Patient safety and communication: A new assessment for doctors trained in countries where language differs from that of the host country: Results of a pilot using a domain-based assessment

Objective

Global migration of healthcare workers places responsibility on employers to comply with legal employment rights whilst ensuring patient safety remains the central goal. We describe the pilot of a communication assessment designed for doctors who trained and communicated with patients and colleagues in a different language from that of the host country. It is unique in assessing clinical communication without assessing knowledge.

A 14-station OSCE was developed using a domain-based marking scheme, covering professional communication and English language skills (speaking, listening, reading and writing) in routine, acute and emotionally challenging contexts, with patients, carers and healthcare teams. Candidates (n = 43), non-UK trained volunteers applying to the UK Foundation Programme, were provided with relevant station information prior to the exam.

The criteria for passing the test included achieving the pass score and passing 10 or more of the 14 stations. Of the 43 candidates, nine failed on the station criteria. Two failed the pass score and also the station criteria. The Cronbach's alpha coefficient was 0.866.

This pilot tested ‘proof of concept’ of a new domain-based communication assessment for non-UK trained doctors.

The test would enable employers and regulators to verify communication competence and safety in clinical contexts, independent of clinical knowledge, for doctors who trained in a language different from that of the host country.

A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer: study protocol

Aim
To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance.

Background
Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy.

Design
A critical ethnographic design will be used, incorporating non-participant observations, individual semi-structured and focus-group interviews as several collecting methods.

Methods
Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012).

Discussion
Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy.

Polarization Distortion as a Means for Securing Wireless Communication

This paper presents a simple polarization encoding strategy that operates using only single element dual port transmit and receive antennas in such a way that selective spatial scrambling of QPSK data can be effected. The key transmitter and receiver relationships needed for this operation to occur are derived. The system is validated using a cross dipole antenna arrangement. Unlike all previously reported physical layer wireless solutions the approach developed in this paper transfers the security property to the receive side resulting in very simple transmit and receive side architectures thus avoiding the need for near field modulated array technology. In addition the scheme permits, for the first time, multiple spatially separated secured receive sites to operate in parallel.

Secure D2D Communication in Large-Scale Cognitive Cellular Networks with Wireless Power Transfer

In this paper, we investigate secure device-to-device (D2D) communication in energy harvesting large-scale cognitive cellular networks. The energy constrained D2D transmitter harvests energy from multi-antenna equipped power beacons (PBs), and communicates with the corresponding receiver using the spectrum of the cellular base stations (BSs). We introduce a power transfer model and an information signal model to enable wireless energy harvesting and secure information transmission. In the power transfer model, we propose a new power transfer policy, namely, best power beacon (BPB) power transfer. To characterize the power transfer reliability of the proposed policy, we derive new closed-form expressions for the exact power outage probability and the asymptotic power outage probability with large antenna arrays at PBs. In the information signal model, we present a new comparative framework with two receiver selection schemes: 1) best receiver selection (BRS), and 2) nearest receiver selection (NRS). To assess the secrecy performance, we derive new expressions for the secrecy throughput considering the two receiver selection schemes using the BPB power transfer policies. We show that secrecy performance improves with increasing densities of PBs and D2D receivers because of a larger multiuser diversity gain. A pivotal conclusion is reached that BRS achieves better secrecy performance than NRS but demands more instantaneous feedback and overhead.

General practitioners perceptions on advance care planning for patients living with dementia

BACKGROUND: Advance care planning (ACP) facilitates communication and understanding of preferences, nevertheless the use of ACPs in primary care is low. The uncertain course of dementia and the inability to communicate with the patient living with dementia are significant challenges for GPs to initiate discussions on goals of care.

METHODS: A cross-sectional survey, using a purposive, cluster sample of GPs across Northern Ireland with registered dementia patients was used. GPs at selected practices received the survey instrument and up to four mail contacts was implemented.

RESULTS: One hundred and thirty-three GPs (40.6%) participated in the survey, representing 60.9% of surveyed practices. While most respondents regarded dementia as a terminal disease (96.2%) only 37.6% felt that palliative care applied equally from the time of diagnosis to severe dementia. While most respondents thought that early discussions would facilitate decision-making during advanced dementia (61%), respondents were divided on whether ACP should be initiated at the time of diagnoses. While most respondents felt that GPs should take the initiative to introduce and encourage ACP, most survey participants acknowledged the need for improved knowledge to involve families in caring for patients with dementia at the end of life and that a standard format for ACP documentation was needed.

CONCLUSION: Optimal timing of ACP discussions should be determined by the readiness of the patient and family carer to face to face end of life. ACP discussions can be enhanced by educational strategies directed towards the patient and family carer that enable shared decision-making with their GP when considering options in future care.

Cross-layer Energy-Efficiency Optimization of Packet Based Wireless MIMO Communication Systems

Energy in today's short-range wireless communication is mostly spent on the analog- and digital hardware rather than on radiated power. Hence,purely information-theoretic considerations fail to achieve the lowest energy per information bit and the optimization process must carefully consider the overall transceiver. In this paper, we propose to perform cross-layer optimization, based on an energy-aware rate adaptation scheme combined with a physical layer that is able to properly adjust its processing effort to the data rate and the channel conditions to minimize the energy consumption per information bit. This energy proportional behavior is enabled by extending the classical system modes with additional configuration parameters at the various layers. Fine grained models of the power consumption of the hardware are developed to provide awareness of the physical layer capabilities to the medium access control layer. The joint application of the proposed energy-aware rate adaptation and modifications to the physical layer of an IEEE802.11n system, improves energy-efficiency (averaged over many noise and channel realizations) in all considered scenarios by up to 44%.

MIMO cooperative communication network design with relay selection and CSI feedback

In this paper, we investigate an amplify-and-forward (AF) multiple-input multiple-output - spatial division multiplexing (MIMO-SDM) cooperative wireless networks, where each network node is equipped with multiple antennas. In order to deal with the problems of signal combining at the destination and cooperative relay selection, we propose an improved minimum mean square error (MMSE) signal combining scheme for signal recovery at the destination. Additionally, we propose two distributed relay selection algorithms based on the minimum mean squared error (MSE) of the signal estimation for the cases where channel state information (CSI) from the source to the destination is available and unavailable at the candidate nodes. Simulation results demonstrate that the proposed combiner together with the proposed relay selection algorithms achieve higher diversity gain than previous approaches in both flat and frequency-selective fading channels.

Plain English: Applying Principles to Home School Written Communication Considering Diverse Families

Schools attempting to engage with the families of all learners, including those with culturally and linguistically diverse backgrounds recognize the importance of effective oral and written communication. The aim of this study is to determine if school generated written communication created by an urban school district serving a culturally and linguistically diverse population in the Northeast of the US adhered to the principles of plain English. This exploratory research examined exemplar pieces of written school generated communication, using different forms of linguistic analysis to determine whether the communication contained elements recognized to facilitate or impede the comprehensibility of each piece of communication. Additionally, a text assessment tool which can help schools to analyze the written text communication they send to families was developed and refined.

Frequency Diverse Array OFDM Transmitter for Secure Wireless Communication

In this reported work, the frequency diverse array concept is employed to construct an orthogonal frequency-division multiplexing (OFDM) transmitter that has the capability of securing wireless communication in free space directly in the physical-layer without the need for mathematical encryption. The characteristics of the proposed scheme in terms of its secrecy performance are validated via bit error rate simulation under both high and low signal to noise ratio scenarios using the IEEE 802.11 OFDM physical-layer specification.

'Talk to me': a mixed methods study on preferred physician behaviours during end-of-life communication from the patient perspective

Background
Despite the recognized importance of end-of-life (EOL) communication between patients and physicians, the extent and quality of such communication is lacking.

Objective
We sought to understand patient perspectives on physician behaviours during EOL communication.

Design
In this mixed methods study, we conducted quantitative and qualitative strands and then merged data sets during a mixed methods analysis phase. In the quantitative strand, we used the quality of communication tool (QOC) to measure physician behaviours that predict global rating of satisfaction in EOL communication skills, while in the qualitative strand we conducted semi-structured interviews. During the mixed methods analysis, we compared and contrasted qualitative and quantitative data.

Setting and Participants
Seriously ill inpatients at three tertiary care hospitals in Canada.

Results
We found convergence between qualitative and quantitative strands: patients desire candid information from their physician and a sense of familiarity. The quantitative results (n = 132) suggest a paucity of certain EOL communication behaviours in this seriously ill population with a limited prognosis. The qualitative findings (n = 16) suggest that at times, physicians did not engage in EOL communication despite patient readiness, while sometimes this may represent an appropriate deferral after assessment of a patient's lack of readiness.

Conclusions
Avoidance of certain EOL topics may not always be a failure if it is a result of an assessment of lack of patient readiness. This has implications for future tool development: a measure could be built in to assess whether physician behaviours align with patient readiness.