Journal of Visual Communication in Medicine最新文献

英文中文

‘We all have friends like that’ “我们都有这样的朋友。”

IF 1.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Visual Communication in Medicine

Pub Date : 2021-01-15 DOI: 10.1558/CAM.39254

L. Roper, N. Sturman

Medical professionals are in an ideal position to mediate between the benefits and harms of internet-sourced medical information, but there is reluctance by patients to discuss with their doctors information found online. This is the first study undertaken in a rural Australian context, where service limitations mean patients’ use of the internet may be especially important. Patients attending general practice clinics (n = 33) were interviewed to discover how they used the internet for health information and how they discussed this with their doctors. Analysis used a constant comparison method, informed by grounded theory and a dramaturgical framework. Most participants used a range of tactics when discussing internet-sourced medical information, including concealment, disguise or upfront apologetic disclosures to avoid undermining the expertise of the doctor. These findings do not confirm predictions made in the past that patients’ acquisition of internet health information would alter the power dynamic of the medical consultation. Potentially, proactive, doctor-initiated inquiry about internet medical information may help to normalise patients’ internet use, allowing open discussion, so doctors can maximise benefits and reduce harms of internet health information. Further study is required to see if this will be an effective strategy and impact health outcomes.

医疗专业人员处于一个理想的位置，可以在互联网医疗信息的利与弊之间进行调解，但患者不愿意与医生讨论在网上找到的信息。这是第一个在澳大利亚农村地区进行的研究，那里的服务限制意味着患者使用互联网可能特别重要。在全科诊所就诊的患者(n = 33)接受了采访，以了解他们如何使用互联网获取健康信息，以及他们如何与医生讨论这个问题。分析采用了不断比较的方法，以扎实的理论和戏剧框架为依据。大多数参与者在讨论来自互联网的医疗信息时采用了一系列策略，包括隐瞒、伪装或提前道歉，以避免损害医生的专业知识。这些发现并不能证实过去的预测，即患者获取互联网健康信息将改变医疗咨询的权力动态。潜在地，医生主动发起的关于互联网医疗信息的询问可能有助于规范患者的互联网使用，允许公开讨论，因此医生可以最大化互联网健康信息的利益并减少危害。需要进一步研究，以确定这是否将是一项有效的战略并影响健康结果。

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引用次数: 0

Metadiscourse, materiality and morality in communication skills training with simulated patients 模拟病人沟通技巧训练中的元话语、物质性与道德性

IF 1.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Visual Communication in Medicine

Pub Date : 2021-01-15 DOI: 10.1558/CAM.39725

G. Peters

Simulated patients (also known as standardized patients) are commonly employed by institutions of medical education to train medical students and assess their communication skills. This article demonstrates that such patients are not translational devices that enact prima facie standards of communication skills as laid out by the institutions that use them, but rather metadiscursively transform communication practices. This is shown via a case study that closely examines a series of interactions between a simulated patient and a third-year medical student during a practice exam designed for the United States Medical Licensing Examination Step 2 Clinical Skills. I use discourse analysis to show how communication skills are transformed in three practices: (1) simulated consultations between standardized patients and medical students; (2) spoken evaluations offered by standardized patients after simulated consultations between standardized patients and medical students; and (3) written evaluations offered by standardized patients in assessment forms. In particular, by attending to how a simulated patient makes the act of draping the patient a relevant communication skill, I explicate the material elements and moral implications of clinical communication. Finally, I consider the instructive role simulated patients play in medical education and how their standards build on and often stand in contrast to communication skills techniques. I conclude by making practical suggestions for communication skills training with simulated patients in medical education.

模拟病人(也称为标准化病人)通常被医学教育机构用来训练医学生和评估他们的沟通技巧。这篇文章表明，这些病人并不是制定由使用它们的机构制定的沟通技巧的初步标准的翻译设备，而是元话语性地转化沟通实践。这是通过一个案例研究来展示的，该案例研究仔细检查了在为美国医疗执照考试第二步临床技能设计的实践考试中，模拟患者和三年级医学生之间的一系列互动。我使用话语分析来展示沟通技巧如何在三个实践中转变:(1)标准化患者和医学生之间的模拟咨询;(2)标准化患者与医学生模拟会诊后的口头评价;(3)标准化患者在评价表中提供的书面评价。特别是，通过关注一个模拟的病人如何使给病人披上衣服的行为成为一种相关的沟通技巧，我解释了临床沟通的物质要素和道德含义。最后，我考虑了模拟病人在医学教育中的指导作用，以及他们的标准如何建立在沟通技巧技巧的基础上，并经常与之形成对比。最后，对医学教育中模拟患者的沟通技巧培训提出了切实可行的建议。

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引用次数: 0

‘No problem’ advice during occupational health examinations 在职业健康检查期间提供“没问题”的建议

IF 1.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Visual Communication in Medicine

Pub Date : 2021-01-15 DOI: 10.1558/CAM.37849

Elina Weiste, T. Leino, J. Laitinen

In many countries, occupational health examinations are considered to have a central role in ensuring that employees’ health and work ability are maintained or enhanced. In contemporary Finland, the institutional goal of these examinations is to construct a health plan based on the client’s own aims, and in this paper we analyse how occupational health nurses and clients in Finland negotiate what is considered to be a problem. The data consist of 10 video-recorded occupational health examination encounters, analysed by means of conversation analysis. Our analysis focuses on ‘no problem’ advice, in which the advice giving is initiated in the absence of a problem-indicative response. The client’s ‘no problem’ response was typically followed by the nurse upgrading the problem that she had identified and giving a general reminder of a possible problem. The clients resisted not so much the content of the advice, but the act of advising itself. In a few cases, the client’s ‘no problem’ response was followed by a turn in which the nurse contested the client’s knowledge and offered advice that was tailored to the client’s situation. The client acknowledged the advice as new information. Our findings indicate that regardless of client-centred ideals, the interaction in occupational health examinations is largely led by nurses, who set up the agenda and raise issues that they consider to be problems for their clients.

在许多国家，职业健康检查被认为在确保维持或提高雇员的健康和工作能力方面具有核心作用。在当代芬兰，这些检查的制度目标是根据客户自己的目标构建一个健康计划，在本文中，我们分析了芬兰的职业健康护士和客户如何协商被认为是一个问题。数据包括10次职业健康检查的视频记录，采用会话分析的方法进行分析。我们的分析集中在“没有问题”的建议上，这种建议是在没有问题指示性回应的情况下提出的。在病人回答“没问题”之后，护士通常会对她发现的问题进行升级，并对可能出现的问题进行一般性提醒。客户反对的与其说是建议的内容，不如说是建议的行为本身。在少数情况下，客户的“没问题”的反应之后，护士会对客户的知识提出质疑，并根据客户的情况提供建议。客户承认这个建议是新的信息。我们的研究结果表明，无论以客户为中心的理想如何，职业健康检查中的互动在很大程度上是由护士主导的，他们制定议程并提出他们认为对客户有问题的问题。

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引用次数: 1

Language barriers in healthcare delivery 卫生保健服务中的语言障碍

IF 1.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Visual Communication in Medicine

Pub Date : 2021-01-15 DOI: 10.1558/CAM.39671

M. A. Ansah, Mercy Adzo Klugah

The relevance of language for quality healthcare delivery cannot be overemphasised. Within the framework of communication accommodation theory, this paper discusses language barriers in expatriate doctor–patient communication in three state-owned hospitals in Ghana, and the strategies employed by the medical personnel to bridge communication gaps. The study design is qualitative and the data were obtained through semi-structured interviews with 16 expatriate doctors, three nurses and three patients. Furthermore, observation of five patient–doctor interactions was undertaken and notes taken. Both datasets were then analysed using the qualitative conventional content analysis approach. The findings revealed that the expatriate doctors employed convergence strategies such as ad hoc interpreters, gestures, picture charts and electronic dictionaries to deal with language barriers. The study is expected to stimulate further research into innovative ways of dealing with language barriers in expatriate doctor–patient interactions.

语言与高质量医疗服务的相关性再怎么强调也不为过。在沟通适应理论的框架下，本文探讨了加纳三家国有医院外籍医患沟通中的语言障碍，以及医务人员为弥合沟通差距所采取的策略。研究设计是定性的，数据是通过对16名外籍医生、3名护士和3名患者的半结构化访谈获得的。此外，对五次医患互动进行了观察并做了记录。然后使用定性常规内容分析方法对两个数据集进行分析。调查结果显示，外籍医生采用融合策略，如特设口译、手势、图片图表和电子词典来处理语言障碍。这项研究有望激发进一步的研究，以创新的方式处理外籍医患互动中的语言障碍。

引用次数: 2

Interaction between patient and health professional 患者与卫生专业人员之间的互动

IF 1.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Visual Communication in Medicine

Pub Date : 2021-01-15 DOI: 10.1558/CAM.39518

A. Holm

This article presents a theoretical view on culturally embedded thinking and action in encounters between patient and health professional. A key point of the analysis indicates that a highly efficient health sector may entail an implicit duality: on the one hand, the health professional can and often must relate pragmatically to the patient in order to solve problems and do so quickly, while on the other, the professional may be personally challenged when embedded cultural thinking leads to conflicts or dilemmas. This means that a purely pragmatic perspective will be challenged when such conflicts arise. The article looks at interrelated concepts such as ‘culture’, ‘prejudice’ and ‘meaning’ in order to shed light on the presuppositions that are brought into the cultural encounter between patient and health professional. This kind of analysis will hopefully contribute to a raised awareness of what is actually – apart from pragmatic problem solving – going on in such encounters. The conceptual framework used in this article primarily draws on the German philosopher Hans-Georg Gadamer, which is contrasted with the pragmatic perspective from the American philosopher Richard Rorty.

这篇文章提出了一个理论观点，文化嵌入的思维和行动，在遇到病人和卫生专业人员。分析的一个关键点表明，高效的卫生部门可能包含一种隐含的两重性:一方面，卫生专业人员能够而且往往必须以务实的态度与患者建立联系，以便迅速解决问题，而另一方面，当根深蒂固的文化思维导致冲突或困境时，专业人员可能会受到个人挑战。这意味着当这种冲突出现时，纯粹的实用主义观点将受到挑战。本文着眼于诸如“文化”、“偏见”和“意义”等相互关联的概念，以便阐明患者与卫生专业人员之间的文化接触所带来的预设。这种分析有望有助于提高人们的意识，即除了务实的解决问题之外，在这种遭遇中究竟发生了什么。本文使用的概念框架主要借鉴了德国哲学家汉斯-乔治·伽达默尔的观点，并与美国哲学家理查德·罗蒂的实用主义观点进行了对比。

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引用次数: 0

Opening up space for compassion in nurses’ handover meetings 在护士交接会议上为同情开辟空间

IF 1.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Visual Communication in Medicine

Pub Date : 2021-01-15 DOI: 10.1558/CAM.38920

Harriet R. Lloyd, Tom Bartlett, Michelle Aldridge-Waddon, Tereza Spilioti, V. Ylänne

In this paper, we complement research into compassion in medical contexts with an analysis of the representation of patients in nursing handovers and the ways in which such practitioner–practitioner interaction can be said to demonstrate and evoke feelings of compassion towards patients. We label such representation as ‘Compassion Talk’ and suggest that potentially it can complement the information given as part of the standard format for handovers. The analysis is based on instances of non-scripted talk (NST) from three nursing handover meetings from a highly performing Medical Assessment Unit in the UK. In a data-led qualitative analysis, we find that within NST patients are represented in terms that not only make nurses’ actions to alleviate their suffering seem possible and necessary, but that also highlight their shared humanity and position the patients as if they are members of the nurses’ wider social group. We further demonstrate how NST can be successfully managed by experienced nursing staff and suggest, therefore, that handovers can function not only to pass on information accurately and concisely, but also as a space for nurses to regroup as a community of practice and to relate to their patients in human terms, as a defining principle of the profession.

在这篇论文中，我们通过分析病人在护理交接中的表现，以及这种医生-医生互动可以说是展示和唤起对病人的同情心的方式，来补充医学背景下的同情心研究。我们将这样的表述称为“同情谈话”，并建议它可能会补充作为移交标准格式一部分的信息。该分析基于英国一个高绩效医疗评估单位的三次护理交接会议的非脚本谈话(NST)实例。在一项以数据为主导的定性分析中，我们发现，在NST中，患者的表现不仅使护士采取行动减轻他们的痛苦似乎是可能的和必要的，而且还突出了他们共同的人性，并将患者定位为护士更广泛的社会群体的成员。我们进一步论证了经验丰富的护理人员如何成功地管理NST，并建议，因此，移交不仅可以准确而简洁地传递信息，而且还可以作为护士重组实践社区的空间，并以人性化的方式与患者建立联系，作为职业的定义原则。

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引用次数: 2

Reporting on individual experience 汇报个人经历

IF 1.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Visual Communication in Medicine

Pub Date : 2021-01-15 DOI: 10.1558/CAM.39205

M. Zabielska

This paper proposes a new model for a patient-centred medical case report. Patient-centred approaches adopt the patient’s perspective and emphasise the individual’s experience of illness, and are intended to answer criticisms that medical texts for professionals, by focusing solely on a disease phenomenon presented within a framework of biomedical reasoning, depersonalise the patient and fail to engage in patient advocacy. The paper provides a systematic review of the most important strands in research on medical case reporting, taking a socio-cultural approach that focuses specifically on the evolution of the genre and on existing examples of patient-centredness that could form a basis for the new model. The aim here is to offer the first systematised proposal containing guidelines already available in the literature, as well as to provide recommendations on how to write about patients in medical case reports in way that does not depersonalise them.

本文提出了一种以患者为中心的病例报告新模式。以患者为中心的方法采用患者的观点，强调个人的疾病经历，旨在回答专业医学文本的批评，这些医学文本仅关注生物医学推理框架内呈现的疾病现象，使患者失去人格，未能参与患者宣传。本文对医学病例报告研究中最重要的部分进行了系统回顾，采用社会文化方法，特别关注该类型的演变和以患者为中心的现有例子，这些例子可以形成新模式的基础。本文的目的是提供第一个系统化的建议，其中包含文献中已有的指导方针，并就如何在医疗病例报告中以不使患者丧失人格的方式撰写患者提供建议。

引用次数: 1

An exploratory study of the efficacy of medical illustration detail for delivering cancer information. 医学插图细节传递癌症信息功效的探索性研究。

IF 1.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Visual Communication in Medicine

Pub Date : 2021-01-01 Epub Date: 2020-11-29 DOI: 10.1080/17453054.2020.1834838

Makiko Haragi, Masayo Hayakawa, Otome Watanabe, Tomoko Takayama

Medical illustrations are an effective means of conveying complex information about cancer to patients and laypersons. However, there are no standard criteria for creating these illustrations. This study used online exploratory research focussed on laypersons to identify the aspects of an illustration that convey the optimal degree of detail and understand these findings. Six illustrations depicting pancreatic cancer and nine depicting cervical cancer, with high, medium, and low levels of detail, were created. A total of 420 participants (male = 210, female = 210, aged 20 years and above) answered an online questionnaire about these illustrations. The results indicated that female participants tended to prefer the same illustration level that they also found most comprehensible. Younger participants (under 40 years) tended to prefer illustrations with a medium level of detail for both cancers. Older participants (40 years and above) tended to prefer illustrations with a high level of detail for both cancers. This study was unable to determine the reasons behind these preferences. However, the researchers hypothesise that older people's preference for higher levels of detail may be due to their greater concerns about cancer and because they find the illustrations to be more effective in conveying relevant information.

医学插图是向病人和外行传达复杂癌症信息的有效手段。然而，没有标准的标准来创建这些插图。本研究使用在线探索性研究，重点关注外行人，以确定插图的各个方面，传达最佳程度的细节，并理解这些发现。绘制了6幅描绘胰腺癌的插图和9幅描绘宫颈癌的插图，分别有高、中、低三个层次的细节。共有420名参与者(男性210人，女性210人，年龄在20岁及以上)回答了一份关于这些插图的在线问卷。结果表明，女性参与者倾向于选择她们认为最容易理解的插图水平。年轻的参与者(40岁以下)倾向于选择两种癌症的中等详细程度的插图。年龄较大的参与者(40岁及以上)倾向于对两种癌症的详细程度较高的插图。这项研究无法确定这些偏好背后的原因。然而，研究人员假设，老年人对更高层次的细节的偏好可能是因为他们更担心癌症，因为他们发现插图在传达相关信息方面更有效。

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引用次数: 6

Editorial. 社论

IF 1 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Visual Communication in Medicine

Pub Date : 2021-01-01 Epub Date: 2020-11-12 DOI: 10.1080/17453054.2020.1845454

Caroline Erolin

引用次数: 0

Using comics and curiosity to drive pandemic research on a national scale. 利用漫画和好奇心推动全国范围内的流行病研究。

IF 1.4 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Visual Communication in Medicine

Pub Date : 2021-01-01 Epub Date: 2020-11-18 DOI: 10.1080/17453054.2020.1823206

Ciléin Kearns, Nethmi Kearns, Irene Braithwaite, Nick Shortt, Allie Eathorne, Alex Semprini, Richard Beasley

An independent online Public Health survey regarding the COVID-19 pandemic was conducted during an Alert Level 4 lockdown, the highest possible, in New Zealand. An illustrated and curiosity-driven public engagement campaign was designed to advertise survey participation, and performance compared with a standard approach using randomised controlled A/B Split tests. The 'Caretoon' approach featured comic illustrations, appealed to goodwill and was intended to pique curiosity. This linked to an illustrated version of the survey which, upon completion, gave a personalised comic summary showing how respondent's answers compared with national averages. The standard ad and survey were not illustrated with comics, and did not provide a personalised comic summary on completion. Both approaches were cost- and time-effective, together resulting in 18,788 responses over six days. The Caretoon approach outperformed the standard approach in terms of the number of people reached, engaged, survey link clicks, gender and ethnic diversity amongst respondents, and cost-effectiveness of advertising. This came at the expense of a small reduction in the proportion of completed surveys and male respondents. The research evidences objective value of public engagement activity, comics and curiosity as tools which can support Public Health research on a national scale.

一项关于COVID-19大流行的独立在线公共卫生调查是在新西兰最高警戒级别4级封锁期间进行的。设计了一个插图和好奇心驱动的公众参与活动，以宣传调查参与，并与使用随机控制a /B分割测试的标准方法进行比较。“卡通化”的方式以漫画插图为特色，吸引善意，旨在激起好奇心。这链接到一个调查的插图版本，在完成后，给出了一个个性化的漫画摘要，显示了受访者的答案与全国平均水平的比较。标准的广告和调查没有配漫画，也没有在完成时提供个性化的漫画摘要。这两种方法都具有成本效益和时间效益，在6天内共收到18788份回复。Caretoon方法在接触到的人数、参与度、调查链接点击、受访者的性别和种族多样性以及广告的成本效益方面都优于标准方法。这是以完成调查的比例和男性受访者比例的小幅下降为代价的。研究证明了公众参与活动、漫画和好奇心作为工具的客观价值，这些工具可以支持全国范围内的公共卫生研究。

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引用次数: 8

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