Search

Objective Breaking bad news (BBN) is challenging for physicians and patients and specific communication strategies aim to improve these situations. This study evaluates whether an E-learning assignment could improve medical students' accurate recognition of BBN communication techniques. Methods This randomized controlled trial was conducted at the University of Basel. After a lecture on BBN, 4th year medical students were randomized to an intervention receiving an E-learning assignment on BBN or to a control group. Both groups then worked on an examination video and identified previously taught BBN elements shown in a physician-patient interaction. The number of correctly, misclassified and incorrectly identified BBN communication elements as well as missed opportunities were assessed in the examination video. Results We included 160 medical students (55% female). The number of correctly identified BBN elements did not differ between control and intervention group (mean [SD] 3.51 [2.50] versus 3.72 [2.34], p = 0.58). However, the mean number of inappropriate BBN elements was significantly lower in the intervention than in the control group (2.33 [2.57] versus 3.33 [3.39], p = 0.037). Conclusions Use of an E-learning tool reduced inappropriate annotations regarding BBN communication techniques. Practice implications This E-learning might help to further advance communication skills in medical students.

SummaryBased on vignettes from clinical cases, supervision and Balint groups this article presents a neo-phenomenological perspective on the lived experience of healthcare professionals in interactions with patients and relatives. Specifically, the familiar phenomenon of “something in the air” between two persons will be analyzed.Constellations and situations are presented as fundamental and generic (ontological) categories that can be differentiated to understand the details and the whole (die Gestalt) of an interaction.The term atmosphere is introduced to investigate the material carrier of something that “colors the air” between healthcare provider and patient.The neo-phenomenological taxonomy of the lived body (der Leib) is used to describe the recipient structure of atmospheric mood.Finally, the potential of these concepts for a more comprehensive diagnosis and for therapeutic use in general practice will be elucidated.

To explore patients' experiences with goal setting during initial rehabilitation after newly acquired spinal cord injury/disorder (SCI/D).Qualitative design with semi-structured interviews and purposively sampled participants. Interviews were transcribed verbatim. Transcripts were analyzed for qualitative content analysis using the Mayring method.Specialized acute care and rehabilitation center for SCI/D-patients.Patients in initial rehabilitation after a newly acquired SCI/D.n.a.n.a.Ten participants were interviewed in the post-acute phase after a newly acquired SCI/D. Participants described individual patient characteristics as well as organizational elements influencing their experience with goal setting. Organizational elements comprised structural elements (e.g. ward rounds, rehabilitation meetings, etc.) and interaction with and among the interprofessional teams. Perspectives from various health care professionals (HCPs) were perceived as increasing adequate goal setting and motivation. Furthermore, the participants described their own involvement and motivation as crucial for goal achievement. The main point of the critique was the standardization of the goal setting process. Interviewees would have preferred individualized goal setting embedded in a clearly foreseeable rehabilitation plan.Organization and collaboration with and among the HCPs should be geared towards identifying specific patient needs during the course of rehabilitation and deriving individually tailored goals from them. Communication plays an important role in the individual goal setting.

Item does not contain fulltext OBJECTIVE: To provide guidance on multilingual and language discordant healthcare communication. DISCUSSION: We provide a critical reflection on common stumbling blocks to securing (professional) language support, as well as on the currently available solutions to language discordance in healthcare. We discuss issues pertaining to i) the assessment of the patient and healthcare professional's language proficiency, ii) the decision making on whether to seek language support, iii) the currently available options of language support and the development of skills that ensure their effective use, iv) the inclusion of professional interpreters in the interprofessional healthcare team, and v) the transition from single- to integrated language support solutions that allow for a more comprehensive approach to multilingual healthcare communication. We present a set of recommendations for good practice. CONCLUSION: Understanding the needs, capabilities and shortcoming of the available language- support solutions and the implications arising from them can enable decision makers to make informed decisions that ensure the quality of communication and care. The integrated use of language-support solutions at different stages of care can create the conditions for effective communication, while promoting patient and family participation in the decision making process. Evidence-based interventions that can inform the implementation of solutions are required.

Background An important question influencing therapy for dizziness is whether the strengths of the relationships of emotional and functional aspects of dizziness to 1) anxiety and other mental states, 2) perceived state of health (SoH) and quality of life (QoL) are different in patients with and without normal balance control. We attempted to answer this question by examining these dimensions’ regression strengths with Dizziness Handicap Inventory (DHI) scores. Methods We divided 40 patients receiving group cognitive behavioural therapy (CBT) and vestibular rehabilitation for dizziness, into 2 groups: dizziness only (DO) and normal balance control; dizziness and a quantified balance deficit (QBD). Group-wise, we first performed stepwise multivariate regression analysis relating total DHI scores with Brief Symptom Inventory (BSI) sub-scores obtained pre- and post-therapy. Then, regression analysis was expanded to include SoH, QoL, and balance scores. Finally, we performed regressions with DHI sub-scores. Results In both groups, the BSI phobic anxiety state score was selected first in the multivariate regression analysis. In the DO group, obsessiveness/compulsiveness was also selected. The correlation coefficient, R, was 0.74 and 0.55 for the DO and QBD groups, respectively. When QoL and SoH scores were included, R values increased to 0.86 and 0.74, explaining in total 74, and 55% of the DHI variance for DO and QBD groups, respectively. Correlations with balance scores were not significant (R ≤ 0.21). The psychometric scores selected showed the strongest correlations with emotional DHI sub-scores, and perceived QoL and SoH scores with functional DHI sub-scores. Conclusions Our findings suggest that reducing phobic anxiety and obsessiveness/compulsiveness during CBT may improve emotional aspects of dizziness and targeting perceived SoH and QoL may improve functional aspects of dizziness for those with and without normal balance control.

Background Although bedside case presentation contributes to patient-centered care through active patient participation in medical discussions, the complexity of medical information and jargon-induced confusion may cause misunderstandings and patient discomfort. Objective To compare bedside versus outside the room patient case presentation regarding patients' knowledge about their medical care. Design Randomized, controlled, parallel-group trial. (ClinicalTrials.gov: NCT03210987). Setting 3 Swiss teaching hospitals. Patients Adult medical patients who were hospitalized. Intervention Patients were randomly assigned to bedside or outside the room case presentation. Measurements The primary endpoint was patients' average knowledge of 3 dimensions of their medical care (each rated on a visual analogue scale from 0 to 100): understanding their disease, the therapeutic approach being used, and further plans for care. Results Compared with patients in the outside the room group (n = 443), those in the bedside presentation group (n = 476) reported similar knowledge about their medical care (mean, 79.5 points [SD, 21.6] vs. 79.4 points [SD, 19.8]; adjusted difference, 0.09 points [95% CI, -2.58 to 2.76 points]; P = 0.95). Also, an objective rating of patient knowledge by the study team was similar for the 2 groups, but the bedside presentation group had higher ratings of confusion about medical jargon and uncertainty caused by team discussions. Bedside ward rounds were more efficient (mean, 11.89 minutes per patient [SD, 4.92] vs. 14.14 minutes per patient [SD, 5.65]; adjusted difference, -2.31 minutes [CI, -2.98 to -1.63 minutes]; P Limitation Only Swiss hospitals and medical patients were included. Conclusion Compared with outside the room case presentation, bedside case presentation was shorter and resulted in similar patient knowledge, but sensitive topics were more often avoided and patient confusion was higher. Physicians presenting at the bedside need to be skilled in the use of medical language to avoid confusion and misunderstandings. Primary funding source Swiss National Foundation (10531C_ 182422).

Kontakti pacijenata s predstavnicima sustava zdravstva obilježeni su određenom atmosferom. Ovdje će biti predstavljena različita izvorišta takvih atmosfera. Arhitektura dviju ustanova za rehabilitaciju pacijenata i pacijentica s povredama mozga i kičmene moždine (Centar za rehabilitaciju u Baselu i Švicarski centar za paraplegičare u Nottwilu) ilustrira nastojanje arhitekata da u djelo provedu projektne ideje korisnika: dok u Baselu prevladava ideja stalnog navođenja na život u kolicima, arhitektura u Nottwilu predočava poletno raspoloženje koje život u kolicima želi osloboditi strahota. I uređenje liječničkih ordinacija oslikava različite namjere da se obilje- ži atmosfera. U drugom dijelu rada razmatra se pitanje kako nastaju atmosfere tijekom susreta kojem na raspolaganju ne stoji potpora estetskim elementima. Kao izvor atmosferskih utjecaja etablira se unutrašnji svijet stručnjaka i pacijenta, a diskutiraju se i trvenja neprihvaćanjem dogme o unutrašnjem svijetu u Novoj fenomenologiji. Kao pretpostavka za nastajanje kompaktnih atmosferskih prostora navodi se stil vođenja razgovora s fokusom na pacijentu i otvoren i radoznao stav, a ovi se onda ilustriraju primjerima.

Objectives The impact of the quality of discharge communication between physicians and their patients is critical on patients’ health outcomes. Nevertheless, low recall of information given to patients at discharge from emergency departments (EDs) is a well-documented problem. Therefore, we investigated the outcomes and related benefits of two different communication strategies: Physicians were instructed to either use empathy (E) or information structuring (S) skills hypothesizing superior recall by patients in the S group. Methods For the direct comparison of two communication strategies at discharge, physicians were cluster-randomized to an E or a S skills training. Feasibility was measured by training completion rates. Outcomes were measured in patients immediately after discharge, after 7, and 30 days. Primary outcome was patients’ immediate recall of discharge information. Secondary outcomes were feasibility of training implementation, patients’ adherence to recommendations and satisfaction, as well as the patient-physician relationship. Results Of 117 eligible physicians, 80 (68.4%) completed the training. Out of 256 patients randomized to one of the two training groups (E: 146 and S: 119) 196 completed the post-discharge assessment. Patients’ immediate recall of discharge information was superior in patients in the S-group vs. E-group. Patients in the S-group adhered to more recommendations within 30 days (p = .002), and were more likely to recommend the physician to family and friends (p = .021). No differences were found on other assessed outcome domains. Conclusions and practice Implications Immediate recall and subsequent adherence to recommendations were higher in the S group. Feasibility was shown by a 69.6% completion rate of trainings. Thus, trainings of discharge information structuring are feasible and improve patients’ recall, and may therefore improve quality of care in the ED.

Background Since there is sound evidence that communication skills training (CST) programs modify communication behavior of oncology clinicians, they have been widely implemented over the last decades. However, more recently, certain aspects of this training have been criticized. Methods Based on this background, a call to re-launch a discussion about the future of CST led to the third European consensus meeting on communication in cancer care, organized by the Swiss Cancer League. During this meeting, which brought together European experts in the field of clinical communication and training of communication in the oncology setting, oncology clinicians, representatives of the European Society of Medical Oncology and a member of the European Oncology Nursing Society, the recommendations of the second European consensus meeting were updated and expanded. Results The expanded recommendations recall the guiding principles of communication in cancer care, underline the important role of clinician’s self-awareness, and of relational and contextual factors in clinical communication, and provide direction for the further development of communication training. Conclusion This third European consensus meeting defines key elements for the development of a next generation of communication training for oncology clinicians.

BACKGROUND: While the need to address language barriers to provide quality care for all is generally accepted, little is known about the complexities of decision-making around patients’ limited language proficiency in everyday clinical encounters. OBJECTIVE: To understand how linguistic complexities shape cross-cultural encounters by incorporating the perspective of both, patients and physicians. DESIGN: A qualitative hospital study with semi-structured interviews and participant-observation in a Swiss University Hospital. Thirty-two encounters were observed and 94 interviews conducted. PARTICIPANTS: Sixteen patients of Turkish and 16 of Albanian origin and all actors (administration, nurses, physicians, if required, interpreters) involved in the patients’ entire process. MAIN APPROACH: Interviews were audio-recorded and transcribed verbatim. A thematic content analysis was conducted using MAXQDA. For reporting, the COREQ guidelines were used. KEY RESULTS: Three themes were relevant to patients and physicians alike: Assessment of the language situation, the use of interpreters, and dealing with conversational limits. Physicians tend to assess patients’ language proficiency by their body language, individual demeanor, or adequacy of responses to questions. Physicians use professional interpreters for “high-stakes” conversations, and “get by” through “low-stakes” topics by resorting to bilingual family members, for example. Patients are driven by factors like fearing costs or the wish to manage on their own. High acceptance of conversational limits by patients and physicians alike stands in stark contrast to the availability of interpreters. CONCLUSIONS: The decision for or against interpreter use in the “real world” of clinical care is complex and shaped by small, frequently inconspicuous decisions with potential for suboptimal health care. Physicians occupy a key position in the decision-making to initiate the process of medical interpreting. The development and testing of a conceptual framework close to practice is crucial for guiding physicians’ assessment of patients’ language proficiency and their decision-making on the use of interpreting services.

ZusammenfassungEs wird über die Erfahrungen einer Leitergruppe berichtet, die an der letzten Balintwoche in Sils (www.sils-balintwoche.ch) mithilfe von Critical Incident Protokollen (CIP) über konkrete Erfahrungen mit Leiterinterventionen diskutiert hat. Dabei ging es um Momente, in denen Interventionen der Leitung als kritisch erlebt oder vermisst wurden. In den CIP wurden Situationen beschrieben, die den Teilnehmenden in lebhafter Erinnerung geblieben waren, entweder als Leiter einer Gruppe oder als ‚Geleiteter‘. In einem ersten Analyseschritt liessen sich die wesentlichen Probleme in der Leitung der Anfangsphase einer Gruppenarbeit (Fallvorstellung und erste Reaktionen der Teilnehmer) und dem Mittelteil (Arbeiten mit den Assoziationen und Kommentaren der Gruppenmitglieder) zuordnen. Im nächsten Schritt wurden mögliche Leiterinterventionen im Rollenspiel erprobt. Als wesentliches Charakteristikum der Balintarbeit wurde der Umgang mit nicht deterministischem Material, das sich nicht ohne Weiteres kategorial einordnen lässt, herausgearbeitet. Der Leiter hat daher die Aufgabe, vorzeitigen Festlegungen und Interpretationen entgegenzuwirken. Dazu gehört, zunächst und sorgfältig Wahrnehmungen am eigenen Leib entgegenzunehmen (z. B. Kältegefühl, Schwere, Wunsch, tief Luft zu holen), bevor diese in eigentliche Gefühle (z. B. Angst, Trauer) ‚übersetzt‘ und diese dann einzelnen Personen zugeschrieben werden. Hilfreiche Leiterinterventionen stammen aus dem Repertoire einer Gesprächsführung, die den diskursiven Raum offenhält (z. B. Spiegeln, Reflecting Back). Der richtige Zeitpunkt für Leiterinterventionen wurde als ein Moment der Überraschung identifiziert, wenn ein Votum etwas völlig Neues anspricht oder wenn ein widersprüchliches Votum im Gruppenprozess untergeht. Theoretisch einordnen liess sich die Auseinandersetzung mit dem Vagen und Unbestimmten und dennoch unendlich Reichen am ehesten mit dem Begriff der Situation aus der Neuen Phänomenologie, die vom Philosophen Hermann Schmitz entwickelt wurde

We examined whether a program combining cognitive-behavioural therapy (CBT), vestibular rehabilitation (VR) and psychoeducation is equally effective in improving psychometric measures in patients with dizziness independent of a balance deficit. Measures of patients with dizziness only (DO) were compared to those of patients also having a quantified balance deficit (QBD).32 patients (23 female, 9 male) with persistent dizziness were analysed as 2 groups based on stance and gait balance control: those with QBD (pathological balance) or DO (normal balance). Dizziness Handicap Inventory (DHI) and Brief Symptom Inventory (BSI) questionnaires were used pre- and post-therapy to assess psychometric measures. Patients then received the same combination therapy in a group setting.The QBD group mean age was 60.6, SD 8.3, and DO group mean age 44.8, SD 12.1, years. Pre-therapy, questionnaire scores were pathological but not different between groups. Balance improved significantly for the QBD group (p=0.003) but not for the DO group. DHI and BSI scores improved significantly in the DO group (0.001p0.045), some BSI sub-scores reaching normal levels. These scores were unchanged for the QBD group. Phobic anxiety scores changed most for both groups, being significantly correlated with DHI scores, higher (R=0.71 vs. 0.57) for the DO group.A combination of CBT, VR, and psychoeducation improves psychological measures in DO patients but not significantly in QBD patients, despite their balance control improving to near normal. Possibly, greater focus on phobic anxiety during the group therapy program would have improved psychological measures of QBD patient.

ZusammenfassungViele Fallbeispiele in der Balintarbeit haben eine gemeinsame Problemstellung: Habe ich so stimmig kommuniziert, dass ich eine tragfähige Arzt-Patient-Beziehung ermöglicht habe? In diesem Artikel wird ausgehend von einem Konsil bei einer todkranken Patientin und ihrem Ehemann aus der Sicht der Neuen Phänomenologie beschrieben, in welcher Art uns Gefühle begegnen und wie sie dazu beitragen können, ein Miteinander zu etablieren. Typische Probleme bei der Arbeit mit Gefühlen werden benannt: Probleme, sie eindeutig zu beschreiben, die Neigung, ihnen eine Ursache zu unterlegen und ihnen eine Richtung zuzuschreiben (z. B.: „A ist enttäuscht von B wegen …“). Gefühle werden als Atmosphären im Raum dargestellt, die leiblich ergreifen und zunächst ohne Zuordnung in ihrer phänomenologischen Breite und Tiefe gewürdigt werden. Die Liebe wird als ein Beispiel eines nicht notwendig gerichteten Gefühls vorgestellt. Balintarbeit im Allgemeinen und das Aufgreifen von Gefühlen im Besonderen entspricht dem Umgang mit Situationen, die in der Neuen Phänomenologie den Konstellationen (von Einzelnem) gegenübergestellt werden und sich durch ihre chaotische Fülle an Sachverhalten, Programmen und Problemen auszeichnen, die so reich ist, dass sie sich nie vollständig explizieren lässt. Fallarbeit ist primär chaotisch, sie führt in eine Situation und nicht in eine Konstellation tatsächlicher Sachverhalte. Der Flash-Begriff von Enid Balint ist ein Beispiel für das Schöpfen eines lebhaften Eindrucks aus dem Chaotischen, nicht vorhersehbar, nicht planbar und im Einzelnen nicht zu begründen. Das Flash-Phänomen erinnert an den Ersten Eindruck von einem anderen Menschen, der diesen in einem bestimmten Licht erscheinen lässt, wobei man sich seiner Vorstellung vom Anderen sehr sicher sein kann, ohne im Einzelnen angeben zu können, wie man zu dieser Einschätzung kommt.

High prevalence rates of non-authentic complaints identified by experts in the field of insurance medicine draw attention to the risk of services, which are of limited availability and financially compensated, being used in ways that are not goal-oriented. Therefore, symptom validity testing has become a growing issue to prevent non-targeted monetary compensations. This paper outlines the best-evaluated methods and instruments. Based on the data currently available, their validity, in particular in the context of medico-legal assessment, is assessed. It is concluded that symptom validity assessment allows inferences about the degree of certainty of clinical judgements on the authenticity of reported symptoms. Thus, the application of the suggested instruments enhances significantly the quality of medical and psychological expertise. However, the integration of the additional results into the overall assessment is challenging and needs to be further clarified.

Lorsque vous aurez lu cet article, vous penserez plus souvent qu’auparavant qu’une hyperventilation non associee a un trouble panique formel et non detectee jusqu’alors en est peut-etre a l’origine.

Die Qualifikation, die die Arztinnen und Arzte zur Praxis einer Psychosomatischen Medizin befahigt, ist am ehesten als psychosomatische Grund­haltung zu beschreiben, die durch wohlwollende Neugierde, Geduld und Bescheidenheit gepragt ist.

Purpose: We aimed to pilot and evaluate communication skills training (CST) for health care professionals (HCPs) interacting with adolescent patients with cancer and their parents based on particip...

BACKGROUND: Ward rounds are important for communicating with patients, but it is unclear whether bedside or non-bedside case presentation is the better approach. METHODS: We conducted a comprehensive search up to July 2018 to identify randomized controlled trials (RCTs) comparing bedside and non-bedside case presentations. Data was abstracted independently by two researchers and study quality was assessed using the Cochrane Risk of Bias Tool. Our primary outcome was patient’s satisfaction with ward rounds. Our main secondary outcome was patient’s understanding of disease and the management plan. RESULTS: Among 1647 identified articles, we included five RCTs involving 655 participants with overall moderate trial quality. We found no difference in having low patient’s satisfaction between bedside and non-bedside case presentations (risk ratio [RR], 0.85; 95% CI, 0.66 to 1.09). We also found no impact on patient’s understanding of their disease and management plan (RR, 0.92; 95% CI, 0.67 to 1.28). Trial sequential analysis (TSA) indicated low power of our main analysis. DISCUSSION: We found no differences in patient-relevant outcomes between bedside and non-bedside case presentations with a lack of statistical power among current trials. There is a need for larger studies to find the optimal approach to patient case presentation during ward rounds. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-018-4714-1) contains supplementary material, which is available to authorized users.

On presente couramment Noel comme une fete de l’amour. Mais l’amour est un concept extremement proteiforme, dont la fete de Noel, si on la reduit exclusivement a la joie de recevoir un cadeau, ne peut selon moi exprimer toute la profondeur. Aussi serait-il peut-etre plus pertinent d’associer la fete de Noel a la joie.

Weihnachten wird propagiert als Fest der Liebe. Liebe ist allerdings ein ausgesprochen vielseitiger Begriff, dessen mogliche Tiefe gerade zum Weihnachtsfest aus meiner Sicht verstellt ist durch die Engfuhrung auf die Freude ausschliesslich uber ein Geschenk. Von daher ware vielleicht eine Zuordnung des Weihnachtsfestes zur Freude eher hilfreich.

Die Neue Phanomenologie von Hermann Schmitz nutzt die im ­Deutschen mogliche Unterscheidung der Begriffe Leib und Korper, um ein eigentliches Alphabet des Leibes zu formulieren. Prazise Begriffe ermoglichen einen fruchtbaren Dialog mit „Korper“- oder – zutreffender formuliert – „Leib“-orientierten ­Therapieverfahren. ­Nonverbales miteinander Agieren und das Aufnehmen von ­Atmospharen lassen sich als grundsatzliche leibliche Formen der Kommunikation verstehen und nutzen.

Background In todays’ super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities. It is crucial to better understand the difficulties patients with migration background and healthcare professionals experience in their shared clinical encounters and to explore ethical aspects involved. Methods We accompanied 32 migrant patients (16 of Albanian and Turkish origin each) during their medical encounters at two outpatient clinics using an ethnographic approach (participant observation and semi-structured interviews with patients and healthcare professionals). Overall, data of 34 interviews with patients and physicians on how they perceived their encounter and which difficulties they experienced are presented. We contrasted the perspectives on the difficult aspects and explore ethical questions surrounding the involved issues. Results Patients and physicians describe similar problem areas, but they have diverging perspectives on them. Two main themes were identified by both patients and physicians: >patients’ behaviour in relation to doctors’ advice< and > relationship issues

We investigated the effects of information structuring and its potential interaction with pre-existing medical knowledge on recall in a simulated discharge communication.127 proxy-patients (i.e. students) were randomly assigned to one of four conditions. Video vignettes provided identical information, differing in means of information structuring only: The natural conversation (NC) condition was not explicitly structured whereas the structure (S) condition presented information organised by chapter headings. The book metaphor (BM) and the post organizer (PO) conditions also presented structured information but in addition included a synopsis, either at the beginning or at the end of discharge communication, respectively. Proxy-patients' recall, perception of quality and pre-existing medical knowledge were assessed.Information structuring (conditions: S, BM, PO) did not increase recall in comparison to NC, but pre-existing medical knowledge improved recall (p .01). An interaction between medical knowledge and recall in the BM condition was found (p = .02). In comparison to the NC, proxy-patients in all information structuring conditions more strongly recommended the physician (p .001).Structured discharge communication complemented by the BM is beneficial in individuals with lower pre-existing medical knowledge.The lower pre-existing medical knowledge, the more recipients will profit from information structuring with the BM.

Kontakti pacijenata s predstavnicima sustava zdravstva obilježeni su određenom atmosferom. Ovdje će biti predstavljena različita izvorišta takvih atmosfera. Arhitektura dviju ustanova za rehabilitaciju pacijenata i pacijentica s povredama mozga i kičmene moždine (Centar za rehabilitaciju u Baselu i Švicarski centar za paraplegičare u Nottwilu) ilustrira nastojanje arhitekata da u djelo provedu projektne ideje korisnika: dok u Baselu prevladava ideja stalnog navođenja na život u kolicima, arhitektura u Nottwilu predočava poletno raspoloženje koje život u kolicima želi osloboditi strahota. I uređenje liječničkih ordinacija oslikava različite namjere da se obilje- ži atmosfera. U drugom dijelu rada razmatra se pitanje kako nastaju atmosfere tijekom susreta kojem na raspolaganju ne stoji potpora estetskim elementima. Kao izvor atmosferskih utjecaja etablira se unutrašnji svijet stručnjaka i pacijenta, a diskutiraju se i trvenja neprihvaćanjem dogme o unutrašnjem svijetu u Novoj fenomenologiji. Kao pretpostavka za nastajanje kompaktnih atmosferskih prostora navodi se stil vođenja razgovora s fokusom na pacijentu i otvoren i radoznao stav, a ovi se onda ilustriraju primjerima., Contacts between patients and health system representatives are marked by a certain atmosphere. In this paper, different sources of this kind of atmospheres will be presented. The architecture of two institutions for the rehabilitation of patients with brain and spinal cord injuries (Centre for rehabilitation in Basel and Swiss Centre for paraplegics in Nottwil) illustrates the architect’s intentions to implement customer ideas. In Basel, the idea of continuous learning about living a life in wheelchair dominates the composition, while the architecture in Nottwil represents an enthusiastic spirit which attempts to free the life in wheelchairs from fear. The internal design of medical offices and dispensaries also reflects different intentions that articulate atmospheres. In the second part of the paper, the question is posed about how atmospheres are created in situations in which there is a lack of aesthetical elements that can support it. As the source of atmospheric influences, we find the inner world of experts and patients, but the discussion will also be about the conflicts that are results of New phenomenology not accepting the dogma of the inner world. Finally, the paper discusses and provides examples for prerequisites for creating compact atmospheric spaces, one of them being a style of leading a dialogue with a special focus on a patient and open-minded and curious attitude., La relation que le patient entretient avec les représentants du système de santé est déterminée par une atmosphère bien spécifique. Ici seront présentées les différentes sources de ces atmosphères. L’architecture de deux institutions (les centres suisses de réadaptation basés à Bâle et à Nottwil) pour la réadaptation des patients et des patientes présentant des lésions cérébrales et des lésions de la moelle épinière illustrent la volonté des architectes de mettre en œuvre les idées des projets des utilisateurs : alors que le centre de Bâle encourage la réinsertion continue en société des patients en fauteuil roulant, l’architecture de Nottwil offre un climat rassurant afin de leur permettre de se défaire de la peur d’une vie en fauteuil roulant. La configuration des cabinets médicaux révèle également les nombreuses intentions de créer une certaine atmosphère. Dans la seconde partie de ce travail sera analysée la question qui touche à la manière dont les atmosphères émergent au sein d’une rencontre qui ne dispose pas de l’appui d’éléments esthétiques. Le monde intérieur qui réunit les spécialistes et les patients est reconnu en tant que l’une des sources d’atmosphères qui exercent une influence, et seront ainsi discutées les tensions issues du refus d’accepter les dogmes du monde intérieur dans la Nouvelle Phénoménologie. La manière de mener des discussions, avec un accent mis sur le patient et sur une attitude qui favorise l’ouverture et la curiosité, constitue la présupposition pour qu’émergent des espaces atmosphériques compacts, discussions qui seront ensuite illustrées par des exemples., Kontakte von Patienten mit Vertretern des Gesundheitssystems sind von einer bestimmten Atmosphäre geprägt. Unterschiedliche Quellen solcher Atmosphären werden vorgestellt. Die Architektur von zwei Rehabilitationseinrichtungen für Patienten und Patientinnen mit Rückenmarks- und Hirnverletzungen (Reha Basel und Schweizer Paraplegiker-Zentrum in Nottwil) verdeutlicht das Bemühen der Architektinnen, die Vorgaben der Bauherrschaft umzusetzen: Während in Basel der Gedanke eines langsamen Heranführens an das Leben im Rollstuhl vorherrscht, vermittelt die Architektur in Nottwil eine Aufbruchsstimmung, die dem Leben im Rollstuhl seine Schrecken nehmen will. Auch die Einrichtung von Praxisräumen widerspiegelt unterschiedliche Absichten, Atmosphäre zu prägen. Im zweiten Teil der Arbeit geht es um die Frage, wie Atmosphären in einer Begegnung entstehen, die nicht auf die Unterstützung ästhetischer Elemente zurückgreifen kann. Als Quelle atmosphärischer Prägungen wird die innere Welt von Fachperson und Patient etabliert, Reibungen mit der Ablehnung des Innenwelt-Dogmas in der Neuen Phänomenologie werden diskutiert. Als Voraussetzung für das Entstehen dichter atmosphärischer Räume wird eine Patienten-zentrierte Gesprächsführung und eine offene und neugierige Haltung benannt und an Beispielen erläutert.

BACKGROUND Movements may be generated consistent with imagining one's own body transformed or "disembodied" to a new position. Based on this concept we hypothesized that patients with objective balance deficits (obj-BD) would have altered neural transformation processes executing own body transformation (OBT) with functional consequences on balance control. Also we examined whether feeling unstable due to dizziness only (DO), without an obj-BD, also lead to an impaired OBT. METHODS 32 patients with chronic dizziness were tested: 16 patients with obj-BD as determined by balance control during a sequence of stance and gait tasks, 16 patients with dizziness only (DO). Patients and 9 healthy controls (HCs) were asked to replicate roll trunk movements of an instructor in a life size video: first, with spontaneously copied (SPO) or "embodied" egocentric movements (lean when the instructor leans); second, with "disembodied" or "transformed" movements (OBT) with exact replication - lean left when the instructor leans left. Onset latency of trunk roll, rise time to peak roll angle (interval), roll velocity, and amplitude were measured. RESULTS SPO movements were always mirror-imaged. OBT task latencies were significantly longer and intervals shorter than for SPO tasks (p

SUMMARYAims – To assess the quality of communication generally two procedures are used: one defines categories of utterances and counts their frequency, the other uses global observer ratings. We investigated whether a sequence analysis of utterances yields results which more precisely reflect the process of a conversation. Methods – We re-examined data from a randomised controlled intervention study in which residents' interviews with simulated patients were analysed with the Maastricht History and Advice Checklist (MAAS-R) and the Roter Interaction Analysis System (RIAS). Using the U-file of the RIAS we studied the effect of different types of physician questions (open, closed questions, facilitators, other physician actions) on the length of uninterrupted patients' speech and content of utterances. We investigated also whether reciprocity indices improve after a communication skills training, and whether they correlate with global scores form MAAS-R. Results – Patients respond to a closed question with a mean of 1.78 (± 1.49) utterances as compared to 2.75 (± 2.72) utterances after an open question. The likelihood of a concern was more than lOfold higher after an open question compared to closed questions. Reciprocal sequences make up less than 2 percent of the conversation, Still, they correlate with global items form MAAS-R. The 'empathy index' improves after the training.Declararation of Interest: preparation of the manuscript was supported by a grant from OncoSuisse.

High prevalence rates of non-authentic complaints identified by experts in the field of insurance medicine draw attention to the risk of services, which are of limited availability and financially compensated, being used in ways that are not goal-oriented. Therefore, symptom validity testing has become a growing issue to prevent non-targeted monetary compensations. This paper outlines the best-evaluated methods and instruments. Based on the data currently available, their validity, in particular in the context of medico-legal assessment, is assessed. It is concluded that symptom validity assessment allows inferences about the degree of certainty of clinical judgements on the authenticity of reported symptoms. Thus, the application of the suggested instruments enhances significantly the quality of medical and psychological expertise. However, the integration of the additional results into the overall assessment is challenging and needs to be further clarified.