Journal articles on the topic 'Miscommunication – Case studies'

INTRODUCTION: Effective communication is integral to the general practice consultation, yet it is acknowledged that problems commonly occur. Previous research has shown that misunderstandings with potentially significant consequences occur frequently, but does not provide a clear picture of how and why miscommunication occurs, or how such problems can be prevented or resolved. This study explored the occurrence and management of specific examples of miscommunication in two routine general practice consultations. METHODS: A multi-method case study approach was used. The primary data collected for each case included a video-recorded consultation and post-consultation interviews with each general practitioner (GP) and patient. Instances of communication mismatch were examined using in-depth interaction analysis techniques. FINDINGS: GPs and patients may not be aware when misunderstandings have occurred. In-depth analysis of the case studies revealed the complexity of miscommunication: it was not a straightforward matter to locate when or why instances of communication mismatch had occurred, and each of the mismatches was quite distinctive: (1) they were identified in different ways; (2) they occurred at different points in the communication process; (3) they arose because of problems occurring at different levels of the communication, and (4) they had different consequences. CONCLUSION: Given the frequency and complexity of miscommunication in general practice consultations, GPs need to consider adopting various strategies, at both the practice/systems level and the level of the consultation interaction to minimise the risk of communication problems. KEYWORDS: Communication; general practice; physician-patient relations

This paper explores the dynamic role of emojis in text-based communication among Nigerian youths and the potential implications for miscommunication. Emojis have become integral to contemporary digital conversations, offering users a visual means of expressing emotions, tone, and context within the constraints of text-based interactions. In the context of Nigeria, a country with a diverse linguistic landscape and a youthful population heavily engaged in online communication, understanding the impact of emojis on interpersonal exchanges becomes particularly pertinent. This paper examines the prevalence and patterns of emoji usage among Nigerian youths across various digital platforms. It investigates the cultural nuances and interpretations associated with emojis within the Nigerian context, considering factors such as regional differences, linguistic diversity, and socio-cultural influences. Furthermore, the study examines instances where emojis may contribute to miscommunication or misunderstanding, potentially exacerbating conflicts or hindering effective communication. Through a comprehensive review of existing literature, online discourse analysis, and case studies, this research aims to shed light on the ways in which emojis influence the interpretation of textual messages and the potential challenges they pose to clear and accurate communication. The study concludes that as digital communication continues to be a primary mode of interaction, it is essential for users to recognize the potential for misinterpretation, prompting the need for increased emoji literacy and awareness.

Intercultural communication serves a vital role in that it can forestall miscommunication and misunderstanding. Because of increased intercultural contact and interdependence, people in the world are forced to "rethink" intercultural communication in order to acquire effective intercultural communication competence. The present paper provides a critical discussion of the conceptualization of intercultural communication and the commonly acknowledged challenge of intercultural communication. With a focus on Japan and the U.S. (since both countries have remarkably different forms of communication in terms of nonverbal communication particularly), the paper defines culture and explores the following: (1) origin of intercultural communication research; (2) cultural fluency and willingness to communicate; and (3) words versus haragei (a Japanese concept), touching upon intercultural (business) communication.

The pharmaceutical sector, with its critical role in healthcare, often faces perceptual barriers that hinder effective communication, collaboration, and progress. This paper delves into the concept of transgressing these perceptual barriers within the pharma sector. It explores the challenges arising from misconceptions, biases, and miscommunication that impede innovation, research, and patient care. Through case studies and illustrative examples, the research highlights successful strategies and initiatives that have broken down these barriers, fostering cross-disciplinary interactions and knowledge exchange. The abstract underscores the importance of transparent communication, interdisciplinary collaboration, and public engagement in reshaping the perception of the pharma sector. By embracing diverse perspectives, understanding patient needs, and aligning with societal expectations, the pharma sector can transcend these barriers and contribute to improved healthcare outcomes. This study offers insights to professionals, researchers, policymakers, and stakeholders seeking to facilitate meaningful change within the pharmaceutical industry by addressing and overcoming perceptual barriers.

The integration of collaborative practices in essay writing within higher education constitutes a pivotal advantage, frequently producing outcomes surpassing those of independent composition endeavors. However, although collaboration is necessary and can yield many positive outcomes, a collaborative effort is not always successful. A paucity of empirical studies has highlighted the causes of the dysfunctions of teamwork in Jamaica. In higher education, participants often express frustration and unwillingness to engage in teamwork because of the various dysfunctions they are likely to experience. Consequently, in response to this gap, this case study explored both functional and dysfunctional attributes Academic Writing participants encountered at a university in Jamaica, as they worked collaboratively to complete their expository and argumentative essays. This mixed methods study collected data from interviews, peer reviews, and a questionnaire. The findings identified both functional and dysfunctional qualities. The results showed that the major functional attributes were clear communication, respect, commitment, and accountability. The main dysfunctional attributes were lack of trust, miscommunication, commitment, disrespect, and limited time management skills. Finally, this paper highlights best practices that educators can use to create and promote functional and effective teams in the teaching and learning environment.

Abstract This article evaluates the historicity of 1 Sam 7:2-17 in light of renewed analysis of the archaeological remains from Tell en-Nasbeh, other Iron Age I sites in the region of Benjamin, broader literary considerations in 1 Sam 1-10, and the geography of the Central Hill Country. In so doing, a case is made that there is far more going on in vv. 6-7 than what appears to be a miscommunication between the Israelites, who have gathered at the site of Mizpah, and the Philistines, who send troops against the Israelites. A historical reconstruction that considers the narrative form of 1 Sam 7:2-17 and the archaeological remains is offered, as is a new proposal for the identification of the site of Gibeath-elohim.

The complex etiopathogenesis of brain injury associated with neurodegeneration has sparked a lot of studies in the last century. These clinical situations are incurable, and the currently available therapies merely act on symptoms or slow down the course of the diseases. Effective methods are being sought with an intent to modify the disease, directly acting on the properly studied targets, as well as to contribute to the development of effective therapeutic strategies, opening the possibility of refocusing on drug development for disease management. In this sense, this review discusses the available evidence for mitochondrial dysfunction induced by Ca2+ miscommunication in neurons, as well as how targeting phosphorylation events may be used to modulate protein phosphatase 2A (PP2A) activity in the treatment of neuronal damage. Ca2+ tends to be the catalyst for mitochondrial dysfunction, contributing to the synaptic deficiency seen in brain injury. Additionally, emerging data have shown that PP2A-activating drugs (PADs) suppress inflammatory responses by inhibiting different signaling pathways, indicating that PADs may be beneficial for the management of neuronal damage. In addition, a few bioactive compounds have also triggered the activation of PP2A-targeted drugs for this treatment, and clinical studies will help in the authentication of these compounds. If the safety profiles of PADs are proven to be satisfactory, there is a case to be made for starting clinical studies in the setting of neurological diseases as quickly as possible.

This paper completes a two-part series on graduate advising that integrates concepts from adult learning, leadership, and psychology into a conceptual framework for graduate advising. The companion paper discussed how to establish a learning-centered working relationship where advisor and graduate student collaborate in different roles to develop the student’s competence and confidence in all aspects of becoming a scientist. To put these ideas into practice, an advisor and a student need to communicate effectively. Here, we focus on the dynamics of day-to-day interactions and discuss (1) how to provide feedback that builds students’ competence and confidence, (2) how to choose the way we communicate and avoid a mismatch between verbal and nonverbal communication, and (3) how to prevent and resolve conflict. Miscommunication may happen out of a lack of understanding of the psychological aspects of human interactions. Therefore, we draw on concepts from Educational Transactional Analysis to provide advisors and students with an understanding of the psychological aspects of graduate advising as a basis for effective communication. Case studies illustrate the relevance of the concepts presented, and four worksheets ( Supplementary Material ) support their practical implementation.

Le langage corporel est souvent le parent pauvre en didactique du français langue étrangère que ce soit dans les recherches théoriques ou en classe de langue. Il constitue pourtant une sérieuse source d’interférences dans les situations de communication interculturelle. Cet article traite d’une approche originale du langage corporel en classe de français en s’appuyant sur les arts de la scène. La pratique du clown, du mime, la technique de déambulation en défilé de mode et quelques exercices de taiji quan (un art martial chinois) sont sollicités dans le cadre d’un cours visant à entrainer des apprenants de Taiwan à l’exercice du discours en public dans une perspective du langage corporel. Body Language and Cross-cultural Studies: A case study in Taiwan Body language is often neglected in theory and practice in the field of teaching French as a foreign language. This happens in spite of its importance in the many aspects of miscommunication between people of different cultures. This article deals with an original approach of body language by using various stage arts in the class of French. Exercises of clown, mime, catwalking and taiji quan (a Chinese martial art) are used to train students from Taiwan in the practice of oral discourse while focusing on body language.

This paper examines the impact of Industry 4.0 on organizational communication, exploring the opportunities and challenges presented by this revolutionary paradigm shift. The study employs a qualitative research methodology, drawing on academic literature, case studies, and in-depth interviews with national and international organizations. By evaluating the importance of effective communication in the Internet of Things (IoT) era, the paper assesses the opportunities and identifies the challenges of Industry 4.0 in organizational communication. The study delves into the complex relationship between technology and communication, outlining best practices for implementing communication tools and artificial intelligence (AI) in Industry 4.0. Effective communication is crucial for success in Industry 4.0, as it enables individuals to collaborate effectively and share ideas, leading to improved decision-making and problem-solving. However, information overload, miscommunication, and isolation risks must be mitigated to ensure effective communication. Investing in employee training and development, establishing clear communication protocols, and balancing virtual and face-to-face communication can help organizations manage these risks effectively. Mitigating the risks associated with organizational communication in Industry 4.0 is crucial to ensure that organizations can successfully leverage the opportunities presented by this era of digitalization. Recommendations include adopting cybersecurity measures, streamlining communication processes, protecting personal information, ensuring clarity and transparency, regularly updating data security measures, and promoting inclusive communication to overcome social barriers and ensure sustainable organizational communication.

Purpose The purpose of this paper is to present a life cycle phase of a software development project which is substantial for the success of the project. This paper visualizes the project start-up phase from suppliers’ perspective. Design/methodology/approach The method is a theory building from case studies. The data were collected from three software supplier firms by conducting process modeling separately in each firm. Findings The study resulted in a model of a supplier’s software project start-up which includes start-up practices and involved roles. The results indicate that project start-up is an integral and structured phase of project life cycle, which influences the execution of a software development project, especially from the supplier’s perspective in the project business context. Research limitations/implications The study focuses on the start-up phase of software development projects delivered to external customers. Therefore, developed project start-up model is applicable as such in software supplier firms. Practical implications The project start-up model presented in this paper indicates that project start-up is a complex and multi-dimensional activity in a supplier firm. This study suggests that if the project start-up phase is clearly defined, planned and followed in a supplier firm, it reduces confusion and miscommunication among the people involved in the project and helps to achieve the business goals of a project. Originality/value This study emphasizes that it is necessary to make a distinction between the perspectives of the customer and the supplier when studying projects in the project business context. The findings contribute the new knowledge for managing outsourced software development projects.

This review paper examines the communication barriers encountered in multinational energy projects, focusing on the challenges posed by cultural differences, language barriers, and differing regulatory environments. It synthesizes existing literature on communication strategies and their effectiveness in complex project environments, providing a comprehensive overview of how project managers can overcome these barriers. The paper also discusses the role of cross-cultural training, language proficiency, and regulatory knowledge in improving communication and project outcomes. This paper will conduct a systematic review of existing research, case studies, and theoretical models related to communication in multinational project management. It will collate findings from various disciplines, including management science, communication studies, and international business, to propose integrated strategies for effective communication. Multinational energy projects, characterized by diverse stakeholders, geographically dispersed operations, and intricate regulatory environments, present a fertile ground for communication challenges. Language differences, cultural nuances, and varying communication norms often hinder seamless information exchange, impeding project progress and fostering misunderstandings. This review identifies several key barriers to effective communication in multinational energy projects. Firstly, linguistic diversity poses a significant hurdle, amplifying the risk of misinterpretation and miscommunication. Secondly, cultural disparities influence communication styles, decision-making processes, and conflict resolution mechanisms, necessitating cultural sensitivity and adaptability. Additionally, organizational hierarchies and power dynamics within project consortia can stifle open dialogue, hindering the flow of vital information across stakeholders. Moreover, technological barriers, such as inadequate infrastructure or incompatible communication platforms, further exacerbate communication challenges, particularly in remote or underdeveloped regions where many energy projects operate. Regulatory frameworks across different jurisdictions also introduce legal and compliance complexities, constraining information sharing and collaboration. The implications of these communication barriers extend beyond mere operational inefficiencies, impacting project outcomes, stakeholder relationships, and even the broader energy landscape. Delays, cost overruns, and quality issues resulting from communication breakdowns undermine project viability and investor confidence. Moreover, fractured relationships among stakeholders may lead to disputes, litigation, or reputational damage, tarnishing the industry's image and impeding future collaborations. Addressing communication barriers in multinational energy projects requires a holistic approach encompassing linguistic, cultural, organizational, technological, and regulatory dimensions. Embracing diversity, fostering inclusive communication practices, leveraging innovative technologies, and promoting cross-cultural understanding are essential strategies for navigating these complexities and fostering success in the dynamic realm of multinational energy ventures. Keywords: Complexities, Communication Barriers, Multinational Energy Projects.

Abstract. Hydraulic fracturing, or fracking, is a borehole stimulation technique used to enhance permeability in geological resource management, including the extraction of shale gas. The process of hydraulic fracturing can induce seismicity. The potential to induce seismicity is a topic of widespread interest and public concern, particularly in the UK where seismicity induced by hydraulic fracturing has halted shale gas operations and triggered moratoria. Prior to 2018, there seemed to be a disconnect between the conclusions of expert groups about the risk of adverse impacts from hydraulic-fracturing-induced seismicity and the reported level of public concern about hydraulic fracturing induced seismicity. Furthermore, a range of terminology was used to describe the induced seismicity (including tremors, earthquakes, seismic events, and micro-earthquakes) which could indicate the level of perceived risk. Using the UK as a case study, we examine the conclusions of expert-led public-facing reports on the risk (likelihood and impact) of seismicity induced by hydraulic fracturing for shale gas published between 2012 and 2018 and the terminology used in these reports. We compare these to results from studies conducted in the same time period that explored views of the UK public on hydraulic fracturing and seismicity. Furthermore, we surveyed participants at professional and public events on shale gas held throughout 2014 asking the same question that was used in a series of surveys of the UK public in the period 2012–2016, i.e. “do you associate shale gas with earthquakes?”. We asked our participants to provide the reasoning for the answer they gave. By examining the rationale provided for their answers, we find that an apparent polarisation of views amongst experts was actually the result of different interpretations of the language used to describe seismicity. Responses are confounded by the ambiguity of the language around earthquake risk, magnitude, and scale. We find that different terms are used in the survey responses to describe earthquakes, often in an attempt to express the risk (magnitude, shaking, and potential for adverse impact) presented by the earthquake, but that these terms are poorly defined and ambiguous and do not translate into everyday language usage. Such “bad language” around fracking has led to challenges in understanding, perceiving, and communicating risks around hydraulic-fracturing-induced seismicity. We call for multi-method approaches to understand the perceived risks around geoenergy resources and suggest that developing and adopting a shared language framework to describe earthquakes would alleviate miscommunication and misperceptions. Our findings are relevant to any applications that present – or are perceived to present – the risk of induced seismicity. More broadly, our work is relevant to any topics of public interest where language ambiguities muddle risk communication.

Structural issues in the health care delivery system can disproportionately affect language minority patients who require interpretation services. This qualitative study addresses the issues Spanish-speaking Latinos face in obtaining health care by examining the experiences of 25 Spanish speakers in California’s Central Valley, a medically underserved area. The following barriers to communication emerged in the findings: time-restricted interactions, unfriendly encounters, discrimination, issues in interpreting, miscommunication, and opposition to providers. We report participants’ recommendations for improving health care communication, including the need for friendlier and more attentive services, more Spanish-speaking providers, and more time with providers. We argue that these recommendations are in line with Latino cultural constructs: confianza (trust), familismo (family-orientation), personalismo (friendliness), respeto (respect), and simpatía (kindness). This study raises awareness about how language use and intercultural competence affect health care communication by centering the voices of Spanish speakers across numerous contextualized examples.

This research was conducted with the aim of knowing the problems that occurred in lectures during the pandemic, as well as finding an alternative in overcoming the problems of lectures. The alternative is studied further in a learning strategy. The theory used in this research is Behavioristic Learning Theory. This research was conducted on Accounting Study Program students at Tanjungpura University using qualitative research methods, case study approaches, where the research conducted resulted in several findings related to problems that occurred in brave learning during the pandemic. Some of the problems found during online learning, namely; miscommunication between lecturers and students, student ethics, lack of commitment and responsibility. To produce good output, an effective learning process must be carried out. The learning process is determined by the learning strategy implemented by the lecturer. Based on these problems, it is an implementation of learning strategies as an effort to handle the problems of the lectures carried out.

Abstract Dementia diagnosis and care relies on extensive communication between a doctor, patient, and oftentimes a family caregiver. Communication is important for recognizing when there is a cognitive concern, gaining an understanding of the patient’s history of cognitive decline, engaging in cognitive testing, and providing quality care post-diagnosis. We conducted a qualitative study of 35 primary care clinicians and primary care nurse practitioners working in safety net settings in California to understand facilitators and barriers to dementia diagnosis and care. Using thematic analysis, we identified similar themes to those that have been explored extensively related to language and communication in doctor-patient relationship. Topics ranging from challenges that emerge when there is language discordance, difficulties finding and using interpreters, and challenges related to communicating medical topics in a patient’s native language. Specifically related to dementia, we found that language challenges emerge due to inadequate translation or availability of cognitive testing and post-diagnostic resources in multiple languages. However, we also identified unique challenges related to communication, including hearing loss, communicating about trauma during the diagnostic history interview, navigating the logistics of care, including communicating with specialists, building trust and rapport when there is language discordance, and cultural miscommunication even when the spoken language is the same. These issues affect historically marginalized individuals and communities, especially when dementia and cognitive impairment are present. We suggest new approaches and policies to enhance communication and better ways of working with patients who are hard of hearing.

In recent years, radiologic imaging has undergone tremendous technological advances and is now a pillar of diagnostic and treatment algorithms in clinical medicine. The increased complexity and volume of medical imaging has led clinicians to become ever more reliant on radiologists to both identify and interpret patient studies. A radiologist’s report provides key insights into a patient’s immediate state of health, information that is vital when choosing the most appropriate next steps in management. As errors in imaging interpretation or miscommunication of results can greatly impair patient care, identifying common error sources is vital to minimizing their occurrence. Although mistakes in medical imaging are practically inevitable, changes to the delivery of imaging reporting and the addition of artificial intelligence algorithms to analyze clinicians’ communication skills can minimize the impact of these errors, keep up with the continuously evolving landscape of medical imaging, and ultimately close the communication gap.

Multiple studies have shown the detrimental effect of miscommunication during transitions of care. The aim of this study is to determine whether a certain method of “sign-out” can improve information transmission and thereby reduce medical errors. Surgical interns underwent a 90-minute training session before starting residency in five previously verified methods of sign-out. They were randomly assigned to six groups (five methods and a control group). They were then given seven simulated patient charts with varying levels of medical complexity. They were then instructed to “sign-out” the patients to randomly selected colleagues. The control group did not use any of the previously taught methods and passed on information in a manner of their choosing. None of the methods consistently results in excellent transitions of care. Patient information values ranged from 26 to 40 (depending on complexity). Major points were consistently missed by all methods, but this may have been a component of the time constraint placed on this study. The “SIGNOUT?” method resulted in superior data transmission when compared with the control group (P = 0.0401). The only method that seemed to be significantly inferior was the “9Ds” method (P = 0.0610). The “SIGNOUT?” method leads to the largest amount of relevant information transmitted to the incoming team. There was no statistically significant difference among the other methods. Improvement in “sign-out” modalities and training may improve transmission of relevant patient information, but larger studies are needed to verify the data seen in this small, single-site study.

Culture shocks, miscommunications, and even conflict will occur due to a lack of intercultural communication skills. Effective communication with native speakers requires language abilities, cultural awareness, and familiarity with local customs. Several studies on intercultural relationships have been documented. However, there is still limited research on the levels that affect intercultural awareness. This study aims to examine the intercultural awareness of pre-service teachers. This study aims to investigate the levels that affect intercultural awareness among aspiring pre-service teachers participating in an international teaching practicum (ITP). The design used a qualitative multiple-case study. Interviews with eight aspiring English pre-service teachers from Indonesia were conducted to collect data. The results show that the majority of participants agreed that during an international teaching practicum program, they gained the ability to compare and mediate cultural differences and similarities. Indonesian pre-service teachers being investigated had good intercultural awareness. The findings suggest important practical implications for providing students with sufficient references to assist pre-service teachers in enhancing and developing their intercultural teaching abilities.

Healthcare practitioners face significant risks of workplace violence due to various reasons such as hospital congestion, miscommunication, and aggressive behaviours of patients and relatives. Exposure to workplace violence may disrupt the workflow process and compromise patient care in healthcare facilities, ultimately affecting job performance, reducing job satisfaction, and negatively affecting the physical and mental health of healthcare practitioners. This study aimed to review all the published studies conducted on the experiences of workplace violence among healthcare practitioners. This study is a systematic review of qualitative studies. Data were collected through online databases including ScienceDirect, PubMed, MEDLINE and JSTOR were searched from the year 2015–2021. The inclusion criteria were: qualitative methods and mixed methods of data collection and analysis; studies that were carried out among healthcare practitioners who have been experience on workplace violence; scope of the primary studies included experience of workplace violence; and published in English/Malay in academic journal between 2015 and 2021. A total of 15 papers were included in the final analysis. The overall quality of the included papers was high. Of the 15 papers, 12 studies fully met the CASP criteria. The results of the 15 included studies were organised into the thematic groups of: i) verbal violence as the common workplace violence; ii) perceived causes of workplace violence and iii) seeking help. Across different countries, verbal violence was the most common type of workplace violence reported by healthcare practitioners. This review also identified that a lack of information, failure to meet patient expectations, and delayed treatment were the main contributing factors to workplace violence.

Background: Continued advances in technology and cancer treatment have made cancer care more complex. A wide range of healthcare professionals are involved in the care and there is a potential for poor coordination and miscommunication. Hence there is a need to integrate and coordinate care to enhance quality care and improved health outcomes patient navigation approach was introduced by Dr Harold Freeman at Harlem Hospital Centre, the USA in 1990. Some literature identified nurses as a suitable candidate to assume this role. But there is a need to further explore the effectiveness of patient/nurse navigation program for its effectiveness on health outcomes such as anxiety, psychological distress, mood states, quality of life, symptom distress (nausea, vomiting, sleep disturbances) physical well being, psychological well being, coping, support and patient satisfaction. Aim: To synthesize the best available evidence on the effectiveness of patient/nurse navigation program in the care of women with breast cancer. Methods: This review was conducted according to Cochrane guidelines. An extensive literature search was conducted in PubMed, CINAHL, Proquest, Cochrane Library, IndMed (Indian database of studies) and Shodhganga, a reservoir of Indian theses from January 1990-January 2017 for relevant studies published in the English language. The search criteria were limited to randomized controlled trials with patient or nurse navigation interventions compared with routine/usual care interventions without patient/nurse navigator in women with diagnosis of breast cancer aged 18 years and above, at any stage of illness undergoing any treatment in a hospital setting, including inpatient and outpatient/ambulatory care and studies. Results: Out of 238 studies assessed for eligibility only 6 studies were assessed for methodological quality. Quality assessment was done by using Delphi checklist by two independent reviewers. The risks of bias in RCTs were assessed using Cochrane risk of bias tool. Due to the methodological heterogeneity of the studies, a meta-analysis was not performed. The reviewers categorized the main outcomes as quality of life, patient satisfaction with care, anxiety, psychological distress and physical problems and other outcomes (treatment adherence, barriers to care, diagnostic interval, timely access to care, time to completion of treatment, use of health care resources) and presented it in narrative form. Conclusion: This review provides evidence that navigation programs have some benefit on breast cancer patients' health outcomes. The findings from this review show that there are a limited number of studies reporting health outcomes of breast cancer patients from inpatient settings and especially no studies from Asian countries. This warrants the need for developing navigation programs in developing countries especially in Indian setting where no navigation programs are being reported in cancer care.

Traditional communication between physicians and patients consists of verbal and non-verbal communication. Non-verbal communication can emphasize, modify, or supplement a message that is verbally conveyed and reduce the possibility of misunderstanding. Web applications offer the ability to communicate with physicians and patients outside the healthcare facility. E-mail communication of the selected physician and patient is defined as electronic communication of doctors and patients in a contractual relationship in which the health information provider bears responsibility for the patient's health as his or her chosen physician. A literature review was conducted based on European and American studies reports to determine whether the use of electronic communication in family medicine could contribute to improving the quality of health care. The search for PUBMED, BMJ, JMIR and OVID was performed using the terms: electronic communication, family medicine, email, physician, patient. The most important benefits of electronic communication in family medicine are the simplicity and increased efficiency of communication, the expansion of resources and the ability to communicate, saving time and the ability to print electronic messages. The disadvantages lie in the potential compromise of confidentiality, the lack of monetary compensation and overload of the doctors, the potential for miscommunication, diagnostic error and unrealistic user expectations. Information technology must not replace traditional physician-patient communication. Although the results of the available studies have not provided strong enough evidence to broaden the introduction of electronic communications into everyday practice, adhering to the guidelines of good clinical practice, email and other forms of internet communication could contribute to improving the quality of primary care.

Introduction: Stroke is the second most common cause of death worldwide after ischemic heart disease. Socioeconomic burden of stroke can be reduced by proper treatment of modifiable risk factors and maintaining adherence to treatment. The aim of this study is to identify factors associated with non-adherence to treatment of modifiable risk factors in elderly stroke patients. Methods: Prospective observational study with 100 acute ischemic stroke patients admitted in Neurology department, Government Medical College Kota between June to September 2018. Risk factors for stroke and reasons for non-adherence to anti-hypertensives, anti-diabetics and antiplatelet agents were studied in detail. Results: Various modifiable risk factors for stroke present in study subjects were smoking (35%), alcoholism (16%), hypertension (82%) and diabetes mellitus (23%). Past history of stroke was present in 14% cases. Total 59 patients were non-adherent to treatment. Reasons for non-adherence include poor knowledge (47%), superstitious belief (32%), intentional withdrawal (25%), due to miscommunication (12%), pill burden (7%), side effects (3%), pill size (1%) and poor family care(1%). Conclusions: Understanding of various factors associated with medication intake and creating awareness among patient could help in medication adherence.

Abstract Background Respiratory tract infections (RTIs) are a common reason for children to consult in general practice. Antibiotics are often prescribed, in part due to miscommunication between parents and GPs. The duration of specific respiratory symptoms has been widely studied. Less is known about illness-related symptoms and the impact of these symptoms on family life, including parental production loss. Better understanding of the natural course of illness-related symptoms in RTI in children and impact on family life may improve GP–parent communication during RTI consultations. Objective To describe the general impact of RTI on children and parents regarding illness-related symptoms, absenteeism from childcare, school and work, use of health care facilities, and the use of over-the-counter (OTC) medication. Methods Prospectively collected diary data from two randomized clinical trials in children with RTI in primary care (n = 149). Duration of symptoms was analysed using survival analysis. Results Disturbed sleep, decreased intake of food and/or fluid, feeling ill and/or disturbance at play or other daily activities are very common during RTI episodes, with disturbed sleep lasting longest. Fifty-two percent of the children were absent for one or more days from childcare or school, and 28% of mothers and 20% of fathers reported absence from work the first week after GP consultation. Re-consultation occurred in 48% of the children. OTC medication was given frequently, particularly paracetamol and nasal sprays. Conclusion Appreciation of, and communication about the general burden of disease on children and their parents, may improve understanding between GPs and parents consulting with their child.

Doctor-patient communication is important in all medical consultations including for In Vitro Fertilisation (IVF) treatment. An unfavourable communication experience can cause a patient to stop taking the treatment, move to another local fertility clinic, or even seek treatment abroad. There are still few studies documenting communication experiences of patients with infertility seeking reproductive treatment in other countries. This study aimed to describe the communication experiences of Indonesian IVF patients receiving IVF treatment from medical practitioners in fertility clinics in Malaysia. This study used Benner's interpretive phenomenology framework in its approach and when analysing the results. Data collection was carried out using in-depth and semi-structured interviews with 11 IVF patients from Pekanbaru city Indonesia who received IVF treatment in fertility clinics in Malaysia. This study found three main themes shared by the IVF patients’ communication experiences: 1) memorable experiences (friendliness and caring, empathy, honesty and openness, clarity and adequacy of the information, and easiness of communication; 2) less memorable experiences (less interpersonal communication, less warm non-verbal communication, and miscommunication); and 3) communication barriers (English). These findings have important implications for both the prospective patients receiving cross-border fertility treatment in the future and for service providers providing fertility treatment to improve doctor-patient communication. Keywords: Health communication, doctor-patient communication, communication experience, infertility, cross-border reproductive care, in vitro fertilisation treatment.

Background and Objectives: People have multi-faceted health care needs and consult a diverse range of health care practitioners (HCP) from both the conventional and complementary medicine healthcare sectors. The effective communication between HCP and with patients are obvious requisites to coordinating multidisciplinary care and shared decision making. Further, miscommunication is a leading cause of patient harm and is associated with reduced patient satisfaction, health literacy, treatment compliance and quality of life. In conventional healthcare settings, the differences in professional hierarchy, training, communication styles and culture are recognised communication barriers. Less is known about interprofessional communication (IPC) that includes traditional and complementary medicine (TCM) HCP. This review aims to summarise the experiences and perceptions of conventional and complementary HCP and identify factors that influence IPC. Methods: A qualitative rapid literature review was conducted. Six databases were searched to identify original research and systematic reviews published since 2009 and in English. Excluded were articles reporting original research outside of Australia that did not include TCM-HCP, already cited in a systematic review, or of low quality with a score of less than three on a critical appraisal skills programme (CASP) checklist. A thematic analysis of included studies was used to identify and explore important and recurring themes. Results: From the conducted searches, 18 articles were included, 11 of which reported data on complementary HCP and seven were literature reviews. Four key themes were identified that impact IPC: medical dominance, clarity of HCP roles, a shared vision, and education and training. Conclusion: IPC within and between conventional and complementary HCP is impacted by interrelated factors. A diverse range of initiatives that facilitate interprofessional learning and collaboration are required to facilitate IPC and help overcome medical dominance and interprofessional cultural divides.

Backgrounds: Currently the world has entered the digital era, marked by rapid advances in technology and information. This progress is included in all aspects of human life, especially the world of education. The use of information technology in the world of education is the use of the internet in searching for learning materials and learning methods online. Online learning is increasingly popular with the Covid-19 pandemic, where government policy encourages students to study online with certain applications. Online and offline learning, educators and students need communication to transfer knowledge and skills according to the material being studied. Often this communication becomes an obstacle in the teaching and learning process. This problem arises from educators and students. Objectives: The purpose of this research is to identify the effectiveness of communication in supporting the learning environment. Methods: This research method is qualitative using Interpretative Phenomenological Analysis (IPA) method with 10 participants. Results: The results of this study obtained six categories, namely flexible; creative; concern; respect others; learning system and communication context. From these categories three major themes were obtained, namely good behavior, good attitude and coordination. From these three themes, one big theme is produced, namely effective learning. Conclusion: The conclusion of this study is that effective learning is formed by good attitudes and behavior and then supported by coordination from various related parties. When coordinating or collaborating, it is expected that you also use language or communicate well. This good communication is not only spoken verbally but is practiced non-verbally with mutual respect and care for one another. In a system there will be problems because it deals with humans. The most common problem that occurs in the teaching and learning process is miscommunication. Educators in this case are required to be flexible in dealing with it without having to violate established policies or regulations. For this reason, educators are required to be creative in finding solutions to problems.

Abstract Risk of severe COVID-19 illness increases with age, and older adults are more likely to be hospitalized and die from COVID-19 and related complications as compared to their younger counterparts. This reality, combined with pandemic-related lockdown and social distancing policies, has increased in-home isolation for older adults. This includes cancelling in-person healthcare appointments and conducting many appointments via tele-health. As older adults have had to quickly pivot to learning new technologies, little is known about their experiences with navigating virtual healthcare during the pandemic. Therefore, this qualitative study aims to address that gap. One-on-one interviews (N=29) were conducted with older adults (Mean age=71.5; 86% female) via phone/Zoom. Participants were asked about their healthcare experiences during the pandemic and the role technology played. Interviews were transcribed and thematically analyzed using Nvivo12 software. Findings demonstrate that participants used technology to schedule medical appointments, engage in virtual visits with their providers, set reminders to take medications, and undertake their daily exercise routine. Post-lockdown, some participants preferred in-person visits due to the nature of their diagnosis, personal preference, or unfamiliarity with the needed technology. Older adults encountered challenges including cancelled appointments, miscommunication with providers, and lack of skill to use technologies. Cancellation of appointments and postponement of treatments affected the health of some of the participants. Implications of this research can inform tele-health approaches with older patients, as well as provider communication and coordination of care. Leveraging technology for preventative health approaches can also assist older adults in ongoing health maintenance and promote well-being.

12054 Background: Sexual dysfunction (SD) is highly prevalent among patients with advanced cancer, but it is not regularly assessed by palliative care (PC) specialists. This study aims to investigate the frequency of SD, and its impact in PC patients with cancer, as well as the barriers they face to have an open communication with PC providers. Methods: AdultPC patients with cancer seen at the outpatient Supportive Care Clinic were invited to participate in a 25-item questionnaire about SD. The survey was voluntary and anonymous. Results: A total of 100 patients (54 women and 46 men) completed the survey. The mean age was 55 (range 24-78), 90% were Caucasians, 16% Hispanics and 77% were married or lived with a partner. In the month and within six months before the survey, the patients received treatment with chemotherapy (44 and 37%), radiation (14 and 13%), or surgery (4 and 20%), respectively. Only 29 patients (29%) would like to discuss their SD with a provider -this was consistent across gender ( p= 0.827) and age groups ( p= 0.194)-, even though 81% had experienced SD in the previous year and merely 45% were satisfied with their sexual function. Only 20 (20%) reported that their clinician had ever asked them about SD. Most of the patients (79%) responded that it was appropriate for the clinician to inquire about SD but only 32% thought that clinicians should always ask. Patients "strongly agreed or agreed" that the SD worsened their depression (39%), anxiety (28%), pain (14%), fatigue (13%), and wellbeing (39%). Factors that worsened the current sexual desire included medications in 33/59 participants, treatments (chemotherapy, radiation or surgery) in 61/80, miscommunication with the partner in 31/66, urinary incontinence in 17/24, weigh loss in 18/36, body image in 45/64, tube/lines (nephrostomy, colostomy, urinary catheter, etc) in 12/18, and oxygen in 4/12. When asked why they did not discuss SD, 64% said that discussing other symptoms was more important, 35% said that they wanted to keep it private, 29% because a family member was present, and 17% because of lack of time. Conclusions: SD is very common among PC patients with cancer and it worsens their emotional and physical symptoms as well as their overall wellbeing. About only a third of the respondents said they would want to discuss it with their provider, and almost two-thirds said that talking about other symptoms was more important. Our findings do not support the notion that PC specialists should always initiate a discussion about SD with their PC patients with cancer. Future studies should try to better identify which PC patients are open to talk about SD and exploring its therapies.

Abstract Background: Palliative care (PC) is a patient-centered care model that aims to relief suffering by establishing a plan of care that integrates physical, psychosocial, cultural, familial and spiritual issues during the course of disease's evolution. Thus, PC applies not only to patients who face a diagnosis beyond the possibility of cure, but to all those who experience significant symptoms throughout the course of the disease. Myelodysplastic syndromes (MDS) are a heterogeneous group of myeloid neoplasms characterized by cytopenias and an elevated risk of developing acute leukemia. As MDS display a wide genetic heterogeneity, patients have a variable clinical presentation, ranging from asymptomatic patients to individuals with severe cytopenias and high-risk disease. MDS are more prevalent in the elderly population, which usually experience several morbidities; thus, MDS frequently lead to notable symptoms and deterioration of quality-of-life, making most of them eligible to PC in addition to standard hematologic care. In spite of that, previous studies demonstrated that patients with hematologic malignancies appear to have restricted access to PC services and receive more aggressive therapies at the end of life. Aims: To evaluate eligibility criteria for PC in a cohort of MDS patients and correlate with clinical and laboratory data. Methods: Clinical and demographic data of MDS patients were collected through interviews using a standardized questionnaire: time from diagnosis, number of morbidities, need for seeking the emergency during the last 12mo, delirium events, wounds, dysphagia, recurrent falls, adverse events to medication, quality of communication with the medical team, fears regarding the disease and its complications, religious support, age, gender, monthly household income and level of schooling. Specific PC scores were also applied: Edmonton Symptom Assessment Scale (ESAS) and Palliative Performance Scale (PPS). Clinical and laboratory data were collected: hemoglobin (Hb), platelet and neutrophil counts, Revised International Prognostic Scoring System (IPSS-R) and transfusion burden. Statistical univariate and multivariate analysis were performed. P value <.05 was considered statistically significant. This research was approved by the Institutional and National Review Board; written informed consent was obtained from all subjects. Results:Thirty-six patients were evaluated: median age 68y (21-90), sex 16F/20M. According to ESAS, tiredness and anxiety were the most relevant symptoms in MDS patients [median (min-max)]: pain 0 (0-10), tiredness 4.5 (0-10), drowsiness 1.5 (0-10), nausea 0 (0-7), lack of appetite 0 (0-10), shortness of breath 0 (0-10), depression 0 (0-10), anxiety 3.5 (0-10), best wellbeing 2.5 (0-8). Younger patients (<60y, n=10) had a worse ESAS for best wellbeing (5 (2-8)) when compared to older individuals (≥60y, n=26): (2 (0-7)), p=.007, and tended to have worse ESAS scores for tiredness: 8.5 (0-10) vs 3.5 (0-10), p=.56. Importantly, ESAS for tiredness was not correlated to Hb levels, the number of red blood cell transfusions nor with IPSS-R (all p>.05). ESAS for drowsiness was significantly higher in patients with two (5 (0-10)) and ≥three morbidities (3 (0-8) vs those with only one morbidity (0 (0-10)): p=.01 and p=.03, respectively. ESAS for best wellbeing was better in individuals with higher household income 0 (0-0) vs patients with lower financial resources 3 (0-7), p=.04). PPS median was 90% (60-100%) and negatively correlated with transfusion burden (r=0.407, p=.01) and with the need for seeking the emergency in the past 12mo (r=-0.332, p=.04). Finally, despite facing a potential life-threatening disease, 94.4% of the patients reported that their doctors had never talked to them about aspects related to end-of-life care. Conversely, 75% of them reported fears and doubts regarding this phase. Conclusions: In our casuistic of MDS patients, tiredness was the most important symptom observed. Surprisingly, it was not correlated with Hb levels and transfusion burden, suggesting that Hb levels alone should not be used to justify symptoms. The number of morbidities and lower household income also impacted ESAS scores. Finally, a great part of the patients revealed miscommunication with their hematologists regarding end-of-life planning. Our data indicate that MDS patients might benefit from a PC multidisciplinary team approach. Disclosures Costa: Novartis: Consultancy.

Abstract Abstract 4192 Introduction: There are no prospective, long-term studies describing the process and quality of care, resource utilization (RU), and quality of life (QoL) associated with being on oral anticoagulant therapy for non-valvular atrial fibrillation (NVAF) patients managed through routine medical care (RMC) in Canada. Methods: Resource utilization associated with Oral Anticoagulant Management (ROAM) is a prospective cohort study being conducted across 9 Canadian provinces whose objective is to describe the process and quality of care, RU, clinical events and health utility scores associated with long-term oral anticoagulant (warfarin) therapy in patients with new onset or chronic NVAF. Eligible, consenting patients are followed for 48 weeks and complete a weekly study diary providing data on international normalized ratio (INR) test dates and values, RU associated with warfarin monitoring, and all physician visits, procedures and hospitalizations. Health utility scores, representing the patient's health state, measured using the EuroQol-5D (EQ-5D) standardized QoL instrument are collected every 4 weeks. INR test values and dates and source documentation around patient reported clinical events are also collected from the participating physicians. Results: 497 out of a planned enrolment of 600 patients have been recruited. 180 patients with completed 48 week follow-up and physician-provided INR values are included in this analysis, 98% from primary care physicians and specialists (RMC) and 2% from anticoagulant clinics. Median age [range] was 75 [39, 90] years with 67% males. Common co-morbidities were hypertension (60%) and ischemic heart disease (27%). Estimated median [range] time since NVAF diagnosis was 4 [0, 32] years. Physicians reported a total of 2484 INR tests over the study duration (a mean of 13.8 tests per patient) while patients recorded 2711 tests being completed in their diaries over the same time period (a mean of 15.06 tests per patient). Of the 2711 patient reported tests only 1914 INR results (71%) were communicated back to patients via telephone (70%) or in person (15%). Median [quartile] time between the INR test and the patient acquiring the results was 1.4 [1.0, 2.5] days. The INR test dates provided by physicians matched the dates recorded by patients in the diary 67% of the time. 51 (28%) of patients recorded no INR values. Of the 129 patients with at least one recorded INR value, physician and patient INR values matched completely for only 8 (4%) patients and matched on average 62% of the time (range 30% to 98%) for the rest. Mean [95% CI] time in therapeutic range (TTR) by the Rosendaal method was 67% [64%, 71%] using physician reported values and 67% [62%, 72%] based on patient reported values. Mean INR testing frequency was 30 days following an INR in the therapeutic range, 25 days following an INR of less than 2 and 22 days following an INR greater than 3. Three strokes and 3 bleeds were self-reported in 5 patients (9%) that are being adjudicated. The initial mean [95% CI] health utility score was 0.85 [0.83, 0.88]. A decrease in health utility score was observed in 133 (74%) of the patients based on a random effects regression model. Fixed effect estimate of the mean [95% CI] change in health utility scores per 6 months was −0.01 [0, −0.02]. Covariates (age, gender and time since diagnosis) were investigated but had limited effect on the health utility score. Conclusions: This is the first prospective cohort study of NVAF patients on long-term warfarin therapy being monitored primarily through RMC in Canada. The majority of patients are monitored via telephone with frequent miscommunication between health care providers and patients about INR results and delays in getting results to patients. TTR is higher than previously reported for RMC, which may suggest a self-selection bias for better quality physician-patient combinations. Although frequency of testing was appropriate for in-range INRs, the times to testing after out-of-range results appear delayed. Analysis of health utility scores showed a small decrease in health status over time in this cohort of patients with generally high health utility scores. Relationship between TTR and clinical events will be presented. Disclosures: Selby: Boehringer Ingelheim: Honoraria, Research Funding. Mittmann:Boehringer Ingelheim: Research Funding. Isogai:Boehringer Ingelheim: Research Funding. Kaus:Boehringer Ingelheim: Research Funding. Koo:Boehringer Ingelheim: Research Funding. Sealey:Boehringer Ingelheim: Research Funding.

The Routledge Handbook of language and culture represents a comprehensive study on the inextricable relationship between language and culture. It is structured into seven parts and 33 chapters. Part 1, Overview and historical background, by Farzad Sharifian, starts with an outline of the book and a synopsis of research on language and culture. The second chapter, John Leavitt’s Linguistic relativity: precursors and transformations discusses further the historical development of the concept of linguistic relativity, identifying different schools’ of thought views on the relation between language and culture. He also tries to demystify some misrepresentations held towards Boas, Sapir, and Whorf’ theories (pp. 24-26). Chapter 3, Ethnosyntax, by Anna Gladkova provides an overview of research on ethnosyntax, starting from the theoretical basis laid by Sapir and Whorf and investigates the differences between a narrow sense of ethnosyntax, which focuses on cultural meanings of various grammatical structures and a broader sense, which emphasises the pragmatic and cultural norms’ impact on the choice of grammatical structures. John Leavitt presents in the fourth chapter, titled Ethnosemantics, a historical account of research on meaning across cultures, introducing three traditions, i.e. ‘classical’ ethnosemantics (also referred to as ethnoscience or cognitive anthropology), Boasian cultural semantics (linguistically inspired anthropology) and Neohumboldtian comparative semantics (word-field theory, or content-oriented Linguistics). In Chapter 5, Goddard underlines the fact that ethnopragmatics investigates emic (or culture-internal) approaches to the use of different speech practices across various world languages, which accounts for the fact that there exists a connection between the cultural values or norms and the speech practices peculiar to a speech community. One of the key objectives of ethnopragmatics is to investigate ‘cultural key words’, i.e. words that encapsulate culturally construed concepts. The concept of ‘linguaculture’ (or languaculture) is tackled in Risager’s Chapter 6, Linguaculture: the language–culture nexus in transnational perspective. The author makes reference to American scholars that first introduced this notion, Paul Friedrich, who looks at language and culture as a single domain in which verbal aspects of culture are mingled with semantic meanings, and Michael Agar, for whom culture resides in language while language is loaded with culture. Risager himself brought forth a new global and transnational perspective on the concept of linguaculture, i.e. the use of language (linguistic practice) is seen as flows in people’s social networks and speech communities. These flows enhance as people migrate or learn new languages, in permanent dynamics. Lidia Tanaka’s Chapter 7, Language, gender, and culture deals with research on language, gender, and culture. According to her, the language-gender relationship has been studied by researchers from various fields, including psychology, linguistics, and anthropology, who mainly consider gender as a construct that preserves inequalities in society, with the help of language, too. Tanaka lists diachronically different approaches to language and gender, focusing on three specific ones: gender stereotyped linguistic resources, semantically, pragmatically or lexically designated language features (including register) and gender-based spoken discourse strategies (talking-time imbalances or interruptions). In Chapter 8, Language, culture, and context, Istvan Kecskes delves into the relationship between language, culture, and context from a socio-cognitive perspective. The author considers culture to be a set of shared knowledge structures that encapsulate the values, norms, and customs that the members of a society have in common. According to him, both language and context are rooted in culture and carriers of it, though reflecting culture in a different way. Language encodes past experience with different contexts, whereas context reflects present experience. The author also provides relevant examples of formulaic language that demonstrate the functioning of both types of context, within the larger interplay between language, culture, and context. Sara Miller’s Chapter 9, Language, culture, and politeness reviews traditional approaches to politeness research, with particular attention given to ‘discursive approach’ to politeness. Much along the lines of the previous chapter, Miller stresses the role of context in judgements of (im)polite language, maintaining that individuals represent active agents who challenge and negotiate cultural as well as linguistic norms in actual communicative contexts. Chapter 10, Language, culture, and interaction, by Peter Eglin focuses on language, culture and interaction from the perspective of the correspondence theory of meaning. According to him, abstracting language and culture from their current uses, as if they were not interdependent would not lead to an understanding of words’ true meaning. David Kronenfeld introduces in Chapter 11, Culture and kinship language, a review of research on culture and kinship language, starting with linguistic anthropology. He explains two formal analytic definitional systems of kinship terms: the semantic (distinctions between kin categories, i.e. father vs mother) and pragmatic (interrelations between referents of kin terms, i.e. ‘nephew’ = ‘child of a sibling’). Chapter 12, Cultural semiotics, by Peeter Torop deals with the field of ‘semiotics of culture’, which may refer either to methodological instrument, to a whole array of methods or to a sub-discipline of general semiotics. In this last respect, it investigates cultures as a form of human symbolic activity, as well as a system of cultural languages (i.e. sign systems). Language, as “the preserver of the culture’s collective experience and the reflector of its creativity” represents an essential component of cultural semiotics, being a major sign system. Nigel Armstrong, in Chapter 13, Culture and translation, tackles the interrelation between language, culture, and translation, with an emphasis on the complexities entailed by translation of culturally laden aspects. In his opinion, culture has a double-sided dimension: the anthropological sense (referring to practices and traditions which characterise a community) and a narrower sense, related to artistic endeavours. However, both sides of culture permeate language at all levels. Chapter 14, Language, culture, and identity, by Sandra Schecter tackles several approaches to research on language, culture, and identity: social anthropological (the limits at play in the social construction of differences between various groups of people), sociocultural (the interplay between an individual’s various identities, which can be both externally and internally construed, in sociocultural contexts), participatory-relational (the manner in which individuals create their social–linguistic identities). Patrick McConvell, in Chapter 15, Language and culture history: the contribution of linguistic prehistory reviews research in this field where historical linguistic evidence is exploited in the reconstruction and understanding of prehistoric cultures. He makes an account of research in linguistic prehistory, with a focus on proto- and early Indo-European cultures, on several North American language families, on Africa, Australian, and Austronesian Aboriginal languages. McConvell also underlines the importance of interdisciplinary research in this area, which greatly benefits from studies in other disciplines, such as archaeology, palaeobiology, or biological genetics. Part four starts with Ning Yu’s Chapter 16, Embodiment, culture, and language, which gives an account of theory and research on the interplay between language, culture, and body, as seen from the standpoint of Cultural Linguistics. Yu presents a survey of embodiment (in embodied cognition research) from a multidisciplinary perspective, starting with the rather universalistic Conceptual Metaphor Theory. On the other hand, Cultural Linguistics has concentrated on the role played by culture in shaping embodied language, as various cultures conceptualise body and bodily experience in different ways. Chapter 17, Culture and language processing, by Crystal Robinson and Jeanette Altarriba deals with research in the field of how culture influence language processing, in particular in the case of bilingualism and emotion, alongside language and memory. Clearly, the linguistic and cultural character of each individual’s background has to be considered as a variable in research on cognition and cognitive processing. Frank Polzenhagen and Xiaoyan Xia, in Chapter 18, Language, culture, and prototypicality bring forth a survey of prototypicality across different disciplines, including cognitive linguistics and cognitive psychology. According to them, linguistic prototypes play a critical part in social (re-)cognition, as they are socially diagnostic and function as linguistic identity markers. Moreover, individuals may develop ‘culturally blended concepts’ as a result of exposure to several systems of conceptual categorisation, especially in the case of L2 learning (language-contact or culture-contact situations). In Chapter 19, Colour language, thought, and culture, Don Dedrick investigates the issue of the colour words in different languages and how these influence cognition, a question that has been addressed by researchers from various disciplines, such as anthropology, linguistics, cognitive psychology, or neuroscience. He cannot but observe the constant debate in this respect, and he argues that it is indeed difficult to reach consensus, as colour language occasionally reveals effects of language on thought and, at other times, it is impervious to such effects. Chapter 20, Language, culture, and spatial cognition, by Penelope Brown concentrates on conceptualisations of space, providing a framework for thinking about and referring to objects and events, along with more abstract notions such as time, number, or kinship. She lists three frames of reference used by languages in order to refer to spatial relations, i.e. a) an ‘absolute’ coordinate system, like north, south, east, west; b) a ‘relative’ coordinate system envisaged from the body’s standpoint; and c) an intrinsic, object-centred coordinate system. Chris Sinha and Enrique Bernárdez focus on, in Chapter 21, Space, time, and space–time: metaphors, maps, and fusions, research on linguistic and cultural concepts of time and space, starting with the seminal Conceptual Metaphor Theory (CMT), which they denounce for failing to situate space–time mapping within the broader patterns of culture and world perspective. Sinha and Bernárdez further argue that although it is possible in all cultures for individuals to experience and discuss about events in terms of their duration and succession, the specific words and concepts they use to refer to temporal landmarks temporal and duration are most of the time language and culture specific. Chapter 22, Culture and language development, by Laura Sterponi and Paul Lai provides an account of research on the interplay between culture and language acquisition. They refer to two widely accepted perspectives in this respect: a developmental mechanism inherent in human beings and a set of particular social contexts in which children are ‘initiated’ into the cultural meaning systems. Both perspectives define culture as “both related to the psychological make-up of the individual and to the socio-historical contexts in which s/he is born and develops”. Anna Wierzbicka presents, in Chapter 23, Language and cultural scripts discusses representations of cultural norms which are encoded in language. She contends that the system of meaning interpretation developed by herself and her colleagues, i.e. Natural Semantic Metalanguage (NSM), may easily be used to capture and convey cultural scripts. Through NSM cross-cultural experiences can be captured in a thorough manner by using a reduced number of conceptual primes which seem to exist in all languages. Chapter 24, Culture and emotional language, by Jean-Marc Dewaele brings forth the issue of the relationship between language, culture, and emotion, which has been researched by cultural and cognitive psychologists and applied linguists alike, although with some differences in focus. He considers that within this context, it is important to see differences between emotion contexts in bilinguals, since these may lead to different perceptions of the self. He infers that generally, culture revolves around the experience and communication of emotions, conveyed through linguistic expression. The fifth part starts with Chapter 25, Language and culture in sociolinguistics, by Meredith Marra, who underlines that culture is a central concept in Interactional Sociolinguistics, where language is considered as social interaction. In linguistic interaction, culture, and especially cultural differences are deemed as a cause of potential miscommunication. Mara also remarks that the paradigm change in sociolinguistics, from Interactional Sociolinguistics to social constructionism reshaped ‘culture’ into a more dynamic as well as less rigid concept. Claudia Strauss’ Chapter 26, Language and culture in cognitive anthropology deals with the relationship between human society and human thought/thinking. The author contends that cognitive anthropologists may be subdivided into two groups, i.e. ones that are concerned with the process of thinking (cognition-in-practice scholars), and the others focusing on the product of thinking or thoughts (concerned with shared cultural understandings). She goes on to explore how different approaches to cognitive anthropology have counted on units of language, i.e. lexical items and their meanings, along with larger chunks of discourse, as information, which may represent learned cultural schemata. Part VI starts with Chapter 27, Language and culture in second language learning, by Claire Kramsch, in which she makes a survey of the definition of ‘culture’ in foreign language learning and its evolution from a component of literature and the arts to a more comprehensive purport, that of culturally appropriate use of language, along with an appropriate use of sociopragmatic and pragmalinguistic norms. According to her, in the postmodern era, communication is not only mere transmission of information, it represents construal and positioning of the self and of self-identity. Chapter 28, Writing across cultures: ‘culture’ in second language writing studies, by Dwight Atkinson focuses on the usefulness of culture in second-language writing (SLW). He reviews several approaches to the issue: contrastive rhetoric (dealing with the impact of first-language patterns of text organisation on writers in a second language), or even alternate notions, like‘ cosmopolitanism’, ‘critical multiculturalism’, and hybridity, as of late native culture is becoming irrelevant or at best far less significant. Ian Malcolm tackles, in Chapter 29, Language and culture in second dialect learning, the issue of ‘standard’ Englishes (e.g., Standard American English, Standard Australian English) versus minority ‘non-standard’ speakers of English. He deplores the fact that in US specialist literature, speaking the ‘non-standard’ variety of English was associated with cognitive, cultural, and linguistic insufficiency. He further refers to other specialists who have demonstrated that ‘non-standard’ varieties can be just as systematic and highly structured as the standard variety. Chapter 30, Language and culture in intercultural communication, by Hans-Georg Wolf gives an account of research in intercultural education, focusing on several paradigms, i.e. the dominant one, investigating successful functioning in intercultural encounters, the minor one, exploring intercultural understanding and the ‘deconstructionist, and or postmodernist’. He further examines different interpretations of the concepts associated with intercultural communication, including the functionalist school, the intercultural understanding approach and a third one, the most removed from culture, focusing on socio-political inequalities, fluidity, situationality, and negotiability. Andy Kirkpatrick’s Chapter 31, World Englishes and local cultures gives a synopsis of research paradigm from applied linguistics which investigates the development of Englishes around the world, through processes like indigenisation or nativisation of the language. Kirkpatrick discusses the ways in which new Englishes accommodate the culture of the very speech community which develops them, e.g. adopting lexical items to express to express culture-specific concepts. Speakers of new varieties could use pragmatic norms rooted in cultural values and norms of the specific new speech community which have not previously been associated with English. Moreover, they can use these new Englishes to write local literatures, often exploiting culturally preferred rhetorical norms. Part seven starts with Chapter 32, Cultural Linguistics, by Farzad Sharifian gives an account of the recent multidisciplinary research field of Cultural Linguistics, which explores the relationship between language and cultural cognition, particularly in the case of cultural conceptualisations. Sharifian also brings forth illustrations of how cultural conceptualisations may be linguistically encoded. The last chapter, A future agenda for research on language and culture, by Roslyn Frank provides an appraisal of Cultural Linguistics as a prospective path for research in the field of language and culture. She states that ‘Cultural Linguistics could potentially create a paradigm that “successfully melds together complementary approaches, e.g., viewing language as ‘a complex adaptive system’ and bringing to bear upon it concepts drawn from cognitive science such as ‘distributed cognition’ and ‘multi-agent dynamic systems theory’.” She further asserts that Cultural Linguistics has the potential to function as “a bridge that brings together researchers from a variety of fields, allowing them to focus on problems of mutual concern from a new perspective” and most likely unveil new issues (as well as solutions) which have not been evident so far. In conclusion, the Handbook will most certainly serve as clear and coherent guidelines for scholarly thinking and further research on language and culture, and also open up new investigative vistas in each of the areas tackled.

AimsTo evaluate attitudes in prescribing and utilising 'As Required' (referred to as PRN/Pro Re Nata) sedating medications (Benzodiazepines, Z-Drugs, Anti-psychotics, and Promethazine)To evaulate current remote prescribing processes and improve safety and transparencyMethodPlan:Review of remote prescribing policy. It was highlighted that current practice was not in line with NMC guidance of the time as no follow-up written instruction by a doctor was received. Concerns were also raised about the general safety of verbal communication of prescriptions out of hours. A survey was conducted to assess attitudes towards the prescription of ‘PRN medication’ and the role of psychological therapies as an alternative to both doctors and nurses working in ABUHB's Mental Health and Learning Disabilities division.Do:Survey results showed a nuanced response from both doctors and nurses but an agreement that there is a role for as required medication, especially in the context of acute mental distress, indicating safety around the process rather than elimination/reduction of PRN medication prescribing would be desired. This lead to an overhaul of the out of hours prescribing process between junior doctors and those receiving the ‘verbal order’ as detailed below: Phone conversation between a junior doctor and ward nurse receiving the verbal order. A digital form is then completed by the ward nurse including current regular medication, PRN medication (including times of use), physical health history, and any additional requested information such as QTc on 12 lead electrocardiogram (ECG) or current vital signs. The junior doctor may assist with obtaining the relevant information but there are clear prompts on the form, to ensure the pertinent questions regarding safe prescribing are considered by both parties. The dose and route of the medication are clearly documented by the junior doctor as well as time of prescription and the form is emailed back to the ward nurse. This process is far more transparent and much less prone to errors due to miscommunication. a. The prompts also save time ensuring the relevant information is on hand prior to discussion as opposed to searching for medication charts, ECGs, etc. b. Highlighting the importance of QTc monitoring to encourage safe prescription of anti-psychotics and Promethazine c. The prompts also highlight the importance of physical health and current vital signs with regards to safe prescribing d. The prompts are stored on a network drive alongside other verbal orders allowing for easier future auditing off remotely off and on site These changes were highlighted via email, junior doctor forums, and induction of new doctors.StudyA Round 2 survey was drafted to evaluate the new process and forms with an aim to ensure uptake and to identify any issues. Despite using the same channels to identify survey participants, the response rate was much lower than the Round 1 survey. See Round 2 results.ActWith the limited feedback obtained the main issue identified was with regards to rapid tranquilisation of an aggressive patient who poses a risk to self and others. In this scenario it was deemed a risk to wait for an email form to be completed. Clarification emails were sent to relevant professionals to clarify that the rapid tranquilisation policy does allow for verbal orders with a subsequent digital order form to be completed at a later time when it is safe to do so.ResultRound 1 Nurses n = 26Doctors n = 27Nursing92% routinely request Z-Drugs and Benzodiazepines for treatment of insomnia88% routinely request Benzodiazepines for treatment of agitation73% routinely request Promethazine for for treatment of agitation69% routinely request PRN Anti-Psychotics for treatment of agitation35% would routinely request Promethazine for treatment of insomnia19% would routinely request Haloperidol without a recent ECG (>3 months)15% would request Benzodiazepines for treatment of psychotic symptoms12% would request Lorazepam above British National Formulary maximum dosesAs required medications dispensed per shift54% report 0 to 3 times23% report 4 to 6 times23% report 6 to 10 timesAgitation was most commonly defined as96% hostile behaviour/physical aggression92% hostile/threatening/derogatory speech81% visible anxiety69% disturbed behaviour that is not threatening/derogatory towards others31% patient reported anxiety without objective evidencePRN medication use reviewed by doctorsDaily (8%)Weekly (85%)Monthly (8%)5 most commmonly cited reasons contributing to PRN medication use77% Ward atmosphere (ie. volatile ward environment)69% Patient depdence (psychological/physiological)54% Patient expectation42% Limitted expectation of benefit from psychological skill utilisation42% Usual habit/culture of prescribing by doctorsWhat are your thoughts on the use of psychological interventions in an acute setting? [Open Ended, n = 22]Reviewing the themes from the open ended responses: Nursing staff feel positively about psychological interventions in the right setting at the right time but find challenges to delivering them. Some staff cite the fact that a patient is admitted indicates their level of acuity requiring PRN utilization. Some responses indicate that patients may be medicating the normal human experience. Ward atmosphere, how ill the patient currently is, patient willingness, staff shortages, paperwork taking priority, lack of training in psychological therapies were all cited as challenges.Doctors96% routinely prescribe Benzodiazepines for treatment of agitation92% routinely prescribe Z-drugs and Benzodiazepines for treatment of insomnia63% routinely prescribe PRN Anti-psychotics for treatment of agitation38% routinely prescribe Promethazine for treatment of agitation29% routinely prescribe Promethazine for treatment of insomnia25% routinely prescribe Benzodiazepines for treatment of psychosis12.5% routinely prescribe Lorazepam above British National Formulary maximum doses8% routinely prescribe Haloperidol without a recent ECG (>3 months)Rapid Tranquilisation Policy70% of doctors were familiar with the up to date Rapid Tranquilistion Policy5 most commmonly cited reasons contributing to PRN medication use19% nursing staff shortages15% ward atmosphere (ie. volatile ward environment)15% nursing staff expectations11% usual habit of prescribing11% patient expectationsWhat are your thoughts on the use of psychological interventions in an acute setting (n = 26)?Reviewing the themes from the open ended responses: Doctors are somewhat divided in their approach to psychological approaches, the majority stating or alluding to it being a first line management option but some citing staffing levels to be a deterrent. Others had a more nuanced view of it rather than a general first line treatment, requiring risk/benefit analyses before use. The minority did not know enough about psychological interventions or thought it often doesn't work.Round 2Nurses n = 8Doctors n = 8NursingTotal responded n = 8Acute psychiatric ward nurses n = 4Psychiatric intensive care unit nurses n = 450% were unaware that physical health emergencies and rapiq tranquilisation can allow for the older process of 'verbal orders' followed by the form due to the imminent risks associated with delaying treatment to complete the form100% (n = 8) were familiar with the digital order forms87.5% (n = 7) were familiar with the digital order policyWith regards to form locations87.5% (n = 7) had access to blank forms and would store them alongside paper medication charts12.5% (n = 1) were not aware that the ‘verbal order’ policy was not digitisedWith regards to digitised order requests: 75% (n = 6) did not report any change the frequency of requesting out of hours prescriptions12.5% (n = 1) reported a reduction in requests12.5% (n = 1) reported an increase in requests75% (n = 6) reported that the digital order form puts up barriers to requesting medication out of hoursWith regards to the form: 12.5% (n = 1) report that the form helps them formulate their requests50% (n = 4) report that the form requires the appropriate amount of information12.5% (n = 1) report that the form requires too much information37.5% (n = 3) did not comment on the amount of information the form requiresWith regards to safety: 25% (n = 2) report that the digitised system is safer75% (n = 6) did not comment on safetyWith regards to time to fill out the form: 87.5% (n = 7) report that the form is more time consuming12.5% (n = 1) did not comment on time consumptionIf given the option to revert to verbal orders: 37.5% (n = 3) would like to revert back to the old system25% (n = 2) would like to remain on current system37.5% (n = 3) did not comment on which system they'd preferDoctorsTotal responded n = 8.Consultants n = 2Staff Grade doctors n = 1Core Trainees in Psychiatry n = 3Fixed term appointees n = 2100% (n = 8) were familiar with the up to date rapid tranquilisation policyWith regards to the digital order forms62.5% regularly see them in patient files (n = 5)37.5% occasionally become aware of them (n = 3)0% were unaware of the new digital order forms (n = 0)With regards to inappropriate out of hours prescriptions37.5% report that there was a reduction (n = 3)50% report there being no significant change (n = 4)12.5% report there being an increase (n = 1)With regards to safety: n = 6 reported the new system to be safern = 2 did not comment on safetyWith regards to time: n = 2 report it being more time consuming to use the digital ordersn = 6 did not comment on time consumptionWith regards to returning to verbal order formsn = 3 would like to remain on digital ordersn = 5 did not comment on returning to verbal order formsOther: n = 2 commented in the comment box that this change was overduen = 1 commented that the forms give insight into patient presentations and managementConclusionDoctors routinely prescribe Z-drugs and benzodiazepines, and would generally consider Haloperidol as a second line over Promethazine (while nurses had a slight preference for requesting Promethazine over Haloperidol). The role of 12 lead electro-cardiogram monitoring would require further exploration in separate audits, as both Promethazine and Haloperidol can cause QTc interval prolongation [4,5].Doctors most commonly cited expectations by nursing staff as the main driver for PRN medication prescription. Profound differences were present with regards to rationale behind PRN medication use when comparisons between doctors and nurses self-reports were made. The majority of nurses cited ward atmosphere and patient dependence/expectation as main drivers, whereas a minority of doctors shared those views. This represents a concerning disconnect between professionals, although it can be explained by the higher proportion of time ward nurses spend on mental health wards and in direct patient care. Nursing staff, being the dispensers of medication, would also likely be the main professionals contacted for the request of PRN medication by patients.Nuanced views were given to the role of psychological redirection. This was shared between doctors and nurses, although many cited concerns about nursing staff shortages leading to a possible overreliance on PRN medication. A minority of doctors (n = 2) would recommend psychological redirection after first line rapid tranquilisation was exhausted. The counterargument being that someone admitted onto a ward tacitly implies a high level of acuity and reduced appropriateness of psychological techniques.Hypnotics most commonly being requested likely reflects the difficult nature to initiate and maintain sleep is an acute ward setting.On review of the Round 2 results indicate that doctors and nurses agree that the new system is safer although more time consuming. Concerns were raised about rapid tranquilisation and immediate emergencies, although the revised policy would allow for the verbal order policy to be followed with a digital order in these circumstances. This was clarified via further communication with relevant parties.The changes were more received more positively by doctors than nurses, with some nurses opting for the older system if possible. It was also raised that this may be putting up barriers for out of hours prescriptions, although the required information is arguably succinct and only requests vital information for safe prescribing. Further exploration of these concerns would be indicated. The Round 2 results were limited by the low sample size compared to the first round.Despite the limitations and concerns about the new system, digitising the system allows for further audits and studies to utilize much more robust methods of measuring out of hours prescriptions than self-reported measures employed in the initial rounds. Although they may not be directly compared to findings of this report, future baselines can be established and compared to in an objective manner.Future RoundsProposed: To design and clearly display information on commonly requested medication by patients, empowering them to make more informed decisions on the medications they request. This could be in the form of leaflets patients could take or posters on areas where patients receive medication. One example is that Zopiclone is a very commonly requested medication on an as required basis although patients may not be as aware of the risks associated with chronic use.Proposed: To design and clearly display information on psychologically informed techniques in patient areas such distress tolerance and sleep hygiene. This would be on mental health sites which do not currently display this information. To measure impact on PRN medication dispensation.Proposed: Further exploration of patient perceived ward environment and measures that can be implemented to reduce anxiety/insomnia associated with inpatient admission.Proposed: Exploration of proportion of inpatient initiated PRN medication progresses to long term use in the community (largely focused on hypnotics and benzodiazepines).

Abstract Background Approximately 235,000 deaf and hard of hearing (DHH) people live in Germany. Due to communication barriers, medical care for this group is difficult in many respects. Especially in the case of acute illnesses, the possibilities of communication, e.g., through sign language interpreters, are limited. This study investigates the satisfaction of DHH patients with medical care in Germany in unplanned medical consultations. The aim of this study is to provide insights into DHH patient's perception of medical care, to identify barriers and avoidance behaviours that stem from fears, miscommunication, and prior experiences. Methods We obtained data from adult DHH participants between February and April 2022 throughout Germany via an online survey in German Sign Language. The responses of N = 383 participants (65% female, M = 44 years, SD = 12.70 years) were included in statistical analyses. Outcomes were convictions of receiving help, satisfaction with healthcare provision, and avoiding healthcare visits; further variables were concerns during healthcare visits, incidences of miscommunication, and a communication score. We calculated t-tests, ANOVAs, correlations, and linear and logistic regression analyses. Results Our main findings show that (1) DHH patients were unsatisfied with provided healthcare (M = 3.88; SD = 2.34; range 0–10); (2) DHH patients reported many concerns primarily about communication and treatment aspects when visiting a doctor; and (3) 57% of participants deliberately avoided doctor visits even though they experienced symptoms. Factors such as concerns during doctor’s visits (B = -0.18; 95%CI: -0.34--0.02; p = .027) or miscommunication with medical staff (B = -0.19; 95%CI: -0.33–0.06; p = .006) were associated with satisfaction with medical care, while we found almost no associations with gender and location, and only few with age and education. Conclusions Overall, our findings suggest that DHH patients are unsatisfied with provided healthcare, they deliberately avoid doctor visits, and they face various communication barriers. This study revealed several communication-related determinants of satisfaction with healthcare in DHH patients, such as incidences of miscommunication and the communication score. Communication-related barriers have high potential to be addressed in collaboration with the DHH community. To improve the medical care and the satisfaction with healthcare in DHH patients, training healthcare professionals, digital technologies, and other communication-enhancing interventions should be explored in future intervention studies.

AbstractIn North America, archaeological prospection has recently undergone a surge in popularity, resulting in higher visibility for both scientific and fringe narratives. This has been partially due to increasingly sensationalized media articles that promote the use of technology to locate overgrown and subsurface features in the landscape. The heightened profile of the field and increasingly sensitive contexts in which it is applied (e.g., locating potential unmarked graves) has expanded the discipline beyond its usual settings where typical archaeological prospection rhetoric and narratives are applied. In this paper, we explore how the presentation of archaeological prospection can impact descendant communities and their burial and cultural spaces. We identify rhetoric, discourse and narrative as key considerations that have resulted in the twisting of interpretations to support fringe narratives. We present two case studies: (1) denialism surrounding unmarked graves at former Indian Residential Schools and (2) the reinterpretation of Indigenous spaces by Graham Hancock's Ancient Apocalypse. We draw upon these seemingly disparate examples as evidence that ambiguity in scholarly communication and ‘certainty’ in fringe communication can both be used to the detriment of Indigenous and other descendant communities in various ways that we term pseudoarchaeological colonialism. Finally, we recommend strategies on how to disseminate results in non‐harmful ways and confront the wrongful usage of archaeological prospection.

Interactional competence involves knowledge of the relation between language forms and the social contexts in which they are applied. The paper aims at focusing on the concept of interactional competence within the framework of cross-cultural pragmatics. The study expresses its author’s belief that non-native language users’ interactional competence to use contextually and situationally appropriate linguistic forms to express the pragmatic intent in question is to be developed at the tertiary level of language studies. The case study was based on the analysis of the speech act of compliment. The research findings indicated that instances of miscommunication resulted from differing beliefs regarding the speech act production and perception. The research has resulted in a conclusion that non-native language learners’ interactional competence can be advanced if the contributions on the speech act theories and an empirical research carried out into the area of the speech act are considered in the developmental process of non-native learners’ interactional competence.

Abstract Background Successful breast cancer screening relies on timely follow-up of abnormal mammograms. Delayed or failure to follow-up abnormal mammograms undermines the potential benefits of screening and is associated with poorer outcomes. However, a comprehensive review of inadequate follow-up of abnormal mammograms in primary care has not previously been reported in the literature. This review could identify modifiable factors that influence follow-up, which if addressed, may lead to improved follow-up and patient outcomes. Methods A systematic literature review to determine the extent of inadequate follow-up of abnormal screening mammograms in primary care and identify factors impacting on follow-up was conducted. Relevant studies published between 1 January, 1990 and 29 October, 2020 were identified by searching MEDLINE®, Embase, CINAHL® and Cochrane Library, including reference and citation checking. Joanna Briggs Institute Critical Appraisal Checklists were used to assess the risk of bias of included studies according to study design. Results Eighteen publications reporting on 17 studies met inclusion criteria; 16 quantitative and two qualitative studies. All studies were conducted in the United States, except one study from the Netherlands. Failure to follow-up abnormal screening mammograms within 3 and at 6 months ranged from 7.2–33% and 27.3–71.6%, respectively. Women of ethnic minority and lower education attainment were more likely to have inadequate follow-up. Factors influencing follow-up included physician-patient miscommunication, information overload created by automated alerts, the absence of adequate retrieval systems to access patient’s results and a lack of coordination of patient records. Logistical barriers to follow-up included inconvenient clinic hours and inconsistent primary care providers. Patient navigation and case management with increased patient education and counselling by physicians was demonstrated to improve follow-up. Conclusions Follow-up of abnormal mammograms in primary care is suboptimal. However, interventions addressing amendable factors that negatively impact on follow-up have the potential to improve follow-up, especially for populations of women at risk of inadequate follow-up.

AbstractA major issue in international business is why many International Joint Ventures (IJVs) fail to live up to partners’ expectations. Research into why IJVs underperform centres on differences between partners’ equity, resources, technical knowledge and cultural values, but seldom internal sensemaking conflicts. We address this research gap: specifically, the sense managers make of their own and their partner managers’ perceived performance in relation to strategy practices, and the effects of sensemaking upon collaboration. Some IJV studies examine outright organizational failure, but we focus on a common situation where partner firms’ expectations about each other’s performance are not met. Our case is a major Sino-New Zealand dairy IJV in a Limbo-like state of severe sensemaking discrepancy. Here, managers struggled to perform strategy effectively in a context of mutual misunderstanding and profound miscommunication, rooted in sensemaking differences. Using a strategy practice lens, we explore how this sensemaking discrepancy arose over organizational identity, learning and experience, strategizing, communication and trust. This eroded meaningful cooperation over strategy, leading to disjointed collaboration: a new concept capturing a state of compromised engagement, where the IJV continued operationally, but collaboration became increasingly difficult. We provide a theoretical framework to help understand sensemaking discrepancy in IJVs, based on a reconceptualization of sensemaking discrepancy in terms of own and others’ expected and perceived performance. We also offer essential practice-based insights into cognitive barriers to strategy collaboration.

The election organizing organization is one of the objects of public administration studies with problems related to ethics and accountability. If the ethical discourse in organizations revolves around the relationship between individuals, values, and the environment, then leadership can be seen as distilling those factors in an individual. One of the district/city-level election organizers, namely the Makassar City KPU, has a significant number of cases of ethical violations by ad hoc bodies. This violation indeed cannot be separated from the leadership of the Makassar City KPU in handling it. This research uses qualitative methods with a case study design. Data collection techniques are carried out by in-depth interviews and document studies. Data was analyzed using the Miles and Huberman model of data reduction, data presentation, and conclusions. The results showed that the Makassar City KPU is still partial in showing the characteristics of ethical leadership by Trevino et al. (2003) in the aspects of setting ethical standards and accountability. This is because the Makassar City KPU generally has moral standards and rules for handling ethical violations contained in PKPU No. 8 of 2022. However, the Makassar City KPU still needs to comply with these rules. This is shown from several cases of ethical violations, where the Makassar City KPU was again reported to the DKPP based on procedural non-compliance with KPU Decree No. 337/HK.06.2-Kpt/01/KPU/VII/2020, which contains related to handling violations of the Code of ethics by ad hoc bodies. In addition, implementing ethical standards and managing ethical violations must also be based on local culture, namely siri' culture in the people of Makassar. However, this has not been practiced well by the Makassar City KPU, so it is prone to causing miscommunication and offense between parties.

Purpose This paper aims to investigate the value management workshop process and specifically identifies the roles and responsibilities of the quantity surveyor within this. Information accrued is then used to develop a novel template value management workshop that provides a platform for educating future quantity surveying and other construction professionals. Design/methodology/approach This research adopts a mixed philosophical epistemological design that uses interpretivism with elements of postpositivism. Specifically, a cross-sectional study of extant literature informs the development of a structured questionnaire that is posed to focus group participants (consisting of experienced industrial practitioners) to secure qualitative feedback and validate the template. Findings Research findings reveal that the roles and responsibilities of the quantity surveyor in the value management workshop process have hitherto received scant academic attention. Additionally, literature has revealed that available information on workshop content is limited, leading to ineffective studies. There has also been a miscommunication among construction practitioners in relation to the quantity surveyor’s role in the workshop process. Following extensive research, a novel template has been created which identifies the content of each workshop session alongside the roles and responsibilities of the quantity surveyor (and other construction professionals) which can be used for educational purposes. Originality/value The literature revealed that scant academic and professional governing body(ies) attention has been paid to the education and training of future generations of quantity surveyors involved in value management. Specifically, there is limited applied case study evidence to investigate this phenomenon and, hence, the workshop curricular presents advance knowledge in this respect and provides a practical template solution.

Abstract Background Establishing and maintaining relationships and ways of connecting and being with others is an important component of health and wellbeing. Harnessing the relational within caring, supportive, educational, or carceral settings as a systems response has been referred to as relational practice. Practitioners, people with lived experience, academics and policy makers, do not yet share a well-defined common understanding of relational practice. Consequently, there is potential for interdisciplinary and interagency miscommunication, as well as the risk of policy and practice being increasingly disconnected. Comprehensive reviews are needed to support the development of a coherent shared understanding of relational practice. Method This study uses a scoping review design providing a scope and synthesis of extant literature relating to relational practice focussing on organisational and systemic practice. The review aimed to map how relational practice is used, defined and understood across health, criminal justice, education and social work, noting any impacts and benefits reported. Searches were conducted on 8 bibliographic databases on 27 October 2021. English language articles were included that involve/discuss practice and/or intervention/s that prioritise interpersonal relationships in service provision, in both external (organisational contexts) and internal (how this is received by workers and service users) aspects. Results A total of 8010 relevant articles were identified, of which 158 met the eligibility criteria and were included in the synthesis. Most were opinion-based or theoretical argument papers (n = 61, 38.60%), with 6 (3.80%) critical or narrative reviews. A further 27 (17.09%) were categorised as case studies, focussing on explaining relational practice being used in an organisation or a specific intervention and its components, rather than conducting an evaluation or examination of the effectiveness of the service, with only 11 including any empirical data. Of the included empirical studies, 45 were qualitative, 6 were quantitative, and 9 mixed methods studies. There were differences in the use of terminology and definitions of relational practice within and across sectors. Conclusion Although there may be implicit knowledge of what relational practice is the research field lacks coherent and comprehensive models. Despite definitional ambiguities, a number of benefits are attributed to relational practices. Systematic review registration PROSPERO CRD42021295958

Previous studies have addressed many different kinds of confessions in police investigations – real, false, coerced, fabricated – and highlighted both psychological and social mechanisms that underlie them. Here, we focus on inadvertent confessions and admissions, which occur when a suspect appears to be confessing without being fully aware of doing so, or when police officers believe they have a confession or admission of guilt when in fact this is not the case. The goal of the study is to explain when, how and why these confessions and admissions occur as well as how they are dealt with in two different jurisdictions, the United States and the United Kingdom. We use a discourse analysis approach because inadvertent confessions and admissions of guilt are the product of miscommunication – they happen because the speaker’s meaning and the hearer’s meaning are misaligned. The data consist of 50 interviews from the United Kingdom and 50 interrogations from the United States with both English-speaking and non-English speaking suspects. Our results demonstrate that inadvertent confessions can occur in both locales due to reliance on inference, which is inevitable since inference is the backbone of any human communication, as well as due to additional factors such as linguistic, cultural and procedural issues. We found that these phenomena are more frequent and less well controlled for in the United States context due to (a) no systematic checking of understanding, (b) adversarial questioning techniques and an absence of legal representation, and (c) lack of professional, high-quality interpreting. We discuss the implications of our findings for current efforts to improve access to justice, custodial procedures and language services, and we make recommendations for the implementation of our research in professional practice.

Abstract Background Vaccine hesitancy is a global public health threat. As the COVID-19 pandemic progressed, vaccines, particularly mRNA vaccines, have reduced overall disease severity and death but population coverage has fallen short and uncertainty about vaccination grown. Miscommunication, neglect of health inequities, failure to address vaccine access and other concerns sufficiently have affected trust between populations and healthcare systems. We built on existing models of increasing vaccine acceptance to develop a more comprehensive explanatory model for testing and evaluation. Methods We reviewed the literature on vaccine hesitancy/acceptance models in English and French from PUBMED, ScienceDirect and Google Scholar. We explored their application using the Irish case study, including the Irish tailored communication model, and used the findings to build our model. Results Previous models had gaps in issues considered, planning and implementation. Many neglected wider determinants or health system responsibilities, treating vaccine acceptance as a one-dimensional issue not a continuum. While the need for vaccination programmes to be redesigned to counter known health inequities, gaps in health literacy, access difficulties, exclusionary practices and mistrust of authorities was recognised, few studies addressed these issues. Our analysis also identified the importance of co-creating delivery models with communities. The resulting model supports prioritisation of communities and individuals in line with need, exposure risk and barriers to immunisation. Conclusions Emergency vaccination programmes require greater depth of shared communication and decision making between populations, practitioners, and policy makers. Our model, which incorporates tailored communication, provides a framework for building vaccine acceptance, widening and welcoming participation in development, design, delivery, and improvement. Key messages • Improving vaccine acceptance requires a whole system approach, addressing issues identified in the literature and in practice to improve the design of immunisation programmes. • To establish an active/robust two-way communication mechanisms which provide rapid feedback between communities and health authorities, to improve programmes and tailor them to meet emerging needs.

The concept of intercultural communication derives from the concepts of culture and communication. Intercultural communication studies communication across different cultures and social groups and describes communication processes and related issues among groups of individuals from different cultural backgrounds. Intercultural communication is characterized by the fact that when representatives of different cultures meet, they act according to their cultural norms. Intercultural communication is a socio-cultural mechanism that enables the possibility of coordinated human activity. The ways of performing this basic function are specific to different people. The more intercultural communication increases, the more opportunities we have for understanding each other. However, the possibilities of misunderstanding and miscommunicating with people, groups, communities, organizations, and nations equally grow. In case of misunderstanding or miscommunication goes unmanaged, it can result in conflicts, which in turn might develop into interpersonal, intergroup, inter-organizational, and finally, international conflicts [1, p252]. In today's world, effective intercultural communication is strategically vital to global security. Seen as a skill or competence, intercultural communication must be developed and practiced by any individual in the 21st century. It should be one of the most important elements that provide peace and balance in our societies. In other words, and seen from a larger context, globalization has brought about the realization that modern societies must learn to cooperate [2, p308]. The skills that underpin intercultural communication can serve as a natural platform for enhancing international security. The essential skills of interacting with representatives of different cultures (nonverbal communication, empathy, conflict resolution, etc.) are necessary to ensure international cooperation, peace, and security. The development of intercultural communication skills, therefore, improves the quality of intercultural interaction, thus minimizing the likelihood of conflicts. Միջմշակութային հաղորդակցությունը բխում է մշակույթ և հաղորդակցություն հասկացություններից: Միջմշակութային հաղորդակցությունը ուսումնասիրում է տարբեր մշակույթների, սոցիալական խմբերի միջև հաղորդակցությունը և նկարագրում է հաղորդակցման գործընթացները, տարբեր մշակութային ծագում ունեցող անհատների և խմբերին առնչվող խնդիրները: Միջմշակութային հաղորդակցությանը բնորոշ առանձնահատկություններից է այն, որ երբ հանդիպում են տարբեր մշակույթների ներկայացուցիչներ, նրանցից յուրաքանչյուրը գործում է իր մշակութային նորմերին համապատասխան: Հարկ է նշել, որ միջմշակութային հաղորդակցությունը սոցիալ-մշակութային մեխանիզմ է, որի շնորհիվ մարդը կարող է համակարգված գործունեություն իրականացնել: Տարբեր մարդիկ կարող են այս պարզ գործառույթը յուրովի իրականացնել։ Որքան մեծանում է միջմշակութային հաղորդակցությունը, այնքան ավելի են շատանում միմյանց հասկանալու հնարավորությունները: Սակայն պետք է նշել նաև, որ տարբեր մարդկանց, խմբերի, համայնքների, կազմակերպությունների և ազգերի հետ շփվելիս թյուրըմբռնման և սխալ հաղորդակցվելու հնարավորությունները հավասարապես մեծանում են։ Եթե թյուրըմբռնումը կամ սխալ հաղորդակցությունը չկառավարվի, այն կարող է հանգեցնել կոնֆլիկտների, որոնք, իրենց հերթին, կարող են վերածվել միջանձնային, միջխմբային, միջկազմակերպչական և, վերջապես, միջազգային հակամարտությունների [1, էջ 252]։ Այսօր արդյունավետ միջմշակութային հաղորդակցությունը ռազմավարական նշանակություն ունի միջազգային անվտանգությանտեսանկյունից : Համարվելով հմտություն կամ իրավասություն՝ միջմշակութային հաղորդակցություն պետք է զարգացնի և կիրառի XXI դարի յուրաքանչյուր անհատ, և այն պետք է լինի մեր հասարակություններում խաղաղություն և հավասարակշռություն ապահովող ամենակարևոր տարրերից մեկը: Այլ կերպ ասած՝ եթե այն դիտարկենք ավելի լայն համատեքստում, գլոբալիզացիան բերեց այն գիտակցմանը, որ ժամանակակից հասարակությունները պետք է սովորեն համագործակցել: Միջմշակութային հաղորդակցության հիմքում ընկած հմտությունները կարող են բնական հարթակ ծառայել միջազգային անվտանգության ամրապնդման համար [2, էջ308]։ Հետևաբար, միջմշակութային հաղորդակցման հմտությունների զարգացումը բարելավում է միջազգային փոխգործակցության որակը՝ դրանով իսկ նվազագույնի հասցնելով կոնֆլիկտների հավանականությունը: Տարբեր մշակույթների ներկայացուցիչների հետ շփվելու էական հմտությունները (ոչ վերբալ հաղորդակցություն, կարեկցանք, կոնֆլիկտների լուծում և այլն) անհրաժեշտ են միջազգային համագործակցության, խաղաղության և անվտանգության ապահովման համար: Термин “межкультурная коммуникация” исходит из понятий “культура” и “коммуникация”. Межкультурная коммуникация изучает контакты различных культур, социальных групп и описывает коммуникационные процессы, проблемы, относящиеся к личностям и группам различного культурного происхождения. Для межкультурной коммуникации характерно, что при встрече представителей разных культур каждый из них действует в соответствии со своими культурными нормами. Следует отметить, что межкультурная коммуникация - это социально-культурный механизм, благодаря которому человек может осуществлять систематизированную деятельность. Каждый человек может по-своему реализовывать эту простую функцию. Чем более ширится межкультурная коммуникация, тем более множатся возможности взаимопонимания. Вместе с тем в равной мере растет возможность недопонимания и искаженного общения при контактах с людьми, группами, общинами, организациями. Если недопонимание и искаженное общение не будут управляться, это может привести к разногласиям, которые, в свою очередь, могут перерасти в межличностные, межгрупповые, межкорпоративные и, наконец, в межнациональные конфликты. [1, с․252]. Сегодня эффективная межкультурная коммуникация имеет стратегическое значение для международной безопасности. Считаясь искусством или компетенцией, межкультурная коммуникация должна развиваться и применяться каждой личностью XXI века, становиться одним из важнейших элементов, обеспечивающих мир и равновесие в наших обществах. Иными словами, если рассматривать это в более широком контексте, глобализация привела к осознанию, что современные общества должны научиться сотрудничать. Мастерство, лежащее в основе межкультурной коммуникации, может служить естественной платформой для укрепления межнациональной безопасности [2, с․308]. Следовательно, развитие искусства межкультурной коммуникации повышает качество международного взаимодействия, тем самым сводя к минимуму возможность конфликтов. Умение общаться с представителями разных культур (невербальная коммуникация, сочувствие, разрешение конфликтов и т.д.) необходимо для международного сотрудничества, для обеспечения мира и безопасности.

It is not possible for every physician and patient to originate from the exact same circumstances. Because of this impossibility, the dynamics between the patient, caregivers, and physician are extremely important to prevent mistrust, disputes, de-emphasizing the values of others, or miscommunication. Similar to how many diverse groups exist in society so, too, are there numerous factors for influencing how medical care is provided and received. Multiple studies demonstrate the inequalities of access and quality of health care in pediatric primary care as well as increased morbidity and mortality rates. This may be even more prevailing within racial and ethnic communities, which are often underserved populations. This article presents an evaluation of cultural humility and how the awareness of differing viewpoints, values, and norms can assist and improve the medical care of pediatric patients with chronic complex conditions. [ Pediatr Ann . 2024;53(3):e88–e92.]

AbstractAlthough many studies have investigated relationships between emotional labour and emotional intelligence among hospital staff, few have paid attention to social intelligence in this field. This study explored the relationships between emotional labour, social intelligence, and narcissism among physicians in governmental hospitals in Jordan. The goal was to improve the understanding of the causes of patients abusing physicians in Jordan. Some patients have maintained that physicians are responsible for hostile behaviour against them, as these resulted from medical errors, physician negligence, and a failure to provide adequate care, exacerbated by physician narcissism, lack of empathy, verbal miscommunication, and lack of sympathy in critical cases. Findings confirmed that whenever physicians engage in strategies of emotional labour, they display higher social intelligence and lower levels of narcissism. Moreover, social intelligence does not mediate the relationship between emotional labour and narcissism. The results of the study suggest that interventions by the Jordan Medical Association to reduce physical and verbal assaults on physicians should encompass more than a mere legal focus.

PurposeEffective internal communication facilitates the transfer of data and information among project parties throughout the execution of construction projects. It minimizes the distortion of data and major cost overruns and delays. The aim of this study was to determine main components of the project characteristics that affect quality of internal communication within owners, designers and contractors in construction projects.Design/methodology/approachProject characteristics that significantly affect quality of internal communication were identified through existing literature. Forty case studies associated with national and international construction projects were gathered. Since data regarding other aspects of collected case studies, which were not included in the case study data, were required, a structured survey was developed and distributed to the primary stakeholders. The factor analysis method was adopted to determine the key components of effective internal communication.FindingsThe results demonstrated that project targets, bureaucracy, location and coordination affect the quality of internal communication among owner entities. Additionally, design and technology, clarity of the project’s scope, resources, delivery, construction management and design management affect quality of internal communication within design entities. Qualified field labor, objectives, restrictions, material quality, equipment quality, availability of qualified project managers and equipment turnovers affect the quality of internal communication within contractors.Originality/valueThe findings of this study help project managers evaluate the effectiveness of internal communication of a construction project during the early stages of the project. Additionally, the outcomes guide project managers to allocate sufficient resources to their projects and adopt proactive strategies which prevent/reduce miscommunications and their unintended consequences.