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This study examined the possible influence of audio and video recording of personality assessment measures on anxiety. Undergraduate students in psychology were randomly assigned to Audiotape, Videotape, or Control conditions and given the State-Trait Anxiety Inventory and Rorschach Inkblot Method. A one-way multivariate analysis of variance indicated no significant differences among these conditions on the Spielberger, et al. State-Trait Anxiety Inventory, A-State scale, and five Rorschach measures of situational anxiety. Tape-recording itself did not seem to affect the anxiety indices of these frequently used personality assessments.

According to the model proposed by Stampfl and Levis (1967), implosion reduces fear by evoking anxiety in the presence of cues associated with the phobic object, but in the absence of primary reinforcement. An essential requirement for rapid therapeutic effect is that the patient be made to experience intense affect, since “the greater the non-reinforced anxiety experienced, the greater the extinction of fear” (Hogan and Kirchner, 1967). Thus, the patient is repeatedly presented with fear-evoking stimuli and kept at a high level of arousal until ‘a significant diminution in anxiety has resulted’ (Stampfl and Levis, 1967). This model assumes that this ‘significant diminution in anxiety’ is equivalent to extinction of the fear response. Only a handful of studies of implosion, using human subjects, have attempted to relate the pattern and magnitude of fear during therapy to outcome measures. Hogan and Kirchner (1967) measured heart rate continuously throughout implosion. Compared to a no-treatment control procedure, implosion generated significantly greater heart rate arousal during therapy and greater behavioral improvement at assessment, suggesting support for the extinction model. In contrast, Watson and Marks (1971) found no correlation between overt anxiety during flooding and measures of outcome. Stern and Marks (1973) found ‘little skin conductance activity or tachycardia’ during flooding in fantasy, rather than the high level of arousal required by Stampfl's model. The present study attempted a partial test of some of the model's assumptions within the context of an outcome study of implosion therapy by tape recording. Kirchner and Hogan (1966) have claimed that a single, brief session of implosion therapy by tape recording can dramatically reduce phobic avoidance behavior. However, Hodgson and Rachman (1970) and Fazio (1970) failed to replicate these results. Findings from these and other studies of implosion are difficult to interpret because of the absence of objective measures of fear during the therapy session. In the absence of such measures, it is difficult to judge whether the implosive procedures succeeded in creating the pattern of arousal demanded by Stampfl's model. Failure to meet the requirements of the model might account for the failures to replicate. The present study included physiological and subjective measures of fear during therapy in an attempt to replicate the Kirchner and Hogan (1966) experiment, using double-blind methodology and a placebo control. It was expected that after exposure to a tape recorded session of implosive therapy, rat phobic subjects would demonstrate significantly greater improvement than controls on a behavioral avoidance test and a questionnaire. In conformity with the extinction model, it was predicted that the implosion group would manifest greater average fear, as well as a significant reduction in fear, during therapy, and that measures of fear during therapy and at assessment would he correlated.

Two kinds of stimuli were presented to the mother rat at random: the natural pain acoustic signal of its infant in response to electrical pain stimulation and the tape recording of the signal performed within the sound frequency region (up to 20 kHz). The mother rat was placed in a special long cage with two parts of different size. Her reaction was ethologically estimated. The natural pain signal proved to be more effective than its magnetic tape recording. The role of the spectrum ultrasound part of the pain acoustic signal is discussed.

Clinical evidence suggests that self-tape recording and listening is a useful technique for enhancing awareness in self-counseling. The question arises as to the roles of talking and listening in the process. This study experimentally compared the effects on self-awareness of three group experiences of “Talk and Listen,” “Talk Only” and “Listen Only,” using 90 graduate students in counseling as subjects. A set of self-awareness scales which utilize core conditions of counseling measured self-awareness in subjects of self-facilitation and self-initiation, following the group experiences. Analysis of variance showed significant differences favoring the “Talk and Listen” experiences over the other two experiences in both self-facilitation and self-initiation. It was concluded that self-tape recording and listening may be a moderately powerful self-counseling technique for producing psychological states which are related to therapeutic movement. It is suggested that self-tape recording is worthy of further investigation and use.

ECG-tape recording has been utilized for diagnosis of transient attacks of syncope and dizziness both before and during cardiac pacing. The display unit can be utilized for automatic starting of the ECG writer according to markings made by the patient or bradycardia alarm. The method has proved extremely useful and convenient, which is illustrated by cases with different types of arrhythmia and pacemaker failure.

The purpose of this study was to collect normative data on a commercially available tape recording of the Synthetic Sentence Identification test with ipsilateral competing message. Twenty normal-hearing subjects with no history of central auditory dysfunction were used. Mean percentage of intelligibility scores and standard deviations were obtained at various message-competition ratios. Results were compared to previous research. The data obtained using this recording can now be used as a reference for making clinical judgments.

To describe and evaluate the contribution of multiple coding approaches applied to a clinical conversation on deprescribing in primary care (PC).Seven distinct coding approaches were applied to one audiotaped consultation. Only exchanges related to deprescribing a benzodiazepine (BZD) were coded for: content, interaction, arguments, connectors, transitions, orientation towards deprescribing and concordance with a deprescribing algorithm. A discursive map presents the unfolding of the exchanges.The deprescribing conversation was broken down into 31 utterances divided into three segments: opening (n = 6), development (n = 16) and closing (n = 9). The family physician dominated the last two segments and most of her utterances were favorable to BZD deprescribing while the patient's utterances were generally unfavorable in the first two segments. The number of distinct codes assigned to utterances varied according to the coding approach. The map illustrates how each utterance can be viewed through different lenses revealing the dynamics and complexity of the deprescribing conversation.This multidimensional methodological approach with its proposed way of presenting results, either quantitatively or qualitatively, and its map offer a comprehensive evaluation of the deprescribing process in this PC setting.This novel multidimensional coding approach has potential to be applied to a range of other topics in clinical communications.

Background Studies consider the clinical encounter as linear, comprising six phases (opening, problem presentation, history-taking, physical examination, diagnosis, treatment and closing). This study utilizes formal conversation analysis to explore patient-physician interactions and understanding diagnostic utterances during these phases. Methods This study is a qualitative sub-analysis that explores how the diagnosis process, along with diagnostic uncertainty, are addressed during 28 urgent care visits. We analyzed physicians’ hypothesis-generation process by focusing on: location of diagnostic utterances during the encounter; whether certain/uncertain diagnostic utterances were revised throughout the encounter; and how physicians tested their hypothesis-generation and managed uncertainty. We recruited 7 primary care physicians (PCPs) and their 28 patients from Brigham and Women’s Hospital (BWH) in 3 urgent care settings. Encounters were audiotaped, transcribed, and coded using NVivo12 qualitative data analysis software. Data were analyzed inductively and deductively, using formal content and conversation analysis. Results We identified 62 diagnostic communication utterances in 12 different clinical situations. In most (24/28, 86%) encounters, the diagnosis process was initiated before the diagnosis phase (57% during history taking and 64% during physical examination). In 17 encounters (61%), a distinct diagnosis phase was not observed. Findings show that the diagnosis process is nonlinear in two ways. First, nonlinearity was observed when diagnostic utterances occurred throughout the encounter, with the six encounter phases overlapping, integrating elements of one phase with another. Second, nonlinearity was noted with respect to the resolution of diagnostic uncertainty, with physicians acknowledging uncertainty when explaining their diagnostic reasoning, even during brief encounters. Conclusions Diagnosis is often more interactive and nonlinear, and expressions of diagnostic assessments can occur at any point during an encounter, allowing more flexible and potentially more patient-centered communication. These findings are relevant for physicians’ training programs and helping clinicians improve their communication skills in managing uncertain diagnoses.

Objectives To investigate how elite track and field athletes with a history of musculoskeletal pain (MSKP) describe their perceptions of clinical treatments based on dry needling guided by a neurological map (neuroanatomical dry needling (naDN)). Design Qualitative study. Methods In-depth interviews were conducted with eight elite Swedish track and field athletes (6 males, 2 females, median age 28.5) treated at a clinic specialised in MSKP management. All interviews were audio recorded and transcribed verbatim. The data were structured and analysed using a thematic method. Results The athletes approached clinical MSKP treatment from a performance-orientated perspective. They explained that they inevitably suffered MSKP episodes due to the intense physical demands of their sport. The use of naDN was considered an integral part of their sports practice and the study clinic's services were readily utilised when MSKP caused minor reductions in physical capacity. The athletes appreciated an unambiguous anatomical diagnosis, preferably supported by imaging scans, as this increased their confidence in clinical services. They valued the naDN treatment as it was perceived to provide fast-acting analgesia that enabled rapid return-to-play. These factors combined to reduce performance-related stress. Conclusions Elite track and field athletes with a history of MSKP sought and appreciated clinical treatment with naDN largely because it provided fast-acting analgesia that enabled rapid return-to-play at a high-performance level. These athletes’ expectations of MSKP diagnosis and management appear incongruent with current research indicating that MSKP sensitivity within the nervous system does not accurately reflect musculoskeletal tissue state or recovery following tissue damage.

Background: Current conventional cognitive assessments are limited in their efficiency and sensitivity, often relying on a single score such as the total correct items. Typically, multiple features of response go uncaptured. Objectives: We aim to explore a new set of automatically derived features from the Digit Span (DS) task that address some of the drawbacks in the conventional scoring and are also useful for distinguishing subjects with Mild Cognitive Impairment (MCI) from those with intact cognition. Methods: Audio-recordings of the DS tests administered to 85 subjects (22 MCI and 63 healthy controls, mean age 90.2 years) were transcribed using an Automatic Speech Recognition (ASR) system. Next, five correctness measures were generated from Levenshtein distance analysis of responses: number correct, incorrect, deleted, inserted, and substituted words compared to the test item. These per-item features were aggregated across all test items for both Forward Digit Span (FDS) and Backward Digit Span (BDS) tasks using summary statistical functions, constructing a global feature vector representing the detailed assessment of each subject’s response. A support vector machine classifier distinguished MCI from cognitively intact participants. Results: Conventional DS scores did not differentiate MCI participants from controls. The automated multi-feature DS-derived metric achieved 73% on AUC-ROC of the SVM classifier, independent of additional clinical features (77% when combined with demographic features of subjects); well above chance, 50%. Conclusion: Our analysis verifies the effectiveness of introduced measures, solely derived from the DS task, in the context of differentiating subjects with MCI from those with intact cognition.

In recent years, there is an increasing interest in building e-health systems. The systems built to deliver the health services with the use of internet and communication technologies aim to reduce the costs arising from outpatient visits of patients. Some of the related recent studies propose machine learning-based telediagnosis and telemonitoring systems for Parkinson's disease (PD). Motivated from the studies showing the potential of speech disorders in PD telemonitoring systems, in this study, we aim to estimate the severity of PD from voice recordings of the patients using motor Unified Parkinson's Disease Rating Scale (UPDRS) as the evaluation metric. For this purpose, we apply various speech processing algorithms to the voice signals of the patients and then use these features as input to a two-stage estimation model. The first step is to apply a wrapper-based feature selection algorithm, called Boruta, and select the most informative speech features. The second step is to feed the selected set of features to a decision tree-based boosting algorithm, extreme gradient boosting, which has been recently applied successfully in many machine learning tasks due to its generalization ability and speed. The feature selection analysis showed that the vibration pattern of the vocal fold is an important indicator of PD severity. Besides, we also investigate the effectiveness of using age and years passed since diagnosis as covariates together with speech features. The lowest mean absolute error with 3.87 was obtained by combining these covariates and speech features with prediction level fusion. Graphical Abstract Framework for the proposed UPDRS estimation model.

Objective In a previous study of patients newly enrolled in HIV care, we observed that clinicians were less likely to address emotional issues expressed by African-American patients compared to whites. We sought to verify and expand these findings in a larger group of patients established in HIV care. Methods We used VR-CoDES to analyze transcripts from 342 audio-recorded medical visits in the United States. We used random intercept multilevel logistic regression to assess associations between patient and clinician characteristics and patterns of emotional talk. Results African-American patients were less likely than others to spontaneously express emotions (OR 0.50; 95 % CI 0.29−0.85). Clinicians, who were predominantly white, were more likely to respond to emotional expressions by African-American patients explicitly (OR 1.56; 95 % CI 1.11–2.20) but less likely to offer neutral/passive responses that provide space for emotional conversation (OR 0.56; 95 % CI 0.37−0.84) and more likely to block discussion of the emotional issue (OR 2.20; 95 % CI 1.05–4.63). Emotional talk did not vary by patient age or gender. Conclusion These results confirm our prior findings, demonstrating less open emotional communication between African-American patients and their providers. Practice Implications Addressing racial differences in communicating about emotions may reduce disparities in patient-clinician relationships.

Objective Despite recognition that hypertension is associated with childhood obesity, data suggest that high blood pressure (BP) is infrequently diagnosed in children. This study sought to examine provider communication with overweight school-age children regarding BP measurements that were high at well-child visits. Methods Cross-sectional mixed-methods analysis of audio-recorded communication from well-child visits with overweight 6-12-year-olds. Data from the subset of children with elevated BPs were used for this study. Three BP measures obtained at the audio-recorded visit were averaged, paired with historical BPs stored in the health record, and compared to contemporary/Fourth-Report thresholds to determine if children had elevated/hypertensive BPs only at the audio-recorded visit or met hypertension-diagnostic criteria (hypertension-level BP ≥3 separate visits). Two reviewers used visit transcripts to categorize communication about BP as "absent," "unclear," or "direct." Provider use of a billing diagnosis for elevated BP/hypertension in visits with direct-BP-communication was explored. Results In 36 of 126 (29%) visit-audio-recordings, children had elevated/hypertensive BPs. Thirty-three of the 36 eligible (92%) had intelligible audio-recordings. Of these, nine (25%) had overweight and 24 (75%), obesity. Seventeen (52%) had elevated BPs, and 16 (48%), hypertensive BPs. Ten (30%) met criteria for hypertension diagnosis. BP communication was absent in 20 visits (61%), unclear in eight (24%), and direct in five visits (15%). Billing diagnoses for elevated BP/hypertension were entered at four of five (80%) visits with direct-BP communication. Conclusions Most overweight children with elevated BPs do not receive communication that BP is high at well-child visits. Relevant billing diagnoses may indicate direct-BP communication.

Objective Among adolescents and young adults (AYAs) with chronic illness, effective provider communication is essential for patient-centered care during a sensitive developmental period. However, communication in chronic illness care for AYAs is not well studied. Our objectives were to describe the provider communication skills in pediatric chronic kidney disease (CKD) care visits; and determine if communication skills differ by AYA characteristics. Methods We adapted a global consultation rating system for pediatric subspecialty care using audiotaped clinic encounters of 18 pediatric nephrologists with 99 AYAs (age M(SD) = 14.9(2.6)) with CKD stages 1–5 and 96 caregivers. We hypothesized that provider communication skills would differ by AYA characteristics (age, gender, and race). Results The strongest provider skills included initiating the session and developing rapport; lowest rated skills were asking patient’s perspective and checking understanding. Communication scores did not consistently differ by AYA age or race, but were rated higher with female AYAs in several domains (ps Conclusions Pediatric providers generally had adequate or good communication scores with AYAs, but improvement in certain skills, particularly with male AYAs, may further support patient-centered care. Practice implications To achieve consistent, patient-centered communication with AYAs, an observation-based global assessment may identify areas for provider improvement.

Objective: To assess the numerical probabilities that individuals associate with frequently-used verbal labels relating to treatment outcomes and their association with medical context, age, gender, educational level, health literacy, and numeracy.Methods: Verbal labels (N = 11) were extracted from N = 90 audiotaped decision encounters in oncology. Three hundred Dutch adults, as proxies for newly-diagnosed cancer patients, assigned numerical probabilities to the labels in the context of cancer recurrence or nausea, and completed questions on their socio-demographic characteristics, health literacy and numeracy.Results: We found considerable variation in how individuals interpreted the verbal labels. Participants' probability estimates of verbal labels was lower in the context of (the more serious) cancer recurrence compared to (less serious) nausea. Lower numerate participants differentiated less between labels. There was no association between participants' estimates and age, gender, educational level or health literacy.Conclusion: There is considerable variation in how individuals interpret verbal labels frequently-used in decision encounters. Individuals seem to take base rates and severity of outcomes into account. Verbal labels may be less helpful to lower numerate individuals.Practice implications: To minimize misinterpretation and to improve patient-clinician decision making about health and care, we recommend to avoid the use of verbal labels only. (C) 2019 Elsevier B.V. All rights reserved.

Background People of lower socioeconomic status often experience disparities related to dietary intake as compared with People of higher socioeconomic status. Foods purchased influence the availability of foods in the home environment, and availability of foods in the home environment is associated with dietary intake. Objective To identify what factors influence food purchasing decisions of low-income parents while food shopping. Design A qualitative study using think-aloud methodology, the processing of information through verbalization concurrent with task performance, was used to verbally capture real-time decision making. Participants and setting Twenty-eight parents with a preschool-aged child enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Study visits took place at the WIC clinic office and local grocery stores. Main outcomes Reasons for making decisions while food shopping. Analysis Audio recordings were transcribed, and thematic analysis was used to analyze the data. Descriptive statistics were used to characterize demographics and shopping behaviors. Results A parent’s decision in a food purchase was based on child preference, value, need of an item, or the parent choice for a product. In addition, themes emerged related to participant shopping behavior included the influence of participation in WIC on food and beverage purchases, multiple trips to the store, and a frequent focus on purchasing bottled water and juice. The average shopping trip was 31.5±15.7 minutes, and the median amount spent was $38.61. Conclusion Understanding the influences of parent decisions while making food purchases can better help inform the nutrition education provided as part of WIC.

Humpback whale males are known to sing on their low-latitude breeding grounds, but it is well established that songs are also commonly produced ‘off-season’ on the feeding grounds or during migration. This opens exciting opportunities to investigate migratory aggregations, study humpback whale behavioral plasticity and potentially even assign individual singers to specific breeding grounds. In this study, we analyzed passive acoustic data from 13 recording positions and multiple years (2011–2018) within the Atlantic sector of the Southern Ocean (ASSO). Humpback whale song was detected at nine recording positions in five years. Most songs were recorded in May, austral fall, coinciding with the rapid increase in sea ice concentration at most recording positions. The spatio-temporal pattern in humpback whale singing activity on Southern Ocean feeding grounds is most likely shaped by local prey availability and humpback whale migratory strategies. Furthermore, the comparative analyses of song structures clearly show a differentiation of two song groups, of which one was solely recorded at the western edge of the ASSO and the other song group was recorded throughout the ASSO. This new finding suggests a common feeding ground occupation by multiple humpback whale populations in the ASSO, allowing for cultural and potentially even genetic exchange among populations.

Despite the importance of empathic communication in cancer patient outcomes, the majority of opportunities to respond empathically to a patient’s concern within clinical consultations are “missed” (i.e., 70-90%), or not responded to by physicians. The present study examined the empathic opportunities and responses within clinical consultations of lung cancer patients and how these each are associated with patient-reported outcomes. Results indicate that lung cancer patients (n=56) most commonly presented empathic opportunities related to emotions, anxiety was significantly associated with empathic opportunity type (p=0.011), and physicians are most likely to respond with high empathy to statements around a patient making progress rather than bringing up a challenge or an emotion they felt (p = 0.031). The present study results highlight the need to train lung cancer physicians to respond with higher empathy to opportunities to respond to negative emotions, including mentions of challenges faced or emotions experienced, as these patients are at the highest risk of experiencing distress and the least likely to receive a high empathic response from physicians.

This study aimed at investigating the effectiveness of audio script and script-fading procedure in teaching initiation to children with ASD. Three children with ASD and a parent of each child participated in the study. A nonconcurrent multiple baseline design across children was used. The findings showed that the initiation emitted by the children increased during audio script and script-fading procedure. Children also generalized initiation across different conditions and maintained the acquired skills. Finally, the social validity findings showed that the opinions of the parents regarding the procedure were overall positive. Results were discussed in terms of recommendations for practitioners and future research, Firat University Scientific Research Projects Management Unit, FÃ?BAP: 1603E088, This research was funded by Anadolu University Committee of Scientific Research Projects (Project No: 1603E088). The views expressed in this article do not necessarily reflect those of Anadolu University Committee of Scientific Research Projects.

Background Shared decision-making (SDM) is a key principle in asthma management, but continues to be poorly implemented in routine care. This study aimed to evaluate the impact of a SDM communication skills training for physicians treating patients with asthma on the SDM behaviors of physicians, and to analyze physician views on the training. Methods A mixed methods study with a partially mixed sequential equal status design was conducted to evaluate a 12 h SDM communication skills training for physicians treating patients with asthma. It included a short introductory talk, videotaped consultations with simulated asthma patients, video analysis in small group sessions, individual feedback, short presentations, group discussions, and practical exercises. The quantitative evaluation phase consisted of a before (t0) after (t1) comparison of SDM performance using the observer-rated OPTION5, the physician questionnaire SDM-Q-Doc, and the patient questionnaire SDM-Q-9, using dependent t-tests. The qualitative evaluation phase (t2) consisted of a content analysis of audiotaped and transcribed interviews. Results Initially, 29 physicians participated in the study, 27 physicians provided quantitative data, and 22 physicians provided qualitative data for analysis. Quantitative results showed significantly improved performance in SDM following the training (t1) when compared with performance in SDM before the training (t0) (OPTION5: t (26) = − 5.16; p

BACKGROUND: Literature suggests that patient-informing process prior to obtaining surgical informed consent (SIC) does not function well. This study aimed to provide insight into the current practice of SIC in the Netherlands.METHODS: This is a prospective, observational, and multicenter study, conducted in one academic and two non-academic teaching hospitals in the Netherlands. Audio recordings were made during outpatient consultations with patients presenting with Dupuytren Disease. The recorded informing process was scored according to a checklist. Written documentation of the SIC process in the patient's chart was compared to these scored checklists. Time spent on SIC during the consultations was also recorded.RESULTS: A total of 41 outpatient consultations were included in the study. Consultations were conducted by 25 plastic surgeons and their residents. Average time spent on SIC was 55.6% of the total consultation time. Considerable variation was observed concerning the amount and type of information given and discussed. In 59% of the consultations, discrepancies were observed between written documentation of consultations and audio recordings. Information on treatment risks, the postoperative period, and the operating surgeon was addressed the least.CONCLUSION: Despite a relatively large part of the consultation time being spent on SIC, patients received scarce information concerning treatment risks, postoperative period, and who their operating surgeon would be. Discrepancies were observed between the written documentation of SIC and information recorded on the audio recordings. This occurred predominantly in one hospital that used a pre-made list of 'discussed information' in its digital patient chart.

Background: Growing evidence demonstrates the benefits of early, integrated palliative care (PC) for patients with advanced cancer and their caregivers. Yet, data are lacking on the communication patterns within this model of care. Objective: The goals of this study were to describe the content of patient–clinician discussions among patients receiving PC and to compare differences in discussion content between oncologists and PC clinicians. Design: We conducted a qualitative observational analysis. Setting/Subjects: We included patients with incurable lung and esophageal cancer enrolled in a randomized trial of early, integrated PC versus usual oncology care. We analyzed 68 audio-recorded clinic visits (34 oncologist visits; 34 PC clinician visits) immediately after patients' (N = 19) first and second cancer progressions. We examined themes of clinician communication, comparing the content and frequency of discussions between oncologists and PC clinicians. Results: Although both oncology and PC clinicians discussed symptom management, medical understanding, and treatment decision making with patients at nearly all postprogression visits, PC clinicians tended to assess patient understanding of the treatment process and prognosis more often than oncologists. PC clinicians addressed patient coping, caregiver experiences and needs, and advance care planning more frequently than oncologists. Conclusion: PC clinicians play a distinct, complementary role to oncologists in providing care for patients with advanced cancer and their caregivers. PC clinicians tend to assess and elaborate on patient understanding of prognosis and treatment and emphasize effective coping, caregiver needs, and advance care planning. These results illuminate the communication elements by which early, integrated PC may improve patient and caregiver outcomes.

Catathrenia is a rare sleep-related breathing disorder marked by nocturnal groaning during prolonged exhalation. Home sleep apnea tests are growing in popularity, but no prior case reports exist documenting catathrenia detected by a home sleep apnea test. We report two cases of catathrenia incidentally detected in patients with low to intermediate risk of obstructive sleep apnea, in which diagnostic polysomnography was recommended but denied by insurers. Events were automatically scored as central apneas, leading to diagnostic uncertainty. The key to identification of catathrenia in both patients was combination of audio review of events, pattern of expiratory air trapping, and mismatch between central apnea flow signal attenuation and increased sound noted on audio amplitude signal. Diagnostic polysomnography was ordered in both cases for confirmation of diagnosis, leading to increased care costs. CITATION: Kazaglis L. The value of a well-trained ear: incidental detection of catathrenia on home sleep apnea tests in patients with low probability for obstructive sleep apnea. J Clin Sleep Med. 2018;14(12):2083–2086.

Background Informed consent is an ethical and legal requirement that differs from informed decision-making—a collaborative process that fosters participation and provides information to help patients reach treatment decisions. The objective of this study was to measure informed consent and informed decision-making before major surgery. Study design We audio-recorded 90 preoperative patient-surgeon conversations before major cardiothoracic, vascular, oncologic, and neurosurgical procedures at 3 centers in the US and Canada. Transcripts were scored for 11 elements of informed consent based on the American College of Surgeons’ definition and 9 elements of informed decision-making using Braddock’s validated scale. Uni- and bivariate analyses tested associations between decision outcomes as well as patient, consultation, and surgeon characteristics. Results Overall, surgeons discussed more elements of informed consent than informed decision-making. They most frequently described the nature of the illness, the operation, and potential complications, but were less likely to assess patient understanding. When a final treatment decision was deferred, surgeons were more likely to discuss elements of informed decision-making focusing on uncertainty (50% vs 15%, p = 0.006) and treatment alternatives (63% vs 27%, p = 0.02). Conversely, when surgery was scheduled, surgeons completed more elements of informed consent. These results were not associated with the presence of family, history of previous surgery, location, or surgeon specialty. Conclusions Surgeons routinely discuss components of informed consent with patients before high-risk surgery. However, surgeons often fail to review elements unique to informed decision-making, such as the patients’ role in the decision, their daily life, uncertainty, understanding, or patient preference.

This paper investigated the performance of a number of acoustic measures, both individually and in combination, in predicting the perceived quality of sustained vowels produced by people impaired with Parkinson’s disease (PD). Sustained vowel recordings were collected from 51 PD patients before and after the administration of the Levodopa medication. Subjective ratings of the overall vowel quality were garnered using a visual analog scale. These ratings served to benchmark the effectiveness of the acoustic measures. Acoustic predictors of the perceived vowel quality included the harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPP), recurrence period density entropy (RPDE), Gammatone frequency cepstral coefficients (GFCCs), linear prediction (LP) coefficients and their variants, and modulation spectrogram features. Linear regression (LR) and support vector regression (SVR) models were employed to assimilate multiple features. Different feature dimensionality reduction methods were investigated to avoid model overfitting and enhance the prediction capabilities for the test dataset. Results showed that the RPDE measure performed the best among all individual features, while a regression model incorporating a subset of features produced the best overall correlation of 0.80 between the predicted and actual vowel quality ratings. This model may therefore serve as a surrogate for auditory-perceptual assessment of Parkinsonian vowel quality. Furthermore, the model may offer the clinician a tool to predict who may benefit from Levodopa medication in terms of enhanced voice quality.

Both researchers and practitioners often rely on direct observation to measure and monitor behavior. When these behaviors are too complex or numerous to be measured in vivo, relying on direct observations using human observers increases the costs of conducting research and monitoring interventions in practice. To address this issue, we conducted a proof of concept examining whether artificial intelligence could measure vocal stereotypy in individuals with autism. More specifically, we used an artificial neural network with over 1,500 minutes of audio data from eight different individuals to train and test models to measure vocal stereotypy. Our results showed that our artificial neural network performed adequately (i.e., session-by-session correlation near or above .80 with a human observer) in measuring engagement in vocal stereotypy for six of eight participants. That said, researchers need to conduct additional research to further improve the generalizability of the approach.

OBJECTIVE: To understand whether clinicians’ empathic concern and perspective-taking traits are associated with their response to patient emotions. METHODS: We audio-recorded 41 HIV clinician interactions with 342 patients at two academic medical centers. We assessed clinicians’ self-reported empathic concern and perspective-taking traits using the Interpersonal Reactivity Index and coded emotional communication using the Verona Coding Definitions of Emotional Sequences. We used random effects models to assess associations between clinician traits and clinician responses to patients’ negative emotions, accounting for clustering of emotions within encounters and patients within clinicians. RESULTS: Clinicians with more self-reported empathic concern received fewer emotional expressions from their patients (β −0.06; 95% CI −0.10, −0.01) and had greater odds of responding to emotions by giving information/advice (OR 1.10; 95% CI 1.01, 1.20). There were no associations between empathic concern or perspective-taking and any other clinician responses. CONCLUSION: Clinicians with higher levels of empathic concern respond to patient emotions by giving information and advice, a response traditionally thought of as a missed empathic opportunity, not by exploring emotions or providing empathy. Whether this is helpful to patients is unknown. PRACTICE IMPLICATIONS: Clinicians should be aware of their tendency to give information to patients with emotional distress, and consider whether this response is helpful to patients.

Background According to the International Liaison Committee on Resuscitation (ILCOR), the trigger words used by callers that are associated with cardiac arrest constitute a scientific knowledge gap. This study was designed to find hypothetical trigger words in emergency calls in order to improve the specificity of out-of-hospital cardiac arrest recognition. Methods In this descriptive pilot study conducted in a Finnish hospital district, linguistic contents of 80 emergency calls of dispatcher-suspected or EMS-encountered out-of-hospital cardiac arrests between January 1, 2017 and May 31, 2017 were analysed. Spontaneous trigger words used by callers were transcribed and grouped into 36 categories. The association between the spontaneous trigger words and confirmed true cardiac arrests was tested with logistic regression. Results Of the suspected cardiac arrests, 51 (64%) were confirmed as true cardiac arrests when ambulance personnel met the patient. A total of 291 spontaneous trigger words were analysed. ‘Is not breathing’ (n = 9 [18%] in the true cardiac arrest group vs n = 1 [3%] in the non-cardiac arrest group, odds ratio [OR] 6.00, 95% confidence interval [CI] 0.72–50.0), ‘the patient is blue’ (n = 9 [18%] vs n = 1 [3%], OR 6.00, 95% CI 0.72–50.0), ‘collapsed or fallen down’ (n = 12 [24%] vs n = 2 [7%], OR 4.15, 95% CI 0.86–20.1) and ‘is wheezing’ (n = 17 [33%] vs n = 5 [17%], OR 2.40, 95% CI 0.78–7.40) were frequently used to describe true cardiac arrest. ‘Is snoring’ was associated with a false suspicion of cardiac arrest (n = 1 [2%] vs n = 6 [21%], OR 0.08, 95% CI 0.009–0.67). Conclusions In our pilot study, no trigger word was associated with confirmed cardiac arrest. ‘Is wheezing’ was a frequently used spontaneous trigger word among later confirmed cardiac arrest victims.

ObjectivesAlthough shared decision making (SDM) is advocated in rheumatoid arthritis (RA) treatment, it is largely unclear when, how and to what extent SDM is applied in routine clinical care of patients with RA. This study aimed to investigate the level of SDM in RA treatment from an observer perspective and to assess associations between the level of SDM and characteristics of the clinician, patient and consultation.MethodsThe level of SDM was investigated by scoring audio-recordings of 168 routine consultations with unique patients with the observer patient involvement (OPTION) scale (scale 0–100, higher OPTION scores indicating higher levels of SDM). Associations between the level of SDM and characteristics of the clinician, patient and consultation were assessed using multilevel modelling. Statistical significance was set at pResultsThe mean OPTION score was 28.3 (SD=15.1). The multilevel model included four characteristics: clinician age, patient age, consultation duration and type of treatment decision. There were significant, positive associations between the level of SDM and the consultation duration (b=0.63, 95% CI 0.16 to 1.11), decision for stopping and/or starting medication (b=14.30, 95% CI 5.62 to 22.98), decision for adjusting medication doses (b=8.36, 95% CI 3.92 to 12.81) and decision for administering single dose glucocorticoids (b=15.03, 95% CI 9.12 to 20.93). Thus, a higher level of SDM was significantly associated with a longer consultation duration and the type of treatment decision. No other significant associations were found.ConclusionsOverall, the level of SDM in RA treatment leaves room for improvement. To foster SDM in routine clinical care, training programmes on patient-centred communication skills may be helpful.

Purpose The purpose of this paper is to explore the extent to which improving doctor–patient communication (DPC) can address and alleviate many healthcare delivery inefficiencies. Design/methodology/approach The authors survey causes and costs of miscommunication including perceptual gaps between how physicians believe they perform their communicative duties vs how patients feel and highlight thresholds such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) used by hospitals to identify health outcomes and improve DPC. Findings The authors find that DPC correlates with better and more accurate care as well as with more satisfied patients. The authors utilize an assessment framework, doctor–patient communication assessment (DPCA), empirically measuring the effectiveness of DPC. While patient care is sometimes viewed as purely technical, there is evidence that DPC strongly predicts clinical outcomes as well as patients’ overall ratings of hospitals. Research limitations/implications More research is needed to extend our understanding of the impact of the DPC on the overall HCAHPS ratings of hospitals. The authors think that researchers should adopt a qualitative method (e.g. content analysis) for analyzing DPC discourse. Practical implications When a sufficient amount of DPCA training is initiated, a norming procedure could be developed and a database may be employed to demonstrate training program’s efficacy, a critical factor in establishing the credibility of the measurement program and nurturing support for its use. Originality/value The authors highlight clinical and operational issues as well as costs associated with miscommunication and the need to use metrics such as HCAHPS that allow consumers to see how hospitals differ on specific characteristics.

To document the effect of a cancer specific question prompt list (QPL) on patients question asking and shared decision-making (SDM), and to evaluate the combined effect of the QPL and consultation audio recording (CAR) on patient outcomes.This exploratory study compared two groups of patients receiving either a QPL or combined QPL/CAR, to a control group. Measurements included number/types of questions asked, and physician SDM behavior (OPTION score). Questionnaire data included anxiety/depression and quality of life (QoL).A total of 93 patients participated (31 Control, 30 QPL and 32 Combined). Patients in the intervention groups asked more questions concerning prognosis (p .0001), the disease (p = .006) and quality of treatment (p .001) than patients in the control group, but no impact was found on the OPTION score. An increase in mean consultation length was observed in the intervention groups compared to the control group (44 vs. 36 min; p = .028). Patients rated both interventions positively.Provision of the QPL facilitates patients to ask a broader range of questions, but does not increase physician SDM behavior.The combination of QPL and CAR seems feasible and should be tested in an implementation study following the disease trajectory.

While the protection of children from all forms of violence is a fundamental right guaranteed by the Convention on the Rights of the Child, violence remains a part of life for children around the globe. Corporal punishment is a form of violence and a dominant practice as a method of corrective parenting in the Caribbean. While researchers are starting to ask children directly about their experiences of violence, there is limited research on children’s perspectives of the function, legality, and boundaries of corporal punishment, particularly in low-and middle-income countries. This study begins to address this gap by reporting on 12 focus groups that were conducted with adolescents (aged 12 to 18 years) and caregivers of Indo-Caribbean background in Suriname. The aim is to explore adolescents’ and caregivers’ shared perspectives about the prevalence of corporal punishment in Suriname, responses to and feelings about its use as a discipline strategy and perspectives of the rationales for and against corporal punishment, and their views on banning it. Analyses were done using ATLAS.ti version 1.0.50, a qualitative data package. Corporal punishment showed to be an everyday experience in children’s lives in Suriname. There was no clear consensus regarding adolescents’ and caregivers’ perspectives on the parental use of corporal punishment. Many participants hesitated to support efforts to prohibit corporal punishment legally. Messages arising from this study could usefully inform the development of a public information campaign on safe and effective discipline of children in Suriname.