Sociality of facial expressions in immersive virtual environments: a facial EMG study

Immersive virtual environment technology is increasingly used by psychologists as a tool for researching social influence in realistic, yet experimentally controllable, settings. The present study demonstrates the validity and reliability of facial electromyography as a marker of affect in immersive virtual environments and further shows that the mere presence of virtual humans is enough to elicit sociality effects on facial expressiveness. Participants viewed pleasant and unpleasant images in a virtual room either alone or with two virtual humans present. The patterns of smiling and frowning activity elicited by positive and negative stimuli in the virtual environment were the same as those found in laboratory settings. Moreover, when viewing positive stimuli, smiling activity was greater when two agents were present than in the alone condition. The results provide new psychophysiological evidence for the potency of social agents in immersive virtual environments.     

Applying Weick's model of organizing to health care and health promotion: Highlighting the central role of health communication

Objective

Communication is a crucial process in the effective delivery of health care services and the promotion of public health. However, there are often tremendous complexities in using communication effectively to provide the best health care, direct the adoption of health promoting behaviors, and implement evidence-based public health policies and practices. This article describes Weick's model of organizing as a powerful theory of social organizing that can help increase understanding of the communication demands of health care and health promotion. The article identifies relevant applications from the model for health communication research and practice.

Conclusion

Weick's model of organizing is a relevant and heuristic theoretical perspective for guiding health communication research and practice. There are many potential applications of this model illustrating the complexities of effective communication in health care and health promotion.

Practice implications

Weick's model of organizing can be used as a template for guiding both research and practice in health care and health promotion. The model illustrates the important roles that communication performs in enabling health care consumers and providers to make sense of the complexities of modern health care and health promotion, select the best strategies for responding effectively to complex health care and health promotion situations, and retain relevant information (develop organizational intelligence) for guiding future responses to complex health care and health promotion challenges.     

Understanding health care communication preferences of veteran primary care users

Objective

To assess veterans’ health communication preferences (in-person, telephone, or electronic) for primary care needs and the impact of computer use on preferences.

Methods

Structured patient interviews (n = 448). Bivariate analyses examined preferences for primary care by ‘infrequent’ vs. ‘regular’ computer users.

Results

Only 54% were regular computer users, nearly all of whom had ever used the internet. ‘Telephone’ was preferred for 6 of 10 reasons (general medical questions, medication questions and refills, preventive care reminders, scheduling, and test results); although telephone was preferred by markedly fewer regular computer users. ‘In-person’ was preferred for new/ongoing conditions/symptoms, treatment instructions, and next care steps; these preferences were unaffected by computer use frequency. Among regular computer users, 1/3 preferred ‘electronic’ for preventive reminders (37%), test results (34%), and refills (32%).

Conclusion

For most primary care needs, telephone communication was preferred, although by a greater proportion of infrequent vs. regular computer users. In-person communication was preferred for reasons that may require an exam or visual instructions. About 1/3 of regular computer users prefer electronic communication for routine needs, e.g., preventive reminders, test results, and refills.

Practice implications

These findings can be used to plan patient-centered care that is aligned with veterans’ preferred health communication methods.     

Darkness-enhanced startle responses in ecologically valid environments: a virtual tunnel driving experiment

Using the startle reflex methodology, researchers have shown that darkness, a phylogenetically relevant aversive context for humans, elicits fear responses. The present study replicated these findings in an ecologically valid situation, a virtual tunnel drive. Furthermore, the study focused on the question whether the darkness-enhanced startle response is modulated by an additional task involvement of the participants. Startle responses were assessed during virtual tunnel drives with darker and brighter sections. Participants once actively drove the virtual car and once passively sat in the car as a passenger. We found more negative feelings during darker parts of the virtual tunnel and during active driving. However, facilitated startle reactions in darkness were restricted to passive drives. Furthermore, correlation analyses revealed that darkness-enhanced startle modulation was more pronounced in participants with lower state anxiety. These results extend earlier findings in an experimental paradigm using ecologically valid virtual environments. Further research should use virtual reality paradigms to address context-dependent research questions.     

Cognitive processing of traffic signs in immersive virtual reality environment: An ERP study

The virtual reality environment can provide an immersive feeling as in the real word. So, using virtual reality technology to construct realistic experimental scenarios, the mechanism of cognitive processing in the human brain could be better studied. In this paper, we have designed an experiment, where through the presentation of traffic signs with correct or incorrect background colors in a virtual reality traffic environment, and studied the cognitive processing in the human brain using event-related potential (ERP) method. The results showed that whether the background colors of traffic signs were correct or not, the degrees of familiarity to these traffic signs in the human brain were similar, and the degree of contrast between the background colors and foreground colors of traffic signs would influence the degree of difficulty in cognitive processing. The degree of complexity in contents of traffic signs appears related to the cognitive speed in the human brain. In sum, simpler contents and larger contrast between the background colors and foreground colors of traffic signs would make the human brain respond faster.     

Addressing health literacy through clear health communication: A training program for internal medicine residents

Objective

To develop, pilot, and test the effectiveness of a clear health communication curriculum to improve resident knowledge, attitudes, and skills regarding health literacy.

Methods

Thirty-one internal medicine residents participated in a small group curriculum that included didactic teaching, practice with a standardized patient, and individualized feedback on videotaped encounters with real patients. Outcomes were assessed using a pre-post survey and a communication skills checklist.

Results

Mean knowledge scores increased significantly from 60.3% to 77.6% (p < 0.001). Residents also reported increased familiarity with the concept of health literacy (mean response 3.2 vs. 4.5 on a 5 point scale), importance placed on health literacy (4.2 vs. 4.9), frequency of considering health literacy in patient care (3.3 vs. 4.0), and confidence in communicating with low literacy patients (3.3 vs. 4.1) (all p < 0.001). Use of plain language increased significantly from 33% to 86% (p = 0.023). There were nonsignificant increases in the use of teach-back (0–36%, p = 0.116) and encouraging questions (0–14%, p = 0.502).

Conclusion

Training in clear health communication improves resident knowledge, attitudes, and skills regarding health literacy.

Practice implications

The increased use of clear health communication techniques can significantly improve the care and outcomes of vulnerable patients with limited health literacy.     

Translating knowledge into practice for communication skills training for health care professionals

Despite the evidence that person-centred communication underpins all that we do in our interactions with patients, caregivers and team members, the knowledge about the implementation of systematic communication skills training is still in its infancy. This position paper describes some of the main contextual facilitators for translating knowledge about communication skills training for health care professionals (HCP) and recommends ways to guide practical implementation. Based on the literature that has been published over the last two decades, it seems evident that communication skills training programs should be underpinned by clinician self-reflection, be experiential, and focused on behaviour change and implementation of new skills into practice. The programs should be delivered by trainers possessing an understanding of communication micro skills, the skills and confidence to observe interactions, and coach learners through the rehearsal of alternative approaches. Communication skills programs should be flexible to adapt to individual learners, local needs, and circumstances. Interventions should not be limited to the empowerment of individual HCP but should be a part of the organisational quality assurance framework, e.g., by including communication skills in clinical audits.Implementation science frameworks may provide tools to align programs to the context and to address the determinants important for a sustained implementation process. Programs need to be embedded as ‘core business’, otherwise the culture change will be elusive and sustainability under threat if they are only dependent on provisional funding.     

虚拟手术中的力学变形和力觉感知

虚拟手术是培训医生的新兴的有效手段,在虚拟环境中利用视觉、听觉、触觉力觉多感知交互信息,学习和感知手术过程,其中触觉力觉是至关重要的和较难的技术,本文分析了触觉力觉技术在虚拟手术过程中的重要性以及国内外研究现状,对力学变形算法和力觉感知硬件设备的研制和应用进行了探讨。虚拟手术研究的进一步开展,将提高我国数字医学研究的水平。     

Patient-physician social concordance, medical visit communication and patients' perceptions of health care quality

Social characteristics (e.g. race, gender, age, education) are associated with health care disparities. We introduce social concordance, a composite measure of shared social characteristics between patients and physicians.

Objective

To determine whether social concordance predicts differences in medical visit communication and patients’ perceptions of care.

Methods

Regression analyses were used to determine the association of patient-provider social concordance with medical visit communication and patients’ perceptions of care using data from two observational studies involving 64 primary care physicians and 489 of their patients from the Baltimore, MD/Washington, DC/Northern Virginia area.

Results

Lower patient-physician social concordance was associated with less positive patient perceptions of care and lower positive patient affect. Patient-physician dyads with low vs. high social concordance reported lower ratings of global satisfaction with office visits (OR = 0.64 vs. OR = 1.37, p = 0.036) and were less likely to recommend their physician to a friend (OR = 0.61 vs. OR = 1.37, p = 0.035). A graded-response was observed for social concordance with patient positive affect and patient perceptions of care.

Conclusion

Patient-physician concordance across multiple social characteristics may have cumulative effects on patient-physician communication and perceptions of care.

Practice implications

Research should move beyond one-dimensional measures of patient-physician concordance to understand how multiple social characteristics influence health care quality.     

Development of virtual reality stimuli for force platform posturography

People relying much on vision in the control of posture are known to have an elevated risk of falling. Dependence on visual control is an important parameter in the diagnosis of balance disorders. We have previously shown that virtual reality (VR) methods can be used to produce visual stimuli that affect balance, but suitable stimuli need to be found. In this study, the effect of six different VR stimuli on the balance of 22 healthy test subjects was evaluated using force platform posturography. We report in more detail and expand the results published earlier. According to the tests two of the stimuli have a significant destabilizing effect on balance. In addition a significant displacement effect on the subject's center of pressure (COP) was found. Thus it is shown that the design of VR stimuli to cause different effects on the control of balance is possible.     

Training in virtual and real environments

Transfer of training between real and virtual environments was examined using a pick-and-place task with two different difficulty levels. The task was to minimize the time to move cans from one color coded location in the first row to the same color coded location in the back row and then to reverse the process. In the first task, the front and back disk colors were aligned, and in the second disk order, the front and back disk colors were randomly placed on the table. Subjects trained in one environment were then tested in the other and their performance compared with that of subjects being trained in that environment. Some virtual world-trained subjects showed small but significant improvement in performance compared with the untrained subjects for the real world task for both disk arrangements. The differences in performance between the two groups decreased with trial number until no difference was seen at the end of the sessions. None of the real world-trained subjects showed any significant improvement when performing the task in the virtual world compared with the untrained subjects. These results suggest that transfer-of-training from virtual to real world tasks can take place under certain conditions.     

Opportunities to improve COVID-19 provider communication resources: A systematic review

ObjectiveCommunication related to COVID-19 between provider and the patient/family is impacted by isolation requirements, time limitations, and lack of family/partner access. Our goal was to determine the content of provider communication resources and peer-reviewed articles on COVID-19 communication in order to identify opportunities for developing future COVID-19 communication curricula and support tools.MethodsA systematic review was conducted using the UpToDate clinical decision support resource database, CINAHL, PubMed, PsycInfo, and Web of Science. The grey literature review was conducted in September 2020 and articles published between January-September 2020 written in English were included.ResultsA total of 89 sources were included in the review, (n = 36 provider communication resources, n = 53 peer-reviewed articles). Resources were available for all providers, mainly physicians, and consisted of general approaches to COVID-19 communication with care planning as the most common topic. Only four resources met best practices for patient-centered communication. All but three articles described physician communication where a general emphasis on patient communication was the most prevalent topic. Reduced communication channels, absence of family, time, burnout, telemedicine, and reduced patient-centered care were identified as communication barriers. Communication facilitators were team communication, time, patient-centered and family communication, and available training resources.ConclusionsOverall, resources lack content that address non-physician providers, communication with family, and strategies for telehealth communication to promote family engagement. The gaps identified in this review reveal a need to develop more materials on the following topics: provider moral distress, prevention communication, empathy and compassion, and grief and bereavement. An evidence-base and theoretical grounding in communication theory is also needed.Practice implicationsFuture development of COVID-19 communication resources for providers should address members of the interdisciplinary team, communication with family, engagement strategies for culturally-sensitive telehealth interactions, and support for provider moral distress.     

The role of health care communication in the development of complementary and integrative medicine

In recent years, complementary medicine (CM) approaches are integrated within a growing number of health care services worldwide. Implementation of CM within primary, secondary and tertiary settings of health care requires attention to a variety of communication challenges. In this special issue of Patient Education and Counseling 23 articles are presented about the patient–provider communication on complementary approaches, and the implementation and integration of CM in health care. Parallel to CM integration in the clinical arena, this special issue emphasizes the importance of two complementary axes: in medical education and in research, particularly on management of chronic illness and life-threatening diseases. The three legs of the integrative stool – research, education, and clinical practice – are perceived in the light of open, non-judgmental patient–health care provider–CM practitioner communication and a patient-centered bio-psycho-social–cultural–spiritual agenda.     

Teachable moments for health behavior change and intermediate patient outcomes

Objective

Teachable moments (TM) are opportunities created through physician–patient interaction and used to encourage patients to change unhealthy behaviors. We examine the effectiveness of TMs to increase patients’ recall of advice, motivation to modify behavior, and behavior change.

Methods

A mixed-method observational study of 811 patient visits to 28 primary care clinicians used audio-recordings of visits to identify TMs and other types of advice in health behavior change talk. Patient surveys assessed smoking, exercise, fruit/vegetable consumption, height, weight, and readiness for change prior to the observed visit and 6-weeks post-visit.

Results

Compared to other identified categories of advice (i.e. missed opportunities or teachable moment attempts), recall was greatest after TMs occurred (83% vs. 49–74%). TMs had the greatest proportion of patients change in importance and confidence and increase readiness to change; however differences were small. TMs had greater positive behavior change scores than other categories of advice; however, this pattern was statistically non-significant and was not observed for BMI change.

Conclusion

TMs have a greater positive influence on several intermediate markers of patient behavior change compared to other categories of advice.

Practice implications

TMs show promise as an approach for clinicians to discuss behavior change with patients efficiently and effectively.     

Interruptive communication patterns in the intensive care unit ward round

OBJECTIVE: An exploratory study to examine interruptive communication patterns of healthcare staff within an intensive care unit (ICU) during ward rounds. METHODS: The study was conducted in a tertiary hospital in Sydney, Australia. Nine participants were observed individually, for a total of 24 h, using the communication observation method (COM). The amount of time spent in conversation, the number of conversation initiating and number of turn-taking interruptions were recorded. RESULTS: Participants averaged 75% [95% confidence interval 72.8-77.2] of their time in communication events during ward rounds. There were 345 conversation-initiating interruptions (C.I.I.) and 492 turn-taking interruptions (T.T.I.). C.I.I. accounted for 37% [95% CI 33.9-40.1] of total communication event time (5 h: 53 min). T.T.I. accounted for 5.3% of total communication event time (56 min). CONCLUSION: This is the first study to specifically examine turn-taking interruptions in a clinical setting. Staff in this intensive care unit spent the majority of their time in communication. Turn taking interruptions within conversations occurred at about the same frequency as conversation initiating interruptions, which have been the subject of earlier studies. These results suggest that the overall burden of interruptions in some settings may be significantly higher than previously suspected.     

Complex health care decisions with older patients in general practice: Patient-centeredness and prioritization in consultations following a geriatric assessment

Objective

To examine to what extent general practitioners in consultations after a geriatric assessment set shared health priorities with older patients experiencing multimorbidity and to what extent this was facilitated through patient-centered behavior.

Methods

Observation of consultations embedded in a cluster randomized controlled trial,¹ in which 317 patients from 41 general practices received the STEP assessment followed by a care planning consultation with their GPs. GPs in the intervention group used a structured procedure for setting health (care) priorities in contrast to control GPs. A sample of 43 consultations (24 intervention; 19 control) were recorded, transcribed and analyzed with regard to priority setting and patient-centeredness.

Results

Patient-centeredness was only moderately apparent in consultations dealing with complex care plans for older patients with multimorbidity. The shared determination of health priorities seemed unusual for both doctors and patients and was rarely practiced, albeit more frequently in intervention consultations.

Conclusion

Setting health care priorities with patients experiencing multimorbidity is ethically desirable and medically appropriate. Yet a short structured guide for doctors cannot easily achieve this.

Practice implications

More research is needed in regard to handling complex health needs of older patients. It requires a professional approach and training in patient-centered holistic care planning.     

The use of artificial intelligence and virtual reality in doctor-patient risk communication: A scoping review

ObjectivesWhile the development of artificial intelligence (AI) and virtual reality (VR) technologies in medicine has been significant, their application to doctor-patient communication is limited. As communicating risk is a challenging, yet essential, component of shared decision-making (SDM) in surgery, this review aims to explore the current use of AI and VR in doctor-patient surgical risk communication.MethodsThe search strategy was prepared by a medical librarian and run in 7 electronic databases. Articles were screened by a single reviewer. Included articles described the use of AI or VR applicable to surgical risk communication between patients, their families, and the surgical team.ResultsFrom 4576 collected articles, 64 were included in this review. Identified applications included decision support tools (15, 23.4%), tailored patient information resources (13, 20.3%), treatment visualization tools (17, 26.6%) and communication training platforms (19, 29.7%). Overall, these technologies enhance risk communication and SDM, despite heterogeneity in evaluation methods. However, improvements in the usability and versatility of these interventions are needed.ConclusionsThere is emerging literature regarding applications of AI and VR to facilitate doctor-patient surgical risk communication.Practice implicationsAI and VR hold the potential to personalize doctor-patient surgical risk communication to individual patients and healthcare contexts.     

Therapeutic communication training in long-term care institutions: recommendations for future research

Objective

The purpose of this review is to critique contemporary experimental research and to recommend future directions for research interventions on nursing aides’ therapeutic communication with older adults who have cognitive impairment and/or dementia in institutional long-term care settings.

Methods

This literature review covers 13 journal articles (1999–2006) and focuses on the strengths and weaknesses of experimental research interventions to improve nursing aides’ therapeutic communication with older adults who have cognitive impairment and/or dementia in long-term care settings.

Results

Based on this review, recommendations for improved experimental designs include a minimum of two groups with one being a control and randomization of subjects at the care unit level, an average 3–5 h of total training, a minimum of a 6-month total evaluation period, and objective outcomes relevant to both nursing aides and residents. Findings from studies in this review indicate that the following therapeutic communication techniques can be taught and can benefit staffs and older adults’ quality of life: verbal and non-verbal communication behaviors including open-ended questions, positive statements, eye contact, affective touch, and smiling.

Conclusions

Some evidence exists to support that nursing aides can improve their therapeutic communication during care.

Practice Implications

Nursing aides need not only more training in therapeutic communication but also ongoing, dedicated supervision in psychosocial aspects of care.