Effective communication with clients: preferred communication.
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A case is reported of hypoplasie of the right ventricle with a wide atrial septal defect in a child of 10. The presence of cyanosis with right atrial and left ventricular preponderance led us to suspect tricuspid atresia, but this was excluded by catheterisation and angiocardiography. There was definitely and atrial septal defect with a two-directional shunt, but the tricuspid valve could be negotiated, and the right-sided opacity provided the essential diagnostic criterion, namely hypoplasia of the sinus portion of the right ventricle with a normal infundibulum. 17 other published cases of hypoplasia of the right ventricle with atrial septal defect are reviewed. The current indications for surgery are discussed in the light of the nature of the disordered physiology. Simple closure of the atrial septal defect, which was carried out successfully in 3 cases, appears to be of great value in the larger child, when there is a wide defect.
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Intergenerational traumatization poses a risk for the well-being of children whose parents have been exposed to potentially traumatic events (PTEs). Previous research has implied that parent-child communication may significantly contribute to the transmission of trauma across generations, but findings remain limited and inconclusive, particularly regarding the mechanisms and factors that could underlie this process. Therefore, the present paper performed a mixed methods systematic literature review to methodically map how PTE-exposed parents communicate with their children-both in general and about parental PTEs-and how such communication may contribute to trauma transmission. Five electronic databases were accessed to conduct keyword-led searches, yielding a final inclusion of 31 peer-reviewed, empirical studies that investigated parent-child communication among PTE-exposed parents and/or their nonexposed children. Parental PTE exposure was found to have a negative impact on general parent-child communication, often due to the presence of parental anger, irritability, and withdrawal. Conversations about parental PTEs showed substantial diversity in their frequency, content and style, with strategies of partial/modulated disclosure appearing most common. How parents approached PTE communication frequently stemmed from a desire to keep their children safe and unburdened by their previous experiences. Finally, both general communication and PTE communication were implied to contribute to trauma transmission, revealing a significant impact of parent-child communication on child functioning, identity, and well-being. Based on these key findings, the authors discuss meaningful implications for future research (i.e., prospective directions, addressing methodological concerns) and formulate suggestions for clinicians and policymakers surrounding the treatment of PTE-exposed parents and their offspring.
The professional communications of a pharmacist providing comprehensive services were studied to determine the accuracy of the information provided, its usefulness to patient care and the level of expertise needed to respond appropriately. Data were collected by a diary technique for a four-month period. Patient charts were reviewed to collect clinical data needed to evaluate the appropriateness of the pharmacist's responses and to ascertain evidence that the information provided was implemented. The analysis classified the communications as either "clinical" or "pharmaceutical" in content. Practitioner panels of pharmacists and a physician assessed the communications for accuracy, relevance to the patient episode and level of pharmacy expertise necessary to communicate. Most communications with physicians were "pharmaceutical" in content. The most frequent information asked concerned dose or dosage schedule. Approximately one-third of the "pharmaceutical" communications could have been handled adequately by a technician. Only one communication should have required an extensive literature search for the pharmacist to respond. Less than half of the pharmacist's communications were pertinent to the patient episode and of clinical importance. Information from half of the communications was implemented in patient care within 48 hours. There did not appear to be any relationship between accuracy of response and implementation of information. It is not known whether the deficiencies identified apply to a large number of pharmacists. Hence, the bearing of the study on the cost-benefit of clinical pharmacy services is not clear.
Of 346 patients with direct intracranial surgery for an aneurysm of anterior communicating artery that we have experienced from June 1961 to September 1975, 213 patients having sufficient data were selected to study a relationship between hypoplasia of the A1 of the anterior communicating artery, and sites of an afferent artery and a neck of an aneurysm. 1. Ninety seven of 182 patients who had had the bilateral angiography before surgery had hypoplasia of the right A1, 90 of which (92%) had an afferent artery of an aneurysm only in the left A1. All 29 patients with hypoplasia of the left A1 had an afferent artery of an aneurysm only in the right A1. An afferent artery was limited to the dominant A1 in about 95% of them. 2. Angiography revealed that of 204 patients in whom the neck of an aneurysm in the anterior communicating artery was confirmed, 140 patients had hypoplasia of a unilateral A1. The neck of an aneurysm was located at the bifurcation of the dominant A1 and the anterior communicating artery in 48 of the 140 patient (34.3%), at the bifurcation of the non-dominant A1 and the anterior communicating artery in 14 patients (10.0%), and in the anterior communicating artery itself in 78 patients (55.7%). Cerebral angiography revealed that the neck of an aneurysm was more than 3 times greater at the bifurcation of the dominant A1 and the anterior communicating artery than at the bifurcation of the non-dominant A1 and the anterior communicating artery. 3. The above findings suggest that hemodynamics in the anterior part of the circle of Willis may participate in the initiation, growth, and rupture of an aneurysm of the anterior communicating artery.