Email Use Reconsidered in Health Professions Education: Viewpoint

Email has become a popular means of communication in the past 40 years, with more than 200 billion emails sent each day worldwide. When used appropriately, email can be an effective and useful form of correspondence, although improper practices, such as email incivility, can present challenges. Email is ubiquitous in education and health care, where it is used for student-to-teacher, provider-to-provider, and patient-to-provider communications, but not all students, faculty members, and health professionals are skilled in its use. This paper examines the challenges and opportunities posed by email communication in health professions education and reveals important deficiencies in training, as well as steps that can be taken by health professions educators to address them. Recommendations are offered to help health professions educators develop approaches for teaching email professionalism.

The Connections of Parole and Probation Agent Communication Patterns With Female Offenders' Job-Seeking Self-Efficacy

Using subsamples of 130 and 96 women on probation and parole, this research explores the direct effect of the supervising agent's communication patterns on client job-seeking self-efficacy. It also tests for the mediating effect through client psychological reactance, which is a feeling that one's freedoms are threatened. Agent and client reports of a conformity pattern of communication were associated with lower levels of job-seeking self-efficacy. Client reactance mediated this relationship. Agent and client reports of a conversational pattern of communication were associated with increased job-seeking self-efficacy. The results suggest that conformity-oriented communication should be avoided because of its potential to increase reactance and to promote low job-seeking self-efficacy. In contrast, conversational communication appears to have more positive effects on job-seeking self-efficacy. Findings highlight communication as a pathway through which agents can improve behavioral outcomes for women offenders searching for work.

A Constructed Reality? A Fairclough-Inspired Critical Discourse Analysis of the Danish HPV Controversy

The World Health Organization (WHO) reports that routine immunization coverage has declined in Europe. In this article, we present the findings of a Norman Fairclough-inspired critical discourse analysis undertaken to explore how the Danish media came to suggest a possible linkage between the human papillomavirus (HPV) vaccine and serious side effects. The findings of the analysis highlight the social consequences of the controversy over the HPV vaccine, identified within the framework of three perspectives: (1) overall criticism of vaccine efficacy and safety, rooted in an ideological opposition; (2) a growing societal tendency to question the authority of the official health bodies; and (3) the specific controversy over the HPV vaccine. We suggest that the controversy over the HPV vaccine is rooted in an ideological conflict, and the declining acceptance implies that the perception that the vaccine causes serious side effects has gained currency among the general public.

Enhancing relationships through technology: directions in parenting, caregiving, romantic partnerships, and clinical practice

Media coverage of research on phones and social media over the last decade has prompted widespread concern and one-size-fits-all guidance to limit screen time. Recognizing the limitations of screen time as a metric, researchers are now studying technology use in terms of affordances, individual differences, and longitudinal patterns. The current review examines technology use by parents, caregivers, couples, and clinicians. Individuals in these roles navigate risks, such as privacy violations, with benefits such as improved communication, empathy, and progress toward shared goals. Successful approaches vary by relationship type but have commonalities such as engaging with the technologies used by the other person to open up sensitive conversations, negotiate conflict, and illuminate patterns that would otherwise be hard to detect. To enhance relationships, some individuals depart from the intended use of technologies, for example, adapting connected devices for emotional communication or drawing on games to cope with social anxiety. One promising way in which individuals adapt technology to improve communication involves sharing technologies that were designed for personal use. This review highlights the importance of context, motivation, and the nuances of use to understand how technologies can be optimally used in personal and clinical relationships.
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Communication and understanding of mild cognitive impairment diagnoses

BACKGROUND

Communication of mild cognitive impairment (MCI) diagnoses is challenging due to its heterogeneity and unclear prognosis.

AIM

To identify how MCI is communicated and to explore the relationship with patient and companion understanding.

METHOD

Conversation analysis identified whether MCI was named and explained in 43 video recorded diagnosis feedback meetings. Afterward, patients and companions were asked to name the diagnosis to assess understanding.

RESULTS

Mild cognitive impairment was not named in 21% meetings. Symptoms were explained as (a) a result of vascular conditions (49%), (b) a stage between normal ageing and dementia (30%), or (c) caused by psychological factors (21%). Fifty-four percentage of prognosis discussions included mention of dementia. There was no association between symptom explanations and whether prognosis discussions included dementia. Fifty-seven percentage patients and 37% companions reported not having or not knowing their diagnosis after the meeting. They were more likely to report MCI when prognosis discussions included dementia.

CONCLUSIONS

Doctors offer three different explanations of MCI to patients. The increased risk of dementia was not discussed in half the diagnostic feedback meetings. This is likely to reflect the heterogeneity in the definition, cause and likely prognosis of MCI presentations. Clearer and more consistent communication, particularly about the increased risk of dementia, may increase patient understanding and enable lifestyle changes to prevent some people progressing to dementia.

Family Meal Practices and Weight Talk Between Adult Weight Management and Weight Loss Surgery Patients and Their Children

OBJECTIVE

To identify predictors associated with specific family meal practices and weight talk among patients participating in weight management programs (WMPs) and weight loss surgery (WLS) and their children.

DESIGN

Cross-sectional survey.

SETTING

Two US weight management centers.

PARTICIPANTS

259 patients (aged ≥ 18 years) in either WMP (n = 101) or WLS (n = 158) and residing with a child (aged 2-18 years) MAIN OUTCOME MEASURE(S): Dependent variables: family meal practices (Project EAT) and weight talk (investigator-created). Covariates: family communication (Family Communication Scale), family discouragement for making eating habit change (Social Support for Eating Habits Survey), child age, sex, and perceived weight status, and WMP or WLS participation.

ANALYSIS

Binomial and ordinal regression models determined the odds of engaging in specific family meal practices and weight talk, including covariates.

RESULTS

Patients had increased odds of engaging in family dinners if they reported lower family discouragement (P = .003) and had younger children (P < .001), and increased odds of engaging in family breakfast if they had higher family communication (P = .002) and younger children (P = .020). Patients had increased odds of talking about their child's weight if their child was perceived to have an overweight/obese weight status (P < .001). Patients with older children had increased odds of talking about their weight with their child (P = .021).

CONCLUSIONS AND IMPLICATIONS

Additional research assessing the family meal practices and weight talk in the families of adults pursuing weight loss could yield important evidence that could lead to improved patient outcomes, and safely promote healthy behaviors and prevention of obesity in children.

Provoking a Conversation Around Students' and Supervisors' Expectations Regarding Workplace Learning

Construct: This study presents a tool that can facilitate a conversation about students' and supervisors' expectations concerning responsibilities during workplace learning. Background: It is often unclear who is responsible for facilitating learning opportunities in the workplace. In order to increase learning opportunities, it is important that expectations are discussed and alignment is reached between the student's and supervisor's expectations. This study collected and interpreted validity evidence for a tool that aims to provoke such a conversation. Approach: Three types of validity evidence were collected: response process, content, and consequences evidence. Educational leaders, medical teachers, and students of four medical schools were involved. The data collection consisted of cognitive interviews, a modified Delphi approach (with three rounds of inquiry), completed tools, and narrative comments. Findings: This study showed that the expectations of most students and supervisors were not initially aligned. The conversation, for which the tool aims to be a catalyst, facilitated better alignment of expectations about responsibilities during workplace learning. Moreover, the students' perceived degree of consensus and satisfaction after the conversation were very high. Conclusions: This study underlined the relevance and usefulness of a tool that facilitates conversation about expectations regarding responsibilities, potentially enhancing learning opportunities at the workplace.

Patients' and providers' experiences with video consultations used in the treatment of older patients with unipolar depression: A systematic review

WHAT IS KNOWN ON THE SUBJECT?: Depression is the most common cause of mental illness amongst older people. As a result of the growth of the older population, it is expected that an increasing number of older people will need treatment. Depression can be effectively treated-but fewer than half of those who are affected receive treatment. Barriers to receiving treatment are lack of resources and trained healthcare providers, social stigma, incorrect diagnoses and long distances to treatment facilities. There is an increased need for alternative ways of treating patients with depression. The use of video consultations has shown to be a viable option for delivering mental health care to older patients. Use of video consultations allows patients to receive treatment in their own homes. None of the existing reviews have focused on satisfaction with the use of video consultations amongst older people with depression. This paper provides knowledge regarding the use of video consultations, especially for older people with depression. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: No previous review has sought to understand the use of video consultations in mental health care to older patients with depression. The results show that video consultations support mental health practice, especially as a useful alternative when face-to-face therapy is not possible. An initial scepticism from participants quickly disappeared when video consultations were experienced in action. The challenges associated with the use of video consultations seem to consist of technical problems and lack of support from staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health practitioners should consider the use of video consultations because it can support mental health practice, especially as a useful alternative when face-to-face therapy is not possible. ABSTRACT: Introduction Depression is the leading cause of mental illness amongst an ageing population and fewer than half of those who are affected receive treatment. There is an increased need for alternative ways of treating patients; the use of video consultations has been shown to be a viable option for delivering mental health care. However, none of the existing reviews have focused on satisfaction with the use of video consultations amongst older people with depression and providers. Aim To conduct a systematic review of the existing literature focusing on patients' and providers' experiences of video consultations for depression. Method Eight scientific databases were searched. In all, 3,537 articles were identified and, of these, 21 peer-reviewed articles were included in this review. Results The results show that video consultations support mental health practice, especially as a useful alternative when face-to-face therapy is not possible. Any initial scepticism quickly disappeared when video consultations were experienced in action. The challenges seem to consist of technical problems and lack of support from staff. Discussion The experiences and satisfaction of older people with depression seem to be positive, although methodological limitations and deficiencies of the reviewed articles should be considered. More qualitative research is needed, and future studies should focus on specific diagnoses and providers' experiences. Implications for practice Video consultations support mental health practice, especially as a useful alternative when face-to-face therapy is not possible.

Pain in low-income older women with disabilities: a qualitative descriptive study

The purpose of this qualitative study was to identify how low-income older women with disabilities perceive pain, pain management, and communication with healthcare providers. We interviewed 26 low-income women (average age 75 years; SD 7.0), eliciting the following overarching themes: "Invisibility of Pain: Unnoticed or Undetected," "Escalating Pain Leads to Help Seeking," "Communication with Healthcare Providers and Outcomes," "Pain Management Facilitates Function and Accomplishment," and "The Intersection of Pain, Disability, and Depressive Symptoms." Study findings support the ways in which behavior changes from pain can impede pain management.

Caregiver-provider communication after resection of pediatric brain tumors

OBJECTIVE

Because caregivers are a crucial part of a child's medical care, it is important to understand how to best communicate with them during hospitalization. Qualitative research can elucidate the best strategies for effective parent-provider communication. This study aims to reveal communication styles of neurosurgery team members, and to identify areas for improvement in the future.

METHODS

Caregivers of children with a newly diagnosed brain tumor requiring neurosurgery were enrolled during their child's hospitalization. During routine follow-up clinic visits within 3 months after diagnosis and tumor resection, caregivers participated in a semistructured interview, which assessed the quality of communication with the neurosurgery and oncology teams during hospitalization. Interviews were audio-recorded, transcribed, and coded for common themes until thematic saturation was reached.

RESULTS

During caregiver interviews (N = 22), several domains were discussed including communicating the diagnosis to the patient and siblings, to the rest of the family/support network, and with the neurosurgery team. Regarding parent-neurosurgeon communication, 82% of caregivers identified at least one positive aspect and 55% identified at least one negative aspect of communication. Caregivers who provided positive feedback appreciated that their neurosurgeon was thorough (73%), direct (27%), or compassionate (14%). They also valued when providers would speak "on my level" (18%) and would speak directly to the patient (27%). In terms of negative feedback, caregivers identified miscommunications (32%), discussing the diagnosis in front of the child before feeling prepared to do so (14%), and a lack of clarity about expectations, medications, or treatment (32%).

CONCLUSIONS

These data provide specific ways in which neurosurgery providers have communicated effectively with caregivers and identify areas for improvement. Results have been used to develop a navigator-led intervention geared toward improving parent-provider communication during hospitalization for resection of a brain tumor.

Modulating Cytokine Production via Select Packaging and Secretion From Extracellular Vesicles

Cytokines are soluble factors that play vital roles in systemic function due to their ability to initiate and mediate cell-to-cell communication. Another important mechanism of intercellular communication that has gained significant attention in the past 10 years is the release of extracellular vesicles (EVs). EVs are released by all cells during normal physiology, in states of resting and activation, as well as during disease. Accumulating evidence indicates that cytokines may be packaged into EVs, and the packaging of cytokines into EVs, along with their ultimate secretion, may also be regulated by cytokines. Importantly, the repertoire of biomolecules packaged into EVs is shaped by the biological state of the cell (resting vs. activated and healthy vs. disease) and the EV biogenesis pathway involved, thus providing mechanisms by which EV packaging and secretion may be modulated. Given the critical role of cytokines in driving acute and chronic inflammatory and autoimmune diseases, as well as their role in establishing the tumor immune microenvironment, in this review, we will focus on these disease settings and summarize recent progress and mechanisms by which cytokines may be packaged within and modulated by EVs, as a therapeutic option for regulating innate and adaptive immunity.

A Systematic Review of Clinical Interventions Facilitating End-of-Life Communication Between Patients and Family Caregivers

Communication between patients and family caregivers plays a key role in successful end-of-life (EOL) care. In the majority of cases, health-care providers (HCP) are responsible for leading this communication in clinical settings. This systematic review aimed to examine the evidence for the efficacy of HCP-led interventions in enhancing communication between patients and family caregivers. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a search of MEDLINE via PubMed, CINAHL, Scopus, Embase, and PsycINFO as well as a manual search for additional articles on Google Scholar without date restrictions. Of 2955 articles retrieved, 8 meeting the eligibility criteria were included in the review. A quality appraisal of the selected studies was performed using the van Tulder Scale, with 5 of 8 studies rated as high quality. All 8 studies employed psychoeducational interventions involving both patients and surrogate/family caregivers. Common elements of the interventions reviewed included encouraging participant dyads to share their concerns about the patient's medical condition, clarify their goals and values for EOL care, and discuss their EOL care preferences. Of 8 interventions reviewed, 6 measured EOL care preference congruence within dyads as a primary outcome, and all 6 interventions were effective in increasing congruence. Secondary outcomes measured included decisional conflict and relationship quality, with mixed outcomes reported. This review suggests that HCP-led EOL communication interventions show promise for improving EOL care preference congruence. However, further studies with improved methodological rigor are needed to establish the optimal timing, intensity, and duration of interventions.

Addressing Individual Values to Impact Prudent Antimicrobial Prescribing in Animal Agriculture

Antimicrobial resistance is a growing public health threat driven by antimicrobial use—both judicious and injudicious—in people and animals. In animal agriculture, antimicrobials are used to treat, control, and prevent disease in herds of animals. While such use generally occurs under the broad supervision of a veterinarian, individual animals are often treated by farm owners or managers. The decision to administer antimicrobials is therefore influenced not only by the clinical situation but also by the motivations and priorities of different individual actors. Many studies have examined the drivers of external forces such as costs, workload and time constraints, or social pressures on antimicrobial use by veterinarians and producers, but none have explored the role of individually held values in influencing decision-making related to antimicrobial use. Values are deeply held normative orientations that guide the formation of attitudes and behaviors across multiple contexts. Values have been shown to be strongly tied to perceptions of and attitudes toward polarizing topics such as climate change, and preliminary evidence suggests that values are also associated with attitudes to antimicrobial resistance and stewardship. In this article, we draw on lessons learned in other fields (human health care, climate change science) to explore how values could be tied to the extrinsic and intrinsic factors that drive antimicrobial use and prescribing in animal agriculture. We also provide suggestions for ways to build a bridge between the veterinary and social sciences and incorporate values into future research aimed at promoting antimicrobial stewardship in animal agriculture.

Virtual learning environment ('Ivy Street') for palliative medicine education: student and facilitator evaluation

AIM

The study aimed to evaluate student and facilitator perceptions regarding the novel use of a virtual learning environment (VLE) in the development and implementation of 'Ivy Street'.

SAMPLE/METHODS

Healthcare professionals enrolled on the first palliative and end-of-life care masters level module and course facilitators were invited to participate in the study. Two online surveys were developed comprising five open-ended questions to gain both student (n=16) and facilitator (n=4) perceptions of Ivy Street. Data were analysed thematically.

FINDINGS

The key theme to emerge was the 'Positive Perceptions of Ivy Street'. A second sub theme 'Critical Feedback of Ivy Street' focused on some initial technical issues. Respondents perceived the use of Ivy Street to be enjoyable, enabling and promoting peer discussion, while also having a high impact on student engagement. Respondents commented how Ivy Street removed concerns regarding confidentiality when discussing patient cases through utilisation of standardised Ivy Street characters.

CONCLUSION

The novel use of a VLE through developing characters, a story and vignettes is considered to be an effective and engaging method of learning for healthcare professionals enrolled on a palliative and end-of-life care module.

Reasons for and Facilitating Factors of Medical Malpractice Complaints. What Can Be Done to Prevent Them?

Background and objectives. Medical malpractice is an increasing phenomenon all over the world, and Romania is not spared. This matter is of concern as it has a significant impact on the physicians and the patients involved, as well as on the health care system and society in general. The purpose of our study was to perform an insight analysis on the reasons for medical malpractice complaints as well as the factors that facilitate the complaints to identify specific ways to prevent them and, implicitly, to improve the medical practice. Materials and Methods. The authors conducted a retrospective study of the medical malpractice complaints registered in the period 2006–2019 at the Commission for monitoring and professional competence for malpractice cases in the region of Moldova, Romania, collecting data on both the patients and the medical professionals involved. Results. The authors analyzed 153 complaints directed against 205 medical professionals and identified 15 categories of reasons for complaints, the most significant being related to the occurrence of complications, and to the doctor–patient interaction (e.g., communication, behavior, informed consent). The most frequently reported medical specialties were obstetrics and gynecology, emergency medicine, general surgery, and orthopedics and traumatology. Emergency medicine was often involved in complaints suggesting an over utilization of this department in our country and the need for health policies, which could divert the large number of patients accessing emergency medicine towards primary care. Conclusions. Regarding the dysfunctions in the doctor–patient relationship frequently claimed by patients, the authors concluded that doctors need special undergraduate training and periodic updating during their practice for them to be able to adequately address the challenges of interacting with their patients.

How do geneticists and prospective parents interpret and negotiate an uncertain prenatal genetic result? An analysis of clinical interactions

Variants of unknown significance (VUS) and susceptibility loci (SL) are a challenge in prenatal genetic counseling. The aim of this study was to explore how such uncertain genetic results are communicated, negotiated, and made meaningful by genetics healthcare providers and couples in the actual clinical setting where results are delivered. The study was based on an anthropological approach and the material consisted of observations and audio-recordings from 16 purposively sampled genetic counseling sessions where prenatal testing had identified an inherited or de novo VUS or SL result. Field notes and transcripts from audio-recordings were analyzed using thematic analysis. The analysis identified a number of specific interpretations and strategies that clinical geneticists and couples collectively used for dealing with the ambiguity of the result. Thus, the analysis resulted in a total of three themes, each with 3-4 subthemes. The theme 'Setting the scene' describes the three-stage structure of the consultation. The theme 'Dealing with uncertainty' includes 'normalizing strategies' that emphasized the inherent uncertainty in human life in general and 'contextualizing strategies' that placed the result in relation to the surrounding society, where technological developments lead to new and unforeseen challenges. The theme 'Regaining control' includes interpretations that made the knowledge useful by focusing on the value of being prepared for potential, future challenges. Other strategies were to book an extra scan-to reconfirm fetal structural health and to reconnect to the pregnancy. Finally, inquiring about the sex was clearly a way for the couple to signal their investment in the pregnancy. Based on the analysis, we propose that these interpretations served to transform and reduce ambiguity through a process of reconfiguring the biomedical information into knowledge that resonated with the couples' lifeworlds. In this process, both geneticist and couples drew on wider social and moral concerns about uncertainty and responsibility.

Elevating the art of medicine: A caregiver's reflection

The following narrative chronicles the unlikely events of the author, an editorial director of an oncology publication, whose experience with cancer was purely academic in nature until 2 family members were diagnosed simultaneously with breast cancer and melanoma, respectively. The perspective-altering encounters from inside the healthcare system revealed critical lessons regarding the importance of patient-centered care as key to empowering patients and creating a sense of peace for survivors.

Role of requests and communication breakdowns in the coordination of teamwork: a video-based observational study of hybrid operating rooms

OBJECTIVES

This study investigated the functional role of 'requests' in the coordination of surgical activities in the operating room (OR). A secondary aim was to describe, closely, instances of potential miscommunication to scrutinise how so-called conversational repairs were used to address and prevent mistakes.

DESIGN

Non-participant video-based observations.

SETTING

Team coordination around image acquisitions (digital subtraction angiography) done during endovascular aortic repair (EVAR) procedures in a hybrid OR.

METHODS

The study followed and documented a total of 72 EVAR procedures, out of which 12 were video-recorded (58 hours). The results were based on 12 teams operating during these recorded surgeries and specifically targeted all sequences involving controlled apnoea. In total, 115 sequences were analysed within the theoretical framework of conversation analysis.

RESULTS

The results indicated a simple structure of communication that can enable the successful coordination of work between different team members. Central to this analysis was the distinction between immediate requests and pre-requests. The results also showed how conversational repairs became key in establishing joint understanding and, therefore, how they can function as crucial resources in safety management operations.

CONCLUSION

The results suggest the possibility of devising an interactional framework to minimise problems with communication, thereby enabling the advancement of patient safety. By making the distinction between different types of requests explicit, certain ambiguities can be mitigated and some misunderstandings avoided. One way to accomplish this practically would be to tie various actions to clearer and more distinct forms of expression.

A wrong diagnosis

Cancer therapy is undergoing rapid advancements and many of the conditions that were incurable earlier can now easily be treated. Making a "correct diagnosis" is the first step in the ladder towards treating the disease. However, once diagnosed, "breaking bad news" to the patient and his family that he/she has cancer is still a big challenge as it is a life-changing event not only for the patient but their families as well. The following article narrates an incident dealing with the significance of diagnosing the condition accurately and that of "breaking bad news". It gives an insight into the emotional ordeal that clinicians dealing with terminal-illnesses like cancer go through on a daily basis while trying to diagnose it and communicating it to the patient and his family.

The Influence of Socioeconomic Status and Academic Standing on Concussion-Reporting Intentions and Behaviors in Collegiate Athletes

Concussion education have served as a keystone for improving concussion reporting. Numerous factors affecting concussion reporting have been explored; however, the role of socioeconomic status (SES) in reporting has not been established. We examined the influence of SES and academic achievement (high-school grade point average [HS-GPA] and American College Testing [ACT] composite scores) on athletes' concussion-reporting intentions and behaviors. A cross-sectional study was employed among 191 athletes (94 female; age 19.3 ± 1.2 years). Athletes reported SES metrics (parental education and occupation, household income, HS-GPA, and ACT composite score) prior to their athletic season and completed a survey assessing symptom- and concussion-reporting intentions. Symptom- and concussion-reporting behaviors were assessed among athletes who experienced a concussion within the past year. SES was determined using the Hollingshead Four-Factor Index grouping athletes into SES strata. Athletes were grouped into low/high categories for academic achievement and household income variables. The 191 athletes were included for symptom- and concussion-reporting intentions analyses, while 46 and 41 were included for symptom- and concussion-reporting behavior, respectively. Nonparametric statistics with false discovery rate adjusted p values were employed. We found symptom- and concussion-reporting intentions, and symptom- and concussion-reporting behaviors were not significantly different based on SES strata (all p values ≥.64), household income (all p values ≥.64), HS-GPA (all p values ≥.24), or ACT scores (all p values ≥.25). Overall, SES and academic achievement may not play a role in understanding concussion reporting among middle- to high-SES collegiate athletes. Implementing policies targeting certain SES and academic levels might be an ineffective health care strategy for increasing reporting.

Surgeon and patient perceptions of cure in advanced gastrointestinal malignancies: Are we on the same page?

BACKGROUND AND OBJECTIVES

Effective communication is essential to complex shared decision making and is associated with improved recovery and pain control. However, patients and surgeons often have disparate expectations of treatment efficacy and perceptions of cure for advanced malignancies. This study measures correlation of patient and surgeon expectations with perceptions of cure.

METHODS

Our prospective study surveying surgeon-patient dyads before and after surgical consultation was performed for advanced abdominal malignancy between July and November 2017 at a single NCI designated cancer center using electronic questionnaires.

RESULTS

Patients and surgeons' own opinions regarding surgical candidacy (Q1), chance at cure (Q2), and life expectancy (Q3) did not measurably change from pre- to postvisit survey as evidenced by unchanged response concordance (patients Q1 P = .82; Q2 P = .81; and Q3 P = .53; surgeon responses Q1: P = .17; Q2: P = .32; and Q3: P = .50). Patient and surgeon perception of likelihood of cure and of estimated life expectancy remained discordant in pre- and postvisit surveys (Q2: P = .006 and Q3: P = .03).

CONCLUSIONS

These data highlight the stark differences between patient and surgeon perceptions of cure and prognosis of gastrointestinal cancers. These results prove that a larger scale study using this electronic questionnaire is feasible and important to better understand these differences and enhance shared decision making.

Turn analysis and patient-centredness in paediatric otolaryngology surgical consultations

OBJECTIVES

Physician and patient/parent communication is of utmost importance in consultations to improve the shared decision-making (SDM) processes. This study investigated SDM-related outcomes through turn analysis and an assessment of patient-centred dialogue.

DESIGN

Multi-centre prospective cohort study analysing audio- and video-recorded patient/parent-physician interactions.

SETTING

Two tertiary paediatric hospitals in Halifax, Nova Scotia and Salt Lake City, Utah.

PARTICIPANTS

Paediatric otolaryngologists, patients and parents during consultation for adenotonsillectomy.

MAIN OUTCOME MEASURES

Medical dialogue measures (turn analysis, patient-centredness scores via the Roter Interaction Analysis System) and SDM questionnaires (SDM-Q-9).

RESULTS

Turn density was significantly higher for physicians than patients/parents (P < .001), as were total statements (P < .001), and total time talking (P < .001). The opening statement was completed by the physician in 91.5% of interactions and was significantly longer than family opening statements (P = .003). The mean number of informed consent elements addressed per interaction was 4.5 out of 6. The mean patient-centredness score was 0.2 (range 0-0.56). Significant negative correlations between patient-centredness score and physician turn density (r = -.390, P = .002), physician mean turn time (r = -.406, P = .001), total physician statements (r = -.426, P = .001) and total physician speaking time (r = -.313, P = .016) were noted. There were no correlations in SDM questionnaire scores with turn analysis variables, informed consent elements or patient-centredness scores.

CONCLUSIONS

Surgeons dominated the consultation in terms of talking, mostly in a unidirectional manner. Neither patient-centredness nor turn analysis correlated with perceptions of SDM from the parents' perspective.

Renal tubular Bim mediates the tubule-podocyte crosstalk via NFAT2 to induce podocyte cytoskeletal dysfunction

Diabetic nephropathy (DN) is mainly regarded as diabetic glomerulopathy, and its progression is tightly correlated with tubular epithelial lesions. However, the underlying molecular mechanisms linking tubular damage and glomerulopathy are poorly understood.

Methods: We previously reported that the upregulation of Bim mediated proximal tubular epithelial cell (PTEC) apoptosis and was crucial in the early stages of DN. Herein we modulated Bim expression in PTECs and subsequently determined podocyte (PC) cytoskeletal arrangement by building a Transwell co-culture system in high glucose (HG).

Results: Compared to normal glucose, exposure to 40 mM of HG for 48 h induced significant expression of Bim in PTECs and disorganization in the PC cytoskeleton. When cocultured with PTECs in HG, exacerbated filamentous actin (F-actin) rearrangement and reduced synaptopodin levels were detected in PCs. In contrast, gene knockdown of Bim in PTECs was correlated with the absence of PC cytoskeletal disorganization. NFAT2 level and its nuclear translocation in PTECs were decreased by suppressing Bim expression. Upregulating NFAT2 disrupted the beneficial effects on F-actin organization in PCs obtained by inhibiting Bim. LncRNA microarray analysis identified NONHSAT179542.1, which was implicated in Bim-mediated PC cytoskeletal disorder.

Conclusion: Our study clarified the functional role of Bim, a pro-apoptotic factor, which is involved in the crosstalk between PTECs and PCs. Bim promotes NFAT2 activation in PTECs, inducing the downregulation of lncRNA NONHSAT179542.1 in PCs, contributing to the cytoskeletal damage. Identification of the role of the Bim/NFAT2 pathway may represent a promising research direction for a better understanding of DN development.