The language and communication attributes of graphic symbol communication aids – a systematic review and narrative synthesis

Background: Symbol communication aids are used by children with little or no intelligible speech as an Augmentative and Alternative Communication strategy. Graphic symbols are used to help support understanding of language and used in symbol communication aids to support expressive communication. The decision making related to the selection of a symbol communication aid for a child is poorly understood and little is known about what language and communication attributes are considered in this selection.

Aim: To identify from the literature the language or communication attributes of graphic symbol communication aids that currently influence AAC practice.

Method and Procedure: A search strategy was developed and searches were performed on a range of electronic databases for papers published since 1970. Quality appraisal was carried out using the CCAT tool and papers rated as weak were not included in the review.

Results: Eleven studies were included in the review reporting data from 66 participants. Weaknesses were identified in most studies that would limit the validity of the results for application to practice. Included studies investigated aspects of vocabulary organization and design, the process of vocabulary selection, and the choice of the symbol system and encoding method. Two studies also evaluated innovative communication aid attributes.

Conclusions: Information from studies reported in the research literature provides a sparse source of information about symbol communication aids from which clinicians, children or family members may make informed decisions.

• Implications for Rehabilitation

• This review is the first to systematically appraise the literature to answer the question what evidence exists to inform clinical decision making in relation to the language or communication attributes of graphic symbol based communication aids? The review establishes that there is a paucity of evidence from studies and that these decisions must thus be based on other information and factors.

• The review does establish a small number of language or communication attributes of symbol communication aids, but no synthesis of the results of these studies was possible. This review thus suggests that vocabulary design and organization, symbol system and encoding method, and the choice of vocabulary selection method are attributes that clinicians may carefully review in order to inform decisions.

• Clinicians encountering symbol vocabulary packages claiming to be ‘evidence based’ should query the nature of this evidence.

• The rehabilitation research community should debate and develop appropriate research designs that will facilitate future robust studies investigating the effect of specific language or communication attributes of communication aids.

     

配偶夫妻沟通对孕妇睡眠质量、心理状态的影响

目的:研究配偶夫妻沟通对孕妇睡眠质量、心理状态的影响.方法:采用随机数表法将2017 年6 月至2018年9 月于中国人民解放军联勤保障部队第901 医院进行产前检查的100例孕妇分为观察组与对照组,每组50例.对照组给予常规心理干预,观察组在其基础上增加配偶夫妻沟通干预.比较干预前后2 组孕妇睡眠质量和心理状态.结果:干预1个月后,观察组孕妇睡眠质量评分明显降低,且低于对照组(P<0.05);干预后2组孕妇汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分均明显降低,且观察组孕妇评分明显低于对照组(P<0.05).结论:加强配偶夫妻沟通可有效改善孕妇焦虑、抑郁等负面情绪,提高睡眠质量.     

The Role of Dual-trained Conventional/Complementary Physicians as Mediators of Integration in Primary Care

A growing number of physicians study complementary and alternative medicine (CAM). Limited data are available on perspectives of physicians with dual training in conventional medicine and CAM, on issues of communication and collaboration with CAM practitioners (CAMPs). Questionnaires were administered to primary care physicians employed in the largest health maintenance organization (HMO) in Israel and to MD and non-MD CAM practitioners employed by a CAM-related agency of the same HMO. Data for statistical analysis were available from 333 primary care physicians (PCPs) and 241 CAM practitioners. Thirty-one of the 241 CAMPs were dual-trained physicians employed in a CAM-related agency as practitioners and/or triage-consultants. Dual trained physicians and CAMPs shared similar attitudes and supported, more so than PCPs, collaborative physician-CAM practitioner teamwork in clinical practice, medical education and research. Nevertheless, dual trained physicians supported a physician-dominant teamwork model (similar to the PCPs' approach) in contrast to non-MD CAM practitioners who mainly supported a co-directed teamwork model. Compared to PCPs and non-MD CAM practitioners, dual trained physicians supported significantly more a medical/referral letter as the preferred means of doctor-CAM practitioner communication. Dual trained physicians have a unique outlook toward CAM integration and physician-practitioner collaboration, compared to non-MD CAM practitioners and PCPs. More studies are warranted to explore the role of dual trained physicians as mediators of integration.     

Successful Catheter Ablation of Reentrant Junctional Tachycardia in a Patient with Asplenia Syndrome before Total Cavo‐Pulmonary Connection

Asplenia syndrome is commonly associated with complex structural cardiac malformations, and junctional tachycardia (JT), which may compromise hemodynamic status, has been reported in association with asplenia syndrome. 1 We report successful radiofrequency catheter ablation of reentrant JT in a patient with asplenia syndrome. (PACE 2010; e43–e45)     

The skills gap in nursing management in South Africa: a sectoral analysis: a research paper

pillay r . (2010) Journal of Nursing Management  18, 134–144
The skills gap in nursing management in South Africa: a sectoral analysis: a research paper Aim To identify competencies important for effective nursing management and to assess managers’ proficiency therein. Background A lack of management capacity has been identified as the key stumbling block to health delivery in South Africa. Despite nursing managers being central to overcoming the challenges facing health care, there has been a paucity of research that empirically evaluates their skill levels. Methods A survey was conducted among 171 senior nursing managers in South Africa using a self-administered questionnaire. Results Public sector managers assessed themselves as being relatively less competent than private sector managers. The largest skill gaps for public sector managers were for ‘ethico–legal’, ‘task-related’ and ‘controlling’ skills whereas those for private sector managers were for ‘ethico–legal’, ‘health-related ‘ and ‘task-related’ skills. Conclusions This research confirmed the lack of management capacity within the health sector and identified areas in which the skills deficit was most significant for both the public and private sectors. Implications for nursing management These findings reflect the needs of nursing managers and will be useful in the conceptualization, design and delivery of health management programmes aimed at enhancing management and leadership capacity in the health sector in South Africa.     

Text Messaging Real-Time COVID-19 Clinical Guidance to Hospital Employees

Background  During the initial days of the coronavirus disease 2019 (COVID-19) pandemic, hospital-wide practices rapidly evolved, and hospital employees became a critical population for receiving consistent and timely communication about these changes. Objectives  We aimed to rapidly implement enterprise text messaging as a crisis communication intervention to deliver key COVID-related safety and practice information directly to hospital employees. Methods  Utilizing a secure text-messaging platform already routinely used in direct patient care, we sent 140-character messages containing targeted pandemic-related updates to on-duty hospital employees three times per week for 13 weeks. This innovation was evaluated through the analysis of aggregate “read” receipts from each message. Effectiveness was assessed by rates of occupational exposures to COVID-19 and by two cross-sectional attitudinal surveys administered to all text-message recipients. Results  On average, each enterprise text message was sent to 1,997 on-duty employees. Analysis of “read” receipts revealed that on average, 60% of messages were consistently read within 24 hours of delivery, 34% were read in 2 hours, and 16% were read in 10 minutes. Readership peaked and fell in the first week of messaging but remained consistent throughout the remainder of the intervention. A survey administered after 2 weeks revealed that 163 (79%) users found enterprise texts “valuable,” 152 (73%) users would recommend these texts to their colleagues, and 114 (55%) users preferred texts to email. A second survey at 9 weeks revealed that 109 (80%) users continued to find texts “valuable.” Enterprise messaging, in conjunction with the system''s larger communication strategy, was associated with a decrease in median daily occupational exposure events (nine events per day premessaging versus one event per day during messaging). Conclusion  Enterprise text messages sent to hospital-employee smartphones are an efficient and effective strategy for urgent communications. Hospitals may wish to leverage this technology during times of routine operations and crisis management.     

Agenda navigation in consultations covering multiple topics. A qualitative case study from general practice

ObjectiveTo explore how agenda navigation may be accomplished underway in consultations covering multiple topics, we identified and analyzed one GP’s communicative strategies.Design, setting, and subjectsA qualitative observational case study with linguistic microanalysis of an exemplary consultation between a female patient with diabetes and her male GP. We used speech act theory to identify communicative actions that indicated agenda navigation by the GP in transitions between episodes concerning ten topics.ResultsMicroanalysis revealed different aspects of agenda navigation by the GP using speech acts, especially ways of opening or closing an episode. The opening of episodes was characterized by speech acts accepting the patient’s request to discuss a topic, mostly at the beginning of the consultation. Speech acts to inform or to request information from the patient dominated later in the consultation. The GP closed all episodes using speech acts to instruct or appraise the patient, or to make agreements and plans.Conclusion and practice implicationsSkilful agenda navigation is an important tool for consultations covering multiple issues and could be further developed for medical education. The opening and closing of episodes were vital communicative strategies supporting patient-centered communication in a complex consultation while maintaining the focus of the consultation agenda.

KEY POINTS

• While traditional consultation models cover one health problem, GP consultations often include many patient issues in each session.
• Linguistic microanalysis of speech acts helped to identify communication strategies in a GP consultation with multiple topics.
• The GP conducted agenda navigation by distinctly opening and closing episodes concerning specific topics.
• Episodes were opened by accepting, informing, and requesting and closed by instruction, appraisal, making agreements, or plans.

     

Medication communication through documentation in medical wards: knowledge and power relations

Health professionals communicate with each other about medication information using different forms of documentation. This article explores knowledge and power relations surrounding medication information exchanged through documentation among nurses, doctors and pharmacists. Ethnographic fieldwork was conducted in 2010 in two medical wards of a metropolitan hospital in Australia. Data collection methods included participant observations, field interviews, video‐recordings, document retrieval and video reflexive focus groups. A critical discourse analytic framework was used to guide data analysis. The written medication chart was the main means of communicating medication decisions from doctors to nurses as compared to verbal communication. Nurses positioned themselves as auditors of the medication chart and scrutinised medical prescribing to maintain the discourse of patient safety. Pharmacists utilised the discourse of scientific judgement to guide their decision‐making on the necessity of verbal communication with nurses and doctors. Targeted interdisciplinary meetings involving nurses, doctors and pharmacists should be organised in ward settings to discuss the importance of having documented medication information conveyed verbally across different disciplines. Health professionals should be encouraged to proactively seek out each other to relay changes in medication regimens and treatment goals.