Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial

ObjectivesTo assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each group’s experiences and learning preferences.MethodsA single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N = 210) to computer-based learning (N = 211). Primary outcomes: communication scores during repeat interactions with MPathic-VR’s intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE). Multivariate analysis of variance was used to compare outcomes. Secondary outcomes: student attitude surveys and qualitative assessments of their experiences with MPathic-VR or computer-based learning.ResultsMPathic-VR-trained students improved their intercultural and interprofessional communication performance between their first and second interactions with each scenario. They also achieved significantly higher composite scores on the OSCE than computer-based learning-trained students. Attitudes and experiences were more positive among students trained with MPathic-VR, who valued its providing immediate feedback, teaching nonverbal communication skills, and preparing them for emotion-charged patient encounters.ConclusionsMPathic-VR was effective in training advanced communication skills and in enabling knowledge transfer into a more realistic clinical situation.Practice implicationsMPathic-VR’s virtual human simulation offers an effective and engaging means of advanced communication training.     

非语言交流在喉癌术后患者康复中的应用价值分析

目的：分析非语言交流在喉癌术后患者康复中的应用价值。方法将广州市番禺区中心医院40例喉癌患者随机均分为对照组和试验组（n=20）。对照组患者实施常规治疗和护理措施,为试验组患者应用发音训练、写字板、自编手语、自制图片等非语言交流方法来促进患者围手术期的康复。结果试验组和对照组沟通满意度的平均得分分别是（82.15±3.31）分和（40.12±2.94）分,差异有统计学意义（P＜0.05）。结论非语言交流训练可使护士的知识内涵得到扩展,使暂时性失语患者的生活质量显著提高,对喉癌术后患者的康复有重要意义。     

Postnatal growth of preterm born children ≤ 750g at birth

Background

Extremely low birth weight (ELBW) infants are at risk of impaired postnatal growth. Impaired postnatal growth has been reported to be associated with delayed cognitive and motor development.

Aims

To describe postnatal growth patterns of appropriate and small for gestational age (AGA and SGA) ELBW children in relation to their cognitive and motor outcome at age 5.5.

Study design

Retrospective cohort study.

Subjects

One hundred one children with a BW ≤ 750 g, born between 1996 and 2005 in the University Hospital Utrecht, The Netherlands.

Outcome measures

Height (Ht), weight (Wt), occipital-frontal circumference (OFC) at birth, 15 months and 2 years corrected age and 3.5 and 5.5 years.Cognitive and motor outcome at 5.5 years of age, classified as normal (Z-score ≥−1), mildly delayed (−2 ≤ Z-score <−1) or severely delayed (Z-score <−2). AGA (Ht, Wt or OFC at birth ≥−2 SDS) infants were compared with SGA (Ht, Wt or OFC at birth <−2 SDS) infants.

Results

Between birth and 5.5 years catch-up growth in Ht, weight for height (Wt/Ht), Wt and OFC was seen in 72.2%, 55.2%, 28.6% and 68.9% respectively of the SGA infants. For AGA infants we found substantial catch-down growth in Ht (15.4%) and Wt (33.8%). Cognitive and motor outcome was normal in 76.2% and 41.6% of the 101 children. A significantly higher percentage of normal cognitive outcome was found in AGA infants with Wt growth remaining at ≥−2 SDS compared to AGA infants with catch-down growth (83% vs 63%). Next, SGA infants who caught-up in OFC had a higher prevalence of normal cognitive outcome compared to SGA infants who did not catch-up in OFC. Furthermore, a higher percentage of severely delayed motor outcome was found in SGA infants without catch-up growth in Wt compared to SGA infants who caught-up in Wt (61.5% vs 32.2%).

Conclusions

Catch-up growth in Ht, Wt/Ht and OFC occurred in the majority of the SGA infants with a BW ≤ 750 g, but was less common in Wt. AGA children who remained their Wt at ≥−2 SDS have a better cognitive and motor developmental outcome at 5.5 years of age. Catch-up growth in OFC was associated with a better cognitive outcome at 5.5 years of age.     

Stability of adaptive behaviors in middle-school children with autism spectrum disorders

This 5-year follow-up study examined the stability of adaptive functioning in two cognitive ability groups of children with an autism spectrum disorder (ASD). Nonverbal intelligence (NVIQ) was assessed at the time of this study and no participant changed cognitive group membership from the previous study (High NVIQ ≥ 97; Low NVIQ ≤ 56). In each group, adaptive skills, as measured by the Vineland Adaptive Behavior Scales (VABS) composite standard score, were significantly below NVIQ. Both groups exhibited a significant decrease in the VABS composite standard scores over time, but analysis of VABS total raw scores showed a significant increase in adaptive functioning over time in the High NVIQ group with no change in the Low NVIQ group. Examining the profile of VABS age equivalent scores in each NVIQ group revealed potential suggestions for interventionists. Caregivers of the Low NVIQ group endorsed having significantly higher stress levels related to their child's level of adaptive functioning. Groups did not differ significantly in the quantity of treatment received within the 9 months preceding this study or caregiver satisfaction with intervention services. Caregivers from both groups identified a variety of school-based service needs to address their child's adaptive skill deficits.     

"智能实验室"一种有效提升滥药青少年戒药动机的工作方法

在香港有不少药物滥用习惯的青少年对传统的预防教育漠不关心,刻意忽视滥用药物对身体的影响。香港明爱南区青少年外展社会工作队在2006年推行了一项名为智能实验室计划,目的是提升药物滥用青少年戒药动机。在推行期间,我们发现部份认知行为状况测试能提升青少年对身体状况的了解并更能具体反映药物滥用行为对青少年的影响。这些测试操作简单,只要能配合上具体及图像化的测试报告,一方面能提升他们的戒药动机,另一方面又轻巧易用,令工作员能在更短时内推动青少年投入戒药服务。     

Gestures convey content: An exploration of the semantic functions of physicians’ gestures

Objectives

Gestures’ semiotic role in clinical interactions is unexplored. Using theoretical underpinnings from basic research on gesture, our objective was to investigate the semantic contributions of physicians’ gestures during interactions with patients with a different native language.

Methods

We analyzed gestures-speech composites in eight videotaped interactions between physicians and patients during treatment plan discussions. Using microanalysis of face-to-face dialogue and conversation analysis, we identified physicians’ gestures, decided whether they served semantic functions, and explored their relationship with the accompanying speech.

Results

Using the operational definitions developed here resulted in high reliability. Physicians gestured at a mean rate of 6.5 gestures per 100 words. Approximately half of the gestures served semantic functions, with referents that were concrete (e.g., actions, body parts) and abstract (e.g., regularity, timelines). Gestures conveyed topic information, but speech conveyed information about that topic and context for interpreting gestures’ meaning.

Conclusion

Analyzing the semantic functions of gestures in clinical interactions is feasible. Physicians’ gestures and speech formed integrated messages; the two modalities conveyed mutually dependent meanings.

Practice implications

Physicians could become aware of the semiotic potential of gestures. However, conversational gestures lack conventional meanings and rely on the accompanying speech to provide necessary context for interpreting their meaning.     

Pain communication through body posture: The development and validation of a stimulus set

Pain can be communicated nonverbally through facial expressions, vocalisations, and bodily movements. Most studies have focussed on the facial display of pain, whereas there is little research on postural display. Stimulus sets for facial and vocal expressions of pain have been developed, but there is no equivalent for body-based expressions. Reported here is the development of a new stimulus set of dynamic body postures that communicate pain and basic emotions. This stimulus set is designed to facilitate research into the bodily communication of pain. We report a 3-phase development and validation study. First 16 actors performed affective body postures for pain, as well as happiness, sadness, fear, disgust, surprise, anger, and neutral expressions. Second, 20 observers independently selected the best image stimuli based on the accuracy of emotion identification and valence/arousal ratings. Third, to establish reliability, this accuracy and valence rating procedure was repeated with a second independent group of 40 participants. A final set of 144 images with good reliability was established and is made available. Results demonstrate that pain, along with basic emotions, can be communicated through body posture. Cluster analysis demonstrates that pain and emotion are recognised with a high degree of specificity. In addition, pain was rated as the most unpleasant (negative valence) of the expressions, and was associated with a high level of arousal. For the first time, specific postures communicating pain are described. The stimulus set is provided as a tool to facilitate the study of nonverbal pain communication, and its possible uses are discussed.     

龚氏非文字智力量表汉族城市与农村儿童测验结果的比较

龚氏非文字智力量表原是为克服我国少数民族因测验时言语不通等困难而编制的一套跨文化智力量表[1] 。后又发展了城市汉族和懂汉语的部分其他民族儿童的常模[1- 2 ] ,但尚未制定全国性大样本的农村汉族儿童常模。本研究采用此量表对农村汉族8～ 12岁儿童的一个小样本进行测试 ,目的是编制一个区域性小样本的农村儿童常模 ,比较该测验在汉族城、乡儿童中应用的结果差异 ,在暂无该测验的农村常模而需要用该测验测试农村儿童智力时可供参考。本文总结了汉族城乡儿童在该测验结果中因文化背景不同的差异。1　对象和方法1.1　研究对象1.1.1　农村…