment, recognition of change, protocols to guide calling for emergency assistance, and communication with other health care providers are essential elements of early recognition of illness that can decrease health care provider anxiety and improve outcomes. This article describes 2 evidence-based assessment instruments: the SPICES tool, which should be used routinely as a first-line method for recognizing change and preventing deepening complications or acute illness, and the FANCAPES tool, which evaluates change in condition. In addition, several acronyms that can guide symptom assessment are provided. Immediately life-threatening conditions and 3 "don't miss" signs of emergencies are discussed, as are nursing interventions for the geriatric emergency. "Should I call?" scenarios are presented in a table that includes common signs and symptoms and recommended nursing actions of who to call. Two case studies illustrate the assessment instruments and analysis of data. Basic information that should be included in a transfer document is described. The article includes a communication model known as SBAR (Situation, Background, Assessment, Recommendation) that can be implemented and used by all staff of the assisted living residence.

International audience; The development of reconfigurable devices that could make themselves domain-specialized at run time is becoming more and more common. Future reconfigurable architecture will have these computing devices as basic blocks, and reconfigurable architecture could make assemblies of these devices, on the fly, to execute concurrent applications. The migration from completely generic lookup tables and highly connected routing fabrics to self adaptive specialized coarse-grain reconfigurable devices and very structured communication resources presents designers with the problem of how to best customize the system based upon anticipated usage. Then there is a need of not only exploiting parallelism from applications at micro-thread level, dynamically, but system also starves for a dynamic and self adaptive middleware to schedule these micro-threads on thousands of such computing devices. This paper focuses at the problem of dynamic allocation and scheduling of resources to numbers of applications on such architecture.

The overall aim of this thesis was to explore aspects of the subjective views and experiences of doctors as prescribers, focusing on responsibility for and factors of importance in achieving appropriate prescribing. To provide insights into the prescriber’s perspective the study designs were qualitative. In the first studies secondary care doctors’ perceptions of appropriate prescribing and influences in prescribing were investigated in interviews. The doctors perceived that appropriate prescribing needed continuous revision. From the perspective of the prescribers the definition of prescribing could be rephrased as: “the outcome of the recurring processes of decision making that maximises net individual health gains within society’s available resources”. Among the influences in prescribing were guidelines, colleagues and therapeutic traditions. In the subsequent studies the experiences of exchanging information regarding a patient’s drugs in an electronic patient medical record (e-PMR) shared between primary and secondary care and views of responsibility was explored, using focus groups with both primary and secondary care doctors. Considering the gap between health care levels, doctors’ views of responsibility in prescribing and exchange of information are of concern. The doctors expressed how they assume information to be in the e-PMR and active information transfer has decreased. On the other hand, they experienced an information overload in the e-PMR system. There is a need for improved and structured communication between health-care givers. Taking responsibility to review all the patient’s medications was perceived as important, but described as still not done. Lack of responsibility taken was often due to acts of omission, i.e. that doctors did not make needed changes to the list of medications due to different barriers. The barriers rested both with individual doctors and the system, but to ensure solutions that are realisable in practise, perspectives of the doctors need to be taken into consideration when overcoming those barriers.

Structured meaning-signal mappings, i.e., mappings that preserve neighborhood relationships by associating similar signals with similar meanings, are advantageous in an environment where signals are corrupted by noise and sub-optimal meaning inferences are rewarded as well. The evolution of these mappings, however, cannot be explained within a traditional language evolutionary game scenario in which individuals meet randomly because the evolutionary dynamics is trapped in local maxima that do not reflect the structure of the meaning and signal spaces. Here we use a simple game theoretical model to show analytically that when individuals adopting the same communication code meet more frequently than individuals using different codes—a result of the spatial organization of the population—then advantageous linguistic innovations can spread and take over the population. In addition, we report results of simulations in which an individual can communicate only with its K nearest neighbors and show that the probability that the lineage of a mutant that uses a more efficient communication code becomes fixed decreases exponentially with increasing K. These findings support the mother tongue hypothesis that human language evolved as a communication system used among kin, especially between mothers and offspring.

This paper relates two different paradigms of descriptions of communication behaviour, one focussing on global message flows and another on end-point behaviours, using formal calculi based on session types. The global calculus, which originates from a web service description language (W3C WS-CDL), describes an interaction scenario from a vantage viewpoint; the end-point calculus, an applied typed π-calculus, precisely identifies a local behaviour of each participant. We explore a theory of end-point projection, by which we can map a global description to its end-point counterpart preserving types and dynamics. Three principles of well-structured description and the type structures play a fundamental role in the theory.

Background In Australia, government-subsidised access to high-cost medicines is "targeted" to particular sub-sets of patients under the Pharmaceutical Benefits Scheme to achieve cost-effective use. In order to determine how this access system could be improved, the opinions of key stakeholders on access to biological agents for rheumatoid arthritis were explored. Methods Thirty-six semi-structured interviews were conducted with persons from relevant stakeholder groups. These were transcribed verbatim, and analysed thematically. Results Controlled access to expensive medicines was considered to be equitable and practical; however, there was disagreement as to the method of defining the target patient populations. Other concerns included timeliness of access, excessive bureaucracy, and the need for additional resources to facilitate the scheme. Collaboration between stakeholders was deemed important because it allows more equitable distribution of limited resources. The majority considered that stakeholder consultation should have been broader. Most wanted increased transparency of the decision-making process, ongoing and timely review of access criteria, and an increased provision of information for patients. More structured communication between stakeholders was proposed. Conclusion The Pharmaceutical Benefit Scheme is adapting to meet the changing needs of patients. Provision of subsidised access to high-cost medicines in a manner that is affordable for individuals and society, and that is equitable and efficiently managed is challenging. The views of stakeholders on targeted access to anti-rheumatic biological medicines in Australia acknowledged this challenge and provided a number of suggestions for modifications. These could serve as a basis to inform the debate on how to change the processes and policies so as to improve the scheme.

The Perinatal Patient Safety Project (PPSP) was created as a systemic strategy for creating high-reliability perinatal units by preventing identified causes of perinatal events in the clinical setting. With developmental funding from a Garfield grant, implementation of the PPSP has been completed at four pilot sites in the Kaiser Permanente Northern California (KPNC) Region. Its success has resulted in implementation at all perinatal units in the KPNC Region as well as being promoted by National Risk Management for nationwide implementation. PPSP emphasizes structured communication, multidisciplinary rounds, a definition of fetal well-being, and practicing for emergencies. Steps taken to create high reliability perinatal care include improved communication, patient safety focus, and satisfaction among perinatal patients, providers, and staff.

Eliciting and re-using knowledge within an organization requires a very structured communication process among its employees in order to avoid misunderstanding and confusion. The transfer of knowledge among actors can only be successful if a common interpretative focus and its context are set up. So far, information about the real context that surrounded team's past activities can help their members to better understand situations at hand. In this paper, we argue that a combination of group storytelling technique and a groupware tool can help the elicitation and use of the context shared by a group. Moreover, our main goal is to discuss how groupware can help to structure and formalize the contextual information behind the scenes of a story told by a group, making it easier to understand, interpret and reuse the knowledge intrinsic to it.

In this paper, we present our approach to the problem of communicating everyday experiences. This is a challenging problem, since media from everyday events are unstructured, and often poorly annotated. We first attempt to communicate everyday experiences using a dramatic framework, by categorizing media and by introducing causal relations. Based on our experience of the dramatic framework for the everyday media, we introduce an event based framework as well as a viewpoint centric visualization that allows the viewer to have agency, in a highly interactive, non-linear manner. Our approach focuses on structured interaction for consumption of everyday experiences, in contrast to non-interactive consumption of structured communication. Our results indicate that dramatic structures do not work well with everyday media, and novel interactions / visualizations are needed. Experimental results indicate that the viewpoint centric visualization works well. We are in the process of creating a large event database of everyday events, and we are creating the necessary recording and annotation tools.

We investigated whether a relatively low-cost, PC-based teleconsultation system could be used for inter-institutional communication about children with complex movement and postural disorders. Four paediatric physiotherapists in three different institutions participated. Both email and videoconferencing were tested. Videoconferencing was unsuccessful, as the low-bandwidth analogue lines, used by the majority of the therapists, made the quality of the realtime video-images very poor. However, email with attached video-recordings was successful and the therapists used the system to consult each other about 20 cases. The therapists regarded the system as effective in clinical practice. However, some improvements would be desirable, such as making the system quicker to use and reducing the number of technical errors. Nonetheless, structured communication between physicians about complex postural and movement disorders appears to be promising both for patient referral and for decisions concerning treatment.

The work addressed in this paper address the problem of the structuration of textual communication through Chats or Forums as a means to (1) support students involved in collective activities and (2) support the tutor in his perception of these activities. OSCAR is a framework based on the speech-acts theory. It allows defining grammars composed of a set of speech-acts and precedence relations between these speech-acts and to perform synchronous and asynchronous discussions structured by these grammars. OSCAR can be used both as an operational tool within a distance-learning platform and as a research tool as it proposes means to study a posteriori the discussions (e.g., analysis of the different students' attitudes in the discussion).; Face au double défi d'engager au mieux les apprenants dans des activités collectives de discussion et au suivi de ces mêmes activités par l'enseignant, il nous semble pertinent d'étudier la problématique de la structuration de la communication textuelle dans des outils de types chat et forums. C'est pourquoi nous proposons dans cet article une structuration des discussions sur la base de la théorie des actes de langage qui a servi de fondement à la conception d'un environnement nommé Oscar. Cet outil permet de définir des grammaires composées d'actes de langage et de relations entre ces actes, et de tenir des discussions (synchrones et asynchrones) structurées par ces grammaires. Oscar est donc à la fois un outil de recherche (pour étudier la pertinence de la structuration des discussions, l'effet des grammaires sur les discussion et les moyens de fournir des informations pertinentes à l'enseignant) et un outil permettant de mettre en place des discussions dans les environnements de formation en ligne.

The work addressed in this paper address the problem of the structuration of textual communication through Chats or Forums as a means to (1) support students involved in collective activities and (2) support the tutor in his perception of these activities. OSCAR is a framework based on the speech-acts theory. It allows defining grammars composed of a set of speech-acts and precedence relations between these speech-acts and to perform synchronous and asynchronous discussions structured by these grammars. OSCAR can be used both as an operational tool within a distance-learning platform and as a research tool as it proposes means to study a posteriori the discussions (e.g., analysis of the different students' attitudes in the discussion)., Face au double défi d'engager au mieux les apprenants dans des activités collectives de discussion et au suivi de ces mêmes activités par l'enseignant, il nous semble pertinent d'étudier la problématique de la structuration de la communication textuelle dans des outils de types chat et forums. C'est pourquoi nous proposons dans cet article une structuration des discussions sur la base de la théorie des actes de langage qui a servi de fondement à la conception d'un environnement nommé Oscar. Cet outil permet de définir des grammaires composées d'actes de langage et de relations entre ces actes, et de tenir des discussions (synchrones et asynchrones) structurées par ces grammaires. Oscar est donc à la fois un outil de recherche (pour étudier la pertinence de la structuration des discussions, l'effet des grammaires sur les discussion et les moyens de fournir des informations pertinentes à l'enseignant) et un outil permettant de mettre en place des discussions dans les environnements de formation en ligne.

Background. Majority of in-hospital deaths occur in the emergency department (ED) and criticalcare settings. Death often follows a failed resuscitation after a sudden-critical-event/injury or after a terminal-crisis event in aprogressive life-limiting illness-trajectory. Family-members are often unprepared and face high emotional support needs. In procedural/resuscitation-based specialties (like emergency medicine and surgery), traditional focus of trainee-education is on acquiring the technical skills associated with advanced cardiac/trauma life-support (ACLS/ATLS). Death is perceived as a professional failure, debriefing is not the norm and self-reflection after these emotionally charged resuscitations rarely addressed. To supplement the resuscitation training we designed a structured communication and self-reflection module that adds-on skills to effectively communicate with family members of critically ill/injured patients who undergo resuscitations.