Developing a Culture of Successful Communication in Acute Care Settings: Part II. Solving Institutional Issues.

Purpose: Establishing services for hospitalized patients with complex communication needs (CCNs) requires identifying and addressing both patient-based and institutional barriers. Although the previous paper (Marshall & Hurtig, 2019) focused on patient-based barriers, this paper addresses overcoming institutional barriers.

Method: We present a series of cases to illustrate the institutional challenges in meeting the CCNs of patients in an acute care setting.

Developing a Culture of Successful Communication in Acute Care Settings: Part I. Solving Patient-Specific Issues.

Purpose: Establishing services for hospitalized patients with complex communication needs requires identifying and addressing both patient-based and institutional barriers. In this 1st article, we focus on overcoming patient-based barriers. The companion paper (Marshall & Hurtig, 2019) addresses overcoming institutional barriers.

Forum on Augmentative and Alternative Communication in Acute Care.

This forum provides some insights into the process of initiating a clinical service to enhance patient- provider communication. It also provides a report of a large-scale clinical trial that introduced augmentative and alternative communication (AAC) tools in an acute-care setting.

Improving Patient Safety and Patient-Provider Communication.

Purpose: Many hospitalized patients experience barriers to effective patient-provider communication that can negatively impact their care. These barriers include difficulty physically accessing the nurse call system, communicating about pain and other needs, or both. For many patients, these barriers are a result of their admitting condition and not of an underlying chronic disability.

The role of maternal psychosocial perceptions in parent-training programs: a preliminary randomized controlled trial.

Parent-child interaction is critical for early language and literacy development. Parent training programs have proliferated to support early interactions. However, many environmental and psychosocial factors can impact the quality of parent-child language and literacy interactions as well as training program outcomes.

The cost of not addressing the communication barriers faced by hospitalized patients.

Preventable adverse events (AEs) lead to poorer patient outcomes, added patient suffering and dissatisfaction, longer hospital stays, and billions in additional annual healthcare spending. Patients facing barriers to communication are three times more likely to experience a preventable adverse event than patients who faced no communication barriers. National data on hospital admissions, incidence and cost of preventable AEs, and the odds ratio regarding the risk of preventable AEs in people facing communication barriers were used to estimate potential benefits of improving patient communication.

Technology-enhanced shared reading with deaf and hard-of-hearing children: the role of a fluent signing narrator.

Early shared reading experiences have been shown to benefit normally hearing children. It has been hypothesized that hearing parents of deaf or hard-of-hearing children may be uncomfortable or may lack adequate skills to engage in shared reading activities. A factor that may contribute to the widely cited reading difficulties seen in the majority of deaf children is a lack of early linguistic and literacy exposure that come from early shared reading experiences with an adult who is competent in the language of the child.

Digital noise reduction: outcomes from laboratory and field studies.

The purpose of this study was to determine the impact of a digital noise reduction (DNR) scheme implemented in a current commercial hearing aid. In a double-blinded design, three conditions of onset time (4, 8, 16 seconds) were randomly assigned to the 25 subjects, plus one condition wherein the noise-reduction feature was disengaged. Subsequently, a fifth trial/condition, wherein the subject had access to three memories in which the different onsets were programmed, was carried out.

Imitative production of rising speech intonation in pediatric cochlear implant recipients.

Purpose: This study investigated the acoustic characteristics of pediatric cochlear implant (CI) recipients' imitative production of rising speech intonation, in relation to the perceptual judgments by listeners with normal hearing (NH).

Method: Recordings of a yes-no interrogative utterance imitated by 24 prelingually deafened children with a CI were extracted from annual evaluation sessions. These utterances were perceptually judged by adult NH listeners in regard with intonation contour type (non-rise, partial-rise, or full-rise) and contour appropriateness (on a 5-point scale).

Augmentative and alternative communication.

With the help of a knowledgeable interdisciplinary team, individuals can find the best AAC system to meet their needs and enrich their quality of life. A new-found ability to communicate often significantly improves a person's overall prognosis and may prevent serious problems in the areas of behavior, learning, reading, and social development. However, because an AAC system is just one component of multimodal communication, it should not inhibit the use of speech by individuals who have some usable or functional speech.

Effects of smoking marijuana on brain perfusion and cognition.

The effects of smoking marijuana on regional cerebral blood flow (rCBF) and cognitive performance were assessed in 12 recreational users in a double-blinded, placebo-controlled study. PET with [(15)Oxygen]-labeled water ([(15)O]H(2)O) was used to measure rCBF before and after smoking of marijuana and placebo cigarettes, as subjects repeatedly performed an auditory attention task. Smoking marijuana resulted in intoxication, as assessed by a behavioral rating scale, but did not significantly alter mean behavioral performance on the attention task.

Effects of frequent marijuana use on memory-related regional cerebral blood flow.

It is uncertain whether frequent marijuana use adversely affects human brain function. Using positron emission tomography (PET), memory-related regional cerebral blood flow was compared in frequent marijuana users and nonusing control subjects after 26+ h of monitored abstention. Memory-related blood flow in marijuana users, relative to control subjects, showed decreases in prefrontal cortex, increases in memory-relevant regions of cerebellum, and altered lateralization in hippocampus.

Acute marijuana effects on rCBF and cognition: a PET study.

The effects of smoking marijuana on cognition and brain function were assessed with PET using H2(15)O. Regional cerebral blood flow (rCBF) was measured in five recreational users before and after smoking a marijuana cigarette, as they repeatedly performed an auditory attention task. Blood flow increased following smoking in a number of paralimbic brain regions (e.

Cerebellar hypoactivity in frequent marijuana users.

It is uncertain whether frequent marijuana use adversely affects human brain function. Using PET, regional cerebral blood flow was compared in frequent marijuana users and comparable, non-using controls after at least 26 h of monitored abstention by all subjects. Marijuana users showed substantially lower brain blood flow than controls in a large region of posterior cerebellum, indicating altered brain function in frequent marijuana users.

Proportional frequency compression of speech for listeners with sensorineural hearing loss.

This study examined proportional frequency compression as a strategy for improving speech recognition in listeners with high-frequency sensorineural hearing loss. This method of frequency compression preserved the ratios between the frequencies of the components of natural speech, as well as the temporal envelope of the unprocessed speech stimuli. Nonsense syllables spoken by a female and a male talker were used as the speech materials.

Construction of a whole body blood flow model for use in positron emission tomography imaging with [15O]water.

A whole body blood flow model (WBBFM) was developed and tested using STELLA II, an icon-driven mathematical simulation software package. The WBBFM uses parallel chambers to represent gray and white areas of the brain, body organs such as lungs, heart (right and left halves), injection site, and blood sampling sites. Input values to the WBBFM include organ blood flows, organ volumes, tissue:blood partition coefficients, injected activity, and data acquisition times for a positron emission tomography (PET) camera.

Auditory and visual attention assessed with PET.

Brain mechanisms involved in the maintenance of attention to auditory and visual stimuli at different spatial locations were assessed using positron emission tomography with [15O]water to measure regional cerebral blood flow (rCBF) changes in 13 normal volunteers. Simultaneous auditory [dichotically presented consonant-vowel-consonants (CVCs)] and visual stimuli (vertically oriented, CVCs presented to the left and right of fixation) were presented on every trial. In different conditions subjects attended for targets in a specified stimulus channel (left or right ears or left or right visual fields) while maintaining fixation on a central x.

Auditory attentional deficits in patients with schizophrenia. A positron emission tomography study.

Background: Patients with schizophrenia have frequently been found to perform poorly on tasks requiring selective attention, defined as the ability to focus attention on relevant information while simultaneously ignoring irrelevant stimuli. This study explores the brain mechanisms mediating attentional processing in patients with schizophrenia by measuring their regional cerebral blood flow (rCBF) with positron emission tomography using [15O] water as they performed tasks that differed systematically in attentional demand.

Methods: Ten schizophrenic patients (either neurolepticnaive or withdrawn from medication) (patient group) and 10 normal volunteers (control group) performed auditory target detection tasks.

A positron emission tomography study of binaurally and dichotically presented stimuli: effects of level of language and directed attention.

Regional cerebral blood flow (rCBF) was measured using positron emission tomography with oxygen- 15 labeled water as 10 normal subjects listened to three types of auditory stimuli (environmental sounds, meaningless speech, and words) presented binaurally or dichotically. Binaurally presented environmental sounds and words caused similar bilateral rCBF increases in left and right superior temporal gyri. Dichotically presented stimuli (subjects attended to left or right ears) caused asymmetric activation in the temporal lobes, resulting from increased rCBF in temporal lobe regions contralateral to the attended ear and decreased rCBF in the opposite hemisphere.

Neural substrates of facial recognition.

Seventeen healthy normal volunteers performed three facial recognition tasks while their cerebral blood flow was measured with PET: categorizing faces according to gender, recognizing new faces, and recognizing familiar faces. These tasks activated three different pathways: respectively, the left inferior temporal lobe and left frontal cortex; a predominantly right frontal-right parietal-left cerebellar network; and left lingual and left and right fusiform gyri. These results suggest that humans use different brain regions in performing these three routine daily activities.

Short-term and long-term verbal memory: a positron emission tomography study.

Short-term and long-term retention of experimentally presented words were compared in a sample of 33 healthy normal volunteers by the [15O]H2O method with positron emission tomography (PET). The design included three conditions. For the long-term condition, subjects thoroughly studied 18 words 1 week before the PET study.

Effects of timing and duration of cognitive activation in [15O]water PET studies.

The multiple injection [15O]water method offers unique opportunities for studying cognitive processing by the human brain. The influence of the duration and temporal placement of an activation task, in relation to the arrival of the radiotracer in the brain, is a fundamental methodologic question for cognitive activation studies. A quantitative positron emission tomography (PET) study of five normal volunteers was performed in which the stimulation consisted of a visual activation task (alternating checkerboard pattern) superimposed on an auditory baseline task (syllable monitoring).

Dual isotope brain SPECT imaging for monitoring cognitive activation: initial studies in humans.

A dual isotope, single photon emission tomography (SPECT) technique using 99Tcm-hexamethylpropyleneamine oxime (HMPAO) and 123I-iodoamphetamine (IMP) was investigated to determine its suitability for assessing regional cerebral blood flow (rCBF) changes resulting from cognitive activation. The similarity of the 123I-IMP and 99Tcm-HMPAO distributions under the same physiological conditions was first investigated by administering the two agents to human subjects (n = 8) either simultaneously or at different times but during the performance of the same task. Normalized ratio images generated from the 99Tcm and 123I data showed that the two tracers distributed similarly in the left and right cerebral hemispheres when administered under similar physiological conditions.

The use of static and dynamic vowel cues by multichannel cochlear implant users.

Multichannel cochlear implant users vary greatly in their word-recognition abilities. This study examined whether their word recognition was related to the use of either highly dynamic or relatively steady-state vowel cues contained in /bVb/ and /wVb/ syllables. Nine conditions were created containing different combinations of formant transition, steady-state, and duration cues.

A system for measurement of prosthetic eye movements using a magnetic search coil technique.

We describe the use of a magnetic search coil technique for measuring the movement of prosthetic eyes. The technique allows for accurate comparison of implant designs and surgical techniques.