Oncology clinicians' defenses and adherence to communication skills training with simulated patients: an exploratory study.

The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms-defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient-on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N = 31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6 months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29) = 5.26, p = 0.03, d = 0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care [1]. Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout [4]. Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information [5]. While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper [8], CSTs need to be taught in small groups (up to 10-12 participants) and have a minimal duration of at least 3 days in order to be effective. Several systematic reviews evaluated the impact of CST on clinicians' communication skills [9-11]. Effectiveness of CST can be assessed by two main approaches: participant-based and patient-based outcomes. Measures can be self-reported, but, according to Gysels et al. [10], behavioral assessment of patient-physician interviews [12] is the most objective and reliable method for measuring change after training. Based on 22 studies on participants' outcomes, Merckaert et al. [9] reported an increase of communication skills and participants' satisfaction with training and changes in attitudes and beliefs. The evaluation of CST remains a challenging task and variables mediating skills improvement remain unidentified. We recently thus conducted a study evaluating the impact of CST on clinicians' defenses by comparing the evolution of defenses of clinicians participating in CST with defenses of a control group without training [13]. Defenses are unconscious psychological processes which protect from anxiety or distress. Therefore, they contribute to the individual's adaptation to stress [14]. Perry refers to the term "defensive functioning" to indicate the degree of adaptation linked to the use of a range of specific defenses by an individual, ranging from low defensive functioning when he or she tends to use generally less adaptive defenses (such as projection, denial, or acting out) to high defensive functioning when he or she tends to use generally more adaptive defenses (such as altruism, intellectualization, or introspection) [15, 16]. Although several authors have addressed the emotional difficulties of oncology clinicians when facing patients and their need to preserve themselves [7, 17, 18], no research has yet been conducted on the defenses of clinicians. For example, repeated use of less adaptive defenses, such as denial, may allow the clinician to avoid or reduce distress, but it also diminishes his ability to respond to the patient's emotions, to identify and to respond adequately to his needs, and to foster the therapeutic alliance. Results of the above-mentioned study [13] showed two groups of clinicians: one with a higher defensive functioning and one with a lower defensive functioning prior to CST. After the training, a difference in defensive functioning between clinicians who participated in CST and clinicians of the control group was only showed for clinicians with a higher defensive functioning. Some clinicians may therefore be more responsive to CST than others. To further address this issue, the present study aimed to evaluate the relationship between the level of adherence to an "ideally conducted interview", as defined by the teachers of the CST, and the level of the clinician' defensive functioning. We hypothesized that, after CST, clinicians with a higher defensive functioning show a greater adherence to the "ideally conducted interview" than clinicians with a lower defensive functioning.

Processes and consequences in business ethical dilemmas: The oil industry and climate changes

This paper proposes a framework to examine business ethical dilemmas andbusiness attitudes towards such dilemmas. Business ethical dilemmas canbe understood as reflecting a contradiction between a socially detrimentalprocess and a self-interested profitable consequence. This representationallows us to distinguish two forms of behavior differing by whetherpriority is put on consequences or on processes. We argue that theseforms imply very different business attitudes towards society:controversial or competitive for the former and aligned or cooperativefor the latter. These attitudes are then analyzed at the discursive level in order to address the question of good faith in businessargumentation, i.e. to which extent are these attitudes consistent withactual business behaviors. We argue that consequential attitudes mostlyinvolve communication and lobbying actions aiming at eluding the dilemma.Therefore, the question of good faith for consequential attitudes liesin the consistency between beliefs and discourse. On the other hand,procedural attitudes acknowledge the dilemma and claim a change of theprocess of behavior. They thus raise the question of the consistencybetween discourses and actual behavior. We apply this processes/consequencesframework to the case of the oil industry s climate change ethical dilemmawhich comes forth as a dilemma between emitting greenhouse gases and making more profits . And we examine the different attitudes of two oilcorporations-BP Amoco and ExxonMobil-towards the dilemma.

Communication skills training and clinicians' defenses in oncology: an exploratory, controlled study.

Objective: The underlying mechanisms modifying clinician's communication skills by means of communication skills training (CST) remain unknown. Defense mechanisms, defined as psychological processes protecting the individual against emotional stress, may be a mediating factor of skills improvement.Methods: Using an adapted version of the Defense Mechanism Rating Scale-Clinician, this study evaluated clinicians' defense mechanisms and their possible modification after CST. Interviews with simulated patients of oncology clinicians (N=57) participating in CST (pre-/post-CST with a 6-month interval) were compared WITH interviews with the same simulated patients of oncology clinicians (N=56) who did not undergo training (T1 and T2 with a 6-month interval).Results: Results showed (i) a high number (mean=16, SD=6) and variety of defenses triggered by the 15-min interviews, (ii) no evolution difference between groups, and (iii) an increase in mature defenses after CST for clinicians with an initial higher level of defensive functioning.Conclusions: This is the first study describing clinicians' defensive functioning; results indicate a possible mediating role of defenses in clinician-patient communication.

Electronic journals, scholarly communication and libraries

The recent surge in scientific electronic journals began when libraries began having access to the WWW in the mid-1990s. The shift from paper to digital has affected the traditional alignment and role of the primary "stakeholders" -mainly authors, publishers, universities and libraries. The author offers a brief review of the history of the scholarly journal followed by the evolution of e-journals in during the past two decades. The article then focuses on the implications that these have had on traditional library processes and services such as selection, acquisitions, cataloguing, storage, preservation and user services. In the conclusion the author speculates on the long term effect of Web-based publishing on the format of the traditional scholarly journal as it has existed for over 300 years.

Astrocytic αVβ3 integrin inhibits neurite outgrowth and promotes retraction of neuronal processes by clustering Thy-1.

Thy-1 is a membrane glycoprotein suggested to stabilize or inhibit growth of neuronal processes. However, its precise function has remained obscure, because its endogenous ligand is unknown. We previously showed that Thy-1 binds directly to α(V)β(3) integrin in trans eliciting responses in astrocytes. Nonetheless, whether α(V)β(3) integrin might also serve as a Thy-1-ligand triggering a neuronal response has not been explored. Thus, utilizing primary neurons and a neuron-derived cell line CAD, Thy-1-mediated effects of α(V)β(3) integrin on growth and retraction of neuronal processes were tested. In astrocyte-neuron co-cultures, endogenous α(V)β(3) integrin restricted neurite outgrowth. Likewise, α(V)β(3)-Fc was sufficient to suppress neurite extension in Thy-1(+), but not in Thy-1(-) CAD cells. In differentiating primary neurons exposed to α(V)β(3)-Fc, fewer and shorter dendrites were detected. This effect was abolished by cleavage of Thy-1 from the neuronal surface using phosphoinositide-specific phospholipase C (PI-PLC). Moreover, α(V)β(3)-Fc also induced retraction of already extended Thy-1(+)-axon-like neurites in differentiated CAD cells as well as of axonal terminals in differentiated primary neurons. Axonal retraction occurred when redistribution and clustering of Thy-1 molecules in the plasma membrane was induced by α(V)β(3) integrin. Binding of α(V)β(3)-Fc was detected in Thy-1 clusters during axon retraction of primary neurons. Moreover, α(V)β(3)-Fc-induced Thy-1 clustering correlated in time and space with redistribution and inactivation of Src kinase. Thus, our data indicates that α(V)β(3) integrin is a ligand for Thy-1 that upon binding not only restricts the growth of neurites, but also induces retraction of already existing processes by inducing Thy-1 clustering. We propose that these events participate in bi-directional astrocyte-neuron communication relevant to axonal repair after neuronal damage.

Communication with terminal cancer patients in palliative care: are there differences between nurses and physicians?

The aim of this study was to find whether there were interprofessional differences in specific elements of communication with terminal cancer patients and decision-making processes that concern such patients. Given that interdisciplinary team work is one of the basic values in palliative care, if there are conflicting views between professions on such important issues it is most important to know about these and to understand them. A questionnaire utilized in an earlier survey of palliative care physicians and addressing their attitudes to and beliefs about specific elements of communication and decision making was sent to a sample of palliative care nurses working in the same regions, i.e. the French-speaking parts of Switzerland, Belgium and France. After a second mailing (reminder), 135 of the 163 questionnaires (83%) were returned. There was general agreement between nurses and physicians on questions dealing with perceptions of patients' knowledge of their diagnosis and stage of disease, patients' need for information, "do not resuscitate" orders and ethical principles in decision-making processes. Statistically significant, but small, differences between professional groups were only observed for a minority of the questions. Interprofessional differences in specific elements of communication with terminal cancer patients and decision-making processes affecting these patients were not so marked that they could be called "conflicting interprofessional views."

Infant's triangular communication in "two for one" versus "two against one" family triangles: Case illustrations

Infants use their social competence very early to communicate not only in dyads but also in triads, in particular in the triangle they form with their mother and father. The development of this triangular communication is largely shaped by the ways the parents support or undermine each other in relation to their child. Whereas triangular communication is facilitated in "two for one" alliances, it is recruited in the service of regulating the parents' conflicts in "two against one" coalitions. These processes are manifest in toddlerhood and may be traced back to the coparenting alliance in formation during pregnancy.

Technology selection and group decision support systems: Case studies on supporting strategic technology selection processes

The objective of the dissertation is to increase understanding and knowledge in the field where group decision support system (GDSS) and technology selection research overlap in the strategic sense. The purpose is to develop pragmatic, unique and competent management practices and processes for strategic technology assessment and selection from the whole company's point of view. The combination of the GDSS and technology selection is approached from the points of view of the core competence concept, the lead user -method, and different technology types. In this research the aim is to find out how the GDSS contributes to the technology selection process, what aspects should be considered when selecting technologies to be developed or acquired, and what advantages and restrictions the GDSS has in the selection processes. These research objectives are discussed on the basis of experiences and findings in real life selection meetings. The research has been mainly carried outwith constructive, case study research methods. The study contributes novel ideas to the present knowledge and prior literature on the GDSS and technology selection arena. Academic and pragmatic research has been conducted in four areas: 1) the potential benefits of the group support system with the lead user -method,where the need assessment process is positioned as information gathering for the selection of wireless technology development projects; 2) integrated technology selection and core competencies management processes both in theory and in practice; 3) potential benefits of the group decision support system in the technology selection processes of different technology types; and 4) linkages between technology selection and R&D project selection in innovative product development networks. New type of knowledge and understanding has been created on the practical utilization of the GDSS in technology selection decisions. The study demonstrates that technology selection requires close cooperation between differentdepartments, functions, and strategic business units in order to gather the best knowledge for the decision making. The GDSS is proved to be an effective way to promote communication and co-operation between the selectors. The constructs developed in this study have been tested in many industry fields, for example in information and communication, forest, telecommunication, metal, software, and miscellaneous industries, as well as in non-profit organizations. The pragmatic results in these organizations are some of the most relevant proofs that confirm the scientific contribution of the study, according to the principles of the constructive research approach.

The Impact of ICTs on Lecturer and Student Interaction in University Education Processes

Interaction is a basic element in any educational process, and it is something that needs to be reconsidered in the light of technology. In order to examine the methodological changes that ICTs bring to teaching from an interaction perspective, a study was carried out at the University of Lleida to observe interaction processes in various face-to-face, blended learning and e-learning subjects. The methodological design was based on three data collection techniques: documentary analysis of subject curricula, lecturer and student questionnaires, and lecturer interviews. The data showed that, as the online component of subjects increased, the lecturers and students used more technological tools to communicate (e-mail, forums, chats, social networks, etc.). Furthermore, we found that the lecturers and students basically communicated for academic purposes. While they hardly ever communicated for personal reasons (guidance, support, etc.), they claimed that closer contact with a non-academic focus would be preferable. We also observed that the students’ work was more individual in e-learning subjects. Although there is still a considerable way to go in ICT-mediated lecturer-student interaction, both the lecturers and students recognise the potential of such technologies, even though they still do not use them as they feel they should.

Matrix Analytic Analysis of Delays in Communication Systems

Tässä päättötyössä annetaan kuvaus kehitetystä sovelluksesta Quasi Birth Death processien ratkaisuun. Tämä ohjelma on tähän mennessä ainutlaatuinen ja sen avulla voi ratkaista sarjan tehtäviä ja sitä tarvitaan kommunikaatio systeemien analyysiin. Mainittuun sovellukseen on annettu kuvaus ja määritelmä. Lyhyt kuvaus toisesta sovelluksesta Quasi Birth Death prosessien tehtävien ratkaisuun on myös annettu

Development of e-Service tools for customer services and processes, Case: KONE Oyj Finland

Tutkimuksen tavoitteena oli selvittää miten kehittää yrityksen nykyistä e-palvelujärjestelmää, Internet -teknologiaan perustuvaa sähköisiä kommunikaatio- ja tiedonjakojärjestelmää, yrityksen business-to-business asiakkuuksien johtamisessa. Tavoitteena oli myös luoda ehdotukset uusista e-palvelusopimusmalleista. Tutkimuksen teoriaosuudessa pyrittiin kehittämään aikaisempiin tutkimuksiin, tietokirjallisuuteen ja asiantuntijoihin perustuva viitekehysmalli. Empiirisessä osassa tutkimuksen tavoitteisiin pyrittiin haastattelemalla yrityksen asiakkaita ja henkilöstöä, sekä tarkastelemalla asiakaskontaktien nykyistä tilaa ja kehittymistä. Näiden tietojen perusteella selvitettiin e-palvelun käyttäjien tarpeita, profiilia ja valmiuksia palvelun käyttöön sekä palvelun nykyistä houkuttelevuutta. Tutkimuksen teoriaosan lähdeaineistona käytettiin kirjallisuutta, artikkeleita ja tilastoja asiakashallinnasta sekä e-palveluiden, erityisesti Internet ja verkkopalveluiden markkinoinnista, nykytilasta sekä palveluiden kehittämisestä. Lisäksi tutkittiin kirjallisuutta arvoverkostoanalyysistä, asiakkaan arvosta, informaatioteknologiasta, palvelun laadusta ja asiakastyytyväisyydestä. Tutkimuksen empiirinen osa perustuu yrityksen henkilöstöltä sekä asiakkailta haastatteluissa kerättyihin tietoihin, yrityksen ennalta keräämiin materiaaleihin sekä Taloustutkimuksen keräämiin tietoihin. Tutkimuksessa käytettiin case -menetelmää, joka oli yhdistelmä sekä kvalitatiivista että kvantitatiivista tutkimusta. Casen tarkoituksena oli testata mallin paikkansapitävyyttä ja käyttökelpoisuutta, sekä selvittää onko olemassa vielä muita tekijöitä, jotka vaikuttavat asiakkaan saamaan arvoon. Kvalitatiivinen aineisto perustuu teemahaastattelumenetelmää soveltaen haastateltuihin asiakkaisiin ja yrityksen työntekijöihin. Kvantitatiivinen tutkimus perustuu Taloustutkimuksen tutkimukseen ja yrityksen asiakaskontakteista kerättyyn tietoon. Haastatteluiden perusteella e-palvelut nähtiin hyödyllisinä ja tulevaisuudessa erittäin tärkeinä. E-palvelut nähdään yhtenä tärkeänä kanavana, perinteisten kanavien rinnalla, tehostaa business-to-business -asiakkuuksien johtamista. Tutkimuksen antamien tulosten mukaan asiakkaiden palveluun liittyvän tieto-, taito-, tarpeellisuus- ja kiinnostavuustasojen vaihtelevaisuus osoittaa selvän tarpeen eritasoisille e-palvelupaketti ratkaisuille. Tuloksista muodostettu ratkaisuehdotus käsittää neljän eri e-palvelupaketin rakentamisen asiakkaiden eri tarpeita mukaillen.

Adoption of an E-service Innovation and its Effects on Customer Service Processes in Forest Industry

Tämän tutkielman tavoitteena oli selvittää miten asiakkaille suunnattu Internet –pohjainen palvelu muuttaa asiakaspalvelua metsäteollisuudessa, ja mitkä tekijät vaikuttavat tällaisen palvelun omaksumiseen. Tutkimuksesta ilmenee että muutokset asiakaspalvelussa ovat olleet asiakkaiden mielestä pääasiassa positiivisia. Selvisi, että uuden sovelluksen laatuun ollaan tyytyväisiä, mutta että kaikki asiakkaat eivät pidä sen etuja huomattavina verrattuna vanhoihin toimintatapoihin. Esimerkkiyrityksen oma henkilöstö ei keskimäärin koe sovellusta kovin hyödylliseksi oman työnsä kannalta. Jotta sovelluksen käyttöä ja mahdollisia hyötyjä esimerkkiyritykselle saataisiin lisättyä, on sovellukseen tehtävien parannusten lisäksi panostettava tehokkaampaan kommunikointiin ja lisäkoulutukseen asiakkaille. Lisäksi on löydettävä keinoja, joiden avulla asiakkaat kokisivat sovelluksen käytön itselleen edullisemmaksi kuin pitäytymisen vanhoissa toimintatavoissa. Edellä mainitun saavuttaminen edellyttää esimerkkiyrityksen asiakaspalvelu-henkilöstön ja operatiivisen johdon sitoutumista sovelluksen aktiiviseen markkinointiin asiakkaiden suuntaan. Tutkimuksen aineisto kerättiin haastatteluilla ja asiakkaille suunnatulla kyselylomakkeella käyttäen pääasiassa kvalitatiivisia menetelmiä. Haastatteluja tehtiin kahdessa esimerkkiyrityksen yksikössä, kolmessa myyntikonttorissa sekä kahden asiakasyrityksen yhteensä neljässä eri yksikössä. Kyselylomake lähetettiin 215 asiakaskäyttäjälle, joista 30 palautti lomakkeen. Palautusprosentiksi tuli 14.

Quality and analysis of administration processes in server operations

IT outsourcing refers to the way companies focus on their core competencies and buy the supporting functions from other companies specialized in that area. Service is the total outcome of numerous of activities by employees and other resources to provide solutions to customers' problems. Outsourcing and service business have their unique characteristics. Service Level Agreements quantify the minimum acceptable service to the user. The service quality has to be objectively quantified so that its achievement or non-achievement of it can be monitored. Usually offshoring refers to the transferring of tasks to low-cost nations. Offshoring presents a lot of challenges that require special attention and they need to be assessed thoroughly. IT Infrastructure management refers to installation and basic usability assistance of operating systems, network and server tools and utilities. ITIL defines the industry best practices for organizing IT processes. This thesis did an analysis of server operations service and the customers’ perception of the quality of daily operations. The agreed workflows and processes should be followed better. Service providers’ processes are thoroughly defined but both the customer and the service provider might disobey them. Service provider should review the workflows regarding customer functions. Customer facing functions require persistent skill development, as they communicate the quality to the customer. Service provider needs to provide better organized communication and knowledge exchange methods between the specialists in different geographical locations.

The nature of communication structures of university students in an international web-based computer-supported collaborative learning (CSCL) course

Communication, the flow of ideas and information between individuals in a social context, is the heart of educational experience. Constructivism and constructivist theories form the foundation for the collaborative learning processes of creating and sharing meaning in online educational contexts. The Learning and Collaboration in Technology-enhanced Contexts (LeCoTec) course comprised of 66 participants drawn from four European universities (Oulu, Turku, Ghent and Ramon Llull). These participants were split into 15 groups with the express aim of learning about computer-supported collaborative learning (CSCL). The Community of Inquiry model (social, cognitive and teaching presences) provided the content and tools for learning and researching the collaborative interactions in this environment. The sampled comments from the collaborative phase were collected and analyzed at chain-level and group-level, with the aim of identifying the various message types that sustained high learning outcomes. Furthermore, the Social Network Analysis helped to view the density of whole group interactions, as well as the popular and active members within the highly collaborating groups. It was observed that long chains occur in groups having high quality outcomes. These chains were also characterized by Social, Interactivity, Administrative and Content comment-types. In addition, high outcomes were realized from the high interactive cases and high-density groups. In low interactive groups, commenting patterned around the one or two central group members. In conclusion, future online environments should support high-order learning and develop greater metacognition and self-regulation. Moreover, such an environment, with a wide variety of problem solving tools, would enhance interactivity.

Planning and implementation of entrepreneurial marketing processes in SMEs

Entrepreneurial marketing is newly established term and there is need for more specific studies in order to understand the concept fully. SMEs have entrepreneurial marketing elements more visible in their marketing and therefore provide more fruitful insights for this research. SMEs marketing has gained more recognition during the past years and in some cases innovative characteristics can be identified despite constraints such as lack of certain resources. The purpose of this research is to study entrepreneurial marketing characteristics and SME processes in order to wider understanding and gain more insights of entrepreneurial marketing. In addition, planning and implementation of entrepreneurial marketing processes is examined in order to gain full coverage of SMEs marketing activities. The research was conducted as a qualitative research and data gathering was based on semi-structured interview survey, which involved nine company interviews. Multiple case research was used to analyze data so that focus and clarity could be maintained in organized manner. Case companies were chosen from different business fields so that more variation and insights could be identified. The empirical results suggest that two examined processes networking and word-of-mouth communication are very important processes for case companies which supports the previous researches. However, the entrepreneurial marketing characteristics had variation some were more visible and recognizable than others. Examining more closely the processes companies did not fully understand that networking or word-of-mouth marketing could be used as efficiently as other conventional marketing methods.